Effect of dose metrics and radiation risk models when optimizing CT x-ray tube voltage

We investigated the effect of different CT dose metrics, as well as the implications of various radiation risk models, on the optimization of x-ray tube voltage (kV) in CT. Soft tissue attenuation characteristics and noise levels, obtained from CT scans of a Rando phantom, were used to compute contrast-to-noise ratios (CNR) at x-ray tube voltages between 80 and 140 kV. Four CT dose metrics were evaluated: (a) CTDI(air), (b) weighted CTDI(w), (c) organ dose (D(organ)), and (d) effective dose (E). All doses were obtained using the ImPACT CT Dosimetry software package. Soft tissue CNR was adjusted by the modification of the mAs by assuming that CNR(2) was proportional to mAs. Optimization criteria were: (a) maintaining a constant CNR at each kV and identifying the value that minimizes patient dose; and (b) maintaining a constant dose at each kV and identifying the value that maximizes CNR. We also investigated the implication for optimization strategies assuming that radiation risk is proportional to E(n), with n varying between 0 and 2. Optimizing with respect to phantom measurements (i.e., CTDI(air) and CTDI(w)) could generate results that differed quantitatively and qualitatively from those obtained using patient doses (i.e., D(organ) and E). For head CT scans, 140 kV offered the lowest patient doses as well as the highest CNR, whereas in abdominal scans 80 kV was optimal. Use of an optimal kV for CT imaging over current practice of using 120 kV might reduce patient doses by 10-15%, or improve CNR by 5-10%. Assuming that the risk was proportional to E(n) made no difference to the optimal kV for positive values of n up to 2. We conclude that (a) CT optimization with respect to kV should generally be performed with respect to the patient effective dose, (b) neither CTDI(air) nor the body CTDI(w) are appropriate for use in CT optimization, (c) the range of current radiation risk models should not affect the optimal kV value in CT imaging.     

X-ray scatter correction algorithm for cone beam CT imaging

Developing and optimizing an x-ray scatter control and reduction technique is one of the major challenges for cone beam computed tomography (CBCT) because CBCT will be much less immune to scatter than fan-beam CT. X-ray scatter reduces image contrast, increases image noise and introduces reconstruction error into CBCT. To reduce scatter interference, a practical algorithm that is based upon the beam stop array technique and image sequence processing has been developed on a flat panel detector-based CBCT prototype scanner. This paper presents a beam stop array-based scatter correction algorithm and the evaluation results through phantom studies. The results indicate that the beam stop array-based scatter correction algorithm is practical and effective to reduce and correct x-ray scatter for a CBCT imaging task.     

Effect of scattered radiation on image noise in cone beam CT

Cone beam CT has a capability for the 3-dimensional imaging of large volumes with isotropic resolution, and has a potentiality for 4-dimensional imaging (dynamic volume imaging), because cone beam CT acquires data of a large volume with one rotation of an x-ray tube-detector pair. However, one of the potential drawbacks of cone beam CT is a larger amount of scattered x-rays, which may enhance the noise in reconstructed images, and thus affect the low-contrast detectablity. Our aim in this work was to estimate the scatter fractions and effects of scatter on image noise, and to seek methods of improving image quality in cone beam CT. First we derived a relationship between the noise in a reconstructed image and in an x-ray intensity measurement. Then we estimated the scatter to primary ratios in x-ray measurements using a Monte-Carlo simulation. From these we estimated the image noise under relevant clinical conditions. The results showed that the scattered radiation made a substantial contribution to the image noise. However, focused collimators could improve it by decreasing the scattered radiation drastically while keeping the primary radiation at nearly the same level. A conventional grid also improved the image noise, though the improvement was less than that of focused collimators.     

Patient dose from kilovoltage cone beam computed tomography imaging in radiation therapy

Kilovoltage cone-beam computerized tomography (kV-CBCT) systems integrated into the gantry of linear accelerators can be used to acquire high-resolution volumetric images of the patient in the treatment position. Using on-line software and hardware, patient position can be determined accurately with a high degree of precision and, subsequently, set-up parameters can be adjusted to deliver the intended treatment. While the patient dose due to a single volumetric imaging acquisition is small compared to the therapy dose, repeated and daily image guidance procedures can lead to substantial dose to normal tissue. The dosimetric properties of a clinical CBCT system have been studied on an Elekta linear accelerator (Synergy RP, XVI system) and additional measurements performed on a laboratory system with identical geometry. Dose measurements were performed with an ion chamber and MOSFET detectors at the center, periphery, and surface of 30 and 16-cm-diam cylindrical shaped water phantoms, as a function of x-ray energy and longitudinal field-of-view (FOV) settings of 5,10,15, and 26 cm. The measurements were performed for full 360 degrees CBCT acquisition as well as for half-rotation scans for 120 kVp beams using the 30-cm-diam phantom. The dose at the center and surface of the body phantom were determined to be 1.6 and 2.3 cGy for a typical imaging protocol, using full rotation scan, with a technique setting of 120 kVp and 660 mAs. The results of our measurements have been presented in terms of a dose conversion factor fCBCT, expressed in cGy/R. These factors depend on beam quality and phantom size as well as on scan geometry and can be utilized to estimate dose for any arbitrary mAs setting and reference exposure rate of the x-ray tube at standard distance. The results demonstrate the opportunity to manipulate the scanning parameters to reduce the dose to the patient by employing lower energy (kVp) beams, smaller FOV, or by using half-rotation scan.     

Evaluation of on-board kV cone beam CT (CBCT)-based dose calculation

On-board CBCT images are used to generate patient geometric models to assist patient setup. The image data can also, potentially, be used for dose reconstruction in combination with the fluence maps from treatment plan. Here we evaluate the achievable accuracy in using a kV CBCT for dose calculation. Relative electron density as a function of HU was obtained for both planning CT (pCT) and CBCT using a Catphan-600 calibration phantom. The CBCT calibration stability was monitored weekly for 8 consecutive weeks. A clinical treatment planning system was employed for pCT- and CBCT-based dose calculations and subsequent comparisons. Phantom and patient studies were carried out. In the former study, both Catphan-600 and pelvic phantoms were employed to evaluate the dosimetric performance of the full-fan and half-fan scanning modes. To evaluate the dosimetric influence of motion artefacts commonly seen in CBCT images, the Catphan-600 phantom was scanned with and without cyclic motion using the pCT and CBCT scanners. The doses computed based on the four sets of CT images (pCT and CBCT with/without motion) were compared quantitatively. The patient studies included a lung case and three prostate cases. The lung case was employed to further assess the adverse effect of intra-scan organ motion. Unlike the phantom study, the pCT of a patient is generally acquired at the time of simulation and the anatomy may be different from that of CBCT acquired at the time of treatment delivery because of organ deformation. To tackle the problem, we introduced a set of modified CBCT images (mCBCT) for each patient, which possesses the geometric information of the CBCT but the electronic density distribution mapped from the pCT with the help of a BSpline deformable image registration software. In the patient study, the dose computed with the mCBCT was used as a surrogate of the 'ground truth'. We found that the CBCT electron density calibration curve differs moderately from that of pCT. No significant fluctuation was observed in the calibration over the period of 8 weeks. For the static phantom, the doses computed based on pCT and CBCT agreed to within 1%. A notable difference in CBCT- and pCT-based dose distributions was found for the motion phantom due to the motion artefacts which appeared in the CBCT images (the maximum discrepancy was found to be approximately 3.0% in the high dose region). The motion artefacts-induced dosimetric inaccuracy was also observed in the lung patient study. For the prostate cases, the mCBCT- and CBCT-based dose calculations yielded very close results (<2%). Coupled with the phantom data, it is concluded that the CBCT can be employed directly for dose calculation for a disease site such as the prostate, where there is little motion artefact. In the prostate case study, we also noted a large discrepancy between the original treatment plan and the CBCT (or mCBCT)-based calculation, suggesting the importance of inter-fractional organ movement and the need for adaptive therapy to compensate for the anatomical changes in the future.     

Minimization of over-ranging in helical volumetric CT via hybrid cone beam image reconstruction--benefits in dose efficiency

Diagnostic computed tomography (CT) images are usually acquired in both helical and axial scans in the clinical applications using cone beam volumetric CT. In addition to faster patient throughput, a helical scan in volumetric CT can provide better image quality because of the satisfaction of data sufficiency condition, and thus has been performed far more frequently so far in the clinic. However, the first and last images in a helical scan are usually prescribed at the locations that are half helical turn indented from the starting and ending points of the scan. Due to such an indention, the dose efficiency of helical scan deteriorates with increasing detector dimension along z direction. To improve the dose efficiency of helical scan in volumetric CT, a hybrid helical cone beam filtered backprojection (CB-FBP) algorithm is presented here to reconstruct helical images beyond the conventional indented image zone. The hybrid algorithm is a combination of the ray-wise three-dimensional (3D) weighted CB-FBP algorithms that are recently proposed for helical and axial CB image reconstructions. Through the hybridization, the ray-wise 3D weighting becomes dependent on both helical pitch and image slice location. Phantom study shows that the conventional indented image zone in helical scan can be extended substantially by using the hybrid algorithm. Consequently, the dose efficiency of volumetric CT in helical scan can be improved significantly. It is believed that, with increasing detector dimension along z direction in cone beam volumetric CT, the hybrid algorithm will become more attractive in clinical applications.     

锥形束CT图像引导乳腺癌放疗中不同配准方法研究

目的：比较锥形束CT(CBCT)图像引导乳腺癌放疗中采用不同配准方法[3D配准（平移）和6D配准（平移+旋转）对配准精度的影响,为选择合理的图像引导方法提供临床依据。方法：回顾性分析18例乳腺癌患者共101次治疗前摆位CBCT图像,将CBCT图像与计划CT图像分别采用3D灰度配准和6D灰度配准方法进行配准,比较和分析两种配准方法的3D平移方向的配准偏差差异并计算其平移差别,进一步统计分析旋转角度偏差与平移差别的相关性并做线性模拟。结果：3D和6D两种配准方法得到不同的平移配准结果,其中在头脚（Y）方向[（-1.47±3.00）mm vs(-0.87±3.27)mm]和前后（Z）方向[（-2.91±4.49）mm vs(-3.41±5.38)mm]的差异存在统计学意义（P<0.001）。旋转角度偏差与平移差别存在相关性,其中ΔX和ΔZ均与Ry呈线性强相关性,其相关系数PCC分别为-0.883和0.795(P<0.001);ΔY与Rx呈线性强负相关性,PCC=-0.722(P<0.001)。根据线性模拟公式计算,当Rx>1°且Ry>2°时,两种配准方法将在各平...     

Technique factors and their relationship to radiation dose in pendant geometry breast CT

The use of breast computed tomography (CT) as an alternative to mammography in some patients is being studied at several institutions. However, the radiation dosimetry issues associated with breast CT are markedly different than in the case of mammography. In this study, the spectral properties of an operational breast CT scanner were characterized both by physical measurement and computer modeling of the kVp-dependent spectra, from 40 to 110 kVp (Be window W anode with 0.30 mm added Cu filtration). Previously reported conversion factors, normalized glandular dose for CT-DgN(ct), derived from Monte Carlo methods, were used in concert with the output spectra of the breast scanner to compute the mean glandular dose to the breast based upon different combinations of x-ray technique factors (kVp and mAs). The mean glandular dose (MGD) was measured as a function of the compressed breast thickness (2-8 cm) and three different breast compositions (0%, 50%, and 100% glandular fractions) in four clinical mammography systems in our institution. The average MGD from these four systems was used to compute the technique factors for breast CT systems that would match the two-view mammographic dose levels. For a 14 cm diameter breast (equivalent to a 5 cm thick compressed breast in mammography), air kerma levels at the breast CT scanner's isocenter (468 mm from the source) of 4.4, 6.4, and 9.0 mGy were found to deliver equivalent mammography doses for 0%, 50%, and 100% glandular breasts (respectively) at 80 kVp. At 80 kVp (where air kerma was 11.3 mGy/100 mAs at the isocenter), 57 mAs (integrated over the entire scan) was required to match the mammography dose for a 14 cm 50% glandular breast. At 50 kVp, 360 mAs is required to match mammographic dose levels. Tables are provided for both air kerma at the isocenter and mAs for 0%, 50%, and 100% glandular breasts. Other issues that impact breast CT technique factors are also discussed.     

Spatial resolution properties in cone beam CT: a simulation study

This work is intended to investigate the spatial resolution properties in cone beam CT by estimating the point spread functions (PSFs) in the reconstructed 3D images through simulation. The point objects were modeled as 3D delta functions. Their projections onto the detector plane were analytically derived and blurred with 2D PSFs estimated and used to represent the detector and focal spot blurring effects. The 2D PSF for detector blurring was computed from the line spread function measured for a typical a-Si/CsI flat panel detector used for general radiography. The focal spot blurring effect was simulated for an x-ray source with a nominal focal spot size of 0.6 mm and 1.33 x magnification at the rotating center. Projection images were computed and sampled with an interval significantly smaller than the detector pixel size to avoid aliasing. Images were reconstructed using the Feldkamp algorithm with the five different filter functions. Reconstructed PSFs were plotted and analyzed to investigate the effects of detector blurring alone, focal spot blurring alone, or a combination of the two on the PSFs and their variations with the radial distance and z-level. Effects of binning and reconstruction filters were also studied. Our results show that the PSFs due to detector blurring are largely symmetric and vary little with the locations of the point objects. With focal spot blurring only or added to detector blurring, the PSFs along the rotation axis were largely symmetric but became increasingly asymmetric as the point objects were moved away from the rotation axis. The PSFs were found to become wider in the axial (anode to cathode) direction as the objects were moved toward the cathode side. The 3D PSFs may be approximated by an ellipsoid with three different axial lengths. They were found to point upright along the rotating axis but tilt toward the rotating axis as the point object was moved away from the axis.     

Linac-integrated 4D cone beam CT: first experimental results

A new online imaging approach, linac-integrated cone beam CT (CBCT), has been developed over the past few years. It has the advantage that a patient can be examined in their treatment position directly before or during a radiotherapy treatment. Unfortunately, respiratory organ motion, one of the largest intrafractional organ motions, often leads to artefacts in the reconstructed 3D images. One way to take this into account is to register the breathing phase during image acquisition for a phase-correlated image reconstruction. Therefore, the main focus of this work is to present a system which has the potential to investigate the correlation between internal (movement of the diaphragm) and external (data of a respiratory gating system) information about breathing phase and amplitude using an inline CBCT scanner. This also includes a feasibility study about using the acquired information for a respiratory-correlated 4D CBCT reconstruction. First, a moving lung phantom was used to develop and to specify the required methods which are based on an image reconstruction using only projections belonging to a certain moving phase. For that purpose, the corresponding phase has to be detected for each projection. In the case of the phantom, an electrical signal allows one to track the movement in real time. The number of projections available for the image reconstruction depends on the breathing phase and the size of the position range from which projections should be used for the reconstruction. The narrower this range is, the better the inner structures can be located, but also the noise of the images increases due to the limited number of projections. This correlation has also been analysed. In a second step, the methods were clinically applied using data sets of patients with lung tumours. In this case, the breathing phase was detected by an external gating system (AZ-733V, Anzai Medical Co.) based on a pressure sensor attached to the patient's abdominal region with a fixation belt. The comparison of the reconstructed 4D CBCT images and the corresponding 4D CT images used for the treatment planning provides the required information for the calculation of possible setup errors. So, a repositioning of the patient is feasible even though the patient moves due to respiration. In addition to the external signal, the position of the diaphragm in the cranial-caudal direction could be extracted from each projection. Both independent sources of information show a very good agreement of the phase and even the amplitude of the movement and the external signal respectively. This suggests the usability of such a system for a gated dose delivery approach. However, more studies involving patients with different incidences have to be carried out to confirm these first results.     

A comprehensive study on the relationship between the image quality and imaging dose in low-dose cone beam CT

While compressed sensing (CS)-based algorithms have been developed for the low-dose cone beam CT (CBCT) reconstruction, a clear understanding of the relationship between the image quality and imaging dose at low-dose levels is needed. In this paper, we qualitatively investigate this subject in a comprehensive manner with extensive experimental and simulation studies. The basic idea is to plot both the image quality and imaging dose together as functions of the number of projections and mAs per projection over the whole clinically relevant range. On this basis, a clear understanding of the tradeoff between the image quality and imaging dose can be achieved and optimal low-dose CBCT scan protocols can be developed to maximize the dose reduction while minimizing the image quality loss for various imaging tasks in image-guided radiation therapy (IGRT). Main findings of this work include (1) under the CS-based reconstruction framework, image quality has little degradation over a large range of dose variation. Image quality degradation becomes evident when the imaging dose (approximated with the x-ray tube load) is decreased below 100 total mAs. An imaging dose lower than 40 total mAs leads to a dramatic image degradation, and thus should be used cautiously. Optimal low-dose CBCT scan protocols likely fall in the dose range of 40-100 total mAs, depending on the specific IGRT applications. (2) Among different scan protocols at a constant low-dose level, the super sparse-view reconstruction with the projection number less than 50 is the most challenging case, even with strong regularization. Better image quality can be acquired with low mAs protocols. (3) The optimal scan protocol is the combination of a medium number of projections and a medium level of mAs/view. This is more evident when the dose is around 72.8 total mAs or below and when the ROI is a low-contrast or high-resolution object. Based on our results, the optimal number of projections is around 90 to 120. (4) The clinically acceptable lowest imaging dose level is task dependent. In our study, 72.8 mAs is a safe dose level for visualizing low-contrast objects, while 12.2 total mAs is sufficient for detecting high-contrast objects of diameter greater than 3 mm.     

An iterative approach to the beam hardening correction in cone beam CT

In computed tomography (CT), the beam hardening effect has been known to be one of the major sources of deterministic error that leads to inaccuracy and artifact in the reconstructed images. Because of the polychromatic nature of the x-ray source used in CT and the energy-dependent attenuation of most materials, Beer's law no longer holds. As a result, errors are present in the acquired line integrals or measurements of the attenuation coefficients of the scanned object. In the past, many studies have been conducted to combat image artifacts induced by beam hardening. In this paper, we present an iterative beam hardening correction approach for cone beam CT. An algorithm that utilizes a tilted parallel beam geometry is developed and subsequently employed to estimate the projection error and obtain an error estimation image, which is then subtracted from the initial reconstruction. A theoretical analysis is performed to investigate the accuracy of our methods. Phantom and animal experiments are conducted to demonstrate the effectiveness of our approach.     

基于Contourlet变换的CT和锥形束CT图像配准算法

目的提出一种基于Contourlet变换,用于放射治疗定位的CT与锥形束CT（cone beam CT,CBCT）图像配准的方法。方法利用Contourlet变换多尺度多方向的分辨特性,将待配准图像进行Contourlet变换分解,分解后的高频方向子带合成梯度图像,采用归一化互信息作为相似性测度,把梯度图像与低频方向子带以加权函数结合,进行临床医学图像的刚性配准,有效弥补了互信息配准中缺少空间信息的不足。结果通过已知空间变换参数图像的配准结果验证了算法的准确性。配准后lO幅图像变换参数的误差极小,且均方根误差接近于0。结论该图像配准算法精确度高,并具有很好的鲁棒性,有助于提高图像引导放射治疗（image guid edradiation therapy,IGRT）中解剖组织结构和靶区的定位精度。     

Image registration algorithm in CT and cone beam CT based on Contourlet transform

目的提出一种基于Contourlet变换,用于放射治疗定位的CT与锥形束CT(cone beam CT,CBCT)图像配准的方法.方法 利用Contourlet变换多尺度多方向的分辨特性,将待配准图像进行Contourlet变换分解,分解后的高频方向子带合成梯度图像,采用归一化互信息作为相似性测度,把梯度图像与低频方向子带以加权函数结合,进行临床医学图像的刚性配准,有效弥补了互信息配准中缺少空间信息的不足.结果 通过已知空间变换参数图像的配准结果验证了算法的准确性.配准后10幅图像变换参数的误差极小,且均方根误差接近于0.结论 该图像配准算法精确度高,并具有很好的鲁棒性,有助于提高图像引导放射治疗(image guided radiation therapy,IGRT)中解剖组织结构和靶区的定位精度.     

锥形束CT数字成像分析牙槽嵴裂植骨修复的成骨效果

BACKGROUND:In alveolar cleft patients, the amount of bone stock after alveolar bone grafting is mostly measured and analyzed by two-dimensional imaging, which can result in a large error.OBJECTIVE:To evaluate the 6-month osteogenesis of alveolar bone graft in alveolar cleft patients using cone beam CT.METHODS: Alveolar bone grafting was performed in 25 patients with unilateral complete alveolar cleft. The patients were followed up for 6 months after surgery and the osteogenesis of the bone graft was evaluated by CBCT.RESULTS AND CONCLUSION: After the surgery, the labial bone support was better than the palatal one. There were significant differences in the alveolar bone thickness of the cleft region and the normal region of the central incisor as well as the alveolar bone thickness of the cleft region and the normal region of the canine tooth 0 mm distant to the alveolar crest. These findings indicate that the palatal bone support is less than the labial one, and the bone support of the central incisor is not satisfactory, which provide the basis for the tooth movement in the alveolar bone grafting and the orthodontics treatment.  中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Noise simulation in cone beam CT imaging with parallel computing

We developed a computer noise simulation model for cone beam computed tomography imaging using a general purpose PC cluster. This model uses a mono-energetic x-ray approximation and allows us to investigate three primary performance components, specifically quantum noise, detector blurring and additive system noise. A parallel random number generator based on the Weyl sequence was implemented in the noise simulation and a visualization technique was accordingly developed to validate the quality of the parallel random number generator. In our computer simulation model, three-dimensional (3D) phantoms were mathematically modelled and used to create 450 analytical projections, which were then sampled into digital image data. Quantum noise was simulated and added to the analytical projection image data, which were then filtered to incorporate flat panel detector blurring. Additive system noise was generated and added to form the final projection images. The Feldkamp algorithm was implemented and used to reconstruct the 3D images of the phantoms. A 24 dual-Xeon PC cluster was used to compute the projections and reconstructed images in parallel with each CPU processing 10 projection views for a total of 450 views. Based on this computer simulation system, simulated cone beam CT images were generated for various phantoms and technique settings. Noise power spectra for the flat panel x-ray detector and reconstructed images were then computed to characterize the noise properties. As an example among the potential applications of our noise simulation model, we showed that images of low contrast objects can be produced and used for image quality evaluation.