The method of the PCT protocol was based on our previous study (Wang et al., 2021 (link)). First, all patients underwent a non‐contrast‐enhanced CT scan on the Philips Brilliance 256‐slice spiral CT scanner after the patients had undergone an iodine anaphylaxis test and the result was negative. Second, the contrast agent (iobitridol, 350 mgI/mL) was administered rapidly (6 mL/s) via an elbow intravenous bolus injection at the elbow using an automatic injector (2 mL/kg). Third, normal saline (30 mL) was injected at the same rate. After a delay of 5 s, scanning was performed with the following parameters: 80 kV, 100 mA s, 0.4 s/cycle, 4.1 s interval, 13 cycles in total, 5 mm slice thickness, 512 × 512 matrix, 54.4 s contrast agent tracking time, and 12.8 cm coverage. Finally, the reconstructed dynamic images were transferred to the workstation for processing in the Philips Extended Brilliance Workstation using CT brain perfusion software.
Extended brilliance workstation
Manufactured by Philips
Sourced in United States, Sweden
The Extended Brilliance Workstation is a lab equipment product from Philips. It is designed to provide a comprehensive platform for various imaging and analysis tasks in research and clinical settings. The core function of the workstation is to enable efficient data management, processing, and visualization of medical images and related information.
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11 protocols using extended brilliance workstation
1
Contrast-Enhanced CT Brain Perfusion Protocol
2
Esophageal Tumor Metabolic Delineation
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SUVs were calculated using an elliptical region of interest (ROI) drawn around the area of increased uptake within the esophagus. The maximum SUV was recorded as the SUVmax. MTV was defined as the volume of hyper-metabolic tissue with an SUV greater than a defined threshold of 2.5 [25 , 26 ].
Using an automatic rigid registration algorithm based on CT scan information, failure PET/CT images were fused to initial PET/CT images on the Philips extended brilliance workstation. If the automatic registration showed a large deformation between the two CT scans, the images were manually registered on the surrounding anatomy of the tumor. On initial PET/CT images, the pre-subvolume was delineated using a relative threshold method (40%, 50%, 60%, and 70% of primary tumor SUVmax) as Pre40%, Pre50%, Pre60%, and Pre70%, respectively. On failure PET/CT images, an SUV threshold of 2.5 was used to delineate LF volume. 90% SUVmax was used to delineate the failure region hotspot. The overlap fraction (OF) of the primary tumor was calculated as pre-subvolume ∩ failure subvolume / Vmin, where ∩ denotes the intersection, and Vmin is the smaller of these two subvolumes [18 ].
Using an automatic rigid registration algorithm based on CT scan information, failure PET/CT images were fused to initial PET/CT images on the Philips extended brilliance workstation. If the automatic registration showed a large deformation between the two CT scans, the images were manually registered on the surrounding anatomy of the tumor. On initial PET/CT images, the pre-subvolume was delineated using a relative threshold method (40%, 50%, 60%, and 70% of primary tumor SUVmax) as Pre40%, Pre50%, Pre60%, and Pre70%, respectively. On failure PET/CT images, an SUV threshold of 2.5 was used to delineate LF volume. 90% SUVmax was used to delineate the failure region hotspot. The overlap fraction (OF) of the primary tumor was calculated as pre-subvolume ∩ failure subvolume / Vmin, where ∩ denotes the intersection, and Vmin is the smaller of these two subvolumes [18 ].
3
Simplified Metabolic Staging of Lung Cancer
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Images were interpreted by two nuclear medicine physicians with 6 and more than 10 years of experience with PET/CT in lung cancer, respectively. All suspected malignant lesions were recorded to determine a simplified metabolic TNM stage. The metabolic TNM stages were defined as: a primary tumour (T+ or T−), suspected malignant intrathoracic lymph nodes (N+ or N−), or distant metastases (M+ or M−). The reviewers evaluated the scans in a blinded fashion without knowledge of the PET/CT scanner, clinical history, sex, age, and patient outcome. The latest diagnostic CT or referral information was available on request for all patients when the findings were difficult to interpret on the PET examination, for example to better determine if lesions were malignant or inflammatory. Information was given in 7 cases. All PET/CT images were evaluated on an Extended Brilliance Workstation version V4.5.3.40140 (Philips Healthcare, Cleveland, OH, USA).
The histology results from endobronchial ultrasound with real-time-guided transbronchial needle aspiration (EBUS-TBNA), surgery, and biopsies were collected from the patients’ medical records when available and compared to the results from the simplified TNM staging (9 patients).
The histology results from endobronchial ultrasound with real-time-guided transbronchial needle aspiration (EBUS-TBNA), surgery, and biopsies were collected from the patients’ medical records when available and compared to the results from the simplified TNM staging (9 patients).
4
Cardiac CT Imaging Protocol for Atherosclerosis Assessment
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Cardiac computed tomography was performed using a 64-MDCT scanner (Philips Brilliance 64, Philips Medical System, Best, Netherlands). A β-blocker (40-80 mg of propranolol hydrochloride; Pranol, Dae Woong, Seoul, Korea) was administered orally 1 hour before the scan, to decrease the heart rate of women with a heart rate of ≥70 beats/min. Image reconstruction was performed on the scanner's workstation using commercially available software (Extended Brilliance Workstation, Philips Medical System). Coronary atherosclerosis was defined as any size of calcified, or non-calcified, atherosclerotic plaque with luminal narrowing.
5
Hybrid Imaging Workstations Evaluation
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To be consistent with the manufacturers' indications and with the typical clinical scenarios, the hybrid studies were assessed with the workstations recommended by each of the manufacturers. Therefore, PET-CT images were co-registered, fused by and evaluated at a dedicated workstation (Extended Brilliance Workstation; Philips) and a picture archiving and communication system (IDS7; Sectra, Linkoping, Sweden); whereas PET-MR images were fused by and evaluated at a dedicated workstation (Syngo.via; Siemens Healthcare, Erlangen, Germany) and the aforementioned picture archiving and communication system.
6
Optimized CTA and CTP Imaging Protocols
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The protocols for CTA and CTP imaging have been reported previously [18 (link), 20 (link)].
All CTA and CTP imaging were performed with 40–320 detector CT scanners (Philips, Best, the Netherlands; Siemens, Erlangen, Germany; GE, Little Chalfont, United Kingdom; Toshiba, Otawara-shi, Japan) covering at least both ASPECTS levels. The CTP scans were performed with 80 kV, 150 mA, and 0.625 mm slice thickness: 40 ml of non-ionic contrast material followed by 40 ml of saline was injected with a flow of 6 ml/s. Images were acquired every 2 s for 50 s after the initiation of contrast injection. The thin slice acquisition is directly reconstructed to 5 mm slice thickness on the CT scanner with no overlap. Using commercially available post-processing software (Extended Brilliance Workstation version 4.5, Philips Healthcare), temporal maximum intensity projections (tMIP) of the 5 mm slices were made by detecting the pixel with the highest attenuation across all time frames on each slice. This enhances the visibility of all vessels within the acquired time frames and results in images similar to CTA, only timing-independent [16 (link)]. The CTA was acquired from the aortic arch to the cranium vertex using 50–70 ml of contrast material followed by 40 ml of saline with a flow of 6 ml/s.
All CTA and CTP imaging were performed with 40–320 detector CT scanners (Philips, Best, the Netherlands; Siemens, Erlangen, Germany; GE, Little Chalfont, United Kingdom; Toshiba, Otawara-shi, Japan) covering at least both ASPECTS levels. The CTP scans were performed with 80 kV, 150 mA, and 0.625 mm slice thickness: 40 ml of non-ionic contrast material followed by 40 ml of saline was injected with a flow of 6 ml/s. Images were acquired every 2 s for 50 s after the initiation of contrast injection. The thin slice acquisition is directly reconstructed to 5 mm slice thickness on the CT scanner with no overlap. Using commercially available post-processing software (Extended Brilliance Workstation version 4.5, Philips Healthcare), temporal maximum intensity projections (tMIP) of the 5 mm slices were made by detecting the pixel with the highest attenuation across all time frames on each slice. This enhances the visibility of all vessels within the acquired time frames and results in images similar to CTA, only timing-independent [16 (link)]. The CTA was acquired from the aortic arch to the cranium vertex using 50–70 ml of contrast material followed by 40 ml of saline with a flow of 6 ml/s.
7
PET-CT Imaging Fusion Protocol
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The PET images and CT images were separately reconstructed using row action maximum likelihood algorithm iterative reconstruction technique and displayed in transaxial, sagittal, and coronal planes. Fusion software was used to fuse the images accurately that was then viewed on the Philips extended brilliance workstation displaying maximal intensity projection images, PET images, CT images and fused PET-CT images. Maximum standardized uptake values were automatically generated by the software. The study was reviewed independently by two experienced nuclear medicine physicians and a radiologist.
8
Failure FDG PET/CT Imaging Protocol
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All patients underwent an initial PET/CT scan for tumor staging and therapy planning. A “failure” FDG PET/CT (failure PET/CT) was performed for patients with pathologically established treatment failure. FDG PET/CT scans were obtained with an advanced PET/CT scanner (Discovery LS; GE Healthcare, Waukesha, WI, USA). All patients fasted for at least 6 h before the examination, and blood glucose levels were recorded before injection of 5.50 MBq/kg of FDG. Images were acquired 60 min after injection. Scanning was performed in whole-body mode from head to thigh for 5 min per field of view, each covering 14.5 cm, at an axial sampling thickness of 4.25 mm per slice. Unenhanced CT scan was performed with an X-ray tube voltage peak of 120 kV, 90 mA, a 6:1 pitch, a slice thickness of 4.25 mm, and a rotational speed of 0.8 sec per rotation. Both PET and CT scans were performed with patients under normal shallow respiration. PET data sets were reconstructed iteratively using CT data for attenuation correction. PET, CT, and fused PET/CT images displayed as coronal, sagittal, and transaxial slices were viewed on the Philips extended brilliance workstation.
9
Cardiac CT Imaging Protocol
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Cardiac computed tomography (CT) was performed using a 64-multidetector-row CT (MDCT) scanner (Philips Brilliance 64; Philips Medical System, Best, the Netherlands). In women with a heart rate of ≥ 70 beats/minute, a β-blocker (40-80 mg of propranolol hydrochloride; Pranol, Dae Woong, Seoul, Korea) was administered orally 1 hour before the scan. Images were reconstructed on the scanner's workstation using commercially available software (Extended Brilliance Workstation, Philips Medical System). Coronary atherosclerosis was defined if there is any size of calcified, or non-calcified, atherosclerotic plaque with luminal narrowing.
10
Multimodal Imaging for Aortic Assessment
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