Implementation and Characterization of Cone Beam Computed Tomography Using a Cobalt-60 Gamma Ray Source for Radiation Therapy Patient Localization

Abstract

Cobalt 60 (Co-60) radiation therapy is a simple and reliable method of treating cancer by irradiating treatment volumes within the patient with high energy gamma rays. Medical linear accelerators (linacs) began to replace Co-60 units during the 1960’s in more developed countries, but Co 60 has remained the main source of radiotherapy treatment in less developed countries around the world. As a result, technological advancements made in more developed countries to deliver more precise radiation treatment that improves patient outcome have not been clinically applied to Co-60 machines. The medical physics group at the Cancer Centre of Southeastern Ontario has shown that these same technological advancements can be applied to Co-60 machines which would increase the accessibility of these modern improvements in radiotherapy treatment. However, for these modern treatments to improve patient outcome they require more precise localization of the patient prior to therapy. In more developed countries, this is currently provided by comparing computed tomography (CT) used for treatment planning with images acquired on the linac immediately before treatment. In the past decade, cone-beam CT (CBCT) has been developed to provide 3D CT images of the patient immediately prior to treatment on a linac. This imaging modality would also be ideal for patient localization when conducting modern Co-60 treatments since it would only require the addition of an imaging panel to produce CBCT images using the Co-60 source. A prototype Co-60 CBCT imaging system was implemented and characterized. Image noise, contrast, spatial resolution, and artifacts were studied. Algorithms to reduce the image artifacts were implemented and found to improve perceived image quality. The imaging system was found to have a ~1.8 mm high-contrast spatial resolution and the ability to detect 3 cm low-contrast soft-tissue structures in water. Anthropomorphic phantoms were also imaged and the observed anatomy in Co-60 CBCT images was comparable to kilovoltage CT. These results are comparable to clinically relevant linac-based CBCT using high energy X rays of similar energies to Co-60 gamma rays. This suggests that Co-60 CBCT should be able to provide the necessary images to localize patients for modern Co-60 radiation treatments.