PROCEEDINGS OF SPIE

SPIEDigitalLibrary.org/conference-proceedings-of-spie

Volumetric soft tissue brain imaging

on xCAT, a mobile flat-panel x-ray CT
system

Wojciech Zbijewski, J. Webster Stayman

Wojciech Zbijewski, J. Webster Stayman, "Volumetric soft tissue brain

imaging on xCAT, a mobile flat-panel x-ray CT system," Proc. SPIE 7258,
Medical Imaging 2009: Physics of Medical Imaging, 72582K (13 March 2009);
doi: 10.1117/12.811025

Event: SPIE Medical Imaging, 2009, Lake Buena Vista (Orlando Area),
Florida, United States

Downloaded From: https://journals.spiedigitallibrary.org/conference-proceedings-of-spie on 26 Aug 2022 Terms of Use: https://journals.spiedigitallibrary.org/terms-of-use

 Volumetric soft tissue brain imaging on xCAT, a mobile, flat-panel
X-ray CT system
Wojciech Zbijewski∗a, J. Webster Staymana,b
a
Xoran Technologies, Inc., 309 N. First Street, Ann Arbor, MI, USA 48103;
b
Michigan Tech Research Institute, 3600 Green Court, Suite 100, Ann Arbor, MI, USA 48105

ABSTRACT

We discuss the ongoing development of soft-tissue imaging capabilities on xCAT, a highly portable, flat-panel based
cone-beam X-ray CT platform. By providing the ability to rapidly detect intra-cranial bleeds and other symptoms of
stroke directly at the patient’s bedside, our new system can potentially significantly improve the management of
neurological emergency and intensive care patients. The paper reports on the design of our system, as well as on the
methods used to combat artifacts due to scatter, non-linear detector response and scintillator glare. Images of cadaveric
head samples are also presented and compared with conventional CT scans.

Keywords: X-ray CT, mobile, flat-panel detector, cone-beam

1. INTRODUCTION
The xCAT is a highly compact and portable flat-panel based X-ray CT scanner for head and neck applications. A version
of the scanner targeted towards intra-operative ENT (Ear, Nose and Throat) use is already commercially available. Its
utility in guiding endoscopic sinus surgery has been demonstrated in numerous studies1,2,3. Another area where the
compactness and portability of our scanner can potentially provide significant improvements in patient handling is
neurological emergency and intensive care. The most important imaging task in this context is reliable detection of intra-
cranial bleeds, accompanied by the ability to detect brain shift, brain swelling and enlargement of the ventricles. A
portable scanner capable of providing this level of imaging performance directly at patient’s bedside would accelerate
the detection of hemorrhagic strokes, as well as simplify the follow-up of intensive care patients.
While the case for providing soft tissue imaging capabilities on the xCAT platform is compelling, a number of
engineering and scientific challenges had to be addressed in order to achieve that goal and maintain the small size and
portability of our scanner. Most of the challenges were related to design choices made in order to ensure compact design,
such as the use of a large area flat-panel detector, cone-beam imaging geometry and a small, fixed anode X-ray source.
Compared to our ENT system, we had to use a higher intensity X-ray beam, which required us to switch to a new fixed
anode source. Due to limited dynamic range of standard flat-panel receptors, soft-tissue imaging necessitated the
utilization of dual-gain mode on our Varian 4030 detector. There is a number of other limitations of flat-panel detectors
that pose challenges when contrast resolution sufficient for soft-tissue imaging is sought. Non-linear response of such
detectors results in ring artifacts in the images. Spread of light in the scintillator layer (glare) leads to image blur. Finally,
the cone-beam imaging geometry, while ensuring compactness and large area coverage, leads to increased scatter
fractions. This paper discusses the methods used to combat the artifacts caused by nonlinear detector response, detector
glare and scatter. We present images of human cadaveric head samples obtained with the xCAT and compare them to
images acquired with a conventional CT scanner.

∗
wzbijewski@xorantech.com

Medical Imaging 2009: Physics of Medical Imaging, edited by Ehsan Samei, Jiang Hsieh,
Proc. of SPIE Vol. 7258, 72582K · © 2009 SPIE
CCC code: 1605-7422/09/$18 · doi: 10.1117/12.811025

Proc. of SPIE Vol. 7258 72582K-1

Downloaded From: https://journals.spiedigitallibrary.org/conference-proceedings-of-spie on 26 Aug 2022

Terms of Use: https://journals.spiedigitallibrary.org/terms-of-use
 2. MATERIALS AND METHODS
2.1 xCAT system design and imaging protocol

A
E

Fig. 1. The xCAT mobile CT scanner. A – X-ray power supply, UPS, and control
electronics, B - X-ray source assembly, C – 4030CB flat panel detector, D – operator
console, E – pivoting axle.
Fig. 1 depicts an xCAT mobile CT scanner. The system is powered up from 20 A electrical wall outlet, commonly
available in the hospitals, but can also be operated from a battery backup power source. The system employs a Varian
PaxScan 4030CB detector, consisting of an amorphous silicon flat-panel receptor coupled to a CsI scintillator4. Dual-
gain read-out mode is used in order to increase the effective dynamic range. In the dual gain mode, high and low internal
gains are alternately applied to subsequent detector rows. The high gain pixels allow for accurate sampling of X-ray
intensity in the areas of high attenuation, but saturate in the regions of lower attenuation. In these areas, the low gain
detector cells are used.
The source is a 32 degree target angle, 0.4 mm focal pot, fixed anode X-ray tube rated at 160 kVp. The high voltage
circuitry of the source is confined to the enclosed tube-head, which is driven by a generator in the base of the system. In
order to enhance the control of scatter and beam hardening and to flatten the dose distribution, a bow tie is placed on the
source’s exit window. The source assembly is mounted together with the detector on a rotating gantry. The imaging area
is surrounded with leaded acrylic shields to limit the scattered radiation. The acquisition and reconstruction computer,
operator’s console and an uninterruptible power supply are all integrated into scanner’s chassis. The front two wheels of
the scanner are mounted on a pivoting axle. The pivot provides a virtual tripod base during acquisition, so that the unit
remains highly stable throughout a scan even if the floor surface is uneven, while maintaining excellent stability during
transport due the relatively wide wheelbase provided by the four casters. The wheels of the unit have electromechanical
brakes and automatically lock upon the commencement of the scan to ensure stability. The entire system weighs about
450 pounds.
Soft tissue images presented here have been obtained with the source operated at 140 kVp and approx. 230 mAs. The
scans consisted of 600 frames acquired in a 40 s rotation. The detector was operated in a dual-gain mode.

2.2 Data processing and image reconstruction

Reduction of rings caused by non-linear detector response. The response of a flat-panel detector depends non-linearly on
the intensity and spectral shape of the incoming beam. Disturbing artifacts may emerge due to the mismatch between the
X-ray beam impinging on the detector during gain (air) calibration and the X-ray beam that reaches the detector after
passing through the object of interest. These artifacts will usually have the form of broad, low intensity rings. In order to
combat them, the gain scan is always performed at source intensity lower than that used for object scan, typically by a
factor of approx. 30. In this way, the X-ray flux reaching the detector during the gain scan is made comparable with that
encountered behind a typical head. Since this approach does not completely suppress the rings, an additional

Proc. of SPIE Vol. 7258 72582K-2

Downloaded From: https://journals.spiedigitallibrary.org/conference-proceedings-of-spie on 26 Aug 2022

Terms of Use: https://journals.spiedigitallibrary.org/terms-of-use
 reconstruction domain post-processing step is necessary. Reconstruction slices are transformed into cylindrical
coordinates and processed using a ring detector similar to the one described in Ref. 5. The thus obtained ring artifact
maps are subsequently subtracted from their corresponding reconstruction slices.
Glare correction. The term detector glare refers to the lateral spread of the scintillation light within the CsI layer. This
spread results in blur in the reconstructions. We determine the glare Point Spread Function (PSF) by imaging a lead
block placed on the detector so that its edge corresponds with the central slice. An average profile through the edge is
extracted from the projections and a PSF best describing the blurring of the edge is estimated through iterative
optimization. Projections are corrected for glare by de-convolving with this PSF.
Scatter correction. Scatter is corrected for by subtracting a constant scatter field from each projection frame. The value
of scatter is set at a constant fraction of minimal intensity in a given projection view after the gain and offset correction
and glare correction. Since this model does not completely account for the true distribution of scatter, the resulting
reconstructions typically exhibit some remaining non-uniformity. In order to reduce this non-uniformity, an image
domain post-processing algorithm is utilized. Similarly to Ref. 6 and 7, we estimate the shape of image non-uniformity
in each slice of the reconstruction by fitting a surface to the soft tissue voxels. The soft tissue regions are segmented out
using a simple thresholding.
Beam hardening correction. In order to reduce streaking artifacts and improve the visualization of bone-brain interface,
a beam hardening correction algorithm is employed. Similarly to the method described in Ref. 8, bone is first segmented
out of the initial, scatter-corrected reconstruction. Line integrals through the bone-only image are then computed, scaled
by an experimentally determined constant, raised to the second power and reconstructed. This reconstruction constitutes
the artifact map that is subsequently subtracted from the initial reconstruction, yielding a beam-hardening corrected
volume.
Image reconstruction. The following processing chain is used to obtain soft tissue reconstructions: first, the projections
are gain, offset and glare corrected. Next, an initial reconstruction is computed. This step includes the subtraction of
constant scatter fraction. Subsequently, beam hardening correction is executed. The resulting volume is finally post
processed to remove the remaining non-uniformity and reduce the rings. The images presented here were obtained from
projections down-sampled onto a 192 (axial) x 256 (trans-axial) projection grid with 1.552 mm pixels. Reconstruction
was performed with the Feldkamp algorithm with a Hamming filter having the cutoff at 0.92 of Nyquist frequency.
Voxel size was 0.5 mm.

3. RESULTS AND CONCLUSIONS

Fig. 2 compares reconstructions of two cadaveric head samples obtained using a clinical 16 slice helical CT scanner (GE
LightSpeed 16 employing a standard brain protocol) and our modified xCAT system. The slice thickness for the
conventional scan is 5 mm. The xCAT images are a result of averaging several native reconstruction slices to yield slice
thickness of 4.5 mm. The overall quality of images produced using the xCAT is still lower than that of a conventional
CT, but should be adequate for imaging tasks that do not require extremely high low contrast resolution. In particular,
the ventricles are adequately visualized and the level of low contrast detail seems sufficient for bleed detection. Even
though no ring artifacts are visible and the cupping is greatly mitigated, further work is needed to address the uniformity
of the xCAT image. The bright arc visible throughout some of the trans-axial slices (see 2nd row of images for Sample 1)
is most probably caused by image lag. We are currently working on addressing this issue, as well as on increasing image
resolution.
The bottom panel of Fig. 2 clearly demonstrates one of the important advantages of our system: due to the use of cone-
beam geometry, coronal, sagittal and axial images are all immediately available and the resolution is uniform in all three
planes. This improved visualization may be of great help to physicians in quickly identifying the areas of concern in the
brain.

Proc. of SPIE Vol. 7258 72582K-3

Downloaded From: https://journals.spiedigitallibrary.org/conference-proceedings-of-spie on 26 Aug 2022

Terms of Use: https://journals.spiedigitallibrary.org/terms-of-use
 Sample 1: Sample 2:

Conventional CT xCAT Conventional CT xCAT

Sample 1: xCAT, coronal and sagittal views Sample 2: xCAT, coronal and sagittal views

Fig. 2. Top panel: comparison of conventional CT and xCAT images of two cadaveric head samples. Bottom
panel: coronal and sagittal cuts through xCAT reconstructions of the same two head samples. Viewing window
for the conventional scan is 80 (width)/40 (level). Viewing window for the xCAT scan is 40/0.

The results presented here suggest that our flat-panel based, mobile X-ray CT system can achieve image quality
sufficient for e.g. detecting intra-cranial bleeds, brain shift and changes in the volume of the ventricles. We believe that
the combination of compactness, ease of use and soft tissue imaging capabilities of the xCAT will bring about significant
improvements in the treatment of intensive care or emergency unit patients, where speed of diagnosis is often of utmost
importance and moving the patient is frequently undesirable.

REFERENCES
[1]
Jackman AH, Palmer JN, Chiu AG, Kennedy DW: Use of intraoperative CT scanning in endoscopic sinus surgery:
a preliminary report. Am. J. Rhinol., 22(2), March-April 2008.
[2]
Das S, Maeso PA, Figueroa RE, Senior BA, Delgaudio JM, Sillers MJ, Schlosser RJ, Kuhn FA, Kountakis SE: The
use of portable intraoperative computed tomography scanning for real-time image guidance: A pilot cadaver study.
Am. J. Rhinol., 22(2), March-April 2008.

Proc. of SPIE Vol. 7258 72582K-4

Downloaded From: https://journals.spiedigitallibrary.org/conference-proceedings-of-spie on 26 Aug 2022

Terms of Use: https://journals.spiedigitallibrary.org/terms-of-use
 [3]
Woodworth BA, Chiu AG, Cohen HA, Kennedy DW, O’Malley BW, Palmer JN: Real-time computed tomography
image update for endoscopic skull base surgery (abs). J. Lar. & Otol., Aug 16, 2007 p. 1-5.
[4]
E. Matsinos and W. Kaissl, The dual-gain mode: a way to enhance the dynamic range of X-ray detectors, available
at: http://arxiv.org/PS_cache/physics/pdf/0607/0607021v1.pdf.
[5]
Sijbers, J., and Postnov, A. Reduction of ring artifacts in high resolution micro-CT reconstructions. Physics in
Medicine and Biology, Vol. 49, Nr. 14, p. 247-253, (2004)
[6]
Altunbas, M.C., et al., A post-reconstruction method to correct cupping artifacts in cone beam breast computed
tomography. Medical Physics, 2007. 34(7): p. 3109–3118.
[7]
Wiegert, J., et al. Soft-tissue contrast resolution within the head of human cadaver by means of flat-detector-based
cone-beam CT. in SPIE Medical Imaging. 2004. San Diego: SPIE.
[8]
Hsieh, J., et al., An iterative approach to the beam hardening correction in cone beam CT. Medical Physics, 2000.
27(1): p. 23-29.

Proc. of SPIE Vol. 7258 72582K-5

Downloaded From: https://journals.spiedigitallibrary.org/conference-proceedings-of-spie on 26 Aug 2022

Terms of Use: https://journals.spiedigitallibrary.org/terms-of-use