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The concept of using kilovoltage (kV) and megavoltage (MV) beams concurrentlyhas potential applications in cone beam computed tomography (CBCT) guidedradiation therapy, such as single breath hold scans, metal artifact reduction,and simultaneous imaging during MV treatment delivery. However, MVcross-scatter generated during MV beam delivery degrades CBCT image quality. Toaddress this, a 2D antiscatter grid and cross scatter correction method wereinvestigated. a 3D printed, tungsten 2D antiscatter grid prototype was utilizedto reduce MV cross-scatter fluence in kV projections during concurrent MV beamdelivery. Remaining cross-scatter was corrected by using the 2D grid itself asa cross-scatter intensity sampling device, referred as Grid-based ScatterSampling. To test this approach, kV CBCT acquisitions were performed whiledelivering 6 and 10 MV beams, mimicking high dose rate treatment deliveryscenarios. MV cross-scatter suppression performance of the proposed approachwas evaluated in projections and CBCT images of phantoms. 2D grid reduced theintensity of MV cross-scatter in kV projections by a factor of 3 on theaverage. Remaining MV cross-scatter estimated by Grid-based Scatter Samplingwas within 7% of measured reference intensity values. CBCT image quality wasimproved substantially during concurrent kV-MV beam delivery. Median HounsfieldUnit (HU) inaccuracy was up to 191 HU without our methods, and it was reducedto 3 HU with our 2D grid and scatter correction approach. Our methods provideda factor of 2-6 improvement in contrast-to-ratio. Results indicate that ourapproach can successfully minimize the effects of high energy cross-scatter inconcurrent kV CBCT imaging and megavoltage treatment delivery.

physics in medicine and biology/physics in medicine and biology

Concurrent kilovoltage CBCT imaging and megavoltage beam delivery:  Suppression of cross-scatter with 2D antiscatter grids and grid-based scatter  sampling