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Elekta Synergy - XVI

Cone-Beam CT for IGRT

Dose Calculation on CBCT


Datasets
Elekta System
Daniel Ltourneau, PhD, DABR

Field of View (FOV)


Sup-Inf: 12 and 26 cm
Axial: 27 to 50 cm

Selectable mAs and kV


Scatter correction
in software
Single Bowtie Filter
No scatter rejection grid

Elekta Synergy - XVI


Cone-Beam CT for IGRT

Tolerance on Electron Density


Limiting Relative Dose Error to 2%

Field of View (FOV)


Sup-Inf: 12 and 26 cm
Axial: 27 to 50 cm

15 MV

Based on Effective Depth Inhomogeneity Correction

6 MV

Selectable mAs and kV


Co-60

~ 5%

~ 3%

Scatter correction
in software
Single Bowtie Filter
No scatter rejection grid
Kilby et al, PMB, 47: p.1485-92, 2002

Impact of Residual Artifacts

Dose Calculation on CBCT Images


Key Requirements for Accurate Dose Calculation

Result: 99.8% within 2% dose diff. and 3 mm DtoA


Dose distribution on CBCT images

2.5

E le c tro n D e n s ity

Gamma map

Image Geometric Integrity

HU to ED conversion
2

Scale
No distortion
Skin-line

1.5
1

Reproducible CBCT numbers

0.5
0
0

1000

2000

3000

CT number

Accurate CBCT numbers


Letourneau et al, IJROBP, 67: p.1229-37, 2007

CBCT Image Artifacts


Three Categories:
-

Panel and tube calibration


Post reconstruction processing

Technique
-

kVp, FOV, Panel Offset, Bowtie filter,


Grid, Pre-reconstruction processing

Patient
-

CBCT # from 4 Systems:

Same phantom and imaging technique

2500

- Inter-system
CBCT# variations
- Uniformity
- Lag/Skin-line
- CBCT# variation

Size, prosthesis, intra-scan organ motion


and truncation

- Uniformity
- Streaks

CBCT numbers

System

InterInter-System CBCT# Variation

2000

ES05
ES07
NS09
NS10

1500
1000
500
0
-1500 -1000

-500

500

1000

1500

Helical CT numbers

InterInter-System CBCT# Variation


CBCT # from 6 Systems:

Same phantom and imaging technique

CBCT numbers

2500

InterInter-System CBCT# Variation


Potential Solutions:
CBCT-to-ED table per machine

ES05
ES07
ES08
NS09
NS10
WS17

2000
1500
1000
500

Flood field calibration


-

Adjust the amount of water to compensate for tube output


variation

Post-Processing algorithm

0
-1500 -1000

-500

500

1000

1500

Helical CT numbers

User-defined linear CBCT number conversion

All these solutions require periodical QA!!!!

No Detector Calibration in Air?

InterInter-Technique CBCT# Variation


Variation in FOV, kVp, mAs and filter

InterInter-Technique CBCT# Variation


Variation in FOV, kVp, mAs and filter

Same Phantom, Different Imaging Techniques

Change in kVp
(100 to 120 kVp) :
About 500 HU variation

Ritcher et al, Radiation Oncology, 3:42, 2008

Ritcher et al, Radiation Oncology, 3:42, 2008

InterInter-Technique CBCT# Variation


Variation in FOV, kVp, mAs and filter

InterInter-Technique CBCT# Variation


CBCT-to-ED table per technique or per anatomic site
Dose on CT and CBCT for a pelvis patient

Change in Sup-Inf FOV


(12 to 25 cm) :

Mean Difference

About 70 HU variation
Single CBCT Imaging Technique

Ritcher et al, Radiation Oncology, 3:42, 2008

Ritcher et al, Radiation Oncology, 3:42, 2008

InterInter-Technique CBCT# Variation

InterInter-Technique CBCT# Variation

CBCT-to-ED table per technique or per anatomic site

CBCT-to-ED table per technique or per anatomic site

Dose on CT and CBCT for a pelvis patient

Dose on CT and CBCT for a pelvis patient

Mean Difference

Mean Difference

Using a technique-based CBCT-to-ED table

Using an anatomic-site-based CBCT-to-ED table

20 cm diameter phantom for pelvis!


Ritcher et al, Radiation Oncology, 3:42, 2008

Ritcher et al, Radiation Oncology, 3:42, 2008

InterInter-Technique CBCT# Variation


Summary:

Some cases:

Dose accuracy within 2% is achievable


-

InterInter-Patient CBCT# Variation

Physiological motion

Prosthesis

Truncation

- Streaking

-Photon starvation
- Streaking
-Shift in CBCT #

- Shift in CBCT #

Multiple fields are more forgiving

CBCT-to-ED table per technique and


anatomic sites
- Require maintenance
- Risk of mismatch

Conclusion
Accurate dose calculation on CBCT is possible
Inter-system CBCT# variation
CBCT-to-ED table per technique and
anatomic sites
Periodical QA required