WE-DE-BRA-09: Fast Megavoltage CT Imaging with Rapid Scan Time and Low Imaging Dose in Helical Tomotherapy.

PURPOSE: Megavoltage computed tomography (MVCT) imaging has been widely used for daily patient setup with helical tomotherapy (HT). One drawback of MVCT is its very long imaging time, owing to slow couch speed. The purpose of this study was to develop an MVCT imaging method allowing faster couch speeds, and to assess its accuracy for image guidance for HT.

METHODS: Three cadavers (mimicking closest physiological and physical system of patients) were scanned four times with couch speeds of 1, 2, 3, and 4 mm/s. The resulting MVCT images were reconstructed using an iterative reconstruction (IR) algorithm. The MVCT images were registered with kilovoltage CT images, and the registration errors were compared with the errors with conventional filtered back projection (FBP) algorithm. Moreover, the fast MVCT imaging was tested in three cases of total marrow irradiation as a clinical trial.

RESULTS: Three-dimensional registration errors of the MVCT images reconstructed with the IR algorithm were significantly smaller (p < 0.05) than the errors of images reconstructed with the FBP algorithm at fast couch speeds (3, 4 mm/s). The scan time and imaging dose at a speed of 4 mm/s were reduced to 30% of those from a conventional coarse mode scan. For the patient imaging, a limited number of conventional MVCT (1.2 mm/s) and fast MVCT (3 mm/s) reveals acceptable reduced imaging time and dose able to use for anatomical registration.

CONCLUSION: Fast MVCT with IR algorithm maybe clinically feasible alternative for rapid 3D patient localization. This technique may also be useful for calculating daily dose distributions or organ motion analyses in HT treatment over a wide area.