Low-contrast visualization in megavoltage cone-beam CT at one beam pulse per projection using thick segmented scintillators

Megavoltage cone-beam computed tomography (MV CBCT) using an electronic portal imaging device (EPID) is a highly promising technique for providing valuable volumetric information for image guidance in radiotherapy. However, active matrix flat-panel imagers (AMFPIs), which are the established gold standard in portal imaging, require a relatively large dose to create images that are clinically useful. This is a consequence of the inefficiency of the phosphor screens employed in conventional MV AMFPIs, which utilize only ~2% of the incident radiation at 6 MV. Fortunately, the incorporation of thick, segmented scintillators can significantly improve the performance of MV AMFPIs, leading to improved image quality for projection imaging at extremely low dose. It is therefore of interest to explore the performance of such thick scintillators for MV CBCT toward the goal of soft-tissue contrast visualization. In this study, prototype AMFPIs incorporating segmented scintillators based on CsI:Tl and BGO crystals with thicknesses ranging from ~11 to 25 mm have been constructed and evaluated. Each prototype incorporates a detector consisting of a matrix of 120 × 60 scintillator elements separated by reflective septal walls, with an element-to-element pitch of 1.016 mm, coupled to an overlying ~1 mm thick Cu plate. The prototype AMFPIs were incorporated into a bench-top CBCT system, allowing the acquisition of tomographic images of a contrast phantom using a 6 MV radiotherapy photon beam. The phantom consists of a water-equivalent (solid water) cylinder, embedded with tissue-equivalent inserts having electron densities, relative to water, varying from ~0.43 to ~1.47. Reconstructed images of the phantom were obtained down to the lowest available dose (one beam pulse per projection), corresponding to a total scan dose of ~4 cGy using 180 projections. In this article, reconstructed images, contrast, noise and contrast-to-noise ratio for the tissue-equivalent objects using the various prototype AMFPIs are examined as a function of dose and compared to those of a conventional MV AMFPI.