Initial application of digital tomosynthesis with on-board imaging in radiation oncology

We present preliminary investigations that examine the feasibility of incorporating digital tomosynthesis into radiation oncology practice with the use of kilovoltage on-board imagers (OBI). Modem radiation oncology linear accelerators now include hardware options for the addition of OBI for on-line patient setup verification. These systems include an x-ray tube and detector mounted directly on the accelerator gantry that rotate with the same isocenter. Applications include cone beam computed tomography (CBCT), fluoroscopy, and radiographs to examine daily patient positioning to determine if the patient is in the same location as the treatment plan. While CBCT provides the greatest anatomical detail, this approach is limited by long acquisition and reconstruction times and higher patient dose. We propose to examine the use of tomosynthesis reconstructed volumetric data from limited angle projection images for short imaging time and reduced patient dose. Initial data uses 61 projection images acquired over an isocentric arc of twenty degrees with the detector approximately fifty-four centimeters from isocenter. A modified filtered back projection technique, which included a mathematical correction for isocentric motion, was used to reconstruct volume images. These images will be visually and mathematically compared to volumetric computed tomography images to determine efficacy of this system for daily patient positioning verification. Initial images using the tomosynthesis reconstruction technique show much promise and bode well for effective daily patient positioning verification with reduced patient dose and imaging time. Additionally, the fast image acquisition may allow for a single breath hold imaging sequence, which will have no breath motion.