Publications by Year: 2008

Wang M, Rohling R, Duzenli C, Clark B, Archip N. Evaluation of targeting errors in ultrasound-assisted radiotherapy. Ultrasound Med Biol. 2008;34 (12) :1944-56.Abstract
A method for validating the start-to-end accuracy of a 3-D ultrasound (US)-based patient positioning system for radiotherapy is described. A radiosensitive polymer gel is used to record the actual dose delivered to a rigid phantom after being positioned using 3-D US guidance. Comparison of the delivered dose with the treatment plan allows accuracy of the entire radiotherapy treatment process, from simulation to 3-D US guidance, and finally delivery of radiation, to be evaluated. The 3-D US patient positioning system has a number of features for achieving high accuracy and reducing operator dependence. These include using tracked 3-D US scans of the target anatomy acquired using a dedicated 3-D ultrasound probe during both the simulation and treatment sessions, automatic 3-D US-to-US registration and use of infrared LED (IRED) markers of the optical position-sensing system for registering simulation computed tomography to US data. The mean target localization accuracy of this system was 2.5 mm for four target locations inside the phantom, compared with 1.6 mm obtained using the conventional patient positioning method of laser alignment. Because the phantom is rigid, this represents the best possible set-up accuracy of the system. Thus, these results suggest that 3-D US-based target localization is practically feasible and potentially capable of increasing the accuracy of patient positioning for radiotherapy in sites where day-to-day organ shifts are greater than 1 mm in magnitude.
Xia T, Baird C, Jallo G, Hayes K, Nakajima N, Hata N, Kazanzides P. An integrated system for planning, navigation and robotic assistance for skull base surgery. Int J Med Robot. 2008;4 (4) :321-30.Abstract
BACKGROUND: We developed an image-guided robot system to provide mechanical assistance for skull base drilling, which is performed to gain access for some neurosurgical interventions, such as tumour resection. The motivation for introducing this robot was to improve safety by preventing the surgeon from accidentally damaging critical neurovascular structures during the drilling procedure. METHODS: We integrated a Stealthstation navigation system, a NeuroMate robotic arm with a six-degree-of-freedom force sensor, and the 3D Slicer visualization software to allow the robotic arm to be used in a navigated, cooperatively-controlled fashion by the surgeon. We employed virtual fixtures to constrain the motion of the robot-held cutting tool, so that it remained in the safe zone that was defined on a preoperative CT scan. RESULTS: We performed experiments on both foam skull and cadaver heads. The results for foam blocks cut using different registrations yielded an average placement error of 0.6 mm and an average dimensional error of 0.6 mm. We drilled the posterior porus acusticus in three cadaver heads and concluded that the robot-assisted procedure is clinically feasible and provides some ergonomic benefits, such as stabilizing the drill. We obtained postoperative CT scans of the cadaver heads to assess the accuracy and found that some bone outside the virtual fixture boundary was cut. The typical overcut was 1-2 mm, with a maximum overcut of about 3 mm. CONCLUSIONS: The image-guided cooperatively-controlled robot system can improve the safety and ergonomics of skull base drilling by stabilizing the drill and enforcing virtual fixtures to protect critical neurovascular structures. The next step is to improve the accuracy so that the overcut can be reduced to a more clinically acceptable value of about 1 mm.
McDannold N, Maier SE. Magnetic resonance acoustic radiation force imaging. Med Phys. 2008;35 (8) :3748-58.Abstract
Acoustic radiation force impulse imaging is an elastography method developed for ultrasound imaging that maps displacements produced by focused ultrasound pulses systematically applied to different locations. The resulting images are "stiffness weighted" and yield information about local mechanical tissue properties. Here, the feasibility of magnetic resonance acoustic radiation force imaging (MR-ARFI) was tested. Quasistatic MR elastography was used to measure focal displacements using a one-dimensional MRI pulse sequence. A 1.63 or 1.5 MHz transducer supplied ultrasound pulses which were triggered by the magnetic resonance imaging hardware to occur before a displacement-encoding gradient. Displacements in and around the focus were mapped in a tissue-mimicking phantom and in an ex vivo bovine kidney. They were readily observed and increased linearly with acoustic power in the phantom (R2=0.99). At higher acoustic power levels, the displacement substantially increased and was associated with irreversible changes in the phantom. At these levels, transverse displacement components could also be detected. Displacements in the kidney were also observed and increased after thermal ablation. While the measurements need validation, the authors have demonstrated the feasibility of detecting small displacements induced by low-power ultrasound pulses using an efficient magnetic resonance imaging pulse sequence that is compatible with tracking of a dynamically steered ultrasound focal spot, and that the displacement increases with acoustic power. MR-ARFI has potential for elastography or to guide ultrasound therapies that use low-power pulsed ultrasound exposures, such as drug delivery.
Maddah M, Zöllei L, Grimson EWL, Wells WM. Modeling of Anatomical Information in Clustering of White Matter Fiber Trajectories Using Dirichlet Distribution. Proc Workshop Math Methods Biomed Image Analysis. 2008;2008 :1-7.Abstract
In this work, we describe a white matter trajectory clustering algorithm that allows for incorporating and appropriately weighting anatomical information. The influence of the anatomical prior reflects confidence in its accuracy and relevance. It can either be defined by the user or it can be inferred automatically. After a detailed description of our novel clustering framework, we demonstrate its properties through a set of preliminary experiments.
Hoge SW, Brooks DH. Using GRAPPA to improve autocalibrated coil sensitivity estimation for the SENSE family of parallel imaging reconstruction algorithms. Magn Reson Med. 2008;60 (2) :462-7.Abstract
Two strategies are widely used in parallel MRI to reconstruct subsampled multicoil image data. SENSE and related methods employ explicit receiver coil spatial response estimates to reconstruct an image. In contrast, coil-by-coil methods such as GRAPPA leverage correlations among the acquired multicoil data to reconstruct missing k-space lines. In self-referenced scenarios, both methods employ Nyquist-rate low-frequency k-space data to identify the reconstruction parameters. Because GRAPPA does not require explicit coil sensitivities estimates, it needs considerably fewer autocalibration signals than SENSE. However, SENSE methods allow greater opportunity to control reconstruction quality though regularization and thus may outperform GRAPPA in some imaging scenarios. Here, we employ GRAPPA to improve self-referenced coil sensitivity estimation in SENSE and related methods using very few auto-calibration signals. This enables one to leverage each methods' inherent strength and produce high quality self-referenced SENSE reconstructions.
Poynton C, Jenkinson M, Whalen S, Golby AJ, Wells W. Fieldmap-free retrospective registration and distortion correction for EPI-based functional imaging. Med Image Comput Comput Assist Interv. 2008;11 (Pt 2) :271-9.Abstract
We describe a method for correcting the distortions present in echo planar images (EPI) and registering the EPI to structural MRI. A fieldmap is predicted from an air / tissue segmentation of the MRI using a perturbation method and subsequently used to unwarp the EPI data. Shim and other missing parameters are estimated by registration. We obtain results that are similar to those obtained using fieldmaps, however neither fieldmaps, nor knowledge of shim coefficients is required.
Tricoche X, Kindlmann G, Westin C-F. Invariant crease lines for topological and structural analysis of tensor fields. IEEE Trans Vis Comput Graph. 2008;14 (6) :1627-34.Abstract
We introduce a versatile framework for characterizing and extracting salient structures in three-dimensional symmetric second-order tensor fields. The key insight is that degenerate lines in tensor fields, as defined by the standard topological approach, are exactly crease (ridge and valley) lines of a particular tensor invariant called mode. This reformulation allows us to apply well-studied approaches from scientific visualization or computer vision to the extraction of topological lines in tensor fields. More generally, this main result suggests that other tensor invariants, such as anisotropy measures like fractional anisotropy (FA), can be used in the same framework in lieu of mode to identify important structural properties in tensor fields. Our implementation addresses the specific challenge posed by the non-linearity of the considered scalar measures and by the smoothness requirement of the crease manifold computation. We use a combination of smooth reconstruction kernels and adaptive refinement strategy that automatically adjust the resolution of the analysis to the spatial variation of the considered quantities. Together, these improvements allow for the robust application of existing ridge line extraction algorithms in the tensor context of our problem. Results are proposed for a diffusion tensor MRI dataset, and for a benchmark stress tensor field used in engineering research.
Tokuda J, Fischer GS, Csoma C, Dimaio SP, Gobbi DG, Fichtinger G, Tempany CM, Hata N. Software strategy for robotic transperineal prostate therapy in closed-bore MRI. Med Image Comput Comput Assist Interv. 2008;11 (Pt 2) :701-9.Abstract
A software strategy to provide intuitive navigation for MRI-guided robotic transperineal prostate therapy is presented. In the system, the robot control unit, the MRI scanner, and open-source navigation software are connected to one another via Ethernet to exchange commands, coordinates, and images. Six states of the system called "workphases" are defined based on the clinical scenario to synchronize behaviors of all components. The wizard-style user interface allows easy following of the clinical workflow. On top of this framework, the software provides features for intuitive needle guidance: interactive target planning; 3D image visualization with current needle position; treatment monitoring through real-time MRI. These features are supported by calibration of robot and image coordinates by the fiducial-based registration. The performance test shows that the registration error of the system was 2.6 mm in the prostate area, and it displayed real-time 2D image 1.7 s after the completion of image acquisition.
Maier SE, Mulkern RV. Biexponential Analysis of Diffusion Related Signal Decay in Normal Human Cortical and Deep Gray Matter. Magn Reson Imaging. 2008;26 (7) :897-904.Abstract

Diffusion imaging with high-b factors, high spatial resolution and cerebrospinal fluid signal suppression was performed in order to characterize the biexponential nature of the diffusion-related signal decay with b-factor in normal cortical gray and deep gray matter (GM). Integration of inversion pulses with a line scan diffusion imaging sequence resulted in 91% cerebrospinal fluid signal suppression, permitting accurate measurement of the fast diffusion coefficient in cortical GM (1.142+/-0.106 microm2/ms) and revealing a marked similarity with that found in frontal white matter (WM) (1.155+/-0.046 microm2/ms). The reversal of contrast between GM and WM at low vs high b-factors is shown to be due to a significantly faster slow diffusion coefficient in cortical GM (0.338+/-0.027 microm2/ms) than in frontal WM (0.125+/-0.014 microm2/ms). The same characteristic diffusion differences between GM and WM are observed in other brain tissue structures. The relative component size showed nonsignificant differences among all tissues investigated. Cellular architecture in GM and WM are fundamentally different and may explain the two- to threefold higher slow diffusion coefficient in GM.

Xiao Z, Hoge WS, Mulkern RV, Zhao L, Hu G, Kyriakos WE. Comparison of Parallel MRI Reconstruction Methods for Accelerated 3D Fast Spin-echo Imaging. Magn Reson Med. 2008;60 (3) :650-60.Abstract

Parallel MRI (pMRI) achieves imaging acceleration by partially substituting gradient-encoding steps with spatial information contained in the component coils of the acquisition array. Variable-density subsampling in pMRI was previously shown to yield improved two-dimensional (2D) imaging in comparison to uniform subsampling, but has yet to be used routinely in clinical practice. In an effort to reduce acquisition time for 3D fast spin-echo (3D-FSE) sequences, this work explores a specific nonuniform sampling scheme for 3D imaging, subsampling along two phase-encoding (PE) directions on a rectilinear grid. We use two reconstruction methods-2D-GRAPPA-Operator and 2D-SPACE RIP-and present a comparison between them. We show that high-quality images can be reconstructed using both techniques. To evaluate the proposed sampling method and reconstruction schemes, results via simulation, phantom study, and in vivo 3D human data are shown. We find that fewer artifacts can be seen in the 2D-SPACE RIP reconstructions than in 2D-GRAPPA-Operator reconstructions, with comparable reconstruction times.

Archip N, Clatz O, Whalen S, Dimaio SP, Black PM, Jolesz FA, Golby AJ, Warfield SK. Compensation of geometric distortion effects on intraoperative magnetic resonance imaging for enhanced visualization in image-guided neurosurgery. Neurosurgery. 2008;62 (3 Suppl 1) :209-15; discussion 215-6.Abstract

OBJECTIVE: Preoperative magnetic resonance imaging (MRI), functional MRI, diffusion tensor MRI, magnetic resonance spectroscopy, and positron-emission tomographic scans may be aligned to intraoperative MRI to enhance visualization and navigation during image-guided neurosurgery. However, several effects (both machine- and patient-induced distortions) lead to significant geometric distortion of intraoperative MRI. Therefore, a precise alignment of these image modalities requires correction of the geometric distortion. We propose and evaluate a novel method to compensate for the geometric distortion of intraoperative 0.5-T MRI in image-guided neurosurgery. METHODS: In this initial pilot study, 11 neurosurgical procedures were prospectively enrolled. The scheme used to correct the geometric distortion is based on a nonrigid registration algorithm introduced by our group. This registration scheme uses image features to establish correspondence between images. It estimates a smooth geometric distortion compensation field by regularizing the displacements estimated at the correspondences. A patient-specific linear elastic material model is used to achieve the regularization. The geometry of intraoperative images (0.5 T) is changed so that the images match the preoperative MRI scans (3 T). RESULTS: We compared the alignment between preoperative and intraoperative imaging using 1) only rigid registration without correction of the geometric distortion, and 2) rigid registration and compensation for the geometric distortion. We evaluated the success of the geometric distortion correction algorithm by measuring the Hausdorff distance between boundaries in the 3-T and 0.5-T MRIs after rigid registration alone and with the addition of geometric distortion correction of the 0.5-T MRI. Overall, the mean magnitude of the geometric distortion measured on the intraoperative images is 10.3 mm with a minimum of 2.91 mm and a maximum of 21.5 mm. The measured accuracy of the geometric distortion compensation algorithm is 1.93 mm. There is a statistically significant difference between the accuracy of the alignment of preoperative and intraoperative images, both with and without the correction of geometric distortion (P < 0.001). CONCLUSION: The major contributions of this study are 1) identification of geometric distortion of intraoperative images relative to preoperative images, 2) measurement of the geometric distortion, 3) application of nonrigid registration to compensate for geometric distortion during neurosurgery, 4) measurement of residual distortion after geometric distortion correction, and 5) phantom study to quantify geometric distortion.

McDannold N, Tempany CM, Jolesz FA, Hynynen K. Evaluation of Referenceless Thermometry in MRI-guided Focused Ultrasound Surgery of Uterine Fibroids. J Magn Reson Imaging. 2008;28 (4) :1026-32.Abstract

PURPOSE: To clinically assess a previously described method (Rieke, Magn Reson Med 2004) to produce more motion-robust MRI-based temperature images using data acquired during MRI-guided focused ultrasound surgery (MRgFUS) of uterine fibroids. MATERIALS AND METHODS: The method ("referenceless thermometry") uses surface fitting in nonheated regions of individual phase images to extrapolate and then remove background phase variations that are unrelated to temperature changes. We tested this method using images from 100 sonications selected from 33 patient MRgFUS treatments. Temperature measurements and thermal dose contours estimated with the referenceless method were compared with those produced with the standard phase-difference technique. Fitting accuracy and noise level were also measured. RESULTS: In 92/100 sonications, the difference between the two measurements was less than 3 degrees C. The average difference in the measurements was 1.5 +/- 1.4 degrees C. Small motion artifacts were observed in the phase-difference imaging when the difference was greater than 3 degrees C. The method failed in two cases. The mean absolute error in the surface fit in baseline images corresponded to a temperature error of 0.8 +/- 1.4 degrees C. The noise level was approximately 40% lower than the phase-difference method. Thermal dose contours calculated from the two methods agreed well on average. CONCLUSION: Based on the small error when compared with the standard technique, this method appears to be adequate for temperature monitoring of MRgFUS in uterine fibroids and may prove useful for monitoring temperature changes in moving organs.

Tie Y, Whalen S, Suarez RO, Golby AJ. Group Independent Component Analysis of Language fMRI from Word Generation Tasks. Neuroimage. 2008;42 (3) :1214-25.Abstract

Language fMRI has been used to study brain regions involved in language processing and has been applied to pre-surgical language mapping. However, in order to provide clinicians with optimal information, the sensitivity and specificity of language fMRI needs to be improved. Type II error of failing to reach statistical significance when the language activations are genuinely present may be particularly relevant to pre-surgical planning, by falsely indicating low surgical risk in areas where no activations are shown. Furthermore, since the execution of language paradigms involves cognitive processes other than language function per se, the conventional general linear model (GLM) method may identify non-language-specific activations. In this study, we assessed an exploratory approach, independent component analysis (ICA), as a potential complementary method to the inferential GLM method in language mapping applications. We specifically investigated whether this approach might reduce type II error as well as generate more language-specific maps. Fourteen right-handed healthy subjects were studied with fMRI during two word generation tasks. A similarity analysis across tasks was proposed to select components of interest. Union analysis was performed on the language-specific components to increase sensitivity, and conjunction analysis was performed to identify language areas more likely to be essential. Compared with GLM, ICA identified more activated voxels in the putative language areas, and signals from other sources were isolated into different components. Encouraging results from one brain tumor patient are also presented. ICA may be used as a complementary tool to GLM in improving pre-surgical language mapping.

Maddah M, Zöllei L, Grimson EWL, Westin C-F, Wells WM. A Mathematical Framework for Incorporating Anatomical Knowledge in DT-MRI Analysis. Proc IEEE Int Symp Biomed Imaging. 2008;4543943 :105-8.Abstract

We propose a Bayesian approach to incorporate anatomical information in the clustering of fiber trajectories. An expectation-maximization (EM) algorithm is used to cluster the trajectories, in which an atlas serves as the prior on the labels. The atlas guides the clustering algorithm and makes the resulting bundles anatomically meaningful. In addition, it provides the seed points for the tractography and initial settings of the EM algorithm. The proposed approach provides a robust and automated tool for tract-oriented analysis both in a single subject and over a population.

Fennessy FM, Tuncali K, Morrison PR, Tempany CM. MR imaging-guided interventions in the genitourinary tract: an evolving concept. Radiol Clin North Am. 2008;46 (1) :149-66.Abstract

MR imaging-guided interventions are well established in routine patient care in many parts of the world. There are many approaches, depending on magnet design and clinical need, based on MR imaging providing excellent inherent tissue contrast without ionizing radiation risk for patients. MR imaging-guided minimally invasive therapeutic procedures have advantages over conventional surgical procedures. In the genitourinary tract, MR imaging guidance has a role in tumor detection, localization, and staging and can provide accurate image guidance for minimally invasive procedures. The advent of molecular and metabolic imaging and use of higher strength magnets likely will improve diagnostic accuracy and allow targeted therapy to maximize disease control and minimize side effects.

Tempany CM, Straus S, Hata N, Haker S. MR-guided prostate interventions. J Magn Reson Imaging. 2008;27 (2) :356-67.Abstract

In this article the current issues of diagnosis and detection of prostate cancer are reviewed. The limitations for current techniques are highlighted and some possible solutions with MR imaging and MR-guided biopsy approaches are reviewed. There are several different biopsy approaches under investigation. These include transperineal open magnet approaches to closed-bore 1.5T transrectal biopsies. The imaging, image processing, and tracking methods are also discussed. In the arena of therapy, MR guidance has been used in conjunction with radiation methods, either brachytherapy or external delivery. The principles of the radiation treatment, the toxicities, and use of images are outlined. The future role of imaging and image-guided interventions lie with providing a noninvasive surrogate for cancer surveillance or monitoring treatment response. The shift to minimally invasive focal therapies has already begun and will be very exciting when MR-guided focused ultrasound surgery reaches its full potential.

Fischer GS, Iordachita I, Csoma C, Tokuda J, Mewes PW, Tempany CM, Hata N, Fichtinger G. Pneumatically Operated MRI-Compatible Needle Placement Robot for Prostate Interventions. IEEE Int Conf Robot Autom. 2008;2008 :2489-95.Abstract

Magnetic Resonance Imaging (MRI) has potential to be a superior medical imaging modality for guiding and monitoring prostatic interventions. The strong magnetic field prevents the use of conventional mechatronics and the confined physical space makes it extremely challenging to access the patient. We have designed a robotic assistant system that overcomes these difficulties and promises safe and reliable intra-prostatic needle placement inside closed high-field MRI scanners. The robot performs needle insertion under real-time 3T MR image guidance; workspace requirements, MR compatibility, and workflow have been evaluated on phantoms. The paper explains the robot mechanism and controller design and presents results of preliminary evaluation of the system.

Lénárd ZM, McDannold N, Fennessy FM, Stewart EA, Jolesz FA, Hynynen K, Tempany CM. Uterine Leiomyomas: MR Imaging-guided Focused Ultrasound Surgery-Imaging Predictors of Success. Radiology. 2008;249 (1) :187-94.Abstract

PURPOSE: To retrospectively assess the magnetic resonance (MR) imaging predictors of success at reducing uterine leiomyoma volume and achieving patient symptom relief 12 months after MR imaging-guided focused ultrasound surgery. MATERIALS AND METHODS: This single-center retrospective analysis of 71 symptomatic fibroids in 66 women was approved by the institutional review board and was HIPAA-compliant. Patients were treated with MR imaging-guided focused ultrasound surgery. The volume of treated fibroid and nonperfused volume (NPV) were calculated with software, while symptom outcome was assessed with a symptom severity score (SSS). Fibroids were classified as hyperintense or hypointense relative to skeletal muscle on pretreatment T2-weighted MR images. RESULTS: Baseline volume of treated fibroids was 255.5 cm(3) +/- 201.7 (standard deviation), and baseline SSS was 61.5 +/- 14.9. Both pretreatment fibroid signal intensity (SI) and posttreatment NPV predicted 12-month volume reduction independently: Fibroids with an NPV of at least 20% or with low SI both showed significantly larger volume reduction (17.0% +/- 13.0 and 17.2% +/- 20.1, respectively) than fibroids with an NPV less than 20% or with high SI (10.7% +/- 18.2 and no significant change, respectively). Patients whose fibroids demonstrated an NPV of at least 20% also experienced a larger decrease in SSS than did patients with fibroids with an NPV less than 20% (50.1% +/- 19.8 vs 32.6% +/- 29.9). CONCLUSION: Fibroids with low SI on pretreatment T2-weighted MR images were more likely to shrink than were ones with high SI. The larger the NPV immediately after treatment, the greater the volume reduction and symptom relief were. These findings may help both in selecting appropriate patients for MR-guided focused ultrasound surgery and in predicting patient outcome.