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Estimation of organ and effective doses of CBCT scans of radiotherapy using size-specific field of view (FOV): a Monte Carlo study

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Abstract

The kV cone beam computed tomography (CBCT) is one of the most common imaging modalities used for image-guided radiation therapy (IGRT) procedures. Additional doses are delivered to patients, thus assessment and optimization of the imaging doses should be taken into consideration. This study aimed to investigate the influence of using fixed and patient-specific FOVs on the patient dose. Monte Carlo simulations were performed to simulate kV beams of the imaging system integrated into Truebeam linear accelerator using BEAMnrc code. Organ and size-specific effective doses resulting from chest and pelvis scanning protocols were estimated with DOSXYZnrc code using a phantom library developed by the National Cancer Institute (NCI) of the US. The library contains 193 (100 male and 93 female) mesh-type computational human adult phantoms, and it covers a large ratio of patient sizes with heights and weights ranging from 150 to 190 cm and 40 to 125 kg. The imaging doses were assessed using variable FOV of three sizes, small (S), medium (M), and large (L) for each scan region. The results show that the FOV and the patient size played a major role in the scan dose. The average percentage differences (PDs) for doses of organs that were fully inside the different FOVs were relatively low, all within 11% for both protocols. However, doses to organs that were scanned partially or near the FOVs were affected significantly. For the chest protocol, the inclusion of the thyroid in the scan field could give a dose of 1–7 mGy/100 mAs to the thyroid, compared to 0.4–1 mGy/100 mAs when it was excluded. Similarly, on average, testes doses could be 6 mGy/100 mAs for the male pelvis protocol compared to 3 mGy/100 mAs when it did not lie in the field irradiated. These dose differences resulted in an average increase of up to 27% in the size-specific effective dose of the protocols. Since changing the field size is possible for CBCT scans, the results suggest that patient-specific scanning protocols could be applied for each scan area in a manner similar to that used for CT scans. Adjustment of the FOV size should be subject to the clinical needs, and assist in improving the treatment accuracy. The patient’s height and weight might be considered as the main factors upon which, the selection of the appropriate patient-specific protocol is based. This approach should optimize the imaging doses used for IGRT procedures by minimizing doses of a large ratio of patients.

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References

  1. Jaffray DA, Siewerdsen JH, Wong JW, Martinez AA (2002) Flat-panel cone-beam computed tomography for image-guided radiation therapy. Int J Radiat Oncol Biol Phys 53:1337–1349. https://doi.org/10.1016/S0360-3016(02)02884-5

    Article  PubMed  Google Scholar 

  2. Murphy MJ, Balter J, Balter S, Bencomo JA, Das IJ, Jiang SB et al (2007) The management of imaging dose during image-guided radiotherapy: report of the AAPM Task Group 75. Med Phys 34:4041–4063. https://doi.org/10.1118/1.2775667

    Article  PubMed  Google Scholar 

  3. Ding GX, Alaei P, Curran B, Flynn R, Gossman M, Mackie TR et al (2018) Image guidance doses delivered during radiotherapy: quantification, management, and reduction: report of the AAPM Therapy Physics Committee Task Group 180. Med Phys 45:e84-99. https://doi.org/10.1002/MP.12824

    Article  PubMed  Google Scholar 

  4. Alaei P, Spezi E (2015) Imaging dose from cone beam computed tomography in radiation therapy. Phys Med 31:647–658. https://doi.org/10.1016/j.ejmp.2015.06.003

    Article  PubMed  Google Scholar 

  5. Martin CJ, Kron T, Vassileva J, Wood TJ, Joyce C, Ung NM et al (2021) An international survey of imaging practices in radiotherapy. Phys Med 90:53–65. https://doi.org/10.1016/j.ejmp.2021.09.004

    Article  CAS  PubMed  Google Scholar 

  6. Boda-Heggemann J, Lohr F, Wenz F, Flentje M, Guckenberger M (2011) kV cone-beam CT-based IGRT. Strahlenther Onkol 187:284–291. https://doi.org/10.1007/s00066-011-2236-4

    Article  PubMed  Google Scholar 

  7. Posiewnik M, Piotrowski T (2019) A review of cone-beam CT applications for adaptive radiotherapy of prostate cancer. Phys Med 59:13–21. https://doi.org/10.1016/j.ejmp.2019.02.014

    Article  CAS  PubMed  Google Scholar 

  8. Martin CJ, Gros S, Kron T, Wood TJ, Vassileva J, Small W et al (2023) Factors affecting implementation of radiological protection aspects of imaging in radiotherapy. Appl Sci 13:1533. https://doi.org/10.3390/APP13031533

    Article  CAS  Google Scholar 

  9. Martin CJ, Abuhaimed A (2022) Variations in size-specific effective dose with patient stature and beam width for kV cone beam CT imaging in radiotherapy. J Radiol Prot 42:031512. https://doi.org/10.1088/1361-6498/AC85FA

    Article  CAS  Google Scholar 

  10. Martin CJ, Abuhaimed A, Lee C (2021) Dose quantities for measurement and comparison of doses to individual patients in computed tomography (CT). J Radiol Prot 41:792. https://doi.org/10.1088/1361-6498/ABECF5

    Article  Google Scholar 

  11. Martin CJ, Harrison JD, Rehani MM (2020) Effective dose from radiation exposure in medicine: past, present, and future. Phys Med 79:87–92. https://doi.org/10.1016/j.ejmp.2020.10.020

    Article  PubMed  Google Scholar 

  12. Abuhaimed A, Martin CJ (2023) Assessment of organ and size-specific effective doses from cone beam CT (CBCT) in image-guided radiotherapy (IGRT) based on body mass index (BMI). Radiat Phys Chem 208:110889. https://doi.org/10.1016/J.RADPHYSCHEM.2023.110889

    Article  CAS  Google Scholar 

  13. ICRP (2015) Radiological protection in cone beam computed tomography (CBCT). ICRP Publication 129. Ann ICRP 44(1):9–127. https://doi.org/10.1177/ANIB_44_1

    Article  Google Scholar 

  14. Buckley JG, Wilkinson D, Malaroda A, Metcalfe P (2018) Investigation of the radiation dose from cone-beam CT for image-guided radiotherapy: a comparison of methodologies. J Appl Clin Med Phys 19:174–183. https://doi.org/10.1002/ACM2.12239

    Article  PubMed  Google Scholar 

  15. Spezi E, Downes P, Radu E, Jarvis R (2009) Monte Carlo simulation of an X-ray volume imaging cone beam CT unit. Med Phys 36:127–136. https://doi.org/10.1118/1.3031113

    Article  PubMed  Google Scholar 

  16. Rogers DWO, Faddegon BA, Ding GX, Ma CM, We J, Mackie TR (1995) BEAM: a Monte Carlo code to simulate radiotherapy treatment units. Med Phys 22:503–524. https://doi.org/10.1118/1.597552

    Article  CAS  PubMed  Google Scholar 

  17. Kawrakow I, Rogers DWO, Mainegra-Hing E, Tessier F, Townson RW, Walters BRB (2000) EGSnrc toolkit for Monte Carlo simulation of ionizing radiation transport. https://doi.org/10.4224/40001303

  18. Walters BRB, Kawrakow I, Rogers DWO (2002) History by history statistical estimators in the BEAM code system. Med Phys 29:2745–2752. https://doi.org/10.1118/1.1517611

    Article  CAS  PubMed  Google Scholar 

  19. Abuhaimed A, Martin CJ, Sankaralingam M, Gentle DJ, McJury M (2014) An assessment of the efficiency of methods for measurement of the computed tomography dose index (CTDI) for cone beam (CBCT) dosimetry by Monte Carlo simulation. Phys Med Biol 59(21):6307–26. https://doi.org/10.1088/0031-9155/59/21/6307

    Article  PubMed  Google Scholar 

  20. Abuhaimed A, Martin CJ, Sankaralingam M, Gentle DJ (2015) A Monte Carlo investigation of cumulative dose measurements for cone beam computed tomography (CBCT) dosimetry. Phys Med Biol 60(4):1519–42. https://doi.org/10.1088/0031-9155/60/4/1519

    Article  PubMed  Google Scholar 

  21. Abuhaimed A, Martin CJCJ, Sankaralingam M (2018) A Monte Carlo study of organ and effective doses of cone beam computed tomography (CBCT) scans in radiotherapy. J Radiol Prot 38:61–80. https://doi.org/10.1088/1361-6498/aa8f61

    Article  PubMed  Google Scholar 

  22. Abuhaimed A, Martin CJ (2018) A Monte Carlo study of impact of scan position for cone beam CT on doses to organs and effective dose. Radiat Phys Chem 151:25–35. https://doi.org/10.1016/j.radphyschem.2018.05.014

    Article  CAS  Google Scholar 

  23. Rogers DWO, Walters B, Kawrakow I (2023) BEAMnrc users manual. NRCC report, PIRS-0509 (A) revL. https://nrc-cnrc.github.io/EGSnrc/doc/pirs509a-beamnrc.pdf

  24. Kawrakow I, Rogers DWO, Walters BRB (2004) Large efficiency improvements in BEAMnrc using directional bremsstrahlung splitting. Med Phys 31:2883–2898. https://doi.org/10.1118/1.1788912

    Article  CAS  PubMed  Google Scholar 

  25. Mainegra-Hing E, Kawrakow I (2006) Efficient X-ray tube simulations. Med Phys 33:2683–2690. https://doi.org/10.1118/1.2219331

    Article  PubMed  Google Scholar 

  26. Kawrakow I, Walters BRB (2006) Efficient photon beam dose calculations using DOSXYZnrc with BEAMnrc. Med Phys 33:3046–3056. https://doi.org/10.1118/1.2219778

    Article  CAS  PubMed  Google Scholar 

  27. Walters B, Kawrakow I, Rogers DWO (2023) DOSXYZnrc users manual. NRCC report PIRS-794 revB. https://nrc-cnrc.github.io/EGSnrc/doc/pirs794-dosxyznrc.pdf

  28. NCI (2023) NCIDOSE/PHANTOMS. https://dceg.cancer.gov/tools/radiation-dosimetry-tools/phantoms-library. Accessed 2 Jan 2024

  29. Geyer AM, O’Reilly S, Lee C, Long DJ, Bolch WE (2014) The UF/NCI family of hybrid computational phantoms representing the current US population of male and female children, adolescents, and adults—application to CT dosimetry. Phys Med Biol 59:5225. https://doi.org/10.1088/0031-9155/59/18/5225

    Article  PubMed  PubMed Central  Google Scholar 

  30. ICRP (2007) The 2007 recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP 2007(37):1–332. https://doi.org/10.1177/ANIB_37_2-4

    Article  Google Scholar 

  31. Martin CJ, Abuhaimed A, Sankaralingam M, Metwaly M, Gentle DJ (2016) Organ doses can be estimated from the computed tomography (CT) dose index for cone-beam CT on radiotherapy equipment. J Radiol Prot 36(2):215–29. https://doi.org/10.1088/0952-4746/36/2/215

    Article  CAS  PubMed  Google Scholar 

  32. Abuhaimed A, Martin CJ (2018) Evaluation of coefficients to derive organ and effective doses from cone-beam CT (CBCT) scans: a Monte Carlo study. J Radiol Prot 38(1):189–206. https://doi.org/10.1088/1361-6498/aa9b9f

    Article  PubMed  Google Scholar 

  33. Fetin A, Cartwright L, Sykes J, Wach A (2022) PCXMC cone beam computed tomography dosimetry investigations. Phys Eng Sci Med 45:205–218. https://doi.org/10.1007/S13246-022-01103-9/METRICS

    Article  PubMed  Google Scholar 

  34. Nelson AP, Ding GX (2014) An alternative approach to account for patient organ doses from imaging guidance procedures. Radiother Oncol 112:112–118. https://doi.org/10.1016/J.RADONC.2014.05.019

    Article  PubMed  Google Scholar 

  35. Dzierma Y, Nuesken F, Otto W, Alaei P, Licht N, Rübe C (2014) Dosimetry of an in-line kilovoltage imaging system and implementation in treatment planning. Int J Radiat Oncol Biol Phys 88:913–9. https://doi.org/10.1016/J.IJROBP.2013.12.007

    Article  PubMed  Google Scholar 

  36. Alaei P, Spezi E (2012) Commissioning kilovoltage cone-beam CT beams in a radiation therapy treatment planning system. J Appl Clin Med Phys 13:19–33. https://doi.org/10.1120/JACMP.V13I6.3971

    Article  PubMed Central  Google Scholar 

  37. Alaei P, Ding G, Guan H (2010) Inclusion of the dose from kilovoltage cone beam CT in the radiation therapy treatment plans. Med Phys 37:244–248. https://doi.org/10.1118/1.3271582

    Article  PubMed  Google Scholar 

  38. Alaei P, Spezi E, Reynolds M (2014) Dose calculation and treatment plan optimization including imaging dose from kilovoltage cone beam computed tomography. Acta Oncol (Madr) 53:839–844. https://doi.org/10.3109/0284186X.2013.875626

    Article  Google Scholar 

  39. Albarakati H, Jackson P, Gulal O, Ramachandran P, Osbourne G, Liu M et al (2022) Dose assessment for daily cone-beam CT in lung radiotherapy patients and its combination with treatment planning. Phys Eng Sci Med 45:231–237. https://doi.org/10.1007/S13246-022-01105-7/METRICS

    Article  PubMed  Google Scholar 

  40. Pawlowski JM, Ding GX (2014) An algorithm for kilovoltage X-ray dose calculations with applications in kV-CBCT scans and 2D planar projected radiographs. Phys Med Biol 59:2041. https://doi.org/10.1088/0031-9155/59/8/2041

    Article  PubMed  Google Scholar 

  41. Ordóñez-Sanz C, Cowen M, Shiravand N, Macdougall ND (2021) CBCT imaging: a simple approach for optimising and evaluating concomitant imaging doses, based on patient-specific attenuation, during radiotherapy pelvis treatment. Br J Radiol 94(1124):20210068. https://doi.org/10.1259/BJR.20210068/ASSET/IMAGES/LARGE/BJR.20210068.G009.JPEG

    Article  PubMed  PubMed Central  Google Scholar 

  42. Khan M, Sandhu N, Naeem M, Ealden R, Pearson M, Ali A et al (2022) Implementation of a comprehensive set of optimised CBCT protocols and validation through imaging quality and dose audit. Br J Radiol 95(1139):20220070. https://doi.org/10.1259/BJR.20220070/ASSET/IMAGES/LARGE/BJR.20220070.G003.JPEG

    Article  PubMed  PubMed Central  Google Scholar 

  43. Parsons D, Robar JL (2016) Volume of interest CBCT and tube current modulation for image guidance using dynamic kV collimation. Med Phys 43:1808–17. https://doi.org/10.1118/1.4943799

    Article  PubMed  Google Scholar 

  44. Stankovic U, Ploeger LS, Sonke J-J (2021) Improving linac integrated cone beam computed tomography image quality using tube current modulation. Med Phys 48:1739–49. https://doi.org/10.1002/mp.14746

    Article  PubMed  Google Scholar 

  45. Shimizu H, Sasaki K, Aoyama T, Iwata T, Kitagawa T, Kodaira T (2022) Evaluation of a new acrylic-lead shielding device for peripheral dose reduction during cone-beam computed tomography. BJR Open 4(1):20220043. https://doi.org/10.1259/BJRO.20220043

    Article  PubMed  PubMed Central  Google Scholar 

  46. WHO (2024) A healthy lifestyle—WHO recommendations. https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations. Accessed 3 Jan 2024

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Acknowledgements

The authors would like to thank the National Cancer Institute of the National Institutes of Health (NIH) of the US for sharing the phantoms library used in this study, and the supercomputing lab at King Abdullah University of Science and Technology (KAUST) for their permission of performing all Monte Carlo simulations on the supercomputer (SHAHEEN).

Funding

The authors would like to extend their sincere appreciation to the researchers supporting program for funding this work under Researchers Supporting Project number (RSPD2024R780), King Saud University, P.O. Box 145111, Riyadh 4545, Saudi Arabia.

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Authors and Affiliations

  1. King Abdulaziz City for Science and Technology (KACST), P.O Box 6086, 11442, Riyadh, Saudi Arabia

    Abdullah Abuhaimed

  2. Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 145111, 4545, Riyadh, Saudi Arabia

    Huda Mujammami, Khaled AlEnazi, Ahmed Abanomy & Yazeed Alashban

  3. Department of Clinical Physics and Bio-Engineering, Gartnavel Royal Hospital, University of Glasgow, Glasgow, G12 8QQ, UK

    Colin J. Martin

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All authors contributed to the study conception. Material preparation, design, data collection, and analysis were performed by AA and HM. The first draft of the manuscript was written by AA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Abdullah Abuhaimed.

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Abuhaimed, A., Mujammami, H., AlEnazi, K. et al. Estimation of organ and effective doses of CBCT scans of radiotherapy using size-specific field of view (FOV): a Monte Carlo study. Phys Eng Sci Med (2024). https://doi.org/10.1007/s13246-024-01413-0

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