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Purpose: We optimize scan orbits and acquisition protocols for 3D imaging of the weight-bearing spine on a twin-robotic x-ray system (Multitom Rax). An advanced Cone-Beam CT (CBCT) simulation framework is used for systematic optimization and evaluation of protocols in terms of scatter, noise, imaging dose, and task-based performance in 3D image reconstructions. Methods: The x-ray system uses two robotic arms to move an x-ray source and a 43×43 cm2 flat-panel detector around an upright patient. We investigate two classes of candidate scan orbits, both with the same source-axis distance of 690 mm: circular scans with variable axis-detector distance (ADD, air gap) ranging from 400 to 800 mm, and elliptical scans, where the ADD smoothly changes between the anterior-posterior view (ADDAP) and the lateral view (ADDLAT). The study involved elliptical orbits with fixed ADDAP of 400 mm and variable ADDLAT, ranging 400 to 800 mm. Scans of human lumbar spine were simulated using a framework that included accelerated Monte Carlo scatter estimation and realistic models of the x-ray source and detector. In the current work, x-ray fluence was held constant across all imaging configurations, corresponding to 0.5 mAs/frame. Performance of circular and elliptical orbits was compared in terms of scatter and scatter-to-primary ratio (SPR) in projections, and contrast, noise, contrast-to-noise ratio (CNR), and truncation (field of view, FOV) in 3D image reconstructions. Results: The highest mean SPR was found in lateral views, ranging from ~5 at ADD of 300 mm to ~1.2 at ADD of 800 mm. Elliptical scans enabled image acquisition with reduced lateral SPR and almost constant SPR across projection angles. The improvement in contrast across the investigated range of air gaps (due to reduction in scatter) was ~2.3x for circular orbits and ~1.9x for elliptical orbits. The increase in noise associated with increased ADD was more pronounced for circular scans (~2x) compared to elliptical scans (~1.5x). The circular orbit with the best CNR performance (ADD=600 mm) yielded ~10% better CNR than the best elliptical orbit (ADDLAT=600 mm); however, the elliptical orbit increased FOV by ~16%. Conclusion: The flexible imaging geometry of the robotic x-ray system enables development of highly optimized scan orbits. Imaging of the weight-bearing spine could benefit from elliptical detector trajectories to achieve improved tradeoffs in scatter reduction, noise, and truncation.
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