Cine MRI-based analysis of intrafractional motion in radiation treatment planning of head and neck cancer patients.

PURPOSE/OBJECTIVE(S): To investigate intrafraction motion of (HN) target volumes and to determine patient-specific planning target volume (PTV) margins. MATERIALS/METHODS: MR-cine imaging was performed for radiation treatment planning in HN cancer patients treated with definitive EBRT (n = 62) or SBRT (n = 4) on a 1.5 T MRI between 2017-2019. Dynamic MRI scans (sagittal orientation, 2 × 82 × 7 mm3 resolution), ranging from 3-5 min and 900-1500 images, were acquired. The position of the maximum tumor displacement along each direction in the anterior/posterior (A/P) and superior/inferior (S/I) position was recorded and analyzed to determine average PTV margins. RESULTS: Primary tumor sites (n = 66) were oropharynx (n = 39), larynx (n = 24) and hypopharynx (n = 3). PTV margins for A/P/S/I positions were 4.1/4.4/5.0/6.2 mm and 4.9/4.3/6.7/7.7 mm for oropharyngeal and laryngeal/hypopharyngeal cancers when accounting for all motion. V100 for PTV was calculated and compared to the original plans. The mean drop in PTV coverage was in most cases under 5%. For a subset of patients with 3 mm plans available, V100 for PTV had more substantial decreases in coverage averaging 8.2% - and 14.3% for oropharyngeal and laryngeal/hypopharynx plans, respectively. CONCLUSION: The use of MR-cine in treatment planning allows for quantification of tumor motion during swallow and resting periods and should be accounted for during treatment planning. With motion considered, the derived margins may exceed the commonly used 3-5 mm PTV margins. Quantification and analysis of tumor and patient-specific PTV margins is a step towards real-time MRI guidance adaptive radiotherapy.

Development and assessment of an x-ray tube-based multi-beam x-ray scatter projection imaging system.

Coherent scatter x-ray imaging systems are sensitive to material structure and chemical composition, and generate soft-material images with contrast superior to conventional transmission x-ray imaging. For practicality in medical or security applications, the image data acquisition time should be <10 min. Our approach is a multi-beam projection imaging design. Previously, as a development stage, we implemented a synchrotron-based system with five coplanar pencil beams and continuous motion of the object. In the work reported here, we developed a more practical coherent scatter projection imaging system using a conventional x-ray tube source. The object is irradiated by an array of up to three rows by five columns of pencil beams, and motorized stages translate the object through the beams for step-and-shoot acquisition. For the same tube loading, broad spectrum beams, such as 110 kVp filtered with 2.25 mm Al, were found to provide a higher signal-difference-to-noise ratio between soft materials in scatter images than lower kVp, more heavily filtered beams that have a narrower, lower intensity spectrum. The shortest acquisition time for a 6.0 × 10.0 cm2 object with 6000 pixels was 8.8 min. The width of a sharp edge in the scatter image was consistent with the pencil beam diameter. Contrast-detail performance was similar to our synchrotron-based system. In this first x-ray tube-based system, for simplicity, the transmitted x rays are measured through attenuators using the same flat-panel detector that measures scattered x rays. As a result, the primary image quality was reduced.

A detective quantum efficiency for spectroscopic X-ray imaging detectors.

PURPOSE: Spectroscopic X-ray detectors (SXDs) are under development for X-ray imaging applications. Recent efforts to extend the detective quantum efficiency (DQE) to SXDs impose a barrier to experimentation and/or do not provide a task-independent measure of detector performance. The purpose of this article is to define a task-independent DQE for SXDs that can be measured using a modest extension of established DQE-metrology methods. METHODS: We defined a task-independent spectroscopic DQE and performed a simulation study to determine the relationship between the zero-frequency DQE and the ideal-observer signal-to-noise ratio (SNR) of low-frequency soft-tissue, bone, iodine, and gadolinium signals. In our simulations, we used calibrated models of the spatioenergetic response of cadmium telluride (CdTe) and cadmium-zinc-telluride (CdZnTe) SXDs. We also measured the zero-frequency DQE of a CdTe detector with two energy bins and of a CdZnTe detector with up to six energy bins for an RQA9 spectrum and compared with model predictions. RESULTS: The spectroscopic DQE accounts for spectral distortions, energy-bin-dependent spatial resolution, interbin spatial noise correlations, and intrabin spatial noise correlations; it is mathematically equivalent to the squared SNR per unit fluence of the generalized least-squares estimate of the height of an X-ray impulse in a uniform noisy background. The zero-frequency DQE has a strong linear relationship with the ideal-observer SNR of low-frequency soft-tissue, bone, iodine, and gadolinium signals, and can be expressed in terms of the product of the quantum efficiency and a Swank noise factor that accounts for DQE degradation due to, for example, charge sharing (CS) and electronic noise. The spectroscopic Swank noise factor of the CdTe detector was measured to be 0.81 ± 0.04 and 0.83 ± 0.04 with and without anticoincidence logic for CS suppression, respectively. The spectroscopic Swank noise factor of the CdZnTe detector operated with four energy bins was measured to be 0.82 ± 0.02 which is within 5% of the theoretical value. CONCLUSIONS: The spectroscopic DQE defined here is (1) task-independent, (2) can be measured using a modest extension of existing DQE-metrology methods, and (3) is predictive of the ideal-observer SNR of soft-tissue, bone, iodine, and gadolinium signals. For CT applications, the combination of CS and electronic noise in CdZnTe spectroscopic detectors will degrade the zero-frequency DQE by 10 %-20 % depending on the electronic noise level and pixel size.

Development and assessment of a multi-beam continuous-phantom-motion x-ray scatter projection imaging system.

X-ray image formation using scattered radiation can yield a superior contrast-to-noise ratio compared to conventional transmission x-ray imaging. A barrier to practical implementation of scatter imaging systems has been slow image acquisition. We have developed a projection imaging system which uses five monoenergetic pencil beams in combination with continuous phantom motion to achieve acquisition times that are practical for medical and security applications. The system was configured at the Canadian Light Source synchrotron and consists of a primary collimator, motorized stages for phantom translation, a flat-panel x-ray detector for measuring scattered x rays, and photodiodes for simultaneously measuring transmitted x rays. Image generation requires several corrections to raw data artifacts arising from the nature of the detector, x-ray source, and acquisition procedure. We developed a novel correction for pixel location inaccuracy arising from continuous phantom motion. A five-beam system had nearly five times faster acquisition than a single-beam system. Continuous motion acquisition was approximately 30 times faster than step-and-shoot acquisition. The total acquisition time for a 9 cm × 5 cm phantom with 8425 pixels was just over 2 min. Image quality was also assessed, in part to determine its relation to acquisition speed. The width of sharp material boundaries was found to be at a minimum equal to the pencil beam width (1.75 mm) and to have an additional width equal to the product of the phantom translation speed and the acquisition time per pixel (up to 1.0 mm in our experiments). Contrast-detail performance was independent of acquisition speed, depending only on phantom entrance x-ray fluence. Pixel signal-to-noise ratio measurements indicate that detector readout noise is important for the scatter data, even for phantom air kerma as high as 30 mGy. Images could be improved with a detector having lower readout noise and higher sensitivity. Its spatial resolution could be moderate. We confirmed that for the same range of λ-1 sin(θ/2), where λ is the x-ray wavelength and θ is the scattering angle, scatter images acquired using different beam energies (33-70 keV) had nearly identical contrast.