Evaluation of computed tomography metal artifact and CyberKnife fiducial recognition for novel size fiducial markers.

Abstract

This study aimed to compare fiducial markers used in CyberKnife treatment in terms of metal artifact intensity observed in CT images and fiducial recognition in the CyberKnife system affected by patient body thickness and type of marker. Five markers, ACCULOC 0.9mm×3mm, Ball type Gold Anchor (GA) 0.28mm×10mm, 0.28mm×20mm, and novel size GA 0.4mm×10mm, 0.4mm×20mm were evaluated. To evaluate metal artifacts of CT images, two types of CT images of water-equivalent gels with each marker were acquired using Aquilion LB CT scanner, one applied SEMAR (SEMAR-on) and the other did not apply this technique (SEMAR-off). The evaluation metric of artifact intensity (MSD ) which represents a variation of CT values were compared for each marker. Next, 5, 15, and 20cm thickness of Tough Water (TW) was placed on the gel under the condition of overlapping the vertebral phantom in the Target Locating System, and the live image of each marker was acquired to compare fiducial recognition. The mean MSD of SEMAR-off was 78.80, 74.50, 97.25, 83.29, and 149.64 HU for ACCULOC, GA0.28mm×10mm, 20mm, and 0.40mm×10mm, 20mm, respectively. In the same manner, that of SEMAR-on was 23.52, 20.26, 26.76, 24.89, and 33.96 HU, respectively. Fiducial recognition decreased in the order of 5, 15, and 20cm thickness, and GA 0.4×20mm showed the best recognition at thickness of 20cm TW. We demonstrated the potential to reduce metal artifacts in the CT image to the same level for all the markers we evaluated by applying SEMAR. Additionally, the fiducial recognition of each marker may vary depending on the thickness of the patient's body. Particularly, we showed that GA 0.40×20mm may have more optimal recognition for CyberKnife treatment in cases of high bodily thickness in comparison to the other markers.