Region-of-interest image reconstruction with intensity weighting in circular cone-beam CT for image-guided radiation therapy

Imaging plays a vital role in radiation therapy and with recent advances in technology considerable emphasis has been placed on cone-beam CT (CBCT). Attaching a kV x-ray source and a flat panel detector directly to the linear accelerator gantry has enabled progress in target localization techniques, which can include daily CBCT setup scans for some treatments. However, with an increasing number of CT scans there is also an increasing concern for patient exposure. An intensity-weighted region-of-interest (IWROI) technique, which has the potential to greatly reduce CBCT dose, in conjunction with the chord-based backprojection-filtration (BPF) reconstruction algorithm, has been developed and its feasibility in clinical use is demonstrated in this article. A nonuniform filter is placed in the x-ray beam to create regions of two different beam intensities. In this manner, regions outside the target area can be given a reduced dose but still visualized with a lower contrast to noise ratio. Image artifacts due to transverse data truncation, which would have occurred in conventional reconstruction algorithms, are avoided and image noise levels of the low- and high-intensity regions are well controlled by use of the chord-based BPF reconstruction algorithm. The proposed IWROI technique can play an important role in image-guided radiation therapy.