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    To investigate cone beam computed tomography (CBCT) image quality using novel combinations of kilovoltage (kV) and megavoltage (MV) beams and detector materials. MV and kV CBCT imaging was simulated using the Fastcat hybrid Monte Carlo application. CBCT imaging with various beam energies was investigated: 2.5 and 6 MV photon beams generated with carbon, aluminum, and tungsten targets and a 120 kVp x-ray tube beam based off of a Varian Truebeam on-board imager (OBI). Cadmium tungstate (CWO), gadolinium oxysulfide (GOS), and cesium iodide (CsI) detectors with identical pixel pitch of 0.784 mm were evaluated. Modulation transfer functions (MTF) for all detector/beam combinations were calculated. MV and kV CBCT images for each detector/beam combination of a contrast phantom containing inserts with rib and spongiosa bone, lung, and adipose tissues were simulated with an imaging dose of 7 mGy. Contrast to noise ratio (CNR) of all inserts were compared for all detector/beam combinations. CBCT images of an anthropomorphic head phantom with silver amalgam fillings were also generated. The CWO/120 kVp beam combination resulted in the highest MTF at low frequencies and the CsI detector showed the highest MTF for all other beams and at high frequencies. The CWO/120 kVp beam combination showed the highest CNR for all tissues. The unoptimized CWO/2.5 MV carbon target beam showed the highest CNR of the MV beam/detector combinations with CNR 4% and 17% worse than the optimized Truebeam CsI 120 kVp setup with a bowtie filter and antiscatter grid. Additionally, the CWO 2.5 MV setup showed qualitative reduction of metal artifacts surrounding silver amalgam fillings in an anthropomorphic head phantom. This finding makes a compelling case that further optimization of this CWO carbon target setup could produce CBCT images with similar CNR to current OBI CBCT for equivalent dose with added resilience to metal artifacts. © 2022 American Association of Physicists in Medicine.


    Jericho O'Connell, Magdalena Bazalova-Carter. Investigation of image quality of MV and kV CBCT with low-Z beams and high DQE detector. Medical physics. 2022 Apr;49(4):2334-2341

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    PMID: 35098549

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