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Cone beam CT dose reduction in prostate radiotherapy using Likert scale methods.

Keith A Langmack1, Louise A Newton1, Suzanne Jordan2

  • 11 Departments of Medical Physics, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham.

The British Journal of Radiology
|December 23, 2015
PubMed
Summary

Image quality for prostate cancer radiotherapy can be optimized by reducing cone beam CT (CBCT) exposure. This study found that lower exposure levels maintained image quality for soft-tissue matching, especially for patients with smaller separations.

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Area of Science:

  • Medical Physics
  • Radiotherapy
  • Image Analysis

Background:

  • Image quality (IQ) is critical for soft-tissue matching in image-guided radiotherapy (IGRT).
  • Cone beam computed tomography (CBCT) is widely used for IGRT, but radiation exposure is a concern.

Purpose of the Study:

  • To optimize CBCT image quality for prostate cancer soft-tissue matching using a Likert scale method.
  • To determine acceptable reductions in radiation exposure without compromising image guidance accuracy.

Main Methods:

  • A 4-point Likert scale was used to assess CBCT IQ in 23 prostate cancer patients across three exposure levels.
  • Statistical analyses (Friedman test, Wilcoxon signed-rank test, point-biserial correlation) were employed to evaluate IQ, exposure, and patient separation.

Main Results:

  • Image quality was significantly related to exposure levels (p < 0.0000002).
  • Lowering exposure decreased image quality, but acceptable IQ was maintained for soft-tissue matching.
  • No correlation was found between IQ and patient separation, with reduced exposure feasible for separations <35 cm.

Conclusions:

  • Radiation exposure for CBCT in prostate IGRT can be reduced by up to 20% for all patients and 36% for patients with lateral separations <35 cm without hindering soft-tissue matching.
  • Likert scales are effective for optimizing CBCT IQ in radiotherapy image guidance.