Development and clinical translation of a cone-beam CT scanner for high-quality imaging of intracranial hemorrhage

A. Sisniega, J. Xu, H. Dang, W. Zbijewski, J. W. Stayman, M. Mow, V. E. Koliatsos, N. Aygun, X. Wang, D. H. Foos, J. H. Siewerdsen

Research output: Chapter in Book/Report/Conference proceedingConference contribution


Purpose: Prompt, reliable detection of intracranial hemorrhage (ICH) is essential for treatment of stroke and traumatic brain injury, and would benefit from availability of imaging directly at the point-of-care. This work reports the performance evaluation of a clinical prototype of a cone-beam CT (CBCT) system for ICH imaging and introduces novel algorithms for model-based reconstruction with compensation for data truncation and patient motion. Methods: The tradeoffs in dose and image quality were investigated as a function of analytical (FBP) and model-based iterative reconstruction (PWLS) algorithm parameters using phantoms with ICH-mimicking inserts. Image quality in clinical applications was evaluated in a human cadaver imaged with simulated ICH. Objects outside of the field of view (FOV), such as the head-holder, were found to introduce challenging truncation artifacts in PWLS that were mitigated with a novel multi-resolution reconstruction strategy. Following phantom and cadaver studies, the scanner was translated to a clinical pilot study. Initial clinical experience indicates the presence of motion in some patient scans, and an image-based motion estimation method that does not require fiducial tracking or prior patient information was implemented and evaluated. Results: The weighted CTDI for a nominal scan technique was 22.8 mGy. The high-resolution FBP reconstruction protocol achieved < 0.9 mm full width at half maximum (FWHM) of the point spread function (PSF). The PWLS soft-tissue reconstruction showed <1.2 mm PSF FWHM and lower noise than FBP at the same resolution. Effects of truncation in PWLS were mitigated with the multi-resolution approach, resulting in 60% reduction in root mean squared error compared to conventional PWLS. Cadaver images showed clear visualization of anatomical landmarks (ventricles and sulci), and ICH was conspicuous. The motion compensation method was shown in clinical studies to restore visibility of fine bone structures, such as the subtle fracture, cranial sutures, and the cochlea as well as subtle low-contrast structures in the brain parenchyma. Conclusion: The imaging performance of the prototype suggests sufficient quality for ICH imaging and motivates continued clinical studies to assess the diagnosis utility of the CBCT system in realistic clinical scenarios at the point of care.

Original languageEnglish (US)
Title of host publicationMedical Imaging 2017
Subtitle of host publicationPhysics of Medical Imaging
EditorsTaly Gilat Schmidt, Joseph Y. Lo, Thomas G. Flohr
ISBN (Electronic)9781510607095
StatePublished - 2017
EventMedical Imaging 2017: Physics of Medical Imaging - Orlando, United States
Duration: Feb 13 2017Feb 16 2017

Publication series

NameProgress in Biomedical Optics and Imaging - Proceedings of SPIE
ISSN (Print)1605-7422


OtherMedical Imaging 2017: Physics of Medical Imaging
Country/TerritoryUnited States

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Biomaterials
  • Atomic and Molecular Physics, and Optics
  • Radiology Nuclear Medicine and imaging


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