Organ and effective dose reduction for region-of-interest (ROI) CBCT and fluoroscopy

In some medical-imaging procedures using CBCT and fluoroscopy, it may be needed to visualize only the center of the field-of-view with optimal quality. To reduce the dose to the patient as well as enable increased contrast in the region of interest (ROI) during CBCT and fluoroscopy procedures, a 0.7 mm thick Cu ROI attenuator with a circular aperture 12% of the FOV was used. The aim of this study was to quantify the dose-reduction benefit of ROI imaging during a typical CBCT and interventional fluoroscopy procedures in the head and torso. The Toshiba Infinix C-Arm System was modeled in BEAMnrc/EGSnrc with and without the ROI attenuator. Patient organ and effective doses were calculated in DOSXYZnrc/EGSnrc Monte-Carlo software for CBCT and interventional procedures. We first compared the entrance dose with and without the ROI attenuator on a 20 cm thick solid-water block. Then we simulated a CBCT scan and an interventional fluoroscopy procedure on the head and torso with and without an ROI attenuator. The results showed that the entrance-surface dose reduction in the solid water is about 85.7% outside the ROI opening and 10.5% in the ROI opening. The results showed a reduction in most organ doses of 45%-70% and in effective dose of 46%-66% compared to the dose in a CBCT scan and in an interventional procedure without the ROI attenuator. This work provides evidence of substantial reduction of organ and effective doses when using an ROI attenuator during CBCT and fluoroscopic procedures.