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The pharmacokinetic behavior of iodine contrast agents makes it difficult to achieve significant enhancement during contrast-enhanced cone-beam CT (CE-CBCT). This study modeled this dynamic behavior to optimize CE-CBCT and improve the localization of liver lesions for SBRT. We developed a model that allows for controlled study of changing iodine concentrations using static phantoms. A projection database consisting of multiple phantom images of differing iodine/scan conditions was built. To reconstruct images of dynamic hepatic concentrations, hepatic contrast enhancement data from conventional CT scans were used to re-assemble the projections to match the expected amount of contrast. In this way the effect of various parameters on image quality was isolated, and using our dynamic model we found parameters for iodine injection, CBCT scanning, and injection/scanning timing which optimize contrast enhancement. Increasing the iodine dose, iodine injection rate, and imaging dose led to significant increases in signal-to-noise ratio (SNR). Reducing the CBCT imaging time also increased SNR, as the image can be completed before the iodine exits the liver. Proper timing of image acquisition played a significant role, as a 30 second error in start time resulted in a 40% SNR decrease. The effect of IV contrast is severely degraded in CBCT, but there is promise that, with optimization of the injection and scan parameters to account for iodine pharmacokinetics, CE-CBCT which models venous-phase blood flow kinetics will be feasible for accurate localization of liver lesions.

Optimized dynamic contrast-enhanced cone-beam CT for target visualization during liver SBRT