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Acquiring and Assessing Upright CBCT Images for Future Treatment Planning

X Fave

X Fave1,2*, J Yang1, P Balter1, L Court1 1UT MD Anderson Cancer Center, Houston, TX 2The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX


SU-E-J-186 Sunday 3:00PM - 6:00PM Room: Exhibit Hall

Purpose: To acquire upright CBCT images using the onboard imager of a Varian TrueBeam. An easy to implement upright imaging protocol could allow for widespread upright radiation therapy which would greatly benefit certain patients. These include thoracic cancer patients (because lung volume increases in a seated position) and patients who experience substantial discomfort during supine treatment.

Methods: To acquire upright CBCT images, the gantry head remained stationary at 0 degrees with the KV imager arms extended to their lateral positions. Phantoms were placed upright at the end of the treatment couch. During a scan, the couch rotated from 270 to 90 degrees while continuous fluoroscopic projections were taken by the onboard imager. To extend the field-of-view, this sequence was performed twice: once with the KV detector longitudinally offset +14.5cm and once with it longitudinally offset -14.5cm. The resulting two image sets were stitched together before reconstruction. The imaging beam parameters were chosen to deliver a dose similar to that given during a simulation CT. Image quality was evaluated for spatial linearity, high and low contrast resolution, and HU linearity using CatPhan and anthropomorphic phantoms. A deformable registration technique was used to evaluate HU mapping from a simulation CT.

Results: Spatial linearity and high contrast resolution were maintained in upright CBCT when compared to simulation CT. However, low contrast resolution and HU linearity degraded. Streak artifacts were caused by the limited 180 degree arc of the couch, and the stitching process created a sharp artifact at the center of the reconstruction. The deformable registration was robust in the HU mapping even with these artifacts and the loss of HU linearity.

Conclusions: The image quality obtained from upright CBCT was sufficient for treatment planning. The success of this novel technique is an important step towards a future clinical protocol.

Funding Support, Disclosures, and Conflict of Interest: This project was funded in part by Varian Medical Systems, Inc.

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