Computed tomography dose index and dose length product for cone-beam CT: Monte Carlo simulations

The effect of cone beam computerized tomography voxel size and the presence of root filling on the assessment of middle mesial canals in mandibular molar teeth

INTRODUCTION

The study aims to compare the detection of the middle mesial canal (MMC) in mandibular molar teeth using cone beam computed tomography (CBCT) with different voxel sizes when the mesiobuccal (MB) and mesiolingual (ML) canals have three distinct phases (unpreparation, preparation and obturation and the removal of the obturation and repreparation).

METHODS

Two hundred forty-two extracted human mandibular molars were collected and kept in a physiological saline solution prior to use. 0.2-, 0.28- and 0.35-mm voxel sizes CBCT (n = 242) were performed in three phases (Ph): Ph1, no MB and ML canal preparation or obturation; Ph2, after MB and ML canals preparation and obturation; and Ph3, after the removal of the obturation of MB and ML canals and canals repreparation. Images were analyzed using OnDemand3D® software. After the CBCT acquisition in Ph3, all the samples were clarified to visualize the presence of the MMC directly. A blinded, previously calibrated examiner analyzed all the images.

RESULTS

The MMC was detected in 15 of the 242 teeth after the clearing technique. The lowest MMC detection rate was observed at 0.35-mm voxel size regardless of the ML and MB canal condition, while the highest was observed at 0.2-mm voxel size (P < 0.05). There is no statistically significant difference between 0.2-mm and 0.28-mm voxel sizes (P > 0.05). In all voxel sizes, the highest rate of detectability of the MMC was seen in Phase 1, while the lowest was in Phase 2.

CONCLUSIONS

It may be appropriate to take a 0.20-mm voxel size CBCT image, especially after the removal of root canal filling.

CLINICAL RELEVANCE

An appropriate CBCT voxel size and the absence of root canal filling in the root canal system help to detect the missing MMC.

Ex vivo detection of mandibular incisors' root canal morphology using cone-beam computed tomography with 4 different voxel sizes and micro-computed tomography

BACKGROUND

In recent years, cone-beam computed tomography (CBCT) has been widely used to evaluate patients' root canal anatomy due to its high resolution and noninvasive nature. As voxel size is one of the most important parameters affecting CBCT image quality, the current study evaluated the diagnostic potential of CBCT with 4 different voxel sizes in the detection of double root canal systems and accessory canals (ACs) in permanent mandibular incisors.

METHODS

A total of 106 extracted mandibular permanent incisors were collected from the dental clinics, and then were scanned by using micro-CT with a voxel size of 9 μm. The teeth were then fixed in the tooth sockets of human dry mandibles and scanned by using a CBCT device with 4 different voxel sizes (300, 200, 250, and 125 μm). Four observers detected in blind the root canal morphology of the teeth according to the CBCT images, and the presence or absence of a double root canal system, and the presence or absence of ACs, were scored according to a 5-point scale, respectively. Receiver operating characteristic (ROC) analysis was performed, and DeLong test was used to compare the area under the curve (AUC) values and the micro-CT data was taken as a gold standard.

RESULTS

Among 106 sample teeth, 25 specimens with a double root canal system were identified by the micro-CT. ROC curve analysis of the data obtained by the four observers showed that in the detection of double root canal systems, the AUC values ranged from 0.765 to 0.889 for 300 μm voxel size, from 0.877 to 0.926 for 250 μm voxel size, from 0.893 to 0.967 for 200 μm voxel size, and from 0.914 to 0.967 for 125 μm voxel size (all p < 0.01). In general, we observed a trend that the AUC values, sensitivity, and specialty increased with the decrease in the voxel size, and significantly higher AUC values were detected in 125 μm voxel size images. In the detection of ACs, ROC curve analysis showed that among the four observers, the AUC values ranged from 0.554 to 0.639 for 300 μm voxel size, from 0.532 to 0.654 for 250 μm voxel size, from 0.567 to 0.626 for 200 μm voxel size, and from 0.638 to 0.678 for 125 μm voxel size. CBCT images at a voxel size of 125 μm had a weak diagnostic potential (AUC: 0.5-0.7, all p < 0.05) in the detection of AC, with a lower sensitivity ranging from 36.8 to 57.9% and a higher specialty ranging from 73.6 to 98.8%.

CONCLUSIONS

CBCT with 300 μm voxel size could only provide moderate diagnostic accuracy in the detection of a double canal system in mandibular incisors. CBCT with a voxel size of 125 μm exhibited high diagnostic value in the detection of double canal systems, while showing low but statistically significant value in the detection of ACs.

Evaluation of computed tomography dose profiler probe for computed tomography dose index and geometric efficiency measurements

The purpose of this study was to evaluate the performance of solid state sensor based computed tomography dose profiler (CTDP) probe for measurement of standard computed tomography dose metric CTDI100 and free in air geometric efficiency for various beam widths available in a 128 slice CT scanner and also to estimate the efficiency of CTDI100 metric. The response accuracy of CTDP probe was verified using a standard 100 mm long ionization chamber. The geometric efficiency measurements performed by CTDP probe were validated using XR-QA2 radiochromic film measurements. The efficiency of CTDI100 metric was assessed by calculating the ratio of CTDI100 measured in the center hole position to CTDI∞ measured in the same position of both head and body phantoms. The weighted CTDI values derived from CTDI100 measured by CTDP probe showed an average variation of 8% from ionization chamber measured values. The efficiency of CTDI100 metric estimated using CTDP probe and 150 mm long phantoms was in the range of 82% to 86% and 76% to 80% for head and body phantom measurements respectively. The variation in the geometric efficiency values for various beam settings and tube voltages measured by the CTDP probe and films were within 7%. Taken together, the results of this study proved that unlike the 100 mm long ionization chamber, the CTDP probe can be efficiently used to determine CTDI for any length over which dose integration is desired and also measure geometric efficiency of MDCT scanners for various beam widths in helical mode of operation.

AUTOMATIC BRAIN DOSE ESTIMATION IN COMPUTED TOMOGRAPHY USING PATIENT DICOM IMAGES

This study aims to develop an Automatic Brain Dose Estimation (ABDE) methodology for head computed tomography examinations. The ABDE is to be applied first to an anthropomorphic Alderson phantom to obtain a Correction factor (Cf) between the ABDE and the direct absorbed brain dose using dosemeters positioned within the anthropomorphic phantom. Then, in order to estimate the correct brain dose for patient, the Cf was multiplied by the mean ABDE values for each patient. Results were compared to those registered with a mathematical simulation phantom using CT-Expo V 2.4 software. Results showed no significant difference between the correct ABDE values and the CT-Expo values with a mean percent difference of 2.54 ± 0.01%. In conclusion, ABDE yields a correct estimation of brain dose, taking into account the size and attenuation of the irradiated region. Thus, it is clinically recommended for accurate patient brain dose assessment.

A Monte Carlo investigation of dose length product of cone beam computed tomography scans

The dose length product (DLP) provides a measurement related to energy imparted from a computed tomography (CT) scan. The DLP is based on the volume-averaged CT dose index (CTDI _vol), which is designed for fan beams. The aims of this study were to investigate the use of DLP for scans with wide beams used in cone beam CT (DLP _CBCT) in radiotherapy that would be analogous to the DLP of fan beam scans (DLP _CT), and to compare the efficiencies of DLP _CT and DLP _CBCT in reporting the total energy imparted in patients. A validated Monte Carlo model of a kV imaging system integrated into a Varian TrueBeam linac was employed. The DLP _CT was assessed by multiplying the CTDI _vol for a 20 mm fan beam by scan length, and the DLP _CBCT determined through multiplying the CTDI _vol, estimated for wide beams using a correction factor based on free-in-air measurements, by the beam width. Two scan protocols for head and body were investigated for tube potentials between 80 and 140 kV and a range of scan lengths/widths. Efficiency values were estimated by normalising the DLP _CT and DLP _CBCT with respect to the corresponding dose profile integrals (DPIs), which were evaluated within 900 mm long phantoms. The results show that the DLP _CBCT values were within 1% of those for DLP _CT of similar length performed on the same system, and the efficiencies decrease with tube potential. However, whereas DLP values for fan beams are approximately proportional to scan length, those for wide beams decrease by ∼2% between beam widths of 20 and 320 mm. As a result, while the DLP _CT efficiency is similar over all scan lengths, that for DLP _CBCT increases slightly with beam width. The DLP _CT and DLP _CBCT underestimated the total energy imparted by comparable amounts with efficiencies within the range of 80-81% and 80-83% for the head scans, and 71-76% and 70-77% for the body scans, respectively. The results indicate that the DLP _CBCT can be considered as an analogous dose index to the DLP _CT. It could, therefore, be used for quantification of doses from imaging in radiotherapy and provide a valuable tool to aid optimisation.

Development of a computational tool for estimating computed tomography dose parameters

BACKGROUND

Computed Tomographic (CT) imaging procedures have been reported as the main source of radiation in diagnostic procedures compared to other modalities. To provide the optimal quality of CT images at the minimum radiation risk to the patient, periodic inspections and calibration tests for CT equipment are required. These tests involve a series of measurements that are time consuming and may require specific skills and highly-trained personnel.

OBJECTIVE

This study aims to develop a new computational tool to estimate the dose of CT radiation outputs and assist in the calibration of CT scanners. It may also provide an educational resource by which radiological practitioners can learn the influence of technique factors on both patient radiation dose and the produced image quality.

METHODS

The computational tool was developed using MATLAB in order to estimate the CT radiation dose parameters for different technique factors. The CT radiation dose parameters were estimated from the calibrated energy spectrum of the x-ray tube for a CT scanner.

RESULTS

The estimated dose parameters and the measured values utilising an Adult CT Head Dose Phantom showed linear correlations for different tube voltages (80 kVp, 100 kVp, 120 kVp, and 140 kVp), with R2 nearly equal to 1 (0.99). The maximum differences between the estimated and measured CTDIvol were under 5 %. For 80 kVp and low tube currents (50 mA, 100 mA), the maximum differences were under 10%.

CONCLUSIONS

The prototyped computational model provides a tool for the simulation of a machine-specific spectrum and CT dose parameters using a single dose measurement.

An evaluation of computed tomography dose index measurements using a pencil ionisation chamber and small detectors

The aim of this study was to compare the values of the computed tomography dose index 100 (CTDI₁₀₀) obtained using two small detectors (i.e. a small ionisation chamber and a small solid state detector) with those obtained from a 100 mm pencil ionisation chamber for various input CT parameters: beam width, kVp, mAs, pitch, and head-body phantom variation. The measurement of CTDI₁₀₀ using the 100 mm pencil chamber was carried out in a single rotation of axial mode, while the measurement using small detectors was carried out in helical mode. The differences of CTDI₁₀₀ values obtained with two small detectors were about 7% for all variations. The differences of CTDI₁₀₀ values obtained with small detectors and a 100 mm pencil ionisation chamber for beam widths of more than 4 mm were within 40%. However, for the narrowest beam widths (4 mm), the difference between them was very large (about 150%).

Effective Radiation Dose in the Wrist Resulting from a Radiographic Device, Two CBCT Devices and One MSCT Device: A Comparative Study

The objective of the present study was to assess and compare the effective doses in the wrist region resulting from conventional radiography device, multislice computed tomography (MSCT) device and two cone beam computed tomography (CBCT) devices using MOSFET dosemeters and a custom made anthropomorphic RANDO phantom according to the ICRP 103 recommendation. The effective dose for the conventional radiography was 1.0 μSv. The effective doses for the NewTom 5 G CBCT ranged between 0.7 μSv and 1.6 μSv, for the Planmed Verity CBCT 2.4 μSv and for the MSCT 8.6 μSv. When compared with the effective dose for AP- and LAT projections of a conventional radiographic device, this study showed an 8.6-fold effective dose for standard MSCT protocol and between 0.7 and 2.4-fold effective dose for standard CBCT protocols. When compared to the MSCT device, the CBCT devices offer a 3D view of the wrist at significantly lower effective doses.

ASSESSMENT OF EFFECTIVE DOSE FROM CONE BEAM CT IMAGING IN SPECT/CT EXAMINATION IN COMPARISON WITH OTHER MODALITIES

The aim of this study was to assess radiation dose from the cone beam computed tomography (CBCT) component of single photon emission tomography/computed tomography (SPECT/CT) examinations and to compare it with the radiopharmaceutical related dose as well as dose from multidetector computed tomography (MDCT). Effective dose (ED) from computed tomography (CT) was estimated using dose-length product values and anatomy-specific conversion factors. The contribution from the SPECT component was evaluated using ED per unit administered activity for the radiopharmaceuticals listed in the International Commission on Radiological Protection Publications 80 and 106. With the exception of cardiac studies (0.11 mSv), the CBCT dose (3.96-6.04 mSv) was similar to that from the radiopharmaceutical accounting for 29-56 % of the total ED from the examination. In comparison with MDCT examinations, the CBCT dose was 48 and 42 % lower for abdomen/pelvis and chest/abdomen/pelvis scans, respectively, while in the chest the CBCT scan resulted in higher dose (23 %). Radiation dose from the CT component should be taken into consideration when evaluating total SPECT/CT patient dose.

A methodology for on-board CBCT imaging dose using optically stimulated luminescence detectors

Cone‐beam computed tomography CBCT systems are used in radiation therapy for patient alignment and positioning. The CBCT imaging procedure for patient setup adds substantial radiation dose to patient's normal tissue. This study presents a complete procedure for the CBCT dosimetry using the InLight optically‐stimulated‐luminescence (OSL) nanoDots. We report five dose parameters: the mean slice dose (DMSD); the cone beam dose index (CBDIW); the mean volume dose (DMVD); point‐dose profile, D(FOV); and the off‐field Dose. In addition, CBCT skin doses for seven pelvic tumor patients are reported. CBCT‐dose measurement was performed on a custom‐made cylindrical acrylic body phantom (50 cm length, 32 cm diameter). We machined 25 circular disks (2 cm thick) with grooves and holes to hold OSL‐nanoDots. OSLs that showed similar sensitivities were selected and calibrated against a Farmer‐type ionization‐chamber (0.6 CT) before being inserted into the grooves and holes. For the phantom scan, a standard CBCT‐imaging protocol (pelvic sites: 125 kVp, 80 mA and 25 ms) was used. Five dose parameters were quantified: DMSD, CBDIW, DMVD, D(FOV), and the off‐field dose. The DMSD for the central slice was 31.1±0.85 mGy, and CBDIW was 34.5±0.6 mGy at 16 cm FOV. The DMVD was 25.6±1.1 mGy. The off‐field dose was 10.5 mGy. For patients, the anterior and lateral skin doses attributable to CBCT imaging were 39.04±4.4 and 27.1±1.3 mGy, respectively.

OSL nanoDots were convenient to use in measuring CBCT dose. The method of selecting the nanoDots greatly reduced uncertainty in the OSL measurements. Our detailed calibration procedure and CBCT dose measurements and calculations could prove useful in developing OSL routines for CBCT quality assessment, which in turn gives them the property of high spatial resolution, meaning that they have the potential for measurement of dose in regions of severe dose‐gradients.

PACS number(s): 87.57.‐s, 87.57.Q, 87.57.uq

Automated Calculation of Water-equivalent Diameter (DW) Based on AAPM Task Group 220

The purpose of this study is to accurately and effectively automate the calculation of the water‐equivalent diameter (DW) from 3D CT images for estimating the size‐specific dose. DW is the metric that characterizes the patient size and attenuation. In this study, DW was calculated for standard CTDI phantoms and patient images. Two types of phantom were used, one representing the head with a diameter of 16 cm and the other representing the body with a diameter of 32 cm. Images of 63 patients were also taken, 32 who had undergone a CT head examination and 31 who had undergone a CT thorax examination. There are three main parts to our algorithm for automated DW calculation. The first part is to read 3D images and convert the CT data into Hounsfield units (HU). The second part is to find the contour of the phantoms or patients automatically. And the third part is to automate the calculation of DW based on the automated contouring for every slice (DW,all). The results of this study show that the automated calculation of DW and the manual calculation are in good agreement for phantoms and patients. The differences between the automated calculation of DW and the manual calculation are less than 0.5%. The results of this study also show that the estimating of DW,all using DW,n=1 (central slice along longitudinal axis) produces percentage differences of −0.92%±3.37% and 6.75%±1.92%, and estimating DW,all using DW,n=9 produces percentage differences of 0.23%±0.16% and 0.87%±0.36%, for thorax and head examinations, respectively. From this study, the percentage differences between normalized size‐specific dose estimate for every slice (nSSDEall) and nSSDEn=1 are 0.74%±2.82% and −4.35%±1.18% for thorax and head examinations, respectively; between nSSDEall and nSSDEn=9 are 0.00%±0.46% and −0.60%±0.24% for thorax and head examinations, respectively.

PACS number(s): 87.57.Q‐, 87.57.uq‐

An energy minimization method for the correction of cupping artifacts in cone-beam CT

The purpose of this study was to reduce cupping artifacts and improve quantitative accuracy of the images in cone-beam CT (CBCT). An energy minimization method (EMM) is proposed to reduce cupping artifacts in reconstructed image of the CBCT. The cupping artifacts are iteratively optimized by using efficient matrix computations, which are verified to be numerically stable by matrix analysis. Moreover, the energy in our formulation is convex in each of its variables, which brings the robustness of the proposed energy minimization algorithm. The cupping artifacts are estimated as a result of minimizing this energy. The results indicate that proposed algorithm is effective for reducing the cupping artifacts and preserving the quality of the reconstructed image. The proposed method focuses on the reconstructed image without requiring any additional physical equipment; it is easily implemented and provides cupping correction using a single scan acquisition. The experimental results demonstrate that this method can successfully reduce the magnitude of cupping artifacts. The correction algorithm reported here may improve the uniformity of the reconstructed images, thus assisting the development of perfect volume visualization and threshold-based visualization techniques for reconstructed images.

Interior tomographic imaging of mouse heart in a carbon nanotube micro-CT

BACKGROUND

The relatively high radiation dose from micro-CT is a cause for concern in preclinical research involving animal subjects. Interior region-of-interest (ROI) imaging was proposed for dose reduction, but has not been experimentally applied in micro-CT.

OBJECTIVE

Our aim is to implement interior ROI imaging in a carbon nanotube (CNT) x-ray source based micro-CT, and present the ROI image quality and radiation dose reduction for interior cardiac micro-CT imaging of a mouse heart in situ.

METHODS

An aperture collimator was mounted at the source-side to induce a small-sized cone beam (10 mm width) at the isocenter. Interior in situ micro-CT scans were conducted on a mouse carcass and several micro-CT phantoms. A GPU-accelerated hybrid iterative reconstruction algorithm was employed for volumetric image reconstruction. Radiation dose was measured for the same system operated at the interior and global micro-CT modes.

RESULTS

Visual inspection demonstrated comparable image quality between two scan modes. Quantitative evaluation demonstrated high structural similarity index (up to 0.9614) with improved contrast-noise-ratio (CNR) on interior micro-CT mode. Interior micro-CT mode yielded significant reduction (up to 83.9%) for dose length product (DLP).

CONCLUSIONS

This work demonstrates the applicability of using CNT x-ray source based interior micro-CT for preclinical imaging with significantly reduced radiation dose.

Evaluation of cumulative dose for cone-beam computed tomography (CBCT) scans within phantoms made from different compositions using Monte Carlo simulations

Measurement of cumulative dose ƒ(0,150) with a small ionization chamber within standard polymethyl methacrylate (PMMA) CT head and body phantoms, 150 mm in length, is a possible practical method for cone-beam computed tomography (CBCT) dosimetry. This differs from evaluating cumulative dose under scatter equilibrium conditions within an infinitely long phantom ƒ(0,∞), which is proposed by AAPM TG-111 for CBCT dosimetry. The aim of this study was to investigate the feasibility of using ƒ(0,150) to estimate values for ƒ(0,∞) in long head and body phantoms made of PMMA, polyethylene (PE), and water, using beam qualities for tube potentials of 80-140 kV. The study also investigated the possibility of using 150 mm PE phantoms for assessment of ƒ(0,∞) within long PE phantoms, the ICRU/AAPM phantom. The influence of scan parameters, composition, and length of the phantoms was investigated. The capability of ƒ(0,150) to assess ƒ(0,∞) has been defined as the efficiency and assessed in terms of the ratios ε(ƒ(0,150) / ƒ(0,∞)). The efficiencies were calculated using Monte Carlo simulations for an On-Board Imager (OBI) system mounted on a TrueBeam linear accelerator. Head and body scanning protocols with beams of width 40-500 mm were used. Efficiencies ε(PMMA/PMMA) and ε(PE/PE) as a function of beam width exhibited three separate regions. For beam widths < 150 mm, ε(PMMA/PMMA) and ε(PE/PE) values were greater than 90% for the head and body phantoms. The efficiency values then fell rapidly with increasing beam width before levelling off at 74% for ε(PMMA/PMMA) and 69% for ε(PE/PE) for a 500 mm beam width. The quantities ε(PMMA/PE) and ε(PMMA/Water) varied with beam width in a different manner. Values at the centers of the phantoms for narrow beams were lower and increased to a steady state for ~100-150 mm wide beams, before declining with increasing the beam width, whereas values at the peripheries decreased steadily with beam width. Results for ε(PMMA/PMMA) were virtually independent of tube potential, but there was more variation for ε(PMMA/PE) and ε(PMMA/Water). ƒ(0,150) underestimated ƒ(0,∞) for beam widths used for CBCT scans, thus it is necessary to use long phantoms, or apply conversion factors (Cƒs) to measurements with standard PMMA CT phantoms. The efficiency values have been used to derive (Cƒs) to allow evaluation of ƒ(0,∞) from measurements of ƒ(0,150). The (Cƒs) only showed a weak dependence on scan parameters and scanner type, and so may be suitable for general application.

Effective radiation dose of a MSCT, two CBCT and one conventional radiography device in the ankle region

BACKGROUND

The aim of this study was to assess and compare the effective doses (ICRP 103) in the ankle region of X-ray imaging resulting from a multi slice computed tomography (MSCT) device, two cone beam CT (CBCT) devices and one conventional x-ray device.

METHODS

Organ dose measurements were performed using 20 metal oxide field effect transistor (MOSFET) dosimeters that were placed in a custom made anthropomorphic RANDO ankle phantom. The following scanners were assessed in this study: Siemens Sensation Open 24-slice MSCT-scanner (120 kVp, 54 mAs), NewTom 5G CBCT scanner (110 kVp, 2.3 - 59 mAs), Planmed Verity CBCT-scanner (90 kVp, 48 mAs), Shimadzu FH-21 HR direct radiography equipment (AP + LAT), (57 kVp, 16 mAs).

RESULTS

Measurements of the MSCT device resulted in 21.4 μSv effective dose. The effective doses of CBCTs were between 1.9 μSv and 14.3 μSv for NewTom 5G and 6.0 μSv for Planmed Verity. Effective doses for the Shimadzu FH-21 HR conventional radiography were 1.0 μSv (LAT) and 0.5 μSv (AP), respectively.

CONCLUSIONS

Compared with a conventional 2D radiographic device, this study showed a 14-fold effective dose for standard MSCT and 1.3 -10 fold effective dose for standard CBCT protocols. CBCT devices offers a 3D view of ankle imaging and exhibited lower effective doses compared with MSCT.

Metal and motion artifacts by cone beam computed tomography (CBCT) in dental and maxillofacial study

OBJECTIVES

This study aimed at evaluating incidence/degree of metal/motion artifacts and CT-dose-index in oral/maxillofacial examinations using Cone-Beam-CT.

METHODS

Interferences caused by metal and motion artifacts were evaluated in 500 patients aged from 6 to 81 years, in dental arches, maxillofacial and splanchocranium Cone-Beam-CT exams. The interferences was divided into four progressive degrees (G0-G3) related to the possibility to answer the clinical query. The parameters considered were field-of-view, scan time, patient's age, and anatomical area. Furthermore volumetric CT-dose-index was measured.

RESULTS

In the presence of metal artifacts the clinical query was always answered (G3 = 0). No artifacts (G0) were found in all cases when metal was beyond 5 cm from interest site and in 18.4% when metal was inside this distance. Beam hardening and photon starvation due to implants, restoration and orthodontic therapies achieved 56.2% G1 and 25.4% G2. Motion artifacts were more frequent in under ten (31.5%) and over sixty (82.2%), and in mandible analysis (inferior arch 59.5%, both arches 47.3%). Moreover, their incidence and intensity were influenced by scan time (49.1% at 36 s) but not by field-of-view. Mean volumetric CT-dose-index of all patients was mGy 9.11 (mGy 3.62, 5.78, 8.89, and 13.07 at 18, 24, 26, and 36 s, respectively).

CONCLUSIONS

In our series Cone-Beam-CT diagnostic evaluation was never inhibited by metal artifacts and only in 1.9% of the cases by motion artifacts, always with a very low CT-dose-index.

A Monte Carlo investigation of cumulative dose measurements for cone beam computed tomography (CBCT) dosimetry

Many studies have shown that the computed tomography dose index (CTDI100) which is considered as a main dose descriptor for CT dosimetry fails to provide a realistic reflection of the dose involved in cone beam computed tomography (CBCT) scans. Several practical approaches have been proposed to overcome drawbacks of the CTDI100. One of these is the cumulative dose concept. The purpose of this study was to investigate four different approaches based on the cumulative dose concept: the cumulative dose (1) f(0,150) and (2) f(0,∞) with a small ionization chamber 20 mm long, and the cumulative dose (3) f100(150) and (4) f100(∞) with a standard 100 mm pencil ionization chamber. The study also aimed to investigate the influence of using the 20 and 100 mm chambers and the standard and the infinitely long phantoms on cumulative dose measurements. Monte Carlo EGSnrc/BEAMnrc and EGSnrc/DOSXYZnrc codes were used to simulate a kV imaging system integrated with a TrueBeam linear accelerator and to calculate doses within cylindrical head and body PMMA phantoms with diameters of 16 cm and 32 cm, respectively, and lengths of 150, 600, 900 mm. f(0,150) and f100(150) approaches were studied within the standard PMMA phantoms (150 mm), while the other approaches f(0,∞) and f100(∞) were within infinitely long head (600 mm) and body (900 mm) phantoms. CTDI∞ values were used as a standard to compare the dose values for the approaches studied at the centre and periphery of the phantoms and for the weighted values. Four scanning protocols and beams of width 20-300 mm were used. It has been shown that the f(0,∞) approach gave the highest dose values which were comparable to CTDI∞ values for wide beams. The differences between the weighted dose values obtained with the 20 and 100 mm chambers were significant for the beam widths <120 mm, but these differences declined with increasing beam widths to be within 4%. The weighted dose values calculated within the infinitely long phantoms with both the chambers for the beam widths ≤140 were within 3% of those within the standard phantoms, but the differences rose to be within 15% at wider beams. By comparing the approaches studied in this investigation with other methodologies taking into account the efficiency of the approach as a dose descriptor and the simplicity of the implementation in the clinical environment, the f(0,150) method may be the best for CBCT dosimetry combined with the use of correction factors.

Longitudinal dose distribution and energy absorption in PMMA and water cylinders undergoing CT scans

PURPOSE

The knowledge of longitudinal dose distribution provides the most direct view of the accumulated dose in computed tomography (CT) scanning. The purpose of this work was to perform a comprehensive study of dose distribution width and energy absorption with a wide range of subject sizes and beam irradiated lengths.

METHODS

Cumulative dose distribution along the z-axis was calculated based on the previously published CT dose equilibration data by Li, Zhang, and Liu [Med. Phys. 40, 031903 (10pp.) (2013)] and a mechanism for computing dose on axial lines by Li, Zhang, and Liu [Med. Phys. 39, 5347-5352 (2012)]. Full width at half maximum (FWHM), full width at tenth maximum (FWTM), the total energy (E) absorbed in a small cylinder of unit mass per centimeter square about the central or peripheral axis, and the energy (Ein) absorbed inside irradiated length (L) were subsequently extracted from the dose distribution.

RESULTS

Extensive results of FWHM, FWTM, and Ein/E were presented on the central and peripheral axes of infinitely long PMMA (diameters 6-50 cm) and water (diameters 6-55 cm) cylinders with L < 100 cm. FWHM was greater than the primary beam width only on the central axes of large phantoms and also with L ranging from a few centimeter to about 33 cm. FWTM generally increased with phantom diameter, and could be up to 32 cm longer than irradiated length, depending on L, phantom diameter and axis, but was insensitive to phantom material (PMMA or water). Ein/E increased with L and asymptotically approached unity for large L. As phantom diameter increased, Ein/E generally decreased, but asymptotically approached constant levels on the peripheral axes of large phantoms. A heuristic explanation of dose distribution width results was presented.

CONCLUSIONS

This study enables the reader to gain a comprehensive view of dose distribution width and energy absorption and provides useful data for estimating doses to organs inside or beyond the irradiated region. The dose length product (DLP) presented by CT scanners is equal to neither E nor Ein. Both E and Ein can be evaluated using the equations and results presented in this paper and are robust with both constant and variable tube current scanning techniques.

Measurement of radiotherapy CBCT dose in a phantom using different methods

Cone beam computed tomography (CBCT) is used widely for the precise and accurate patient set up needed during radiation therapy, notably for hypo fractionated treatments, such as intensity modulated radiation therapy and stereotactic radiation therapy. Reported doses associated with CBCT indicate the potential to approach radiation tolerance levels for some critical organs. However while some manufacturers state the CBCT dose for each standard protocol, currently there are no standard or recognised protocols for CBCT dosimetry. This study has applied wide beam computed tomography dosimetry approaches as reported by the International Atomic Energy Agency and the American Association of Physicists in Medicine to investigate dosimetry for the Varian Trilogy linear accelerator with on-board imager v1.5. Three detection methods were used including (i) the use of both 100 mm and 300 mm pencil ionisation chambers, (ii) a 0.6 cm(3) ionisation chamber and (iii) gafchromic film. Measurements were performed using custom built 45 cm long PMMA phantoms as well as standard 15 cm long phantoms for both head and body simulation. The results showed good agreement between each other detector system (within 3 %). The measured CBCT dose for the above methods showed a large difference to the dose stated by Varian, with the measured dose being 40 % over the stated dose for the standard head protocol. This shows the importance of independently verifying the stated dose given by the vendor for standard procedures.

A study of the short- to long-phantom dose ratios for CT scanning without table translation

PURPOSE

For CT scanning in the stationary-table modes, AAPM Task Group 111 proposed to measure the midpoint dose on the central and peripheral axes of sufficiently long phantoms. Currently, a long cylindrical phantom is usually not available in many clinical facilities. The use of a long phantom is also challenging because of the heavy weight. In order to shed light on assessing the midpoint dose in CT scanning without table movement, the authors present a study of the short- to long-phantom dose ratios, and perform a cross-comparison of CT dose ratios on different scanner models.

METHODS

The authors performed Geant4-based Monte Carlo simulations with a clinical CT scanner (Somatom Definition dual source CT, Siemens Healthcare), and modeled dosimetry measurements using a 0.6 cm3 Farmer type chamber and a 10-cm long pencil ion chamber. The short (15 cm) to long (90 cm) phantom dose ratios were computed for two PMMA diameters (16 and 32 cm), two phantom axes (the center and the periphery), and a range of beam apertures (3-25 cm). The results were compared with the published data of previous studies with other multiple detector CT (MDCT) scanners and cone beam CT (CBCT) scanners.

RESULTS

The short- to long-phantom dose ratios changed with beam apertures but were insensitive to beam qualities (80-140 kV, the head and body bowtie filters) and MDCT and CBCT scanner models.

CONCLUSIONS

The short- to long-phantom dose ratios enable medical physicists to make dosimetry measurements using the standard CT dosimetry phantoms and a Farmer chamber or a 10 cm long pencil chamber, and to assess the midpoint dose in long phantoms. This method provides an effective approach for the dosimetry of CBCT scanning in the stationary-table modes, and is useful for perfusion and interventional CT.

Development and validation of a measurement-based source model for kilovoltage cone-beam CT Monte Carlo dosimetry simulations

PURPOSE

The purpose of this study is to adapt an equivalent source model originally developed for conventional CT Monte Carlo dose quantification to the radiation oncology context and validate its application for evaluating concomitant dose incurred by a kilovoltage (kV) cone-beam CT (CBCT) system integrated into a linear accelerator.

METHODS

In order to properly characterize beams from the integrated kV CBCT system, the authors have adapted a previously developed equivalent source model consisting of an equivalent spectrum module that takes into account intrinsic filtration and an equivalent filter module characterizing the added bowtie filtration. An equivalent spectrum was generated for an 80, 100, and 125 kVp beam with beam energy characterized by half-value layer measurements. An equivalent filter description was generated from bowtie profile measurements for both the full- and half-bowtie. Equivalent source models for each combination of equivalent spectrum and filter were incorporated into the Monte Carlo software package MCNPX. Monte Carlo simulations were then validated against in-phantom measurements for both the radiographic and CBCT mode of operation of the kV CBCT system. Radiographic and CBCT imaging dose was measured for a variety of protocols at various locations within a body (32 cm in diameter) and head (16 cm in diameter) CTDI phantom. The in-phantom radiographic and CBCT dose was simulated at all measurement locations and converted to absolute dose using normalization factors calculated from air scan measurements and corresponding simulations. The simulated results were compared with the physical measurements and their discrepancies were assessed quantitatively.

RESULTS

Strong agreement was observed between in-phantom simulations and measurements. For the radiographic protocols, simulations uniformly underestimated measurements by 0.54%-5.14% (mean difference = -3.07%, SD = 1.60%). For the CBCT protocols, simulations uniformly underestimated measurements by 1.35%-5.31% (mean difference = -3.42%, SD = 1.09%).

CONCLUSIONS

This work demonstrates the feasibility of using a measurement-based kV CBCT source model to facilitate dose calculations with Monte Carlo methods for both the radiographic and CBCT mode of operation. While this initial work validates simulations against measurements for simple geometries, future work will involve utilizing the source model to investigate kV CBCT dosimetry with more complex anthropomorphic phantoms and patient specific models.

Computed tomography radiation dosimetry: from the indicators to the indications

The technological advances in computed tomography (CT) scanners and their continuously increased use have raised concern about the patient-induced risks from the CT procedures. In the present review, all available dose metrics used in CT dosimetry are described, evaluated, and compared. The various models and methodologies currently existing for the estimation of the effective dose and, by extension, the carcinogenesis probability as well as the way that this is derived from dose descriptors are also considered.

Evaluation of radiation dose to organs during kilovoltage cone-beam computed tomography using Monte Carlo simulation

Image-guided techniques for radiation therapy have improved the precision of radiation delivery by sparing normal tissues. Cone-beam computed tomography (CBCT) has emerged as a key technique for patient positioning and target localization in radiotherapy. Here, we investigated the imaging radiation dose delivered to radiosensitive organs of a patient during CBCT scan. The 4D extended cardiac-torso (XCAT) phantom and Geant4 Application for Tomographic Emission (GATE) Monte Carlo (MC) simulation tool were used for the study. A computed tomography dose index (CTDI) standard polymethyl methacrylate (PMMA) phantom was used to validate the MC-based dosimetric evaluation. We implemented an MC model of a clinical on-board imager integrated with the Trilogy accelerator. The MC model's accuracy was validated by comparing its weighted CTDI (CTDIw) values with those of previous studies, which revealed good agreement. We calculated the absorbed doses of various human organs at different treatment sites such as the head-and-neck, chest, abdomen, and pelvis regions, in both standard CBCT scan mode (125 kVp, 80 mA, and 25 ms) and low-dose scan mode (125 kVp, 40 mA, and 10 ms). In the former mode, the average absorbed doses of the organs in the head and neck and chest regions ranged 4.09-8.28 cGy, whereas those of the organs in the abdomen and pelvis regions were 4.30-7.48 cGy. In the latter mode, the absorbed doses of the organs in the head and neck and chest regions ranged 1.61-1.89 cGy, whereas those of the organs in the abdomen and pelvis region ranged between 0.79-1.85 cGy. The reduction in the radiation dose in the low-dose mode compared to the standard mode was about 20%, which is in good agreement with previous reports. We opine that the findings of this study would significantly facilitate decisions regarding the administration of extra imaging doses to radiosensitive organs.

Assessment of effective radiation dose of an extremity CBCT, MSCT and conventional X ray for knee area using MOSFET dosemeters

The objective of this study was to assess and compare the organ and effective doses in the knee area resulting from different commercially available multislice computed tomography devices (MSCT), one cone beam computed tomography device (CBCT) and one conventional X-ray radiography device using MOSFET dosemeters and an anthropomorphic RANDO knee phantom. Measurements of the MSCT devices resulted in effective doses ranging between 27 and 48 µSv. The CBCT measurements resulted in an effective dose of 12.6 µSv. The effective doses attained using the conventional radiography device were 1.8 µSv for lateral and 1.2 µSv for anterior-posterior projections. The effective dose resulting from conventional radiography was considerably lower than those recorded for the CBCT and MSCT devices. The MSCT effective dose results were two to four times higher than those measured on the CBCT device. This study demonstrates that CBCT can be regarded as a potential low-dose 3D imaging technique for knee examinations.

Direct action of radiation on mummified cells: modeling of computed tomography by Monte Carlo algorithms

X-ray imaging is a nondestructive and preferred method in paleopathology to reconstruct the history of ancient diseases. Sophisticated imaging technologies such as computed tomography (CT) have become common for the investigation of skeletal disorders in human remains. Researchers have investigated the impact of ionizing radiation on living cells, but never on ancient cells in dry tissue. The effects of CT exposure on ancient cells have not been examined in the past and may be important for subsequent genetic analysis. To remedy this shortcoming, we developed different Monte Carlo models to simulate X-ray irradiation on ancient cells. Effects of mummification were considered by using two sizes of cells and three different phantom tissues, which enclosed the investigated cell cluster. This cluster was positioned at the isocenter of a CT scanner model, where the cell hit probabilities P(0,1,…, n) were calculated according to the Poisson distribution. To study the impact of the dominant physics process, CT scans for X-ray spectra of 80 and 120 kVp were simulated. Comparison between normal and dry tissue phantoms revealed that the probability of unaffected cells increased by 21 % following cell shrinkage for 80 kVp, while for 120 kVp, a further increase of unaffected cells of 23 % was observed. Consequently, cell shrinkage caused by dehydration decreased the impact of X-ray radiation on mummified cells significantly. Moreover, backscattered electrons in cortical bone protected deeper-lying ancient cells from radiation damage at 80 kVp X-rays.