Tomographic Imaging on a Cobalt Radiotherapy Machine

Abstract

Cancer is a global problem, and many people in low-income countries do not have access to the treatment options, such as radiation therapy, that are available in wealthy countries. Where radiation therapy is available, it is often delivered using older Co-60 equipment that has not been updated to modern standards.

Previous research has indicated that an updated Co-60 radiation therapy machine could deliver treatments that are equivalent to those performed with modern linear accelerators. Among the key features of these modern treatments is a tightly conformal dose distribution-- the radiation dose is shaped in three dimensions to closely match the tumour, with minimal irradiation of surrounding normal tissues. Very accurate alignment of the patient in the beam is therefore necessary to avoid missing the tumour, so all modern radiotherapy machines include imaging systems to verify the patient's position before treatment.

Imaging with the treatment beam is relatively cost-effective, as it avoids the need for a second radiation source and the associated control systems. The dose rate from a Co-60 therapy source, though, is more than an order of magnitude too high to use for computed tomography (CT) imaging of a patient. Digital tomosynthesis (DT), a limited-arc imaging method that can be thought of as a hybrid of CT and conventional radiography, allows some of the three-dimensional selectivity of CT but with shorter imaging times and a five- to fifteen-fold reduction in dose.

In the present work, a prototype Co-60 DT imaging system was developed and characterized. A class of clinically useful Co-60 DT protocols has been identified, based on the filtered backprojection algorithm originally designed for CT, with images acquired over a relatively small arc. Parts of the reconstruction algorithm must be modified for the DT case, and a way to reduce the beam intensity will be necessary to reduce the imaging dose to acceptable levels. Some additional study is required to determine whether improvements made to the DT imaging protocol translate to improvements in the accuracy of the image guidance process, but it is clear that Co-60 DT is feasible and will probably be practical for clinical use.