WE-A-BRF-01: Dual-Energy CT Imaging in Diagnostic Imaging and Radiation Therapy

The quantification accuracy of dual-energy imaging is influenced by the fundamentals of x-ray physics, system geometry, data acquisition hardware/protocol, system calibration, and image processing technique. This symposium will provide updates on the following advanced application areas: Mammography. Volumetric breast density techniques based on standard mammograms require estimation of breast thickness, which is difficult to accurately measure. By comparison, calculation of breast density using dual energy mammography does not require measurement of breast thickness. Dual energy mammography has been implemented using both energy integrating flat panel detectors in conjunction with beam energy switching and energy resolved photon counting detectors. These techniques have been optimized using simulation studies and validated using physical phantoms and postmortem breasts. Chemical decomposition was used as the gold standard for volumetric breast density measurement in postmortem breasts. Breast density measurements have also been compared with results from four-category BI-RADS density rankings, standard image thresholding and Fuzzy k-mean clustering techniques. These studies indicate that dual energy mammography can be used to accurately measure volumetric breast density. Cardiovascular CT. The predicative accuracy of risk models for recurrent stroke and cardiac arrest depends heavily on accurate differentiation of thrombus or calcium from iodine in left atrial appendage or coronary arteries. The amount of energy separation is constrained by image noise; therefore, optimal kVp, beam filtration, and balanced flux are essential for the quantification accuracy of iodine and calcium. The basis materials are combined linearly to generate monochromatic energy images, where CT# accuracy and CNR are energy dependent. With optimal monochromatic energy, the mean iodine concentration for the thrombus, circulatory stasis, and control groups are significantly different. Risk classification based on calcium scores shows excellent agreement with classification on the basis of conventional coronary artery calcium scoring. These studies demonstrate dual-energy cardiovascular CT can potentially be a noninvasive and sensitive modality in high risk patients. On-board KV/MV Imaging. To enhance soft tissue contrast and reduce metal artifacts, we have developed a dual-energy CBCT technique and a novel on-board kV/MV imaging technique based on hardware available on modern linear accelerators. We have also evaluated the feasibility of these two techniques in various phantom studies. Optimal techniques (energy, beam filtration, # of overlapping projections, etc) have been investigated with unique calibration procedures, which leads to successful decomposition of imaged material into acrylic-aluminum basis material pair. This enables the synthesis of virtual monochromatic (VM) CBCT images that demonstrate much less beam hardening, significantly reduced metal artifacts, and/or higher soft tissue CNR compared to single-energy CBCT. Adaptive Radiation Therapy. DECT could actually contribute to the area of Dose-Guided Radiation Therapy (or Adaptive Therapy). The application of DECT imaging using 80kV and 140 kV combinations could potentially increase the image quality by reducing the bone or high density material artifacts and also increase the soft tissue contrast by a light contrast agent. The result of this higher contrast / quality images is beneficial for deformable image registration / segmentation algorithm to improve its accuracy hence to make adaptive therapy less time consuming in its recontouring process. The real time re-planning prior to per treatment fraction could become more realistic with this improvement especially in hypofractional SBRT cases. Learning Objectives: 1. Learn recent developments of dual-energy imaging in diagnosis and radiation therapy; 2. Understand the unique clinical problem and required quantification accuracy in each application; 3. Understand the different approaches to optimize dual-energy imaging techniques for different applications.