SU-E-J-39: Minimizing IGRT Imaging Exposures: KV Radiograph Vs. KV-CBCT Vs. MV Portal Images

To compare the IGRT doses from MV, kV and CBCT images.

kV imaging systems integrated into Varian Trilogy and TrueBeam accelerators were modeled using BEAMnrc/DOSXYZnrc Monte Carlo codes and the dose to calibration phantoms for a variety of kV beams(kVp, bow-tie filters, etc.) were calculated. The doses to the same phantoms and kV beams were then measured experimentally using calibrated ion-chambers.The "calibrated" Monte Carlo kV beams were used to calculate dose to CT images of patients. Organ doses were analyzed using DVHs.

The doses to the prostate are 0.015 and 2.2cGy using AP kV and MV images; are 0.06 and 2.3cGy using lateral kV and MV images; and, are 1.7 cGy using CBCT images. For head and neck images, the doses to the eye are 0.08 and 0.001 cGy using AP and PA kV images; are 2.3 and 1.8cGy using AP and PA MV images; are 0.001 and 2.4cGy for lateral kV and MV images; and, are 0.2 cGy for CBCT images. For kV radiographs, organ doses can be further reduced, by over 30%, by using bow-tie filters. CBCT doses to the prostate are 1.6 and 0.9cGy for OBI and TrueBeam pelvis scans; a >40% dose reduction for the same image quality. For OBI CBCT head scans the doses to the eye and brain stem are 0.2 and 2.8cGy, respectively.

Due to the low penetration of kV beams,selecting beam angles so that the sensitive organs are near the beam exit, and/or using bow-tie filters, can substantially reduce organ doses when using kV radiographs. For daily positioning of pediatric brain patient with a set of orthogonal kV images, a CBCT scan, or a set of orthogonal MV images, the doses to the eyes are 0.1, 0.2, and 4.7 cGy, respectively.