Adaptive CaRdiac cOne BEAm computed Tomography (ACROBEAT): Developing the next generation of cardiac cone beam CT imaging

Reynolds, Tess; Dillon, Owen; Prinable, Joseph; Whelan, Brendan; Keall, P.; O’Brien, Ricky

doi:10.1002/mp.14811

Cited by 6 publications

(7 citation statements)

References 24 publications

(50 reference statements)

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“…As such, there are a number of limitations to the experimental set up used to implement the continuous dual‐isocenter imaging trajectory. These limitations have also been noted in previous novel imaging trajectory investigations using the TACS 8,14,15 . First, there is a limit on how fast the C‐arm gantry can rotate when being controlled via the TACS.…”

Section: Discussionmentioning

confidence: 99%

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Technical note: Extended longitudinal and lateral 3D imaging with a continuous dual‐isocenter CBCT scan

et al. 2023

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Background:The clinical benefits of intraoperative cone beam CT (CBCT) during orthopedic procedures include (1) improved accuracy for procedures involving the placement of hardware and (2) providing immediate surgical verification. Purpose: Orthopedic interventions often involve long and wide anatomical sites (e.g., lower extremities). Therefore, in order to ensure that the clinical benefits are available to all orthopedic procedures, we investigate the feasibility of a novel imaging trajectory to simultaneously expand the CBCT field-of -view longitudinally and laterally. Methods: A continuous dual-isocenter imaging trajectory was implemented on a clinical robotic CBCT system using additional real-time control hardware. The trajectory consisted of 200 • circular arcs separated by alternating lateral and longitudinal table translations.Due to hardware constraints,the direction of rotation (clockwise/anticlockwise) and lateral table translation (left/right) was reversed every 400 • . X-ray projections were continuously acquired at 15 frames/s throughout all movements. A whole-body phantom was used to verify the trajectory. As comparator, a series of conventional large volume acquisitions were stitched together. Image quality was quantified using Root Mean Square Deviation (RMSD),Mean Absolute Percentage Deviation (MAPD), Structural Similarity Index Metric (SSIM) and Contrast-to-Noise Ratio (CNR). Results:The imaging volume produced by the continuous dual-isocenter trajectory had dimensions of L = 95 cm × W = 45 cm × H = 45 cm. This enabled the hips to the feet of the whole-body phantom to be captured in approximately half the imaging dose and acquisition time of the 11 stitched conventional acquisitions required to match the longitudinal and lateral imaging dimensions. Compared to the stitched conventional images, the continuous dual-isocenter acquisition had RMSD of 4.84, MAPD of 6.58% and SSIM of 0.99. The CNR of the continuous dual-isocenter and stitched conventional acquisitions were 1.998 and 1.999, respectively. Conclusion: Extended longitudinal and lateral intraoperative volumetric imaging is feasible on clinical robotic CBCT systems.

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Section: Discussionmentioning

confidence: 99%

“…These limitations have also been noted in previous novel imaging trajectory investigations using the TACS. 8,14,15 First, there is a limit on how fast the C-arm gantry can rotate when being controlled via the TACS. Clinically, the gantry of robotic CBCT imaging systems can rotate up to 45 • /s.…”

Section: Discussionmentioning

confidence: 99%

Technical note: Extended longitudinal and lateral 3D imaging with a continuous dual‐isocenter CBCT scan

et al. 2023

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“…Future studies will look to quantify this effect and examine the possibility of integrating adaptive imaging strategies to mitigate physiological motion. 16,17 In addition, during future iterations of the multi-turn reverse helical scan where the gantry velocity can match that of current clinical 3D imaging (velocities >45 degrees/s, reducing the scan time to approximately 30 seconds), the possibility of acquiring images during breath hold to mitigate motion blur needs to be investigated. This is the first report of a continuous multi-turn reverse helical CBCT scan to image an animal specimen within the context of an interventional procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The C-arm begins at the maximum right anterior oblique angle, allowing full angular range (400 degrees around the table) in every clockwise and anticlockwise rotation. During each rotation, the C-arm rotates at constant speed (20 degrees/s), currently limited by prototype control hardware 16,17 . Rotation speeds exceeding 45 degrees/s are common in clinical use.…”

Section: Methodsmentioning

confidence: 99%

Extended Intraoperative Longitudinal 3-Dimensional Cone Beam Computed Tomography Imaging With a Continuous Multi-Turn Reverse Helical Scan

et al. 2022

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Objectives: Cone beam computed tomography (CBCT) imaging is becoming an indispensable intraoperative tool; however, the current field of view prevents visualization of long anatomical sites, limiting clinical utility. Here, we demonstrate the longitudinal extension of the intraoperative CBCT field of view using a multi-turn reverse helical scan and assess potential clinical utility in interventional procedures. Materials and Methods: A fixed-room robotic CBCT imaging system, with additional real-time control, was used to implement a multi-turn reverse helical scan. The scan consists of C-arm rotation, through a series of clockwise and anticlockwise rotations, combined with simultaneous programmed table translation. The motion properties and geometric accuracy of the multi-turn reverse helical imaging trajectory were examined using a simple geometric phantom. To assess potential clinical utility, a pedicle screw posterior fixation procedure in the thoracic spine from T1 to T12 was performed on an ovine cadaver. The multi-turn reverse helical scan was used to provide postoperative assessment of the screw insertion via cortical breach grading and mean screw angle error measurements (axial and sagittal) from 2 observers. For all screw angle measurements, the intraclass correlation coefficient was calculated to determine observer reliability. Results: The multi-turn reverse helical scans took 100 seconds to complete and increased the longitudinal coverage by 370% from 17 cm to 80 cm. Geometric accuracy was examined by comparing the measured to actual dimensions (0.2 ± 0.1 mm) and angles (0.2 ± 0.1 degrees) of a simple geometric phantom, indicating that the multi-turn reverse helical scan provided submillimeter and degree accuracy with no distortion. During the pedicle screw procedure in an ovine cadaver, the multi-turn reverse helical scan identified 4 cortical breaches, confirmed via the postoperative CT scan. Directly comparing the screw insertion angles (n = 22) measured in the postoperative multi-turn reverse helical and CT scans revealed an average difference of 3.3 ± 2.6 degrees in axial angle and 1.9 ± 1.5 degrees in the sagittal angle from 2 expert observers. The intraclass correlation coefficient was above 0.900 for all measurements (axial and sagittal) across all scan types (conventional CT, multi-turn reverse helical, and conventional CBCT), indicating excellent reliability between observers.Conclusions: Extended longitudinal field-of-view intraoperative 3-dimensional imaging with a multi-turn reverse helical scan is feasible on a clinical robotic CBCT imaging system, enabling long anatomical sites to be visualized in a single image, including in the presence of metal hardware.

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“…Motion artifacts in the planning scans can propagate errors throughout the planning process from segmentation, guide development to 3D-printing. Future studies involving live animals will be used to quantify the extent of these errors and determine whether adaptive CBCT imaging approaches [26][27][28] are required to reduce the size and number of motion artifacts. Another limitation in the planning process of these studies was that the segmentation software (3D Slicer) used is not United States Food and Drug Administration (US FDA) approved.…”

Section: Discussionmentioning

confidence: 99%

Generating patient‐matched 3D‐printed pedicle screw and laminectomy drill guides from Cone Beam CT images: Studies in ovine and porcine cadavers

et al. 2022

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Background The emergence of robotic Cone Beam Computed Tomography (CBCT) imaging systems in trauma departments has enabled 3D anatomical assessment of musculoskeletal injuries, supplementing conventional 2D fluoroscopic imaging for examination, diagnosis, and treatment planning. To date, the primary focus has been on trauma sites in the extremities. Purpose To determine if CBCT images can be used during the treatment planning process in spinal instrumentation and laminectomy procedures, allowing accurate 3D‐printed pedicle screw and laminectomy drill guides to be generated for the cervical and thoracic spine. Methods The accuracy of drill guides generated from CBCT images was assessed using animal cadavers (ovine and porcine). Preoperative scans were acquired using a robotic CBCT C‐arm system, the Siemens ARTIS pheno (Siemens Healthcare, GmbH, Germany). The CBCT images were imported into 3D‐Slicer version 4.10.2 (http://www.slicer.org) where vertebral models and specific guides were developed and subsequently 3D‐printed. In the ovine cadaver, 11 pedicle screw guides from the T1–T5 and T7–T12 vertebra and six laminectomy guides from the C2–C7 vertebra were planned and printed. In the porcine cadaver, nine pedicle screw guides from the C3–T4 vertebra were planned and printed. For the pedicle screw guides, accuracy was assessed by three observers according to pedicle breach via the Gertzbein–Robbins grading system as well as measured mean axial and sagittal screw error via postoperative CBCT and CT scans. For the laminectomies, the guides were designed to leave 1 mm of lamina. The average thickness of the lamina at the mid‐point was used to assess the accuracy of the guides, measured via postoperative CBCT and CT scans from three observers. For all measurements, the intraclass correlation coefficient (ICC) was calculated to determine observer reliability. Results Compared with the planned screw angles for both the ovine and porcine procedures (n = 32), the mean axial and sagittal screw error measured on the postoperative CBCT scans from three observers were 3.9 ± 1.9° and 1.8 ± 0.8°, respectively. The ICC among the observes was 0.855 and 0.849 for the axial and sagittal measurements, respectively, indicating good reliability. In the ovine cadaver, directly comparing the measured axial and sagittal screw angle of the visible screws (n = 14) in the postoperative CBCT and conventional CT scans from three observers revealed an average difference 1.9 ± 1.0° in axial angle and 1.8 ± 1.0° in the sagittal angle. The average thickness of the lamina at the middle of each vertebra, as measured on‐screen in the postoperative CBCT scans by three observes was 1.6 ± 0.2 mm. The ICC among observers was 0.693, indicating moderate reliability. No lamina breaches were observed in the postoperative images. Conclusion Here, CBCT images have been used to generate accurate 3D‐printed pedicle screw and laminectomy drill guides for use in the cervical and thoracic spine. The results demonstrate sufficient precision compared with th...

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Adaptive CaRdiac cOne BEAm computed Tomography (ACROBEAT): Developing the next generation of cardiac cone beam CT imaging

Cited by 6 publications

References 24 publications

Technical note: Extended longitudinal and lateral 3D imaging with a continuous dual‐isocenter CBCT scan

Technical note: Extended longitudinal and lateral 3D imaging with a continuous dual‐isocenter CBCT scan

Extended Intraoperative Longitudinal 3-Dimensional Cone Beam Computed Tomography Imaging With a Continuous Multi-Turn Reverse Helical Scan

Generating patient‐matched 3D‐printed pedicle screw and laminectomy drill guides from Cone Beam CT images: Studies in ovine and porcine cadavers

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