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    The Applicability of Stitching Cone Beam CT Scans Presentation

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    The document discusses the applicability of stitching multiple cone beam CT scans together for head and neck patients. Stitching CBCT scans allows for a larger field of view to be imaged but comes with additional imaging dose. Studies have found the dimensional accuracy of stitched CBCT images to be clinically insignificant compared to conventional CT. While stitching provides benefits like improved visualization, the added radiation dose must be considered, particularly for head and neck cases that already receive a high imaging dose from daily CBCTs. More research is still needed to fully understand how patient setup may be influenced between different imaging techniques.

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    The Applicability of Stitching Cone Beam CT Scans Presentation

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    api-498724117
    123 views19 pages
    The document discusses the applicability of stitching multiple cone beam CT scans together for head and neck patients. Stitching CBCT scans allows for a larger field of view to be imaged but comes with additional imaging dose. Studies have found the dimensional accuracy of stitched CBCT images to be clinically insignificant compared to conventional CT. While stitching provides benefits like improved visualization, the added radiation dose must be considered, particularly for head and neck cases that already receive a high imaging dose from daily CBCTs. More research is still needed to fully understand how patient setup may be influenced between different imaging techniques.

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    The document discusses the applicability of stitching multiple cone beam CT scans together for head and neck patients. Stitching CBCT scans allows for a larger field of view to be imaged but comes with additional imaging dose. Studies have found the dimensional accuracy of stitched CBCT images to be clinically insignificant compared to conventional CT. While stitching provides benefits like improved visualization, the added radiation dose must be considered, particularly for head and neck cases that already receive a high imaging dose from daily CBCTs. More research is still needed to fully understand how patient setup may be influenced between different imaging techniques.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    123 views19 pages

    The Applicability of Stitching Cone Beam CT Scans Presentation

    Uploaded by

    api-498724117
    The document discusses the applicability of stitching multiple cone beam CT scans together for head and neck patients. Stitching CBCT scans allows for a larger field of view to be imaged but comes with additional imaging dose. Studies have found the dimensional accuracy of stitched CBCT images to be clinically insignificant compared to conventional CT. While stitching provides benefits like improved visualization, the added radiation dose must be considered, particularly for head and neck cases that already receive a high imaging dose from daily CBCTs. More research is still needed to fully understand how patient setup may be influenced between different imaging techniques.

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    of 19

    The

    Applicability
    of Stitching
    Cone Beam
    CT Scans for
    H&N Patients
    Nicole Pitzer
    Constantly Changing,
    Refreshing, and Improving8
    o IGRT
    o Means of localizing exact target of treatment within
    the body
    o The ultimate goal: to increase in target dose →
    “only possible by reducing field margins. Thus, the
    field margin is the limiting factor…”
    o IGRT is to reduce field margins by managing tumor
    motion and provide optimal treatment plans using
    images with the patient in the treatment position
    immediately prior to or during the treatment.
    o Overall has potential to improve side effects
    o Gives confidence in patient set up and placement of
    dose
    Quality Assurance3

    Lasers Field Light Rotations


    Types of IGRT

    kV image MV image CBCT

    Bony anatomy with more detail Bony anatomy with less detail Soft tissues + bony anatomy
    CBCT8

    o First implemented in dentomaxillofacial imaging in


    2001
    o “The use of CBCT with kV x-rays (30-140 kV) offers
    superior low contrast resolution when compared to
    EPIDs. Additionally, high spatial resolution and high
    quantum efficiency have made CBCT a popular choice
    in radiotherapy applications.”
    Head and Neck Patients
    o Large amount of critical structures to be
    concerned with → have very little room for error
    when treating
    o Requires a very precise set up

    o Half trajectory CBCT vs imaging of the pelvis,


    abdomen, chest, etc. which require a full
    trajectory

    o Most H&N patients the info acquired is sufficient

    o For others:
    o Treating into upper thorax as well → need more
    information
    What is cone beam stitching?8

    o The normal Varian kV imaging panel only has a 39.73x29.80


    cm2 physical size
    o This translates to a 30cm x 24cm image size
    o Utilizes 2 normal cone beams
    o To accomplish this, take the first cone beam like normal
    o Then shift the table ___cm superior (iso moves inferior) and
    take a second cone beam
    o Shifts from iso are determined on the first day
    o There is some overlap
    o Merge the two together = one large CBCT image
    o Match just like normal
    Some points to consider
    ❑ Accuracy & reliability
    ❑ Added dose
    ❑ Purpose
    Where was it
    Dentomaxillofacial
    first field & orthopedic
    implemented? interventions

    The beginning Is there


    of CBCT dimensional
    stability?

    stitching6,8
    How
    accurate are
    these
    images?
    Accuracy and reliability of stitched images

    Egbert et al.5 Kopp & Ottl7


    o Study focused in the dental field
    o Summarizes several studies that have o “a new 3D acquisition mode that automatically combines
    concluded few to no differences exist in two or three small FOV volumes to construct a larger,
    the dimensional accuracy of conventional composite 3D image that is needed for a wider region of
    computed tomography and CBCT examination.”
    o Mounted mandible positioned centrally using laser lights
    o All of these studies were performed much like the treatment room
    utilizing implants for the maxillofacial
    o Conclusion: differences in anatomic and stitched small FOV
    region CBCT dimensions statistically significant but clinically
    o Utilizes the same principle of merging the insignificant
    images o the difference is “beyond the resolution of the human eye and
    hand”
    Some points to consider
    ✓ Accuracy & reliability
    ❑ Added dose
    ❑ Purpose
    *Head and Neck cases especially are in need for imaging verification due to the
    fact that the anatomical region comes with a complex shape in need of steep
    dose gradients and exact patient positioning.
    Alaei et al.2,8

    o 40 patients diagnosed with pharyngeal cancer, cancer of Assessed how


    the mouth – or base of tongue, tonsil, parotid and larynx much dose a
    o Range of fractions → most receiving 30-35 treatments patient receives
    with a total dose of 50 Gy from daily CBCT
    o Used a 6 MV photon beam imaging
    compared to the
    o Assessed daily imaging in the kV range for CBCT
    total dose to
    o Thermoplastic masks aligned with room lasers to surrounding
    corresponding marks tissues and
    o Findings: 3-9 mGy for each H&N CBCT normal tissue
    o Similar study done found additional dose of around 30-40 mGy tolerances
    for a 35 fraction H&N treatment with daily CBCT imaging
    Food for thought…
    For a 35 fraction treatment if stitching is
    prescribed on the imaging order, this adds at
    least 7-14 extra CBCTs to add to the total
    imaging dose

    Keep in mind, if this is done on a pelvis patient it will require


    more frames and a full 360 degree rotation of the machine
    to acquire the full image = even more dose
    Some points to consider
    ✓ Accuracy & reliability
    ✓ Added dose
    ❑ Purpose
    Dzierma et al.1,4

    o Wanted to study how patient set ups were influenced from different imaging techniques
    and what errors occurred due to the exchange of imaging techniques
    o Would be very useful in determining if the stitched CBCT had a direct effect on a patient’s set up
    for that day
    o Ran into a few complications which prevented a full conclusion
    1. No direct comparison of set up shifts made from one imaging modality to another on the same
    patient on the same fraction
    2. Results were not being evaluated on the basis of taking a verification image after shifts have
    been made to verify that where you think you shifted is where you treated
    • When referring to the ACR-ASTRO Practice Parameter for Communication: Radiation
    Oncology, there is no statement that requires this as documentation.
    o Conclusion: Deviations in patient set up from day to day could arise from chance and the
    patient lying down differently on a different day
    Discussion
    Is it worth
    PROS CONS
    it? 2,4,5,7,8

    *cone beam geometry in


    general covers a large field
    of view in 1 rotation
    contributing to a larger
    scattered radiation
    component vs even a
    normal CT
    o More body marks
    o Taking another type of IGRT
    image with less dose to get
    patient in ball park area Where do we go
    o Theoretically the more marks the
    better from here?
    o The overall goal is to find the best
    clinical outcome for the patient
    without increasing the risk for
    secondary malignancies
    References

    1. ACR-ASTRO Practice Parameter for Communication: Radiation Oncology. 2014.


    2. Alaei P, Spezi E, and Reynolds M. Dose calculation and treatment plan optimization including imaging dose from kilovoltage
    cone beam computed tomography. Acta Oncologica, 53:6, 839-844, DOI: 10.3109/0284186X.2013.875626.
    3. Ayan, A. Isocenter Powerpoint. Lecture in Atwell Hall. 2019.
    4. Dzierma Y, Beyhs M, Palm J, Niewald M, et al. Set-up errors and planning margins in planar and CBCT image-guided
    radiotherapy using three different imaging systems: A clinical study for prostate and head-and-neck cancer. Physica Media.
    2015.
    5. Egbert N, Cagna D, Ahuja S, and Wicks R. Accuracy and reliability of stitched cone-beam computed tomography images. Imaging
    Science in Dentistry. 2015; 45: 41-7.
    6. Fotouhi J, Fuerst B, Unberath M, Reichenstein S, and Lee S. Automatic intraoperative stitching of nonoverlapping cone-beam CT
    acquisitions. 2018.
    7. Kopp S and Ottl P. Dimensional stability in composite cone beam computed tomography. Dentomaxillofacial Radiology. 2010;
    39: 512-516.
    8. Srinivasan K, Mohammadi M, Shepherd J. Applications of linac-mounted kilovoltage Cone-beam Computed Tomography in
    modern radiation therapy: A review. Pol J Radiol. 2014;79:181–193. Published 2014 Jul 3. doi:10.12659/PJR.890745

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