Purpose/Objective(s): To determine preferred system components and settings to improve image quality and beam stability of an imaging beam line which utilizes the beam of a clinical linear accelerator (linac) incident on a low-Z target used for megavoltage cone-beam CT (MV CBCT). Materials/Methods: Image quality is determined from MV CBCT using the EMMA phantom. This phantom contains a low contrast module consisting of 2 cm thick water equivalent with cylindrical inserts of variable contrast and sizes. The diameters of the cylinders are 3 mm, 5 mm, 7 mm, 10 mm, and 20 mm. There are four groups of inserts with variable densities of 1%, 3%, 5%, and 7% relative to water. The following system components and settings were varied to improve the imaging beam line: beam energy, target material, cranio-caudal image length and the detector buildup plate. The 6 MV treatment beam is stable. Lower energies, desired for improved image quality, push the linac toward a less stable beam. The 6 MV treatment beam with tungsten target and stainless steel flattener was used as well as unflattened beams generated from a 1.3 cm thick industrial diamond target at 4 and 6 MV and a 1.3 cm thick graphite target at 4 MV only. The graphite target thickness, limited by available physical space, was not thick enough to stop primary electron leakage at 6 MV. The diamond target is much higher density and absorbs the primary electron beam at 6 MV. Flat panel buildup plates of different thicknesses of copper, aluminum, brass, and no plate, were assessed with a standard CT phantom. The effect of scatter reduction on image quality was assessed at field lengths of 2 cm, 5 cm, 15 cm, 27.4 cm. The phantom used was a head-size water cylinder with tissue equivalent materials from the CT phantom placed in it. All images are taken with a dose of 10 cGy delivered at the depth of maximum dose at the isocenter. Results: For the tungsten target at 6 MV, 5% inserts down to 3 cm diameter are resolved. With both the graphite and the diamond target at 4 MV, 3% inserts are visible at all sizes. A small difference was observed between the diamond target at 4 MV and 6 MV, indicating that image quality is affected more by target Z than beam energy. Different buildup plates did not play a significant role in soft tissue contrast. In the scatter reduction study, only a weak dependence of contrast to noise ratio on field length was observed. Improved spatial resolution was observed with the graphite and diamond targets compared to the tungsten target. Evaluation of 2D projections shows an increase in f50 value from 0.5 lp/mm to 0.6 lp/mm. This improvement may be attributed to the absence of the flattening filter, which acts as a scatter source. This improvement did not directly translate to CBCT images due to limited number of projections used and the resolution of reconstructed volume (256x256x270). Conclusions: A diamond target offers the possibility of running MV CBCT at a more stable energy of 5-6 MV with image quality comparable to graphite at 4 MV. A narrow field and lower-Z (or no) build-up plate separately yield a modest improvement in image quality. Patient imaging is scheduled for the summer, 2007. It is anticipated that MV CBCT images taken for the same patient with the treatment and imaging beams will be available to compare and show at the meeting.
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