Imaging dose from cone beam computed tomography in radiation therapy.

Imaging dose in radiation therapy has traditionally been ignored due to its low magnitude and frequency in comparison to therapeutic dose used to treat patients. The advent of modern, volumetric, imaging modalities, often as an integral part of linear accelerators, has facilitated the implementation of image-guided radiation therapy (IGRT), which is often accomplished by daily imaging of patients. Daily imaging results in additional dose delivered to patient that warrants new attention be given to imaging dose. This review summarizes the imaging dose delivered to patients as the result of cone beam computed tomography (CBCT) imaging performed in radiation therapy using current methods and equipment. This review also summarizes methods to calculate the imaging dose, including the use of Monte Carlo (MC) and treatment planning systems (TPS). Peripheral dose from CBCT imaging, dose reduction methods, the use of effective dose in describing imaging dose, and the measurement of CT dose index (CTDI) in CBCT systems are also reviewed.

[1]  J. Seuntjens,et al.  Radiochromic film based dosimetry of image‐guidance procedures on different radiotherapy modalities , 2014, Journal of applied clinical medical physics.

[2]  G. Ding,et al.  Inclusion of the dose from kilovoltage cone beam CT in the radiation therapy treatment plans. , 2009, Medical physics.

[3]  M. Stock,et al.  IGRT induced dose burden for a variety of imaging protocols at two different anatomical sites. , 2012, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[4]  B. Movsas,et al.  Dose delivered from Varian's CBCT to patients receiving IMRT for prostate cancer , 2007, Physics in medicine and biology.

[5]  R. Gagne,et al.  A METHOD FOR DESCRIBING THE DOSES DELIVERED BY TRANSMISSION X‐RAY COMPUTED TOMOGRAPHY , 1981, Medical physics.

[6]  Ravinder Nath,et al.  Testicular doses in image-guided radiotherapy of prostate cancer. , 2012, International journal of radiation oncology, biology, physics.

[7]  E. Spezi,et al.  Reply to ''Comment on 'Monte Carlo simulation of an x-ray volume imaging cone beam CT unit' ''[Med. Phys. 36, 1039 (2009)] , 2009 .

[8]  A. Isambert,et al.  Dose délivrée au patient lors de l ’ acquisition d ’ images par tomographie conique de haute énergie Dose delivered to the patient by megavoltage cone beam computed tomography imaging , 2009 .

[9]  J. Galvin,et al.  Comparative dose evaluations between XVI and OBI cone beam CT systems using Gafchromic XRQA2 film and nanoDot optical stimulated luminescence dosimeters. , 2013, Medical physics.

[10]  Bo Lu,et al.  A comprehensive study on decreasing the kilovoltage cone‐beam CT dose by reducing the projection number , 2010, Journal of applied clinical medical physics.

[11]  Aiping Ding,et al.  Monte Carlo calculation of imaging doses from diagnostic multidetector CT and kilovoltage cone-beam CT as part of prostate cancer treatment plans. , 2010, Medical physics.

[12]  M. Oatey,et al.  An Investigation of the concomitant doses from Cone Beam CT and CT simulation in Radiotherapy , 2009 .

[13]  Steve B. Jiang,et al.  The management of imaging dose during image-guided radiotherapy: report of the AAPM Task Group 75. , 2007, Medical physics.

[14]  Image quality & dosimetric property of an investigational Imaging Beam Line MV‐CBCT , 2009, Journal of applied clinical medical physics.

[15]  G. Ding,et al.  An algorithm for kilovoltage x-ray dose calculations with applications in kV-CBCT scans and 2D planar projected radiographs , 2014, Physics in medicine and biology.

[16]  Shuichi Ozawa,et al.  A dose comparison study between XVI and OBI CBCT systems. , 2008, Medical physics.

[17]  Dosimetric characterization and application of an imaging beam line with a carbon electron target for megavoltage cone beam computed tomography. , 2009, Medical physics.

[18]  D. Jaffray,et al.  Evaluation of the effect of patient dose from cone beam computed tomography on prostate IMRT using Monte Carlo simulation. , 2007, Medical physics.

[19]  Gang Li.  Patient radiation dose and protection from cone-beam computed tomography , 2013, Imaging science in dentistry.

[20]  Ping Xia,et al.  Dose calculation using megavoltage cone-beam CT. , 2007, International journal of radiation oncology, biology, physics.

[21]  Rob Barnett,et al.  Dose assessment from an online kilovoltage imaging system in radiation therapy , 2009, Journal of radiological protection : official journal of the Society for Radiological Protection.

[22]  J. Seuntjens,et al.  Comment on "Reference radiochromic film dosimetry in kilovoltage photon beams during CBCT image acquisition" [Med. Phys. 37, 1083-1092 (2010)]. , 2010, Medical Physics (Lancaster).

[23]  Moyed Miften,et al.  Patient dose and image quality from mega-voltage cone beam computed tomography imaging. , 2007, Medical physics.

[24]  A correction-based dose calculation algorithm for kilovoltage x rays. , 2008, Medical physics.

[25]  T. Kron,et al.  Simple methods to reduce patient dose in a Varian cone beam CT system for delivery verification in pelvic radiotherapy. , 2009, The British journal of radiology.

[26]  M. Fix,et al.  A virtual source model for kilo-voltage cone beam CT: source characteristics and model validation. , 2011, Medical physics.

[27]  伊沢 正実,et al.  Recommendations of the International Commission on Radiological Protection , 1961 .

[28]  Jin Sung Kim,et al.  Evaluation of radiation dose to organs during kilovoltage cone‐beam computed tomography using Monte Carlo simulation , 2014, Journal of applied clinical medical physics.

[29]  Xun Jia,et al.  Comprehensive evaluations of cone-beam CT dose in image-guided radiation therapy via GPU-based Monte Carlo simulations. , 2014, Physics in medicine and biology.

[30]  Piotr Zygmanski,et al.  Evaluation of radiation dose delivered by cone beam CT and tomosynthesis employed for setup of external breast irradiation. , 2008, Medical physics.

[31]  Chuan-Jong Tung,et al.  Mathematical estimation and in vivo dose measurement for cone-beam computed tomography on prostate cancer patients. , 2009, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[32]  G. Ding,et al.  An optically stimulated luminescence dosimeter for measuring patient exposure from imaging guidance procedures , 2013, Physics in medicine and biology.

[33]  M. Oldham,et al.  Cone-beam-CT guided radiation therapy: technical implementation. , 2005, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[34]  G. Ding,et al.  An alternative approach to account for patient organ doses from imaging guidance procedures. , 2014, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[35]  J. Staffurth,et al.  Patient-specific three-dimensional concomitant dose from cone beam computed tomography exposure in image-guided radiotherapy. , 2012, International journal of radiation oncology, biology, physics.

[36]  G. Ding,et al.  Accurate patient dosimetry of kilovoltage cone-beam CT in radiation therapy. , 2008, Medical physics.

[37]  I. Hernandez-Giron,et al.  Dosimetry of a cone beam CT device for oral and maxillofacial radiology using Monte Carlo techniques and ICRP adult reference computational phantoms. , 2013, Dento maxillo facial radiology.

[38]  Dosimetric integration of daily mega-voltage cone-beam CT for image-guided intensity-modulated radiotherapy , 2012, Strahlentherapie und Onkologie.

[39]  Ravinder Nath,et al.  Kilovoltage imaging doses in the radiotherapy of pediatric cancer patients. , 2012, International journal of radiation oncology, biology, physics.

[40]  D. Thwaites,et al.  Dosimetry of CBCT: methods, doses and clinical consequences , 2013 .

[41]  Lars Herrnsdorf,et al.  Absorbed dose and dose rate using the Varian OBI 1.3 and 1.4 CBCT system , 2009, Journal of applied clinical medical physics.

[42]  Marco D'Andrea,et al.  Preliminary studies for a CBCT imaging protocol for offline organ motion analysis: registration software validation and CTDI measurements. , 2011, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[43]  Ping Xia,et al.  Patient dose considerations for routine megavoltage cone-beam CT imaging. , 2007, Medical physics.

[44]  V. Moiseenko,et al.  Equivalent doses for gynecological patients undergoing IMRT or RapidArc with kilovoltage cone beam CT. , 2012, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[45]  I Kawrakow,et al.  Skeletal dosimetry in cone beam computed tomography. , 2009, Medical physics.

[46]  Nelson Lam,et al.  Radiation dose from cone beam computed tomography for image-guided radiation therapy. , 2008, International Journal of Radiation Oncology, Biology, Physics.

[47]  R. Vetter.  ICRP Publication 103, The Recommendations of the International Commission on Radiological Protection , 2008 .

[48]  Jan Seuntjens,et al.  Reference radiochromic film dosimetry in kilovoltage photon beams during CBCT image acquisition. , 2010, Medical physics.

[49]  P. Alaei,et al.  Commissioning kilovoltage cone‐beam CT beams in a radiation therapy treatment planning system , 2012, Journal of applied clinical medical physics.

[50]  P. Xia,et al.  Dosimetric evaluation between megavoltage cone-beam computed tomography and body mass index for intracranial, thoracic, and pelvic localization. , 2011, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[51]  J. Purdy,et al.  Comparison of peripheral dose from image-guided radiation therapy (IGRT) using kV cone beam CT to intensity-modulated radiation therapy (IMRT). , 2008, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[52]  Daniel E Hyer,et al.  Estimation of organ doses from kilovoltage cone-beam CT imaging used during radiotherapy patient position verification. , 2010, Medical physics.

[53]  K. Ruchala,et al.  Patient dose from megavoltage computed tomography imaging. , 2008, International journal of radiation oncology, biology, physics.

[54]  Jack Valentin,et al.  The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. , 2007, Annals of the ICRP.

[55]  J. Booth,et al.  An investigation of image guidance dose for breast radiotherapy , 2013, Journal of applied clinical medical physics.

[56]  V. Moiseenko,et al.  Mega-voltage versus kilo-voltage cone beam CT used in image guided radiation therapy: comparative study of microdosimetric properties. , 2011, Radiation protection dosimetry.

[57]  D. Kwong,et al.  Evaluation of radiation dose and image quality for the Varian cone beam computed tomography system. , 2011, International journal of radiation oncology, biology, physics.

[58]  M. Jia,et al.  Peripheral dose from megavoltage cone‐beam CT imaging for nasopharyngeal carcinoma image‐guided radiation therapy , 2012, Journal of applied clinical medical physics.

[59]  G. S. Panayiotakis,et al.  A review of patient dose and optimisation methods in adult and paediatric CT scanning. , 2012, European journal of radiology.

[60]  C. Rübe,et al.  Dosimetry of an in-line kilovoltage imaging system and implementation in treatment planning. , 2014, International journal of radiation oncology, biology, physics.

[61]  Peter Munro,et al.  Radiation exposure to patients from image guidance procedures and techniques to reduce the imaging dose. , 2013, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[62]  Myonggeun Yoon,et al.  Imaging Doses and Secondary Cancer Risk From Kilovoltage Cone-beam CT in Radiation Therapy , 2013, Health physics.

[63]  J. Seuntjens,et al.  Comment on "Reference radiochromic film dosimetry in kilovoltage photon beams during CBCT image acquisition" [Med. Phys. 37, 1083-1092 (2010)]. , 2010, Medical physics.

[64]  U. Schneider,et al.  Systematic measurements of whole-body imaging dose distributions in image-guided radiation therapy. , 2012, Medical physics.

[65]  Christopher J Moore,et al.  A feasibility study for image guided radiotherapy using low dose, high speed, cone beam X-ray volumetric imaging. , 2005, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[66]  Jonathan G. Li,et al.  An organ and effective dose study of XVI and OBI cone‐beam CT systems , 2010, Journal of applied clinical medical physics.

[67]  Steve B. Jiang,et al.  Assessment of patient organ doses and effective doses using the VIP-Man adult male phantom for selected cone-beam CT imaging procedures during image guided radiation therapy. , 2008, Radiation protection dosimetry.

[68]  Icrp.  1990 Recommendations of the International Commission on Radiological Protection , 1991 .

[69]  Shinichiro Mori,et al.  Effective and organ doses using helical 4DCT for thoracic and abdominal therapies , 2013, Journal of radiation research.

[70]  Rebecca Fahrig,et al.  Dose and image quality for a cone-beam C-arm CT system. , 2006, Medical physics.

[71]  R. Wiersma,et al.  Combined MV + kV inverse treatment planning for optimal kV dose incorporation in IGRT , 2014, Physics in medicine and biology.

[72]  Young Min Moon,et al.  EFFECTIVE DOSE MEASUREMENT FOR CONE BEAM COMPUTED TOMOGRAPHY USING GLASS DOSIMETER , 2014 .

[73]  J. Lagrange,et al.  Radiothérapie des cancers de la prostate : évaluation in vivo de la dose délivrée par tomographie conique de basse énergie (kV) , 2009 .

[74]  Lei Xing,et al.  American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) practice guidelines for image-guided radiation therapy (IGRT). , 2010, International journal of radiation oncology, biology, physics.

[75]  A. Isambert,et al.  [Dose delivered to the patient by megavoltage cone beam computed tomography imaging]. , 2009, Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique.

[76]  L. Holloway,et al.  Megavoltage cone beam CT near surface dose measurements: potential implications for breast radiotherapy. , 2011, Medical physics.

[77]  S. Sim,et al.  Dose comparison of megavoltage cone‐beam and orthogonal‐pair portal images , 2007, Journal of applied clinical medical physics.

[78]  P. Munro,et al.  Reducing radiation exposure to patients from kV-CBCT imaging. , 2010, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[79]  M. Little,et al.  Database of normalised computed tomography dose index for retrospective CT dosimetry , 2014, Journal of radiological protection : official journal of the Society for Radiological Protection.

[80]  P. Alaei,et al.  Dose calculation and treatment plan optimization including imaging dose from kilovoltage cone beam computed tomography , 2014, Acta oncologica.

[81]  Patrick A Kupelian,et al.  Performance characterization of megavoltage computed tomography imaging on a helical tomotherapy unit. , 2005, Medical physics.

[82]  T. Marchant,et al.  Imaging doses from the Elekta Synergy X-ray cone beam CT system. , 2007, The British journal of radiology.

[83]  G. Ding,et al.  A new approach to account for the medium-dependent effect in model-based dose calculations for kilovoltage x-rays , 2011, Physics in medicine and biology.

[84]  John M. Boone,et al.  Comprehensive Methodology for the Evaluation of Radiation Dose in X-Ray Computed Tomography , 2010 .

[85]  G. Ding,et al.  Beam characteristics and radiation output of a kilovoltage cone-beam CT , 2010, Physics in medicine and biology.

[86]  Jan-Jakob Sonke,et al.  Quality assurance for image-guided radiation therapy utilizing CT-based technologies: a report of the AAPM TG-179. , 2012, Medical physics.

[87]  Charles W. Coffey,et al.  Radiation dose from kilovoltage cone beam computed tomography in an image-guided radiotherapy procedure. , 2009, International journal of radiation oncology, biology, physics.

[88]  Frederik Wenz,et al.  Phantom and in-vivo measurements of dose exposure by image-guided radiotherapy (IGRT): MV portal images vs. kV portal images vs. cone-beam CT. , 2007, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[89]  I Kawrakow,et al.  Monte Carlo simulation and patient dosimetry for a kilovoltage cone-beam CT unit. , 2009, Medical physics.

[90]  I. Horáková,et al.  Organ and effective doses from verification techniques in image-guided radiotherapy. , 2011, Radiation protection dosimetry.

[91]  E. Attalla,et al.  Megavoltage cone beam computed tomography: Commissioning and evaluation of patient dose , 2011, Journal of medical physics.

[92]  Patrick Downes,et al.  Monte Carlo simulation of an x-ray volume imaging cone beam CT unit. , 2008, Medical physics.

[93]  M. Zelefsky,et al.  Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. , 2012, International journal of radiation oncology, biology, physics.

[94]  Jean Pouliot,et al.  Low dose megavoltage cone beam computed tomography with an unflattened 4 MV beam from a carbon target. , 2008, Medical physics.

[95]  Y. Yoshioka,et al.  Megavoltage cone beam computed tomography dose and the necessity of reoptimization for imaging dose-integrated intensity-modulated radiotherapy for prostate cancer. , 2012, International journal of radiation oncology, biology, physics.

[96]  David A. Jaffray,et al.  Safety considerations for IGRT: Executive summary , 2013, Practical radiation oncology.

[97]  Ravinder Nath,et al.  Personalized assessment of kV cone beam computed tomography doses in image-guided radiotherapy of pediatric cancer patients. , 2012, International journal of radiation oncology, biology, physics.

[98]  Willi A Kalender,et al.  Dose in x-ray computed tomography , 2014, Physics in medicine and biology.

[99]  Moyed Miften,et al.  IMRT planning and delivery incorporating daily dose from mega-voltage cone-beam computed tomography imaging. , 2007, Medical physics.

[100]  David A Jaffray,et al.  Patient dose from kilovoltage cone beam computed tomography imaging in radiation therapy. , 2006, Medical physics.

[101]  E. Aird,et al.  Contribution to normal tissue dose from concomitant radiation for two common kV-CBCT systems and one MVCT system used in radiotherapy. , 2012, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.