Faculty Bibliography

Despite the improvements in current imaging modalities such as CT and MRI, the detection of normal or malignant lymph nodes remains a challenge due to the large variability in lymph node characteristics and the variation in imaging quality and the limited imaging resolution. A computerized lymph node atlas could be the ideal tool for target volume definition based on the distribution of normal lymph nodes surrounding the verified malignant nodes to improve the accuracy of intensity-modulated radiation therapy planning. The standard lymph node topography in the newly constructed 3D lymph node atlas offers a detailed topographical distribution of discrete nodal locations in relation to surrounding organs at risk. In the present paper, the recently developed lymph node atlas is used for selection and delineation of target volumes in the head and neck, thorax and pelvic region. Image registration techniques were implemented to integrate the topography of the lymph node atlas into the patient's data set. By combining the knowledge-based lymph node distribution with the patient's data set, more detailed definitions of the target volumes were obtained to facilitate biologically based treatment plan optimization. The response values of the biologically optimized treatment plans were used to derive the probability of tumor control and the probability of complications in organs at risk. The treatment outcome of the lung reference plan showed a lower probability of recurrence in comparison to planning without the lymph node atlas. The lymph node atlas can improve and standardize the target volume definition by including more accurate anatomical knowledge for target volume definition and biologically optimized radiation therapy planning. (c) 2007 Elsevier B.V. All rights reserved

MRI is a sensitive method for detecting invasive breast cancer, but it lacks specificity. To examine the effect of combining PET with MRI on breast lesion characterization, a prototype positioning device was fabricated to allow PET scans to be acquired in the same position as MRI scans--that is, prone. METHODS: To test the hypothesis that fusion of (18)F-FDG PET and MRI scans improves detection of breast cancer, 23 patients with suspected recurrent or new breast cancer underwent a routine whole-body PET scan, a prone PET scan of the chest, and a routine breast MRI scan. The attenuation-corrected prone PET and MRI datasets were registered twice by different operators. The fusion results were judged for quality by visual inspection and statistical analysis. A joint reading of the MRI and PET scans side by side and integrated images was performed by a nuclear medicine physician and a radiologist. Sensitivity and specificity of MRI and combined MRI and PET scans were calculated on the basis of pathology reports or at least 1 y of clinical and radiologic follow-up. RESULTS: All fusions were verified to be well matched using specific anatomic criteria. A total of 45 lesions was assessed. Lesion size range was 0.6 to 10.0 cm. Of the 44 breasts examined, 29 were suspicious for cancer, of which 15 were found to be positive on surgical excision. In lesion-by-lesion analysis, sensitivity and specificity of MRI alone were 92% and 52%, respectively; after MRI and PET fusion, they were 63% and 95%, respectively. The positive predictive value and the negative predictive value for MRI alone were 69% and 85%, respectively; after MRI and PET fusion, they were 94% and 69%, respectively. CONCLUSION: Acquisition of prone PET scans using the new positioning device permitted acquisition of prone scans suitable for fusion with breast MRI scans. Fused PET and MRI scans increased the specificity of MRI but decreased the sensitivity in this small group of patients. Additional data are needed to confirm the statistical significance of these preliminary findings

PURPOSE: This study compared prone acquisition of PET scans with traditional supine acquisition to improve fusion of PET scans with MRI scans and improve evaluation of enhancing breast lesions detected on MRI. MATERIALS AND METHODS: MRI breast scans are acquired in the prone position using a breast coil to allow the breasts to hang pendant. An apparatus was fabricated to allow prone acquisition of PET scans. Fused scans from 2 patients acquired both prone and supine were contrasted with those from 3 patients acquired supine only. All 5 MRI scans were acquired on standard scanners. The PET scans were acquired with a PET/CT unit using a low-dose CT scan for attenuation correction. The PET and MRI volumes were matched twice (using a semiautomated registration method) by different operators. The additional value of fusion was judged using reports from the original (nonfused) MRI and PET, joint rereading of the volumes side by side, and examination of fused images. RESULTS: Of 12 enhancing lesions on breast MRI, 7 demonstrated uptake on PET/CT. In the 3 supine-only cases, the fused images were not interpretable because of the marked distortion of the breasts. In the 2 prone cases, the fused images increased our confidence in characterizing a lesion as benign or malignant. Interpretations were confirmed by clinical follow up in 2 or histologic results in 3 patients. CONCLUSIONS: PET MRI fusion is feasible and may assist in localizing lesions detected on either study. A more extensive study is underway to confirm the value of this fusion technique

Improvement of joint prostheses is dependent upon information concerning the biomechanical properties of the joint. Radiostereometric analysis (RSA) and electromagnetic techniques have been applied in previous cadaver and in vivo studies on the elbow joint to provide valuable information concerning joint motion axes. However, such information is limited to mathematically calculated positions of the axes according to an orthogonal coordinate system and is difficult to relate to individual skeletal anatomy. The aim of this study was to evaluate the in vivo application of a new fusion method to provide three-dimensional (3D) visualization of flexion axes according to bony landmarks. In vivo RSA data of the elbow joint's flexion axes was combined with data obtained by 3D computed tomography (CT). Results were obtained from five healthy subjects after one was excluded due to an instable RSA marker. The median error between imported and transformed RSA marker coordinates and those obtained in the CT volume was 0.22 mm. Median maximal rotation error after transformation of the rigid RSA body to the CT volume was 0.003 degrees . Points of interception with a plane calculated in the RSA orthogonal coordinate system were imported into the CT volume, facilitating the 3D visualization of the flexion axes. This study demonstrates a successful fusion of RSA and CT data, without significant loss of RSA accuracy. The method could be used for relating individual motion axes to a 3D representation of relevant joint anatomy, thus providing important information for clinical applications such as the development of joint prostheses.

This project investigated reducing the artifact content of In-ill ProstaScint SPECT scans for use in treatment planning and management. Forty-one patients who had undergone CT or MRI scans and simultaneous Tc-99m RBC/In-111 ProstaScint SPECT scans were included. SPECT volume sets, reconstructed using Ordered Set-Expectation Maximum (OS-EM) were compared against those reconstructed with standard Filtered Back projection (FBP). Bladder activity in Tc-99m scans was suppressed within an ellipsoidal volume. Tc-99m voxel values were subtracted from the corresponding In-111 after scaling based on peak activity within the descending aorta. The SPECT volume data sets were merged with the CT or MRI scans before and after processing. Volume merging, based both on visual assessment and statistical evaluation, was not affected. Thus iterative reconstruction together with bladder suppression and blood pool subtraction may improve the interpretation and utility of ProstaScint SPECT scans for patient management

The purpose of this paper is to demonstrate the clinical advantages of using semiautomatic volume registration where automatic registration is problematic due to large deformations, small bone anatomy, or extraneous structures. Examples are drawn from clinical cases of MRI/PET breast studies, CT angiography/SPECT cardiac studies, and total wrist arthroplasty. These types of studies should be contrasted with those involving the head, thorax, and pelvis where there is much less deformation and the existence of (some) large bones facilitates automatic matching

Other than scattering problems where perturbation theory is applicable, there are basically two ways to solve problems in physics. One is to reduce the problem to harmonic oscillators, and the other is to formulate the problem in terms of two-by-two matrices. If two oscillators are coupled, the problem combines both two-by-two matrices and harmonic oscillators. This method then becomes a powerful research tool which can be used in many different branches of physics. Indeed, the concept and methodology in one branch of physics can be translated into another through the common mathematical formalism. Coupled oscillators provide clear illustrative examples for some of the current issues in physics, including entanglement and Feynman's rest of the universe. In addition, it is noted that the present form of quantum mechanics is largely a physics of harmonic oscillators. Special relativity is the physics of the Lorentz group which can be represented by the group of two-by-two matrices commonly called SL(2, c). Thus the coupled harmonic oscillator can play the role of combining quantum mechanics with special relativity. It is therefore possible to relate the current issues of physics to the Lorentz-covariant formulation of quantum mechanics

PURPOSE: To validate a clinically useful method for measuring acetabular cup wear using computed tomography (CT). MATERIAL AND METHODS: Eight uncemented acetabular cups were scanned twice ex vivo using CT. The linear penetration depth of the femoral component head into the cup and the thickness of the remaining polyethylene liner were measured in the CT volumes using dedicated software. Two independent examiners twice assessed each volume. The CT measurements were compared to direct measurements using a coordinate measuring device and micrometer measurements. RESULTS: Accuracy of wear measurements expressed as penetration depth was +/-0.6 and +/- 1.0 mm for the two examiners, respectively, with no significant differences between examiners, trials, and CT scans. Accuracy of measurements of remaining polyethylene was +/- 1.3 and +/- 1.0 mm, respectively, for the two examiners. Systematic differences between examiners were found, but no significant differences between trials and CT scans. These differences were due to different interpretations of metal artifacts in the volumes. CONCLUSION: The proposed CT method for evaluating wear as head penetration depth allows for reliable wear detection at a clinically relevant level. Measurements of remaining polyethylene on CT volumes are not as reliable as wear measurements owing to metal artifacts.

PURPOSE: To retrospectively determine the accuracy of low-dose (20-mAs) computed tomography (CT) in the diagnosis of acute appendicitis in children by using a technique that enables the simulation of human CT scans acquired at a lower tube current given the image acquired at a standard dose. MATERIALS AND METHODS: Institutional review board approval was obtained, informed consent was not required, and the study was HIPAA compliant. The authors reviewed 100 standard-dose pediatric abdominal-pelvic CT scans (50 positive and 50 negative scans) obtained in 100 patients and corresponding simulated low-dose (20-mAs) scans. The standard-dose scans were obtained for evaluation in patients suspected of having appendicitis. Scans were reviewed in randomized order by four experienced pediatric radiologists. The patients with positive findings included 21 girls (mean age, 9.2 years) and 29 boys (mean age, 8.4 years). The patients with negative findings included 28 girls (mean age, 9.2 years) and 22 boys (mean age, 8.4 years). Simulation was achieved by adding noise patterns from repeated 20-mAs scans of a pediatric pelvis phantom to the original scans obtained with a standard tube current. Observers recorded their confidence in the diagnosis of appendicitis by using a six-point scale. Dose-related changes were analyzed with generalized estimating equations and the nonparametric sign test. RESULTS: There was a statistically significant (P < .001, sign test) decrease in both sensitivity and accuracy with a lower tube current, from 91.5% with the original tube current to 77% with the lower tube current. A low dose was the only statistically significant (P < .001) risk factor for a false-negative result. The specificity was unchanged at 94% for both the images obtained with the original tube current and the simulated low-dose images. The overall accuracy decreased from 92% with the original dose to 86% with the low dose. CONCLUSION: Preliminary findings indicate that it is feasible to optimize the CT dose used to evaluate appendicitis in children by using phantom-based computer simulations

When Einstein formulated his special relativity, he developed his dynamics for point particles. Of course, many valiant efforts have been made to extend his relativity to rigid bodies, but this subject is forgotten in history. This is largely because of the emergence of quantum mechanics with wave-particle duality. Instead of Lorentz-boosting rigid bodies, we now boost waves and have to deal with Lorentz transformations of waves. We now have some nderstanding of plane waves or running waves in the covariant picture, but we do not yet have a clear picture of standing waves. In this report, we show that there is one set of standing waves which can be Lorentz-transformed while being consistent with all physical principle of quantum mechanics and relativity. It is possible to construct a representation of the Poincare group using harmonic oscillator wave functions satisfying space-time boundary conditions. This set of wave functions is capable of explaining the quantum bound state for both slow and fast hadrons. In particular it can explain the quark model for hadrons at rest, and Feynman's parton model hadrons moving with a speed close to that of light