XVI

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Planning and treating in 3D requires verification in 3D. The 3D imaging capability of XVI enables clinicians to take full advantage of complex techniques without the need for implanted markers to visualize soft tissue structures, target volume and the position of critical structures. It allows precise registration of the reconstructed image data with the historical CT planning data as a non-invasive procedure. XVI offers a variety of image guided options to suit the individual needs of the patient and the clinic XVI software offers the flexibility to vary the dosage necessary to acquire a VolumeView image, depending on the level of contrast required.

Working closely with the Elekta Synergy Research Group, Elekta, in collaboration with its clinical partners, became the first company to support research on IGRT, the first to bring 3D volumetric imaging into clinical use and the first to bring these solutions to the wider market. Versatile, all in one system from classic radiotherapy to advanced stereotactic precision. Ideal for stereotactic treatment techniques. These techniques have given clinicians the flexibility to deliver conventional therapies to treat a wide range of tumors throughout the body, while also enabling treatment of highly complex cancers that require extreme targeting precision.

This site uses cookies. Resolution was evaluated by the smallest pattern that could be visually resolved in the CTP module, and detectability was evaluated by the smallest acrylic sphere that could be visually resolved in the CTP module. The head scan covered the brain, salivary glands, extrathoracic region, oral mucosa, and parts of the esophagus. Of all the organs, the lens of the eye received the maximum dose of 1.

Image quality was assessed through visual evaluation of the reconstructed images of the Catphan phantom. The CTP resolution module was used to evaluate the spatial resolution. This can be seen in Fig. The chest scan covered the lungs, breast, heart, thymus, thyroid, and parts of the esophagus, liver, stomach and spleen. The thyroid received the maximum dose of The pelvis scan covered the prostate, bladder, testes, and parts of the small intestine and colon. The testes received the maximum dose for both systems at 29 and It is important to differentiate the data presented in the current study with that which can be found in current literature.

Kan et al.

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Previous protocols for the OBI were all at a fixed tube voltage kVp and consisted of full rotation scans. The updated OBI protocols utilize body region specific tube voltages, with lower energies for less attenuating body regions. Tube voltages include kV, kV, and kV for the head, chest, and pelvis, respectively. Additionally, the new head protocol for the OBI utilizes only a partial rotation rather than a full rotation for image acquisition. Lastly, the tube current time product for all OBI protocols has been reduced substantially.

While the tube current time product has been increased with the use of the new protocols to account for the added filtration, results indicate that individual organ doses for the XVI have remained comparable to the limited studies in the literature.. On the XVI, image acquisition begins at the anterior surface of the patient and rotates around the left lateral side of the head, finishing posteriorly when the patient is placed in a supine position. On the OBI, image acquisition moves from left to right lateral or vice versa while rotating around the posterior surface of the patient.

Due to the choice of acquisition angles, superficial organs located on the anterior surface of the head are directly irradiated during image acquisition with the XVI but not with the OBI, resulting in comparatively higher doses to some organs for the XVI. The chest protocol for each system utilized a full rotation scan. However, the beam width for the XVI was larger than the OBI 26 cm compared to 16 cm resulting in higher doses to organs outside of the treatment volume. The thyroid was one such organ, which is included in the larger field of view and subsequently received the highest dose of any organ during a chest scan from the XVI, but was outside of the primary field on the OBI.

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Contributing to the thyroid dose on the XVI was also the fact that the outer body contour was smaller in this region, resulting in less attenuation of the primary beam as the tube rotated around the body. This finding suggests reducing the beam width of the XVI in future versions if the necessary information can be gained from a narrower beam width such as is used on the OBI to avoid unnecessarily irradiating organs outside of the treatment volume.

As expected, the breast received the highest dose on the OBI due to its anatomical location at the periphery of the body. The pelvis scans for each system also utilized a full rotation. Interestingly, the OBI had organ doses similar to those measured using the XVI, even though the tube current time product was approximately a factor of 2. This can be attributed to the fact that the OBI has a larger beam width 16 cm compared to As reported by Song et al.

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Similar to the chest scan, the larger beam width resulted in more organs outside of the treatment volume being irradiated and an increased scatter dose inside of the scan volume. The effective dose for each scan is also shown at the bottom of Tables 4 and 5. The chest scan yielded effective doses of 7.

The higher effective dose for the XVI chest scan was due to its larger beam width, which covered more organs, and higher tube current time product, which resulted in higher overall organ doses. The pelvis scan for each system had similar effective doses at 3. As is evident from the data presented in this study, the effective dose for each protocol was small due to the limited number of organs involved in each scan. This is especially true for the pelvis scans, where both the gonads and prostate received doses greater than 25 mGy, but most other organs received little if any dose.

The effective dose was on the order of only 3—4 mSv.

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Therefore, organ doses are likely more meaningful for predicting future risk, such as organ specific disease, but the effective dose offers a single number to compare the different protocols and equipment quickly and easily. The image analysis performed in this study quantified the observed image quality for each system and imaging protocol — supplementing the extensive dosimetry measurements performed.

Again, it is important to remember that the protocols selected for this study were those recommended by the manufacturer for clinical use. When first comparing the reconstructed OBI images to the XVI images, it was readily apparent that the XVI images were not as sharp and had more artifacts streaking and rings.

However, this increased image quality did not always come at the cost of higher dose, with the chest protocol for the OBI actually yielding lower dose and better image quality.


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Data presented in this study shows that daily use of CBCT for patient positioning will deliver a substantial imaging dose to organs in the primary imaging field. It should be noted that when used for daily position verification, the organ doses listed in Tables 4 and 5 must be multiplied by the total number of fractions, which can be as high as 30— This results in organ doses exceeding 1 Gy in some cases, such as the testes, indicating that the dose from daily CBCT imaging in a high fraction therapy regimen should be taken into consideration during the treatment planning process.

The systems were evaluated by performing organ dose and image quality measurements for three clinically relevant scan sites head, chest, and pelvis using the latest manufacturer installed clinical protocols. Organ dose measurements demonstrated that the XVI yielded higher doses for a chest scan, while the OBI yielded higher doses for both head and pelvis scans. The dosimetric differences between these two CBCT systems are magnified over the course of a fractionated treatment with daily imaging. For head and pelvis scans, the OBI delivers a dose 6.

Results also showed a decrease in organ dose for the OBI when compared to previous studies which used an earlier version of the manufacturer installed clinical protocols. This work was supported by the U. National Center for Biotechnology Information , U. J Appl Clin Med Phys. Published online Apr Daniel E.

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Hyer , 1 Christopher F. Serago , 2 Siyong Kim , 2 Jonathan G. Li , 3 and David E. Hintenlang 1.

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Christopher F. Jonathan G. David E. Author information Article notes Copyright and License information Disclaimer. Hyer, Email: moc. Corresponding author.


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  8. Received Sep 16; Accepted Nov This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. PACS number: Open in a separate window. Figure 1.