TY - JOUR
T1 - Antiscatter grids in mobile C-arm cone-beam CT
T2 - Effect on image quality and dose
AU - Schafer, S.
AU - Stayman, J. W.
AU - Zbijewski, W.
AU - Schmidgunst, C.
AU - Kleinszig, G.
AU - Siewerdsen, J. H.
N1 - Funding Information:
The authors gratefully acknowledge valuable discussion with Dr. Rainer Graumann (Siemens Healthcare, Erlangen, Germany) and the support of the Minimally Invasive Surgical Training Center at Johns Hopkins University (Dr. Michael Marohn, Ms. Sue Eller, Ms. Katherine Braid, and Mr. Nicholas Louloudis). This work was supported by research collaboration with Siemens Healthcare (Erlangen, Germany) and by National Institutes of Health R01 Grant No. CA-127444.
PY - 2012/1
Y1 - 2012/1
N2 - Purpose: X-ray scatter is a major detriment to image quality in cone-beam CT (CBCT). Existing geometries exhibit strong differences in scatter susceptibility with more compact geometries, e.g., dental or musculoskeletal, benefiting from antiscatter grids, whereas in more extended geometries, e.g., IGRT, grid use carries tradeoffs in image quality per unit dose. This work assesses the tradeoffs in dose and image quality for grids applied in the context of low-dose CBCT on a mobile C-arm for image-guided surgery.Methods: Studies were performed on a mobile C-arm equipped with a flat-panel detector for high-quality CBCT. Antiscatter grids of grid ratio (GR) 6:1-12:1, 40 lpcm, were tested in body surgery, i.e., spine, using protocols for bone and soft-tissue visibility in the thoracic and abdominal spine. Studies focused on grid orientation, CT number accuracy, image noise, and contrast-to-noise ratio (CNR) in quantitative phantoms at constant dose.Results: There was no effect of grid orientation on possible gridline artifacts, given accurate angle-dependent gain calibration. Incorrect calibration was found to result in gridline shadows in the projection data that imparted high-frequency artifacts in 3D reconstructions. Increasing GR reduced errors in CT number from 31%, thorax, and 37%, abdomen, for gridless operation to 2% and 10%, respectively, with a 12:1 grid, while image noise increased by up to 70%. The CNR of high-contrast objects was largely unaffected by grids, but low-contrast soft-tissues suffered reduction in CNR, 2%-65%, across the investigated GR at constant dose.Conclusions: While grids improved CT number accuracy, soft-tissue CNR was reduced due to attenuation of primary radiation. CNR could be restored by increasing dose by factors of ∼1.6-2.5 depending on GR, e.g., increase from 4.6 mGy for the thorax and 12.5 mGy for the abdomen without antiscatter grids to approximately 12 mGy and 30 mGy, respectively, with a high-GR grid. However, increasing the dose poses a significant impediment to repeat intraoperative CBCT and can cause the cumulative intraoperative dose to exceed that of a single diagnostic CT scan. This places the mobile C-arm in the category of extended CBCT geometries with sufficient air gap for which the tradeoffs between CNR and dose typically do not favor incorporation of an antiscatter grid.
AB - Purpose: X-ray scatter is a major detriment to image quality in cone-beam CT (CBCT). Existing geometries exhibit strong differences in scatter susceptibility with more compact geometries, e.g., dental or musculoskeletal, benefiting from antiscatter grids, whereas in more extended geometries, e.g., IGRT, grid use carries tradeoffs in image quality per unit dose. This work assesses the tradeoffs in dose and image quality for grids applied in the context of low-dose CBCT on a mobile C-arm for image-guided surgery.Methods: Studies were performed on a mobile C-arm equipped with a flat-panel detector for high-quality CBCT. Antiscatter grids of grid ratio (GR) 6:1-12:1, 40 lpcm, were tested in body surgery, i.e., spine, using protocols for bone and soft-tissue visibility in the thoracic and abdominal spine. Studies focused on grid orientation, CT number accuracy, image noise, and contrast-to-noise ratio (CNR) in quantitative phantoms at constant dose.Results: There was no effect of grid orientation on possible gridline artifacts, given accurate angle-dependent gain calibration. Incorrect calibration was found to result in gridline shadows in the projection data that imparted high-frequency artifacts in 3D reconstructions. Increasing GR reduced errors in CT number from 31%, thorax, and 37%, abdomen, for gridless operation to 2% and 10%, respectively, with a 12:1 grid, while image noise increased by up to 70%. The CNR of high-contrast objects was largely unaffected by grids, but low-contrast soft-tissues suffered reduction in CNR, 2%-65%, across the investigated GR at constant dose.Conclusions: While grids improved CT number accuracy, soft-tissue CNR was reduced due to attenuation of primary radiation. CNR could be restored by increasing dose by factors of ∼1.6-2.5 depending on GR, e.g., increase from 4.6 mGy for the thorax and 12.5 mGy for the abdomen without antiscatter grids to approximately 12 mGy and 30 mGy, respectively, with a high-GR grid. However, increasing the dose poses a significant impediment to repeat intraoperative CBCT and can cause the cumulative intraoperative dose to exceed that of a single diagnostic CT scan. This places the mobile C-arm in the category of extended CBCT geometries with sufficient air gap for which the tradeoffs between CNR and dose typically do not favor incorporation of an antiscatter grid.
KW - antiscatter grid
KW - cone-beam CT
KW - flat-panel detector
KW - image quality
KW - image-guided surgery
KW - minimally invasive surgery
KW - mobile C-arm
KW - spine surgery
KW - x-ray scatter
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U2 - 10.1118/1.3666947
DO - 10.1118/1.3666947
M3 - Article
C2 - 22225284
AN - SCOPUS:84855472258
SN - 0094-2405
VL - 39
SP - 153
EP - 159
JO - Medical physics
JF - Medical physics
IS - 1
ER -