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Dual resolution cone beam breast CT: A feasibility study

PURPOSE In this study, the authors investigated the feasibility of a dual resolution volume-of-interest (VOI) cone beam breast CT technique and compared two implementation approaches in terms of dose saving and scatter reduction. METHODS With this technique, a lead VOI mask with an opening is inserted between the x-ray source and the breast to deliver x-ray exposure to the VOI while blocking x rays outside the VOI. A CCD detector is used to collect the high resolution projection data of the VOI. Low resolution cone beam CT (CBCT) images of the entire breast, acquired with a flat panel (FP) detector, were used to calculate the projection data outside the VOI with the ray-tracing reprojection method. The Feldkamp-Davis-Kress filtered backprojection algorithm was used to reconstruct the dual resolution 3D images. Breast phantoms with 180 microm and smaller microcalcifications (MCs) were imaged with both FP and FP-CCD dual resolution CBCT systems, respectively. Two approaches of implementing the dual resolution technique, breast-centered approach and VOI-centered approach, were investigated and evaluated for dose saving and scatter reduction with Monte Carlo simulation using a GEANT4 package. RESULTS The results showed that the breast-centered approach saved more breast absorbed dose than did VOI-centered approach with similar scatter reduction. The MCs in fatty breast phantom, which were invisible with FP CBCT scan, became visible with the FP-CCD dual resolution CBCT scan. CONCLUSIONS These results indicate potential improvement of the image quality inside the VOI with reduced breast dose both inside and outside the VOI.

Analysis of the track- and dose-averaged LET and LET spectra in proton therapy using the GEANT4 Monte Carlo code

PURPOSE The motivation of this study was to find and eliminate the cause of errors in dose-averaged linear energy transfer (LET) calculations from therapeutic protons in small targets, such as biological cell layers, calculated using the geant 4 Monte Carlo code. Furthermore, the purpose was also to provide a recommendation to select an appropriate LET quantity from geant 4 simulations to correlate with biological effectiveness of therapeutic protons. METHODS The authors developed a particle tracking step based strategy to calculate the average LET quantities (track-averaged LET, LETt and dose-averaged LET, LETd) using geant 4 for different tracking step size limits. A step size limit refers to the maximally allowable tracking step length. The authors investigated how the tracking step size limit influenced the calculated LETt and LETd of protons with six different step limits ranging from 1 to 500 μm in a water phantom irradiated by a 79.7-MeV clinical proton beam. In addition, the authors analyzed the detailed stochastic energy deposition information including fluence spectra and dose spectra of the energy-deposition-per-step of protons. As a reference, the authors also calculated the averaged LET and analyzed the LET spectra combining the Monte Carlo method and the deterministic method. Relative biological effectiveness (RBE) calculations were performed to illustrate the impact of different LET calculation methods on the RBE-weighted dose. RESULTS Simulation results showed that the step limit effect was small for LETt but significant for LETd. This resulted from differences in the energy-deposition-per-step between the fluence spectra and dose spectra at different depths in the phantom. Using the Monte Carlo particle tracking method in geant 4 can result in incorrect LETd calculation results in the dose plateau region for small step limits. The erroneous LETd results can be attributed to the algorithm to determine fluctuations in energy deposition along the tracking step in geant 4. The incorrect LETd values lead to substantial differences in the calculated RBE. CONCLUSIONS When the geant 4 particle tracking method is used to calculate the average LET values within targets with a small step limit, such as smaller than 500 μm, the authors recommend the use of LETt in the dose plateau region and LETd around the Bragg peak. For a large step limit, i.e., 500 μm, LETd is recommended along the whole Bragg curve. The transition point depends on beam parameters and can be found by determining the location where the gradient of the ratio of LETd and LETt becomes positive.

High resolution dual detector volume-of-interest cone beam breast CT––Demonstration with a bench top system

PURPOSE In this study, we used a small field high resolution detector in conjunction with a full field flat panel detector to implement and investigate the dual detector volume-of-interest (VOI) cone beam breast computed tomography (CBCT) technique on a bench-top system. The potential of using this technique to image small calcifications without increasing the overall dose to the breast was demonstrated. Significant reduction of scatter components in the high resolution projection image data of the VOI was also shown. METHODS With the regular flat panel based CBCT technique, exposures were made at 80 kVp to generate an air kerma of 6 mGys at the isocenter. With the dual detector VOI CBCT technique, a high resolution small field CMOS detector was used to scan a cylindrical VOI (2.5 cm in diameter and height, 4.5 cm off-center) with collimated x-rays at four times of regular exposure level. A flat panel detector was used for full field scan with low x-ray exposures at half of the regular exposure level. The low exposure full field image data were used to fill in the truncated space in the VOI scan data and generate a complete projection image set. The Feldkamp-Davis-Kress (FDK) filtered backprojection algorithm was used to reconstruct high resolution images for the VOI. Two scanning techniques, one breast centered and the other VOI centered, were implemented and investigated. Paraffin cylinders with embedded thin aluminum (Al) wires were imaged and used in conjunction with optically stimulated luminescence (OSL) dose measurements to demonstrate the ability of this technique to image small calcifications without increasing the mean glandular dose (MGD). RESULTS Using exposures that produce an air kerma of 6 mGys at the isocenter, the regular CBCT technique was able to resolve the cross-sections of Al wires as thin as 254 μm in diameter in the phantom. For the specific VOI studied, by increasing the exposure level by a factor of 4 for the VOI scan and reducing the exposure level by a factor of 2 for the full filed scan, the dual-detector CBCT technique was able to resolve the cross-sections of Al wires as thin as 152 μm in diameter. The CNR evaluated for the entire Al wire cross-section was found to be improved from 5.5 in regular CBCT to 14.4 and 16.8 with the breast centered and VOI centered scanning techniques, respectively. Even inside VOI center, the VOI scan resulted in significant dose saving with the dose reduced by a factor of 1.6 at the VOI center. Dose saving outside the VOI was substantial with the dose reduced by a factor of 7.3 and 7.8 at the breast center for the breast centered and VOI centered scans, respectively, when compared to full field scan at the same exposure level. The differences between the two dual detector techniques in terms of dose saving and scatter reduction were small with VOI scan at 4× exposure level and full field scan at 0.5 × exposure level. The MGDs were only 94% of that from the regular CBCT scan. CONCLUSIONS For the specific VOI studied, the dual detector VOI CBCT technique has the potential to provide high quality images inside the VOI with MGD similar to or even lower than that of full field breast CBCT. It was also found that our results were compromised by the use of inadequate detectors for the VOI scan. An appropriately selected detector would better optimize the image quality improvement that can be achieved with the VOI CBCT technique.

Radiation doses in cone-beam breast computed tomography: a Monte Carlo simulation study.

PURPOSE In this article, we describe a method to estimate the spatial dose variation, average dose and mean glandular dose (MGD) for a real breast using Monte Carlo simulation based on cone beam breast computed tomography (CBBCT) images. We present and discuss the dose estimation results for 19 mastectomy breast specimens, 4 homogeneous breast models, 6 ellipsoidal phantoms, and 6 cylindrical phantoms. METHODS To validate the Monte Carlo method for dose estimation in CBBCT, we compared the Monte Carlo dose estimates with the thermoluminescent dosimeter measurements at various radial positions in two polycarbonate cylinders (11- and 15-cm in diameter). Cone-beam computed tomography (CBCT) images of 19 mastectomy breast specimens, obtained with a bench-top experimental scanner, were segmented and used to construct 19 structured breast models. Monte Carlo simulation of CBBCT with these models was performed and used to estimate the point doses, average doses, and mean glandular doses for unit open air exposure at the iso-center. Mass based glandularity values were computed and used to investigate their effects on the average doses as well as the mean glandular doses. Average doses for 4 homogeneous breast models were estimated and compared to those of the corresponding structured breast models to investigate the effect of tissue structures. Average doses for ellipsoidal and cylindrical digital phantoms of identical diameter and height were also estimated for various glandularity values and compared with those for the structured breast models. RESULTS The absorbed dose maps for structured breast models show that doses in the glandular tissue were higher than those in the nearby adipose tissue. Estimated average doses for the homogeneous breast models were almost identical to those for the structured breast models (p=1). Normalized average doses estimated for the ellipsoidal phantoms were similar to those for the structured breast models (root mean square (rms) percentage difference = 1.7%; p = 0.01), whereas those for the cylindrical phantoms were significantly lower (rms percentage difference = 7.7%; p < 0.01). Normalized MGDs were found to decrease with increasing glandularity. CONCLUSIONS Our results indicate that it is sufficient to use homogeneous breast models derived from CBCT generated structured breast models to estimate the average dose. This investigation also shows that ellipsoidal digital phantoms of similar dimensions (diameter and height) and glandularity to actual breasts may be used to represent a real breast to estimate the average breast dose with Monte Carlo simulation. We have also successfully demonstrated the use of structured breast models to estimate the true MGDs and shown that the normalized MGDs decreased with the glandularity as previously reported by other researchers for CBBCT or mammography.

Reduction in x-ray scatter and radiation dose for volume-of-interest (VOI) cone-beam breast CT—a phantom study

With volume-of-interest (VOI) cone-beam computed tomography (CBCT) imaging, one set of projection images are acquired with the VOI collimator at a regular or high exposure level and the second set of projection images are acquired without the collimator at a reduced exposure level. The high exposure VOI scan data inside the VOI and the low exposure full-field scan data outside the VOI are then combined together to generate composite projection images for image reconstruction. To investigate and quantify scatter reduction, dose saving and image quality improvement in VOI CBCT imaging, a flat panel detector-based bench-top experimental CBCT system was built to measure the dose, the scatter-to-primary ratio (SPR), the image contrast, noise level, the contrast-to-noise ratio (CNR) and the figure of merit (FOM) in the CBCT reconstructed images for two polycarbonate cylinders simulating the small and the large phantoms. The results showed that, compared to the full field CBCT technique, radiation doses for the VOI CBCT technique were reduced by a factor of 1.20 and 1.36 for the small and the large phantoms at the phantom center, respectively, and from 2.7 to 3.0 on the edge of the phantom, respectively. Inside the VOI, the SPRs were substantially reduced by a factor of 6.6 and 10.3 for the small and the large phantoms, the contrast signals were improved by a factor of 1.35 and 1.8, and the noise levels were increased by a factor of 1.27 and 1.6, respectively. As a result, the CNRs were improved by a factor of 1.06 and 1.13 for the small and the large phantoms and the FOM improved by a factor of 1.4 and 1.7, respectively.

Breast density measurement: 3D cone beam computed tomography (CBCT) images versus 2D digital mammograms

Breast density has been recognized as one of the major risk factors for breast cancer. However, breast density is currently estimated using mammograms which are intrinsically 2D in nature and cannot accurately represent the real breast anatomy. In this study, a novel technique for measuring breast density based on the segmentation of 3D cone beam CT (CBCT) images was developed and the results were compared to those obtained from 2D digital mammograms. 16 mastectomy breast specimens were imaged with a bench top flat-panel based CBCT system. The reconstructed 3D CT images were corrected for the cupping artifacts and then filtered to reduce the noise level, followed by using threshold-based segmentation to separate the dense tissue from the adipose tissue. For each breast specimen, volumes of the dense tissue structures and the entire breast were computed and used to calculate the volumetric breast density. BI-RADS categories were derived from the measured breast densities and compared with those estimated from conventional digital mammograms. The results show that in 10 of 16 cases the BI-RADS categories derived from the CBCT images were lower than those derived from the mammograms by one category. Thus, breasts considered as dense in mammographic examinations may not be considered as dense with the CBCT images. This result indicates that the relation between breast cancer risk and true (volumetric) breast density needs to be further investigated.

SU‐FF‐I‐41: Accuracy and Computing Time of a Ray‐Driven Projector/back‐Projector for Simulation and Reconstruction in Tomosynthesis and Cone Beam CT Imaging

Accurate and fast projector/back‐projector (PBP) is the key to successful simulation and iterative reconstruction of tomosynthesis and cone beam CT. In this study, the accuracy and computation speed of a ray‐driven PBP operator were investigated. To simulate x‐ray tomographyimaging, a ray‐driven projector was developed and implemented on a 64 computing node PC Cluster. Each x‐ray path is represented by sampling points in the object. Their μ values are summed up to compute the integral attenuation along the path. To evaluate the accuracy of the reprojection algorithm as the function of sampling ratio (Sampling length / voxel length), reprojections obtained with a significantly smaller sampling ratio were used as reference. To minimize the additional loss of accuracy from pixelization, the pixel size of the projection images was selected to be one third of the voxel size projected back to the image plane. Error images were formed by subtracting the re‐projection from the reference re‐projection and used to compute the percentage errors. SART were implemented for image reconstruction in tomosynthesis and CBCTimaging. To evaluate its accuracy, CBCTimagesreconstructed with 300 projection views over 360 degree were compared to the original CBCTimages. Errors were computed from the subtraction images and plotted together the computing time as the function of the sampling ratio. With reduced sampling ratio, the accuracies of both the re‐projection and SART algorithms were improved at the expense of longer computing time. The improvement was accelerated with smaller sampling ratios. Aliasing artifacts were visible when the sampling ratios were greater than 0.5. We have demonstrated that the accuracy of the re‐projection and SART reconstructions improved with reduced the sampling ratio at the expense of longer computing time for a ray‐driven PBP. The tradeoff between accuracy and computing time should be determined by the imaging requirement.

SU-FF-I-23: Full-Scan Versus Half-Scan in Cone Beam Breast CT - a Quantitative Comparison

Purpose: To evaluate and compare half‐scan and full scan techniques for cone beam breast CT in terms of CT number, radiation dose distribution and CNR.Method and Materials:CT number comparison: A 11 cm diameter breast phantom, made of a stack of glandular and fat tissue, was analytically modeled to evaluate the difference of CT numbers reconstructed from Feldkamp algorithm based half and full scan reconstruction. Radiation dose distribution: An 11 cm diameter cylindrical breast model was constructed to evaluate the dose distribution with Geant4 based Monte Carlo simulation.CNR evaluation: An 11 cm diameter polycarbonate cylinder was imaged to simulate breast imaging. Five holes of the same size (5 mm in diameter) were drilled at different radial distance from the phantom center. The phantom, filled with iodine solution, was imaged with an aSi/CsI flat panel detector based cone beam CT scanner. Iodine CNRs were measured for different half‐scan coverage selection. Results: It has been found that the CT numbers reconstructed from half‐scan were close to those from full‐scan. The radiation doses in the half‐scan coverage can be twice than those out the coverage as the radial distance increasing. The CNRs for different half‐scan coverage were approximately identical. Conclusion: Our results show that the reconstructed data from half‐scan are comparable to that from full‐scan. The radiation doses are low for the positions out the half‐scan coverage. The CNRs vary little with half‐scan coverage. Acknowledgement: This work was supported in part by grants CA104759 and CA124585 from NIH‐NCI, a grant EB00117 from NIH‐NIBIB, and a subcontract from NIST‐ATP.

SU‐F‐T‐120: How Many and Which Respiratory Phases Should Be Included During the 4D Robust Optimization Process

PURPOSE To study how many and which respiratory phases should be included to conduct an efficient 4D robust optimization since contouring CTV and critical organs at all 10 phases are time consuming. METHODS A 4D robust optimization algorithm which simultaneously optimizes dose distributions for all 10 respiratory phases has been developed to desensitize plan quality to various uncertainties. To study the possibility of reducing number of phases included during the optimization process while keep the plan quality, four strategies have been conducted and compared: A. including 2 phases: 0% and 50%; B. including 4 phases: 0%, 20%, 50% and 80%. C. including 5 phases: 0%, 20%, 50%, 60% and 80%; D. including all 10 phases during the optimization process. The resulting plans for two patients were evaluated at all 10 respiratory phases. RESULTS For patient one, reducing the number of phases included in optimization process will degrade CTV coverage while improve the normal tissue sparing. The possible worst CTV coverage at prescription dose (74Gy) for IMPT plans optimized for strategy A, B, C, D was 98.13%, 98.29%, 99.00% and 99.05% respectively. The CTV coverage is almost the same when including 5 phases compared to including 10 phases. For patient 2, reducing the number of phases included in optimization process will degrade CTV coverage, while the normal tissue sparing is not affected too much. The possible worst CTV coverage at prescription dose for IMPT plans optimized for strategy A, B, C, D was 95.85%, 99.01%, 99.18% and 99.72% respectively. The CTV coverage is similar when including 4 phases or 5 phases compared to including 10 phases. CONCLUSION The preliminary data shows that at least 4 phases or 5 phases should be included during optimization process to achieve a high quality IMPT plan considering CTV coverage and normal tissue sparing.

SU-F-T-187: Quantifying Normal Tissue Sparing with 4D Robust Optimization of Intensity Modulated Proton Therapy

PURPOSE To report an approach to quantify the normal tissue sparing for 4D robustly-optimized versus PTV-optimized IMPT plans. METHODS We generated two sets of 90 DVHs from a patients 10-phase 4D CT set; one by conventional PTV-based optimization done in the Eclipse treatment planning system, and the other by an in-house robust optimization algorithm. The 90 DVHs were created for the following scenarios in each of the ten phases of the 4DCT: ± 5mm shift along x, y, z; ± 3.5% range uncertainty and a nominal scenario. A Matlab function written by Gay and Niemierko was modified to calculate EUD for each DVH for the following structures: esophagus, heart, ipsilateral lung and spinal cord. An F-test determined whether or not the variances of each structures DVHs were statistically different. Then a t-test determined if the average EUDs for each optimization algorithm were statistically significantly different. RESULTS T-test results showed each structure had a statistically significant difference in average EUD when comparing robust optimization versus PTV-based optimization. Under robust optimization all structures except the spinal cord received lower EUDs than PTV-based optimization. Using robust optimization the average EUDs decreased 1.45% for the esophagus, 1.54% for the heart and 5.45% for the ipsilateral lung. The average EUD to the spinal cord increased 24.86% but was still well below tolerance. CONCLUSION This work has helped quantify a qualitative relationship noted earlier in our work: that robust optimization leads to plans with greater normal tissue sparing compared to PTV-based optimization. Except in the case of the spinal cord all structures received a lower EUD under robust optimization and these results are statistically significant. While the average EUD to the spinal cord increased to 25.06 Gy under robust optimization it is still well under the TD50 value of 66.5 Gy from Emami et al. Supported in part by the NCI U19 CA021239.