KEYWORDS: Scanners, Monte Carlo methods, Fluctuations and noise, Systems modeling, X-ray sources, Signal attenuation, X-rays, Calibration, Photovoltaics, Computer simulations
Research on CT systems often requires knowledge of intensity as a function of angle in the fan-beam, due to the presence of bowtie filters, for studies such as dose reduction simulation, Monte Carlo dose calculations, or statistical reconstruction algorithms. Since manufacturers consider the x-ray bowtie filter design to be proprietary information, several methods have been proposed to measure the beam intensity profile independently: 1) calculate statistical properties of noise in acquired sinograms (requires access to raw data files, which is also vendor proprietary); 2) measure the waveform of a dosimeter located away from the isocenter (requires dosimeter equipment costing > $10K). We present a novel method that is inexpensive (parts costing ~$100 from any hardware store, using Gafchromic film at ~$3 per measurement), requires no proprietary information, and can be performed in a few minutes. A fixture is built from perforated steel tubing, which forms an aperture that selectively samples the intensity at a particular fan-beam angle in a rotating gantry. Two exposures (1× and 2×) are made and self-developing radiochromic film (Gafchromic XR- Ashland Inc.) is then scanned on an inexpensive PC document scanner. An analysis method is described that linearizes the measurements for relative exposure. The resultant profile is corrected for geometric effects (1/LΛ2 fall-off, gantry dwell time) and background exposure, providing a noninvasive estimate of the CT fan-beam intensity present in an operational CT system. This method will allow researchers to conveniently measure parameters required for modeling the effects of bowtie filters in clinical scanners.
X-ray equipment testing using phantoms that mimic the specific human anatomy, morphology, and structure is a very
important step in the research, development, and routine quality assurance for such equipment. Although the NEMA
XR21 phantom exists for cardiac applications, there is no such standard phantom for neuro-, peripheral and cardiovascular
angiographic applications. We have extended the application of the NEMA XR21-2000 phantom to evaluate
neurovascular x-ray imaging systems by structuring it to be
head-equivalent; two aluminum plates shaped to fit into the
NEMA phantom geometry were added to a 15 cm thick section. Also, to enable digital subtraction angiography (DSA)
testing, two replaceable central plates with a hollow slot were made so that various angiographic sections could be
inserted into the phantom. We tested the new modified phantom using a flat panel C-arm unit dedicated for endovascular
image-guided interventions. All NEMA XR21-2000 standard test sections were used in evaluations with the new "headequivalent"
phantom. DSA and DA are able to be tested using two standard removable blocks having simulated arteries
of various thickness and iodine concentrations (AAPM Report 15). The new phantom modifications have the benefits of
enabling use of the standard NEMA phantom for angiography in both neuro- and cardio-vascular applications, with the
convenience of needing only one versatile phantom for multiple applications. Additional benefits compared to using
multiple phantoms are increased portability and lower cost.
KEYWORDS: Angiography, Neck, Scanning electron microscopy, Arteries, Polyurethane, In vivo imaging, Animal model studies, Electron microscopy, Hemodynamics, Domes
Image-guided endovascular intervention (EIGI), using new flow modifying endovascular devices for intracranial
aneurysm treatment is an active area of stroke research. The new polyurethane-asymmetric vascular stent (P-AVS), a
vascular stent partially covered with a polyurethane-based patch, is used to cover the aneurysm neck, thus occluding
flow into the aneurysm. This study involves angiographic imaging of partially covered aneurysm orifices. This
particular situation could occur when the vascular geometry does not allow full aneurysm coverage. Four standard in-vivo
rabbit-model aneurysms were investigated; two had stent patches placed over the distal region of the aneurysm
orifice while the other two had stent patches placed over the proximal region of the aneurysm orifice. Angiographic
analysis was used to evaluate aneurysm blood flow before and immediately after stenting and at four-week follow-up.
The treatment results were also evaluated using histology on the aneurysm dome and electron microscopy on the
aneurysm neck. Post-stenting angiographic flow analysis revealed aneurysmal flow reduction in all cases with faster
flow in the distally-covered case and very slow flow and prolonged pooling for proximal-coverage. At follow-up,
proximally-covered aneurysms showed full dome occlusion. The electron microscopy showed a remnant neck in both
distally-placed stent cases but complete coverage in the proximally-placed stent cases. Thus, direct flow (impingement
jet) removal from the aneurysm dome, as indicated by angiograms in the proximally-covered case, was sufficient to
cause full aneurysm healing in four weeks; however, aneurysm healing was not complete for the distally-covered case.
These results support further investigations into the treatment of aneurysms by flow-modification using partial
aneurysm-orifice coverage.
Effective minimally invasive treatment of cerebral bifurcation aneurysms is challenging due to the complex and
remote vessel morphology. An evaluation of endovascular treatment in a phantom involving image-guided deployment
of new asymmetric stents consisting of polyurethane patches placed to modify blood flow into the aneurysm is reported.
The 3D lumen-geometry of a patient-specific basilar-artery bifurcation aneurysm was derived from a segmented
computed-tomography dataset. This was used in a stereolithographic rapid-prototyping process to generate a mold
which was then used to create any number of exact wax models. These models in turn were used in a lost-wax technique
to create transparent elastomer patient-specific aneurysm phantoms (PSAP) for evaluating the effectiveness of
asymmetric-stent deployment for flow modification. Flow was studied by recording real-time digitized video images of
optical dye in the PSAP and its feeding vessel. For two asymmetric stent placements: through the basilar into the right-posterior
communicating artery (RPCA) and through the basilar into the left-posterior communicating artery (LPCA),
the greatest deviation of flow streamlines away from the aneurysm occurred for the RPCA stent deployment. Flow was
also substantially affected by variations of inflow angle into the basilar artery, resulting in alternations in washout times
as derived from time-density curves. Evaluation of flow in the PSAPs with real-time optical imaging can be used to
determine new EIGI effectiveness and to validate computational-fluid-dynamic calculations for EIGI-treatment
planning.
In this study, we compare the results obtained from Time-Density Curve (TDC) analysis of angiographic imaging
sequences with histological evaluation for a rabbit aneurysm model treated with standard stents and new asymmetric
vascular stents (AVS) placed by image-guided endovascular deployment. AVSs are stents having a low-porosity
patch region designed to cover the aneurysm neck and occlude blood flow inside. To evaluate the AVSs, rabbits with
elastase-induced aneurysm models (n=20) were divided into three groups: the first (n=10) was treated with an AVS,
the second (n=5) with a non-patch standard coronary stent, and third was untreated as a control (n=5). We used TDC
analysis to measure how much contrast media entered the aneurysm before and after treatment. TDCs track contrast-media-density changes as a function of time over the region of interest in x-ray DSA cine-sequences. After 28 days,
the animals were sacrificed and the explanted specimens were histologically evaluated. The first group showed an
average reduction of contrast flow into the aneurysm of 95% after treatment with an AVS with fully developed
thrombus at 28 days follow-up. The rabbits treated with standard stents showed an increase in TDC residency time
after treatment and partial-thrombogenesis. The untreated control aneurysms displayed no reduction in flow and
were still patent at follow-up. The quantitative TDC analysis findings were confirmed by histological evaluation
suggesting that the new AVS has great potential as a definitive treatment for cerebro-vascular aneurysms and that
angiographic TDC analysis can provide in-vivo verification.
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