Characterization of an x-ray source with a partitioned diamond-tungsten target for electronic brachytherapy with 3D beam directionality.

The Sculptura™ is a new high-dose-rate electronic brachytherapy system developed by Sensus Healthcare. By combining a steerable electron beam with a partitioned diamond-tungsten x-ray target, the x-ray source of the Sculptura™ is capable of producing highly anisotropic dose distributions, thus achieving true 3D beam directionality. This article reports the spectral and dosimetric characterization of the Sculptura™ x-ray source through a combination of measurements and Monte Carlo simulations for operating points between 50-100 kV. Excellent agreement (~5% discrepancy) between the simulations and measurements was obtained for in-air dose rate characterization. The validated simulations were then used to calculate the dose distribution in water. Dose rates of >2 cGy/min/µA can be produced at 100 kV, thus delivering 10 Gy in 1 min for typical operating conditions. The dose distributions are sharply peaked, with a full-width at half-maximum azimuth of about 100°.

Feasibility of external beam radiation therapy to deep-seated targets with kilovoltage x-rays.

PURPOSE: Radiation therapy to deep-seated targets is typically delivered with megavoltage x-ray beams generated by medical linear accelerators or 60 Co sources. Here, we used computer simulations to design and optimize a lower energy kilovoltage x-ray source generating acceptable dose distributions to a deep-seated target. METHODS: The kilovoltage arc therapy (KVAT) x-ray source was designed to treat a 4-cm diameter target located at a 10-cm depth in a 40-cm diameter homogeneous cylindrical phantom. These parameters were chosen as an example of a clinical scenario for testing the performance of the kilovoltage source. A Monte Carlo (MC) model of the source was built in the EGSnrc/BEAMnrc code and source parameters, such as beam energy, tungsten anode thickness, beam filtration, number of collimator holes, collimator hole size and thickness, and source extent were varied. Dose to the phantom was calculated in the EGSnrc/DOSXYZnrc code for varying treatment parameters, such as the source-to-axis distance and the treatment arc angle. The quality of dose distributions was quantified by means of target-to-skin ratio and dose output expressed in D50 (50% isodose line) for a 30-min irradiation in the homogeneous phantom as well as a lung phantom. Additionally, a patient KVAT dose distribution to a left pararenal lesion (~1.6 cm in diameter) was calculated and compared to a 15 MV volumetric modulated arc therapy (VMAT) plan. RESULTS: In the design of the KVAT x-ray source, the beam energy, beam filtration, collimator hole size, source-to-isocenter distance, and treatment arc had the largest effect on the source output and the quality of dose distributions. For the 4-cm target at 10-cm depth, the optimized KVAT dose distribution generated a conformal plan with target-to-skin ratio of 5.1 and D50 in 30 min of 24.1 Gy in the homogeneous phantom. In the lung phantom, a target-to-skin ratio of 7.5 and D50 in 30 min of 25.3 Gy were achieved. High dose conformity of the 200 kV KVAT left pararenal plan was comparable to the 15 MV VMAT plan. The volume irradiated to at least 10% (<240 cGy) of the prescription dose was 2.2 × larger in the 200 kV KVAT plan than in the 15 MV VMAT plan, but considered clinically insignificant. CONCLUSIONS: This study demonstrated that conformal treatments of deep-seated targets were achievable with kilovoltage x-rays with dose distributions comparable to MV beams. However, due to the larger volumes irradiated to clinically tolerated low doses, KVAT x-ray source usage for deep-seated lesions will be further evaluated to determine optimal target size.

The feasibility of an inverse geometry CT system with stationary source arrays.

PURPOSE: Inverse geometry computed tomography (IGCT) has been proposed as a new system architecture that combines a small detector with a large, distributed source. This geometry can suppress cone-beam artifacts, reduce scatter, and increase dose efficiency. However, the temporal resolution of IGCT is still limited by the gantry rotation time. Large reductions in rotation time are in turn difficult due to the large source array and associated power electronics. We examine the feasibility of using stationary source arrays for IGCT in order to achieve better temporal resolution. We anticipate that multiple source arrays are necessary, with each source array physically separated from adjacent ones. METHODS: Key feasibility issues include spatial resolution, artifacts, flux, noise, collimation, and system timing clashes. The separation between the different source arrays leads to missing views, complicating reconstruction. For the special case of three source arrays, a two-stage reconstruction algorithm is used to estimate the missing views. Collimation is achieved using a rotating collimator with a small number of holes. A set of equally spaced source spots are designated on the source arrays, and a source spot is energized when a collimator hole is aligned with it. System timing clashes occur when multiple source spots are scheduled to be energized simultaneously. We examine flux considerations to evaluate whether sufficient flux is available for clinical applications. RESULTS: The two-stage reconstruction algorithm suppresses cone-beam artifacts while maintaining resolution and noise characteristics comparable to standard third generation systems. The residual artifacts are much smaller in magnitude than the cone-beam artifacts eliminated. A mathematical condition is given relating collimator hole locations and the number of virtual source spots for which system timing clashes are avoided. With optimization, sufficient flux may be achieved for many clinical applications. CONCLUSIONS: IGCT with stationary source arrays could be an imaging platform potentially capable of imaging a complete 16-cm thick volume within a tenth of a second.

Feasibility of low-dose single-view 3D fiducial tracking concurrent with external beam delivery.

PURPOSE: In external-beam radiation therapy, existing on-board x-ray imaging chains orthogonal to the delivery beam cannot recover 3D target trajectories from a single view in real-time. This limits their utility for real-time motion management concurrent with beam delivery. To address this limitation, the authors propose a novel concept for on-board imaging based on the inverse-geometry Scanning-Beam Digital X-ray (SBDX) system and evaluate its feasibility for single-view 3D intradelivery fiducial tracking. METHODS: A chest phantom comprising a posterior wall, a central lung volume, and an anterior wall was constructed. Two fiducials were placed along the mediastinal ridge between the lung cavities: a 1.5 mm diameter steel sphere superiorly and a gold cylinder (2.6 mm length × 0.9 mm diameter) inferiorly. The phantom was placed on a linear motion stage that moved sinusoidally. Fiducial motion was along the source-detector (z) axis of the SBDX system with ±10 mm amplitude and a programmed period of either 3.5 s or 5 s. The SBDX system was operated at 15 frames per second, 100 kVp, providing good apparent conspicuity of the fiducials. With the stage moving, detector data were acquired and subsequently reconstructed into 15 planes with a 12 mm plane-to-plane spacing using digital tomosynthesis. A tracking algorithm was applied to the image planes for each temporal frame to determine the position of each fiducial in (x,y,z)-space versus time. A 3D time-sinusoidal motion model was fit to the measured 3D coordinates and root mean square (RMS) deviations about the fitted trajectory were calculated. RESULTS: Tracked motion was sinusoidal and primarily along the source-detector (z) axis. The RMS deviation of the tracked z-coordinate ranged from 0.53 to 0.71 mm. The motion amplitude derived from the model fit agreed with the programmed amplitude to within 0.28 mm for the steel sphere and within -0.77 mm for the gold seed. The model fit periods agreed with the programmed periods to within 7%. CONCLUSIONS: Three dimensional fiducial tracking with approximately 1 mm or better accuracy and precision appears to be feasible with SBDX, supporting its use to guide radiotherapy.

Scanning-beam digital x-ray (SBDX) technology for interventional and diagnostic cardiac angiography.

The scanning-beam digital x-ray (SBDX) system is designed for x-ray dose reduction in cardiac angiographic applications. Scatter reduction, efficient detection of primary x-rays, and an inverse beam geometry are the main components of the entrance dose reduction strategy. This paper reports the construction of an SBDX prototype, image reconstruction techniques, and measurements of spatial resolution and x-ray output. The x-ray source has a focal spot that is electronically scanned across a large-area transmission target. A multihole collimator beyond the target defines a series of x-ray beams directed at a distant small-area detector array. The prototype has a 23 cm X 23 cm target, 100 X 100 focal spot positions, and a 5 cm X 5 cm CdTe detector positioned 150 cm from the target. With this nonmechanical method of beam scanning, patient images with low detected scatter are generated at up to 30 frame/s. SBDX data acquisition is tomosynthetic. The prototype simultaneously reconstructs 16 planes spaced throughout the cardiac volume using shift-and-add backprojection. Image frames analogous to conventional projection images are generated with a multiplane compositing algorithm. Single-plane versus multiplane reconstruction of contrast-filled coronary arteries is demonstrated with images of the porcine heart. Phantom and porcine imaging studies show multiplane reconstruction is practicable under clinically realistic levels of patient attenuation and cardiac motion. The modulation transfer function for an in-plane slit at mechanical isocenter measured 0.41-0.56 at 1 cycle/mm, depending on the detector element to image pixel interpolation technique. Modeling indicates that desired gains in spatial resolution are achievable by halving the detector element width. The x-ray exposure rate 15 cm below isocenter, without table or patient in the beam, measured 11.5 R/min at 120 kVp, 24.3 kWp and 3.42 R/min at 70 kVp, 14.2 kWp.

Comparison of entrance exposure and signal-to-noise ratio between an SBDX prototype and a wide-beam cardiac angiographic system.

The scanning-beam digital x-ray (SBDX) system uses an inverse geometry, narrow x-ray beam, and a 2-mm thick CdTe detector to improve the dose efficiency of the coronary angiographic procedure. Entrance exposure and large-area iodine signal-to-noise ratio (SNR) were measured with the SBDX prototype and compared to that of a clinical cardiac interventional system with image intensifier (II) and charge coupled device (CCD) camera (Philips H5000, MRC-200 x-ray tube, 72 kWp max). Phantoms were 18.6-35.0 cm acrylic with an iohexol-equivalent disk placed at midthickness (35 mg/cm2 iodine radiographic density). Imaging was performed at 15 frame/s, with the disk at mechanical isocenter and an 11-cm object-plane field width. The II/CCD system was operated in cine mode with automatic exposure control. With the SBDX prototype at maximum x-ray output (120 kVp, 24.3 kWp), the SBDX SNR was 107%-69% of the II/CCD SNR, depending on phantom thickness, and the SBDX entrance exposure rate was 10.7-9.3 R/min (9.4-8.2 cGy/min air kerma). For phantoms where an equal-kVp imaging comparison was possible (> or = 23.3 cm), the SBDX SNR ranged from 47% to 69% of the II/CCD SNR while delivering 6% to 9% of the II/CCD entrance exposure rate. From these measurements it was determined that the relative SBDX entrance exposure at equal SNR would be 31%-16%. Results were consistent with a model for relative entrance exposure at equal SNR, which predicted a 3-7 times reduction in entrance exposure due to SBDX's comparatively low scatter fraction (5.5%-8.1% measured, including off-focus radiation), high detector detective quantum efficiency (66%-73%, measured from 70 to 120 kVp), and large entrance field area (1.7x - 2.3x, for the same object-plane field width). With improvements to the system geometry, detector, and x-ray source, SBDX technology is projected to achieve conventional cine-quality SNR over a full range of patient thicknesses, with 5-10 times lower skin dose.