kV-CBCT Imaging Research Articles

Assessment of image quality and dose calculation accuracy on kV CBCT, MV CBCT, and MV CT images for urgent palliative radiotherapy treatments.

A clinical workflow was developed for urgent palliative radiotherapy treatments that integrates patient simulation, planning, quality assurance, and treatment in one 30‐minute session. This has been successfully tested and implemented clinically on a linac with MV CBCT capabilities. To make this approach available to all clinics equipped with common imaging systems, dose calculation accuracy based on treatment sites was assessed for other imaging units. We evaluated the feasibility of palliative treatment planning using on‐board imaging with respect to image quality and technical challenges. The purpose was to test multiple systems using their commercial setup, disregarding any additional in‐house development. kV CT, kV CBCT, MV CBCT, and MV CT images of water and anthropomorphic phantoms were acquired on five different imaging units (Philips MX8000 CT Scanner, and Varian TrueBeam, Elekta VersaHD, Siemens Artiste, and Accuray Tomotherapy linacs). Image quality (noise, contrast, uniformity, spatial resolution) was evaluated and compared across all machines. Using individual image value to density calibrations, dose calculation accuracies for simple treatment plans were assessed for the same phantom images. Finally, image artifacts on clinical patient images were evaluated and compared among the machines. Image contrast to visualize bony anatomy was sufficient on all machines. Despite a high noise level and low contrast, MV CT images provided the most accurate treatment plans relative to kV CT‐based planning. Spatial resolution was poorest for MV CBCT, but did not limit the visualization of small anatomical structures. A comparison of treatment plans showed that monitor units calculated based on a prescription point were within 5% difference relative to kV CT‐based plans for all machines and all studied treatment sites (brain, neck, and pelvis). Local dose differences >5% were found near the phantom edges. The gamma index for 3%/3 mm criteria was ≥95% in most cases. Best dose calculation results were obtained when the treatment isocenter was near the image isocenter for all machines. A large field of view and immediate image export to the treatment planning system were essential for a smooth workflow and were not provided on all devices. Based on this phantom study, image quality of the studied kV CBCT, MV CBCT, and MV CT on‐board imaging devices was sufficient for treatment planning in all tested cases. Treatment plans provided dose calculation accuracies within an acceptable range for simple, urgently planned palliative treatments. However, dose calculation accuracy was compromised towards the edges of an image. Feasibility for clinical implementation should be assessed separately and may be complicated by machine specific features. Image artifacts in patient images and the effect on dose calculation accuracy should be assessed in a separate, machine‐specific study.PACS number(s): 87.55.D‐, 87.57.C‐, 87.57.Q‐

Dosimetric impact of setup errors in head and neck cancer patients treated by image-guided radiotherapy.

To assess and analyze the impact of setup uncertainties on target volume coverage and doses to organs at risk (OAR) in head and neck cancer (HNC) patients treated by image-guided radiotherapy (IGRT). Translational setup errors in 25 HNC patients were observed by kilovoltage cone beam computed tomography (kV CBCT). Two plans were generated. Plan one – the original plan which was the initially optimized and approved plan of the patient. All patients were treated according to their respective approved plans at a defined isocenter. Plan two – the plan sum which was the sum of all plans recalculated at a different isocenter according to setup errors in x, y, and z-direction. Plan sum was created to evaluate doses that would have been received by planning target volume (PTV) and OARs if setup errors were not corrected. These 2 plans were analyzed and compared in terms of target volume coverage and doses to OARs. A total 503 kV CBCT images were acquired for evaluation of setup errors in 25 HNC patients. The systematic (mean) and random errors (standard deviation) combined for 25 patients in x, y, and z directions were 0.15 cm, 0.21 cm, and 0.19 cm and 0.09 cm, 0.12 cm, and 0.09 cm, respectively. The study showed that there was a significant difference in PTV coverage between 2 plans. The doses to various OARs showed a nonsignificant increase in the plan sum. The correction of translational setup errors is essential for IGRT treatment in terms of delivery of planned optimal doses to target volume.

Dosimetric consequences of tumor volume changes after kilovoltage cone-beam computed tomography for non-operative lung cancer during adaptive intensity-modulated radiotherapy or fractionated stereotactic radiotherapy

Abstract Objective The aim of this study was to investigate tumor volume changes with kilovoltage cone-beam computed tomography (kV-CBCT) and their dosimetric consequences for non-operative lung cancer during intensity-modulated radiotherapy (IMRT) or fractionated stereotactic radiotherapy. Methods Eighteen patients with non-operative lung cancer who received IMRT consisting of 1.8-2.2 Gy/fraction and five fractions per week or stereotactic radiotherapy with 5-8 Gy/fraction and three fractions a week were studied. kV-CBCT was performed once per week during IMRT and at every fraction during stereotactic radiotherapy. The gross tumor volume (GTV) was contoured on the kV-CBCT images, and adaptive treatment plans were created using merged kV-CBCT and primary planning computed tomography image sets. Tumor volume changes and dosimetric parameters, including the minimum dose to 95% (D95) or 1% (D1) of the planning target volume (PTV), mean lung dose (MLD), and volume of lung tissue that received more than 5 (V5), 10 (V10), 20 (V20), and 30 (V30) Gy were retrospectively analyzed. Results The average maximum change in GTV observed during IMRT or fractionated stereotactic radiotherapy was -25.85% (range, -13.09% - -56.76%). The D95 and D1 of PTV for the adaptive treatment plans in all patients were not significantly different from those for the initial or former adaptive treatment plans. In patients with tumor volume changes of >20% in the third or fourth week of treatment during IMRT, adaptive treatment plans offered clinically meaningful decreases in MLD and V5, V10, V20, and V30; however, in patients with tumor volume changes of < 20% in the third or fourth week of treatment as well as in patients with stereotactic radiotherapy, there were no significant or clinically meaningful decreases in the dosimetric parameters. Conclusion Adaptive treatment planning for decreasing tumor volume during IMRT may be beneficial for patients who experience tumor volume changes of >20% in the third or fourth week of treatment.

An investigation of kV CBCT image quality and dose reduction for volume-of-interest imaging using dynamic collimation.

The focus of this work was to investigate the improvements in image quality and dose reduction for volume-of-interest (VOI) kilovoltage-cone beam CT (CBCT) using dynamic collimation. A prototype iris aperture was used to track a VOI during a CBCT acquisition. The current aperture design is capable of 1D translation as a function of gantry angle and dynamic adjustment of the iris radius. The aperture occupies the location of the bow-tie filter on a Varian On-Board Imager system. CBCT and planar image quality were investigated as a function of aperture radius, while maintaining the same dose to the VOI, for a 20 cm diameter cylindrical water phantom with a 9 mm diameter bone insert centered on isocenter. Corresponding scatter-to-primary ratios (SPR) were determined at the detector plane with Monte Carlo simulation using EGSnrc. Dose distributions for various sizes VOI were modeled using a dynamic BEAMnrc library and DOSXYZnrc. The resulting VOI dose distributions were compared to full-field distributions. SPR was reduced by a factor of 8.4 when decreasing iris diameter from 21.2 to 2.4 cm (at isocenter). Depending upon VOI location and size, dose was reduced to 16%-90% of the full-field value along the central axis plane and down to 4% along the axis of rotation, while maintaining the same dose to the VOI compared to full-field techniques. When maintaining constant dose to the VOI, this change in iris diameter corresponds to a factor increase of approximately 1.6 in image contrast and a factor decrease in image noise of approximately 1.2. This results in a measured gain in contrast-to-noise ratio by a factor of approximately 2.0. The presented VOI technique offers improved image quality for image-guided radiotherapy while sparing the surrounding volume of unnecessary dose compared to full-field techniques.

Weekly kilovoltage cone-beam computed tomography for detection of dose discrepancies during (chemo)radiotherapy for head and neck cancer

ABSTRACTBackground. Use of highly conformal radiotherapy in patients with head and neck carcinoma may lead to under-/overdosage of gross target volume (GTV) and organs at risk (OAR) due to changes in patients’ anatomy. A method to achieve more effective radiation treatment combined with less toxicity is dose-guided radiotherapy (DGRT). The aim of this study was to evaluate discrepancies between planned and actually delivered radiation dose in head and neck patients and to identify predictive factors.Methods. In this retrospective analysis, 20 patients with cT2-4 N0-3 M0 carcinoma originating from oropharynx, oral cavity, larynx and hypopharynx (Cohort 1), and seven patients with cT1-4 N0-3 M0 nasopharyngeal carcinoma (Cohort 2) treated with primary (chemo)radiotherapy and undergoing weekly kV-CBCT scans were included. Radiation dose was recalculated on 184 kV-CBCT images, which was quantified by D95% (GTV), Dmean (parotid and submandibular glands) and D2% (spinal cord). Predictive factors investigated for changes in these dose metrics were: gender, age, cT/N-stage, tumor grade, HPV-status, systemic therapy, body mass index at start of treatment, weight loss and volume change over the duration of the radiotherapy.Results. There was no significant difference between the planned and delivered dose for GTV and OARs of Week 1 to subsequent weeks for Cohort 1. In Cohort 2, actually delivered Dmean to parotid glands was significant higher than planned dose (1.1 Gy, p = 0.002). No clinically relevant correlations between dose changes and predictive factors were found.Conclusion. Weekly dose calculations do not seem to improve dose delivery for patients with tumors of the oral cavity, oropharynx, larynx and hypopharynx. In patients with nasopharyngeal carcinoma, however, mid-treatment imaging may facilitate DGRT.

TU-AB-303-10: KVCBCT, MVCBCT and MVCT On-Board Imaging Suitability for An Urgent Radiotherapy Treatment Workflow

Purpose: A comparison of image quality and dose calculation accuracy to study the suitability of available on-board imaging systems for a new treatment workflow in emergency radiotherapy situations. Methods: Water and anthropomorphic phantom images were acquired on four different Linac on-board imaging systems, including kVCBCT (Varian TrueBeam and Elekta VersaHD), MVCBCT (Siemens Artiste) and MVCT (Accuray Tomotherapy). Simple treatments of single or opposed beams were planned on the respective kVCT images and copied to all CT images. Image suitability for dose planning was based on the overall mean dose differences and 3D gamma index with 3%/3mm criteria for a prescription of 100 monitor units (MU) and differences in calculated MUs per plan for dose prescriptions to mid-plane. Results: TrueBeam kVCBCT and Tomotherapy MVCT images produced most accurate dose calculation for all tested cases (γ-index >95%). MVCBCT and VersaHD kVCBCT images resulted in minimum γ-passing rates of 94% and 87%, respectively. MUs calculated from treatment plans prescribed to mid-plane were within differences of 5% relative to kVCT-based plans in all cases. However, VersaHD images showed considerable local image artifacts in the pelvis water and anthropomorphic neck phantom that complicated accurate Hounsfield unit (HU) to electron density conversion, thus causing local dose differences of more than 10% relative to kVCT-based dose distributions. Conclusion: TrueBeam kVCBCT, MVCBCT and MVCT systems provide image quality that allows for accurate simple treatment plan calculation. Prescription points should be placed away from areas found to cause local dose discrepancies, such as air cavities. Improved image filter settings and HU-to-electron density calibration adjustments may be required for the VersaHD system to obtain an overall accurate dose distribution. To evaluate a system’s overall suitability, its clinical features also require consideration, such as imaging field of view, acquisition time and the ability to instantly export images for treatment planning.

SU-E-J-89: Comparative Analysis of MIM and Velocity's Image Deformation Algorithm Using Simulated KV-CBCT Images for Quality Assurance

Purpose: Deformable image registration (DIR) is used routinely in the clinic without a formalized quality assurance (QA) process. Using simulated deformations to digitally deform images in a known way and comparing to DIR algorithm predictions is a powerful technique for DIR QA. This technique must also simulate realistic image noise and artifacts, especially between modalities. This study developed an algorithm to create simulated daily kV cone-beam computed-tomography (CBCT) images from CT images for DIR QA between these modalities. Methods: A Catphan and physical head-and-neck phantom, with known deformations, were used. CT and kV-CBCT images of the Catphan were utilized to characterize the changes in Hounsfield units, noise, and image cupping that occur between these imaging modalities. The algorithm then imprinted these changes onto a CT image of the deformed head-and-neck phantom, thereby creating a simulated-CBCT image. CT and kV-CBCT images of the undeformed and deformed head-and-neck phantom were also acquired. The Velocity and MIM DIR algorithms were applied between the undeformed CT image and each of the deformed CT, CBCT, and simulated-CBCT images to obtain predicted deformations. The error between the known and predicted deformations was used as a metric to evaluate the quality of the simulated-CBCT image. Ideally, themore » simulated-CBCT image registration would produce the same accuracy as the deformed CBCT image registration. Results: For Velocity, the mean error was 1.4 mm for the CT-CT registration, 1.7 mm for the CT-CBCT registration, and 1.4 mm for the CT-simulated-CBCT registration. These same numbers were 1.5, 4.5, and 5.9 mm, respectively, for MIM. Conclusion: All cases produced similar accuracy for Velocity. MIM produced similar values of accuracy for CT-CT registration, but was not as accurate for CT-CBCT registrations. The MIM simulated-CBCT registration followed this same trend, but overestimated MIM DIR errors relative to the CT-CBCT registration.« less

SU‐E‐J‐13: Six Degree of Freedom Image Fusion Accuracy for Cranial Target Localization On the Varian Edge Stereotactic Radiosurgery System: Comparison Between 2D/3D and KV CBCT Image Registration

Purpose:To determine the 6 degree of freedom systematic deviations between 2D/3D and CBCT image registration with various imaging setups and fusion algorithms on the Varian Edge Linac.Methods:An anthropomorphic head phantom with radio opaque targets embedded was scanned with CT slice thicknesses of 0.8, 1, 2, and 3mm. The 6 DOF systematic errors were assessed by comparing 2D/3D (kV/MV with CT) with 3D/3D (CBCT with CT) image registrations with different offset positions, similarity measures, image filters, and CBCT slice thicknesses (1 and 2 mm). The 2D/3D registration accuracy of 51 fractions for 26 cranial SRS patients was also evaluated by analyzing 2D/3D pre‐treatment verification taken after 3D/3D image registrations.Results:The systematic deviations of 2D/3D image registration using kV‐ kV, MV‐kV and MV‐MV image pairs were within ±0.3mm and ±0.3° for translations and rotations with 95% confidence interval (CI) for a reference CT with 0.8 mm slice thickness. No significant difference (P>0.05) on target localization was observed between 0.8mm, 1mm, and 2mm CT slice thicknesses with CBCT slice thicknesses of 1mm and 2mm. With 3mm CT slice thickness, both 2D/3D and 3D/3D registrations performed less accurately in longitudinal direction than thinner CT slice thickness (0.60±0.12mm and 0.63±0.07mm off, respectively). Using content filter and using similarity measure of pattern intensity instead of mutual information, improved the 2D/3D registration accuracy significantly (P=0.02 and P=0.01, respectively). For the patient study, means and standard deviations of residual errors were 0.09±0.32mm, −0.22±0.51mm and −0.07±0.32mm in VRT, LNG and LAT directions, respectively, and 0.12°±0.46°, −0.12°±0.39° and 0.06°±0.28° in RTN, PITCH, and ROLL directions, respectively. 95% CI of translational and rotational deviations were comparable to those in phantom study.Conclusion:2D/3D image registration provided on the Varian Edge radiosurgery, 6 DOF‐based system provides accurate target positioning for frameless image‐guided cranial stereotactic radiosurgery.

SU-E-J-100: The Combination of Deformable Image Registration and Regions-Of-Interest Mapping Technique to Accomplish Accurate Dose Calculation On Cone Beam Computed Tomography for Esophageal Cancer

Purpose: We introduce a new method combined with the deformable image registration (DIR) and regions-of-interest mapping (ROIM) technique to accurately calculate dose on daily CBCT for esophageal cancer. Methods: Patients suffered from esophageal cancer were enrolled in the study. Prescription was set to 66 Gy/30 F and 54 Gy/30 F to the primary tumor (PTV66) and subclinical disease (PTV54) . Planning CT (pCT) were segmented into 8 substructures in terms of their differences in physical density, such as gross target volume (GTV), venae cava superior (SVC), aorta, heart, spinal cord, lung, muscle and bones. The pCT and its substructures were transferred to the MIM software to readout their mean HU values. Afterwards, a deformable planning CT to daily KV-CBCT image registration method was then utilized to acquire a new structure set on CBCT. The newly generated structures on CBCT were then transferred back to the treatment planning system (TPS) and its HU information were overridden manually with mean HU values obtained from pCT. Finally, the treatment plan was projected onto the CBCT images with the same beam arrangements and monitor units (MUs) to accomplish dose calculation. Planning target volume (PTV) and organs at risk (OARs) from both of the pCTmore » and CBCT were compared to evaluate the dose calculation accuracy. Results: It was found that the dose distribution in the CBCT showed little differences compared to the pCT, regardless of whether PTV or OARs were concerned. Specifically, dose variation in GTV, PTV54, PTV66, SVC, lung and heart were within 0.1%. The maximum dose variation was presented in the spinal cord, which was up to 2.7% dose difference. Conclusion: The proposed method combined with DIR and ROIM technique to accurately calculate dose distribution on CBCT for esophageal cancer is feasible.« less

TU-AB-303-05: Clinical Guidelines for Determining When An Adaptive Replan May Be Warranted for Head and Neck Patients

Purpose: Tools are now available to perform daily dose assessment in radiotherapy, however, guidance is lacking as to when to replan to limit increase in normal tissue dose. This work performs statistical analysis to provide guidance for when adaptive replanning may be necessary for head/neck (HN) patients. Methods: Planning CT and daily kVCBCT images for 50 HN patients treated with VMAT were retrospectively evaluated. Twelve of 50 patients were replanned due to anatomical changes noted over their RT course. Daily dose assessment was performed to calculate the variation between the planned and delivered dose for the 38 patients not replanned and the patients replanned using their delivered plan. In addition, for the replanned patients, the dose that would have been delivered if the plan was not modified was also quantified. Deviations in dose were analyzed before and after replanning, the daily variations in patients who were not replanned assessed, and the predictive power of the deviation after 1, 5, and 15 fractions determined. Results: Dose deviations were significantly reduced following replanning, compared to if the original plan would have been delivered for the entire course. Early deviations were significantly correlated with total deviations (p<0.01). Using the criteria that a 10% increase in the final delivered dose indicates a replan may be needed earlier in the treatment course, the following guidelines can be made with a 90% specificity after the first 5 fractions: deviations of 7% in the mean dose to the inferior constrictors and 5% in the mean dose to the parotid glands and submandibular glands. No significant dose deviations were observed in any patients for the CTV _70Gy (max deviation 4%). Conclusions: A 5–7% increase in mean dose to normal tissues within the first 5 fractions strongly correlate to an overall deviatios in the delivered dose for HN patients. This work is funded in part by NIH 2P01CA059827-16

IMPROVEMENT OF DOSE CALCULATION ACCURACY ON kV CBCT IMAGES WITH CORRECTED ELECTRON DENSITY TO CT NUMBER CURVE

To improve accuracy of dose calculation on kilovoltage cone beam computed tomography (kV CBCT) images, a custom-made phantom was fabricated to acquire an accurate CT number to electron density curve by full scatter of cone beam x-ray. To evaluate the dosimetric accuracy, 9 volumetric modulated arc therapy (VMAT) plans for head and neck (HN) cancer and 9 VMAT plans for lung cancer were generated with an anthropomorphic phantom. Both CT and CBCT images of the anthropomorphic phantom were acquired and dose-volumetric parameters on the CT images with CT density curve (CTCT), CBCT images with CT density curve (CBCTCT) and CBCT images with CBCT density curve (CBCTCBCT) were calculated for each VMAT plan. The differences between CTCT vs. CBCTCT were similar to those between CTCT vs. CBCTCBCT for HN VMAT plans. However, the differences between CTCT vs. CBCTCT were larger than those between CTCT vs. CBCTCBCT for lung VMAT plans. Especially, the differences in D98% and D95% of lung target volume were statistically significant (4.7% vs. 0.8% with p = 0.033 for D98% and 4.8% vs. 0.5% with p = 0.030 for D95%). In order to calculate dose distributions accurately on the CBCT images, CBCT density curve generated with full scatter condition should be used especially for dose calculations in the region of large inhomogeneity.

KV-CBCT由来の患者被ばく線量の低減(世界の放射線防護関連論文紹介(2))

kV-CBCT由来の患者被ばく線量の低減(世界の放射線防護関連論文紹介(2))

On-Board CBCT Imaging Using 2.5 MV Beam on a Radiation Therapy Linac for Metal Artifact Reduction

Purpose/Objective(s): Highly attenuating metallic objects such as dental fillings, hip/shoulder prosthesis, fiducial markers, cause severe streaking artifacts in on-board kV CBCT imaging and can lead to errors in imageguided patient setup. The purpose of this work is to reduce metal artifact in on-board CBCT imaging using new 2.5 MV beam available on a radiation therapy Linac. Materials/Methods: A head phantom with a copper bar inserted in the center was scanned with the 2.5 MV beam. With a full gantry rotation, 68 projection views were collected for a total of 20 MU. For comparison, a CBCT scan was also performed using the on-board kV imaging system. The peak voltage for kV scanning was 100 kVp. Due to the sparse projections of MV scanning, we performed iterative image reconstruction on both kV and MV data respectively. Several representative regions of interest were selected for evaluation of metal artifacts and contrast. Results: The mean CT numbers of the bright and dark metal artifacts in kV CBCT are 9000HU and -3000HU. In comparison, there are no bright metal artifacts and the mean CT number of dark metal artifacts is reduced to -460HU in MV CBCT. The mean CT numbers of the bone and metal are 1000HU, 5000HU for kV, and 380HU, 3600HU for MV. The mean CT numbers for three low contrast regions are -800HU, -600HU, -400HU for kV, and -460HU,-300HU, -100HU for MV. Conclusions: Using the new 2.5 MV beam for on-board CBCT imaging, we have significantly reduced metal artifacts compared with kV imaging, although with a decrease in soft-tissue contrast. Combining kV and MV imaging may lead to improved soft-tissue contrast with negligible metal artifact. Author Disclosure: Q. Xu: None. R. Li: None. Y. Yang: None. L. Xing: None.

Assessment of Volumetric and Dosimetric Variations for Image Guided Stereotactic Body Radiation Therapy Treatment

Assessment of Volumetric and Dosimetric Variations for Image Guided Stereotactic Body Radiation Therapy Treatment

SU‐E‐I‐72: First Experimental Study of On‐Board CBCT Imaging Using 2.5MV Beam On a Radiotherapy Linac

Purpose:Varian TrueBeam version 2.0 comes with a new inline 2.5MV beam modality for image guided patient setup. In this work we develop an iterative volumetric image reconstruction technique specific to the beam and investigate the possibility of obtaining metal artifact free CBCT images using the new imaging modality.Methods:An iterative reconstruction algorithm with a sparse representation constraint based on dictionary learning is developed, in which both sparse projection and low dose rate (10 MU/min) are considered. Two CBCT experiments were conducted using the newly available 2.5MV beam on a Varian TrueBeam linac. First, a Rando anthropomorphic head phantom with and without a copper bar inserted in the center was scanned using both 2.5MV and kV (100kVp) beams. In a second experiment, an MRI phantom with many coils was scanned using 2.5MV, 6MV, and kV (100kVp) beams. Imaging dose and the resultant image quality is studied.Results:Qualitative assessment suggests that there were no visually detectable metal artifacts in MV CBCT images, compared with significant metal artifacts in kV CBCT images, especially in the MRI phantom. For a region near the metal object in the head phantom, the 2.5MV CBCT gave a more accurate quantification of the electron density compared with kV CBCT, with a ∼50% reduction in mean HU error. As expected, the contrast between bone and soft‐tissue in 2.5MV CBCT decreased compared with kV CBCT.Conclusion:On‐board CBCT imaging with the new 2.5MV beam can effectively reduce metal artifacts, although with a reduced softtissue contrast. Combination of kV and MV scanning may lead to metal artifact free CBCT images with uncompromised soft‐tissue contrast.

SU‐E‐J‐129: A Strategy to Consolidate the Image Database of a VERO Unit Into a Radiotherapy Management System

Purpose:To present a strategy to integrate the imaging database of a VERO unit with a treatment management system (TMS) to improve clinical workflow and consolidate image data to facilitate clinical quality control and documentation.Methods:A VERO unit is equipped with both kV and MV imaging capabilities for IGRT treatments. It has its own imaging database behind a firewall. It has been a challenge to transfer images on this unit to a TMS in a radiation therapy clinic so that registered images can be reviewed remotely with an approval or rejection record. In this study, a software system, iPump‐VERO, was developed to connect VERO and a TMS in our clinic. The patient database folder on the VERO unit was mapped to a read‐only folder on a file server outside VERO firewall. The application runs on a regular computer with the read access to the patient database folder. It finds the latest registered images and fuses them in one of six predefined patterns before sends them via DICOM connection to the TMS. The residual image registration errors will be overlaid on the fused image to facilitate image review.Results:The fused images of either registered kV planar images or CBCT images are fully DICOM compatible. A sentinel module is built to sense new registered images with negligible computing resources from the VERO ExacTrac imaging computer. It takes a few seconds to fuse registered images and send them to the TMS. The whole process is automated without any human intervention.Conclusion:Transferring images in DICOM connection is the easiest way to consolidate images of various sources in your TMS. Technically the attending does not have to go to the VERO treatment console to review image registration prior delivery. It is a useful tool for a busy clinic with a VERO unit.

TH‐A‐18C‐11: An Investigation of KV CBCT Image Quality and Dose Reduction for Volume‐Of‐Interest Imaging Using Dynamic Collimation

Purpose:The focus of this work was to investigate the improvements in image quality and dose reduction for volume‐of‐interest (VOI) kV‐CBCT using dynamic collimation.Methods:A prototype iris aperture was used to track a VOI during a CBCT acquisition. The current aperture design is capable of one‐dimensional translation as a function of gantry angle and dynamic adjustment of the iris radius. The aperture occupies the location of the bow‐tie filter on a Varian OBI system. CBCT and planar image quality was investigated as a function of aperture radius, while maintaining the same dose to the VOI, for a 20 cm diameter cylindrical water phantom with a 9 mm diameter bone insert centered on isocenter. Corresponding scatter‐to‐primary ratios (SPR) were determined at the detector plane with Monte Carlo simulation using EGSnrc. Dose distributions for various anatomical sites were modeled using a dynamic BEAMnrc library and DOSXYZnrc. The resulting VOI dose distributions were compared to full‐field distributions.Results:SPR was reduced by a factor of 8.4 when decreasing iris diameter from 21.2 cm to 2.4 cm (at isocenter). Similarly, this change in iris diameter corresponds to a factor increase of approximately 1.4 and 1.5 in image contrast for CBCT and planar images, respectively, and similarly a factor decrease in image noise of approximately 1.7 and 1.5. This results in a measured gain in contrast‐to‐noise ratio of a factor of approximately 2.3 for both CBCT and planar images. Depending upon the anatomical site, dose was reduced to 10%–70% of the full field value along the central axis plane and down to 2% along the axial planes, while maintaining the same dose to the VOI compared to full‐field techniques.Conclusion:The presented VOI technique offers improved image quality for image‐guided radiotherapy while sparing the surrounding volume of unnecessary dose compared to full‐field techniques.

A study on the necessity of kV-CBCT imaging compared to kV-orthogonal portal imaging based on setup errors: considering other socioeconomical factors.

Evaluation of setup accuracy in kV-orthogonal portal imaging (OPI)-based and kV-CBCT-based radiotherapy treatment and to find out the necessity of cone-beam computed tomography (CBCT) compared to OPI. A retrospective study was carried out on 30 patients, who received radiotherapy to the Brain, Head and Neck, and Pelvis. In the OPI technique, anterior-posterior and right-lateral portal images were taken by the On Board Imaging (OBI) system and were superimposed on the reference images. Similarly, in the kV-CBCT technique, CBCT was performed by the OBI system and CBCT images were superimposed on the reference CT images. A total of 150 comparison sets of kV-OPI and kV-CBCT images were analyzed and evaluated. Shifts in the Lateral, Longitudinal, and Vertical directions were noted in both techniques. The iso displacement vector (IDV) was calculated for all imaging. The mean IDV (in cm) are found to be 0.3395 (SD: 0.1477) and 0.3088 (SD: 0.1593) in cases of the brain, 0.4266 (SD: 0.1511) and 0.3666 (SD: 0.1533) in cases of the head and neck, and 1.0339 (SD: 0.5893) and 0.9498 (SD: 0.6047) in cases of the pelvis for the CBCT and OPI techniques, respectively. The P values were 0.3201, 0.0515, and 0.4829 for the brain, head and neck, and pelvic cases, respectively. There is statistically no significant difference between both the imaging techniques. As the dose delivered by the CBCT technique is higher than that by the OPI technique, from the socioeconomical and radiation safety point of view, the OPI technique is possibly better than the CBCT technique. Hence, it can be concluded that CBCT is not a mandatory technique compared to the OPI technique in routine brain, head and neck, and pelvic cases, except in those cases where better information about interfraction movements of soft tissue is necessarily required for positioning of the target, as is the case in prostate carcinoma.

Évaluation et choix des protocoles d’imagerie sur le système de tomographie conique de basse énergie XVI® d’Elekta

PurposeThis work proposes an evaluation of the Elekta XVI® kilovoltage cone-beam computed tomography imaging system. The average dose delivered for each acquisition protocol proposed by default by the manufacturer was measured with several detectors and compared to theoretical dose values given by Elekta. At the same time, an evaluation of image quality for pelvic protocols correlated to dose measurements in homogeneous and heterogeneous mediums allowed to optimize the use of the XVI® system. Materials and methodsThe dose was measured for each acquisition protocol (varying filters, FOV and collimations) with four detectors (CT pencil ion chamber, 0.3 and 0.125cm3 cylindrical ion chambers, radiothermoluminescent dosimeters) in a CTDI phantom. The dose evaluation in a heterogeneous medium was performed in an experimental anthropomorphic phantom simulating a male pelvis. Image quality was assessed with a Catphan® 600 phantom. ResultsThe average dose measured in a homogeneous medium was about 17mGy and 25mGy per acquisition for Pelvis and Prostate protocols and about 17mGy and 1mGy for Lung and Head protocols. The study performed with different detectors showed that doses obtained were of the same order of magnitude (±10%) and agreed with those supplied by the manufacturer. The evaluation of image quality correlated to the average dose measured allowed to optimize the use of XVI® acquisition protocols. Measurement results in a heterogeneous medium showed a dose decrease by a factor 1.5 for bone and by a factor 2 for titanium. ConclusionThe study showed that theoretical values proposed by the manufacturer could be used to estimate the average dose delivered to the patient by the kV-CBCT imaging system. The analysis of all the results led to the implementation of a procedure allowing to optimize and account for the dose delivered to the patient by the CBCT imaging system and to report it in the patient folder.

The Evaluation of Rectum Dose Associated by kV-CBCT Imaging in IGRT

The Evaluation of Rectum Dose Associated by kV-CBCT Imaging in IGRT