The Role of In-Room kV X-Ray Imaging for Patient Setup and Target Localization

Image‐guided radiation therapy using cone‐beam computed tomography (CBCT) is becoming routine practice in modern radiation therapy. The purpose of this work was to develop an imaging QA program for CT and CBCT units in our department, based on the American College of Radiology (ACR) CT accreditation phantom. The phantom has four testing modules, permitting one to test CT number accuracy, slice width, low contrast resolution, image uniformity, in‐plane distance accuracy, and high‐contrast resolution reproducibly with suggested window/levels for image analysis. Additional tests for contrast‐to‐noise ratio (CNR) and noise were added using the polyethylene and acrylic plugs. Baseline values were obtained from CT simulator images acquired on a Phillips Brilliance Big Bore CT simulator and CBCT images acquired on three Varian CBCTs for the imaging protocols most used clinically. Images were then acquired quarterly over a period of two years. Images were exported via DICOM and analyzed manually using OsiriX. Baseline values were used to ensure that image quality remained consistent quarterly, and baselines were reset at any major maintenance or recalibration. Analysis of CT simulator images showed that image quality was within ACR guidelines for all tested scanning protocols. All three CBCT systems were unable to distinguish the low‐contrast resolution plugs and had the same high‐contrast resolution over all imaging protocols. Analysis of CBCT results over time determined a range of values that could be used to establish quantitative tolerance levels for image quality deterioration. While appropriate for the helical CT, the ACR phantom and guidelines could be modified to be more useful in evaluating CBCT systems. In addition, the observed values for the CT simulator were well within ACR tolerances.PACS numbers: 87.57.Q‐, 87.57.qp, 87.57.C‐

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using the ACR CT accreditation phantom for routine image quality assurance on both CT and CBCT imaging systems in a radiotherapy environment

Hobson

Soisson

Davis

et al. 2014

“…CBCT is routinely used as interventional tool in IGRT; (22) however, elongation of a tumor by patient motion affects the localization accuracy and patient setup. In this study, controlled cyclic motion was employed with known motion amplitude and frequency.…”

Section: Discussionmentioning

confidence: 99%

“…In CBCT, the projections are acquired by rotating the imaging gantry around the patient to obtain different angular views to reconstruct volumetric images of the patient (21) . Over the last decade, interventional applications of CBCT have grown, where increasing number of radiation therapy machines are being equipped with kV on‐board imaging (OBI) systems that can provide planar radiographic imaging, volumetric CT imaging, and fluoroscopy (22) . The OBI has become a vital clinical tool to perform image‐guided radiation therapy (IGRT).…”

Section: Introductionmentioning

confidence: 99%

Modeling and measurement of the variations of CT number distributions for mobile targets in cone‐beam computed tomographic imaging

Ali

Alsbou

Ahmad

2015

The purpose of this study was to investigate quantitatively by measurement and modeling the variations in CT number distributions of mobile targets in cone‐beam CT (CBCT) imaging. CBCT images were acquired for three targets manufactured from homogenous water‐equivalent gel that was inserted into a commercial mobile thorax phantom. The phantom moved with a controlled cyclic motion in one‐dimension along the superior–inferior direction to simulate patient respiratory motion. Profiles of the CT number distributions of the static and mobile targets were obtained using CBCT images. A mathematical model was developed that predicted the variations in CT number distributions and their dependence on the motion parameters of targets moving in one‐dimension using CBCT imaging. The measured CT number distributions for the mobile targets varied considerably, depending on the motion parameters. The extension of the CT number distribution increased linearly with motion amplitude where maximum target elongation reached twice the motion amplitude. The CT number levels of the mobile targets were smeared over a longer distribution; for example, the CT number level for the 20 mm target dropped by nearly 30% at motion amplitude (A) equal to 20 mm in comparison with the CT number distribution of stationary targets. Frequency of motion played an important role in spatial and level variations of the CT number distributions. For example, the level of the CT number profile for the medium target (20 mm) decreased evenly by nearly 50% at A=20 mm with high motion frequencies. Motion phase did not affect the CT number distributions for prolonged projection acquisition that included several respiratory cycles. The mathematical model of the CT number distributions of mobile targets in CBCT reproduced well the measured CT number distributions and predicted their dependence on the target size and phantom motion parameters such as speed, amplitude, frequency, and phase. The CT number distributions varied considerably with motion in CBCT. A motion model of CT number distribution for mobile targets has been developed in this work that predicted well the variations in the measured CT number profiles and their dependence on motion parameters. The model corrected the CT number distribution retrospective to CT image reconstruction where it used a first‐order linear relationship between the number of projections collected in the imaging window of a mobile voxel to obtain the cumulative CT number. This model provides quantitative characterization of motion artifacts on CT number distributions in CBCT that is useful to determine the validity of CT numbers and the accuracy of localization and volume measurement of tumors in diagnostic imaging and interventional applications, such as radiotherapy.PACS number: 87.57.C‐

Normal tissue doses from MV image‐guided radiation therapy (IGRT) using orthogonal MV and MV‐CBCT

Netherton

Nitsch

et al. 2018

PurposeThe aim of this study was to measure and compare the mega‐voltage imaging dose from the Halcyon medical linear accelerator (Varian Medical Systems) with measured imaging doses with the dose calculated by Eclipse treatment planning system.MethodsAn anthropomorphic thorax phantom was imaged using all imaging techniques available with the Halcyon linac — MV cone‐beam computed tomography (MV‐CBCT) and orthogonal anterior‐posterior/lateral pairs (MV‐MV), both with high‐quality and low‐dose modes. In total, 54 imaging technique, isocenter position, and field size combinations were evaluated. The imaging doses delivered to 11 points in the phantom (in‐target and extra‐target) were measured using an ion chamber, and compared with the imaging doses calculated using Eclipse.ResultsFor high‐quality MV‐MV mode, the mean extra‐target doses delivered to the heart, left lung, right lung and spine were 1.18, 1.64, 0.80, and 1.11 cGy per fraction, respectively. The corresponding mean in‐target doses were 3.36, 3.72, 2.61, and 2.69 cGy per fraction, respectively. For MV‐MV technique, the extra‐target imaging dose had greater variation and dependency on imaging field size than did the in‐target dose. Compared to MV‐MV technique, the imaging dose from MV‐CBCT was less sensitive to the location of the organ relative to the treatment field. For high‐quality MV‐CBCT mode, the mean imaging doses to the heart, left lung, right lung, and spine were 8.45, 7.16, 7.19, and 6.51 cGy per fraction, respectively. For both MV‐MV and MV‐CBCT techniques, the low‐dose mode resulted in an imaging dose about half of that in high‐quality mode.ConclusionThe in‐target doses due to MV imaging using the Halcyon ranged from 0.59 to 9.75 cGy, depending on the choice of imaging technique. Extra‐target doses from MV‐MV technique ranged from 0 to 2.54 cGy. The MV imaging dose was accurately calculated by Eclipse, with maximum differences less than 0.5% of a typical treatment dose (assuming a 60 Gy prescription). Therefore, the cumulative imaging and treatment plan dose distribution can be expected to accurately reflect the actual dose.