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Background: Scatter radiation is a traditional problem in cone-beam computed tomography (CBCT). Accordingly, numerous methods have been researched for scatter reduction in terms of software- or hardware-based solutions. The concept of a two-dimensional antiscatter grid (2D-ASG) has been shown to provide a solution to the scatter reduction in CBCT. However, the use of an ASG makes it challenging to use in clinical CBCT systems because it causes Moire artifacts of the image., Purpose: We have developed a Moire-free 2D-ASG that was designed to solve the Moire artifact and the scatter radiation problems. We provide the experimental results pertaining to the image quality measurements from the evaluation of the 2D-ASG compared with those obtained from a one-dimensional antiscatter grid (1D-ASG) and no antiscatter grid (No-ASG) to demonstrate the quantitative extent of the improvements., Methods: The 2D-ASG, fabricated based on a sawing process with a graphite body, was prepared to evaluate image quality improvements. Projection images for Pro-CT MK II phantom were acquired using the CBCT testbed of sample rotation type and reconstructed by Feldkamp-Davis-Kress (FDK) algorithm without any filters. We measured the contrast-to-noise ratio (CNR) and uniformity index for the cupping artifacts of the 2D-ASG, 1D-ASG, and No-ASG cases., Results: 2D-ASG considerably reduced the cupping artifacts owing to the scatter reduction compared with the 1D-ASG and No-ASG cases. The cupping artifacts were reduced by 85% in the 2D-ASG compared with No-ASG, while the cupping artifacts were reduced by 63% in 1D-ASG compared with No-ASG. The 2D-ASG also yielded a CNR improvement. The average CNR improvements for eight insert materials were 47% in the 2D-ASG compared with No-ASG, while the CNR was improved by 36% in the 1D-ASG compared with No-ASG., Conclusions: We demonstrated that the Moire-free 2D-ASG improved the image quality by removing scatter radiation in CBCT compared with 1D-ASG and No-ASG. We believe that the Moire-free 2D-ASG can become one of the effective ways to solve the scatter radiation problem in CBCT images because it provides usability and has the potential to have synergistic effects on other methods, such as bow-tie filter and scatter correction., (© 2023 American Association of Physicists in Medicine.)

Purpose: The authors aim was to investigate the effects of using transmission and reflection scanning modes, the film orientation during scanning, and ambient room light on a dosimetry system based on the Gafchromic(TM) EBT2 film model., Methods: For calibration, the films were cut to 3 × 3 cm(2) and irradiated from 20 to 700 cGy at the depth of maximum dose using 6 and 10 MV photon beams in a 10 × 10 cm(2) field size. Absolute dose calibration of the linear accelerator was done according to the TRS398 protocol. An FG65-G ionization chamber was used to monitor the dose while irradiating the films in solid water. The film pieces were scanned with an EPSON Expression 1680 Pro flatbed scanner in transmission and reflection modes. Authors investigated the effect of orientation on films and examined the optical properties of EBT2 film using an ellipsometer and an ultraviolet (UV)/visible spectrometer to explain the dosimetric dependence of the film on orientation during the scanning process. To investigate the effect of ambient room light, films were preirradiated in 6 and 10 MV photon beams with intensity-modulated radiotherapy (IMRT) quality assurance (QA) plans, and then exposed to room light, either directly for 2 days in a workroom or for 2 months in a film box. Gamma index pass criteria of (3%, 3 mm) were used., Results: The dose response curves based on net optical density (NOD) indicated that the reflection scanning mode can provide a better dose sensitivity than the transmission scanning mode, whereas the standard deviation of the dose is greater in reflection mode than in transmission mode. When the film was rotated 90° from the portrait orientation, the average dose of the EBT2 film decreased by 11.5-19.6% in transmission mode and by 1.5-2.3% in reflection mode. Using an ellipsometer, variation of the refractive index of EBT2 film-the birefringence property-was found to be the largest between 45° (1.72 and 1.71) and 135° (1.8 and 1.77) for 300 and 800 cGy. Absorption spectra of EBT2 films measured with spectrometer were the function of film orientation. The readings in reflection scanning mode were more stable against room light than those in transmission scanning mode, although dose readings increased in both modes after the films were exposed to room light., Conclusions: The transmission scanning mode exhibited a strong dependence on film orientation during scanning and a change in optical density resulting from room light exposure, so a constant scanning orientation and minimal exposure to light can reduce uncertainty in the measured dose (23 ± 3%). The angular dependence was analyzed using Jones matrices and optical properties of EBT2 film were obtained using an ellipsometer and an UV/visible spectrometer. The reflection scanning mode has relatively good stability with respect to room light and film orientation on a scanner, although the large standard deviation of dose is a disadvantage in measurements of absolute dose. Reflection scanning mode can offer a potential advantage for film dosimetry in radiotherapy, although transmission scanning mode is still recommended for dosimetry as it provides better uncertainty results.

Several studies on the effect of tumor cell killing by dose rate variation have implied that the use of a shorter treatment time is more favorable for intensity modulated radiation therapy (IMRT). Aiming at step-and-shoot IMRT with higher dose rates, the stabilities of beam output and profiles with small monitor unit (MU) settings were investigated for various dose rates. With the use of a Varian 21EX (Varian Medical Systems Inc., Palo Alto, CA), static and step-and-shoot IMRT beam output along with profiles were measured by use of an ion chamber and a two-dimensional diode array detector as a function of monitor units and dose rates. For a static case, as the MU approached 1, the beam output increased up to 2% for 300 MU/min and 4.5% for 600 MU/min, showing a larger overdose as the dose rate increased. Deterioration of the beam symmetry and flatness were also observed as the MU decreased to 1 monitor unit. For the step-and-shoot IMRT case, a large dosimetric error of more than 10% was also detected with the use of a small MU segment. However, no definite correlation with the dose rate was observed due to the combined beam start-up effects by the grid pulse and finite communication time between the machine console and multileaf collimator (MLC) controller. For step-and-shoot IMRT with higher dose rates, beam output and beam profile stability with small MU needs to be checked, and adequate MU limitation where segments are not allowed need to be reflected in the step-and-shoot IMRT planning.