Technical Principles of Dual-Energy Cone Beam Computed Tomography and Clinical Applications for Radiation Therapy

Abstract

Medical imaging is an indispensable tool in radiotherapy for dose planning, image guidance and treatment monitoring. Cone beam CT (CBCT) is a low dose imaging technique with high spatial resolution capability as a direct by-product of using flat-panel detectors. However, certain issues such as x-ray scatter, beam hardening and other artifacts limit its utility to the verification of patient positioning using image-guided radiotherapy.Methods and Materials: Dual-energy (DE)-CBCT has recently demonstrated promise as an improved tool for tumor visualization in benchtop applications. It has the potential to improve soft-tissue contrast and reduce artifacts caused by beam hardening and metal. In this review, the practical aspects of developing a DE-CBCT based clinical and technical workflow are presented based on existing DE-CBCT literature and concepts adapted from the well-established library of work in DE-CT. Furthermore, the potential applications of DE-CBCT on its future role in radiotherapy are discussed.Results and Conclusions: Based on current literature and an investigation of future applications, there is a clear potential for DE-CBCT technologies to be incorporated into radiotherapy. The applications of DE-CBCT include (but are not limited to): adaptive radiotherapy, brachytherapy, proton therapy, radiomics and theranostics.

Breast Adjuvant Radiotherapy Amid the COVID-19 Crisis in a Hub Cancer Center, Lombardy, Italy

“…Treatment prioritization and recommendations [ 1 , 2 , 3 , 4 , 5 , 18 , 19 , 20 ] were issued to ensure that high-quality therapy continued under difficult circumstances, especially in the curative setting such as in frontline hospitals, where Oncology and Radiotherapy Divisions were hard-pressed to keep their services up and running [ 14 , 17 ]. Treatment prioritization was adopted by more than 80% of the centers in Lombardy, favoring short treatments and home assistance, if feasible [ 13 ].…”

“…Delays in delivering RT, which were allowed until 5 months following surgery by the multidisciplinary Italian guidelines [ 5 ] in selected patients, were handled with caution. Besides the fact that physicians and patients were reported to be uncomfortable with both the options of omission and deferral [ 18 , 25 ], caution was due to the largely unknown pandemic trajectory in the early phase of the outbreak. As a matter of fact, while priority for high-risk patients was always fulfilled, low-risk patients experienced a statistically significant, although clinically negligible, delay in commencing RT, which was well within the range allowed by the national recommendations [ 5 ].…”

Basic Physical Principles and Clinical Applications of Computed Tomography

“…DECT techniques may be useful to differentiate substances such as iodine, calcium, and uric acid from soft tissues [21][22][23][24]. Detector-based spectral computed tomography employs dual layers of detectors to simultaneously collect low and high-energy data generated from a single X-ray tube in all patients using conventional helical CT protocols.…”

3D printed CT-based abdominal structure mannequin for enabling research

“…Since the discovery of x-rays in 1895, major advances have taken place in X-ray imaging including computed tomography (CT), dual energy (DE) imaging, cone beam CT (CBCT) and digital tomosynthesis (DT) [1][2][3][4][5][6]. Because these radiologic imaging technologies have been shown to expose the patient to harmful ionizing radiation, rigorous quality assurance (QA) testing is needed to minimize the radiation dose and maximize the diagnostic information from each scan [7].…”