MV CBCT Images Research Articles

Synthetic Megavoltage Cone Beam Computed Tomography Image Generation for Improved Contouring Accuracy of Cardiac Pacemakers.

In this study, we aimed to enhance the contouring accuracy of cardiac pacemakers by improving their visualization using deep learning models to predict MV CBCT images based on kV CT or CBCT images. Ten pacemakers and four thorax phantoms were included, creating a total of 35 combinations. Each combination was imaged on a Varian Halcyon (kV/MV CBCT images) and Siemens SOMATOM CT scanner (kV CT images). Two generative adversarial network (GAN)-based models, cycleGAN and conditional GAN (cGAN), were trained to generate synthetic MV (sMV) CBCT images from kV CT/CBCT images using twenty-eight datasets (80%). The pacemakers in the sMV CBCT images and original MV CBCT images were manually delineated and reviewed by three users. The Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and mean surface distance (MSD) were used to compare contour accuracy. Visual inspection showed the improved visualization of pacemakers on sMV CBCT images compared to original kV CT/CBCT images. Moreover, cGAN demonstrated superior performance in enhancing pacemaker visualization compared to cycleGAN. The mean DSC, HD95, and MSD for contours on sMV CBCT images generated from kV CT/CBCT images were 0.91 ± 0.02/0.92 ± 0.01, 1.38 ± 0.31 mm/1.18 ± 0.20 mm, and 0.42 ± 0.07 mm/0.36 ± 0.06 mm using the cGAN model. Deep learning-based methods, specifically cycleGAN and cGAN, can effectively enhance the visualization of pacemakers in thorax kV CT/CBCT images, therefore improving the contouring precision of these devices.

Metal artifacts reduction in kV-CT images with polymetallic dentures and complex metals based on MV-CBCT images in radiotherapy

This paper proposes a metal artifact reduction method of using MV-CBCT images to correct metal artifacts in kV-CT images, especially for the complex metal artifacts caused by multi-metal interaction of patients with head and neck tumors. The different tissue regions are segmented in the MV-CBCT images to obtain template images and the metal region is segmented in the kV-CT images. Forward projection is performed to get sinogram of the template images, kV-CT images and metal region images. Artifact images can be reconstructed through those sonograms. Corrected images is generated by subtracting the artifact images from the original kV-CT images. After the first correction, the template images are generated again and brought into the previous step for iteration to get better correction result. CT data set of 7 patients are used in this study, compared with linear interpolation metal artifact (LIMAR) and normalized metal artifact reduction method, mean relative error of CT value is reduced by 50.5% and 63.3%, noise is reduced by 56.2% and 58.9%. The Identifiability Score of the tooth, upper/lower jaw, tongue, lips, masseter muscle and cavity in the corrected images by the proposed method have significantly improved (P < 0.05) than original images. The artifacts correction method proposed in this paper can effectively remove the metal artifacts in the images and greatly improve the CT value accuracy, especially in the case of multi-metal and complex metal implantation.

Evaluation of CTV to PTV Margin for Head and Neck Cancer with Daily Setup Using MVCBCT Imaging

Purpose: Geometrical inaccuracies of setup using MV-CBCT imaging for patients with head and neck cancer were evaluated. Possibility of modifying of CTV to PTV margin while delineation of such tumors was estimated. Materials and methods: Additional adjustment of simulation kV CT pictures with MV-CBCT images received during the implementation of the online protocol was conducted for 35 patients with head and neck cancer. Offline analysis revealed the discrepancy in the results of online correction and offline analyses. CTV to PTV margin considering daily setup was computed. Results: Obtained values of CTV to PTV margin: 2.4 mm in Vrt, 2.1 mm in Lng and 2.5 mm in Lat. Upward variations from 5 mm margin used in unit were registered for 2 patients. Conclusions: Reduction of CTV to PTV margin up to 2.5 mm is precarious because CTV dose coverage is not reasonable for all patients. Implementation of routine work practice in Off-line Review is required for identification of problem cases and determination of individual CTV to PTV margin.

Commissioning and quality assurance of HalcyonTM 2.0 linear accelerator.

BackgroundVarian Medical Systems has introduced a new medical linear accelerator called HalcyonTM 2.0, which is based on the ring delivery system (RDS). It is a true IGRT machine having 6MV FFF photon energy. In addition to the planar and MV-CBCT imaging techniques it also has an option of ultra-fast kV-iCBCT which enhances the image reconstruction and improves the visualization of soft tissue. The field portals are shaped by a unique dual layer MLC with special stacked and staggered design which enables high modulation with low radiation leakage. Recently, we have commissioned our first Halcyon 2.0 machine. The aim of this work was to systematically investigate various parameters of a newly installed HalcyonTM 2.0 linear accelerator.Materials and methodsDetailed measurements were conducted as per various guidelines. Also, the measurements were performed to fulfil the national regulatory requirements. Commissioning data of Halcyon 6 MV-FFF beam was performed in a water tank. For absolute measurements, a 0.6-cc waterproof Farmer chamber and electrometer were used. All relative measurements (PDDs, in-line, cross-line and angular profiles) were performed with 0.0125 cc point chamber.ResultsAll the tests were within the acceptable limit. Measured data were compared with factory data as well as the existing medical linear accelerator of the same category. The obtained results were quite satisfactory.ConclusionsThis study summarizes the commissioning experience with Halcyon linear accelerator. Evaluation of mechanical, radiation safety and dosimetric parameters were performed. The obtained parameters were well below the specified tolerance limits.

MV CBCT-Based Synthetic CT Generation Using a Deep Learning Method for Rectal Cancer Adaptive Radiotherapy.

Due to image quality limitations, online Megavoltage cone beam CT (MV CBCT), which represents real online patient anatomy, cannot be used to perform adaptive radiotherapy (ART). In this study, we used a deep learning method, the cycle-consistent adversarial network (CycleGAN), to improve the MV CBCT image quality and Hounsfield-unit (HU) accuracy for rectal cancer patients to make the generated synthetic CT (sCT) eligible for ART. Forty rectal cancer patients treated with the intensity modulated radiotherapy (IMRT) were involved in this study. The CT and MV CBCT images of 30 patients were used for model training, and the images of the remaining 10 patients were used for evaluation. Image quality, autosegmentation capability and dose calculation capability using the autoplanning technique of the generated sCT were evaluated. The mean absolute error (MAE) was reduced from 135.84 ± 41.59 HU for the CT and CBCT comparison to 52.99 ± 12.09 HU for the CT and sCT comparison. The structural similarity (SSIM) index for the CT and sCT comparison was 0.81 ± 0.03, which is a great improvement over the 0.44 ± 0.07 for the CT and CBCT comparison. The autosegmentation model performance on sCT for femoral heads was accurate and required almost no manual modification. For the CTV and bladder, although modification was needed for autocontouring, the Dice similarity coefficient (DSC) indices were high, at 0.93 and 0.94 for the CTV and bladder, respectively. For dose evaluation, the sCT-based plan has a much smaller dose deviation from the CT-based plan than that of the CBCT-based plan. The proposed method solved a key problem for rectal cancer ART realization based on MV CBCT. The generated sCT enables ART based on the actual patient anatomy at the treatment position.

A Simulated Dosimetric Study of Contribution to Radiotherapy Accuracy by Fractional Image Guidance Protocol of Halcyon System.

PurposeFrequency of conventional kV-image guidance is sometimes sacrificed to reduce concomitant risk, leaving deviations of unguided fractions unknown. MV-imaging and treatment dose can be collectively optimized on Halcyon, where fractional MVCBCT provides complete anatomic records for course-wide dose reconstruction. By retrospective dose accumulation, this work simulated the impact of imaging frequency on patient treatment dose on the platform of Halcyon.MethodsFour hundred and sixteen MVCBCT image sets from 16 patients of various tumor sites treated with radiotherapy on Halcyon were retrospectively selected. After applying the image-guided couch shifts of the clinical records, deformable image registration was performed using Velocity software, to deform the planning CTs to the corresponding MVCBCTs, generating pseudo CTs representing the actual anatomies on the treatment day. Fractional treatment dose was reconstructed on pseudo CTs for accumulation, representing the actual patient dose (Ddaily). To simulate weekly image guidance, fractional dose was reconstructed and accumulated by incorporating 1 CBCT-guided corrections and 4 laser-guided setups of each week (Dweekly). Limited by partially imaged volumes and different organs-at-risk of various sites, only target dose-volume parameters were evaluated across all patients.ResultsGTV_D98%, CTV_D98%, PTV_D90%, PTV_D95%, PGTV_D90%, and PGTV_D95% were evaluated, where Dx% means the minimal dose received by x% volume. Pairwise comparisons were made between plan dose and Ddaily, Ddaily and Dweekly respectively. PGTV_D95% of accumulated Dweekly were significantly lower than those of accumulated Ddaily by up to 32.90% of prescription dose, suggesting that weekly-guidance may result in unacceptable under dose to the target. The broad distribution of fractional differences between Ddaily and Dweekly suggested unreliable patient positioning based on aligning surface markers to laser beams, as a popular approach broadly used on conventional Linac systems. Slight target under-dose was observed on daily reconstructed results compared with planned dose, which provided quantitative data to guide clinical decisions such as the necessity of adaptive radiotherapy.ConclusionFractional image guided radiotherapy on Halcyon provides more reliable treatment accuracy than using sacrificed imaging frequency, which also provides complete anatomic records for deformable dose reconstruction supporting more informed clinical decisions.

PO-1629: A quantitative evaluation of deformable image registration based on Halcyon MVCBCT images

PO-1629: A quantitative evaluation of deformable image registration based on Halcyon MVCBCT images

A quantitative evaluation of deformable image registration based on MV cone beam CT images: Impact of deformation magnitudes and image modalities

Background and purposeTo evaluate the impact of deformation magnitude and image modality on deformable-image-registration (DIR) accuracy using Halcyon megavoltage cone beam CT images (MVCBCT). Materials and methodsPlanning CT images of an anthropomorphic Head phantom were aligned rigidly with MVCBCT and re-sampled to achieve the same resolution, denoted as pCT. MVCBCT was warped with twenty simulated pre-known virtual deformation fields (Ti, i = 1–20) with increasing deformation magnitudes, yielding warped CBCT (wCBCT). The pCT and MVCBCT were registered to wCBCT respectively (Multi-modality and Uni-modality DIR), generating deformation vector fields Vi and Vi′ (i = 1–20). Vi and Vi′ were compared with Ti respectively to assess the DIR accuracy geometrically. In addition, Vi, Ti, and Vi′ were applied to pCT, generating deformed CT (dCTi), ground-truth CT (Gi) and deformed CT′ (dCTi′) respectively. The Hounsfield Unit (HU) on these virtual CT images were also compared. ResultsThe mean errors of vector displacement increased with the deformation magnitude. For deformation magnitudes between 2.82 mm and 7.71 mm, the errors of uni-modality DIR were 1.16 mm ~ 1.73 mm smaller than that of multi-modality (p = 0.0001, Wilcoxon signed rank test). DIR could reduce the maximum signed and absolute HU deviations from 70.8 HU to 11.4 HU and 208 HU to 46.2 HU respectively. ConclusionsAs deformation magnitude increases, DIR accuracy continues to deteriorate and uni-modality DIR consistently outperformed multi-modality DIR. DIR-based adaptive radiotherapy utilizing the noisy MVCBCT images is only conditionally applicable with caution.

Positioning errors of metal localization devices with motion artifacts on kV and MV cone beam CT.

Objective:To investigate motion artifacts on kV CBCT and MV CBCT images with metal localization devices for image-guided radiation therapy.Methods:The 8 μ pelvis CBCT template for the Siemens Artiste MVision and Pelvis template for the Varian IX on-board Exact Arms kV were used to acquire CBCT images in this study. Images from both CBCT modalities were compared in CNRs, metal landmark absolute positions, and image volume distortion on three different planes of view. The images were taken on a breathing-simulated thoracic phantom in which several typical metal localization devices were implanted, including clips and wires for breast patients, gold seeds for prostate patients, and BBs as skin markers. To magnify the artifacts, a 4 cm diameter metal ball was also implanted into the thoracic phantom to mimic the metal artifacts.Results:For MV CBCT, the CNR at a 4 sec breathing cycle with 1 cm breathing amplitude was 5.0, 3.4 and 4.6 for clips, gold seeds and BBs, respectively while it was 1.5, 2.0 and 1.6 for the kV CBCT. On the images, the kV CBCT showed symmetric streaking artifacts both in the transverse and longitudinal directions relative to the motion direction. The kV CBCT images predicted 89 % of the expected volume, while the MV CBCT images predicted 95 % of the expected volume. The simulated soft tissue observed in the MVCT could not be detected in the kV CBCT.Conclusion:The MV CBCT images showed better volume prediction, less streaking effects and better CNRs of a moving metal target, i.e. clips, BBs, gold seeds and metal balls than on the kV CBCT images. The MV CBCT was more advantageous compared to the kV CBCT with less motion artifacts for metal localization devices.Advances in knowledge:This study would benefit clinicians to prescribe MV CBCT as localization modality for radiation treatment with moving target when metal markers are implanted.

EP-2382: Impact on treatment plan of daily MV EPI versus MV CBCT imaging for prostate cancer IGRT

EP-2382: Impact on treatment plan of daily MV EPI versus MV CBCT imaging for prostate cancer IGRT

Accuracy in automatic image registration between MV cone beam computed tomography and planning kV computed tomography in image guided radiotherapy

AimTo verify the accuracy of automatic image registration (IR) between the planning kilo voltage computed tomography (kV CT) and megavoltage cone beam computed tomography (MV CBCT) datasets using phantom and patient images. BackgroundThe automatic IR between MV CBCT and planning kV CT is a fast solution for performing online image guided radiotherapy (IGRT). The IR accuracy has to be verified periodically as it directly affects patient setup accuracy. Materials and methodsThe automatic IR accuracy was evaluated using image quality phantom acquired with different kV CT slice thickness, different MV CBCT acquisition MUs and reconstruction slice size and thickness. The IR accuracy was also evaluated on patient images on different anatomical sites such as brain, head & neck, thorax and pelvis. The uncertainty in the automatic registration was assessed by introducing known offset to kV CT dataset and compared with the registration results. ResultsThe result with the phantom images was within 2mm in all three translational directions. The accuracy in automatic IR using patient images was within 2mm in most of the cases. 3mm planning kV CT slice thickness was sufficient to perform automatic IR successfully within 2mm accuracy. The MV CBCT reconstruction parameters such as slice thickness and slice size had no effect on the registration accuracy. ConclusionThis study shows that the automatic IR is accurate within 2mm and provides confidence in performing them between planning kV CT and MV CBCT image datasets for online image guided radiotherapy.

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‐

Feasibility of MV CBCT-based treatment planning for urgent radiation therapy: dosimetric accuracy of MV CBCT-based dose calculations.

Unlike scheduled radiotherapy treatments, treatment planning time and resources are limited for emergency treatments. Consequently, plans are often simple 2D image‐based treatments that lag behind technical capabilities available for nonurgent radiotherapy. We have developed a novel integrated urgent workflow that uses onboard MV CBCT imaging for patient simulation to improve planning accuracy and reduce the total time for urgent treatments. This study evaluates both MV CBCT dose planning accuracy and novel urgent workflow feasibility for a variety of anatomic sites. We sought to limit local mean dose differences to less than 5% compared to conventional CT simulation. To improve dose calculation accuracy, we created separate Hounsfield unit–to–density calibration curves for regular and extended field‐of‐view (FOV) MV CBCTs. We evaluated dose calculation accuracy on phantoms and four clinical anatomical sites (brain, thorax/spine, pelvis, and extremities). Plans were created for each case and dose was calculated on both the CT and MV CBCT. All steps (simulation, planning, setup verification, QA, and dose delivery) were performed in one 30 min session using phantoms. The monitor units (MU) for each plan were compared and dose distribution agreement was evaluated using mean dose difference over the entire volume and gamma index on the central 2D axial plane. All whole‐brain dose distributions gave gamma passing rates higher than 95% for 2%/2 mm criteria, and pelvic sites ranged between 90% and 98% for 3%/3 mm criteria. However, thoracic spine treatments produced gamma passing rates as low as 47% for 3%/3 mm criteria. Our novel MV CBCT‐based dose planning and delivery approach was feasible and time‐efficient for the majority of cases. Limited MV CBCT FOV precluded workflow use for pelvic sites of larger patients and resulted in image clearance issues when tumor position was far off midline. The agreement of calculated MU on CT and MV CBCT was acceptable for all treatment sites.PACS numbers: 87.55.D‐, 87.57.Q‐

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‐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‐99: Reconstruction of Cone Beam CT Image Using Volumetric Modulated Arc Therapy Exit Beams

Purpose:To test the possibility of obtaining an image of the treated volume during volumetric modulated arc therapy (VMAT) with exit beams.Method:Using a Varian Clinac 21EX and MVCT detector the following three sets of detector projection data were obtained for cone beam CT reconstruction with and without a Catphan 504 phantom. 1) 72 projection images from 20 × 16 cm^2 open beam with 3 MUs, 2) 72 projection images from 20 × 16 cm^2 MLC closed beam with 14 MUs. 3) 137 projection images from a test RapicArc QA plan. All projection images were obtained in ‘integrated image’ mode. We used OSCaR code to reconstruct the cone beam CT images. No attempts were made to reduce scatter or artifacts.Results:With projection set 1) we obtained a good quality MV CBCT image by optimizing the reconstruction parameters. Using projection set 2) we were not able to obtain a CBCT image of the phantom, which was determined to be due to the variation of interleaf leakage with gantry angle. From projection set 3), we were able to obtain a weak but meaningful signal in the image, especially in the target area where open beam signals were dominant. This finding suggests that one might be able to acquire CBCT images with rough body shape and some details inside the irradiated target area.Conclusion:Obtaining patient images using the VMAT exit beam is challenging but possible. We were able to determine sources of image degradation such as gantry angle dependent interleaf leakage and beams with a large scatter component. We are actively working on improving image quality.

Optimization of the design of thick, segmented scintillators for megavoltage cone-beam CT using a novel, hybrid modeling technique.

Active matrix flat-panel imagers (AMFPIs) incorporating thick, segmented scintillators have demonstrated order-of-magnitude improvements in detective quantum efficiency (DQE) at radiotherapy energies compared to systems based on conventional phosphor screens. Such improved DQE values facilitate megavoltage cone-beam CT (MV CBCT) imaging at clinically practical doses. However, the MV CBCT performance of such AMFPIs is highly dependent on the design parameters of the scintillators. In this paper, optimization of the design of segmented scintillators was explored using a hybrid modeling technique which encompasses both radiation and optical effects. Imaging performance in terms of the contrast-to-noise ratio (CNR) and spatial resolution of various hypothetical scintillator designs was examined through a hybrid technique involving Monte Carlo simulation of radiation transport in combination with simulation of optical gain distributions and optical point spread functions. The optical simulations employed optical parameters extracted from a best fit to measurement results reported in a previous investigation of a 1.13 cm thick, 1016 μm pitch prototype BGO segmented scintillator. All hypothetical designs employed BGO material with a thickness and element-to-element pitch ranging from 0.5 to 6 cm and from 0.508 to 1.524 mm, respectively. In the CNR study, for each design, full tomographic scans of a contrast phantom incorporating various soft-tissue inserts were simulated at a total dose of 4 cGy. Theoretical values for contrast, noise, and CNR were found to be in close agreement with empirical results from the BGO prototype, strongly supporting the validity of the modeling technique. CNR and spatial resolution for the various scintillator designs demonstrate complex behavior as scintillator thickness and element pitch are varied--with a clear trade-off between these two imaging metrics up to a thickness of ~3 cm. Based on these results, an optimization map indicating the regions of design that provide a balance between these metrics was obtained. The map shows that, for a given set of optical parameters, scintillator thickness and pixel pitch can be judiciously chosen to maximize performance without resorting to thicker, more costly scintillators. Modeling radiation and optical effects in thick, segmented scintillators through use of a hybrid technique can provide a practical way to gain insight as to how to optimize the performance of such devices in radiotherapy imaging. Assisted by such modeling, the development of practical designs should greatly facilitate low-dose, soft tissue visualization employing MV CBCT imaging in external beam radiotherapy.

Comparison of PTV Margins for Contouring Using MVCBCT and KView Imaging: A Pilot Study

Comparison of PTV Margins for Contouring Using MVCBCT and KView Imaging: A Pilot Study

Use of Implanted Gold Fiducial Markers With MV-CBCT Image Guided IMRT for Pancreatic Tumors

Use of Implanted Gold Fiducial Markers With MV-CBCT Image Guided IMRT for Pancreatic Tumors

An investigation into factors affecting electron density calibration for a megavoltage cone‐beam CT system

There is a growing interest in the use of megavoltage cone‐beam computed tomography (MV CBCT) data for radiotherapy treatment planning. To calculate accurate dose distributions, knowledge of the electron density (ED) of the tissues being irradiated is required. In the case of MV CBCT, it is necessary to determine a calibration‐relating CT number to ED, utilizing the photon beam produced for MV CBCT. A number of different parameters can affect this calibration. This study was undertaken on the Siemens MV CBCT system, MVision, to evaluate the effect of the following parameters on the reconstructed CT pixel value to ED calibration: the number of monitor units (MUs) used (5, 8, 15 and 60 MUs), the image reconstruction filter (head and neck, and pelvis), reconstruction matrix size (256 by 256 and 512 by 512), and the addition of extra solid water surrounding the ED phantom. A Gammex electron density CT phantom containing EDs from 0.292 to 1.707 was imaged under each of these conditions. The linear relationship between MV CBCT pixel value and ED was demonstrated for all MU settings and over the range of EDs. Changes in MU number did not dramatically alter the MV CBCT ED calibration. The use of different reconstruction filters was found to affect the MV CBCT ED calibration, as was the addition of solid water surrounding the phantom. Dose distributions from treatment plans calculated with simulated image data from a 15 MU head and neck reconstruction filter MV CBCT image and a MV CBCT ED calibration curve from the image data parameters and a 15 MU pelvis reconstruction filter showed small and clinically insignificant differences. Thus, the use of a single MV CBCT ED calibration curve is unlikely to result in any clinical differences. However, to ensure minimal uncertainties in dose reporting, MV CBCT ED calibration measurements could be carried out using parameter‐specific calibration measurements.PACS number: 87.59.bd