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Chiacchiaretta P.,University of Chieti Pescara | Chiacchiaretta P.,Bioengineering Unit | Ferretti A.,University of Chieti Pescara | Ferretti A.,Bioengineering Unit
PLoS ONE | Year: 2015

Previous evidence showed that, due to refocusing of static dephasing effects around large vessels, spin-echo (SE) BOLD signals offer an increased linearity and promptness with respect to gradient-echo (GE) acquisition, even at low field. These characteristics suggest that, despite the reduced sensitivity, SE fMRI might also provide a potential benefit when investigating spontaneous fluctuations of brain activity. However, there are no reports on the application of spin-echo fMRI for connectivity studies at low field. In this study we compared resting state functional connectivity as measured with GE and SE EPI sequences at 3T. Main results showed that, within subject, the GE sensitivity is overall larger with respect to that of SE, but to a less extent than previously reported for activation studies. Noteworthy, the reduced sensitivity of SE was counterbalanced by a reduced inter-subject variability, resulting in comparable group statistical connectivity maps for the two sequences. Furthermore, the SE method performed better in the ventral portion of the default mode network, a region affected by signal dropout in standard GE acquisition. Future studies should clarify if these features of the SE BOLD signal can be beneficial to distinguish subtle variations of functional connectivity across different populations and/or treatments when vascular confounds or regions affected by signal dropout can be a critical issue. © 2015 Chiacchiaretta, Ferretti.

Paganelli C.,Polytechnic of Milan | Peroni M.,Polytechnic of Milan | Peroni M.,Paul Scherrer Institute | Baroni G.,Bioengineering Unit | Riboldi M.,Bioengineering Unit
Medical Physics | Year: 2013

Purpose: The availability of corresponding landmarks in IGRT image series allows quantifying the inter and intrafractional motion of internal organs. In this study, an approach for the automatic localization of anatomical landmarks is presented, with the aim of describing the nonrigid motion of anatomo-pathological structures in radiotherapy treatments according to local image contrast. Methods: An adaptive scale invariant feature transform (SIFT) was developed from the integration of a standard 3D SIFT approach with a local image-based contrast definition. The robustness and invariance of the proposed method to shape-preserving and deformable transforms were analyzed in a CT phantom study. The application of contrast transforms to the phantom images was also tested, in order to verify the variation of the local adaptive measure in relation to the modification of image contrast. The method was also applied to a lung 4D CT dataset, relying on manual feature identification by an expert user as ground truth. The 3D residual distance between matches obtained in adaptive-SIFT was then computed to verify the internal motion quantification with respect to the expert user. Extracted corresponding features in the lungs were used as regularization landmarks in a multistage deformable image registration (DIR) mapping the inhale vs exhale phase. The residual distances between the warped manual landmarks and their reference position in the inhale phase were evaluated, in order to provide a quantitative indication of the registration performed with the three different point sets. Results: The phantom study confirmed the method invariance and robustness properties to shape-preserving and deformable transforms, showing residual matching errors below the voxel dimension. The adapted SIFT algorithm on the 4D CT dataset provided automated and accurate motion detection of peak to peak breathing motion. The proposed method resulted in reduced residual errors with respect to standard SIFT, providing a motion description comparable to expert manual identification, as confirmed by DIR. Conclusions: The application of the method to a 4D lung CT patient dataset demonstrated adaptive-SIFT potential as an automatic tool to detect landmarks for DIR regularization and internal motion quantification. Future works should include the optimization of the computational cost and the application of the method to other anatomical sites and image modalities. © 2013 American Association of Physicists in Medicine.

Spadea M.F.,University of Catanzaro | Verburg J.,Massachusetts General Hospital | Baroni G.,Polytechnic of Milan | Baroni G.,Bioengineering Unit | Seco J.,Massachusetts General Hospital
Journal of Applied Clinical Medical Physics | Year: 2013

The aim of this study was to assess the ability of metal artifact reduction (MAR) algorithm in restoring the CT image quality while correcting the tissue density information for the accurate estimation of the absorbed dose. A phantom filled with titanium (low-Z metal) and Cerrobend (high-Z metal) inserts was used for this purpose. The MAR algorithm was applied to phantom's CT dataset. Static intensity-modulated radiation therapy (IMRT) plans, including five beam angles, were designed and optimized on the uncorrected images to deliver 10 Gy on the simulated target. Monte Carlo dose calculation was computed on uncorrected, corrected, and ground truth image datasets. It was firstly verified that MAR methodology was able to correct HU errors due to the metal presence. In the worst situation (high-Z phantom), the image difference, uncorrected ground truth and corrected ground truth, went from -4.4 ± 118.8 HU to 0.4 ± 10.8 HU, respectively. Secondly, it was observed that the impact of dose errors estimation depends on the atomic number of the metal: low-Z inserts do not produce significant dose inaccuracies, while high-Z implants substantially influence the computation of the absorbed dose. In this latter case, dose errors in the PTV region were up to 23.56% (9.72% mean value) when comparing the uncorrected vs. the ground truth dataset. After MAR correction, errors dropped to 0.11% (0.10% mean value). In conclusion, it was assessed that the new MAR algorithm is able to restore image quality without distorting mass density information, thus producing a more accurate dose estimation.

Seregni M.,Polytechnic of Milan | Cerveri P.,Polytechnic of Milan | Cerveri P.,Bioengineering Unit | Riboldi M.,Polytechnic of Milan | And 4 more authors.
Physics in Medicine and Biology | Year: 2012

In radiotherapy, organ motion mitigation by means of dynamic tumor tracking requires continuous information about the internal tumor position, which can be estimated relying on external/internal correlation models as a function of external surface surrogates. In this work, we propose a validation of a time-independent artificial neural networks-based tumor tracking method in the presence of changes in the breathing pattern, evaluating the performance on two datasets. First, simulated breathing motion traces were specifically generated to include gradually increasing respiratory irregularities. Then, seven publically available human liver motion traces were analyzed for the assessment of tracking accuracy, whose sensitivity with respect to the structural parameters of the model was also investigated. Results on simulated data showed that the proposed method was not affected by hysteretic target trajectories and it was able to cope with different respiratory irregularities, such as baseline drift and internal/external phase shift. The analysis of the liver motion traces reported an average RMS error equal to 1.10mm, with five out of seven cases below 1mm. In conclusion, this validation study proved that the proposed method is able to deal with respiratory irregularities both in controlled and real conditions. © 2012 Institute of Physics and Engineering in Medicine.

Riyahi-Alam S.,Polytechnic University of Turin | Peroni M.,Paul Scherrer Institute | Baroni G.,Polytechnic of Milan | Baroni G.,Bioengineering Unit | And 2 more authors.
Methods of Information in Medicine | Year: 2014

Background: Similarity measures in medical images do not uniquely determine the correspondence between two voxels in deformable image registration. Uncertainties in the final computed deformation exist, questioning the actual physiological consistency of the deformation between the two images. Objectives: We developed a deformable image registration method that regularizes the deformation field in order to model a deformation with physiological properties, relying on vector calculus based operators as a regularization function. Method: We implemented a 3D multi-resolution parametric deformable image registration, containing divergence and curl of the deformation field as regularization terms. Exploiting a BSpline model, we fit the transformation to optimize histogram-based mutual information similarity measure. In order to account for compression/expansion, we extract sink/source/circulation components as irregularities in the warped image and compensate them. The registration performance was evaluated using Jacobian determinant of the deformation field, inverse-consistency, landmark errors and residual image difference along with displacement field errors. Finally, we compare our results to a robust combination of second derivative regularization, as well as to non-regularized methods. Results: The implementation was tested on synthetic phantoms and clinical data, leading to increased image similarity and reduced inverse-consistency errors. The statistical analysis on clinical cases showed that regularized methods are able to achieve better image similarity than non regularized methods. Also, divergence/curl regularization improves anatomical landmark errors compared to second derivative regularization. Conclusion: The implemented divergence/ curl regularization was successfully tested, leading to promising results in comparison with competitive regularization methods. Future work is required to establish parameter tuning and reduce the computational cost. © Schattauer 2014.

Schaerer J.,CNRS Research Center for Image Acquisition and Processing for Health | Schaerer J.,Center Leon Berard | Fassi A.,Polytechnic of Milan | Riboldi M.,Polytechnic of Milan | And 6 more authors.
Physics in Medicine and Biology | Year: 2012

Real-time optical surface imaging systems offer a non-invasive way to monitor intra-fraction motion of a patient's thorax surface during radiotherapy treatments. Due to lack of point correspondence in dynamic surface acquisition, such systems cannot currently provide 3D motion tracking at specific surface landmarks, as available in optical technologies based on passive markers. We propose to apply deformable mesh registration to extract surface point trajectories from markerless optical imaging, thus yielding multi-dimensional breathing traces. The investigated approach is based on a non-rigid extension of the iterative closest point algorithm, using a locally affine regularization. The accuracy in tracking breathing motion was quantified in a group of healthy volunteers, by pair-wise registering the thoraco-abdominal surfaces acquired at three different respiratory phases using a clinically available optical system. The motion tracking accuracy proved to be maximal in the abdominal region, where breathing motion mostly occurs, with average errors of 1.09 mm. The results demonstrate the feasibility of recovering multi-dimensional breathing motion from markerless optical surface acquisitions by using the implemented deformable registration algorithm. The approach can potentially improve respiratory motion management in radiation therapy, including motion artefact reduction or tumour motion compensation by means of internal/external correlation models. © 2012 Institute of Physics and Engineering in Medicine.

Spadea M.F.,University of Catanzaro | Spadea M.F.,Harvard University | Verburg J.M.,Harvard University | Baroni G.,Polytechnic of Milan | And 2 more authors.
Medical Physics | Year: 2014

Purpose: The aim of the study was to evaluate the dosimetric impact of low-Z and high-Z metallic implants on IMRT plans. Methods: Computed tomography (CT) scans of three patients were analyzed to study effects due to the presence of Titanium (low-Z), Platinum and Gold (high-Z) inserts. To eliminate artifacts in CT images, a sinogram-based metal artifact reduction algorithm was applied. IMRT dose calculations were performed on both the uncorrected and corrected images using a commercial planning system (convolutionsuperposition algorithm) and an in-house Monte Carlo platform. Dose differences between uncorrected and corrected datasets were computed and analyzed using gamma index (Pγ1) and setting 2 mm and 2 as distance to agreement and dose difference criteria, respectively. Beam specific depth dose profiles across the metal were also examined. Results: Dose discrepancies between corrected and uncorrected datasets were not significant for low-Z material. High-Z materials caused under-dosage of 20-25 in the region surrounding the metal and over dosage of 10-15 downstream of the hardware. Gamma index test yielded Pγ1>99 for all low-Z cases; while for high-Z cases it returned 91 Pγ1 99. Analysis of the depth dose curve of a single beam for low-Z cases revealed that, although the dose attenuation is altered inside the metal, it does not differ downstream of the insert. However, for high-Z metal implants the dose is increased up to 10-12 around the insert. In addition, Monte Carlo method was more sensitive to the presence of metal inserts than superpositionconvolution algorithm. Conclusions: The reduction in terms of dose of metal artifacts in CT images is relevant for high-Z implants. In this case, dose distribution should be calculated using Monte Carlo algorithms, given their superior accuracy in dose modeling in and around the metal. In addition, the knowledge of the composition of metal inserts improves the accuracy of the Monte Carlo dose calculation significantly. © 2014 American Association of Physicists in Medicine.

Fassi A.,Polytechnic of Milan | Schaerer J.,CNRS Research Center for Image Acquisition and Processing for Health | Schaerer J.,Center Leon Berard | Fernandes M.,CNRS Research Center for Image Acquisition and Processing for Health | And 7 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2014

Purpose To develop a tumor tracking method based on a surrogate-driven motion model, which provides noninvasive dynamic localization of extracranial targets for the compensation of respiration-induced intrafraction motion in high-precision radiation therapy. Methods and Materials The proposed approach is based on a patient-specific breathing motion model, derived a priori from 4-dimensional planning computed tomography (CT) images. Model parameters (respiratory baseline, amplitude, and phase) are retrieved and updated at each treatment fraction according to in-room radiography acquisition and optical surface imaging. The baseline parameter is adapted to the interfraction variations obtained from the daily cone beam (CB) CT scan. The respiratory amplitude and phase are extracted from an external breathing surrogate, estimated from the displacement of the patient thoracoabdominal surface, acquired with a noninvasive surface imaging device. The developed method was tested on a database of 7 lung cancer patients, including the synchronized information on internal and external respiratory motion during a CBCT scan. Results About 30 seconds of simultaneous acquisition of CBCT and optical surface images were analyzed for each patient. The tumor trajectories identified in CBCT projections were used as reference and compared with the target trajectories estimated from surface displacement with the a priori motion model. The resulting absolute differences between the reference and estimated tumor motion along the 2 image dimensions ranged between 0.7 and 2.4 mm; the measured phase shifts did not exceed 7% of the breathing cycle length. Conclusions We investigated a tumor tracking method that integrates breathing motion information provided by the 4-dimensional planning CT with surface imaging at the time of treatment, representing an alternative approach to point-based external-internal correlation models. Although an in-room radiograph-based assessment of the reliability of the motion model is envisaged, the developed technique does not involve the estimation and continuous update of correlation parameters, thus requiring a less intense use of invasive imaging. © 2014 Elsevier Inc. All rights reserved.

Paganelli C.,Polytechnic of Milan | Seregni M.,Polytechnic of Milan | Fattori G.,Polytechnic of Milan | Summers P.,Instituto Europeo Of Oncologia | And 6 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2015

Purpose This study applied automatic feature detection on cine-magnetic resonance imaging (MRI) liver images in order to provide a prospective comparison between MRI-guided and surrogate-based tracking methods for motion-compensated liver radiation therapy. Methods and Materials In a population of 30 subjects (5 volunteers plus 25 patients), 2 oblique sagittal slices were acquired across the liver at high temporal resolution. An algorithm based on scale invariant feature transform (SIFT) was used to extract and track multiple features throughout the image sequence. The position of abdominal markers was also measured directly from the image series, and the internal motion of each feature was quantified through multiparametric analysis. Surrogate-based tumor tracking with a state-of-the-art external/internal correlation model was simulated. The geometrical tracking error was measured, and its correlation with external motion parameters was also investigated. Finally, the potential gain in tracking accuracy relying on MRI guidance was quantified as a function of the maximum allowed tracking error. Results An average of 45 features was extracted for each subject across the whole liver. The multi-parametric motion analysis reported relevant inter- and intrasubject variability, highlighting the value of patient-specific and spatially-distributed measurements. Surrogate-based tracking errors (relative to the motion amplitude) were were in the range 7% to 23% (1.02-3.57mm) and were significantly influenced by external motion parameters. The gain of MRI guidance compared to surrogate-based motion tracking was larger than 30% in 50% of the subjects when considering a 1.5-mm tracking error tolerance. Conclusions Automatic feature detection applied to cine-MRI allows detailed liver motion description to be obtained. Such information was used to quantify the performance of surrogate-based tracking methods and to provide a prospective comparison with respect to MRI-guided radiation therapy, which could support the definition of patient-specific optimal treatment strategies. © 2015 Elsevier Inc. All rights reserved.

Riboldi M.,Polytechnic of Milan | Riboldi M.,Bioengineering Unit | Orecchia R.,CNAO Foundation | Orecchia R.,Oncology and Radiotherapy Institute | And 3 more authors.
The Lancet Oncology | Year: 2012

A key challenge in radiation oncology is accurate delivery of the prescribed dose to tumours that move because of respiration. Tumour tracking involves real-time target localisation and correction of radiation beam geometry to compensate for motion. Uncertainties in tumour localisation are important in particle therapy (proton therapy, carbon-ion therapy) because charged particle beams are highly sensitive to geometrical and associated density and radiological variations in path length, which will affect the treatment plan. Target localisation and motion compensation methods applied in x-ray photon radiotherapy require careful performance assessment for clinical applications in particle therapy. In this Review, we summarise the efforts required for an application of real-time tumour tracking in particle therapy, by comparing and assessing competing strategies for time-resolved target localisation and related clinical outcomes in x-ray radiation oncology. © 2012 Elsevier Ltd.

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