Initial clinical evaluation of stationary digital chest tomosynthesis in adult patients with cystic fibrosis

Gunnell, Elias T.; Franceschi, D.K.; Inscoe, Christina R.; Hartman, Allison; Goralski, Jennifer L.; Ceppe, Agathe; Handly, Brian; Sams, Cassandra M.; Fordham, Lynn Ansley; Lü, Jianping; Zhou, Otto; Lee, Yueh Z.

doi:10.1007/s00330-018-5703-9

Cited by 12 publications

(15 citation statements)

References 38 publications

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“…New advancements in carbon nanotube technology have allowed a linear X‐ray imaging array to be substituted for the conventional moving X‐ray source to provide X‐ray projections from multiple directions. Thus, sequential activations of a carbon nanotube linear X‐ray source allows for image acquisition without the need for motion, thus reducing the chance of blur artifact 16,17 . This provides high‐resolution coronal images of the chest with approximately 1/10th of the radiation dose of a typical CT scan (Figure 1).…”

Section: Chest Tomosynthesismentioning

confidence: 99%

“…The chest tomosynthesis image (C) was scored as 14 on tomosynthesis scoring system and demonstrated bronchial wall thickening (white circle), bronchiectasis (black circle), and mucus plugging (white arrow). Reprinted, in part, with permission by Springer Nature (Gunnell et al 16 ). CF, cystic fibrosis; CT, computed tomography; CXR, chest radiography; FEV 1 , forced expiratory volume in 1 second…”

Section: Chest Tomosynthesismentioning

confidence: 99%

“…This provides high‐resolution coronal images of the chest with approximately 1/10th of the radiation dose of a typical CT scan (Figure 1). While the technique is currently limited to a few research centers and limited personnel are trained to interpret stationary digital chest tomosynthesis (DCT), the few available studies suggest higher sensitivity of disease detection for DCT compared with CXR 16 for mild CF lung disease, though lower when compared with CT 17 . A DCT scoring system has been devised with good correlation to Brasfield scores on CXR, a standard tool for assessing CF lung disease 18 (see Table 2).…”

Section: Chest Tomosynthesismentioning

confidence: 99%

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Novel imaging techniques for cystic fibrosis lung disease

Goralski

Stewart

Woods

2021

Pediatric Pulmonology

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With an increasing number of patients with cystic fibrosis (CF) receiving highly effective CFTR (cystic fibrosis transmembrane regulator protein) modulator therapy, particularly at a young age, there is an increasing need to identify imaging tools that can detect and regionally visualize mild CF lung disease and subtle changes in disease state. In this review, we discuss the latest developments in imaging modalities for both structural and functional imaging of the lung available to CF clinicians and researchers, from the widely available, clinically utilized imaging methods for assessing CF lung disease—chest radiography and computed tomography—to newer techniques poised to become the next phase of clinical tools—structural/functional proton and hyperpolarized gas magnetic resonance imaging (MRI). Finally, we provide a brief discussion of several newer lung imaging techniques that are currently available only in selected research settings, including chest tomosynthesis, and fluorinated gas MRI. We provide an update on the clinical and/or research status of each technique, with a focus on sensitivity, early disease detection, and possibilities for monitoring treatment efficacy.

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Section: Chest Tomosynthesismentioning

confidence: 99%

Section: Chest Tomosynthesismentioning

confidence: 99%

Section: Chest Tomosynthesismentioning

confidence: 99%

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Novel imaging techniques for cystic fibrosis lung disease

Goralski

Stewart

Woods

2021

Pediatric Pulmonology

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“…This has led to the development of a variety of electron sources for x‐ray generation, such as carbon nanotube (CNT)‐based field emitters, 13 tungsten dispenser cathodes, 14 and Spindt type emitters 15 . Recently, spatially distributed x‐ray source array technology with CNT field emitters has been demonstrated for a variety of 3D imaging applications 16–19 . Featuring source‐to‐source distances as low as 4 mm, these unique switching x‐ray systems are well suited to provide the necessary angular resolution for CT imaging.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of carbon nanotube x‐ray source array for stationary head computed tomography

et al. 2021

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Purpose Stationary computed tomography (s‐CT) conceptually offers several advantages over existing rotating gantry‐based CT. Over the last 40 yr, s‐CT has been investigated using different technological approaches. We are developing a s‐CT system specifically for head/brain imaging using carbon nanotube (CNT)‐based field emission x‐ray source array technology. The noncircular geometry requires different assessment approaches as compared to circular geometries. The purpose of the present study is to investigate whether the CNT source array meets the requirements for stationary head CT (s‐HCT). Methods Multiple prototype CNT x‐ray source arrays were manufactured based on the system requirements obtained from simulation. Source characterization was performed using a benchtop setup consisting of an x‐ray source array with 45 distributed focal spots, each operating at 120 kVp, and an electronic control system (ECS) for high speed control of the x‐ray output from individual focal spots. Due to the forward‐angled geometry of the linear anode, the projected focal spot shape is expected to vary at wide angle views. A pinhole method was implemented to determine the effective focal spot size (FSS) in the imaging plane at a range of angular viewpoints with a flat panel detector. The output spectrum and half value layer (HVL) were also evaluated for a range of viewing angles to characterize the beam quality across the fan‐beam. Dosimetry was performed on a simulated scan to evaluate total exposure. Results The prototype CNT x‐ray source array demonstrated adequate specifications for a s‐HCT imaging machine. The source array was operated at 120 kVp with long‐term stability over a full year of regular laboratory use. Multiple cathode current measurements were used to confirm submicrosecond accuracy with regards to exposure time and subsequently dose control. All 45 focal spots were measured with an average value of 1.26 (±0.04) mm × 1.21 (±0.03) mm (equivalent to IEC 1,0). The x‐ray spectrum was found to be appropriately filtered based on sources used in existing rotary CT systems. A stable and reliable output of 0.04 mAs per emitter and a resulting dose of 0.015 mGy per projection were observed over several months of rigorous phantom imaging. Dose per projection was regulated by the ECS and measured with ±0.5% tolerance. Conclusions The CNT x‐ray source array was found to meet the requirements for the proposed stationary head CT scanner, with regard to FSS, beam quality, and dose precision. The remaining challenges are related to the overall system design of a nonrotating CT scanner with distributed sources. The next phase of the project will incorporate multiple CNT source arrays with multirow detectors in a proof‐of‐concept study and analysis of a fully functional s‐HCT system.

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“…( 26 ) A recent study reported good correlation between the tomosynthesis scoring and Brasfield score. ( 27 ) However, there are no available studies comparing DTS and CT regarding quantitative surveillance of structural lung disease in CF.…”

Section: Introductionmentioning

confidence: 99%

Quantification of Pulmonary Pathology in Cystic Fibrosis–comparison Between Digital Chest Tomosynthesis and Computed Tomography

Meltzer

Gilljam

Vikgren

et al. 2021

Radiation Protection Dosimetry

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Purpose: Digital tomosynthesis (DTS) is currently undergoing validation for potential clinical implications. The aim of this study was to investigate the potential for DTS as a low-dose alternative to computed tomography (CT) in imaging of pulmonary pathology in patients with cystic fibrosis (CF). Methods: DTS and CT were performed as part of the routine triannual follow-up in 31 CF patients. Extent of disease was quantified according to modality-specific scoring systems. Statistical analysis included Spearman’s rank correlation coefficient (r) and Krippendorff’s alpha (α). Major findings: The median effective dose was 0.14 for DTS and 2.68 for CT. Intermodality correlation was very strong for total score and the subscores regarding bronchiectasis and bronchial wall-thickening (r = 0.82–0.91, P < 0.01). Interobserver reliability was high for total score, bronchiectasis and mucus plugging (α = 0.83–0.93) in DTS. Conclusion: Chest tomosynthesis could be a low-dose alternative to CT in quantitative estimation of structural lung disease in CF.

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Initial clinical evaluation of stationary digital chest tomosynthesis in adult patients with cystic fibrosis

Abstract: We are requesting dual first authorship for E. Taylor Gunnell and Dora Franceschi. These students contributed equally to the design, implementation, analysis, and write up of this study.

Cited by 12 publications

References 38 publications

Novel imaging techniques for cystic fibrosis lung disease

Novel imaging techniques for cystic fibrosis lung disease

Evaluation of carbon nanotube x‐ray source array for stationary head computed tomography

Quantification of Pulmonary Pathology in Cystic Fibrosis–comparison Between Digital Chest Tomosynthesis and Computed Tomography

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