Dans le contexte du traitement du cancer de la prostate, l’utilisation de la tomodensitométrie à faisceau conique (CBCT) pour la radiothérapie guidée par l’image, éventuellement adaptative, présente certaines difficultés en raison du faible contraste et du bruit important dans les images pelviennes. L’objectif principal de cette thèse est d’apporter des contributions méthodologiques pour le recalage automatique entre l’image scanner CT de référence et l’image CBCT acquise le jour du traitement. La première partie de nos contributions concerne le développement d’une stratégie de correction du positionnement du patient à l’aide du recalage rigide (RR) CT/CBCT. Nous avons comparé plusieurs algorithmes entre eux : (a) RR osseux, (b) RR osseux suivi d’un RR local dans une région qui correspond au clinical target volume (CTV) de la prostate dans l’image CT élargie d’une marge allant de 1 à 20 mm. Une analyse statistique complète des résultats quantitatifs et qualitatifs utilisant toute la base de données, composée de 115 images cone beam computed tomography (CBCT) et de 10 images computed tomography (CT) de 10 patients atteints du cancer de la prostate, a été réalisée. Nous avons également défini une nouvelle méthode pratique et automatique pour estimer la distension rectale produite dans le voisinage de la prostate entre l’image CT et l’image CBCT. A l’aide de notre mesure de distension rectale, nous avons évalué l’impact de la distension rectale sur la qualité du RR local et nous avons fourni un moyen de prédire les échecs de recalage. Sur cette base, nous avons élaboré des recommandations concernant l’utilisation du RR automatique pour la localisation de la prostate sur les images CBCT en pratique clinique. La seconde partie de la thèse concerne le développement méthodologique d’une nouvelle méthode combinant le recalage déformable et la segmentation. Pour contourner le problème du faible rapport qualité/bruit dans les images CBCT qui peut induire le processus de recalage en erreur, nous avons imaginé une nouvelle énergie composée de deux termes : un terme de similarité globale (la corrélation croisée normalisée (NCC) a été utilisée, mais tout autre mesure de similarité pourrait être utilisée à la place) et un terme de segmentation qui repose sur une adaptation locale du modèle de l’image homogène par morceaux de Chan-Vese utilisant un contour actif dans l’image CBCT. Notre but principal était d’améliorer la précision du recalage comparé à une énergie constituée de la NCC seule. Notre algorithme de recalage est complètement automatique et accepte comme entrées (1) l’image CT de planification, (2) l’image CBCT du jour et (3) l’image binaire associée à l’image CT et correspondant à l’organe d’intérêt que l’on cherche à segmenter dans l’image CBCT au cours du recalage. / The use of CBCT imaging for image-guided radiation therapy (IGRT), and beyond that, image-guided adaptive radiation therapy (IGART), in the context of prostate cancer is challenging due to the poor contrast and high noise in pelvic CBCT images. The principal aim of the thesis is to provide methodological contributions for automatic intra-patient image registration between the planning CT scan and the treatment CBCT scan. The first part of our contributions concerns the development of a CBCT-based prostate setup correction strategy using CT-to-CBCT rigid registration (RR). We established a comparison between different RR algorithms: (a) global RR, (b) bony RR, and (c) bony RR refined by a local RR using the prostate CTV in the CT scan expanded with 1- to-20-mm varying margins. A comprehensive statistical analysis of the quantitative and qualitative results was carried out using the whole dataset composed of 115 daily CBCT scans and 10 planning CT scans from 10 prostate cancer patients. We also defined a novel practical method to automatically estimate rectal distension occurred in the vicinity of the prostate between the CT and the CBCT scans. Using our measure of rectal distension, we evaluated the impact of rectal distension on the quality of local RR and we provided a way to predict registration failure. On this basis, we derived recommendations for clinical practice for the use of automatic RR for prostate localization on CBCT scans. The second part of the thesis provides a methodological development of a new joint segmentation and deformable registration framework. To deal with the poor contrast-to-noise ratio in CBCT images likely to misguide registration, we conceived a new metric (or enery) which included two terms: a global similarity term (the normalized cross correlation (NCC) was used, but any other one could be used instead) and a segmentation term based on a localized adaptation of the piecewise-constant region-based model of Chan-Vese using an evolving contour in the CBCT image. Our principal aim was to improve the accuracy of the registration compared with an ordinary NCC metric. Our registration algorithm is fully automatic and takes as inputs (1) the planning CT image, (2) the daily CBCT image and (3) the binary image associated with the CT image and corresponding to the organ of interest we want to segment in the CBCT image in the course of the registration process.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: During root canal treatment (RCT), an opening is made through the crown of the tooth to access and to disinfect the root canal system (RCS). Traditional endodontic access (TEA) may sacrifice tooth structure and weaken the tooth. Cone beam computed tomography (CBCT) provides information about the exact location of the root canals. This information can be used for the design of a canal-directed endodontic access (CDEA). It may also be used for the 3D printing of an acrylic endodontic stent that could help to create a conservative CDEA. Objective: 1) Evaluate the ability of the Dolphin 3D imaging software to assist in creating a CDEA; 2) Compare tooth structure loss in a CDEA to that in a TEA by measuring the volume of remaining tooth structure, surface area of the access opening at the occlusal, and remaining dentin thickness at the CEJ. Materials and Methods: Thirty extracted human mandibular premolars were used. Teeth with large, wide canals were excluded. CBCT images will be taken for all teeth using Kodak 9000. Fifteen teeth were randomly assigned to the TEA group and 15 teeth were assigned to the CDEA group. The CDEA path was mapped using Dolphin 3D imaging software. Acrylic access stents were designed using Rhino 3D software and printed using a 3D printer. The teeth were accessed through the corresponding stents. The 15 teeth that are part of the traditional access group were accessed without a stent. A CBCT scan was taken post-access for all 30 teeth. Wilcoxon Rank Sum Tests were performed to compare the following outcomes for the two groups: the volume of remaining tooth structure, the surface area of the access opening at the occlusal, and remaining dentin thickness at the CEJ. Results: The remaining dentin thickness (percent loss) was not significantly larger for TEA than for CDEA. The surface area (post-treatment) was significantly larger for TEA than for CDEA, and volume (percent loss) was significantly larger for TEA than for CDEA. Conclusion: The use of the CBCT and Dolphin 3D imaging provided an accurate and more conservative CDEA with the guide of an acrylic stent.

Made available in DSpace on 2014-07-29T15:21:58Z (GMT). No. of bitstreams: 1 Dissertacao Andre Luiz Gomide de Morais.pdf: 1627953 bytes, checksum: 05ab427707618c3afdeb890e320268e6 (MD5) Previous issue date: 2012-02-13 / Introduction Strategies to obtain the working length to prepare and fill the root canals has been relevant theme of discussion in endodontics. The purpose of this study was to compare in vivo the canal root working length measures determined by cone beam computed tomography (CBCT) images with the ones obtained by using periapical radiograph and electronic apex locator. Methods The root canal working lengths of 30 single-rooted teeth from 19 patients whose diagnosis was apical periodontitis were evaluated. Initial periapical radiographs for diagnosis and treatment planning, employing the parallelism technique, were taken. CBCT images were acquired with i-CAT system (aiming of diagnosing the cases of apical periodontitis that showed to be complex and doubtful) and measured with specific function of i-CAT software. The coronal opening was made, the root canals were irrigated with sodium hypochlorite solution 2.5%, being performed the exploration and initial emptying of root canal. After, the preparation of the inlet orifice and of the cervical root third was carried out . The minor foramen was located using Root ZX® locator by advancing a stainless steel K-file that best suited the root canal, according to the manufacturer´s instructions. The radiographic measurement was made by advancing a stainless steel K-file in the root canal, until its tip was 1.0 mm from the root apex (determined from the measures obtained by the electronic ape locator). These 3 working length were tabulated and compared. Kruskal-Wallis test was used to analyze the differences between working lengths methods. The significance was set at α=5%. Results The mean values and standard deviations for working length determination by electronic apex locator, periapical radiograph and CBCT images were 21.5 ± 3.1, 21.32 ± 3, 21.4 ± 2.7, respectively. Significant differences were not verified statistically (P>0.05). Conclusions CBCT images working length determination showed to be as similar as the determinations obtained by using periapical radiograph and electronic apex locator. / Introdução: Estratégias para obtenção do comprimento de trabalho para preparar e obturar canais radiculares têm sido tema relevante de discussão em Endodontia. O objetivo deste estudo foi comparar in vivo as medidas de comprimento de trabalho do canal radicular determinadas por meio da tomografia computadorizada de feixe cônico (TCFC) com as obtidas por meio de radiografia periapical e localizador apical eletrônico. Metodologia: Foram avaliados os comprimentos de trabalho dos canais radiculares em 30 dentes de 19 pacientes com diagnóstico de periodontite apical. Radiografias periapicais iniciais de diagnóstico e plano de tratamento, empregando a técnica do paralelismo, foram realizadas. As imagens de TCFC foram obtidas usando o sistema i-CAT (com o intuito de diagnosticar os casos de periodontite apical que se mostraram complexos ou duvidosos) e foram medidas a partir de função específica do programa desse sistema. Foi realizada a abertura coronária, os canais radiculares foram irrigados solução de hipoclorito de sódio a 2,5%, sendo realizada a exploração e o esvaziamento inicial do canal radicular. Depois foi realizado o preparo do orifício de entrada e do terço cervical da raiz. O forame apical foi localizado usando o localizador Root ZX® por meio do avanço de uma lima tipo K-file que melhor se adaptasse ao canal radicular de aço inoxidável no canal radicular, de acordo com instruções do fabricante. A medida radiográfica foi feita por meio da colocação de uma lima tipo K-file de aço inoxidável no canal radicular, até que sua ponta estivesse a 1,0mm do ápice radicular (determinado pelas medidas obtidas com o localizador apical eletrônico). Essas três medidas de comprimento de trabalho foram tabuladas e comparadas. O teste de Kruskal-Wallis foi empregado para analisar as diferenças entre os métodos de obtenção dos comprimentos de trabalho. O nível de significância foi estabelecido em α=5%. Resultados: O valor médio e os desvios-padrões para a determinação do comprimento de trabalho por meio de imagens de TCFC, localizador apical eletrônico e radiografia periapical foram de e 21,4 ± 2,7, 21,5 ± 3,1, 21,32 ± 3, respectivamente. Diferenças significantes entre as medidas obtidas pelos três métodos não foram verificadas (p>0.05). Conclusões: A determinação do comprimento de trabalho em imagens de TCFC mostrou ser tão similar quanto às determinações obtidas por meio do método radiográfico e do localizador apical eletrônico.

Filtered backprojection (FBP) reconstruction algorithms are very popular in the field of X-ray computed tomography (CT) because they give advantages in terms of the numerical accuracy and computational complexity. Ramp filter based fan-beam FBP reconstruction algorithms have the position dependent weight in the backprojection which is responsible for spatially non-uniform distribution of noise and resolution, and artifacts. Many algorithms based on shift variant filtering or spatially-invariant interpolation in the backprojection step have been developed to deal with this issue. However, these algorithms are computationally demanding. Recently, fan-beam algorithms based on Hilbert filtering with inverse distance weight and no weight in the backprojection have been derived using the Hamaker’s relation. These fan-beam reconstruction algorithms have been shown to improve noise uniformity and uniformity in resolution. In this thesis, fan-beam FBP reconstruction algorithms with inverse distance back-projection weight and no backprojection weight for 2D image reconstruction are presented and discussed for the two fan-beam scan geometries -equi-angular and equispace detector array. Based on the proposed and discussed fan-beam reconstruction algorithms with inverse distance backprojection and no backprojection weight, new 3D cone-beam FDK reconstruction algorithms with circular and helical scan trajectories for curved and planar detector geometries are proposed. To start with three rebinning formulae from literature are presented and it is shown that one can derive all fan-beam FBP reconstruction algorithms from these rebinning formulae. Specifically, two fan-beam algorithms with no backprojection weight based on Hilbert filtering for equi-space linear array detector and one new fan-beam algorithm with inverse distance backprojection weight based on hybrid filtering for both equi-angular and equi-space linear array detector are derived. Simulation results for these algorithms in terms of uniformity of noise and resolution in comparison to standard fan-beam FBP reconstruction algorithm (ramp filter based fan-beam reconstruction algorithm) are presented. It is shown through simulation that the fan-beam reconstruction algorithm with inverse distance in the backprojection gives better noise performance while retaining the resolution properities. A comparison between above mentioned reconstruction algorithms is given in terms of computational complexity. The state of the art 3D X-ray imaging systems in medicine with cone-beam (CB) circular and helical computed tomography scanners use non-exact (approximate) FBP based reconstruction algorithm. They are attractive because of their simplicity and low computational cost. However, they produce sub-optimal reconstructed images with respect to cone-beam artifacts, noise and axial intensity drop in case of circular trajectory scan imaging. Axial intensity drop in the reconstructed image is due to the insufficient data acquired by the circular-scan trajectory CB CT. This thesis deals with investigations to improve the image quality by means of the Hilbert and hybrid filtering based algorithms using redundancy data for Feldkamp, Davis and Kress (FDK) type reconstruction algorithms. In this thesis, new FDK type reconstruction algorithms for cylindrical detector and planar detector for CB circular CT are developed, which are obtained by extending to three dimensions (3D) an exact Hilbert filtering based FBP algorithm for 2D fan-beam beam algorithms with no position dependent backprojection weight and fan-beam algorithm with inverse distance backprojection weight. The proposed FDK reconstruction algorithm with inverse distance weight in the backprojection requires full-scan projection data while the FDK reconstruction algorithm with no backprojection weight can handle partial-scan data including very short-scan. The FDK reconstruction algorithms with no backprojection weight for circular CB CT are compared with Hu’s, FDK and T-FDK reconstruction algorithms in-terms of axial intensity drop and computational complexity. The simulation results of noise, CB artifacts performance and execution timing as well as the partial-scan reconstruction abilities are presented. We show that FDK reconstruction algorithms with no backprojection weight have better noise performance characteristics than the conventional FDK reconstruction algorithm where the backprojection weight is known to result in spatial non-uniformity in the noise characteristics. In this thesis, we present an efficient method to reduce the axial intensity drop in circular CB CT. The efficient method consists of two steps: the first one is reconstruction of the object using FDK reconstruction algorithm with no backprojection weight and the second is estimating the missing term. The efficient method is comparable to Zhu et al.’s method in terms of reduction in axial intensity drop, noise and computational complexity. The helical scanning trajectory satisfies the Tuy-smith condition, hence an exact and stable reconstruction is possible. However, the helical FDK reconstruction algorithm is responsible for the cone-beam artifacts since the helical FDK reconstruction algorithm is approximate in its derivation. In this thesis, helical FDK reconstruction algorithms based on Hilbert filtering with no backprojection weight and FDK reconstruction algorithm based on hybrid filtering with inverse distance backprojection weight are presented to reduce the CB artifacts. These algorithms are compared with standard helical FDK in-terms of noise, CB artifacts and computational complexity.

This thesis addresses three problems related to image registration, prediction and tracking, applied to Angiography and Oncology. For image analysis, various probabilistic models have been employed to characterize the image deformations, target motions and state estimations. (i) In Digital Subtraction Angiography (DSA), having a high quality visualization of the blood motion in the vessels is essential both in diagnostic and interventional applications. In order to reduce the inherent movement artifacts in DSA, non-rigid image registration is used before subtracting the mask from the contrast image. DSA image registration is a challenging problem, as it requires non-rigid matching across spatially non-uniform control points, at high speed. We model the problem of sub-pixel matching, as a labeling problem on a non-uniform Markov Random Field (MRF). We use quad-trees in a novel way to generate the non uniform grid structure and optimize the registration cost using graph-cuts technique. The MRF formulation produces a smooth displacement field which results in better artifact reduction than with the conventional approach of independently registering the control points. The above approach is further improved using two models. First, we introduce the concept of pivotal and non-pivotal control points. `Pivotal control points' are nodes in the Markov network that are close to the edges in the mask image, while 'non-pivotal control points' are identified in soft tissue regions. This model leads to a novel MRF framework and energy formulation. Next, we propose a Gaussian MRF model and solve the energy minimization problem for sub-pixel DSA registration using Random Walker (RW). An incremental registration approach is developed using quad-tree based MRF structure and RW, wherein the density of control points is hierarchically increased at each level M depending of the features to be used and the required accuracy. A novel numbering scheme of the control points allows us to reuse the computations done at level M in M + 1. Both the models result in an accelerated performance without compromising on the artifact reduction. We have also provided a CUDA based design of the algorithm, and shown performance acceleration on a GPU. We have tested the approach using 25 clinical data sets, and have presented the results of quantitative analysis and clinical assessment. (ii) In External Beam Radiation Therapy (EBRT), in order to monitor the intra fraction motion of thoracic and abdominal tumors, the lung diaphragm apex can be used as an internal marker. However, tracking the position of the apex from image based observations is a challenging problem, as it undergoes both position and shape variation. We propose a novel approach for tracking the ipsilateral hemidiaphragm apex (IHDA) position on CBCT projection images. We model the diaphragm state as a spatiotemporal MRF, and obtain the trace of the apex by solving an energy minimization problem through graph-cuts. We have tested the approach using 15 clinical data sets and found that this approach outperforms the conventional full search method in terms of accuracy. We have provided a GPU based heterogeneous implementation of the algorithm using CUDA to increase the viability of the approach for clinical use. (iii) In an adaptive radiotherapy system, irrespective of the methods used for target observations there is an inherent latency in the beam control as they involve mechanical movement and processing delays. Hence predicting the target position during `beam on target' is essential to increase the control precision. We propose a novel prediction model (called o set sine model) for the breathing pattern. We use IHDA positions (from CBCT images) as measurements and an Unscented Kalman Filter (UKF) for state estimation. The results based on 15 clinical datasets show that, o set sine model outperforms the state of the art LCM model in terms of prediction accuracy.