High-Performance Soft-Tissue Imaging in Extremity Cone-Beam CT.

PURPOSE Clinical performance studies of an extremity cone-beam CT (CBCT) system indicate excellent bone visualization, but point to the need for improvement of soft-tissue image quality. To this end, a rapid Monte Carlo (MC) scatter correction is proposed, and Penalized Likelihood (PL) reconstruction is evaluated for noise management. METHODS The accelerated MC scatter correction involved fast MC simulation with low number of photons implemented on a GPU (107 photons/sec), followed by Gaussian kernel smoothing in the detector plane and across projection angles. PL reconstructions were investigated for reduction of imaging dose for projections acquired at ~2 mGy. RESULTS The rapid scatter estimation yielded root-mean-squared-errors of scatter projections of ~15% of peak scatter intensity for 5·106 photons/projection (runtime ~0.5 sec/projection) and 25% improvement in fat-muscle contrast in reconstructions of a cadaveric knee. PL reconstruction largely restored soft-tissue visualization at 2 mGy dose to that of 10 mGy FBP image. CONCLUSION The combination of rapid (5-10 minutes/scan) MC-based, patient-specific scatter correction and PL reconstruction offers an important means to overcome the current limitations of extremity CBCT in soft-tissue imaging.