Endorectal digital prostate tomosynthesis (endoDPT): a proof-of-concept study

In this study we present endorectal digital prostate tomosynthesis (endoDPT), a proposed method of high resolution prostate imaging using an endorectal x-ray sensor and an external x-ray source. endoDPT may be useful for visualizing the fine detail of small structures such as low dose rate brachytherapy (LDRBT) seeds that are difficult to visualize with current methods. The resolution of endoDPT was characterized through measurement of the modulation transfer function (MTF) and artifact spread function (ASF) in computational and physical phantoms. The qualitative resolution of endoDPT was assessed relative to computed tomography (CT) through imaging of LDRBT seeds implanted inex vivocanine prostates. The x-ray sensor MTF reached 10% at 11.50 mm^-1, the reconstruction algorithm MTF reached a maximum at 7.08 mm^-1, and the ASF was 2.5 mm (full-width at half-maximum). Fine structures in LDRBT seeds like the 0.05 mm thick shell were visible with endoDPT but not CT. All endoDPT images exhibited an overshoot artifact. The measured MTFs were consistent with other studies using similar x-ray sensors and demonstrated improved resolution compared to digital breast tomosynthesis; this result was due to the smaller endoDPT x-ray sensor detection element size and quantitatively demonstrates the high resolution of endoDPT. The ASF demonstrated worse depth resolution compared to in-plane resolution, due to partial angular sampling; partial angular sampling also caused the observed overshoot artifact in the endoDPT images. However, endoDPT still was able to visualize fine structures such as the LDRBT seed shell to a much higher degree than CT. This high-resolution visualization may be useful for improvements in patient specific LDRBT dosimetry. Overall, these results indicate endoDPT is capable of high in-plane spatial resolution and is thus well poised for optimization and studies assessing clinical utility.