Rotational artifacts in on-board cone beam computed tomography

Rotational artifacts in image guidance systems lead to registration errors that affect non-isocentric treatments and dose to off-axis organs-at-risk. This study investigates a rotational artifact in the images acquired with the on-board cone beam computed tomography system XVI (Elekta, Stockholm, Sweden). The goals of the study are to identify the cause of the artifact, to characterize its dependence on other quantities, and to investigate possible solutions. A 30 cm diameter cylindrical phantom is used to acquire clockwise and counterclockwise scans at five speeds (120 to 360 deg min(-1)) on six Elekta linear accelerators from three generations (MLCi, MLCi2 and Agility). Additional scans are acquired with different pulse widths and focal spot sizes for the same mAs. Image quality is evaluated using a common phantom with an in-house three dimensional contrast transfer function attachment. A robust, operator-independent analysis is developed which quantifies rotational artifacts with 0.02 degrees accuracy and imaging system delays with 3 ms accuracy. Results show that the artifact is caused by mislabelling of the projections with a lagging angle due to various imaging system delays. For the most clinically used scan speed (360 deg min(-1)), the artifact is similar to 0.5 degrees, which corresponds to similar to 0.25 degrees error per scan direction with the standard Elekta procedure for angle calibration. This leads to a 0.5 mm registration error at 11 cm off-center. The artifact increases linearly with scan speed, indicating that the system delay is independent of scan speed. For the most commonly used pulse width of 40 ms, this delay is 34 +/- 1 ms, part of which is half the pulse width. Results are consistent among the three linac generations. A software solution that corrects the angles of individual projections is shown to eliminate the rotational error for all scan speeds and directions. Until such a solution is available from the manufacturer, three clinical solutions are presented, which reduce the rotational error without compromising image quality.