Cone-beam computed tomography (CBCT) plays an important role in adaptive radiation therapy and can be used to observe changes in body shape, tumor size, and organ position during the treatment period. This technique can also be used to generate an image for replanning. However, performing CBCT during every image guided radiotherapy (IGRT) process increases the radiation dose. Therefore, in this study, we investigated the reduction of the CBCT exposure dose using an image-based edge-preserving noise-reduction technique. A three-dimensional cross-directional bilateral filter (3D-CDBF) which was recently developed by one of the coauthors and reported to provide a noise reduction performance better than a mode-based iterative reconstruction.Catphan was used to evaluate the performance of 3D-CDBF in CBCT. The baseline scan parameters were 120 kV, 40 mA, 40 ms, and 660 frames/360° rotation. The tube current was changed to 32, 20, and 10 mA to reduce the exposure dose. The CBCT images were reconstructed with the filtered back projection (FBP). The 3D-CDBF images were obtained by processing the FBP images. Task-based spatial resolution (task-based transfer function: TTF) and noise power spectrum (NPS) were used to evaluate image quality. Visual evaluation of the image quality was also performed by two experienced radiation oncologists and five radiologists using clinical pelvic images of two patients undergoing radiotherapy for prostate cancer. Additionally, the accuracy of the dose calculation when replanning with 3D-CDBF images was evaluated.The 50%/10% TTFs were 0.364/0.646 mm-1 using FBP and 0.362/0.645 mm-1 using 3D-CDBF, suggesting the excellent edge preservation ability of 3D-CDBF. The noise power of 3D-CDBF compared to FBP were 25.4% at 0.2 mm-1 and 17.0% at 0.5 mm-1. 3D-CDBF notably reduced noise power over the entire frequency range. Therefore, the NPS level of 10 mA became similar to that of 40 mA. The visual evaluation allowed by the 3D-CDBF images was considerably higher than that realized with other images. Additionally, dose evaluation by gamma analysis showed that 3D-CDBF had no effect on the accuracy of the dose calculation.Compared with conventional FBP, the 3D-CDBF yielded significant improvements in quantitative and qualitative image qualities. The results indicated a possible 75% dose reduction of this method, while preserving the accuracy of the dose calculation.
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