Dose-efficiency quantification of computed tomography systems using a model-observer.

BACKGROUND: Recent advances in computed tomography (CT) technology have considerably improved the quality of CT images and reduced radiation exposure in patients. At present, however, there is no generally accepted figure of merit (FOM) for comparing the dose efficiencies of CT systems. PURPOSE: (i) To establish an FOM that characterizes the quality of CT images in relation to the radiation dose by means of a mathematical model observer and (ii) to evaluate the new FOM on different CT systems and image reconstruction algorithms. METHODS: Images of a homogeneous phantom with four low-contrast inserts were acquired using three different CT systems at three dose levels and a representative protocol for CT imaging of low-contrast objects in the abdomen. The images were reconstructed using filtered-back projection and iterative algorithms. A channelized hotelling observer with difference-of-Gaussian channels was applied to compute the detectability ( d ' $d^{\prime}$ ). This was done for each insert and each of the considered imaging conditions from square regions of interest (ROIs) that were (semi-)automatically centered on the inserts. The estimated detectabilities ( d ' $d^{\prime}$ ) were averaged in the first step over the three dose levels ( ⟨ d ' ⟩ $\langle {d^{\prime}} \rangle $ ), and subsequently over the four contrast inserts ( ⟨ d ' ⟩ w ${\langle {d^{\prime}} \rangle _{\rm{w}}}$ ). All calculation steps included a dedicated assessment of the related uncertainties following accepted metrological guidelines. RESULTS: The determined detectabilities ( d ' $d^{\prime}$ ) varied considerably with the contrast and diameter of the four inserts, as well as with the radiation doses and reconstruction algorithms used for image generation ( d ' $d^{\prime}\;$ = 1.3-5.5). Thus, the specification of a single detectability as an FOM is not well suited for comprehensively characterizing the dose efficiency of a CT system. A more comprehensive and robust characterization was provided by the averaged detectabilities ⟨ d ' ⟩ $\langle {d^{\prime}} \rangle $ and, in particular, ⟨ d ' ⟩ w ${\langle {d^{\prime}} \rangle _{\rm{w}}}$ . Our analysis reveals that the model observer analysis is very sensitive to the exact position of the ROIs. CONCLUSIONS: The presented automatable software approach yielded with the weighted detectability ⟨ d ' ⟩ w ${\langle {d^{\prime}} \rangle _{\rm{w}}}$ an objective FOM to benchmark different CT systems and reconstruction algorithms in a robust and reliable manner. An essential advantage of the proposed model-observer approach is that uncertainties in the FOM can be provided, which is an indispensable prerequisite for type testing.

Assessment of CT Image Quality Using a Bayesian Framework.

In computed tomography, there is a tradeoff between the quality of the reconstructed image and the radiation dose received by the patient. In order to find an appropriate compromise between the image quality of the reconstructed images and the radiation dose, it is important to have reliable methods for evaluating the quality of the reconstructed images. A successful family of methods for the assessment of image quality is task-based image quality assessment, which often involves the use of model observers, and which assesses the quality of the image reconstruction by deriving a figure of merit. Here, we present a Bayesian framework that can be used in task-based image quality assessment. Our framework is applicable to binary classification problems with normally distributed observations, and we make the additional assumption that the covariance matrix is the same in both image classes. We choose a particular non-informative prior for the parameters of our model, which allows us to derive an expression for the Bayes factor for the binary classification problem which to the best of our knowledge is novel. We introduce a novel model observer based on this Bayes factor. Further, we have developed a methodology for estimating the posterior distribution of the figure of merit for this type of classification problem. Compared with classical statistical approaches, our Bayesian approach has the advantage that it provides a full characterization of the uncertainty of the figure of merit. Our choice of prior allows us to design a simple Monte Carlo algorithm to efficiently sample the posterior of the figure of merit of the ideal observer, in contrast to common Bayesian procedures which rely on computationally expensive Markov chain Monte Carlo sampling. We have shown that for training samples of sufficient size, our estimated credible intervals for the figure of merit have coverage probabilities close to their credibility, so that our approach can reasonably be used within a classical statistical framework as well.

Feasibility study of entrance and exit dose measurements at the contra lateral breast with alanine/electron spin resonance dosimetry in volumetric modulated radiotherapy of breast cancer.

The Physikalisch-Technische Bundesanstalt has established a secondary standard measurement system for the dose to water, D W, based on alanine/ESR (Anton et al 2013 Phys. Med. Biol. 58 3259-82). The aim of this study was to test the established measurement system for the out-of-field measurements of inpatients with breast cancer. A set of five alanine pellets were affixed to the skin of each patient at the contra lateral breast beginning at the sternum and extending over the mammilla to the distal surface. During 28 fractions with 2.2 Gy per fraction, the accumulated dose was measured in four patients. A cone beam computer tomography (CBCT) scan was generated for setup purposes before every treatment. The reference CT dataset was registered rigidly and deformably to the CBCT dataset for 28 fractions. To take the actual alanine pellet position into account, the dose distribution was calculated for every fraction using the Acuros XB algorithm. The results of the ESR measurements were compared to the calculated doses. The maximum dose measured at the sternum was 19.9 Gy ± 0.4 Gy, decreasing to 6.8 Gy ± 0.2 Gy at the mammilla and 4.5 Gy ± 0.1 Gy at the distal surface of the contra lateral breast. The absolute differences between the calculated and measured doses ranged from -1.9 Gy to 0.9 Gy. No systematic error could be seen. It was possible to achieve a combined standard uncertainty of 1.63% for D W = 5 Gy for the measured dose. The alanine/ESR method is feasible for in vivo measurements.

Relative response of alanine dosemeters for high-energy electrons determined using a Fricke primary standard.

A significant proportion of cancer patients is treated using MeV electron radiation. One of the measurement methods which is likely to furnish reliable dose values also under non-reference conditions is the dosimetry using alanine and read-out via electron spin resonance (ESR). The system has already proven to be suitable for QA purposes for modern radiotherapy involving megavoltage x-rays. In order to render the secondary standard measurement system of the Physikalisch-Technische Bundesanstalt based on alanine/ESR useable for dosimetry in radiotherapy, the dose-to-water (D(W)) response of the dosemeter needs to be known for relevant radiation qualities. For MeV electrons, the D(W) response was determined using the Fricke primary standard of the Swiss Federal Office of Metrology. Since there were no citable detailed publications on the Swiss primary standard available, this measurement system is described in some detail. The experimental results for the D(W) response are compared to results of Monte Carlo simulations which model in detail the beams furnished by the electron accelerator as well as the geometry of the detectors. The agreement between experiment and simulation is very good, as well as the agreement with results published by the National Research Council of Canada which are based on a different primary standard. No significant dependence of the D(W) response was found in the range between 6 and 20 MeV. It is therefore suggested to use a unique correction factor k(E) for alanine for all MeV qualities of k(E) = 1.012 ± 0.010.

Dose uncertainty in radiotherapy of patients with head and neck cancer measured by in vivo ESR/alanine dosimetry using a mouthpiece.

In order (i) to evaluate the dose uncertainty of the mouthpiece in daily use during intensity-modulated radiotherapy of patients with head and neck cancer, and (ii) to present a system for in vivo dosimetry of the oral mucosa, we equipped the mouthpiece with alanine dosimeter probes for in vivo dosimetry. The aim was to determine the dose uncertainty caused by the daily positioning of the mouthpiece during dynamic treatment techniques. During IMRT radiotherapy of patients with head and neck cancer, the doses accumulated next to the mucosa were measured in five patients and compared to the dose calculated by the treatment planning system. The comparison of the applied and measured dose for each measurement point showed in six of the eight alanine probe positions a good agreement within the given relative combined standard uncertainty of less than 4.5% for a accumulated dose of 30 Gy and less than 4.6% for an accumulated dose of 8 Gy, respectively. In two of the eight alanine probe positions the applied and measured doses differed by 7.7% and 8.2% from each other. The dominant contribution to the overall uncertainty for the in vivo measurements was the positioning of the dosimeter probes in the patient's body and their corresponding localization in the CT data as well as the inaccuracy of the available algorithm for dose distribution calculation at the low-density material/soft tissue interface between the mouthpiece and the mucosa. Regarding our results, we refrain from the use of a mouthpiece during dynamic treatments such as IMRT.

In vivo dosimetry in the urethra using alanine/ESR during (192)Ir HDR brachytherapy of prostate cancer--a phantom study.

A phantom study for dosimetry in the urethra using alanine/ESR during (192)Ir HDR brachytherapy of prostate cancer is presented. The measurement method of the secondary standard of the Physikalisch-Technische Bundesanstalt had to be slightly modified in order to be able to measure inside a Foley catheter. The absorbed dose to water response of the alanine dosimetry system to (192)Ir was determined with a reproducibility of 1.8% relative to (60)Co. The resulting uncertainty for measurements inside the urethra was estimated to be 3.6%, excluding the uncertainty of the dose rate constant Lambda. The applied dose calculated by a treatment planning system is compared to the measured dose for a small series of (192)Ir HDR irradiations in a gel phantom. The differences between the measured and applied dose are well within the limits of uncertainty. Therefore, the method is considered to be suitable for measurements in vivo.

Is there an influence of the surrounding material on the response of the alanine dosimetry system?

In a combined experimental and Monte Carlo study the possible influence of the surrounding material on the response of the alanine dosimetry system was investigated. The aim of this work was to estimate the uncertainties induced by the surroundings with respect to quality assurance measurements for radiotherapy, for example in humanoid phantoms. Six different materials were tested. The electron density range covered comprises the range present in human tissue. No significant influence of the surrounding material could be found for irradiations in the (60)Co reference field of the Physikalisch-Technische Bundesanstalt (PTB).

Response of the alanine/ESR dosimetry system to MV X-rays relative to (60)Co radiation.

The measurand relevant in dosimetry for radiation therapy is the absorbed dose to water, D(W). The Physikalisch-Technische Bundesanstalt (PTB) has established a secondary standard for D(W) for high-energy photon and electron radiation based on electron spin resonance (ESR) of the amino acid alanine. Since the calibration is usually performed using (60)Co radiation while a huge part of the external radiation therapy is done with high-energy x-rays from linear accelerators, determination of the response is an important issue. The results presented in this paper are the most accurate ones available today with uncertainties assigned to the relative response for 8 MV and 16 MV of the order of 0.3%. The experimental results are compared to Monte Carlo simulations using the EGSnrc software package. In the appendix, it is demonstrated how mean values from repetitive irradiations and their uncertainties are obtained in a consistent way using Bayesian statistics, even in the presence of at first sight inconsistent data. It is important to note that the formulae derived to obtain the final results follow from first principles, without recurring to ad hoc solutions or simple recipes and are valid for all kinds of repetitive measurements.

In vivo alanine/electron spin resonance (ESR) dosimetry in radiotherapy of prostate cancer: a feasibility study.

PURPOSE: We have developed a device to evaluate the potential of alanine/electron spin resonance (ESR) dosimetry for quality assurance in 3D conformal radiotherapy for prostate cancer. It consists of a rectal balloon carrying eight alanine dosimeter probes and two metal markers to document the exact position of the balloon. We measured the effects of an air-filled rectal balloon on the dose at the rectal wall and compared these results with the applied dose distribution of the treatment planning system. MATERIALS AND METHODS: During 10 fractions with 2.0 Gy per fraction, the accumulated doses were measured in 3 patients. The results of the ESR measurements were compared to the applied doses. RESULTS: It was possible to insert the device without clinical complications and without additional rectal discomfort for the patients. The measurements of the dose accumulated at the anterior and the posterior rectal wall agreed with the applied dose within a mean deviation of 1.5% (overestimation of the dose) and 3.5% (underestimation of the dose), respectively. However, clinically significant differences between applied and measured rectal doses were seen in a patient with a hip prosthesis. In this case, the dose at the anterior rectal wall was overestimated by the TPS by about 11% and the dose at the posterior rectal wall was underestimated by approximately 7%. CONCLUSION: The method presented in this study is useful for quality control of irradiations in vivo.

Postirradiation effects in alanine dosimeter probes of two different suppliers.

The measurand relevant for the dosimetry for radiation therapy is the absorbed dose to water, DW. The Physikalisch-Technische Bundesanstalt (PTB) is establishing a secondary standard for DW for high-energy photon and electron radiation based on electron spin resonance (ESR) of the amino acid alanine. For practical applications, like, for example, intercomparison measurements using the ESR/alanine dosimetry system, the temporal evolution of the ESR signal of irradiated probes is an important issue. This postirradiation behaviour is investigated for alanine pellets of two different suppliers for different storage conditions. The influence of the storage conditions on the temporal evolution may be dependent on the type of probes used. The measurement and analysis method developed at the PTB is able to circumvent the apparent difficulties in the case of alanine/paraffin probes. Care has to be taken in case this method cannot be applied.

Uncertainties in alanine/ESR dosimetry at the Physikalisch-Technische Bundesanstalt.

In radiation therapy, the effect of ionizing radiation is quantified in terms of the absorbed dose to water. Dosimetry with alanine and readout via electron spin resonance (ESR) is a method which is used as a secondary standard by several national metrology institutions. The advantages of the method are the good water-equivalence of the probes, their small size and the very weak dependence of the response on the radiation quality for MV x-rays and high-energy electrons used in radiation therapy. For radiation therapy, a small uncertainty of the applied dose is required. The present publication describes the determination of the uncertainty budget for the alanine/ESR dosimetry system of the Physikalisch-Technische Bundesanstalt (PTB), which relies on the use of a reference sample. A method is also presented which allows a reduction of the influence of fading or other changes of the ESR amplitude of irradiated alanine probes with time. If certain conditions are met which are described in detail, a relative uncertainty of less than 0.5% can be reached for probes irradiated with (60)Co in the 5-25 Gy dose range, including the uncertainty of the primary standard. First results for dose values between 2 Gy and 10 Gy are presented as well. From the high accuracy achievable with alanine dosimetry, we conclude that this method has great potential to solve measurement problems for modern methods of radiation therapy such as intensity modulated radiation therapy (IMRT) or tomotherapy.

Development of a secondary standard for the absorbed dose to water based on the alanine EPR dosimetry system.

The primary measurand in the dosimetry for radiation therapy is the absorbed dose to water, D(W). An alanine/EPR based secondary standard for D(W) for high-energy photon and electron radiation is presently under construction at the Physikalisch-Technische Bundesanstalt. A technique of transfer dosimetry that makes it possible to reduce the reproducibility to a level below 0.5% in the 5-50 Gy range is presented. It takes advantage of a reference sample. Results of investigations of some effects, such as environmental humidity, are presented.