Feasibility of 4D HDR brachytherapy source tracking using x-ray tomosynthesis: Monte Carlo investigation.

PURPOSE: High dose rate (HDR) brachytherapy rapidly delivers dose to targets with steep dose gradients. This treatment method must adhere to prescribed treatment plans with high spatiotemporal accuracy and precision, as failure to do so may degrade clinical outcomes. One approach to achieving this goal is to develop imaging techniques to track HDR sources in vivo in reference to surrounding anatomy. This work investigates the feasibility of using an isocentric C-arm x-ray imager and tomosynthesis methods to track Ir-192 HDR brachytherapy sources in vivo over time (4D). METHODS: A tomosynthesis imaging workflow was proposed and its achievable source detectability, localization accuracy, and spatiotemporal resolution were investigated in silico. An anthropomorphic female XCAT phantom was modified to include a vaginal cylinder applicator and Ir-192 HDR source (0.5 × 0.5 × 5.0 mm3 ), and the workflow was carried out using the MC-GPU Monte Carlo image simulation platform. Source detectability was characterized using the reconstructed source signal-difference-to-noise-ratio (SDNR), localization accuracy by the absolute 3D error in its measured centroid location, and spatiotemporal resolution by the full-width-at-half-maximum (FWHM) of line profiles through the source in each spatial dimension considering a maximum C-arm angular velocity of 30° per second. The dependence of these parameters on acquisition angular range (θtot = 0°-90°), number of views, angular increment between views (Δθ = 0°-15°), and volumetric constraints imposed in reconstruction was evaluated. Organ voxel doses were tallied to derive the workflow's attributable effective dose. RESULTS: The HDR source was readily detected and its centroid was accurately localized with the proposed workflow and method (SDNR: 10-40, 3D error: 0-0.144 mm). Tradeoffs were demonstrated for various combinations of image acquisition parameters; namely, increasing the tomosynthesis acquisition angular range improved resolution in the depth-encoded direction, for example from 2.5 mm to 1.2 mm between θtot = 30o and θtot = 90o , at the cost of increasing acquisition time from 1 to 3 s. The best-performing acquisition parameters (θtot = 90o , Δθ = 1°) yielded no centroid localization error, and achieved submillimeter source resolution (0.57 × 1.21 × 5.04 mm3 apparent source dimensions, FWHM). The total effective dose for the workflow was 263 µSv for its required pre-treatment imaging component and 7.59 µSv per mid-treatment acquisition thereafter, which is comparable to common diagnostic radiology exams. CONCLUSIONS: A system and method for tracking HDR brachytherapy sources in vivo using C-arm tomosynthesis was proposed and its performance investigated in silico. Tradeoffs in source conspicuity, localization accuracy, spatiotemporal resolution, and dose were determined. The results suggest this approach is feasible for localizing an Ir-192 HDR source in vivo with submillimeter spatial resolution, 1-3 second temporal resolution and minimal additional dose burden.

Evaluation of a hybrid direct-indirect active matrix flat-panel imager using Monte Carlo simulation.

Purpose: Monte Carlo simulations were used to evaluate the imaging properties of a composite direct-indirect active matrix flat-panel imager (AMFPI) with potentially more favorable tradeoffs between x-ray quantum efficiency and spatial resolution than direct or indirect AMFPIs alone. This configuration, referred to as a hybrid AMFPI, comprises a scintillator that is optically coupled to an a-Se direct AMFPI through a transparent electrode and hole blocking layer, such that a-Se acts as both a direct x-ray converter and an optical sensor. Approach: GEANT4 was used to simulate x-ray energy deposition, optical transport, and charge signal generation processes in various hybrid AMPFI configurations under RQA5 and RQA9 x-ray beam conditions. The Fujita-Lubberts-Swank method was used to quantify the impact of irradiation geometry, x-ray converter thicknesses, conversion gain of each layer, and x-ray cross talk between layers on detective quantum efficiency (DQE). Results: Each hybrid configuration had a greater DQE than its direct AMFPI layer alone. The DQE improvement was largest at low spatial frequencies in both front- and back-irradiation (BI) geometries due to increased x-ray quantum efficiency provided by the scintillator. DQE improvements persisted at higher frequencies in BI geometry due to preferential x-ray absorption in a-Se. Matching the x-ray-to-charge conversion gains of a hybrid AMFPI's direct and indirect detection layers affects its Swank factor and, thus, DQE(0). X-ray cross talk has a negligible impact on the DQE ( f ) of hybrid AMFPIs with sufficiently high optical quantum efficiency. Conclusion: An optimized hybrid AMFPI can achieve greater DQE performance than current direct or indirect AMFPIs.