Investigation of planar image quality for a novel 2.5 MV diamond target beam from a radiotherapy linear accelerator

Background and purpose

A commercial 2.5 MV beam has been clinically available for beam’s-eye-view imaging in radiotherapy, offering improved contrast-to-noise ratio (CNR) compared to therapeutic beams, due to the softer spectrum. Previous research suggested that imaging performance could be improved using a low-Z diamond target to reduce the self-absorption of diagnostic energy photons. The aim of this study was to 1) investigate the feasibility of two 2.5 MV diamond target beamline configurations and 2) characterize the dosimetry and planar image quality of these novel low-Z beams.

Materials and methods

The commercial 2.5 MV beam was modified by replacing the copper target with sintered diamond. Two beamlines were investigated: a carousel-mounted diamond target beamline and a ‘conventional’ beamline, with the diamond target in the target arm. Planar image quality was assessed in terms of spatial resolution and CNR.

Results

Due to image artifacts, image quality could not be assessed for the carousel-mounted low-Z target beam. The ‘conventional’ 2.5 MV low-Z beam quality was softer by 2.7% compared to the commercial imaging beam, resulting in improved CNR by factors of up to 1.3 and 1.7 in thin and thick phantoms, respectively. In regard to spatial resolution, the ‘conventional’ 2.5 MV low-Z beam slightly outperformed the commercial imaging beam.

Conclusion

With a simple modification to the 2.5 MV commercial beamline, we produced an improved energy spectrum for imaging. This 2.5 MV diamond target beam proved to be an advantageous alternative to the commercial target configuration, offering both superior resolution and CNR.

Image guidance doses delivered during radiotherapy: Quantification, management, and reduction: Report of the AAPM Therapy Physics Committee Task Group 180

BACKGROUND

With radiotherapy having entered the era of image guidance, or image-guided radiation therapy (IGRT), imaging procedures are routinely performed for patient positioning and target localization. The imaging dose delivered may result in excessive dose to sensitive organs and potentially increase the chance of secondary cancers and, therefore, needs to be managed.

AIMS

This task group was charged with: a) providing an overview on imaging dose, including megavoltage electronic portal imaging (MV EPI), kilovoltage digital radiography (kV DR), Tomotherapy MV-CT, megavoltage cone-beam CT (MV-CBCT) and kilovoltage cone-beam CT (kV-CBCT), and b) providing general guidelines for commissioning dose calculation methods and managing imaging dose to patients.

MATERIALS & METHODS

We briefly review the dose to radiotherapy (RT) patients resulting from different image guidance procedures and list typical organ doses resulting from MV and kV image acquisition procedures.

RESULTS

We provide recommendations for managing the imaging dose, including different methods for its calculation, and techniques for reducing it. The recommended threshold beyond which imaging dose should be considered in the treatment planning process is 5% of the therapeutic target dose.

DISCUSSION

Although the imaging dose resulting from current kV acquisition procedures is generally below this threshold, the ALARA principle should always be applied in practice. Medical physicists should make radiation oncologists aware of the imaging doses delivered to patients under their care.

CONCLUSION

Balancing ALARA with the requirement for effective target localization requires that imaging dose be managed based on the consideration of weighing risks and benefits to the patient.

Low-dose 2.5 MV cone-beam computed tomography with thick CsI flat-panel imager

Most of the treatment units, both new and old models, are equipped with a megavoltage portal imager but its use for volumetric imaging is limited. This is mainly due to the poor image quality produced by the high‐energy treatment beam (>6 MV). A linac at our center is equipped with a prototype 2.5 MV imaging beam. This study evaluates the feasibility of low‐dose megavoltage cone‐beam imaging with the 2.5 MV beam and a thick cesium iodide detector, which is a high‐efficiency imager. Basic imaging properties such as spatial resolution and modulation transfer function were assessed for the 2.5 MV prototype imaging system. For image quality and imaging dose, a series of megavoltage cone‐beam scans were acquired for the head, thorax, and pelvis of an anthropomorphic phantom and were compared to kilovoltage cone‐beam and 6X megavoltage cone‐beam images. To demonstrate the advantage of MV imaging, a phantom with metallic inserts was scanned and the image quality was compared to CT and kilovoltage cone‐beam scans. With a lower energy beam and higher detector efficiency, the 2.5 MV imaging system generally yields better image quality than does the 6 MV imaging system with the conventional MV imager. In particular, with the anthropomorphic phantom studies, the contrast to noise of bone to tissue is generally improved in the 2.5 MV images compared to 6 MV. With an image quality sufficient for bony alignment, the imaging dose for 2.5 MV cone‐beam images is 2.4−3.4 MU compared to 26 MU in 6 MV cone‐beam scans for the head, thorax, and pelvis regions of the phantom. Unlike kilovoltage cone‐beam, the 2.5 MV imaging system does not suffer from high‐Z image artifacts. This can be very useful for treatment planning in cases where high‐Z prostheses are present.

PACS number(s): 87.57.Q‐

Optimization of the design of thick, segmented scintillators for megavoltage cone-beam CT using a novel, hybrid modeling technique

PURPOSE

Active matrix flat-panel imagers (AMFPIs) incorporating thick, segmented scintillators have demonstrated order-of-magnitude improvements in detective quantum efficiency (DQE) at radiotherapy energies compared to systems based on conventional phosphor screens. Such improved DQE values facilitate megavoltage cone-beam CT (MV CBCT) imaging at clinically practical doses. However, the MV CBCT performance of such AMFPIs is highly dependent on the design parameters of the scintillators. In this paper, optimization of the design of segmented scintillators was explored using a hybrid modeling technique which encompasses both radiation and optical effects.

METHODS

Imaging performance in terms of the contrast-to-noise ratio (CNR) and spatial resolution of various hypothetical scintillator designs was examined through a hybrid technique involving Monte Carlo simulation of radiation transport in combination with simulation of optical gain distributions and optical point spread functions. The optical simulations employed optical parameters extracted from a best fit to measurement results reported in a previous investigation of a 1.13 cm thick, 1016 μm pitch prototype BGO segmented scintillator. All hypothetical designs employed BGO material with a thickness and element-to-element pitch ranging from 0.5 to 6 cm and from 0.508 to 1.524 mm, respectively. In the CNR study, for each design, full tomographic scans of a contrast phantom incorporating various soft-tissue inserts were simulated at a total dose of 4 cGy.

RESULTS

Theoretical values for contrast, noise, and CNR were found to be in close agreement with empirical results from the BGO prototype, strongly supporting the validity of the modeling technique. CNR and spatial resolution for the various scintillator designs demonstrate complex behavior as scintillator thickness and element pitch are varied--with a clear trade-off between these two imaging metrics up to a thickness of ~3 cm. Based on these results, an optimization map indicating the regions of design that provide a balance between these metrics was obtained. The map shows that, for a given set of optical parameters, scintillator thickness and pixel pitch can be judiciously chosen to maximize performance without resorting to thicker, more costly scintillators.

CONCLUSIONS

Modeling radiation and optical effects in thick, segmented scintillators through use of a hybrid technique can provide a practical way to gain insight as to how to optimize the performance of such devices in radiotherapy imaging. Assisted by such modeling, the development of practical designs should greatly facilitate low-dose, soft tissue visualization employing MV CBCT imaging in external beam radiotherapy.

A Monte Carlo investigation of low-Z target image quality generated in a linear accelerator using Varian's VirtuaLinac

PURPOSE

The focus of this work was the demonstration and validation of VirtuaLinac with clinical photon beams and to investigate the implementation of low-Z targets in a TrueBeam linear accelerator (Linac) using Monte Carlo modeling.

METHODS

VirtuaLinac, a cloud based web application utilizing Geant4 Monte Carlo code, was used to model the Linac treatment head components. Particles were propagated through the lower portion of the treatment head using BEAMnrc. Dose distributions and spectral distributions were calculated using DOSXYZnrc and BEAMdp, respectively. For validation, 6 MV flattened and flattening filter free (FFF) photon beams were generated and compared to measurement for square fields, 10 and 40 cm wide and at dmax for diagonal profiles. Two low-Z targets were investigated: a 2.35 MeV carbon target and the proposed 2.50 MeV commercial imaging target for the TrueBeam platform. A 2.35 MeV carbon target was also simulated in a 2100EX Clinac using BEAMnrc. Contrast simulations were made by scoring the dose in the phosphor layer of an IDU20 aSi detector after propagating through a 4 or 20 cm thick phantom composed of water and ICRP bone.

RESULTS

Measured and modeled depth dose curves for 6 MV flattened and FFF beams agree within 1% for 98.3% of points at depths greater than 0.85 cm. Ninety three percent or greater of points analyzed for the diagonal profiles had a gamma value less than one for the criteria of 1.5 mm and 1.5%. The two low-Z target photon spectra produced in TrueBeam are harder than that from the carbon target in the Clinac. Percent dose at depth 10 cm is greater by 3.6% and 8.9%; the fraction of photons in the diagnostic energy range (25-150 keV) is lower by 10% and 28%; and contrasts are lower by factors of 1.1 and 1.4 (4 cm thick phantom) and 1.03 and 1.4 (20 cm thick phantom), for the TrueBeam 2.35 MV/carbon and commercial imaging beams, respectively.

CONCLUSIONS

VirtuaLinac is a promising new tool for Monte Carlo modeling of novel target designs. A significant spectral difference is observed between the low-Z target beam on the Clinac platform and the proposed imaging beam line on TrueBeam, with the former providing greater diagnostic energy content.

Beam quality and dose perturbation of 6 MV flattening-filter-free linac

The aim of this study is twofold: (a) determination of the spectral differences for flattening-filter-free (FFF) versus standard (STD) linac under various clinical conditions, (b) based on an extensive list of clinically important beam configurations, identification of clinical scenarios that lead to higher macroscopic dose perturbations due to the presence of high-Z material. The focus is on dose enhancement due to contrast agents including high-Z elements such as gold or gadolinium. EGSnrc was used to simulate clinical beams under various irradiation conditions: open/IMRT/spit-IMRT fields, in/out-off-field areas, different depths and field sizes. Spectra were calculated and analyzed for about 80 beams and for a total of 480 regions. Quantitative differential effects in beam quality were characterized using energy-dependent and cumulative dose perturbation metrics. Analysis of the spectral database showed that even though the general trends for both linacs (FFF/STD) were the same, there were crucial differences. In general, the relative changes between different conditions were smaller for FFF spectra. This was because of the higher component of low-energy photons of the FFF linac, which already lead to higher dose enhancement than for the STD linac (photon energies were more "uniformly" distributed for FFF spectra and henceforth their perturbation resulted in lesser relative changes). For out-of-field FFF spectra and split-IMRT fields the strongest enhancement were observed (∼25 and ∼5 respectively). Different spectral scenarios lead to different dose enhancements, however, they scale with the higher effective-Z of the materials and were directly related to the lower range of the spectra (<200 keV).

Noise suppression in reconstruction of low-Z target megavoltage cone-beam CT images

PURPOSE

To improve the image contrast-to-noise (CNR) ratio for low-Z target megavoltage cone-beam CT (MV CBCT) using a statistical projection noise suppression algorithm based on the penalized weighted least-squares (PWLS) criterion.

METHODS

Projection images of a contrast phantom, a CatPhan(®) 600 phantom and a head phantom were acquired by a Varian 2100EX LINAC with a low-Z (Al) target and low energy x-ray beam (2.5 MeV) at a low-dose level and at a high-dose level. The projections were then processed by minimizing the PWLS objective function. The weighted least square (WLS) term models the noise of measured projection and the penalty term enforces the smoothing constraints of the projection image. The variance of projection data was chosen as the weight for the PWLS objective function and it determined the contribution of each measurement. An anisotropic quadratic form penalty that incorporates the gradient information of projection image was used to preserve edges during noise reduction. Low-Z target MV CBCT images were reconstructed by the FDK algorithm after each projection was processed by the PWLS smoothing.

RESULTS

Noise in low-Z target MV CBCT images were greatly suppressed after the PWLS projection smoothing, without noticeable sacrifice of the spatial resolution. Depending on the choice of smoothing parameter, the CNR of selected regions of interest in the PWLS processed low-dose low-Z target MV CBCT image can be higher than the corresponding high-dose image.

CONCLUSION

The CNR of low-Z target MV CBCT images was substantially improved by using PWLS projection smoothing. The PWLS projection smoothing algorithm allows the reconstruction of high contrast low-Z target MV CBCT image with a total dose of as low as 2.3 cGy.

Comparative study of a low-Z cone-beam computed tomography system

Computed tomography images have been acquired using an experimental (low atomic number (Z) insert) megavoltage cone-beam imaging system. These images have been compared with standard megavoltage and kilovoltage imaging systems. The experimental system requires a simple modification to the 4 MeV electron beam from an Elekta Precise linac. Low-energy photons are produced in the standard medium-Z electron window and a low-Z carbon electron absorber located after the window. The carbon electron absorber produces photons as well as ensuring that all remaining electrons from the source are removed. A detector sensitive to diagnostic x-ray energies is also employed. Quantitative assessment of cone-beam computed tomography (CBCT) contrast shows that the low-Z imaging system is an order of magnitude or more superior to a standard 6 MV imaging system. CBCT data with the same contrast-to-noise ratio as a kilovoltage imaging system (0.15 cGy) can be obtained in doses of 11 and 244 cGy for the experimental and standard 6 MV systems, respectively. Whilst these doses are high for everyday imaging, qualitative images indicate that kilovoltage like images suitable for patient positioning can be acquired in radiation doses of 1-8 cGy with the experimental low-Z system.