IMAR correction algorithm could be readily implemented in an existing clinical workflow upon commercial release. While residual errors still exist in IMAR corrected images, these images present with better overall conspicuity of the patient/phantom geometry and offer more accurate CT numbers for improved local dosimetry. The variety of different scenarios included herein attest to the utility of the evaluated IMAR for a wide range of radiotherapy clinical scenarios.

Quantitative reconstruction of cone beam X-ray computed tomography (CT) datasets requires accurate modeling of scatter, beam-hardening, beam profile, and detector response. Typically, commercial imaging systems use fast empirical corrections that are designed to reduce visible artifacts due to incomplete modeling of the image formation process. In contrast, Monte Carlo (MC) methods are much more accurate but are relatively slow. Scatter kernel superposition (SKS) methods offer a balance between accuracy and computational practicality. We show how a single SKS algorithm can be employed to correct both kilovoltage (kV) energy (diagnostic) and megavoltage (MV) energy (treatment) X-ray images. Using MC models of kV and MV imaging systems, we map intensities recorded on an amorphous silicon flat panel detector to water-equivalent thicknesses (WETs). Scattergrams are derived from acquired projection images using scatter kernels indexed by the local WET values and are then iteratively refined using a scatter magnitude bounding scheme that allows the algorithm to accommodate the very high scatter-to-primary ratios encountered in kV imaging. The algorithm recovers radiological thicknesses to within 9% of the true value at both kV and megavolt energies. Nonuniformity in CT reconstructions of homogeneous phantoms is reduced by an average of 76% over a wide range of beam energies and phantom geometries.

The authors present the design and simulation of an imaging system that employs a compact multiple source x-ray tube to produce a tomosynthesis image from a set of projections obtained at a single tube position. The electron sources within the tube are realized using cold cathode carbon nanotube technology. The primary intended application is tomosynthesis-based 3D image guidance during external beam radiation therapy. The tube, which is attached to the gantry of a medical linear accelerator (linac) immediately below the multileaf collimator, operates within the voltage range of 80-160 kVp and contains a total of 52 sources that are arranged in a rectilinear array. This configuration allows for the acquisition of tomographic projections from multiple angles without any need to rotate the linac gantry. The x-ray images are captured by the same amorphous silicon flat panel detector employed for portal imaging on contemporary linacs. The field of view (FOV) of the system corresponds to that part of the volume that is sampled by rays from all sources. The present tube and detector configuration provides an 8 x 8 cm2 FOV in the plane of the linac isocenter when the 40.96 x 40.96 cm2 imaging detector is placed 40 cm from the isocenter. Since this tomosynthesis application utilizes the extremities of the detector to record image detail relating to structures near the isocenter, simultaneous treatment and imaging is possible for most clinical cases, where the treated target is a small region close to the linac isocenter. The tomosynthesis images are reconstructed using the simultaneous iterative reconstruction technique, which is accelerated using a graphic processing unit. The authors present details of the system design as well as simulated performance of the imaging system based on reprojections of patient CT images.

We describe a focused beam-stop array (BSA) for the measurement of object scatter in imaging systems that utilize x-ray beams in the megavoltage (MV) energy range. The BSA consists of 64 doubly truncated tungsten cone elements of 0.5 cm maximum diameter that are arranged in a regular array on an acrylic slab. The BSA is placed in the accessory tray of a medical linear accelerator at a distance of approximately 50 cm from the focal spot. We derive an expression that allows us to estimate the scatter in an image taken without the array present, given image values in a second image with the array in place. The presence of the array reduces fluence incident on the imaged object. This leads to an object-dependent underestimation bias in the scatter measurements. We apply corrections in order to address this issue. We compare estimates of the flat panel detector response to scatter obtained using the BSA to those derived from Monte Carlo simulations. We find that the two estimates agree to within 10% in terms of RMS error for 30 cm x 30 cm water slabs in the thickness range of 10-30 cm. Larger errors in the scatter estimates are encountered for thinner objects, probably owing to extrafocal radiation sources. However, RMS errors in the estimates of primary images are no more than 5% for water slab thicknesses in the range of 1-30 cm. The BSA scatter estimates are also used to correct cone beam tomographic projections. Maximum deviations of central profiles of uniform water phantoms are reduced from 193 to 19 HU after application of corrections for scatter, beam hardening, and lateral truncation that are based on the BSA-derived scatter estimate. The same corrections remove the typical cupping artifact from both phantom and patient images. The BSA proves to be a useful tool for quantifying and removing image scatter, as well as for validating models of MV imaging systems.

Tomosynthesis imaging requires projection images from different viewing angles. Conventional systems use a moving xray source to acquire the individual projections. Using a stationary distributed x-ray source with a number of sources that equals the number of required projections, this can be achieved without any mechanical motion. Advantages are a potentially faster image acquisition speed, higher spatial and temporal resolution and simple system design. We present distributed x-ray sources based on carbon nanotube (CNT) field emission cathodes. The field emission cathodes deliver the electrons required for x-ray production. CNT emitters feature a stable emission at high current density, a cold emission, excellent temporal control of the emitted electrons and good configurability. We discuss the use of stationary sources for two applications: (i) a linear tube for stationary digital breast tomosynthesis (sDBT), and (ii) a square tube for on-board tomosynthesis image-guided radiation therapy (IGRT). Results from high energy distributed sources up to 160kVp are also presented.