Cardiac CT (CCT) is of vital importance in heart disease diagnosis but is conventionally limited by its complex workflow that requires dedicated phase and bolus monitoring devices [e.g., electrocardiogram (ECG) gating]. Our previous work has demonstrated the possibility of replacing ECG devices with deep learning (DL)-based monitoring of continuously acquired pulsed mode projections (PMPs, i.e., only a few sparsely sampled projections per gantry rotation). In this work, we report the development of a new projection domain DL-based cardiac phase estimation method that uses ensemble learning [i.e., training multiple convolution neural network (CNN) in parallel] to estimate and reduce DL uncertainty. The estimated DL uncertainty information was then used drive an analytical regularizer in a principled time-dependent manner (i.e., stronger regularization when DL uncertainty is higher). Combined with our previous work on PMP-based bolus curve estimation, the proposed method could potentially be used to achieve autonomous cardiac scanning in a robust (i.e., reduced uncertainty) manner without ECG and bolus timing devices.
Cardiac CT plays an important role in diagnosing heart diseases but is conventionally limited by its complex workflow that requires dedicated phase and bolus tracking [e.g., electrocardiogram (ECG) gating]. This work reports initial progress towards robust and autonomous cardiac CT exams through deep learning (DL) analysis of pulsed-mode projections (PMPs). To this end, cardiac phase and its uncertainty were simultaneously estimated using a novel projection domain cardiac phase estimation network (PhaseNet), which utilizes a sliding-window multi-channel feature extraction approach and a long short-term memory (LSTM) block to extract temporal correlation between time-distributed PMPs. Monte-Carlo dropout layers were utilized to predict the uncertainty of deep learning-based cardiac phase prediction. The performance of the proposed phase estimation pipeline was evaluated using accurate physics-based emulated data.
PhaseNet demonstrated improved phase estimation accuracy compared to more standard methods in terms of RMSE (~43% improvement vs. a standard CNN-LSTM; ~17% improvement vs. a multi-channel residual network [ResNet]), achieving accurate phase estimation with <8% RMSE in cardiac phase (phase ranges from 0-100%). These findings suggest that the cardiac phase can be accurately estimated with the proposed projection domain approach. Combined with our previous work on PMP-based bolus curve estimation, the proposed method could potentially be used to achieve autonomous cardiac CT scanning without ECG device or expert-in-the-loop bolus timing.
Cardiac CT exams are some of the most complex CT exams due to the need to carefully time the scan to capture the heart during a quiescent cardiac phase and when the intravenous contrast bolus is at its peak concentration in the left and/or right heart. We are interested in developing a robust and autonomous cardiac CT exam, using deep learning approaches to extract contrast and cardiac phase timing directly from projections. In this paper, we present a new approach to estimate contrast bolus timing directly from a sparse set of CT projections. We present a deep learning approach to estimate contrast agent concentration in left and right sides of the heart directly from a set of projections. We use a virtual imaging framework to generate training and test data, derived from real patient datasets. We finally combine this with a simple analytical approach to decide on the start of the cardiac CT exam.
Cardiac CT exams are some of the most complex CT exams due to need to carefully time the scan to capture the heart during the quiescent cardiac phase and when the contrast bolus is at its peak concentration. We are interested in developing a robust and autonomous cardiac CT protocol, using deep learning approaches to extract contrast timing and cardiac phase timing directly from pulsed projections. In this paper, we present a new approach to generate large amounts of clinically realistic virtual data for training deep learning networks. We propose a five-dimensional cardiac model generated from 4D cardiac coronary CT angiography (CTA) data for synthetic contrast bolus dynamics and patient ECG profiles. We apply deep learning to segment seven heart compartments and simulate intravenous contrast propagation through each compartment to insert contrast bolus. Additional augmentation techniques by randomizing a bolus curve, patient ECG profile, acquisition timing, and patient motion are applied to increase the amount of data that can be generated. We demonstrate good performance of the deep learning segmentation network, examples of simulated bolus curves using a realistic protocol, and good correspondence between virtually generated projections and real projections from patient scans.
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