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Area of Science:

  • Medical Physics
  • Radiological Imaging
  • Radiation Oncology

Background:

  • Current on-board kV imaging in proton therapy relies on energy-integrating detectors (EIDs), which have limitations in image quality and quantification accuracy.
  • These limitations hinder the progress of online adaptive proton therapy and other advanced imaging applications.
  • Photon-counting detectors (PCDs) offer potential improvements in image quality and spectral information.

Purpose of the Study:

  • To experimentally demonstrate the feasibility of on-board photon-counting detector (PCD) CT imaging integrated with a proton therapy gantry.
  • To evaluate the non-spectral image quality of PCD-CT compared to conventional EID-CBCT.
  • To assess the spectral imaging capability of PCD-CT for electron density ratio estimation.

Main Methods:

  • A CdTe-based PCD with 100 μm pixel size and two energy channels was mounted on an IBA Proteus ONE proton therapy system.
  • PCD-CT scans were performed using the same acquisition protocol as clinical EID-CBCT for head imaging.
  • Image quality was assessed using modulation transfer function (MTF) and contrast-to-noise ratio (CNR) with standardized phantoms; electron density ratios were estimated from spectral data.

Main Results:

  • PCD demonstrated significantly higher detective quantum efficiency than EID, particularly at high spatial frequencies.
  • PCD-CT achieved consistently higher CNR compared to EID-CBCT across various material inserts.
  • Spectral PCD-CT data yielded a mean absolute percent error of 1.8% for estimated electron density ratios.

Conclusions:

  • Gantry-mounted PCD tomographic imaging for proton therapy has been successfully demonstrated for the first time.
  • The PCD-CT prototype offers superior non-spectral image quality compared to conventional EID-CBCT.
  • The spectral imaging capability of PCD-CT enables accurate electron density ratio estimation, crucial for adaptive proton therapy.