Evaluation of cumulative dose for cone-beam computed tomography (CBCT) scans within phantoms made from different compositions using Monte Carlo simulations

Measurement of cumulative dose f(0,150) with a small ionization chamber within standard polymethyl methacrylate (PMMA) CT head and body phantoms, 150 mm in length, is a possible practical method for cone-beam computed tomography (CBCT) dosimetry. This differs from evaluating cumulative dose under scatter equilibrium conditions within an infinitely long phantom f(0,infinity), which is proposed by AAPM TG-111 for CBCT dosimetry. The aim of this study was to investigate the feasibility of using f(0,150) to estimate values for f(0,infinity) in long head and body phantoms made of PMMA, polyethylene (PE), and water, using beam qualities for tube potentials of 80-140 kV. The study also investigated the possibility of using 150 mm PE phantoms for assessment of f(0,infinity) within long PE phantoms, the ICRU/AAPM phantom. The influence of scan parameters, composition, and length of the phantoms was investigated. The capability of f(0,150) to assess f(0,infinity) has been defined as the efficiency and assessed in terms of the ratios epsilon(f(0,150) /f(0,infinity)). The efficiencies were calculated using Monte Carlo simulations for an On-Board Imager (OBI) system mounted on a TrueBeam linear accelerator. Head and body scanning protocols with beams of width 40-500 mm were used. Efficiencies epsilon(PMMA/PMMA) and epsilon(PE/PE) as a function of beam width exhibited three separate regions. For beam widths < 150 mm, epsilon(PMMA/PMMA) and epsilon(PE/PE) values were greater than 90% for the head and body phantoms. The efficiency values then fell rapidly with increasing beam width before levelling off at 74% for epsilon(PMMA/PMMA) and 69% for epsilon(PE/PE) for a 500 mm beam width. The quantities epsilon(PMMA/PE) and epsilon(PMMA/Water) varied with beam width in a different manner. Values at the centers of the phantoms for narrow beams were lower and increased to a steady state for similar to 100-150 mm wide beams, before declining with increasing the beam width, whereas values at the peripheries decreased steadily with beam width. Results for epsilon(PMMA/PMMA) were virtually independent of tube potential, but there was more variation for epsilon(PMMA/PE) and epsilon(PMMA/Water). f(0,150) underestimated f(0,infinity) for beam widths used for CBCT scans, thus it is necessary to use long phantoms, or apply conversion factors (C(f)s) to measurements with standard PMMA CT phantoms. The efficiency values have been used to derive (C(f)s) to allow evaluation of f(0,infinity) from measurements of f(0,150). The (C(f)s) only showed a weak dependence on scan parameters and scanner type, and so may be suitable for general application.