Quantitative analysis

ImSimQA contains all the quantitative analysis tools recommended by TG 132 and provides an extensive, fully customisable library of digital, or virtual phantoms both geometric and anthropomorphic. Additionally, any patient or phantom image can be imported as DICOM and then edited to re-create the precise clinical scenario which will differ across a range of clinical techniques, imaging devices, and from clinic to clinic.

ImSimQA Benefits

“Test without the hard phantom, test without the scanner”

  • Extensively tests and validates modern radiotherapy systems in a way not possible with hard phantoms
  • Increases accuracy of testing
  • Provides a cost-effective toolkit of multiple phantoms
  • Offers flexible and infinite scope for test scenarios
  • Reduces the time needed to acquire test images on busy CT/MR/PET scanners, 4D and IGRT imaging systems

This the underlying software to which optional modules can be added. This module includes a virtual phantom library, manipulation of DICOM-3 images and the creation of new DICOM images for testing clinical applications.

Virtual phantom library

The virtual phantom library contains a library of 25 3D anatomical and geometric virtual phantoms, all of which can be extensively edited and exported as DICOM-3 images, to create uniquely customisable phantoms which offer an infinite range of testing potential. All virtual phantoms can be transformed, deformed, re-orientated, structure density changed etc, to create DICOM-3 series in CT, simulated MR and PET which are then exported to the test application. DICOM headers can be edited. Parameters such as slice spacing and FOV can be modified in the exported DICOM-3 series.


Manipulation of DICOM-3 images

DICOM-3 images of any modality can be imported, edited and exported as new DICOM series. Supported modalities include CT, MR, PET, MVCT and cone beam CT. RT Structure Sets can be imported, and edited prior to export. A selection of noise patterns can be added to images.
DICOM images can be globally translated, rotated, and re-scaled under controlled conditions to assist with systematic validation of clinical systems.
More extensive deformations can be applied using the ImSimQAdform module.


Testing image registration algorithms without the scanner

ImSimQA is used to test rigid and deformable image registration algorithms found in today’s image fusion packages, IGRT treatment machines, auto-contouring and dose mapping in treatment planning applications.

For image registration testing, varying setups of an initial DICOM image series can be created, without having to use valuable scanner time to create multiple scans for testing. Initial high-resolution images e.g. 1mm slice spacing can be resampled to 2,3,5mm etc and exported to test the effect of slice resolution. RT Structure outlines can be edited, and structure densities can be allocated a new density prior to export – to test the effect of density differences on image registration accuracy.

Editing Real DICOM Images

Editing DICOM images imported into ImSimQA is a powerful way of creating an infinite range of new test scenarios, without needing to re-scan or source patient images, yet apply systematic changes in a scientific and methodical fashion.

Any DICOM-3 image modalities such as CT, MR, PET, and radiation therapy images such as MVCT and CBCT, can be imported and extensively edited.

DICOM parameter editing

DICOM header and image acquisition parameters such as name, UID, slice and FOV resolution can be edited and new parameters saved for export.

Density changes and RT Structures

An imported CT series with associated RT Structures can easily be edited to change the density of a contoured structure such as the bladder. A user-defined Hounsfield value can be assigned and the newly created images exported for testing. An example of this would be to apply a density for contrast media to the bladder in an IGRT-CBCT or planning CT image series, to test how image registration and fusion software performs with varying densities.

Virtual Phantom Library & Editing

ImSimQA provides a toolkit of 15 virtual phantoms that can be extensively edited and transformed, before being converted to DICOM CT, MR & PET simulated images. With the ability to add noise, change density, change slice spacing and re-orientate, the phantom DICOM images are then exported to the test application, minimising the use of the real scanner, and increasing the efficiency of testing. Real DICOM images can also be imported into ImSimQA for editing, without having to continually re-scan.

mSimQAdform allows users to implement the requirements of the AAPM Task Group 132 report on the ‘Image Registration and Fusion Algorithms and Techniques in Radiotherapy’. The user can create deformed changes to virtual or real image structures. Deformations can be local or global and applied to any user-defined anatomy or object. Once deformations have been applied, static or 4D image series of CT/MR/PET can be created and exported to a 3rd party system for testing of, for example, image fusion software. Examples could include CT-CBCT IGRT image matching assessing daily anatomy changes; CT-MR image fusion of pre and post-operative images; image fusion of MR images on curved couches – CT image on flat couch tops. 


ImSimQAdform users also have access to an additional library of 10 original and deformed synthetic head and neck phantoms created where the deformed dataset is based on actual anatomical changes seen during the radiotherapy treatment course. From these, a ground truth deformable vector field (DVF) was created for each phantom. This allows the phantoms to be used to assess the accuracy and precision of the DIR algorithm in any available system, with clinically relevant data. This was developed through work with clinical partners.

As well as creating ground truth deformed datasets for testing your clinical system. ImSimQA can also be used to compare the ground truth deformation with the clinical dataset.

Comparisons can be made in 4 ways:

  1. Direct comparison of CT images visually and quantitatively using Mutual Information and correlation coefficient.
  2. Contour Analysis Comparison
  3. Comparison of the ground truth and clinical deformation vector fields (DVFs).
  4. Jacobian matrix display (pictured below).

Deforming Images & Structures

Access to scanners for obtaining test images, either of phantoms or patients, can be challenging due to high clinical demand. ImSimQA can import DICOM-3 image series of any imaging modality, plus import DICOM RT Structure sets associate typically with CT data.

Once an initial set of images are imported, they can be extensively edited e.g. slice spacing, FOV changed but can be manipulated and deformed to produce newly created image series and RT structures that can be exported to a test application. A typical example would be to deform an MR image series and export it along with a reference CT series to image registration and fusion application, commonly used in radiation therapy and medical imaging. The test application would then perform its image registration, acting typically to transform (for rigid image registration) or deform (for deformable image registration) the MR. The capability within ImSimQA to generate an infinite range of new test images will provide the physicist or clinician, with a powerful tool to test the performance and limitations of the image registration software in clinical use.

Oncology Systems Limited’s ImSimQA can further re-import the generated images from an image registration or auto-contouring application, and perform quantitative testing on the resulting images, to report and analyse the goodness of matching, and visually highlight areas of mismatch.

Deforming and Transforming Images

Virtual markers can be inserted into any modality image, mapped to a new location, and a local or global deformation applied. New realistic clinical scenarios can be created to produce new images that can be exported to test rigid and deformable image registration, auto-contouring, auto-margining algorithms plus a wide range of medical and oncology imaging systems that reconstruct images or handle image data generated at different points in time when a patient’s anatomy would have changed.

Create 4D image series for testing 4D RTP and gating systems.

ImSimQA4d creates 4D image series of phantoms quickly and effortlessly, using the 4D Phase Wizard. Create multiple phases of whole phantoms or individual phantom structures. Export newly created DICOM image series to test 4D simulation, planning and gating systems.

Imported RPM – phantom plus CT

Step 1: Select ImSimQA thorax virtual phantom

Step 2: Apply motion from imported RPM or manually select motion patterns

Step 3: Export ImSimQA created images as 4D CT DICOM-3 series to test application

ImSimQAcontour compares and analyses pairs of imported contours from radiation therapy applications.

Analyse application performance, compare users

This module has been designed to analyse the performance of automatic contouring/segmentation algorithms commonly found in radiation therapy applications, and also to compare the performance of that personnel involved in the contouring process, such as radiation oncologists and dosimetrists.

Qualitative visualisation and quantifiable metrics are reported and presented for fast and efficient analysis.

Typically, this module is suited to testing atlas-based automatic segmentation performance, general RTP automatic contouring software, to compare operator contouring performance against a gold standard and inter-operator variability. A range of metrics are included such as Conformity Index, Mean Distance to Conformity and Centre of Gravity, all of which provide results of precisely where and by how much contours vary.