KEYWORDS: Head, Attenuators, Eye, Signal attenuation, Collimation, Neuroimaging, Visualization, Monte Carlo methods, Signal intensity, Image processing
Lens dose can be high during neuro-interventional procedures, increasing the risk of cataractogenesis. Although beam collimation can be effective in reducing lens dose, it also restricts the FOV. ROI imaging with a reduced-dose peripheral field permits full-field information with reduced lens dose. This work investigates the magnitude of lens-dose reduction possible with ROI imaging. EGSnrc Monte-Carlo calculations of lens dose were made for the Zubal head phantom as a function of gantry angulation and head shift from isocenter for both large and small FOV’s. The lens dose for ROI attenuators of varying transmission was simulated as the weighted sum of the lens dose from the small ROI FOV and that from the attenuated larger FOV. Image intensity and quantum mottle differences between ROI and periphery can be equalized by image processing. The lens dose varies considerably with beam angle, head shift, and field size. For both eyes, the lens-dose reduction with an ROI attenuator increases with LAO angulation, being highest for lateral projections and lowest for PA. For an attenuator with small ROI field (5 x 5 cm) and 20% transmission, the lens dose for lateral projections is reduced by about 75% compared to a full dose 10 x10 cm FOV, while the reduction ranges between 30 and 40% for PA projections. Use of ROI attenuators can substantially reduce the dose to the lens of the eye for all gantry angles and head shifts, while allowing peripheral information to be seen in a larger FOV.
The patient’s eye-lens dose changes for each projection view during fluoroscopically-guided neuro-interventional procedures. Monte-Carlo (MC) simulation can be done to estimate lens dose but MC cannot be done in real-time to give feedback to the interventionalist. Deep learning (DL) models were investigated to estimate patient-lens dose for given exposure conditions to give real-time updates. MC simulations were done using a Zubal computational phantom to create a dataset of eye-lens dose values for training the DL models. Six geometric parameters (entrance-field size, LAO gantry angulation, patient x, y, z head position relative to the beam isocenter, and whether patient’s right or left eye) were varied for the simulations. The dose for each combination of parameters was expressed as lens dose per entrance air kerma (mGy/Gy). Geometric parameter combinations associated with high-dose values were sampled more finely to generate more high-dose values for training purposes. Additionally, dose at intermediate parameter values was calculated by MC in order to validate the interpolation capabilities of DL. Data was split into training, validation and testing sets. Stacked models and median algorithms were implemented to create more robust models. Model performance was evaluated using mean absolute percentage error (MAPE). The goal for this DL model is that it be implemented into the Dose Tracking System (DTS) developed by our group. This would allow the DTS to infer the patient’s eye-lens dose for real-time feedback and eliminate the need for a large database of pre-calculated values with interpolation capabilities.
The imaging parameters used in neurointerventional procedures were evaluated to better understand the exposure techniques used clinically and their impact on patient dose. All parameters are available on the imaging system’s network bus in real time for each exposure pulse during a procedure. The Canon Dose Tracking System (DTS), which we developed, records the parameters of each exposure event in a raw data log file of controller area network (CAN) packets. We have collected such log files for 120 neurointerventional cases. Parameters are extracted by converting the raw data log file to a reformatted text file using a MATLAB script. The text file is input into a Microsoft Visual Studio project which outputs a new text file, which, with a reference table, allows the parameters to be identified. A written Python script is used to extract the specific parameters that were to be evaluated and output a .csv file. These were then input into MATLAB for analysis. The parameters extracted were the kVp, beam filter type, mAs, and the cranial/caudal angle as well as the RAO/LAO angle for the frontal and lateral gantries for DA and pulsed fluoroscopy (PF) modes. The gantry angles ranged from 34⁰ CRA to 42⁰ CAU and from 114⁰ RAO to 91⁰ LAO for DA and PF, respectively. The median kVp was 84 and 73 and the average per frame mAs was about 11 and 1.8 for DA and PF, respectively. This analysis should allow a better understanding of clinical practice in order to relate technique to patient and staff dose.
KEYWORDS: Signal attenuation, Virtual reality, Cameras, Detection and tracking algorithms, Visualization, Opacity, Algorithm development, Object recognition, Monte Carlo methods, Matrices
We have developed a prototype scatter-display system (SDS) which includes a top-down view, virtual reality (VR) representation of an interventional room containing a color-coded scatter dose rate distribution in real-time. To represent various attenuating objects of interest in the room, such as the C-Arm gantry and ceiling mounted shield, the STL toolbox in Matlab was implemented to produce a 3D VR description of the objects. Attenuation by objects in the room will alter the dose distribution and may lead to shielding of individual staff members, and thus representation of those objects in the software is needed for precise dose rate estimations. Determination of the spatial regions of attenuation requires accurate specification of object position. To retain identification of a ceiling mounted shield, we implemented an open-source package which maintains object recognition using the depth camera feed of a Microsoft Kinect V2 and the features-from-accelerated-segment- test (FAST) algorithm in OpenCV for a dense sampling of salient features. The depth information from the identified object is transferred to an open-source robot operating system (ROS) wrapper for specification of the 3D position to be fed into the SDS. To compute the C-Arm gantry position, we take advantage of a controller area network (CAN) bus interfaced with the angiography system’s application programming interface (API). Methods for computing gantry and ceiling mounted shield shadow regions are discussed and demonstrated. FAST was applied to the ceiling-shield assembly’s flange with reliable recognition. Including object attenuation of room scatter in the SDS will facilitate accurate dose rate computation.
The functionality of a real-time, top-down view virtual reality (VR) display of scattered radiation during fluoroscopic interventional procedures is being expanded to incorporate automatic input of staff member locations. Microsoft Kinect V2 depth sensing camera input was integrated into an open-source Robot Operating System (ROS) wrapper to facilitate automatic extraction of relative landmark body feature coordinates. Coordinates for the torso are selected to represent the staff member location in the selected plane of scatter; these coordinates are stored in a text file to be input into the real-time scatter display system (SDS). Accuracy of the depth sensing camera was evaluated using a pinhole camera model. This model was also implemented in an ROS wrapper to calibrate the Microsoft Kinect V2. Calibrated values were then implemented within a coordinate transformation algorithm which converts the physical distance measurements in the frame of the Kinect to normalized coordinates used in Matlab for visualization of the top-down horizontal plane of the interventional suite. Impact on real-time performance was evaluated for both staff member position update on-screen as well as for the update of SDS image frames.
It is important to determine the patient’s skin dose accurately for fluoroscopic interventional procedures in order to estimate the risk of deterministic injury. The purpose of this study is to investigate how the patient’s skin dose changes as a function of x-ray beam incident angle for flat and curved surfaces. The primary and scatter dose was calculated averaged over a 2.0 mm depth at the surfaces of both cubic and cylindrical water phantoms to simulate different patient curvature. The total skin dose was calculated using EGSnrc Monte-Carlo (MC) software with 1010 photons incident and the primary dose was calculated at the central axis using the mass energy absorption coefficients published by NIST and integrated over the beam-energy spectrum. Simulations were done for incident angles from 90 to 10 degrees, beam field sizes from 5 to 15 cm, cylinder diameters from 20 to 30 cm, and beam energies from 60 to 120 kVp. The results show the scatter-plus-primary to incident-primary dose ratio decreases with decreasing incident angle due to increased primary attenuation and decreases from cubic to cylindrical phantom and with decreasing cylinder diameter at all angles due to reduced backscatter. These results can be used to determine angular correction factors needed to accurately estimate patient skin dose when the beam is not normal to the entrance surface during fluoroscopic procedures.
The lens of the eye can receive a substantial amount of radiation during neuro-interventional fluoroscopic procedures, increasing the risk of cataractogenesis for the patient. The purpose of this study is to investigate the variation of eye lens dose with a variation of the location of the beam isocenter in the head. The primary x-ray beam of a Toshiba (Canon) Infinix fluoroscopy machine was modeled using EGSnrc Monte Carlo code and the lens dose was calculated using 2 × 1010 photons incident on the anthropomorphic Zubal computational head phantom for each simulation. The Zubal phantom is derived from a CT scan of an average adult male and has internal organs, including the lenses, segmented for dose calculation. Computations were performed with the head shifted vertically +/- 4 cm and in the cranial-caudal and lateral directions incrementally up to 6 cm in either direction. At each position, the gantry was rotated to various LAO/RAO and CAU/CRA angles, both 5 cm × 5 cm and 10 cm x 10 cm entrance field sizes were used and the kVp was varied. The results show that substantial changes in lens dose occur when the head is shifted and can result in a dose difference between eyes of over 6 times at certain beam angles for the 5 cm × 5 cm field size. The results of this study should provide increased accuracy in lens dose estimation during neuro interventional procedures and, when incorporated into our real-time dose-tracking system, help interventionalists manage patient lens dose during the procedure to minimize risk.
The purpose of this study is to investigate how the scattered radiation distribution in the interventional procedure room varies with changes in cranial / caudal (CRA/CAU) and right anterior oblique / left anterior oblique (RAO/LAO) gantry angulation of a C-Arm fluoroscopic system to aid in staff dose management. The primary x-ray beam of a Toshiba Infinix fluoroscopy machine was modeled using EGSnrc (DOSXYZnrc) Monte Carlo code and the scattered radiation distributions were calculated using 5 x 109 photons incident on the Zubal computational phantom. The Zubal phantom is derived from a CT scan of an average adult male and is anthropomorphic with internal organs. The results show that substantial changes in the scatter dose are possible for the interventionalist next to the table with Cranial/Caudal and RAO/LAO angle variations. For frontal projections the largest change with CRA/CAU angle occurs below the table height, increasing by 50% at the position of the interventionalist next to the table for a 30 degree cranial angulation compared to a caudal angulation for a beam directed toward the abdomen. The scattered radiation distribution also is shown to change with different body regions such as the chest and abdomen. A library of 3D scatter dose-rate distributions is being developed to be implemented in a scatter display system for increased staff awareness of dose levels during procedures.
KEYWORDS: MATLAB, Virtual reality, Visualization, Cameras, Detection and tracking algorithms, Software development, Monte Carlo methods, Human-machine interfaces, Calibration, Video
We have been working on the development of a Scatter Display System (SDS) for monitoring and displaying scatterrelated dose to staff members during fluoroscopic interventional procedures. We have considered various methods for such a display using augmented reality (AR) and computer-generated virtual reality (VR). The current work focuses on development of the VR SDS display, which shows the color-coded scattered dose distribution in a horizontal plane at a selected height above the floor in a top-down view of the interventional suite. Reported is the first development of the methodology for real-time functionality of this software via integration of controller area network (CAN) bus digital signals from the Canon C-Arm Biplane System. Importing the CAN bus information allows immediate selection of the appropriate pre-calculated scatter dose distribution consistent with the x-ray beam orientation and characteristics as well as selection of the proper gantry and table graphic for the display. The Python CAN interface module was used for streamlining the integration of the CAN bus interface. Development of real-time functionality for the SDS allows it to provide feedback to staff during clinical procedures for informed dose management; the SDS can work alongside the patient skin dose tracking system (DTS) for complete clinical monitoring of staff and patient dose.
The purpose of this study was to evaluate the effect of patient head size on radiation dose to radiosensitive organs, such as the eye lens, brain and spinal cord in fluoroscopically guided neuro-interventional procedures and CBCT scans of the head. The Toshiba Infinix C-Arm System was modeled in BEAMnrc/EGSnrc Monte-Carlo code and patient organ and effective doses were calculated in DOSxynrc/EGSnrc for CBCT and interventional procedures. X-ray projections from different angles, CBCT scans, and neuro-interventional procedures were simulated on a computational head phantom for the range of head sizes in the adult population and for different pediatric ages. The difference of left-eye lens dose between the mean head size and the mean ± 1 standard deviation (SD) ranges from 20% to 300% for projection angles of 0° to 90° RAO. The differences for other organs do not vary as much and is only about 10% for the brain. For a LCI-High CBCT protocol, the difference between mean and mean ± 1 SD head size is about 100% for lens dose and only 10% for mean and peak brain dose; the difference between 20 and 3 year-old mean head size is an increase of about 200% for the eye lens dose and only 30% for mean and peak brain dose. Dose for all organs increases with decreasing head size for the same reference point air kerma. These results will allow size-specific dose estimates to be made using software such as our dose tracking system (DTS).
The forward-scatter dose distribution generated by the patient table during fluoroscopic interventions and its contribution to the skin dose is studied. The forward-scatter dose distribution to skin generated by a water table-equivalent phantom and the patient table are calculated using EGSnrc Monte-Carlo and Gafchromic film as a function of x-ray field size and beam penetrability. Forward scatter point spread function’s (PSFn) were generated with EGSnrc from a 1×1 mm simulated primary pencil beam incident on the water model and patient table. The forward-scatter point spread function normalized to the primary is convolved over the primary-dose distribution to generate scatter-dose distributions. The utility of PSFn to calculate the entrance skin dose distribution using DTS (dose tracking system) software is investigated. The forward-scatter distribution calculations were performed for 2.32 mm, 3.10 mm, 3.84 mm and 4.24 mm Al HVL x-ray beams for 5×5 cm, 9×9 cm, 13.5×13.5 cm sized x-ray fields for water and 3.1 mm Al HVL x-ray beam for 16.5×16.5 cm field for the patient table. The skin dose is determined with DTS by convolution of the scatter dose PSFn’s and with Gafchromic film under PMMA “patient-simulating” blocks for uniform and for shaped x-ray fields. The normalized forward-scatter distribution determined using the convolution method for water table-equivalent phantom agreed with that calculated for the full field using EGSnrc within ±6%. The normalized forwardscatter dose distribution calculated for the patient table for a 16.5×16.5 cm FOV, agreed with that determined using film within ±2.4%. For the homogenous PMMA phantom, the skin dose using DTS was calculated within ±2 % of that measured with the film for both uniform and non-uniform x-ray fields. The convolution method provides improved accuracy over using a single forward-scatter value over the entire field and is a faster alternative to performing full-field Monte-Carlo calculations.
2D and 3D scatter dose display options are evaluated for usefulness and ease of interpretation for real-time feedback to staff to facilitate changes in individual positioning for dose reduction purposes, as well as improving staff consciousness of radiation presence. Room-sized scatter dose 3D matrices are obtained utilizing Monte Carlo simulations in EGSnrc. These distributions are superimposed on either a ceiling-view 2D graphic of the patient and table for reference or a 3D augmented reality (AR) display featuring a real-time video feed of the interventional room. A slice of the scatter dose matrix, at a selectable distance above the floor, is color-coded and superimposed on the computer graphic or AR display. The 3D display obtains depth information from a ceiling mounted Microsoft Kinect camera, which is equipped with a 1080p visual camera, as well as an IR emitter/receiver to generate a depth map of the interventional suite and persons within it. The 3D depth information allows parts of objects above the 2D dose map to pass through the map without being colorized by it so the height perspective of the dose map can be maintained. The 2D and 3D displays incorporate network information from the imaging system to scale the scatter dose with exposure factors and adjust rotation of the distribution to match the gantry. Demonstration images were displayed to neurosurgery interventional staff and survey responses were collected. Results from the survey indicated that scatter distribution displays would be desirable and helpful in managing staff dose.
The purpose of this work is to develop a database of 3D scattered radiation dose-rate distributions to estimate the staff dose by location around a C-Arm fluoroscopic system in an interventional procedure room. The primary x-ray beam of a Toshiba Infinix fluoroscopy machine was modeled using EGSnrc Monte Carlo code and the scattered radiation distributions were calculated using 5 x 109 photons per simulation. These 3D distributions were determined over the volume of the room as a function of various parameters such as the beam kVp and beam filter, the size and shape of the field, the angulation of the Carm, and the phantom size and shape. Two phantom shapes were used in this study: cylindrical and superellipses. The results show that shape of the phantom will affect the dose-rate distribution at distances less than 100 cm, with a higher intensity for the super-ellipse. The scatter intensity per entrance air kerma is seen to be approximately proportional to field area and to increase with increasing kVp. The scatter changes proportionally with increases in primary entrance air kerma for factors such as pulse rate, mA and pulse width. This database will allow estimation of the scatter distribution in the procedure room and, when displayed to the staff during a procedure, may facilitate a reduction of occupational dose.
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