Improved cone-beam computed tomography in supine and prone breast radiotherapy: surface reconstruction, radiation exposure, and clinical workflow

Background and purpose. Cone-beam computerized tomography (CBCT) enables three-dimensional information of the scanned region and provides soft tissue images with good spatial resolution. Our aim was to optimize image acquisition settings for prone and supine breast radiotherapy with respect to contour accuracy, clinical practicalities, and radiation dose. Patients and methods. CBCT images were acquired for both prone and supine anthropomorphic phantoms and a female cadaver in supine and prone set-up. CBCT protocols were investigated by altering the tube current, exposure time, range of projection views, field of view (FOV), and starting angle. For clinical practicalities, the frequency of the use of an offset CBCT isocenter was evaluated at 558 205A degrees-CBCTs (37 patients; 13 prone and 24 supine) and 1272 360A degrees-CBCTs (102 patients; 13 prone and 89 supine). Results. Prone and supine breast CBCT images acquired with a bowtie filter, a small FOV, a range of projection views equaling 180A degrees, a tube current of 20 mA and an exposure time of 32 ms, demonstrated adequate contour accuracy and an elimination of the offset CBCT isocenter procedure, while this occurred in 40.7 % for the old full-rotation protocol. Furthermore a 4.3-fold dose reduction was observed for the Computed Tomography Dose Index (CTDIw) compared to the preset Chest M20 protocol. Conclusion. The established 180A degrees protocol demonstrated acceptable contour accuracy, eliminated the CBCT isocenter offset procedure and reduced patient radiation exposure