Recent developments in two-dimensional x-ray detector technology have made volumetric Cone Beam CT (CBCT) a feasible approach for integration with conventional medical linear accelerators. The requirements of a robust image guidance system for radiation therapy include the challenging combination of soft tissue sensitivity with clinically reasonable doses. The low contrast objects may not be perceptible with MV energies due to the relatively poor signal to noise ratio (SNR) performance. We have developed an imaging system that is optimized for MV and can acquire Megavoltage CBCT images containing soft tissue contrast using a 6MV x-ray beam. This system is capable of resolving relative electron density as low as 1% with clinically acceptable radiation doses. There are many factors such as image noise, x-ray scatter, improper calibration and acquisitions that have a profound effect on the imaging performance of CBCT and in this study attempts were made to optimize these factors in order to maximize the SNR. A QC-3V phantom was used to determine the contrast to noise ratio (CNR) and f50 of a single 2-D projection. The computed f50 was 0.43 lp/mm and the CNR for a radiation dose of 0.02cGy was 43. Clinical Megavoltage CBCT images acquired with this system demonstrate that anatomical structures such as the prostate in a relatively large size patient are visible using radiation doses in range of 6 to 8cGy.
A high-resolution video (HRV) based EPID that is capable of matching the high spatial resolution and SNR (signal to noise ratio) of a-Si flat panel devices was developed at Siemens OCS (Oncology Care Systems) for cone beam CT. This system is using a high resolution CCD camera (1300 x 1030). The optical components and scintillator screen were modified to generate high-resolution images.
A Pips-Pro QC3 phantom was used to compare the spatial resolution and the contrast to noise ratio (CNR) of a-Si flat panel (1024x1024) and HRV system. The QC phantom was placed at the linear accelerator iso-center, and the detectors were placed 40cm below iso-center. The measured f50 for the Siemens a-Si flat panel and HRV are 0.49 lp/mm, and 0.43 lp/mm; respectively. The image of the flat panel had already been corrected for Offset, Gain and Defective pixels; however, no correction was performed on the HRV system.
Due to the fast readout of HRV, small pixel size, and adjustable camera lens aperture, a thicker scintillator screen would have resulted in an increase in SNR without sensor saturation during radiation treatment imaging. This is one of the main advantages of this system compared to the flat panels, and it makes the system ideal for cone beam reconstructions as well as regular therapy imaging. A new electronic readout is implemented in HRV control circuit that will synchronize the image acquisition with the linear accelerator, and thereby increases the SNR.
Three acquisition schemes for a-Si flat panels are described for radiation therapy imaging. The goal of all three acquisition modes is to acquire images with the highest achievable SNR (signal to noise ratio). The acquisition modes are Single mode for low dose acquisition (used for patient positioning), external continuous mode used for patient treatment (verification), and Cone Beam mode for mega-voltage computed tomography (MVCT).
During single mode acquisition, a few frames are readout prior to the start of irradiation. During this cycle, the accumulated dark current and residual data are cleared. During the radiation delivery no readout occurs, and the signal is integrated over the entire exposure period. After the irradiation readout occurs. The advantages of this readout scheme are to reduce the effects of readout noise and eliminate the linear accelerator (linac) pulsing effects on the final image. There is no readout during the exposure; therefore, no beam pulsing artifacts occur. Since the signal is integrated during the exposure time and the readout is performed after the exposure, this improves the SNR compared to acquiring a few frames during the radiation and averaging these frames to create the final image. The single mode acquisition is used clinically routinely and allows the acquisition of clinical images with a small amount of exposure (<=2 MU).
During external trigger continuous mode, the linear accelerator pulsing artifacts are removed by synchronizing the frame readout with linear accelerator pulses. The pulsing artifacts reduce the signal to noise ratio. This degradation is in the range of 70% for a single frame acquisition with 6MV, 300MU/min X-ray beam. Frame averaging reduces the degradation.
The Cone beam acquisition mode is used to perform volume MVCT in the cone beam geometry to visualize 3D (three dimensional) anatomy during patient positioning. In this mode the image acquisition is synchronized with the linear accelerator, which enables the imager to remove linear accelerator pulsing artifacts from the image and also provides the charge integration during low dose imaging. This synchronization improves the SNR.
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