Vessel-based interactive bolus ROI placement and scan planning using 3D CT surveys.

Abstract

A system (FS) and associated method for facilitating contrast-based tomography. A graphics display generator (GDG) generates a graphical user interface (GUI) graphics display (GD) for display on a display device (DD). The graphics display (GD) may include a visualization of a segmentation within a 3D survey image and a visualization of a slider element indicating a reference position (m-ROI) along the segmentation. The reference position can be used to monitor the presence of contrast relative to a target anatomical feature (TAF) during a contrast-assisted imaging phase. An event handler receives user input and directs the graphics display generator (GDG) to update the graphics display (GD) and slides the slider element along the segmentation, thereby causing the slider to indicate one or more different reference positions.

Description

Technical Field

[0001] The present invention relates to a system, related methods, imaging arrangements, computer program elements, and computer-readable media for facilitating contrast agent-based tomography.

Background Art

[0002] 2D (two-dimensional) projection scout images acquired prior to diagnostic CT (computed tomography) imaging play an important role in assisting clinical engineers (the "user"), such as proper positioning of the patient and achieving optimal image quality.

[0003] In addition to conventional 2D scout views (such as frontal and sagittal planes), it is now possible to acquire 3D (reconstructed) scout images (image volumes) with clinically acceptable doses. These have several advantages over conventional 2D scout views, opening up new possibilities for optimizing the CT workflow that were previously impossible.

[0004] In CT imaging, it is common to perform a 2D scout scan that covers the entire region of interest including the expected "bolus" tracking position. The bolus is the amount of contrast agent such as iodine administered. The contrast agent may be used to enhance the image contrast of anatomical structures of interest that weakly absorb radiation, such as blood vessels in cardiac imaging. Next, the user manually selects the Z position on such a 2D scout, and a corresponding axial image, also called a "locator", is acquired and reconstructed to define (position) the region of interest ("ROI") for bolus tracking or monitoring of bolus arrival. The bolus moves with the blood flow and accumulates in the anatomical structure of interest for a certain period. It is an object that triggers imaging at an appropriate timing to capture a high-contrast image before bolus washout.

[0005] Finding the correct location for the tracking ROI may require multiple locator scans. The ROI captured to track the bolus is positioned within this locator slice, and the arrival of the contrast agent bolus is monitored by repeatedly acquiring this single axial slice. When a threshold for contrast agent induction density is reached within this ROI, a subsequent diagnostic CTA (CT angiography) acquisition is triggered.

[0006] The main drawbacks of conventional 2D survey image-based bolus tracking, or general bolus tracking, are that planning bolus tracking during the scan procedure is complex and heavily dependent on the clinical user's skill and experience. This process is prone to errors. For example, it requires manual intervention by the user, such as manually selecting Z-slice or placing ROIs on acquired locator slices. Human error in locating anatomical structures and placing ROIs on localizer images can lead to the diagnostic CT scan being initiated at an inappropriate time. This can result in reduced image quality, misdiagnosis, unnecessary contrast agent re-administration and re-imaging, and potential side effects for the patient and / or medical staff. Furthermore, the manual localization process is subject to intra- and inter-individual variability. Another drawback is the need to acquire special locator scans, which requires additional time and dose. [Overview of the Initiative] [Problems that the invention aims to solve]

[0007] Therefore, it may be necessary to improve the efficient operation of the imaging device. In particular, it is necessary to ensure that the precise timing for initiating the imaging operation of such an imaging device is established. [Means for solving the problem]

[0008] The object of the present invention is achieved by the subject matter of the independent claims, and further embodiments are incorporated into the dependent claims. It should be noted that the following aspects of the present invention are similarly applicable to related methods, image arrangements, computer program elements, and computer-readable media.

[0009] According to a first aspect of the present invention, A system for facilitating tomography using contrast agents, wherein when the system is in use, An input interface for receiving a 3D survey image volume of at least a portion of a patient, acquired by a tomography device during a preparation phase prior to the contrast-assisted imaging phase, wherein the 3D survey image volume includes segmentation of blood vessels through which the contrast agent will pass during the subsequent contrast-assisted imaging phase. A graphics display generator configured to generate a graphics display of a graphical user interface for display on a display device, wherein the graphics display includes a visualization of the segmentation and a visualization of slider elements indicating reference positions along the segmentation, the reference positions being suitable for monitoring the presence of contrast agent with respect to at least one target anatomical feature in the subsequent contrast-assisted imaging stage, and the graphics display generator An event handler configured to receive user input and instruct the graphics display generator to update the graphics display so that the slider element slides along the segmentation, wherein the slider indicates one or more different reference positions, and the event handler A system is provided that has the following features.

[0010] Segmentation is preferably calculated / derived from 3D survey images. For example, machine learning (deep learning models) may be used.

[0011] In one embodiment of the system, the graphics display generator is operable to adapt the spatial range (e.g., shape, orientation, size) of the slider elements to correspond to and change accordingly to the geometric aspects (e.g., cross-sections) of the segmentation at the different reference positions.

[0012] In this embodiment, the graphics display generator can be operated to lock slider elements in the direction defined by segmentation. This allows the user to define clinically meaningful monitoring locations. The operation is not so "cumbersome," especially since defining precise bolus monitoring can be difficult in stressful situations.

[0013] In this embodiment, the direction is along the center line of the segmentation.

[0014] In the embodiment, the segmentation visualization is configured to clearly represent the wall portions of the vessels. For example, wall portions are highlighted by modulation of color or grayscale values, and rendered with dashed lines, thick lines, different colors against the background and / or within the segmentation. The clear visualization of wall portions may be adjusted to distinguish between calcified and non-calcified portions, or between different levels of calcification. This allows the user to avoid placing monitoring ROIs in calcified or heavily calcified vessel portions, as such portions have been found to be of less usefulness for bolus monitoring purposes. Spectral imaging may be used when recording survey images to more accurately define calcification.

[0015] In the embodiment, the graphics display generator is operable to include in the graphics display i) the distance to at least one target anatomical feature, a) the distance to a reference position of the blood vessel corresponding to the current slider position, and / or b) the distance to one or more anatomical landmarks, and / or ii) information regarding the estimated time of arrival of the contrast agent at the reference position.

[0016] In some embodiments, the system may include an output interface for passing one of one or more reference points selected by the user to the imaging device and for defining one end (referred to as a “scanbox”) of a subset within the image region relating to the projection data collected by the imaging device during the imaging phase.

[0017] In the embodiment, the graphics display generator is operable to generate a graphics display that further includes visualizations of the subset, and the slider element is positioned at one end of the visualization of the subset.

[0018] In an embodiment, the system includes an output interface for instructing the imaging device to acquire a first set of projection data while a contrast agent propagates within a patient, passing one of one or more reference locations selected by the user, and a reconstructor for reconstructing a cross-sectional tracker image in a plane passing through the selected reference location with first image quality based on the projection data.

[0019] In this embodiment, the arrival time is based on hemodynamic modeling.

[0020] In this embodiment, the blood vessel includes at least a portion of the aorta.

[0021] Therefore, the facilitator system provides user interface functionality. Users of the facilitator system can use it in conjunction with a fully automated segmentation system [machine learning (ML) based or otherwise]. While such segmentation systems may in some cases find perfectly satisfactory suggestions for defining appropriate bolus monitoring regions, it is often still beneficial if human clinical users can fine-tune the solutions proposed by such automated segmentation systems. Therefore, the proposed user interface functionality provides an intuitive user input solution, enabling users to quickly and safely perform this fine-tuning task to obtain good results and ultimately find appropriate bolus monitoring regions. In particular, as an example, the proposed interface functionality visualizes results from ML-based solutions, particularly (but not limited to), allowing users to make such fine-tuning changes if they deem it necessary.

[0022] Based on the results above, the proposed interface functionality will enable a more accurate and reliable method for establishing the correct timing for acquiring diagnostic projection data. The reduced likelihood of image recapture will lower radiation exposure for both staff and patients, improve acquisition throughput, and reduce machine wear. Machine wear is a particular concern in X-ray imaging, where certain mechanical components, such as the anode disk, are exposed to large temperature gradients during data acquisition.

[0023] The proposed user functionality strikes a good balance between giving users the freedom to fine-tune the initial position of the monitoring area and providing a set of clinically motivated, useful limitations that offer meaningful guidance. Users, even novice or stressed clinical users, can obtain appropriate results for the m-ROI definition more quickly and safely.

[0024] The proposed user functions can be used in combination with the aforementioned automatic segmentation, but such an automated system is not essential here. Thus, the proposed user functions can be used without such an automatic segmentation system and, instead, can be used, if desired, to review, for example, manually segmented m-ROIs of the same or another user. Use with fully automatic, semi-automatic, or manual segmentation tools is envisioned, but the proposed user interface functions may be particularly useful with fully automatic or semi-automatic segmentation tools.

[0025] In the proposed system, a higher level of interaction is possible in the planning of the bolus-tracking ROI compared to a fully automated system. Thus, what is proposed in the embodiments herein is a 3D CT service-based, vessel-based, interactive bolus ROI placement and scan planning method. The proposed user functions are directed to the placement of bolus monitoring ROIs in 3D service scans. By dealing with 3D service images, the following drawbacks seen when dealing with 2D service image data can be overcome, in contrast to mere 2D service data.

[0026] 2D services have the inherent drawback that the exact 3D distance between the bolus ROI and the target anatomical structure cannot be calculated, and thus the time required for the contrast agent to reach the target anatomical region cannot be estimated. This often results in an increase in the contrast agent dosage and a suboptimal image quality.

[0027] The placement of the bolus ROI during scan planning is a complex task and highly dependent on the clinician's expertise.

[0028] A special locator scan (a single Z-slice) needs to be acquired, which requires additional time and dose to the patient. In a 3D survey, the field of view is already covered by axial slices, so these slices are acquired automatically.

[0029] Human user error in locating anatomical structures and positioning ROIs on localizer images can lead to CT scans being initiated at inappropriate times. This can result in reduced image quality, misdiagnosis, re-acquisition of images, patient re-examination, and unnecessary administration of contrast agents that may have side effects.

[0030] The proposed system provides a user-interactive method for positioning m-ROIs, improving user convenience and allowing users to position m-ROIs according to their preferences.

[0031] The proposed system provides segmentation of the blood vessels through which the bolus is expected to pass. These vessels may be, for example, the entire or a portion of the aorta, or a partial or complete segmentation of another vascular system of interest. The segmentation of the bolus's vascular path allows the user to visualize the relative position of the aortic wall in comparison to the positioned or moved bolus ROI symbol (circle, ellipse, etc.). In a preferred embodiment, in addition to the positioned bolus m-ROI, the wall of the blood vessel (e.g., aorta) is explicitly presented to the user. Such a system also allows, for example, the user to visualize calcification within the aorta and position the bolus m-ROI accordingly by avoiding calcified regions within a particularly selected m-ROI. In this regard, material selection imaging, such as spectral imaging, may be particularly beneficial.

[0032] The proposed interactive bolus m-ROI placement system and suggested visualization techniques help users better position bolus m-ROIs relative to other important anatomical landmarks. For example, landmarks may include one or more different subsections of a blood vessel, such as the aorta. Subsections may include the aortic arch, ascending aorta, descending aorta, etc. Because landmarks in blood vessel sections can be differently labeled or highlighted, users will have more control when positioning bolus m-ROIs in relation to anatomically prominent landmarks, enabling them to make more informed decisions. Furthermore, or alternatively, visualizations may provide users with information regarding distance and travel time estimates to one or more landmarks.

[0033] The proposed system and related methods (see below) allow users to better adjust / modify a given m-ROI placement definition along the midline of blood vessels such as the aorta, while using the distance to anatomical landmarks and visualization of the aortic wall / diameter.

[0034] In yet another embodiment, an imaging configuration is provided which includes one or more of the systems of the above-described embodiments, an imaging device, a display device, a contrast agent dispenser for administering a contrast agent, and a segmenter configured to provide segmentation of a survey image.

[0035] In further embodiments, the imaging device may further include a bolus monitoring system. The bolus monitoring system is configured for in-image monitoring and performs monitoring based on tracker images in a predefined image neighborhood within a tracker image around a reference position. In embodiments, the bolus monitoring system may be configured to instruct the imaging device, via a controller, to acquire a second projection dataset at a second image quality higher than a first image quality when an in-image monitoring unit issues a trigger signal based on one or more monitored image values ​​in the image neighborhood.

[0036] In another embodiment, a method for facilitating tomography using a contrast agent, A step in which, in a preparation stage prior to the contrast-assisted imaging stage, a 3D survey image volume of at least a portion of the patient is received by a tomography device, wherein the 3D survey image volume includes segmentation of blood vessels through which the contrast agent will pass in the subsequent contrast-assisted imaging stage. A step of generating a graphical user interface graphics display for display on a display device, wherein the graphics display includes a visualization of the segmentation and a visualization of slider elements indicating reference positions along the segmentation, the reference positions being suitable for monitoring the presence of contrast agent with respect to at least one target anatomical feature in the subsequent contrast-assisted imaging step, Steps include receiving user input and instructing the graphics display generator to update the graphics display so that the slider element slides along the segmentation, wherein the slider indicates one or more different reference positions, and A method is provided that has the following characteristics.

[0037] In yet another embodiment, a computer program element is provided which, when executed by at least one processing unit, is configured to cause a processing unit to perform a method.

[0038] In yet another embodiment, at least one computer-readable medium storing program elements is provided.

[0039] In this specification, the system and related methods (see below) are primarily intended for use in the medical field. However, the principles described herein can also be used in fields other than medicine, such as the examination of inaccessible hydraulic and piping systems using contrast agents (dyes, etc.), or hydrological examinations to understand groundwater movement. As with medical imaging, this system and method allows for the optimization of the timing to start acquisition at the moment when the best image is obtained, thereby reducing wear on imaging equipment and avoiding repeated image processing.

[0040] The term "user" refers to a person, such as a medical professional, who operates imaging equipment or supervises imaging procedures. In other words, the user is generally not the patient.

[0041] In this specification, "object" is used in a general sense and includes living "objects" such as human or animal patients, or their anatomical parts, but also includes inanimate objects such as security baggage and non-destructive testing products. However, since the proposed system will be described primarily in relation to the medical field, "object" will be referred to as "patient," or a part of the patient such as an anatomical structure or organ, or a group of anatomical structures or organs.

[0042] The term "survey image" used here refers to a 3D image volume acquired with a larger field of view (FOV) at a lower radiation dose cost than the subsequent diagnostic image volume. Diagnostic image volumes are necessary to perform or support medical tasks such as diagnosis and treatment. Survey images are generally not used for such tasks, but may be used, for example, for planning. The FOV of a survey image volume includes not only the anatomical structures of interest that are the very object of the medical task, but also other landmark anatomical structures that are generally not useful for the medical task and only serve an auxiliary function for imaging. The FOV may be a whole-body scan, but is not always necessary. Generally, the FOV of a survey image captures a larger anatomical cross-section, such as the abdomen or chest.

[0043] As used herein, “Z position” or similar terms relate to an example of a reference position within the image region assumed herein for the purpose of defining a tracker image. “Z position” generally relates to a position on one of three spatial coordinate axes (the “Z axis”) spanning the image region. Generally, this Z axis corresponds to the rotation axis of a rotational tomography system, or the virtual rotation axis of the imaging system of a fifth-generation scanner. However, the aforementioned Z axis may differ from the rotation axis of a reformatted survey volume assumed herein.

[0044] In this regard, "image processing" means that the image processing assumed and described herein, such as survey images or segmentation of blood vessels, landmarks, m-ROIs, etc., regardless of the embodiment and configuration or setting, specifically includes not only processing of image values ​​(e.g., HU values, etc.) in the image domain, but also processing in transformation domains such as the frequency domain, or other domains where the survey image is initially transformed, at least part of the processing is performed there, and optionally converted back to the image domain as needed. The transformations assumed here include Fourier-based transforms (Laplace transform, discrete cosine transform, etc.), wavelet transforms, Hilbert transforms, Haar transforms, distance transforms, etc.

[0045] Exemplary embodiments of the present invention will be described with reference to the following drawings. Unless otherwise noted, the drawings are not to scale. [Brief explanation of the drawing]

[0046] [Figure 1] A schematic block diagram of a medical imaging system is shown. [Figure 2] This document describes a contrast-based imaging protocol. [Figure 3] This document outlines the steps of a system that facilitates contrast-enhanced tomography. [Figure 4] A block diagram of a facilitator system using a graphical display generator as envisioned in the embodiment is shown. [Figure 5] Figure 4 shows a schematic block diagram of the graphics display generator of the facilitator system. [Figure 6] Figures 4 and 5 illustrate the graphics display that can be generated by the system. [Figure 7] Another diagram of a graphic display according to one optional embodiment is shown. [Figure 8] This shows a flowchart of a computer implementation method for contrast-based imaging with graphical user interface support. [Modes for carrying out the invention]

[0047] First, refer to Figure 1. Figure 1 shows a schematic block diagram of a medical imaging device (MAR) envisioned in an embodiment of the present invention. The device (IAR) may preferably include a tomography-based type medical imaging device (IA) (abbreviated as "imager"). Thus, the imager may be a computed tomography (CT) scanner, but for example, a C-arm / U-arm-type is not excluded here. In other embodiments, other tomography methods such as MRI and PET are also not excluded. The medical image processing device is preferably envisioned for contrast-based image processing protocols such as angiography.

[0048] The placement IAR further includes a computing system CS capable of handling a wide range of data, including image data provided by the imager. The computing system can also control the imager's operation. The computing system can be located away from the imaging device IA, or it can be located near the imaging device IA, for example, by being integrated into an operator console CS that allows the user to operate the imaging device. Specifically, it can control imaging operations to acquire medical images for diagnostic, therapeutic, and planning purposes (such as radiotherapy).

[0049] In general terms, as will be explained in more detail below, the computing system CS includes a facilitator system FS that can be used to establish the appropriate timing for triggering imaging operations to obtain good quality (high-contrast) images. Furthermore, or alternatively, the facilitator system FS supports a user input UI function that allows clinical users to adjust, fine-tune, or define from scratch a contrast bolus monitoring area ("m-ROI") that monitors contrast agent accumulation, in order to precisely establish the timing for triggering imaging operations with respect to a target anatomical feature (TAF). The computing system CS, and in particular its facilitator system FS, can be implemented as a cloud solution running on one or more servers. The imaging device 1A may be installed in a clinical facility such as a hospital. The computing system may be installed in or used in a control room adjacent to the imaging room where the imaging device IA is located. In some embodiments, the computing system may be integrated with the imaging device IA. The imager IA may be communicatively coupled to a computing system CS via a wired or wireless (or partially both) communication channel CC. The computing system CS can be configured as a fixed computing system, such as a desktop computer, or as the server, or as a mobile device, such as a laptop, smartphone, or tablet. For example, the computing system CS may be located on a workstation WS associated with the imaging device IA.

[0050] Before going into more detail about the operation of the Facilitator System FS, first refer to the Imager IA components related to the Facilitator System FS that are covered in the following description.

[0051] The imaging device IA operates to generate, in particular, acquire, projection data λ, which is transferred via a communication channel to the computing system CS and reconstructed into a tomographic image (cross-sectional image). The computing system CS runs one or more reconstruction units RECON that implement one or more reconstruction algorithms. Generally, the reconstruction algorithm implements a mapping that maps the projection data λ in the projection region to the image region. The image region is part of 3D space and is located in the inspection region ER of the imaging device, while the projection region is 2D and is located in the (X-ray) detector XD of the imaging device IA.

[0052] As described above, the imaging device IA is preferably a tomographic type and preferably configured for acquiring multi-directional projection images. Thus, the imaging device IA can acquire projection images λ along different projection directions α with respect to the examination area ER, and therefore the anatomical region of interest ("ROI") of the patient. In the embodiment, acquisition is performed by a rotating system in which at least the X-ray source XS is located within a movable gantry MG.

[0053] The movable gantry (and, in embodiments, the associated X-ray source XS) is rotatable within the fixed gantry SG around the examination area ER, which is present during patient / ROI imaging. On the opposite side of the X-ray source within the movable gantry is an X-ray detector XD, which rotates with the gantry and X-ray source around the examination area ER to achieve different projection directions α.

[0054] As schematically shown in Figure 1, the patient's longitudinal axis or imaging axis Z may extend into the examination area (ER) during imaging. The patient (PAT) may lie on a patient support platform (PS), such as a bed, which is at least partially located within the examination area (ER) during imaging. In some embodiments, though not all, helical imaging protocols are envisioned herein where there is relative lateral movement along the longitudinal axis Z between the X-ray source (XS) and the patient (PAT). For example, the patient support platform (PS) may be advanced through the examination area (ER) during multi-directional projection image acquisition, for example, when rotating the X-ray source (XS) around the patient.

[0055] The CT scanner configuration shown in Figure 1 is merely one embodiment, and other tomographic imaging equipment such as C-arm or U-arm scanners, cone-beam CT systems, and mammography systems are not excluded herein. In some embodiments, C-arm cone-beam imaging systems are preferred. Furthermore, multi-directional acquisition capabilities are not necessarily obtained from a rotational system as shown in Figure 1. Non-rotating imaging systems are also envisioned, such as fourth- or fifth-generation CT scanners, in which multiple X-ray sources are arranged, for example, around the examination area of ​​the source ring. Alternatively, the detector XD may be arranged around the examination area as a detector ring. Thus, in such systems, no rotation of the X-ray source XS or the detector XD, or both, occurs.

[0056] An operator console (OC) may exist for users, such as medical professionals, to control the imaging process. For example, the user can request the start of image acquisition, request reconstruction or other operations, start sending data to the computing system (CS), and stop such transmissions as needed.

[0057] During imaging, the X-ray beam XB is emitted from the focal point of the X-ray source XS along various projection directions α. Beam XB passes through the examination area where the patient is located. The X-rays interact with the patient's tissues. As a result of this interaction, the X-ray beam XB is modified. Generally, such modifications to the X-ray beam XB include attenuation and scattering of the original incident X-ray beam. The modified X-rays are detected as a spatial distribution of varying intensities at the X-ray sensitive pixels of the detector XD.

[0058] Here, it is not necessary to acquire a projection image λ over the entire 360-degree angular range around the inspection area ER. Acquisition over a partial angular range, such as 270 degrees, 180 degrees, or less, may suffice. The X-ray detector is preferably configured to acquire a 2D projection image with rows and columns of intensity values ​​registered by the detector pixels. That is, the detector pixels themselves may be arranged in a matrix layout. Such a 2D layout can be used with divergent imaging geometries such as conical or sectoral beams. However, one-dimensional detector pixel layouts (such as those along a single line) are not excluded here, nor are parallel beam shapes.

[0059] The reconstructor RECON implements one or more reconstruction algorithms for processing projection images. Specifically, the reconstructor RECON can compute a cross-sectional image V of an examination area (including the patient) for diagnostic, therapeutic, or other purposes. The reconstructor RECON may generate cross-sectional volume image data ("image volume") V. However, this does not preclude generating a single image slice in the examination area as needed. Thus, the reconstructed image may be shown herein as V, which may include the entire volume, a partial volume, or a particular section thereof. Volume reconstruction may be facilitated by the 2D layout and / or helical motion of the X-ray detector XD. Scan boxes SB may be defined by the user using user input UI features, particularly supported in the facilitator system FS. A scan box CB is a portion of space within the image area. Thus, although it is a 3D object, it is called a scan box because it can be visualized as a rectangle in a 2D view. A scan box defines the volume that is scanned to obtain projection data for reconstructing the volume of space defined by the scan box. A scan box typically includes a monitoring area (m-ROI), a target anatomical feature (TAF), and optionally one or more anatomical landmarks (LM).

[0060] The reconstructed volume image V is stored in memory MEM or processed in other ways as needed. The reconstructed volume image V may be visualized by a visualizer VIZ. The visualizer VIZ may generate a graphical representation of the volume or a specified slice. The graphical representation is displayed on a display device DD. The visualizer VIZ can map part or all of the image volume V to gray values ​​or a color palette. The visualizer VIZ controls the video circuitry via an appropriate interface to display the graphical representation on the display device DD. In addition to, or instead of, displaying, the reconstructed image V can also be stored in memory for later review or use in other processing. Such memory may include an image repository such as a database (e.g., PACS) or other (preferably) non-volatile data storage configuration.

[0061] The reconstructed volume image V can be manipulated, for example, by reformatting, to define cross-sections different from those defined by the image geometry. Such reformatting allows medical users to better identify the types of tissues and anatomical details within the patient, depending on the current medical purpose, such as diagnosis or preparation for any treatment.

[0062] The reconstructed volume V may, in this specification, be referred to as the target image acquired during the target or operational phase of a contrast-assisted imaging procedure. This reconstructed image V is intended to be a diagnostic image representing a target anatomical feature (TAF) (such as a target anatomical structure, organ, part of an organ, group of organs, or different tissue type) and is displayed with sufficient contrast to safely inform treatment or diagnostic decisions, or, in some cases, other medical decisions such as conducting further imaging sessions using other imaging techniques, or other tasks (such as tests) that need to be performed in light of the image.

[0063] The (target) projection image λ, from which the target volume V is reconstructed, is acquired with sufficient dose by appropriately controlling the dose used via the operator console OC. This can be achieved by controlling the settings for voltage and / or the amperage of the X-ray source XS tube to ensure a consistent diagnostic image quality. As previously stated, the imaging protocols envisioned herein are preferably contrast-based to enable imaging of target anatomical features (TAFs), which may inherently have low radiopaqueness, with sufficient contrast. Such target projection images acquired with sufficiently high doses may also be referred to herein as diagnostic projection images λ, in accordance with established terminology. However, this naming convention does not prevent the use of this projection data λ and its reconstruction V for non-diagnostic tasks, such as treatment (e.g., in a catheterization laboratory), planning, or other tasks.

[0064] The target anatomical feature of a transcatheter aortic flap (TAF) is related to the medical purpose of the imaging. Therefore, if it is necessary to examine a patient's liver, the target anatomical feature of a TAF is the liver. In other words, the purpose and target of an abdominal scan is the liver.

[0065] Each target anatomical feature (TAF) is typically associated with an imaging protocol, a set of specifications that define specific preferred imaging settings, required image contrast to be achieved, the radiation dose used for the TAF for a given purpose, the voltage / amperage settings of the source X used, collimation, etc., preferably based on the patient's biological characteristics (age, weight, sex, height, BMI, medical records, etc.). In other words, the imaging protocol encapsulates medical knowledge regarding a specific imaging task, purpose, target anatomical feature (TAF), etc.

[0066] Before acquiring such a diagnostic projection image λ, and due to the low radiopaqueness of the anatomical feature TAF, a contrast agent CA, such as iodine or another suitable substance, is administered to the patient's PAT via an administration device ADA (e.g., a pump). This amount of contrast agent CA (sometimes called a "bolus") travels through the patient's body with the bloodstream and accumulates in the target anatomical feature TAF. Ideally, a diagnostic projection image of diagnostic quality should only be acquired when sufficient contrast agent CA has accumulated in the target anatomical feature TAF. Therefore, the timing of acquisition of the diagnostic projection image λ of the target image V by the imaging device IA is a critical consideration, as it must ensure that the concentration of contrast agent in the target anatomical feature is sufficient. Only then can the reconstructible image region target volume V be expected to have the required IQ (image quality) according to the protocol or separately defined image contrast. Otherwise, re-imaging may be necessary, but this should be avoided due to the costs, wasted time, increased radiation exposure, and wear and tear on the equipment (especially the anode disk of the XS tube). Therefore, the consideration here is to obtain the diagnosis "correctly from the start."

[0067] The facilitator system (FS) envisioned here facilitates the acquisition of such images at the appropriate time in contrast-enhanced imaging protocols. The facilitator FS ensures that the acquisition of diagnostic projection images is reproducibly and reliably triggered at the appropriate time when sufficient contrast agent has actually accumulated in the target anatomical feature (TAF).

[0068] The facilitator system operates across two phases: the exploration or preparation phase (PP) and the monitoring phase. Both of these phases precede the target phase, in which the target volume V is acquired. Prior to all such phases, an initial phase is performed in which an initial view image V0 is acquired. This initial image V0 is preferably a 3D (image region) survey volume, which is itself reconstructed from a first set of projection images. However, this first / initial set of projection images λ0 is acquired later in the target phase and at a lower quality than the projection images λ used to reconstruct the target image V. In particular, acquiring λ0 results in a lower radiation dose compared to the radiation dose that occurs later in the diagnostic scan to acquire the diagnostic projection images λ. This is to conserve the patient's PAT dose, and also because the 3D survey volume V0 serves a completely different purpose than the target volume V. The purpose of the survey volume / image V0 is essentially one of navigation, as detailed here. In other words, survey image V0 is used to find the right location to monitor bolus arrival, to ensure that imaging of the target anatomical feature TAF is initiated at the appropriate time, and that the target volume V has the expected diagnostic grade of contrast.

[0069] The imaging protocol with contrast agent assistance is schematically shown in Figure 2. Next, referring to Figure 2, the operation of the facilitator system FS will be described in detail.

[0070] As mentioned above, the contrast agent CA enhances the image contrast of the target structure TAF, which is inherently radiopaque. In this regard, referring more specifically to Figure 2, this is a schematic diagram showing a portion of the blood vessel to which a bolus CA is administered by a contrast agent delivery device ADA or other device at an access point (indicated by "X").

[0071] In cardiac imaging, target blood vessels such as arteries and veins are soft tissue and therefore have low radiopaqueness. Consequently, using a non-contrast scan results in low contrast. The volume of contrast agent CA moves with the blood flow and propagates through the bloodstream until the concentration of the contrast agent accumulates in the target feature TAF, at which point the target phase can be initiated, where a higher-quality projection image of the target volume V is obtained.

[0072] Preferably, the target anatomical feature upstream of the TAF (blood flow direction is shown in Figure 2 as a vector). As shown in TIFF0007846442000001.tif1310, the surveillance area m-ROI is defined by the in-image neighborhood U, which will be explained in more detail later. This neighborhood U is based on the 3D segmentation m0 in the initial survey image V0. Neighborhood U and segmentation m0 may be related to anatomical landmarks (such as the aortic arch or parts of the aorta such as the descending portion) where contrast agent concentration monitoring takes place. In other words, while the precise and specific location within the identified volume is provided by the facilitator FS, the surveillance area m-ROI may initially be defined in terms of anatomical landmarks according to medical knowledge.

[0073] Therefore, to account for, for example, the latency of image acquisition, it is preferable to monitor the concentration of the contrast agent CA upstream of the actual target anatomical feature TAF. When the concentration monitored in the monitoring region m-ROI reaches a specific minimum concentration that can be measured by setting a threshold in the time series (t) of the tracker image r(t) (as will be explained in more detail below), it can be estimated that by that point, thanks to blood flow, the concentration of the target anatomical feature TAF has reached an acceptable minimum concentration, and therefore, acquisition of the current diagnostic projection data λ relative to the target volume V may be initiated.

[0074] The spatial distance between the monitored region (m-ROI) and the actual target anatomical feature (TAF) is primarily based on clinical knowledge and / or determined by patient characteristics, blood flow velocity, etc. All such medical contextual information, including the m-ROI-TAF distance which serves as a landmark for monitoring the m-ROI region, etc., is encoded in the aforementioned imaging protocol / specification to suit the current imaging task / purpose.

[0075] In general, the facilitator system FS may include a surveillance area finder (MRF) configured to quickly, reliably, and accurately locate the correct surveillance area m0 = m-ROI for a given patient and target anatomical feature (TAF) within a survey volume V0. Preferably, the operation of the facilitator system FS is well integrated into the existing CT workflow.

[0076] A Surveillance Region Finder (MRF) can be implemented as a Segmenter (SEG) based on, for example, a machine learning ("ML") model (M). Examples of such models (M) include convolutional artificial neural networks in particular. Multiscale CNNs, such as the U-net architecture, can be used. Other machine learning models can also be used. Instead of ML, more classical segmentation techniques such as region augmentation and shape model-based segmentation can be used.

[0077] The Surveillance Area Finder (MRF) of the Facilitator System FS can operate fully automatically and provide a Surveillance Area (m-ROI) without any further user input (other than the identification of the imaging protocol or target anatomical feature TAF). However, it is specifically assumed here that the Facilitator FS includes a user interface function (UI) that enables user interaction with the estimated m-ROI location (m0). Specifically, the Facilitator FS prompts interaction with the user. This specification specifically states that certain components of the Surveillance Area Search procedure can be freely adjusted by the clinical user through a user interface UI, such as a graphical user interface (GUI) specifically configured for such user interaction. User requests regarding such adjustment of m0 may be passed to the Bolus Monitoring System (MS) (see Figure 3 below) via a touchscreen (TS), pointer tool (computer mouse (CM), stylus (STY), etc.). Such user interaction is preferably envisioned here as a dynamic real-time experience. In other words, depending on the adjustments requested by the user regarding the discovered monitoring area m-ROI, the recalculation of the relevant components is triggered, and their displays may be updated as many times as the user requests such changes or adjustments.

[0078] Thus, the facilitator system FS, especially thanks to its user interface function UI, can find the appropriate monitoring area, thereby making it easy to find the appropriate moment t=t0 to initiate the target phase, control the imaging device IA, and reliably acquire a high-quality projection image λ from which the target volume V can be reconstructed.

[0079] Before going into the details of operating the user function UI, first refer to Figure 3. This figure shows the basic operational aspects of the proposed facilitator system FS in conjunction with the (optional) monitoring area finder MRF, which works in conjunction with the bolus monitoring system MS, which is part of the computing system CS. Specifically, as shown in A), the initial 3D survey volume V0 is segmented to match one or more suitable anatomical landmarks that will function as bolus monitoring areas m—ROIs.

[0080] Based on the estimated m-ROI segmentation m0, a reference position z0 within the volume is identified, which can be, for example, a set position along the rotation / imaging axis Z of the imager IA. Preferably, a reference point P, such as the center of gravity, is defined within the 3D segmentation subvolume m0. The reference position z0 can be defined by projecting point P onto the Z axis.

[0081] Next, from each set of low-dose projection images acquired at appropriate sampling intervals around the reference position z0, the time series r of the tracker image is obtained. t It will be reconstructed.

[0082] In part or in each of these tracker images r(t), the monitoring neighborhood U (displayed as a small circle) of B) is automatically defined based on the reference point P. The neighborhood U around P can be an ellipsoid, a sphere, etc. (or an elliptic circle in a 2D view, etc.). Thanks to the proposed user-interactive functionality, an event handler EH can be used to allow the user to change one or more of P, z0, or U as needed. Thus, the monitoring region m—ROI—is defined by two elements: its 3D location identified by the reference position z0, and the spatial extent for monitoring purposes represented in the tracker image r(t) (defined by the neighborhood U). If at least one of the elements P, z0, or U is changed, one or more other elements are automatically changed based on agreement.

[0083] In a series of tracker images r(t), the contrast agent arrival concentration after bolus administration is monitored in the vicinity defining the set monitoring position m-ROI. For example, the contrast curve c in C) of the image vicinity U is shown in the given tracker image. U (t) is shown. In such a curve, the contrast value HU (Haunsfield units) of the neighboring U is recorded over time t. The CA concentration, i.e., the contrast agent, is expected to increase over time during the ramp-up phase, then plateau and reach saturation during the plateau phase, and then decrease during the drop-up phase as the contrast agent washes out. Only the ramp-up phase is shown in Figure 3.

[0084] Image value-based threshold policies can be used in monitoring near U to trigger an acquisition signal to obtain a diagnostic projection image capable of reconstructing the target volume V. This acquisition of λ should begin after the contrast agent concentration (or HU value of the contrast curve c) reaches a specific minimum value. This minimum value may be lower than the expected maximum value at the target anatomical feature TFA, which is expected to be located slightly downstream of the monitoring region m—ROI / U. Instead of making the threshold setting described above based on monitoring absolute HU values, the gradient of HU values ​​can also be monitored, either in addition to or instead of being based on absolute HU values ​​as needed.

[0085] However, in some embodiments where delay is not a concern, the monitored region and the target anatomical feature may coincide, in which case thresholding can be performed so that acquisition of the diagnostic projection image is triggered at the maximum density value of the plateau phase. The maximum value can be found, for example, using a gradient-based method.

[0086] The set of projection images acquired at the set sample rate, from which the tracker image is reconstructed, will be of similarly lower quality (lower dose) than the projection image λ from the later diagnostic acquisition stage. For example, the image quality may be similar to that of the projection image acquired when the survey image V0 is reconstructed.

[0087] The size (field of view ["FOV"]) of the survey (also called a "scout") image volume V0 is preferably selected to include not only the target feature TAF but also at least one anatomical landmark where bolus monitoring is expected to be performed. If in doubt, a whole-body scan can be used as a survey scan, but a whole-body scan is not always necessary, as scans of applicable body regions such as abdominal, head, chest, and leg scans may suffice in some cases.

[0088] In these survey images (V0), the contrast is usually very low due to the low dose, but it is still sometimes sufficient to roughly locate m-ROI landmarks and, optionally, target anatomical features (TAFs). The latter can also be manually marked up by the user (see below).

[0089] Once the system FS finds a reference position z0 based on segmentation m0, it may be necessary to adjust the imaging geometry, for example, by moving the patient table relative to the gantry, so that a tracker image around the reference position is obtained by reconstructing a series of projection images acquired at the aforementioned sampling interval. However, in a preferred embodiment, such repositioning of the table or gantry is unnecessary because the distance between the target anatomical feature and the monitoring position is roughly known, and it is preferable that the monitoring volume V0 is acquired from the outset to cover a sufficiently large volume. For example, since the FOV of the survey scout volume V0 may be linked to the automated plan, very large FOV surveys are generally not required to collect anatomical contextual information, such as landmark detection. Such an automated plan is a function that can detect target anatomical features TAFs in the survey image V0 and define the FOV to use. The automated plan function can be implemented by appropriate image processing (e.g., segmentation) as needed. However, the detection and knowledge of TAF locations can be provided by the user manually or by any method, whether machine learning-based or not. Generally, this specification assumes that the location of the target anatomical feature (TAF) is known, and the primary focus of this disclosure is to reliably identify the m-ROI (Region of Interest).

[0090] The m-ROI segmentation m0 is a 3D segmentation; that is, it is defined by a 3D subvolume within the survey image (m0 ⊂ V0). This subvolume, having spatial extensions in all three spatial directions (X, Y, Z), is preferably anatomically oriented in that its shape, size, and orientation correspond to and particularly conform to the spatial structure of the anatomical structure at its location. For example, segmentation m0 may conform to the spatial structure of an anatomical landmark associated with the target anatomical structure. Thus, the segmentation follows, at least partially, the anatomical / histological boundary of the landmark. This allows the user to quickly and visually confirm at a glance whether the segmentation m0 proposed by the Surveillance Area Finder (MRF) is medically meaningful.

[0091] Generally, relatively small segmented anatomical structures m0 are used to define the reference position Z0, and separately, to define the neighborhood U in the tracker slice image passing through the reference position Z0. As mentioned above, the reference position z0 can be located on the imaging axis Z. However, this is not necessarily required, as the initial survey volume V0 can also be provided as a reformat, and the reference position z0 may be a point on any geometric line of that reformat, and therefore may be different from the rotation / imaging axis Z.

[0092] Notably, the initial locator tracker image r0 can be synthesized purely computationally from the survey volume V0, eliminating the need for separate projection data acquisition and saving dose. Specifically, the neighbor U used in the “live” tracker image for live monitoring of bolus arrival can be defined on this proto-tracker image synthesized from the already available survey 3D image V0. There is no need to bear dose to determine the neighbor U, which represents the spatial extension of the monitored region m—ROI that can be represented in the tracker image. Furthermore, the determination of the reference position and neighbor U can be performed in a single step based only on the survey image V0 and the synthesized locator tracker image r0. This is more convenient and faster for clinical users, and this one-step operation can be easily integrated into existing CT workflows practiced in healthcare facilities worldwide. The use of the locator tracker image r0 is independent of its display, and it will be understood that such a display is not required in all embodiments for the purpose of defining the neighbor U as described in the single-step setup.

[0093] It will be understood that the aforementioned Surveillance Area Finder (MRF) is merely an optional component of the Facilitator System (FS) envisioned herein. In fact, the initial display of Surveillance Area m0 can also be provided entirely manually as a segmentation of Survey Volume V0. It does not necessarily have to come from the Surveillance Area Finder (MRF) or any other similar automated computer system. In fact, it is the user who provides the manual annotations, and their thoughts may change later, or another clinical user may provide instructions on the location of the Surveillance Area, etc.

[0094] However, in this invention, it is assumed that the facilitator system FS includes a graphics display generator GDG, as schematically shown in the block diagram of Figure 4. The graphics display generator GDG is operable to generate a graphics display GD on the display device DD. The graphics display GD includes a visualization of at least some of the segments s of the blood vessel in question, such as the aorta, and a graphics display SL of the current location of the monitoring area. This may be provided through the user or by a computerized automated system such as a monitoring area finder MRF.

[0095] The Graphics Display Generator (GDG) assists (clinical) users in interactively finding the correct monitoring area by changing the position of the Graphics Display SL. Using the Graphics Display Generator (GDG), users can change the current position of the graphical indicator SL of the monitoring area through supported user interface UIs. The graphical display SL is "anatomically structure-aware" and dynamically adjusts to fit the current anatomical environment according to segmented blood vessels. Optionally, additional useful contextual information (such as landmarks, relevant distances, and expected bolus arrival times) can be displayed corresponding to the current position of the graphical display SL. This is explained in more detail below.

[0096] A graphics display generator, a display device DD including a visualization of the graphics display GD, and a user input device UI interact to form a preferred interactive graphical user interface GUI in the present invention. As shown in Figure 4, the graphics display generator GDG takes as input a 3D survey volume containing segmentation s(VS) of vessels of interest VS, and a definition D of the location currently marked up as a region of interest. This initial definition D = m0, regardless of how it was obtained, can include a single 3D coordinate or a set of such coordinates within the 3D segmented survey volume V0, such as one or more of a reference point P, neighborhoods U around P, and associated z0 locations, as shown in Figure 3. The view s=s(VS) of volume V0 and at least a portion of the vessel segmentation is rendered for display, including a graphical indicator SL that is displayed to mark up the current location of the region of interest m—ROI based on the received definition m0=D. The graphical indicator SL can be rendered as a circle, ellipse, or other markup symbol or region delimiter. Preferably, the shape and orientation are such that the graphical indicator SL is located within the boundary of the segmentation region.

[0097] To elaborate further on vascular segmentation, in some embodiments of the proposed approach, vascular segmentation is performed according to the anatomical structure being scanned (e.g., the aorta in the case of the heart, the pulmonary artery in the case of the liver or abdominal examination). This may be specified in the imaging protocol, as previously mentioned. The segmentation is based on low-dose survey images rather than high-dose images that will later be used in the diagnostic scan. Displaying vascular segmentation in addition to bolus ROIs (such as those represented by circles in other geometric diagrams) is particularly helpful in allowing users to place m-ROIs with greater confidence in a clinically appropriate manner. For example, in some embodiments, this guiding function is facilitated by further including segmentation of intravascular calcification in the displayed vascular segmentation. Calcification is typically an area to be avoided when placing bolus m-ROIs. Therefore, the survey images can be recorded using an imager configured for spectral imaging (e.g., dual-energy), and the images are spectrally processed by a material decomposition algorithm for a clearer definition of calcified wall portions. The calcified portion of the blood vessel wall (w) may appear graphically different from the non-calcified portion of the wall.

[0098] Next, refer to the block diagram in Figure 5, which shows in more detail the operation of the graphics display generator, which is part of the facilitator FS. Moving from left to right, the imaging device operates to acquire the low-dose survey 3D volume V0, as described. In some less preferred embodiments, 2D surveys may also be considered, but the technical and clinical advantages of the proposed facilitator FS come to the forefront in the context of 3D survey images.

[0099] The Survey 3D Volume V0 may be provided by the Imager IA, preferably via online configuration, but subsequent retrieval from an image database is not excluded herein.

[0100] The Surveillance Area Finder (MRF) can provide an initial segmentation m0 of the m-ROI. The Surveillance Area Finder (MRF) may or may not be integrated with the Facilitator (FS), and in either case, it is optional. One possible detection / output from the Surveillance Area Finder (MRF) may be one or more landmarks (LM) surrounding an m-ROI circle.

[0101] In fact, the Surveillance Area Finder (MRF) may be an external system and not functionally connected to the Facilitator (FS). Of course, the Facilitator (FS) can also be interfaced to the Surveillance Area Finder (MRF), such as a hospital information system, via a wireless or wired network connection to form a broader image support configuration. The Surveillance Area Finder (MRF) may be implemented, for example, in a cloud system, processing images generated by the Imager (IA), and then segmenting them on demand or automatically. The segmented volume V0 is stored and may be loaded by the Facilitator System (FS) when needed for display and monitoring area adjustment. In any embodiment, the Surveillance Area Finder (MRF) may be a segmentation component that utilizes a machine learning model (M) to segment the initial spatial definition D of the monitoring area within this low-quality (high-noise) 3D volume.

[0102] Optionally, the initial definition of the location of the monitoring region within the segmentation, D=m0(s)=m0, is manually provided by the user, for example, by leaving annotations applied through the appropriate user interface UI. Of course, the monitoring region finder (MRF) can also be omitted entirely.

[0103] Structural segmentation of vessels of interest (VS) within a survey volume (VO) may be provided by a standalone (vascular) segmentation device (SEG), or the segmentation device (SEG) may be part of a monitoring area finder (MR). Even when a monitoring area finder (MRF) is used, the vascular segmentation SEG remains a standalone component and does not need to be associated with the optional monitoring area finder (MRF). In some embodiments, the vascular segmentation device (SEG) is part of a facilitator system.

[0104] The segmenter SEG providing vascular segmentation s(VS) can be based on ML-based (e.g., deep learning), shape model-based (MBS), or other segmentation algorithms such as region expansion. In any case, it is configured to address the low SNR of low-dose survey images and achieve good segmentation. Similar to the initial segmentation m0 of the initial m-ROI, the vascular segmentation s = s(VS) is a 3D segmentation and therefore forms subvolumes within the survey volume V0. In embodiments, the vascular segmentation SEG can be configured to transfer contrast segmentation from spectral CT images to virtual non-contrast images. ML-based methods can be used. The segmenter SEG can use an ML model M', such as a convolutional (CNN) artificial neural network (NN) in particular. You can use NNs or other models configured for multiscale processing, such as NN models of the U-Net architecture or other bottleneck-type models that use convolution and subsequent deconvolution operators. Such models include, for example, the U-Net architecture and its related models described by O. Ronneberger et al., “U-Net: Convolutional Networks for Biomedical Image Segmentation”, available online on the arXiv repository under citation code arXiv:1505.04597 (2015). Segmentation SEGs can also be used to extract the centerline CL and / or radius of segmentation of blood vessels (such as the aorta). This can be done using existing skeletonization or distance transformation methods. The centerline CL can be visualized, which will be discussed in detail below.

[0105] Alternatively, such a segmentation tool, SEG, may not be used, and instead, the user provides vascular segmentation based on 3D annotations, but this can be cumbersome and time-consuming.

[0106] A blood vessel (VS), regardless of how it is segmented, can represent, for example, the entire or a portion of the aorta. It can also represent a portion or all of other blood vessels relevant to the medical task at hand and through which a bolus is expected to pass.

[0107] The vascular segmentation s(VS) in the survey volume V0 and the initial definition m0 of the monitoring area location within it are processed by the graphics display generator GDG to generate a graphics display GD that is displayed on the display device DD. The graphics display generator GDG controls the display device DD via an appropriate video circuit interface and displays the graphics display GD on the display device DD. The graphics display GD includes visualization of the segmentation s=s(VS) or a portion thereof, and visualization of the monitoring area indicator SL within the region of segmentation s, based on the initial position definition m0. This is schematically shown on the right side of Figure 5.

[0108] When the graphics display GD is displayed on the display device DD, the user can use a user input device UI such as a keyboard KB, stylus STY, computer mouse CM, or other pointer tool to request a change to the currently indicated monitoring area according to the graphical indicator widget SL. Alternatively, the graphics display generator GDG may also support a touchscreen TS function as another embodiment of the user interface UI function that allows the user to input a request to change the currently indicated monitoring area by interacting with the display device DD. In some of the aforementioned UI embodiments, such as the pointer tool STY, CM, or the aforementioned touchscreen TS function, the user can interact with the indicator widget SL to request a repositioning and / or resizing of the currently identified monitoring area. For this purpose, and preferably herein, the indicator is configured herein as a sliding element SL that can slide along a segmentation s, thereby allowing the user, based on medical knowledge, to reposition the currently proposed position of the monitoring area to a more appropriate position. This type of slide element provides immediate visual feedback and has been shown to help users quickly achieve satisfactory monitoring location definitions even in time-critical and stressful situations (such as trauma rooms or busy clinical settings with heavy workloads and staff shortages). Furthermore, the slide element allows for quick and intuitive input of such repositioning requests. Thus, throughout much of this disclosure, the indicator SL is referred to herein as the slider element or simply the “slider” SL. The slider SL may also support requests for repositioning and / or resizing, for example, by click-and-drag actions, as needed.However, as described in detail below, preferably, when the slider SL is slid along segmentation s (such as along the center line of segmentation s), or when the user requests a change in the view rendering / reformatting of the volume, the slider SL is automatically and dynamically resized / oriented by the graphics display generator GDG.

[0109] When a user request for position adjustment is received by the graphical display generator via such user input UI, the event handler EH captures this adjustment request event and passes it to the graphics display generator GDG. The event may include specifying the nature of the request, such as the next intended position and size of the slider SL. Alternatively, the event can be mapped to such a specification. The graphics display generator GDG processes the event specification and updates the graphics display accordingly. The updated graphics display GDG indicates the new position of the observation area by changing the position of the SL element along the segmentation. The geometry of the slider element SL may change accordingly when it is rendered to display at the new position. This is explained in more detail below.

[0110] The user can adjust the position of the slider SL as requested, any number of times. Once the user is confident that the appropriate position has been found, the position of the m-ROI indicated by the slider SL can be transmitted via the output interface OUT as the final monitoring position m(s). This final position m(s) is passed to the imaging device, e.g., the operator console OC, via the appropriate control interface, initiating a monitoring phase coordinated by the (bolus) monitoring system MS. In this monitoring phase, based on the currently indicated position (and extent) of the monitoring region m-ROI, the monitoring system MS sends instructions to the imaging device IA, and a stream of tracker projection data around this region m-ROI is acquired. Coordinated by the monitoring system MS, the tomographic reconstructor RECON reconstructs from the stream of tracker images, where changes in voxel values ​​in the monitoring region are monitored by the in-image monitoring unit of the monitoring system MS. For example, image values ​​such as HU values ​​per stream of tracker images are thresholded. Alternatively, or in combination with thresholding, other monitoring policies can be used. Changes in image values ​​indicate the arrival of a bolus. When the monitoring unit of the monitoring system MS determines, based on threshold settings or other applicable monitoring policies, that the bolus has actually reached its identified location m(s), the monitoring system MS issues a new signal for the imager IA to acquire a new set of projection data, this time at a diagnostic dose, higher than the dose used for the survey scan V0 or tracker image r(t). From the diagnostic projection data, the reconstructor RECON can reconstruct a fully contrast-enhanced target volume V. The target volume V is displayed on the display device DD or other display device to support the user in the clinical goal / purpose of the imaging. The purpose may be one or more of the following, or something else, depending on the clinical situation: treatment, diagnosis, planning, medical analysis, etc. The target volume V can be processed (e.g., for analysis), stored, and shipped as needed.

[0111] Figure 6 is a diagram of a graphics display GD that can be generated by a graphics display generator GDG according to one embodiment.

[0112] The graphics display GD shows a view of volume V in 3D rendering (such as isosurfaces) or as a 2D section view on a user-selectable section plane, as shown in Figure 6, along with a visualization of the segmentation s=s(SV) of the vessel VS of interest S. In the example shown in Figure 6, the vessel of interest is a portion of the aorta shown in the sagittal view. A third visualization component is a graphical widget of slider SL, which is rendered as an ellipse, but can be any shape or size as long as it is within the region / volume marked by the segmentation of the vessel of interest VS.

[0113] The view can be any plane and does not necessarily have to be the sagittal plane, as shown in Figure 6. Front and side views are also assumed to be standard views in this specification, as are non-standard reformattings on planes different from the standard plane defined in the image region. When a view change (reformat or standardization) is requested, the visual elements of the graphics display are adjusted accordingly. For example, the segmented artery and slider symbol SL are re-rendered with accurate and consistent geometric perspective. Users can request a view change at any time at their convenience by issuing a request event through the UI. The event handler EH intercepts this and mediates the view change. For this reason, the graphics display generator includes a geometric graphical view generator configured to recognize the geometric shape of the image region and apply projection geometry operations to re-render the graphics display to any view, including the re-rendering of visual components, such as segmentation and slider SL, as described above.

[0114] The segmentation boundary of the aorta VS is shown with a dashed line, indicating that such rendering is actually intended. Therefore, it is preferable that the segmentation include clear visual modulation to represent the wall W of the blood vessel VS, such as the aorta. Such clear visual representation of the blood vessel wall portion W has been found to be more helpful to the user in placing / positioning the slider element SL of the defined monitoring area. This allows even novice users or users in stressful situations to quickly realize a realistic and clinically meaningful spatial specification of the monitoring area m-ROI. Visual modulation of the wall portion allows for the distinction between calcified and non-calcified blood vessel wall portions, as mentioned above.

[0115] The graphics display generator GDG may include additional fail-safe measures to help the user more accurately position the slider FL for m-ROI identification. This can be achieved by the graphics display generator GDG restricting the apparent movement of the slider SL to one dimension during adjustment, primarily by sliding along the direction of blood vessels, which may also include curved portions.

[0116] More specifically, in the embodiment, the slider is fixed to the path of the vessel as defined by a tangent to its centerline / curve. Thus, the slider SL may only be able to slide / move along the tangent to the centerline CL of the vessel segmentation s. The centerline CL is also visualized in the graphics display GD, for example, as shown by the dotted line in Figure 6. Any line style can be used for the centerline and the wall W display of the vessel segmentation s, and the selected dashed and dotted line variations are merely illustrative embodiments. To set the centerline away from the wall W and / or the rest of the vessel segmentation, separate visual modulations by coding of color, hue, or gray values ​​can be used in addition to, or instead of, modulating the line style.

[0117] Due to the adjustment request, the slide element SL may be dragged from the position indicated at (1) to the next position (2), and then to (3), as shown by the numbers in parentheses and the associated arrows in Figure 6.

[0118] The slider element SL itself can have any appropriate form or shape. Ideally, the shape should depend on the rendered view and maintain consistency with view changes. For example, the slider may be rendered as an ellipse, a circle, or other shape. The shape may change when the user requests a new view, such as a cross section from a sagittal view. For example, the shape may be an ellipse in the sagittal view, but change to a circle when the user requests a cross section view. View changes may also be requested by the user interface UI. For example, when the pointer tool is manipulated in a predefined way (such as a right-click of the mouse), a pop-up drop-down menu widget appears, allowing the user to select a new view. This new view is rendered on the display device DD by the graphics display generator GDG.

[0119] Users can also request resizing or reorientation of the slider SL using the user interface UI. Resizing may be limited by the area defined by the segmentation of the blood vessel. In a preferred embodiment, when the user requests to slide the slider element within a segmented area along the centerline SL, the size of the slider SL is automatically adjusted to match the diameter or width of the segmented area. In other words, the size of a slider element SL of a given geometric shape (such as an ellipse) is such that it fits to the maximum size but remains within the segmented wall W. For example, a circle with a specific diameter is inscribed around the segmented centerline, and that circle is preferably inside the fully segmented blood vessel area s. Thus, the slider SL always appears to be in contact with the wall portion W of the segmentation s when slid along the centerline SL, but this sliding occurs when the user issues a corresponding position adjustment request through the user input interface UI. For the user, this automatic fitting feature of slider SL to the shape of the vascular segmentation may appear as if slider SL dynamically expands or contracts when it is dragged within the vascular segmentation at various widths (cross-sections). Automatic fitting of the slider to the shape of the vascular segmentation is also provided, regardless of whether slider SL is slid along the curved or straight portion of the segmentation s(VS).

[0120] The sliding of the slide element along the tangent to the centerline SL may be performed simply by a keyboard stroke, as one possible embodiment of the user interface UI envisioned herein. Thus, in such an embodiment or a similar embodiment, the user is prompted to press one of two specified keyboard keys to issue a slider SL repositioning event. For example, each key indicates one of two directions of movement of the slider SL (up or down in one view), as shown in Figure 6, which may also correspond to left or right in the other view. Furthermore, or instead, the user interface allows the user to increase / decrease the diameter of the bolus ROI circle. For example, this may be achieved in a touchscreen embodiment by the user performing a specific predefined gesture. Alternatively, in a keyboard-based embodiment, the user may press a predefined set of keys to request a change in the displayed m-ROI size. For example, “plus / minus” keys may be appropriately assigned to enable user requests such as changing the m-ROI size.

[0121] In some embodiments, the adjustment of the slider SL's position is restricted to tangentially with respect to the segmentation center CL. Thus, the slider's movement is fixed to the segmentation course. Therefore, in preferred embodiments, the graphics display generator GDG is configured to support only the repositioning of the monitoring region m—ROI, and thus the repositioning of the slider SL along the segmentation. Other repositioning requests are ignored or may be converted to keep the slider SL within the segmentation boundaries. If the initial definition m0 of the current monitoring region m—ROI violates this policy, the initial definition may be automatically modified so that the slider SL at this initial position is within the segmentation. The user may be notified of this automatic modification.

[0122] Some methods of user interaction supported by the graphics display generator GDG may involve mechanical input. For example, in touchscreen interaction TS, the user places their finger in the current position and performs a dragging motion on the screen to slide a slide element. Other examples include computer mouse CM or stylus STY events that indicate dragging operations. In such mechanical user interface configurations where the user describes actions via touchscreen actions, stylus, mouse, etc., the registered action is analyzed by the event handler EH and resolved into a component that includes a component parallel to the current centerline CL, which is tangent to the slider SL at its current position. The graphics display generator GDG's event handler projects this parallel component of the requested movement onto the tangent to the aforementioned centerline. Only this projected parallel component is used to slide the slider SL to the next position. Therefore, the graphics display generator GDG executes the motion of the slider SL along the tangent only in proportion to the projected motion component. In this way, by projecting the motion element onto the instantaneous tangent of the centerline SL, the apparent motion of the slider can be restricted to occur only along the centerline, and thus fixed to segmentation.

[0123] As can be seen above, the graphics display generator GDG supports several limitations, including automatic adjustment of the slider SL size, adapting the shape of its graphics representation to the segmentation width, and supporting a lock function that locks requested repositioning to the segmentation course (such as the centerline). These limitations form a convenient fail-safe measure, as they can be disabled as needed, as shown in the current view. The lock function, which adjusts the size of the slider SL according to the instantaneous segmentation width and forces linear repositioning, allows even novice or stressed users to quickly find a realistic bolus monitoring position, reducing the likelihood of re-examinations and improving patient throughput.

[0124] However, it will be understood that fixing the sliding motion to the tangent of the vascular segmentation is not necessarily required in all embodiments. Furthermore, the graphics display generator GDG may include a feature that allows the user to disable one or more restrictions to allow for more freedom in positioning the sliding element SL, as required in some cases.

[0125] As an additional optional feature, the graphics display generator GDG supports the display of useful medical context information, in addition to the display of segmentation s and slider SL within or around segmentation s. The medical context information mentioned may be provided by a medical context information provider MCP. The medical context information provider MCP may be part of the facilitator system FS, or the facilitator system FS may be configured to appropriately interface with such a medical context information provider MCP. The medical context information provider MCP may include a landmark segmenter LMS module, or a physiological modeling machine PMM configured to provide distance d and / or transport time information.

[0126] Therefore, in some embodiments, as shown in Figure 6, the graphics display generator GDG may operate to display medical context information, such as the distance d to a specific anatomical landmark LM, ANAj, as a function of the bolus transit time T and / or the current position of the slider SL (illustrated as j=1–5). Such medical context information may be displayed in useful and contextually appropriate information popup widgets CL1–CL3. Such widgets (callout type popups are shown in Figure 6) are generated by the graphics display generator GDG in relation to the changing position (1), (2), (3) of the sliding element SL, and the information in popups CL1–CL3 is dynamically updated. Popups CL1, CL2, CL3 may contain information about the distance d to various landmarks LM measured from the respective current position of the slider SL ((1), (2), or (3)) and the expected arrival time T of the bolus. In addition to, or instead of, the information about the time T and distance d to landmark LM, the time T and / or distance d may refer to the target anatomical feature TAF being imaged. Popups are invoked either at the user's request or automatically when the slider SL slides along the segmentation. Popups Cl1 through Cl3 are displayed either permanently or for a limited time. If permanent, the user can forcibly remove them by issuing a close request, for example by clicking the popup. If automatically displayed permanently at the user's request, the time and / or distance information is updated automatically and dynamically.

[0127] Useful landmark ROIs (Roles of Interest) particularly for cardiac applications include one or more of the following: the aortic valve, coronary artery orifices, and the branching points of the renal and hepatic arteries. Any such landmark ROI can be included to facilitate better planning. Knowing the 3D location of such landmarks enables a valuable differentiator for 3D survey-based planning: the ability to incorporate bolus tracking ROIs and the actual 3D distances between associated landmarks into the plan.

[0128] Regarding transit time, the physiological modeling machine PMM can optionally be configured to implement a hemodynamic model and calculate an estimate of the transit time T to a distance d from a landmark. For example, the distance of the survey volume V0 can be determined based on landmark segmentation provided by the landmark segmentation LMS module. The hemodynamic model may include textbook knowledge about blood flow velocity, patient-specific information such as current heart rate and blood pressure, and a model of the patient's vascular system obtained from a 3D survey. Transit time can be used to standardize the bolus tracking position with respect to time delays, and information can be displayed to technicians when changing the position of the bolus m-ROI. Thus, distance and transit time information can be obtained by a medical context information provider and used to implement such hemodynamic modeling or to query such distance and transit time models through an appropriate interface database.

[0129] In some embodiments, the graphical display GD may include visualizations of specific aspects of hemodynamic modeling, such as color-coded streamlines, velocity fields, and pressure fields.

[0130] Pop-ups CL1–3 are particularly effective when used in conjunction with a locking function that locks the slider's movement onto the course of the centerline CL. Locking the slider SL to the centerline in this way avoids the time-consuming user operation of freely positioning the bolus tracking ROI (usually a circle) and instead provides a guide that allows the user to "slide" the ROI along the centerline. For example, for each or several possible locations, the distance d to the relevant landmark ANAj is displayed in pop-ups CL1–3. This helps standardize bolus tracking, for example, by "always positioning the ROI 10 cm downstream of the left coronary artery orifice during coronary scans." Furthermore, the radius of the bolus tracking ROI can be dynamically adjusted based on the local radius of the aorta VS.

[0131] In addition to displaying such pop-ups, the location of relevant landmarks can also be indicated by indicator widgets (boxes, circles, ellipses, etc.). Information on the location of landmark LMs may already be segmented within the survey volume v0 upon reception, or the facilitator system FS may include one or more of the aforementioned landmark segmenter modules LMS, based on ML, MBS, or any technology, provided that the segmentation modules LMS are appropriately configured to address the low signal-to-noise ratio (SNR) expected for low-dose acquisitions. Furthermore, similar to vascular segmentation, the segmentation of landmark LMs is 3D, and the 3D subset of the survey volume V0 is also 3D. Such anatomical landmark LM segmentation can be achieved by using more traditional image processing approaches that take into account the geometric and anatomical characteristics of the landmarks relative to the aorta or other target vessels, such as ML-based landmark detection techniques, segmentation of blobs around landmarks, or MBS shape segmentation techniques.

[0132] Once a suitable position is found based on the current position of the slider SL, the user can indicate this by issuing a specific event through the user interface UI, such as pressing a specific key, performing a specific gesture in a touchscreen embodiment, or a click event. In any case, the range and current position of the slider SL are considered to indicate the monitoring area m—ROI, and its current position / range (size) is transmitted to the imaging device and monitoring system MS via the output port OUT to initiate the acquisition of the tracker image as described above, facilitating the acquisition of the final, full-contrast image V.

[0133] Figure 7 shows a diagram of a second embodiment of the graphics display GD. In addition to the slider element SL, the scan box SB area is indicated by a rectangular area of, for example, a dashed, dotted, solid, or other line style. This visualization of the scan box SB adjusts to the position of the sliding element, as shown in Figure 2. At any given moment, the scan box indicated by a solid line is associated with one position of the slider element SL, but as the slider SL is moved, the scan box also moves to the next position indicated by a dashed line.

[0134] One end of the scanbox, for example, its edge / plane, passes through the currently indicated slider element SL. The end portion of the scanbox defines a 3D subset within the image region along the rotation / imaging axis Z direction from which the tracker projection image r(t) is acquired, once the appropriate location in the monitoring region (indicated by slider SL) is found. The monitoring region is contained within the scanbox, preferably within its edge / end. By default, the scanbox is selected within the volume to include the TAF and, preferably, one or more landmark ANAj, according to the applicable scan protocol. In this way, by graphically displaying the scanbox SB simultaneously with the underlying segmentation and the position of slider SL, the user can better evaluate or understand the imaging operations that need to be performed.

[0135] Therefore, in embodiments of this specification, it is assumed that the planning of the bolus tracking m-ROI can be combined with the synchronization planning of the reconstruction box SB. Since it is usually preferable to start the scan from the bolus tracking position so that there is no need to change the table position before starting the scan, the manipulation of the ROI position can be combined with the definition of an upper reconstruction box limit or a lower reconstruction box limit.

[0136] Depending on the selected protocol and target anatomical structure, the user can use the UI to position the slider SL of the bolus m-ROI around the midline CL of the aortic wall W at the top or bottom of the plan box SB. Ideally, this positioning allows scanning to begin at each start / end position of the target organ TAF, avoiding the need to move the table to cover the entire target organ.

[0137] The scan box size, including its lower and upper edges, can be estimated by the ML model M used in the Surveillance Area Finder (MRF). This model estimates not only the m-ROI m0 but also the applicable scan box size. Alternatively, the scan box size is identified in the imaging protocol, obtained from the graphics display generator (GDG), and used to render the scan box as shown in Figure 7. Alternatively, the scan box SB can be manually marked out graphically by the user using the user interface (UI). Yet another method is for vascular segmentation (SEG), along with vascular segmentation (VS), to estimate the scan box. Image protocol information may be used as contextual information for this estimation.

[0138] In some embodiments, the operation of positioning the slider SL to its final position can automatically initiate scanning at each start / end position of the target organ according to the scan box SB (in interaction with the monitoring system MS), avoiding the movement of the table PS that may be required to cover the entire target organ TAF.

[0139] Thus, in this embodiment, the reconfiguration box SB plan can be combined with the adjustment of the bolus tracking position m according to the user interface UI.

[0140] From the disclosure herein, it will be understood that Figures 6 and 7 are highly schematic and merely illustrative of embodiments. Thus, the specific configuration and rendering of the slider SL, such as the vascular / organ segmentation, centerline CL, wall W, and pop-up CL1–3, are illustrative, and any modification of these elements is also envisioned herein, insofar as it supports the aforementioned advantages and guiding functions of enabling the rapid, consistent, and reproducible placement of the monitored region m–ROI in a (preferably 3D) survey scan.

[0141] Referring now to Figure 8, Figure 8 shows a flowchart illustrating how to facilitate the contrast agent-assisted imaging protocol, particularly when locating and adjusting the position and extent of the monitoring area, based on the graphics display generator and its graphics display described above. However, it should be understood that the procedures described below are not necessarily tied to the system described above.

[0142] In step S810, the segmentation s of the target vessel VS within the survey low-dose reconstructed volume V0 is received, along with an initial indication of the monitoring location for this segmentation. The survey low-dose reconstructed volume V0 may also be received.

[0143] In step S820, a segmentation indicating the current monitoring location is visualized graphically against the view of survey volume V. This can be done, for example, as an overlay graphic on the survey image. The current location of the bolus monitoring area may be indicated by a slider graphic element LS having a shape (ellipse, circle, etc.) that matches the width and size of the segmentation at the current location. It is preferable to place the slider S GUI widget within the segmentation.

[0144] In step S830, the event handler listens for a request issued by the user to change the location of the current monitoring area.

[0145] When such a request is received, the monitoring location is changed accordingly by changing the position of the slider in step S840.

[0146] Preferably, a user request for a slider position change received in S840 is modified so that the apparent movement of the graphical slide element from its current position on the segmentation to the newly requested position is restricted to moving only along the segmentation. Thus, the repositioning operation is locked in the tangential direction of each segmentation centerline. Therefore, the slider moves to the new position along the centerline. Components in other directions within the request are transformed (e.g., by projection) to act only along the centerline of the elongated segmentation region / volume of the vessel.

[0147] Optionally, in step S840, the size (such as width) of the graphical indicator shape in the monitoring area is automatically adjusted to change according to the segmentation width, so that the graphical slider SL always stays within the segmentation boundary. Preferably, the size expands or contracts in response to the variation in segmentation width, so that the slider SL slides along the segmentation boundary as rendered in the visualization and makes contact with it from within the boundary.

[0148] In step S850, a graphics display is rendered, which may include one or more additional visualizations as needed, such as scan boxes for later tracker images, information on the bolus's arrival / passage and / or distance to landmarks, and individual graphic displays of the vessel wall (outline, highlights, etc.).

[0149] Landmark distance and pass / arrive time are calculated relative to the current position of the monitoring area according to the configured slider.

[0150] Scan boxes may be displayed as graphical indicators such as rectangles or squares. Scan boxes mark the region domains from which projection data is acquired for track image and / or final contrast image acquisition. The scan box volume includes the monitoring region, the target anatomical feature TAF, and optionally one or more landmarks. This visualization of the scan box is preferably rendered to change in response to changes in the required position of the monitoring region. Preferably, one of the edges of the scan box, for example, one side of the edge of a rectangular representation, is rendered and positioned to pass through the currently indicated position of a slider element.

[0151] Step S850, which renders the graphics display, may also include a dedicated visualization of the vascular boundary (separate from the main segmentation visualization).

[0152] After one or more requests to change the location of the monitoring area, the appropriate position / size / orientation of the monitoring area m-ROI is established, a corresponding approval signal is issued in step S860, the coordinates of the currently indicated position of slider SL are passed to the imaging device, and acquisition of a low-dose tracker projection image and its reconstruction at that position is requested, and in step S870 a series of tracker images are generated so that changes in image values ​​due to the arrival of a bolus at that position can be monitored.

[0153] In step S880, the tracker image at the indicated location is monitored, and changes in image values ​​indicating the imminent arrival of a bolus are identified.

[0154] In step S870, if it is determined that a sufficient amount of contrast agent has accumulated until the contrast agent concentration of the downstream target anatomical feature TAF enters a plateau phase PP, a second signal for acquiring projection data is issued in step S890, and a fully contrast-enhanced diagnostic projection image is acquired at a higher dose, allowing for the reconstruction of the contrast-enhanced target image volume V in step S900.

[0155] The segmenter SEG used to compute the (vascular VS) segmentation of the survey image V0 may be ML-based. In the ML approach, an ML model (such as a convolutional neural network (CNN)) is trained on training data. The training data may include survey input images x. Survey input images x, like other survey images, have very low contrast, and even human experts are not always able to reliably annotate the m-ROIs of ground truth. In such situations, the training data generation system can operate to generate pairs of training data (x, y) based on noise simulation, as follows: The set of existing historical 3D diagnostic images (spectral or non-spectral images) of the body part of interest to be trained on the model is localized into database queries in a medical database such as PACS. Such diagnostic images allow clinicians to easily create annotations to define the location and extent of the m-ROIs. Next, the high IQ (image quality) of the diagnostic images used for annotation is artificially reduced by simulating noise and adding this noise to the diagnostic images, simulating the low-dose effect in the survey images and obtaining artificially generated samples that fairly accurately represent instances of the survey volume. Thus, the noise-corrupted 3D image samples serve as training input x, and the annotations of the high-quality images serve as the associated ground truth y. Therefore, the training data generation system includes a noise simulator and a noise adder, and as mentioned above, can generate the required number of training data pairs. However, as stated above, the facilitator system FS can be used with any segmenter system, whether ML-based or not.

[0156] The components of the facilitator system FS are implemented as one or more software modules and run on one or more general-purpose processing unit PUs, such as workstations associated with the imager IA, or on server computers associated with a group of imagers.

[0157] Alternatively, some or all components of the facilitator system FS may be arranged in hardware integrated into the imaging system IA as a appropriately programmed microcontroller or microprocessor such as an FPGA (Field Programmable Gate Array), or as a hardwired IC chip or application-specific integrated circuit (ASIC). In yet another embodiment, the facilitator system FS may be implemented partially in software and partially in hardware.

[0158] The various components of the Facilitator System (FS) can be implemented on a single Data Processing Unit (PU). Alternatively, several or more components may be implemented on different PUs, remotely located in a distributed architecture, and connected to appropriate communication networks such as cloud or client-server configurations.

[0159] One or more features described herein may be configured or implemented as, or using, circuits encoded in a computer-readable medium, and / or combinations thereof. Circuits include discrete circuits and / or integrated circuits, systems on a chip (SOC), and combinations thereof, machines, computer systems, processors and memory, computer programs, and the like.

[0160] In another exemplary embodiment of the present invention, a computer program or computer program element is provided, which is configured to perform a method step of a method according to one of the above embodiments on a suitable system.

[0161] Accordingly, the computer program elements may be stored in a computer unit which may be part of an embodiment of the present invention. This computing unit may be configured to perform or induce the execution of the steps of the method described above. Furthermore, the computing unit may be configured to operate each component of the apparatus. The computing unit may be configured to operate automatically and / or to perform user orders. The computer program may be loaded into the working memory of a data processor. Accordingly, the data processor may be equipped to perform the method of the present invention.

[0162] This exemplary embodiment of the present invention encompasses both computer programs that use the present invention from the outset and computer programs that, through updates, transform existing programs into programs that use the present invention.

[0163] Furthermore, the computer program element may provide all the steps necessary to satisfy the procedure of the exemplary embodiment of the method described above.

[0164] According to a further exemplary embodiment of the present invention, a computer-readable medium such as a CD-ROM is presented, and the computer-readable medium has computer program elements stored therein, which are described in the preceding section.

[0165] Computer programs may be stored and / or distributed on suitable media (in particular, non-temporary media, but not necessarily) such as optical storage media or solid-state media supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless telecommunication systems.

[0166] However, computer programs may be presented on a network such as the World Wide Web and can be downloaded from such a network into the working memory of a data processor. According to a further exemplary embodiment of the present invention, a medium for making a computer program element available for download is provided, and this computer program element is configured to perform a method according to one of the aforementioned embodiments of the present invention.

[0167] It should be noted that embodiments of the present invention are described with reference to different subject matter. In particular, some embodiments are described with reference to method-type claims, and other embodiments are described with reference to apparatus-type claims. However, those skilled in the art will understand from the above and below descriptions that, unless otherwise notified, any combination of features belonging to one type of subject matter, as well as any combination of features relating to different subject matter, are also disclosed in this application. However, all features can be combined to provide a greater synergistic effect than the simple sum of the features.

[0168] Although the present invention has been illustrated and described in detail in the drawings and the foregoing description, such illustrations and descriptions should be considered illustrative or descriptive and not limiting. The present invention is not limited to the disclosed embodiments. Other variations of the disclosed embodiments can be understood and achieved by those skilled in the art in carrying out the claimed invention, based on an examination of the drawings, disclosure and dependent claims.

[0169] In a claim, the word “has” does not preclude other elements or steps, and the indefinite article “a” or “an” does not preclude plurality. A single processor or other unit may perform the functions of several items mentioned in a claim. The mere fact that certain means are described in different dependent claims does not imply that combinations of these means cannot be used advantageously. No reference numeral in a claim should be construed as limiting in scope. Such reference numerals may consist of numbers, letters, or combinations of alphanumeric characters.

Claims

1. A system for facilitating tomography using contrast agents, wherein when the system is in use, An input interface for receiving a 3D survey image volume of at least a portion of a patient, acquired by a tomography device during a preparation phase prior to the contrast-assisted imaging phase, wherein the 3D survey image volume includes segmentation of blood vessels through which the contrast agent will pass during the subsequent contrast-assisted imaging phase. A graphics display generator configured to generate a graphical user interface graphics display for display on a display device, wherein the graphics display includes a visualization of the segmentation and a visualization of slider elements indicating reference positions along the segmentation, the reference positions being suitable for monitoring the presence of contrast agent accumulated in at least one target anatomical feature site during the subsequent contrast-assisted imaging stage, and the graphics display generator An event handler configured to receive user input and instruct the graphics display generator to update the graphics display so that the slider element slides along the segmentation, wherein the slider element has different reference positions, and the event handler and A system that has

2. The system according to claim 1, wherein the graphics display generator is operable to adapt the spatial range of the slider element to correspond to and change in accordance with the geometric shape of the segmentation at the different reference positions.

3. The system according to claim 1, wherein the graphics display generator is operable to lock the slider element in the direction defined by the segmentation.

4. The system according to claim 3, wherein the direction is along the center line of the segmentation.

5. The system according to claim 1, wherein the visualization of the segmentation is configured to clearly represent the wall portion of the blood vessel.

6. The system according to claim 1, wherein the graphics display generator is operable to include in the graphics display i) the distance to at least one target anatomical feature site, a) the distance to a reference position of the blood vessel corresponding to the position of the current slider element, and / or b) the distance to one or more anatomical landmarks, and / or ii) information regarding the estimated time of arrival of the contrast agent at the reference position.

7. The system according to claim 1, further comprising an output interface for passing to the imaging device one of one or more reference positions selected by the user in order to define one end of a subset of an image region in which projection data is collected by the imaging device during the imaging stage.

8. The system according to claim 7, wherein the graphics display generator is operable to generate a graphics display further including a visualization of the subset, and the slider element is positioned at one end of the visualization of the subset.

9. The system according to claim 1, comprising an output interface for instructing the imaging device to obtain a first set of projection data while a contrast agent propagates within a patient, passing one of the one or more reference positions selected by the user, and a reconstructor for reconstructing a cross-sectional tracker image in a plane passing through the selected reference position with first image quality based on the projection data.

10. The aforementioned arrival time is based on hemodynamic modeling, according to the system in claim 6.

11. The system according to claim 1, wherein the blood vessel includes at least a portion of the aorta.

12. A method for facilitating tomography using contrast agents, A step in which, in a preparation stage prior to the contrast-assisted imaging stage, a 3D survey image volume of at least a portion of the patient is received by a tomography device, wherein the 3D survey image volume includes segmentation of blood vessels through which the contrast agent will pass in the subsequent contrast-assisted imaging stage. A step of generating a graphical user interface graphics display for display on a display device, wherein the graphics display includes a visualization of the segmentation and a visualization of slider elements indicating reference positions along the segmentation, the reference positions being suitable for monitoring the presence of contrast agent accumulating in at least one target anatomical feature site during the subsequent contrast-assisted imaging step, Steps include receiving user input and instructing the graphics display to update so that the slider element slides along the segmentation, wherein the slider element indicates a different reference position, and A method having

13. An imaging arrangement comprising the system according to any one of claims 1 to 11, and one or more of the imaging device, the display device, the contrast agent delivery device for administering the contrast agent, the segmenter configured to provide the segmentation, and the bolus monitoring system.

14. A computer program configured to cause at least one processing unit to perform the method according to claim 12 when executed by the processing unit.

15. At least one computer-readable medium storing the computer program described in claim 14.

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