An analytical approach to estimating the first order scatter in heterogeneous medium. II. A practical application

Recently, the authors proposed an analytical scheme to estimate the first order x-ray scatter by approximating the Klein-Nishina formula so that the first order scatter fluence is expressed as a function of the primary photon fluence on the detector. In this work, the authors apply the scheme to experimentally obtained 6 MV cone beam CT projections in which the primary photon fluence is the unknown of interest. With the assumption that the higher-order scatter fluence is either constant or proportional to the first order scatter fluence, an iterative approach is proposed to estimate both primary and scatter fluences from projections by utilizing their relationship. The iterative approach is evaluated by comparisons with experimentally measured scatter-primary ratios of a Catphan phantom and with Monte Carlo simulations of virtual phantoms. The convergence of the iterations is fast and the accuracy of scatter correction is high. For a sufficiently long cylindrical water phantom with 10 cm of radius, the relative error of estimated primary photon fluence was within +/- 2% and +/- 4% when the phantom was projected with 6 MV and 120 kVp x-ray imaging systems, respectively. In addition, the iterative approach for scatter estimation is applied to 6 MV x-ray projections of a QUASAR and anthropomorphic phantoms (head and pelvis). The scatter correction is demonstrated to significantly improve the accuracy of the reconstructed linear attenuation coefficient and the contrast of the projections and reconstructed volumetric images generated with a linac 6 MV beam.