Technical assessment of a novel vertical CT system for upright radiotherapy simulation and treatment planning

TL;DR

This study evaluates an upright CT system's image quality, dose, and treatment planning accuracy, demonstrating its potential for upright radiotherapy with acceptable image and dose metrics.

Contribution

It provides a comprehensive characterization of a novel upright CT system for radiotherapy, including image quality, dose, and treatment planning accuracy, which was not previously reported.

Findings

Image dose was 23.5 mGy (head) and 10.1 mGy (body).

Image quality metrics were within acceptable ranges for clinical use.

Gamma analysis showed high agreement in dose calculations.

Abstract

Purpose: To characterize image quality, imaging dose, and dose calculation accuracy for an upright CT scanner with a six-degree-of-freedom patient positioning system. Methods: Imaging dose (CTDIvol) was measured at 120 kVp and 200 mAs. Image quality was evaluated using an ACR-464 phantom. Mean CT number accuracy was assessed within inserts of known material and uniformity as the difference in values at the center and periphery of uniform phantoms. High-contrast resolution was assessed by visible line pairs and modulation transfer function (MTF). Low-contrast performance was quantified by contrast-to-noise-ratio (CNR). Spatial integrity was evaluated between fiducials 100 mm apart. Hounsfield unit to mass density and stopping-power-ratio calibrations were performed. Proton and photon treatment plans were optimized on upright CT scans of a thorax phantom in heterogenous and homogeneous regions. Dose was forward computed on a registered recumbent CT scan and agreement evaluated using 3D gamma analysis. Results: CT imaging dose (CTDIvol) was 23.5 mGy for the 16 cm head phantom and 10.1 mGy for the 32 cm body phantom. Mean CT numbers (HU) were within the expected range for water (1.7) and acrylic (120.8). CT numbers were slightly (5-27 HU) out-of-range for air (-950.4), polyethylene (-78.8), and bone (823.0). Image uniformity was 20.2 HU and 35.0 HU for 20 cm and 48 cm diameter phantoms, respectively. Eight high-contrast line pairs were visualized. The MTF equaled 4.4 cm-1 at 50% and 7.1 cm-1 at 10%. The median CNR was 0.93, below the 1.0 tolerance. Spatial integrity was 0.36 mm. Gamma pass rates were 99.8% for photon and 90.6% for proton plans with 1%/1mm criteria, and greater than or equal to 98.0% for all plans with 3%/2mm criteria. Conclusion: Upright CT image quality and dose calculation accuracy are acceptable for photon and proton radiotherapy.