Gaussian weighted projection for visualization of cardiac calcification

At our institution, we are using dual-energy digital radiography (DEDR) as a cost-effective screening tool for the detection of cardiac calcification. We are evaluating DEDR using CT as the gold standard. We are developing image projection methods for the generation of digitally reconstructed radiography (DRR) from CT image volumes. Traditional visualization methods include maximum intensity projection (MIP) and average-based projection (AVG) that have difficulty to show cardiac calcification. Furthermore, MIP can over estimate the calcified lesion as it displays the maximum intensity along the projection rays regardless of tissue types. For AVG projection, the calcified tissue is usually overlapped with bone, lung and mediastinum. In order to improve the visualization of calcification on DRR images, we developed a Gaussian-weighted projection method for this particular application. We assume that the CT intensity values of calcified tissues have a Gaussian distribution. We then use multiple Gaussian functions to fit the intensity histogram. Based on the mean and standard deviation parameters, we incorporate a Gaussian weighted function into the perspective projection and display the calcification exclusively. Our digital and physical phantom studies show that the new projection method can display tissues selectively. In addition, clinical images show that the Gaussian-weighted projection method better visualizes cardiac calcification than either the AVG or MIP method and can be used to evaluate DEDR as a screening tool for the detection of coronary artery diseases.