no / In this paper, we extend the use of the partial differential equation (PDE) method to head visualization with computed tomography (CT) data and show how the two primary medical visualization means, surface reconstruction, and volume rendering can be integrated into one single framework through PDEs. Our scheme first performs head segmentation from CT slices using a variational approach, the output of which can be readily used for extraction of a small set of PDE boundary conditions. With the extracted boundary conditions, head surface reconstruction is then executed. Because only a few slices are used, our method can perform head surface reconstruction more efficiently in both computational time and storage cost than the widely used marching cubes algorithm. By elaborately introducing a third parameter w to the PDE method, a solid head can be created, based on which the head volume is subsequently rendered with 3D texture mapping. Instead of designing a transfer function, we associate the alpha value of texels of the 3D texture with the PDE parameter w through a linear transform. This association enables the production of a visually translucent head volume. The experimental results demonstrate the feasibility of the developed head visualization method.

State-of-Health (SoH), a specified measure of stability, is a critical parameter for determining the safe operating area of a battery cell and battery packs to avoid abuse and prevent failure and accidents. A series of experiments were performed to evaluate the performance of a 4P1S battery array using electrochemical impedance spectroscopy to identify key frequencies that may describe battery state of health at any state of charge. Using a large sample number of cells, the state of health frequency, fSoH, for these LiFePO4 26650 cells is found to be 158 Hz. Four experiments were performed to evaluate the lifetime in different configurations: single-cell at 1C (2.6A), single-cell at 10C (26A), four cells in parallel at 10C (ideal match), and four cells in parallel (manufacturer match). The lifetime for each experiment set degraded substantially, with the final parallel series reaching end of life at 400 cycles, a 75.32% reduction in life compared to operating solo. Analysis of the fSoH data for these cells revealed a change in imaginary impedance at the critical frequency that corresponded to changes in the capacity and current data, supporting the development of a single-frequency diagnostic tool. An electrochemical model of the battery was generated, and it indicated the anode material was aging faster than the SEI layer, the opposite of normal cell degradation. A post-mortem analysis of cells from three configurations (baseline, single-cell, and parallel-cell) supported the modeling, as physical damage to the copper current collector in the anode was visible in the parallel-connected cell. / Ph. D.

The current cardiac computed tomography (CT) technology is mainly limited by motion blurring and radiation dose. The conceptual multi-source interior CT scheme has provided a potential solution to reduce motion artifacts and radiation exposure. This dissertation work conducted multi-facet investigations on a novel multi-source interior CT architecture (G. Cao, et. al, IEEE Access, 2014;2:1263-71) which employs distributed stationary multi-beam Carbon-nanotube (CNT) X-ray sources and simultaneously operates multiple source-detector chains to improve temporal resolution. The collimation based interior CT is integrated in each imaging chain, to suppress radiation dose. The central thesis statement is: Compared to conventional CT design, this distributed source array based multi-source interior CT architecture shall provide ultra-fast CT scan of region-of-interest (ROI) inside body with comparable image quality at lower radiation dose. Comprehensive studies were conducted to separately investigate three critical aspects of multi-source interior CT: interior CT mode, X-ray scattering, and scatter correction methods. First, a single CNT X-ray source based interior micro-CT was constructed to serve as a down-scaled experimental verification platform for interior CT mode. Interior CT mode demonstrated comparable contrast-noise-ratio (CNR) and image structural similarity to the standard global CT mode, while inducing a significant radiation dose reduction (< 83.9%). Second, the data acquisition of multi-source interior CT was demonstrated at clinical geometry, via numerical simulation and physical experiments. The simultaneously operated source-detector chains induced significant X-ray forward / cross scattering and thus caused severe CNR reduction (< 68.5%) and CT number error (< 1122 HU). To address the scatter artifacts, a stationary beam-stopper-array (BSA) based and a source-trigger-sequence (STS) based scatter correction methods were proposed to enable the online scatter measurement / correction with further radiation dose reduction (< 50%). Moreover, a deterministic physics model was also developed to iteratively remove the scatter-artifacts in the multi-source interior CT, without the need for modifications in imaging hardware or protocols. The three proposed scatter correction methods improved CNR (< 94.0%) and suppressed CT number error (< 48 HU). With the dedicated scatter correction methods, the multi-source interior CT could provide ROI-oriented imaging with acceptable image quality at significantly reduced radiation dose. / Ph. D.

Bone health in the context of two common maladies, osteoporosis and obesity, has spurred research in the area of physical activity (PA) and bariatric surgery (BarS). Objectives: To examine: 1) relationships between PA and the skeleton utilizing the peripheral Quantitative Computed Tomography (pQCT) and Dual-energy X-ray Absorptiometry (DXA) in pre-menopausal women; 2) effects of adjustable gastric banding (AGB) vs. Roux-en-Y gastric bypass (RYGB) surgeries on pQCT and DXA measures; 3) 6-month time course changes on serum biomarkers of bone turnover and associated adipokines induced by AGB vs. RYGB. Methods: Standard DXA and pQCT measurements were taken for all subjects. PA tertiles (PA-L, PA-M, PA-H) were based on a calculated average MET-min/day determined from 4-d self-reported PA and pedometer step counts. For BarS subjects, bone measurements were taken pre-surgery, 3- and 6-months post-surgery along with serum (or plasma) from fasting blood draws, with ELISA assays for total OC, undercarboxylated OC, CTx, adiponectin, and leptin. Results: Minimal DXA differences between the highest and lowest PA tertiles were seen, while pQCT tibial measures and polar strength-strain index (SSIp) indicated differences along the tibial shaft. Comparing the two instruments and adjusting for BMI, the DXA leg and hip BMD and BMC showed differences (p<0.05) between PA-M and PA-L as well as PA-H and PA-L. Similarly, the pQCT tibial cortical area, BMC, and SSIp were progressively greater for the different levels of PA (p<0.05). 3- and 6-months post-BarS weight, fat-free mass, fat mass, central body fat, tibial and radial subcutaneous fat, and radial MCSA decreased (p<0.05). Comparing the AGB and RYGB and adjusting for weight, DXA BMC showed decreases (p<0.01) at both time points for RYGB. RYGB demonstrated differences (p<0.05) in bone measures at 3- and 6-months post-surgery along the tibial shaft that are indicative of increases in bone strength, and at 6-months, total OC, undercarboxylated OC, and HMW adiponectin increased, while leptin decreased. Conclusions: PA is associated with increases in bone, but pQCT data are more discriminatory and sensitive. 6-months post-RYGB, pQCT measures indicate increases in bone strength parameters, and greater bone adaptation was evidenced by biomarkers of increased osteoblastic activity. / Ph. D.

X-ray Luminescent Computed Tomography (XLCT) is a new imaging modality which is under extensive trials at present. The modality works by selective excitation of X-ray sensitive nanophosphors and detecting the optical signal thus generated. This system can be used towards recreating high quality tomographic slices even with low X-ray dose. There have been many studies which have reported successful validation of the underlying philosophy. However, there is still lack of information about optimal settings or combination of imaging parameters, which could yield best outputs. Research groups participating in this area have reported results on basis of dose, signal to noise ratio or resolution only. In this thesis, the candidate has evaluated XLCT taking into consideration noise and resolution in terms of composite indices. Simulations have been performed for various beam widths and noise & resolution metrics deduced. This information has been used in evaluating quality of images on basis of CT Figure of Merit & a modified Wang-Bovik Image Quality index. Simulations indicate the presence of an optimal setting which can be set prior to extensive scans. The conducted study, although focusing on a particular implementation, hopes to establish a paradigm in finding best settings for any XLCT system. Scanning with an optimal setting preconfigured can help in vastly reducing the cost and risks involved with this imaging modality. / Master of Science

Yes / Although the risks associated with iodinated contrast administration are acknowledged to be very low, screening of kidney function prior to administration is still standard practice in many hospitals. This study has evaluated the feasibility of implementing a screening form in conjunction with point of care (PoC) creatinine testing as a method to manage the risks of post contrast acute kidney injury (PC-AKI) within the CT imaging pathway. Method: Over an eight-week period 300 adult outpatients attending a UK CT department for contrast-enhanced scans were approached. Participants completed a screening questionnaire for co-morbidities linked to kidney dysfunction and consented to have a PoC and laboratory creatinine tests. Comparison was made against with previous baseline blood tests obtained within the preceding 3 months, as required by the study site. Participants were also invited to attend for follow up PoC and laboratory bloods tests at 48–72 h. Results: 14 patients (4.7%) had a scan-day eGFR below 45mL/min/1.73m2, all identified through screening. The majority of patients (n=281/300; 93.7%) fell in the same risk category based on previous and scan-day blood results. Six PoC test failures were recorded on the scan day. The constant error between the Abbott i-STAT PoC scan-day measurements and the laboratory scan-day measurements was -3.71 (95% CI: -6.41 to -0.50). Five patients had an elevated creatinine (≥25% from baseline) post contrast administration, but no instances of PC-AKI (≥50% from baseline) were identified. Conclusion: PoC creatinine testing is a practical method of ensuring renal function and is feasible in the radiology environment. / National Cancer Diagnostics Capacity Fund, NHS England. Andrew Lewington, Bethany Shinkins and Michael Messenger are currently supported by the NIHR MIC- Leeds In Vitro Diagnostics Co-operative (was previously NIHR Leeds Diagnostic Evidence Co-operative)

Yes / Reducing tube voltage is an effective dose saving method in computed tomography (CT) assuming tube current is not concurrently increased. Recent innovations in scanner technology now enable CT tube voltage reduction to 70 kV thereby increasing opportunities for dose reduction in paediatric patients, but it is unclear if the increased image noise associated with 70 kV impacts on ability to visualise renal stones accurately. The purpose was to assess detectability of nephrolithiasis using a bespoke paediatric phantom and low kV, non-contrast CT and to assess inter-observer agreement. Methods: Forty-two renal stones of different size and chemical composition were inserted into porcine kidneys and positioned in a bespoke, water-filled phantom mimicking a 9-year-old child weighing approximately 33kg. The phantom was scanned using 120 and 70 kV CT protocols, and the detectability of the stones was assessed by three radiologists. Absolute agreement and Fleiss’ kappa regarding detectability were assessed. Results: The mean diameter of renal stones as measured physically was 4.24 mm ranging from 1 to 11 mm. Four stones were missed by at least one observer. One observer had a sensitivity of 93 and 95% at 70 and 120 kV, respectively, while the sensitivity for observers 2 and 3 was 98% at both kV levels. Specificity was 100% across readers and kV levels. Absolute agreement between the readers at 70 kV was 92% (kappa = 0.86) and 98% (kappa = 0.96) at 120 kV indicating a strong agreement at both kV levels. Conclusions: The results suggest that lowering the kV does not affect the detection rate of renal stones and may be a useful dose reduction strategy for assessment of nephrolithiasis in children.

Yes / Lung cancer remains a major cause of preventable death and early diagnosis is critical to improving survival chances. The chest X-ray (CXR) remains the most common initial investigation, but clinical pathways need to support timely diagnosis through, where necessary, escalation of abnormal findings to ensure priority reporting and early CT scan. This single-centre study included a retrospective evaluation of a rapid lung cancer CXR pathway in its first year of operation (May 2018-April 2019). The pathway was initially designed for primary care referrals but could also be used for any CXR demonstrating abnormal findings. A parallel cross-sectional survey of radiographers explored their understanding, adherence and concerns regarding their role in the pathway operation. Primary care referrals on the rapid diagnostic pathway were low (n = 51/21,980; 0.2%), with 11 (21.6%) requiring a CT scan. A further 333 primary care CXR were escalated by the examining radiographer, with 100 (30.0%) undergoing a CT scan. Overall, 64 of the CT scans (57.7%) were abnormal or demonstrated suspicious findings warranting further investigation. There were 39 confirmed primary lung carcinomas, most with advanced disease. Survey responses showed that most radiographers were familiar with the pathway but some expressed concerns regarding their responsibilities and limited knowledge of CXR pathologies. This baseline evaluation of the rapid lung cancer pathway demonstrated poor referral rates from primary care and identified the need for improved engagement. Radiographer escalation of abnormal findings is an effective adjunct but underlines the need for appropriate awareness, training, and ongoing support. Engagement of the multiprofessional team is critical in new pathway implementation. Rapid diagnostic pathways can enable early diagnosis and the radiographer has a key role to play in their success.

Yes / The suspected scaphoid fracture remains a diagnostic conundrum with over-treatment a common risk-averse strategy. Cross-sectional imaging remains the gold standard with MRI recommended but CT used by some because of easier access or limited MRI availability. The aim of this feasibility study was to evaluate whether cone beam computed tomography (CBCT) could support early diagnosis, or exclusion, of scaphoid fractures. Patients with a suspected scaphoid were recruited fracture between March and July 2020. All underwent a 4-view X-ray. If this examination was normal, they were immediately referred for a CBCT scan of the wrist. Those with a normal scan were discharged to research follow-up at 2 and 6-weeks. 68 participants were recruited, 55 had a normal or equivocal X-ray and underwent CBCT. Nine additional radiocarpal fractures (16.2%) were demonstrated on CBCT, the remainder were discharged to research follow-up. Based on the 2-week and 6-week follow up three patients (4.4%) were referred for MRI to investigate persistent symptoms with no bony injuries identified. CBCT scans enabled a rapid pathway for the diagnosis or exclusion of scaphoid fractures, identifying other fractures and facilitating early treatment. The rapid pathway also enabled those with no bony injury to start rehabilitation, suggesting that patients can be safely discharged with safety-net advice following a CBCT scan.

Over the last fifteen years, there has been a rapid growth in the use of high resolution X-ray computed tomography (HRXCT) imaging in material science applications. We use it at nanoscale resolutions up to 50 nm (nano-CT) for key research problems in large scale operation of polymer electrolyte membrane fuel cells (PEMFC) and lithium-ion (Li-ion) batteries in automotive applications. PEMFC are clean energy sources that electrochemically react with hydrogen gas to produce water and electricity. To reduce their costs, capturing their electrode nanostructure has become significant in modeling and optimizing their performance. For Li-ion batteries, a key challenge in increasing their scope for the automotive industry is Li metal dendrite growth. Li dendrites are structures of lithium with 100 nm features of interest that can grow chaotically within a battery and eventually lead to a short-circuit. HRXCT imaging is an effective diagnostics tool for such applications as it is a non-destructive method of capturing the 3D internal X-ray absorption coefficient of materials from a large series of 2D X-ray projections. Despite a recent push to use HRXCT for quantitative information on material samples, there is a relative dearth of computational tools in nano-CT image processing and analysis. Hence, we focus on developing computational methods for nano-CT image analysis of fuel cell and battery materials as required by the limitations in material samples and the imaging environment. The first problem we address is the segmentation of nano-CT Zernike phase contrast images. Nano-CT instruments are equipped with Zernike phase contrast optics to distinguish materials with a low difference in X-ray absorption coefficient by phase shifting the X-ray wave that is not diffracted by the sample. However, it creates image artifacts that hinder the use of traditional image segmentation techniques. To restore such images, we setup an inverse problem by modeling the X-ray phase contrast optics. We solve for the artifact-free images through an optimization function that uses novel edge detection and fast image interpolation methods. We use this optics-based segmentation method in two main research problems - 1) the characterization of a failure mechanism in the internal structure of Li-ion battery electrodes and 2) the measurement of Li metal dendrite morphology for different current and temperature parameters of Li-ion battery cell operation. The second problem we address is the development of a space+time (4D) reconstruction method for in-operando imaging of samples undergoing temporal change, particularly for X-ray sources with low throughput and nanoscale spatial resolutions. The challenge in using such systems is achieving a sufficient temporal resolution despite exposure times of a 2D projection on the order of 1 minute. We develop a 4D dynamic X-ray computed tomography (CT) reconstruction method, capable of reconstructing a temporal 3D image every 2 to 8 projections. Its novel properties are its projection angle sequence and the probabilistic detection of experimental change. We show its accuracy on phantom and experimental datasets to show its promise in temporally resolving Li metal dendrite growth and in elucidating mitigation strategies. Keywords: X-ray computed tomography, 4D X-ray computed tomography, phase contrast optics, fuel cells, Li-ion batteries, signal processing and optimization.