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  1. Article ; Online: Phantom and methodology for comparison of small lesion detectability in PET.

    Wollenweber, Scott D / Alessio, Adam M / Kinahan, Paul E

    Medical physics

    2023  Volume 50, Issue 5, Page(s) 2998–3007

    Abstract: Purpose: The main goal of this work is to describe a phantom design, data acquisition and data analysis methodology enabling comparison of small lesion detectability between PET imaging systems and reconstruction algorithms. Several methods are ... ...

    Abstract Purpose: The main goal of this work is to describe a phantom design, data acquisition and data analysis methodology enabling comparison of small lesion detectability between PET imaging systems and reconstruction algorithms. Several methods are currently available to characterize intrinsic and image quality performance, but none focus exclusively on small lesion detectability.
    Methods: We previously developed a small-lesion detection phantom and described initial results using a head-size phantom. Unlike most fillable nuclear medicine phantoms, this phantom offers a semi-realistic heterogenous background and wall-less contrast features. In this work, the methodology is extended to include (a) the use of both head- and body-sized phantoms and (b) a multi-scan data collection and analysis method. We present an example use case of the phantom and detection estimation methodology, comparing the small-lesion detection performance across four commercial PET/CT systems.
    Results: Repeat acquisitions of the phantom enabled estimation of model observer performance and surrogates of detectability. As anticipated, estimated detectability increased with the square root of system sensitivity and TOF offered marked improvement in detectability, especially for the body sized object. The proposed approach characterizing detectability at different times during the decay of the phantom enabled comparison of small lesion detectability at matched activity concentrations (and scan durations) across different scanners.
    Conclusion: The proposed approach offers a reproducible tool for evaluating relative tradeoffs of system performance on small lesion detectability.
    MeSH term(s) Positron Emission Tomography Computed Tomography ; Tomography, X-Ray Computed ; Algorithms ; Phantoms, Imaging ; Positron-Emission Tomography/methods ; Image Processing, Computer-Assisted/methods
    Language English
    Publishing date 2023-01-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 188780-4
    ISSN 2473-4209 ; 0094-2405
    ISSN (online) 2473-4209
    ISSN 0094-2405
    DOI 10.1002/mp.16187
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  2. Article ; Online: Multi-Objective Evolutionary Algorithm for PET Image Reconstruction: Concept.

    Abouhawwash, Mohamed / Alessio, Adam M

    IEEE transactions on medical imaging

    2021  Volume 40, Issue 8, Page(s) 2142–2151

    Abstract: In many diagnostic imaging settings, including positron emission tomography (PET), images are typically used for multiple tasks such as detecting disease and quantifying disease. Unlike conventional image reconstruction that optimizes a single objective, ...

    Abstract In many diagnostic imaging settings, including positron emission tomography (PET), images are typically used for multiple tasks such as detecting disease and quantifying disease. Unlike conventional image reconstruction that optimizes a single objective, this work proposes a multi-objective optimization algorithm for PET image reconstruction to identify a set of images that are optimal for more than one task. This work is reliant on a genetic algorithm to evolve a set of solutions that satisfies two distinct objectives. In this paper, we defined the objectives as the commonly used Poisson log-likelihood function, typically reflective of quantitative accuracy, and a variant of the generalized scan-statistic model, to reflect detection performance. The genetic algorithm uses new mutation and crossover operations at each iteration. After each iteration, the child population is selected with non-dominated sorting to identify the set of solutions along the dominant front or fronts. After multiple iterations, these fronts approach a single non-dominated optimal front, defined as the set of PET images for which none the objective function values can be improved without reducing the opposing objective function. This method was applied to simulated 2D PET data of the heart and liver with hot features. We compared this approach to conventional, single-objective approaches for trading off performance: maximum likelihood estimation with increasing explicit regularization and maximum a posteriori estimation with varying penalty strength. Results demonstrate that the proposed method generates solutions with comparable to improved objective function values compared to the conventional approaches for trading off performance amongst different tasks. In addition, this approach identifies a diverse set of solutions in the multi-objective function space which can be challenging to estimate with single-objective formulations.
    MeSH term(s) Algorithms ; Child ; Humans ; Image Processing, Computer-Assisted ; Likelihood Functions ; Models, Statistical ; Phantoms, Imaging ; Positron-Emission Tomography
    Language English
    Publishing date 2021-07-30
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 622531-7
    ISSN 1558-254X ; 0278-0062
    ISSN (online) 1558-254X
    ISSN 0278-0062
    DOI 10.1109/TMI.2021.3073243
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  3. Article ; Online: Use of Dual-Energy CT for Quantification of Essential Trace Metals (Iron, Copper, and Zinc): Proof of Concept.

    Toia, Giuseppe V / Alessio, Adam M / Mileto, Achille

    AJR. American journal of roentgenology

    2020  Volume 216, Issue 2, Page(s) 534–541

    Abstract: OBJECTIVE. ...

    Abstract OBJECTIVE.
    MeSH term(s) Copper/analysis ; Humans ; Iron/analysis ; Phantoms, Imaging ; Proof of Concept Study ; Tomography, X-Ray Computed ; Trace Elements/analysis ; Zinc/analysis
    Chemical Substances Trace Elements ; Copper (789U1901C5) ; Iron (E1UOL152H7) ; Zinc (J41CSQ7QDS)
    Language English
    Publishing date 2020-11-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 82076-3
    ISSN 1546-3141 ; 0361-803X ; 0092-5381
    ISSN (online) 1546-3141
    ISSN 0361-803X ; 0092-5381
    DOI 10.2214/AJR.20.23138
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  4. Article ; Online: Correction to: Ovarian torsion: developing a machine-learned algorithm for diagnosis.

    Otjen, Jeffrey P / Stanescu, A Luana / Alessio, Adam M / Parisi, Marguerite T

    Pediatric radiology

    2020  Volume 50, Issue 5, Page(s) 757–758

    Abstract: The original version of this paper included errors in Fig. 3. The corrected Fig. 3 is presented here. ...

    Abstract The original version of this paper included errors in Fig. 3. The corrected Fig. 3 is presented here.
    Language English
    Publishing date 2020-04-17
    Publishing country Germany
    Document type Published Erratum
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-020-04665-6
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  5. Article ; Online: Ovarian torsion: developing a machine-learned algorithm for diagnosis.

    Otjen, Jeffrey P / Stanescu, A Luana / Alessio, Adam M / Parisi, Marguerite T

    Pediatric radiology

    2020  Volume 50, Issue 5, Page(s) 706–714

    Abstract: Background: Ovarian torsion is a common concern in girls presenting to emergency care with pelvic or abdominal pain. The diagnosis is challenging to make accurately and quickly, relying on a combination of physical exam, history and radiologic ... ...

    Abstract Background: Ovarian torsion is a common concern in girls presenting to emergency care with pelvic or abdominal pain. The diagnosis is challenging to make accurately and quickly, relying on a combination of physical exam, history and radiologic evaluation. Failure to establish the diagnosis in a timely fashion can result in irreversible ovarian ischemia with implications for future fertility. Ultrasound is the mainstay of evaluation for ovarian torsion in the pediatric population. However, even with a high index of suspicion, imaging features are not pathognomonic.
    Objective: We sought to develop an algorithm to aid radiologists in diagnosing ovarian torsion using machine learning from sonographic features and to evaluate the frequency of each sonographic element.
    Materials and methods: All pediatric patients treated for ovarian torsion at a quaternary pediatric hospital over an 11-year period were identified by both an internal radiology database and hospital-based International Statistical Classification of Diseases and Related Health Problems (ICD) code review. Inclusion criteria were surgical confirmation of ovarian torsion and available imaging. Patients were excluded if the diagnosis could not be confirmed, no imaging was available for review, the ovary was not identified by imaging, or torsion involved other adnexal structures but spared the ovary. Data collection included: patient age; laterality of torsion; bilateral ovarian volumes; torsed ovarian position, i.e. whether medialized with respect to the mid-uterine line; presence or absence of Doppler signal within the torsed ovary; visualization of peripheral follicles; and presence of a mass or cyst, and free peritoneal fluid. Subsequently, we evaluated a non-torsed control cohort from April 2015 to May 2016. This cohort consisted of sequential girls and young adults presenting to the emergency department with abdominopelvic symptoms concerning for ovarian torsion but who were ultimately diagnosed otherwise. These features were then fed into supervised machine learning systems to identify and develop viable decision algorithms. We divided data into training and validation sets and assessed algorithm performance using sub-sets of the validation set.
    Results: We identified 119 torsion-confirmed cases and 331 torsion-absent cases. Of the torsion-confirmed cases, significant imaging differences were evident for girls younger than 1 year; these girls were then excluded from analysis, and 99 pediatric patients older than 1 year were included in our study. Among these 99, all variables demonstrated statistically significant differences between the torsion-confirmed and torsion-absent groups with P-values <0.005. Using any single variable to identify torsion provided only modest detection performance, with areas under the curve (AUC) for medialization, peripheral follicles, and absence of Doppler flow of 0.76±0.16, 0.66±0.14 and 0.82±0.14, respectively. The best decision tree using a combination of variables yielded an AUC of 0.96±0.07 and required knowledge of the presence of intra-ovarian flow, peripheral follicles, the volume of both ovaries, and the presence of cysts or masses.
    Conclusion: Based on the largest series of pediatric ovarian torsion in the literature to date, we quantified sonographic features and used machine learning to create an algorithm to identify the presence of ovarian torsion - an algorithm that performs better than simple approaches relying on single features. Although complex combinations using multiple-interaction models provide slightly better performance, a clinically pragmatic decision tree can be employed to detect torsion, providing sensitivity levels of 95±14% and specificity of 92±2%.
    MeSH term(s) Adolescent ; Adult ; Algorithms ; Child ; Child, Preschool ; Cohort Studies ; Female ; Humans ; Image Interpretation, Computer-Assisted/methods ; Infant ; Infant, Newborn ; Machine Learning ; Ovarian Torsion/diagnostic imaging ; Ovary/diagnostic imaging ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography/methods ; Young Adult
    Language English
    Publishing date 2020-01-22
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-019-04601-3
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  6. Article ; Online: Quantitative myocardial perfusion from static cardiac and dynamic arterial CT.

    Bindschadler, Michael / Branch, Kelley R / Alessio, Adam M

    Physics in medicine and biology

    2018  Volume 63, Issue 10, Page(s) 105020

    Abstract: Quantitative myocardial blood flow (MBF) estimation by dynamic contrast enhanced cardiac computed tomography (CT) requires multi-frame acquisition of contrast transit through the blood pool and myocardium to inform the arterial input and tissue response ... ...

    Abstract Quantitative myocardial blood flow (MBF) estimation by dynamic contrast enhanced cardiac computed tomography (CT) requires multi-frame acquisition of contrast transit through the blood pool and myocardium to inform the arterial input and tissue response functions. Both the input and the tissue response functions for the entire myocardium are sampled with each acquisition. However, the long breath holds and frequent sampling can result in significant motion artifacts and relatively high radiation dose. To address these limitations, we propose and evaluate a new static cardiac and dynamic arterial (SCDA) quantitative MBF approach where (1) the input function is well sampled using either prediction from pre-scan timing bolus data or measured from dynamic thin slice 'bolus tracking' acquisitions, and (2) the whole-heart tissue response data is limited to one contrast enhanced CT acquisition. A perfusion model uses the dynamic arterial input function to generate a family of possible myocardial contrast enhancement curves corresponding to a range of MBF values. Combined with the timing of the single whole-heart acquisition, these curves generate a lookup table relating myocardial contrast enhancement to quantitative MBF. We tested the SCDA approach in 28 patients that underwent a full dynamic CT protocol both at rest and vasodilator stress conditions. Using measured input function plus single (enhanced CT only) or plus double (enhanced and contrast free baseline CT's) myocardial acquisitions yielded MBF estimates with root mean square (RMS) error of 1.2 ml/min/g and 0.35 ml/min/g, and radiation dose reductions of 90% and 83%, respectively. The prediction of the input function based on timing bolus data and the static acquisition had an RMS error compared to the measured input function of 26.0% which led to MBF estimation errors greater than threefold higher than using the measured input function. SCDA presents a new, simplified approach for quantitative perfusion imaging with an acquisition strategy offering substantial radiation dose and computational complexity savings over dynamic CT.
    MeSH term(s) Aged ; Arteries/diagnostic imaging ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/physiopathology ; Coronary Circulation ; Female ; Humans ; Image Processing, Computer-Assisted/methods ; Male ; Myocardial Perfusion Imaging/methods ; Myocardium/pathology ; Tomography, X-Ray Computed/methods
    Language English
    Publishing date 2018-05-21
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 208857-5
    ISSN 1361-6560 ; 0031-9155
    ISSN (online) 1361-6560
    ISSN 0031-9155
    DOI 10.1088/1361-6560/aac0bd
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  7. Article ; Online: Sharing and Selling Images: Ethical and Regulatory Considerations for Radiologists.

    Banja, John / Rousselle, Rebecca / Duszak, Richard / Safdar, Nabile / Alessio, Adam M

    Journal of the American College of Radiology : JACR

    2020  Volume 18, Issue 2, Page(s) 298–304

    Abstract: Opportunities to share or sell images are common in radiology. But because these images typically originate as protected health information, their use admits a host of ethical and regulatory considerations. This article discusses four scenarios that ... ...

    Abstract Opportunities to share or sell images are common in radiology. But because these images typically originate as protected health information, their use admits a host of ethical and regulatory considerations. This article discusses four scenarios that reflect data sharing or selling arrangements in radiology, especially as they might occur in "big data" systems or applications. The objective of this article is to acquaint radiologists with a variety of regulatory standards and ethical perspectives that pertain to certain data use agreements, such that the attitudes and practices of data holders and their sharers or purchasers can withstand ethical or regulatory scrutiny and not invite undesirable outcomes.
    MeSH term(s) Artificial Intelligence ; Attitude ; Humans ; Information Dissemination ; Radiologists ; Radiology
    Language English
    Publishing date 2020-09-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2274861-1
    ISSN 1558-349X ; 1546-1440
    ISSN (online) 1558-349X
    ISSN 1546-1440
    DOI 10.1016/j.jacr.2020.08.003
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  8. Article ; Online: Patient factors and outcomes associated with discordance between quantitative and qualitative cardiac PET ischemia information.

    Zigray, Haley / Elman, Shana / Cheng, Richard K / Li, Song / Lee, James / Soine, Laurie / Caldwell, James / Alessio, Adam M

    PloS one

    2021  Volume 16, Issue 3, Page(s) e0246149

    Abstract: Background: Cardiac PET can provide quantitative myocardial blood flow (MBF) estimates. The frequency and clinical significance of discordant ischemia information between quantitative and qualitative parameters is unclear.: Methods: This ... ...

    Abstract Background: Cardiac PET can provide quantitative myocardial blood flow (MBF) estimates. The frequency and clinical significance of discordant ischemia information between quantitative and qualitative parameters is unclear.
    Methods: This retrospective, cohort study analyzed 256 Rb-82 stress-rest PET/CT studies. Global MBF and myocardial flow reserve (MFR) were estimated in absolute units for quantitative results and sum-stress and difference scores were used for qualitative results. Four groups of patients were evaluated based on a specific definition of concordant and discordant quantitative and qualitative results.
    Results: 31% of cases demonstrated discordance. Factors associated with microvascular disease were more common in the groups with abnormal quantitative results, regardless of the qualitative findings. Patients with concordant abnormal results had a significantly increased risk of myocardial infarction, heart failure, percutaneous intervention, and all-cause-mortality at 1 year compared to patients with concordant normal results. In patients with discordant results of abnormal quantitative and normal qualitative findings, there was a higher prevalence of heart failure than in controls (12.5% vs 0%, p = 0.01).
    Conclusions: Discordance in qualitative and quantitative ischemia measures from PET is common, and further study is needed to clarify its prognostic implications. Moreover, quantitative estimation of MBF and MFR appears to add value to qualitative visual interpretation by supporting qualitative findings when results are concordant. Abnormal quantitative findings, regardless of concordance or discordance with qualitative findings, occurred in patients with risk factors associated with diffuse disease and with increased risk of heart failure admission.
    MeSH term(s) Aged ; Aged, 80 and over ; Disease Progression ; Female ; Fractional Flow Reserve, Myocardial ; Humans ; Male ; Middle Aged ; Myocardial Ischemia/diagnostic imaging ; Myocardial Perfusion Imaging/methods ; Positron Emission Tomography Computed Tomography ; Prognosis ; Radiographic Image Interpretation, Computer-Assisted/methods ; Retrospective Studies ; Rubidium Radioisotopes/administration & dosage
    Chemical Substances Rubidium Radioisotopes ; Rubidium-82 (9K730EL8KU)
    Language English
    Publishing date 2021-03-03
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0246149
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  9. Article ; Online: A phantom design for assessment of detectability in PET imaging.

    Wollenweber, Scott D / Alessio, Adam M / Kinahan, Paul E

    Medical physics

    2016  Volume 43, Issue 9, Page(s) 5051

    Abstract: Purpose: The primary clinical role of positron emission tomography (PET) imaging is the detection of anomalous regions of (18)F-FDG uptake, which are often indicative of malignant lesions. The goal of this work was to create a task-configurable fillable ...

    Abstract Purpose: The primary clinical role of positron emission tomography (PET) imaging is the detection of anomalous regions of (18)F-FDG uptake, which are often indicative of malignant lesions. The goal of this work was to create a task-configurable fillable phantom for realistic measurements of detectability in PET imaging. Design goals included simplicity, adjustable feature size, realistic size and contrast levels, and inclusion of a lumpy (i.e., heterogeneous) background.
    Methods: The detection targets were hollow 3D-printed dodecahedral nylon features. The exostructure sphere-like features created voids in a background of small, solid non-porous plastic (acrylic) spheres inside a fillable tank. The features filled at full concentration while the background concentration was reduced due to filling only between the solid spheres.
    Results: Multiple iterations of feature size and phantom construction were used to determine a configuration at the limit of detectability for a PET/CT system. A full-scale design used a 20 cm uniform cylinder (head-size) filled with a fixed pattern of features at a contrast of approximately 3:1. Known signal-present and signal-absent PET sub-images were extracted from multiple scans of the same phantom and with detectability in a challenging (i.e., useful) range. These images enabled calculation and comparison of the quantitative observer detectability metrics between scanner designs and image reconstruction methods. The phantom design has several advantages including filling simplicity, wall-less contrast features, the control of the detectability range via feature size, and a clinically realistic lumpy background.
    Conclusions: This phantom provides a practical method for testing and comparison of lesion detectability as a function of imaging system, acquisition parameters, and image reconstruction methods and parameters.
    MeSH term(s) Equipment Design ; Fluorodeoxyglucose F18 ; Image Processing, Computer-Assisted ; Phantoms, Imaging ; Positron-Emission Tomography/instrumentation
    Chemical Substances Fluorodeoxyglucose F18 (0Z5B2CJX4D)
    Language English
    Publishing date 2016-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 188780-4
    ISSN 2473-4209 ; 0094-2405
    ISSN (online) 2473-4209
    ISSN 0094-2405
    DOI 10.1118/1.4960365
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  10. Article ; Online: Erratum to: How to reconstruct dynamic cardiac PET data?

    Slomka, Piotr J / Alessio, Adam M / Germano, Guido

    Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

    2016  Volume 24, Issue 1, Page(s) 294

    Language English
    Publishing date 2016-08-17
    Publishing country United States
    Document type Journal Article ; Published Erratum
    ZDB-ID 1212505-2
    ISSN 1532-6551 ; 1071-3581
    ISSN (online) 1532-6551
    ISSN 1071-3581
    DOI 10.1007/s12350-016-0645-6
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