INSTITUTE OF PHYSICS PUBLISHING PHYSICS IN MEDICINE AND BIOLOGY

Phys. Med. Biol. 48 (2003) 3069–3084 PII: S0031-9155(03)61243-1

Helical cardiac cone beam reconstruction using

retrospective ECG gating
M Grass1, R Manzke1, T Nielsen1, P Koken1, R Proksa1, M Natanzon2
and G Shechter2
1 Philips Research Laboratories, Sector Technical Systems, Roentgenstr. 24-26,

D-22335 Hamburg, Germany

2 Philips Medical Systems, Haifa, Israel

E-mail: Michael.Grass@Philips.com

Received 25 March 2003, in final form 25 June 2003

Published 3 September 2003
Online at stacks.iop.org/PMB/48/3069

Abstract
In modern computer tomography (CT) systems, the fast rotating gantry and the
increased detector width enable 3D imaging of the heart. Cardiac volume
CT has a high potential for non-invasive coronary angiography with high
spatial resolution and short scan time. Due to the increased detector width,
true cone beam reconstruction methods are needed instead of adapted 2D
reconstruction schemes. In this paper, the extended cardiac reconstruction
method is introduced. It integrates the idea of retrospectively gated cardiac
reconstruction for helical data acquisition into a cone beam reconstruction
framework. It leads to an efficient and flexible algorithmic scheme for the
reconstruction of single- and multi-phase cardiac volume datasets. The method
automatically adapts the number of cardiac cycles used for the reconstruction.
The cone beam geometry is fully taken into account during the reconstruction
process. Within this paper, results are presented on patient datasets which have
been acquired using a 16-slice cone beam CT system.

1. Introduction

The introduction of cone beam computer tomography (CT) systems offers a couple of benefits.
Compared to a single-slice CT system, the time for data acquisition can be reduced roughly
proportional to the number of detector rows. Particularly time critical acquisition procedures
such as cardiac CT imaging (see e.g. Ohnesorge et al (2002) and reference therein), where
a large region of the human body has to be covered within a single breath hold, and a
single contrast agent bolus, benefit from this development. On the other hand, the increasing
number of detector lines with small pixel height requires the use of cone beam reconstruction
algorithms in order to guarantee utmost image quality (Köhler et al 2002a, 2002b). Current
cardiac multi-slice CT reconstruction approaches are based on 2D filtered back projection.
0031-9155/03/183069+16$30.00 © 2003 IOP Publishing Ltd Printed in the UK 3069
3070 M Grass et al

Either they neglect the cone angle completely or the plane used for 2D reconstruction is
adapted to the helical source path (Kachelriess and Kalender 1998, Hu et al 2000, Kachelriess
et al 2000a, 2000b, Taguchi and Anno 2000, Cline et al 2000, Bruder et al 2001). The latter
is a better approximation of the cone beam acquisition geometry, but requires, apart from the
remaining geometric error, an interpolation from the nutating planes to the final 3D image
volume. In order to enable cardiac imaging using cone beam CT acquisition systems, a
retrospectively gated helical reconstruction scheme is introduced in this paper. It takes the
cone beam geometry during the reconstruction process into account.
This method—named extended cardiac reconstruction (ECR)—is an approximate helical
cone beam reconstruction method based on 3D filtered back projection (Tuy 1999, 2000).
Within this cone beam reconstruction framework a retrospective cardiac gating scheme restricts
the temporal information to a certain cardiac motion state of interest. The required high
redundancy of the projection data is achieved by using a low pitch helical acquisition mode.
From the full set of projection data a subset is selected to restrict the information integrated
in the image volume to a defined motion state of the heart. This procedure is known as
retrospectively gated cardiac reconstruction.
Though an exact helical cone beam reconstruction method based on filtered back
projection has been derived (Katsevich 2002a, 2002b), this is not applicable to retrospectively
gated cardiac reconstruction. This is due to the fact that a way to handle redundant projections
in the framework of exact filtered back projection reconstruction is currently not available.
In addition, the application of a temporal gating function to a helical source path yields a
fragmented helix. Consequently, exact reconstruction is not feasible since, e.g., Radon planes
perpendicular to the rotation axis which intersect the missing segments are not available for
reconstruction.
Nevertheless, the use of time-dependent gating functions is required in low pitch helical
cardiac cone beam CT reconstruction. It is known that approximate 3D filtered back projection
methods can handle redundant data and deliver excellent image quality for helical acquisition
paths (Köhler et al 2002b, Proksa et al 2001) in the case of medium cone angle and medium
number of detector rows. Therefore, these methods are an excellent starting point for entering
the arena of cardiac cone beam CT reconstruction.
The ECR method, introduced in this paper, is based on the wedge method for helical
cone beam CT reconstruction (Köhler et al 2002a, Tuy 1999, 2000), which applies fan beam
to parallel beam rebinning prior to cosine weighting, filtering and 3D back projection of the
cone beam data. Apart from the geometric weighting factors inherent to the reconstruction
geometry, two additional weighting functions enter the ECR scheme. One results from the
illumination window of each voxel in the reconstruction volume. The illumination window is
a result of the acquisition geometry. It defines the angular range of x-ray illumination, which
is available for each voxel (Proksa et al 2001). The second weighting function is the cardiac
weighting function. It is calculated from the patient’s electrocardiogram (ECG) which is used
to determine the motion state of the heart. The cardiac weighting function determines the part
of the projection data in the temporal domain, which is used to reconstruct an image volume
for a certain cardiac phase. It restricts the input data for the reconstruction to a fixed motion
state of the heart in order to avoid blurring due to motion in the reconstruction volume. The
function is characterized by a gating window position within each RR-interval of the ECG, and
a corresponding window width and shape. Prior to back projection, the illumination weighting
function and the cardiac weighting function are combined for each voxel in the volume using
a normalization approach.
The key topic of this paper is the demonstration of the full integration of the cardiac gating
and the cone beam reconstruction for helical acquisition geometries into a computationally
Helical cardiac cone beam reconstruction 3071

SO
y
x

SD
G(λ, β, h)

Source Detector
h
β

S(λ)

D(λ, β, h)

λ
Source Trajectory
(0, 0, 0)

Figure 1. 3D representation of the acquisition geometry of a third generation CT system with a

2D focus centred detector array.

efficient and flexible algorithmic framework. Moreover, cardiac image results are shown for
three patient datasets acquired with different acquisition parameter settings. Data acquisition
was performed using the Philips MX 8000 IDT 16-line CT system. Cardiac patient data were
acquired at the University Hospital in Ulm, Germany.
This paper is organized as follows. Section 2 describes the ECR method and is split into
four parts. In section 2.1, the helical cone beam reconstruction method itself is described. In
section 2.2, the illumination weighting is introduced and discussed. The cardiac weighting
function is described in section 2.3. Section 2.4 introduces the normalization process prior
to back projection, which integrates the previous three parts into one reconstruction method.
Results from different patient datasets are shown in section 3. A summary and suggestions
for future work are given in section 4.

2. The ECR method

The description of the ECR method is split into four parts.

2.1. Helical cone beam reconstruction

Helical cone beam imaging using a third generation CT system with a 2D focus centred
detector array can be described by the geometric expressions given in the following. A
schematic representation of the acquisition geometry including the geometric expression is
given in figure 1.
The x-ray source moves on a helical path:
 
SO cos λ


S(λ) =  SO sin λ  . (1)
z(λ)
3072 M Grass et al

Rebinned Detector

h


G(φ, u, h) u
Virtual Source

D(φ, u, h)

u)
S(φ,

φ Source Trajectory
(0, 0, 0)

Figure 2. 3D representation of the acquisition geometry after fan beam to parallel beam rebinning.
Note that the rebinned detector is curved in the x–y and skewed in the z-direction.

SO is the distance from the source to the rotation axis, which coincides with the z-axis. z(λ)
describes the z-axis position of the acquisition system relative to the patient:
(λ + λo )
z(λ) = H rp . (2)
2π
Here, λo is the start position of the acquisition system, rp is the pitch factor and H is the
detector height projected onto the rotation axis. Since the pitch factor is defined with respect
to the detector height, equation (2) describes the absolute z-axis position of the CT system.
A focus centred detector at distance SD from the x-ray source is described by the fan-angle
β and the height position h:


D(λ,
+ G(λ,
β, h) = S(λ)
β, h) (3)
 
−SD cos(λ + β)


G(λ, β, h) =  −SD sin(λ + β)  (4)
h
with −β0 /2
β
β0 /2 and −H /2
h
H /2. Cone beam projections p1 are acquired
according to
 AG (h)
p1 (λ, β, h) =
+ t E
G (λ, β, h)) dt
f (S(λ) (5)
0

where E
G (λ, β, h) marks the unit vector in the direction G(λ,

β, h):


G(λ, β, h)
E
G (λ, β, h) = (6)


|G(λ, β, h)|


and AG (h) = |G(λ, β, h)| is its length.
As a first step of the reconstruction method, a fan beam to parallel beam rebinning is
applied to the projection data (see figure 2). Using the variable transformation:
φ =λ+β (7)
Helical cardiac cone beam reconstruction 3073

u = SO sin β (8)
the parallel rebinned projection data result as
     
u u
p2 (φ, u, h) = p1 φ − arcsin , arcsin ,h . (9)
SO SO
Please note that the z-position of the projection is not only dependent on φ, but also on u. The
detector changed its original focus centred shape and has a curved shape in the z-direction
now.
The reconstruction steps consist of a cosine-type weighting step, a one-dimensional
filtering and a 3D back projection (Tuy 1999, 2000). The cosine weighting function after
parallel rebinning is the cosine of the cone angle γ given by
SD
wa (h) =  = cos γ . (10)
2
h2 + SD
The weighted projection data are given below:
p3 (φ, u, h) = wa (h) · p2 (φ, u, h). (11)
The high pass filter is defined as a band limited ramp filter (see Magnusson-Seger (1993)) and
is applied to the weighted projections:
 +∞
p4 (φ, u, h) = p3 (φ, u , h)g(u − u ) du . (12)
−∞
The one-dimensional filtering is performed along the detector rows and depends only on the
coordinate u.
The final step consists of a 3D back projection along the measured rays into the defined
reconstruction volume to recover the original object function:
 φl (
x )
1
x) =
f (
wall (φ, x
)p4 (φ, u(φ, x
), h(φ, x
)) dφ. (13)
2π φf (
x )
The point on the rebinned detector where the ray from the extended source S(φ,
u) through
the voxel x
intersects the detector is given by u(φ, x
) and h(φ, x
). This position is calculated
from the relation:

u) + α E
G (φ, u, h).
x
= S(φ, (14)
The angular integration interval [φf (
x )] given in the back projection formula depends
x ); φl (

on the voxel position in the reconstruction volume. This effect is known as the voxel-dependent
illumination window.
The weighting function wall (φ, x
) describes the voxel position dependent combined
illumination and cardiac weighting function after normalization. The calculation of this
weighting function from the illumination and cardiac weighting function is the topic of the
following parts of this paper.

2.2. Illumination weighting

The illumination window of a single voxel for a given acquisition geometry is described by
x ) to φl (

the angular range φf (
x ). These angular positions define the first (φf ) and last (φl )
projections which illuminate a voxel, respectively. It is known that, for wide area detector CT
systems in combination with a low pitch helix, the case of interrupted illumination may occur
(Proksa et al 2001). Since this effect is rather small for the cone angles of current 16-line CT
3074 M Grass et al

Figure 3. Grey value coded variation of the beginning (left image), end (central image) and length
(right image) of the voxel position dependent illumination window in the x–y plane of a cardiac
reconstruction volume. The values have been calculated for the geometry of the scanner (see
section 3) with the acquisition parameters as defined in table 1, case A.

systems, here and in the following, we restrict ourselves to the central illumination window
only.
A numerical approach to determining the voxel-dependent illumination window width is
chosen here. The illumination window is calculated from the system geometry for each voxel
of the reconstruction volume. Depending on the voxel position and the system parameters,
the interval boundaries show a variation over the 3D imaging volume. An example of this
variation is presented in figure 3 for the system geometry used in this paper.
An example for an illumination weighting function is described below:


 0 φ < φf (
x)


 φ−φf (

 π
x)
φf (
x )
φ < φf (

x) + π
wi (φ, x
) = 1 φf (
x ) + π
φ
φl (

x) − π (15)




φl (

x )−φ
x ) − π < φ
φl (

φl (
x)
 π

0 φl (

x ) < φ.
The trapezoidal shape of this function essentially contains a triangular shape for (φl (
x) −
φf (
x ) − φf (

x )) < 2π , while it is not defined for (φl (
x )) < π . The latter corresponds to
the case of insufficient angular coverage. A graphical representation can be found in figure 4
(left column) for the three central voxels of the reconstruction volumes of the patient datasets
described in section 3.
The angular range defined by the illumination window determines the number of redundant
data available for each voxel in the reconstruction volume. The rays, which are contained
in the illumination window intersecting a voxel at a position x
in the 3D volume, can be
parametrized by their projection angle φ and their cone angle γ (see equations (7) and (10)).
The redundancy is defined with respect to the projection angle φ of the rays, disregarding that
the rays may have a different cone angle γ . Rays intersecting a voxel with the projection angle
φ + j π, j ∈ Z are named π -partners and classified as redundant rays. The resulting multiple
coverage within the illumination window φf (
x ) to φl (

x ) is used for the cardiac gating in the
following.

2.3. Cardiac weighting

The cardiac weighting function selects those projection data from the low pitch helical
acquisition which correspond to a certain motion state of the heart. Retrospective cardiac
gating is based on the assumption that the heart returns to the motion state in each cardiac
cycle and keeps this motion state for a certain duration. Since the heart performs a continuous
Helical cardiac cone beam reconstruction 3075

Weighting Functions (Central Voxel) Cardiac cycles used for reconstruction

3.25
Phasepoints Case A
1.2 Cardiac Weighting
Illumination Weighting
Self-Normalized Weighting
3
1

2.75

Number cardiac cycles

0.8
Weight

2.5
0.6

2.25
0.4

0.2 2

0 1.75
24500 25000 25500 26000 26500 27000 27500 28000 28500 0 20 40 60 80 100 120 140 160 180 200 220 240
Projection Number z-Position

Weighting Functions (Central Voxel) Cardiac cycles used for reconstruction

3.25
Phasepoints Case B
1.2 Cardiac Weighting
Illumination Weighting
Self-Normalized Weighting
3
1

2.75

Number cardiac cycles

0.8
Weight

2.5
0.6

2.25
0.4

0.2 2

0 1.75
27000 28000 29000 30000 31000 32000 0 20 40 60 80 100 120 140 160 180 200 220 240
Projection Number z-Position

Weighting Functions (Central Voxel) Cardiac cycles used for reconstruction

2.25
Phasepoints Case C
1.2 Cardiac Weighting
Illumination Weighting
Self-Normalized Weighting
2
1

1.75
Number cardiac cycles

0.8
Weight

1.5
0.6

1.25
0.4

0.2 1

0 0.75
21500 22000 22500 23000 23500 24000 24500 25000 25500 0 20 40 60 80 100 120 140 160 180 200 220 240
Projection Number z-Position

Figure 4. Left column: weighting function used for the reconstruction of the central voxel in
the reconstruction volume for case A/B/C (upper/central/lower graph). The graphs show the
central illumination window, the phase points and cardiac weighting functions contributing to the
reconstruction of this voxel as well as the final weighting function after the normalization process.
Right column: number of cardiac cycles contributing to the reconstruction of the central voxel of
each slice of the reconstruction volume for case A/B/C (upper/central/lower graph).

motion over the cardiac cycle a finite size of the cardiac gating window may lead to some
remaining motion artefacts in the reconstruction volume. Another source for these artefacts
may be slight variations in the motion behaviour from cycle to cycle. However, a finite gating
window size in combination with multi-cycle reconstruction is required in retrospectively
gated helical cardiac cone beam CT in order to achieve optimal temporal resolution at finite
scan times.
3076 M Grass et al

The cardiac weighting function is characterized by three different parameters, which

depend on the scan protocol and the patient’s physiology. The first one is the phase
point, which determines the centre of the gating window within each RR-interval extracted
from the patient’s ECG. Its position is set by the radiologist or cardiologist according to
the motion characteristic of the patient’s heart and the required diagnostic information.
The other two parameters are the width and shape of the gating window within each
RR-interval, which depend on the scan parameters and their relation to the heart motion of the
patient.
The position of the R-peaks is determined from the patient’s ECG, which is measured
synchronously with the helical cone beam projection data. The list of R-peaks determines the
periodicity of the patient’s heart movements. Prior to reconstruction, the time point in the
cardiac cycle is chosen at which the resulting image will be reconstructed. This time point is
expressed as a percentage of the RR-interval. Based on this value a list of phase points in each
RR-interval is generated.
More complex methods to determine the best position in the cardiac cycle are also
applicable in the framework of this reconstruction method, such as e.g. nonlinear adaptation
of the phase point position as a function of the patient’s heart rate (Chandra et al 2000).
Other approaches, which employ information generated in cardiac modelling to determine
physiology adapted gating functions (Wang et al 2002) or apply projection based motion
information (see Kachelriess et al (2002)), could also be integrated. However, the
results presented in section 3 employ the following approach to define the list of phase
points:
The list of NR R-peaks at angular CT system positions φ(Ri ) is determined from the ECG.
Within this paper, it is assumed that the list of R-peaks available for the scan starts/ends at
least one cycle before/after the start/end of the helical scan. This guarantees the usage of the
complete z-range covered by the projection data. From the list of R-peaks, the corresponding
phase points Pi at angular positions φ(Pi ) are calculated based on a user defined central
position for the gating window in the RR-interval. Using a relative phase point position Pr in
the RR-interval, this is described by

φ(Pi ) = φ(Ri ) + Pr Ri (16)

and

Ri = φ(Ri+1 ) − φ(Ri ) (17)

with Pr ∈ [0.0; 1.0]. The number of phase points NP is reduced by one compared with the
available number of R-peaks NR .
A gating window with a certain width Wi is centred at each phase point, which is
characterized by its relative width Wr of the cardiac interval:

Wi = Wr Ri . (18)

The relative width Wr determines the number of rays from the illumination window of each
voxel, which are taken into account by the reconstruction. The relative width must be chosen in
a way that the rays, which are selected out of the illumination window, still fulfil the boundary
condition that the projection angles φ of the rays intersecting each voxel must cover an angular
range of π .
As an example of a cardiac weighting function shape defined within this window, a
cosine squared function is described below. This function reaches zero at the gating window
boundaries and applies small/large weights to rays with a large/small temporal distance to
Helical cardiac cone beam reconstruction 3077

the phase point. It is suitable for smooth transitions within the gating windows:
 
2 cos 2 (φ−φ(Pi ))
π φ(Pi ) − W i

φ
φ(Pi ) + Wi
cicos (φ) = Wi 2 2 . (19)
0 else
The cardiac weighting function for all cardiac cycles is calculated by

NP
wc (φ) = ci (φ). (20)
i=1

A graphical representation of the shape of the cardiac weighting functions is presented

in figure 4 (left column) for the three patient datasets presented in section 3. Since the
method finally uses only those projection data which are acquired in the cardiac windows, an
application of prospective helical gating is feasible to further reduce the dose. However, this
requires the a priori knowledge of which phase is the best one to reconstruct an almost motion
artefact free image of this specific patient.
It remains open for the following section to integrate the acquisition-dependent
illumination weighting function and the patient specific cardiac weighting function into a
combined weighting scheme.

2.4. Normalization
The normalization process consists of the combination of the illumination weighting function
and the cardiac weighting function into a voxel-dependent weighting function wall (φ, x
).
During back projection of each projection to each voxel in the reconstruction volume, the
weighting functions are normalized with respect to all different π -partners. These rays are all
contained in the illumination window [φf (
x )] and differ by an angular increment of π :
x ); φl (

wc (φ)wi (φ, x
)
wall (φ, x
) = jmax (21)
j =jmin wc (φ + j π )wi (φ + j π, x
)
where jmin and jmax are determined by the equations given below
0
((φ + jmin π ) − φf (

x )) < π (22)

0
(φl (

x ) − (φ + jmax π )) < π. (23)
Note that wall (φ, x
) is a function of the voxel position x
. This function determines the
number of cardiac cycles used in reconstruction of a voxel. For a single voxel contained in the
reconstruction volume of the three different cases, the resulting normalized weighting function
is presented in figure 4 (left column).
The integration of this weighting function in the back projection formula (see
equation (13)) finally leads to a retrospectively gated cardiac multi-cycle cone beam CT
reconstruction method. Results are presented and discussed in the following section.

3. Results

Three different cardiac patient datasets are presented in this section. The projection data
acquisition was performed using a Philips MX 8000 IDT CT system in low pitch helical mode
with parallel ECG recording.
The system geometry is characterized by a source to rotation axis distance of SO =
570 mm and a source to detector distance of SD = 1040 mm. The fan angle is βmax = 52.14◦
3078 M Grass et al

Table 1. Variable scan, patient and reconstruction parameters for three different patient
datasets. Note that the temporal resolution has been calculated as a mean value for all voxels
in the reconstruction volume as the FWTM of the weight distribution (Kachelriess et al 2000a,
Shechter et al 2003).

Case A Case B Case C

Scan parameter
Pitch (mm) 2.88 2.88 3.60
Number of turns per scan 47 52 46
Total acquisition time (s) 19.74 21.84 19.32
Patient parameter
Mean heart rate (bpm) 84.98 71.41 70.44
Minimum heart rate (bpm) 82.77 65.97 65.40
Maximum heart rate (bpm) 96.40 81.19 77.08
Heart rate deviation (RMS) (bpm) 2.84 5.57 3.90
Reconstruction parameter
Cardiac gating window width (%(RR)) 30.0 30.0 30.0
Cardiac gating window position (%(RR)) 45.0 75.0 35.0
Mean temporal resolution (ms) 176.5 212.8 234.2

covering 672 detector elements. The physical detector height is H = 21.90 mm covering 16
detector lines. This corresponds to a detector element size (projected onto the rotation axis)
of 0.75 mm. 1160 views are acquired per turn.
The variable acquisition and patient parameters are summarized in table 1. The total
acquisition time for each of the datasets is approximately 20 s. The reconstruction volume has
a squared size of 200 × 200 mm2 in-plane and an extension of 120 mm along the patient axis.
The grid size is 512 × 512 in-plane and 240 voxels along the rotation axis. The patient’s ECG
signal is recorded in parallel with the acquisition, and the detected R-waves are determined.
Contrast agent is injected intravenously at a flow rate of 4.0/3.5 ml s−1 in a two-phasic injection
protocol (Hoffmann et al 2003).
For all of the datasets, the angular illumination window width has been calculated on a per
voxel basis. The weighting function of equation (15) has been applied. For the central voxel
of the reconstruction volume for each patient dataset, the illumination weighting function is
presented in figure 4 (left column).
The parameters for the cardiac weighting function are given in table 1. For all datasets a
relative cardiac window width of Wr = 30% RR-interval is sufficient to fulfil the angular
coverage with respect to the projection angle φ. As a consequence of the cosine squared shape
of the cardiac weighting function (see equation (19)) redundant rays are multiplied by a weight
which is decreasing with increasing distance to the phase point. Therefore, they generate only
a minor contribution to the reconstructed image volume.
For each patient dataset the cardiac weighting function of the central voxel in the
reconstruction volume is shown in figure 4 (left column). Due to the relative position of
the voxel with respect to the acquisition path and the cardiac cycle, a two/three/two phase
reconstruction results for case A/B/C. For case A, two cardiac cycles fully contribute to the
reconstruction of the voxel. Three different cardiac cycles are used for the reconstruction
of the central voxel for case B. The gating windows located at the beginning and the end of
the illumination window deliver only a minor contribution. The same effect happens to the
gating window located at the beginning of the illumination window of case C, which is only
reconstructed from two cycles. The number of cardiac cycles contributing to the reconstruction
Helical cardiac cone beam reconstruction 3079

Temporal Resolution Function (Central Voxel)

Case A (176.7 msec @ FWTM)

1.2 Case B (208.6 msec @ FWTM)
Case C (239.0 msec @ FWTM)

Resolution Function
0.8

0.6

0.4

0.2

0
-150 -100 -50 0 50 100 150
Time/msec

Figure 5. The temporal distribution of normalized weights contributing to the reconstruction of

the central voxel in the reconstruction volume for the three different cases. The histogram of the
weight distribution is plotted as a function of the temporal distance to the next phase point. The
temporal resolution, calculated as the FWTM of this distribution, is given in the figure for this
voxel.

of the central voxels of all slices along the rotation axis is presented in figure 4 (right column).
Due to the higher pitch used for the acquisition of case C, a one to two cycle reconstruction
is used, while for the other two cases a two to three cycle reconstruction is applied. The
number of cycles used for the reconstruction of a voxel depends on its position, the length
of its illumination window and their relative position with respect to the cardiac windows.
Therefore, it is a phase selective, heart rate adaptive, multi-cycle approach.
The final normalization process is performed on a per voxel basis during the final back
projection step as described in section 2.4. Due to the smoothness of the cardiac weighting
function, the final weight distribution after normalization behaves smoothly for all patient
datasets, as can be seen in figure 4. For cases A and C the late systolic gating window is
chosen for the reconstruction at a relative phase point of Pr = 45% and Pr = 35% RR-interval.
For case B, the phase points for the reconstruction are chosen in the late diastolic part at a
relative position of Pr = 75%.
The temporal resolution is also calculated on a per voxel basis as the full width tenth
maximum (FWTM) of the temporal distribution of normalized weights contributing to the
reconstruction of a voxel (Kachelriess et al 2000b, Shechter et al 2003). This approach has
been originally introduced by Kachelriess et al (2000b) on a per image basis and has been
extended to a fully spatially resolved measure by Shechter et al (2003) on a per voxel basis.
Examples of distributions for a single voxel in the centre of the reconstruction volume are
presented for the three patient datasets in figure 5. The mean value for all voxels in the
reconstruction volume is given in table 1.
For each of the presented patient datasets (see figures 6, 7 and 8), one transversal, one
coronal and two sagittal planes are presented from the 3D dataset. Images reconstructed
with and without gating are compared. In addition, a volume rendered view of the complete
volume reconstructed with cardiac gating is shown for all cases in figure 9. The overall image
quality is homogeneous and shows a low level of motion artefacts, independent of the different
pitch values. The method is capable of handling the different patient heart rates and heart
3080 M Grass et al

Figure 6. Four different reconstructed slices of case A. From top to bottom: one transversal, one
coronal and two sagittal images. Left/right column: reconstruction without/with cardiac gating
(level: 50 HU/window: 500 HU).

rate variabilities (see table 1 for the patient parameters). The volume rendered views (see
figure 9) clearly show the coronaries.

4. Summary and outlook

In this paper, we have introduced an efficient and flexible cone beam reconstruction framework
for helical cardiac imaging named ECR. It is based on an approximate filtered back projection
Helical cardiac cone beam reconstruction 3081

Figure 7. Four different reconstructed slices of case B. From top to bottom: one transversal, one
coronal and two sagittal images. Left/right column: reconstruction without/with cardiac gating
(level: 50 HU/window: 500 HU).

reconstruction method using parallel rebinning and true cone beam back projection. The
introduction of an illumination and a cardiac weighting function as well as the combination
of both, using a voxel based normalization, leads to a flexible computational scheme. It is a
multi-cycle method, which determines the number of heart beats used for the reconstruction
of each voxel from the scan parameters and the ECG data. It always uses the maximum of
available cycles for the reconstruction. It is capable of performing multi-phase reconstruction
in order to visualize dynamic volume processes for functional cardiac examinations.
3082 M Grass et al

Figure 8. Four different reconstructed slices of case C. From top to bottom: One transversal, one
coronal and two sagittal images. Left/right column: reconstruction without/with cardiac gating
(level: 100 HU/window: 500 HU).

In the future, more effort will be spent to examine and optimize the temporal and spatial
resolution of this method, and to generate patient specific weighting functions. In order to
analyse the overall performance of the reconstruction technique based on various scan and
patient parameters, a study with phantoms and a larger patient population will be carried
out.
Helical cardiac cone beam reconstruction 3083

Figure 9. Volume rendered views of the reconstructed cardiac volume. The left image (case
A) presents the right coronary artery while the central image (case B) presents the left anterior
descending artery. In the right image (case C) a bypass is clearly visible.

Acknowledgments

The authors are indebted to Dr M Hoffmann from the Department of Radiology, University
Hospital of Ulm, Germany for acquiring the patient data.

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