Effect of scatter suppression with 2D antiscatter grids in photon counting compact CBCT.

Energy sensitive and photon counting detectors can provide improved tissue visualization and material quantification capabilities in Cone Beam Computed Tomography (CBCT) systems. However, their implementation in CBCT systems is more challenging, which is in part due to high fluence of scattered X-rays in wide cone angle CBCT geometry. Specifically, high scatter contamination in lower energy spectrum challenges reconstruction of high fidelity CBCT images by using lower energy X-rays. To address this problem, we investigated a robust scatter rejection with 2D antiscatter grids in a benchtop photon counting and compact CBCT system. The benchtop system employs a 35 cm wide CdTe photon counting detector with two energy thresholds. To reject scatter, a dedicated 2D antiscatter grid (2D grid) prototype made from tungsten was developed and mounted directly on the detector. To correct residual scatter not stopped by the 2D grid, a measurement-based scatter correction method, referred to as Grid-based Scatter Sampling (GSS), was utilized. Without 2D grid, scatter to primary ratio (SPR) reached 2.3 in the 15-40 keV energy bin. SPR was factor of 3 higher in the lowest energy bin when compared to the highest energy bin (90-120 keV). With the 2D grid, SPR was reduced below 0.14, and SPR values were more homogenous across the energy spectrum. CT number nonuniformity was factor of 3 lower in both low and high energy bin CBCT reconstructions. Improvement in contrast to noise ratio and contrast was more pronounced in the low energy bin CBCT images. This work indicates that 2D grids can significantly reduce spectral contamination caused by scatter in photon counting compact CBCT, and potentially enable higher fidelity CBCT image reconstructions.

2D antiscatter grid and scatter sampling based CBCT method for online dose calculations during CBCT guided radiation therapy of pelvis.

BACKGROUND: Online dose calculations before the delivery of radiation treatments have applications in dose delivery verification, online adaptation of treatment plans, and simulation-free treatment planning. While dose calculations by directly utilizing CBCT images are desired, dosimetric accuracy can be compromised due to relatively lower HU accuracy in CBCT images. PURPOSE: In this work, we propose a novel CBCT imaging pipeline to enhance the accuracy of CBCT-based dose calculations in the pelvis region. Our approach aims to improve the HU accuracy in CBCT images, thereby improving the overall accuracy of CBCT-based dose calculations prior to radiation treatment delivery. METHODS: An in-house developed quantitative CBCT pipeline was implemented to address the CBCT raw data contamination problem. The pipeline combines algorithmic data correction strategies and 2D antiscatter grid-based scatter rejection to achieve high CT number accuracy. To evaluate the effect of the quantitative CBCT pipeline on CBCT-based dose calculations, phantoms mimicking pelvis anatomy were scanned using a linac-mounted CBCT system, and a gold standard multidetector CT used for treatment planning (pCT). A total of 20 intensity-modulated treatment plans were generated for five targets, using 6 and 10 MV flattening filter-free beams, and utilizing small and large pelvis phantom images. For each treatment plan, four different dose calculations were performed using pCT images and three CBCT imaging configurations: quantitative CBCT, clinical CBCT protocol, and a high-performance 1D antiscatter grid (1D ASG). Subsequently, dosimetric accuracy was evaluated for both targets and organs at risk as a function of patient size, target location, beam energy, and CBCT imaging configuration. RESULTS: When compared to the gold-standard pCT, dosimetric errors in quantitative CBCT-based dose calculations were not significant across all phantom sizes, beam energies, and treatment sites. The largest error observed was 0.6% among all dose volume histogram metrics and evaluated dose calculations. In contrast, dosimetric errors reached up to 7% and 97% in clinical CBCT and high-performance ASG CBCT-based treatment plans, respectively. The largest dosimetric errors were observed in bony targets in the large phantom treated with 6 MV beams. The trends of dosimetric errors in organs at risk were similar to those observed in the targets. CONCLUSIONS: The proposed quantitative CBCT pipeline has the potential to provide comparable dose calculation accuracy to the gold-standard planning CT in photon radiation therapy for the abdomen and pelvis. These robust dose calculations could eliminate the need for density overrides in CBCT images and enable direct utilization of CBCT images for dose delivery monitoring or online treatment plan adaptations before the delivery of radiation treatments.

A 2D antiscatter grid and scatter sampling based CBCT method for online dose calculations during CBCT guided radiation therapy of pelvis.

Online dose calculations before radiation treatment have applications in dose delivery verification, plan adaptation, and treatment planning. We propose a novel CBCT imaging pipeline to enhance accuracy. Our approach aims to improve HU accuracy in CBCT images for more precise dose calculations. A quantitative CBCT pipeline was implemented, combining data correction strategies and scatter rejection, achieving high CT number accuracy. We evaluated the pipeline's effect using pelvis anatomy phantoms and found that dosimetric errors in quantitative CBCT-based dose calculations were minimal. In contrast, clinical CBCT and high-performance ASG CBCT-based plans showed significant errors. The proposed quantitative CBCT pipeline offers comparable dose calculation accuracy to the gold-standard planning CT, eliminating the need for density overrides and enabling precise dose delivery monitoring or online plan adaptations in radiation therapy.

A simulation study to evaluate the effect of 2D antiscatter grid primary transmission on flat panel detector based CBCT image quality.

Purpose. Two-dimensional antiscatter grids' (2D-ASGs) septal shadows and their impact on primary transmission play a critical role in cone-beam computed tomography (CBCT) image noise and artifact characteristics. Therefore, a numerical simulation platform was developed to evaluate the effect of 2D-ASG's primary transmission on image quality, as a function of grid geometry and CBCT system properties.Methods. To study the effect of 2D-ASG's septal shadows on primary transmission and CBCT image quality, two new methods were introduced; one to simulate projection signal gradients in septal shadows, and the other to simulate septal shadow variations due to gantry flex. Signal gradients in septal shadows were simulated by generating a system point spread function that was directly extracted from projection images of 2D-ASG prototypes in experiments. Variations in septal shadows due to gantry flex were simulated by generating oversampled shadow profiles extracted from experiments. Subsequently, the effect of 2D-ASG's septal shadows on primary transmission and image quality was evaluated.Results.For an apparent septal thickness of 0.15 mm, the primary transmission of 2D-ASG varied between 72%-90% for grid pitches 1-3 mm. In low-contrast phantoms, the effect of 2D-ASG's radiopaque footprint on information loss was subtle. At high spatial frequencies, information loss manifested itself as undersampling artifacts, however, its impact on image quality is subtle when compared to quantum noise. Effects of additive electronic noise and gantry flex induced ring artifacts on image quality varied as a function of grid pitch and septal thickness. Such artifacts were substantially less in lower resolution images.Conclusion. The proposed simulation platform allowed successful evaluation of CBCT image quality variations as a function of 2D-ASG primary transmission properties and CBCT system characteristics. This platform can be potentially used for optimizing 2D-ASG design properties based on the imaging task and properties of the CBCT system.

A quantitative CBCT pipeline based on 2D antiscatter grid and grid-based scatter sampling for image-guided radiation therapy.

BACKGROUND: Quantitative accuracy is critical for expanding the role of cone beam CT (CBCT) imaging from target localization to quantitative treatment monitoring and plan adaptations in radiation therapy. Despite advances in CBCT image quality improvement methods, quantitative accuracy gap between CBCT and multi-detector CT (MDCT) remains. PURPOSE: In this work, a physics-driven approach was investigated that combined robust scatter rejection, raw data correction and iterative image reconstruction to further improve CBCT image quality and quantitative accuracy, referred to as quantitative CBCT (qCBCT). METHODS: QCBCT approach includes tungsten 2D antiscatter grid hardware, residual scatter correction with grid-based scatter sampling, image lag, and beam hardening correction for offset detector geometry linac-mounted CBCT. Images were reconstructed with iterative image reconstruction to reduce image noise. qCBCT was evaluated using a variety of phantoms to investigate the effect of object size and its composition on image quality, and image quality was benchmarked against clinical CBCT and gold standard MDCT images used for treatment planning. RESULTS: QCBCT provided statistically significant improvement in CT number accuracy and reduced image artifacts when compared to clinical CBCT images. When compared to gold standard MDCT, mean HU errors in qCBCT and clinical CBCT were 17 ± 9 and 38 ± 29 HU, respectively. Magnitude of phantom size dependent HU variations were comparable between MDCT and qCBCT images. With iterative reconstruction, contrast-to-noise ratio improved by 25% when compared to clinical CBCT protocols. CONCLUSIONS: Combination of novel scatter suppression techniques and other data correction methods in qCBCT provided CT number accuracy comparable to gold standard MDCT used for treatment planning. This approach may potentially improve CBCT's promise in fulfilling the tasks that demand high quantitative accuracy, such as online dose calculations and treatment response assessment, in image guided radiation therapy.

2D antiscatter grid and scatter sampling based CBCT pipeline for image guided radiation therapy.

Poor tissue visualization and quantitative accuracy in CBCT is a major barrier in expanding the role of CBCT imaging from target localization to quantitative treatment monitoring and plan adaptations in radiation therapy sessions. To further improve image quality in CBCT, 2D antiscatter grid based scatter rejection was combined with a raw data processing pipeline and iterative image reconstruction. The culmination of these steps was referred as quantitative CBCT, qCBCT. qCBCT data processing steps include 2D antiscatter grid implementation, measurement based residual scatter, image lag, and beam hardening correction for offset detector geometry CBCT with a bow tie filter. Images were reconstructed with iterative image reconstruction to reduce image noise. To evaluate image quality, qCBCT acquisitions were performed using a variety of phantoms to investigate the effect of object size and its composition on image quality. qCBCT image quality was benchmarked against clinical CBCT and MDCT images. Addition of image lag and beam hardening correction to scatter suppression reduced HU degradation in qCBCT by 10 HU and 40 HU, respectively. When compared to gold standard MDCT, mean HU errors in qCBCT and clinical CBCT were 10 HU and 27 HU, respectively. HU inaccuracy due to change in phantom size was 22 HU and 85 HU in qCBCT and clinical CBCT images, respectively. With iterative reconstruction, contrast to noise ratio improved by a factor of 1.25 when compared to clinical CBCT protocols. Robust artifact and noise suppression in qCBCT images can reduce the image quality gap between CBCT and MDCT, improving the promise of qCBCT in fulfilling the tasks that demand high quantitative accuracy, such as CBCT based dose calculations and treatment response assessment in image guided radiation therapy.

Concurrent kilovoltage CBCT imaging and megavoltage beam delivery: suppression of cross-scatter with 2D antiscatter grids and grid-based scatter sampling.

Objective. The concept of using kilovoltage (kV) and megavoltage (MV) beams concurrently has potential applications in cone beam computed tomography (CBCT) guided radiation therapy, such as single breath hold scans, metal artifact reduction, and simultaneous imaging during MV treatment delivery. However, MV cross-scatter generated during MV beam delivery degrades CBCT image quality. To address this, a 2D antiscatter grid and a cross-scatter correction method were investigated in the context of high dose MV treatment delivery.Approach. A 3D printed, tungsten 2D antiscatter grid prototype was utilized in kV CBCT scans to reduce MV cross-scatter fluence during concurrent MV beam delivery. Remaining cross-scatter in projections was corrected by using the 2D grid itself as a cross-scatter intensity sampling device, referred to as grid-based scatter sampling (GSS). To test this approach, kV CBCT acquisitions were performed while delivering 6 and 10 MV beams, mimicking high dose rate treatment delivery scenarios. kV and MV beam deliveries were not synchronized to eliminate MV beam delivery interruption. MV cross-scatter suppression performance of the proposed approach was evaluated in projections and CBCT images of phantoms.Main results. 2D grid reduced the intensity of MV cross-scatter in kV projections by a factor of 3 on the average, when compared to conventional antiscatter grid. Remaining cross scatter as measured by the GSS method was within 7% of measured reference intensity values, and subsequently corrected. CBCT image quality was improved substantially during concurrent kV-MV beam delivery. Median Hounsfield Unit (HU) inaccuracy was up to 182 HU without our methods, and it was reduced to a median 6.5 HU with our 2D grid and scatter correction approach. Our methods provided a factor of 2-6 improvement in contrast-to-noise ratio.Significance. This investigation demonstrates the utility of 2D antiscatter grids and grid-based scatter sampling in suppressing MV cross-scatter. Our approach successfully minimized the effects of MV cross-scatter in concurrent kV CBCT imaging and high dose MV treatment delivery scenarios. Hence, robust MV cross-scatter suppression is potentially feasible without MV beam delivery interruption or compromising kV image acquisition rate.

Megavoltage cross-scatter rejection and correction using 2D antiscatter grids in kilovoltage CBCT imaging.

Simultaneous use of kilovoltage (kV) and megavoltage (MV) beams has numerous potential applications in cone beam computed tomography (CBCT)-guided radiotherapy, such as fast MV+kV CBCT for single breath-hold scan, tumor localization with kV CBCT imaging during MV therapy delivery, and metal artifact suppression. However, the introduction of MV beams results in a large MV-cross scatter fluence incident on the kV Flat Panel Detector (FPD), and thus, deteriorating the low contrast visualization and Hounsfield Unit (HU) accuracy. In this work, we introduced a novel and robust method for reducing the effects of MV cross scatter. First, we implemented a 2D antiscatter grid atop the detector which rejects a large section of MV cross scatter. This hardware-based approach, while effective, allows a fraction of MV cross scatter to be transmitted to the FPD, resulting in artifacts and degraded HU accuracy in CBCT images. We thus introduced a data correction step, which aimed to estimate and correct the remaining MV cross scatter. This approach, referred to as Grid-Based Scatter Sampling, utilized 2D antiscatter grid itself to measure and correct remaining MV cross scatter in projections. We investigated the performance of the proposed approach in experiments by simultaneously acquiring kV CBCT and delivering MV beams with a clinical linac. The results show that the proposed method can substantially reduce HU inaccuracy and increase contrast-to-noise ratio (CNR). Our method does not require synchronization of kV and MV beam pulses, reduction of kV frame acquisition rate, or MV dose rate, and therefore, it is more practical to implement in radiation therapy clinical setting.