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Purpose To investigate the possible advantages of using 4pi‐optimized arc trajectories in stereotactic body radiation therapy of ventricular tachycardia (VT‐SBRT) to minimize exposure of healthy tissues. Methods and materials Thorax computed tomography (CT) data for 15 patients were used for contouring organs at risk (OARs) and defining realistic planning target volumes (PTVs). A conventional trajectory plan, defined as two full coplanar arcs was compared to an optimized‐trajectory plan provided by a 4pi algorithm that penalizes geometric overlap of PTV and OARs in the beam's‐eye‐view. A single fraction of 25 Gy was prescribed to the PTV in both plans and a comparison of dose sparing to OARs was performed based on comparisons of maximum, mean, and median dose. Results A significant average reduction in maximum dose was observed for esophagus (18%), spinal cord (26%), and trachea (22%) when using 4pi‐optimized trajectories. Mean doses were also found to decrease for esophagus (19%), spinal cord (33%), skin (18%), liver (59%), lungs (19%), trachea (43%), aorta (11%), inferior vena cava (25%), superior vena cava (33%), and pulmonary trunk (26%). A median dose reduction was observed for esophagus (40%), spinal cord (48%), skin (36%), liver (72%), lungs (41%), stomach (45%), trachea (53%), aorta (45%), superior vena cava (38%), pulmonary veins (32%), and pulmonary trunk (39%). No significant difference was observed for maximum dose (p = 0.650) and homogeneity index (p = 0.156) for the PTV. Average values of conformity number were 0.86 ± 0.05 and 0.77 ± 0.09 for the conventional and 4pi optimized plans respectively. Conclusions 4pi optimized trajectories provided significant reduction to mean and median doses to cardiac structures close to the target but did not decrease maximum dose. Significant improvement in maximum, mean and median doses for noncardiac OARs makes 4pi optimized trajectories a suitable delivery technique for treating VT.

Purpose To evaluate possible use for cone-beam computed tomography (CBCT) guidance, this phantom study evaluated the contrast enhancement provided by Gadoxetate Disodium (Primovist® CAN/EU, or Eovist® USA, Bayer Healthcare, Leverkusen, Germany), a contrast agent that is taken up selectively by liver cells and is retained for up to an hour. Image quality from CBCT was benchmarked against helical fan-beam computed tomography for two phantom geometries. Methods and materials Concentrations were diluted to 0.0125-0.1 mmol per kilogram of body weight (mmol/kg) corresponding to expected physiological concentrations in the liver. Kilovoltage CBCT imaging parameters of x-ray tube potential, current, and filtration were investigated using clinically available options on a TrueBeam STx linear accelerator CBCT platform. Two phantoms were created, a cylindrical idealized imaging geometry and an ellipsoidal more realistic abdominal geometry. All parameters were optimized according to the contrast-to-noise ratio (CNR) image quality metric, as a function of concentration, following the Rose criterion for CNR. Results Acceptable CNR was defined as greater than or equal to three, in accordance with the Rose criterion for CNR. These were found in a range of expected liver concentrations of 0.025-0.1 mmol/kg for a tube potential of 100 kVp, half-fan bowtie filtration and tube currents giving exposures between 2025 and 5085 mAs. Linear correlations were found for all CNR as a function of concentration, in agreement with the literature. Conclusion Based on this phantom study, with appropriate selection of imaging protocol, Gadoxetate Disodium may provide useful liver CBCT enhancement at physiologically achievable liver concentrations.

This work presents a non-contact, non-ionizing solution for the continuous detection and characterization of intrafraction cranial motion with six-degrees of freedom (DoF). This capacitive monitoring system is a modular tool capable of detecting the cranial position through a thermoplastic mask without the use of skin as a surrogate. The purpose of this investigation is to develop an array of capacitive monitoring sensor plates capable of detecting translational and rotational cranial motion during radiotherapy. This study compares the performance of different capacitive monitoring array designs for their potential to detect intrafraction cranial translations and rotations. To this end, a finite element analysis (FEA) model of the human cranium was used to calculate the system capacitance while simulating translational (superior-inferior, lateral, anterior-posterior) and rotational (roll, pitch, yaw) cranial motion. The model was validated by comparing simulation results against experimental results acquired with the help of human volunteers. The verified FEA model was then used to compare multiple potential array designs. The arrays' sensitivities to translational and rotational motion and uniqueness of response were compared to determine the most promising design for six-DoF motion detection. The most promising array design was chosen for a clinical volunteer study.

PURPOSE The purpose of this study is to improve dose distribution and organ-at-risk sparing during gynecologic HDR brachytherapy with patient-specific applicators. The majority of applicators used today are generic in design and do not allow for dose modulation for patient-specific shaping of dose distributions. Their performance might be adjusted with commercially available wedge shields; however, this provides dose modulation in the orthogonal plane only and does not allow for variation along the length of the applicator. Generic applicators are available only in standard sizes and geometries, and provide suboptimal patient fit with limited dose modulation. METHODS In this paper we use Monte Carlo modeling for comprehensive characterization of radiologic properties of various 3D printable biocompatible and sterilizable materials with comparison to water. Based on these results, we choose the optimal set of materials for a patient-specific applicator. We develop a novel method to design the patient-specific applicator without incurring a significant increase in treatment time or changes to clinical workflow. Finally, using an example of two selected vaginal cancers, we compare the performance of patient-specific and water-equivalent applicators in terms of target coverage and rectum sparing. RESULTS In the energy range from 1 MeV to 4 MeV, all materials have similar attenuation coefficients. In the range from ~2 keV to 1 MeV and above 4 MeV, tungsten-polylactic acid composite (WPLA) was seen to have the highest attenuation coefficient. The dose distribution of the water-equivalent applicator was found to be symmetric about its central axis. At the same time patient-specific shielded applicators exhibit well-modulated dose distributions. Their isodose lines are seen to spread radially into the patient, while merging close to the applicator surface, where WPLA shielding has been applied. CONCLUSIONS The patient-specific cylinders provide comparable dose to the target, while offering advanced healthy tissue sparing, not achievable with the generic design.

Radiotherapy (RT) is an effective cancer treatment modality, but standard RT often causes collateral damage to nearby healthy tissues. To increase therapeutic ratio, radiosensitization via gold nanoparticles (GNPs) has been shown to be effective. One challenge is that megavoltage beams generated by clinical linear accelerators are poor initiators of the photoelectric effect. Previous computer models predicted that a diamond target beam (DTB) will yield 400% more low-energy photons, increasing the probability of interacting with GNPs to enhance the radiation dose by 7.7-fold in the GNP vicinity. After testing DTB radiation coupled with GNPs in multiple cell types, we demonstrate decreased head-and-neck cancer (HNC) cell viability in vitro and enhanced cell-killing in zebrafish xenografts compared to standard RT. HNC cell lines also displayed increased double-stranded DNA breaks with DTB irradiation in the presence of GNPs. This study presents preclinical responses to GNP-enhanced radiotherapy with the novel DTB, providing the first functional data to support the theoretical evidence for radiosensitization via GNPs in this context, and highlighting the potential of this approach to optimize the efficacy of RT in anatomically difficult-to-treat tumors.

We propose a new methodology for the fabrication and evaluation of scintillating detector elements using a consumer grade fusion deposition modeling (FDM) 3D printer. In this study we performed a comprehensive investigation into both the effects of the 3D printing process on the scintillation light output of 3D printed plastic scintillation dosimeters (PSDs) and their associated dosimetric properties. Fabrication properties including print variability, layer thickness, anisotropy and extrusion temperature were assessed for 1 cm3 printed samples. We then examined the stability, dose linearity, dose rate proportionality, energy dependence and reproducibility of the 3D printed PSDs compared to benchmarks set by commercially available products. Experimental results indicate that the shape of the emission spectrum of the 3D printed PSDs do not show significant spectral differences when compared to the emission spectrum of the commercial sample. However, the magnitude of scintillation light output was found to be strongly dependent on the parameters of the fabrication process. Dosimetric testing indicates that the 3D printed PSDs share many desirable properties with current commercially available PSDs such as dose linearity, dose rate independence, energy independence in the MV range, repeatability, and stability. These results demonstrate that not only does 3D printing offer a new avenue for the production and manufacturing of PSDs but also allows for further investigation into the application of 3D printing in dosimetry. Such investigations could include options for 3D printed, patient-specific scintillating dosimeters that may be used as standalone dosimeters or incorporated into existing 3D printed patient devices (e.g. bolus or immobilization) used during the delivery of radiation therapy.

The purpose of this investigation is to improve intra-fractional motion detection during cranial stereotactic radiosurgery with a novel capacitive motion sensing (CMS) system. Previous work showed that a capacitive detection system, based on a MPR121 capacitance-to-digital converter, provided a number of advantages over existing patient imaging systems used in the clinic, by uniquely offering ionizing-radiation-free and continuous monitoring without modification to the immobilization mask or treatment room. However, in order to provide submillimeter detection accuracy, the MPR121-based CMS system required relatively large sensors in close proximity to the patient. Therefore, the aim of this investigation was to improve sensitivity of the system, allowing reduction in sensor size and preserving its stable operation in the linear accelerator environment. For this, we developed, characterized and compared motion detection capabilities of four CMS systems based on different capacitance-to-digital converters: MPR121, CPT212B, FDC1004 and FDC2214. Among all candidates, the FDC2214-based system was found to uniquely combine accurate 3D motion detection in real time, with stable performance under ionizing radiation. It exhibited an order of magnitude improvement in sensitivity in comparison with the proof-of-study system, allowing a spatial precision as low as 0.3 mm, and its overall performance was found to satisfy the AAPM practice guidelines of positioning tolerance within 1 mm. Furthermore, the high sensitivity of the system allows both reduction of the sensor area and location more distant from the patient surface, which are key improvements with regard to development of a clinical device.

Purpose/objectives Three‐dimensional (3D) printing is recognized as an effective clinical and educational tool in procedurally intensive specialties. However, it has a nascent role in radiation oncology. The goal of this investigation is to clarify the extent to which 3D printing applications are currently being used in radiation oncology through a systematic review of the literature. Materials/methods A search protocol was defined according to preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines. Included articles were evaluated using parameters of interest including: year and country of publication, experimental design, sample size for clinical studies, radiation oncology topic, reported outcomes, and implementation barriers or safety concerns. Results One hundred and three publications from 2012 to 2019 met inclusion criteria. The most commonly described 3D printing applications included quality assurance phantoms (26%), brachytherapy applicators (20%), bolus (17%), preclinical animal irradiation (10%), compensators (7%), and immobilization devices (5%). Most studies were preclinical feasibility studies (63%), with few clinical investigations such as case reports or series (13%) or cohort studies (11%). The most common applications evaluated within clinical settings included brachytherapy applicators (44%) and bolus (28%). Sample sizes for clinical investigations were small (median 10, range 1–42). A minority of articles described basic or translational research (11%) and workflow or cost evaluation studies (3%). The number of articles increased over time (P

Brachytherapy is a mature treatment modality. The literature is abundant in terms of review articles and comprehensive books on the latest established as well as evolving clinical practices. The intent of this article is to part ways and look beyond the current state-of-the-art and review emerging technologies that are noteworthy and perhaps may drive the future innovations in the field. There are plenty of candidate topics that deserve a deeper look, of course, but with practical limits in this communicative platform, we explore four topics that perhaps is worthwhile to review in detail at this time. First, intensity modulated brachytherapy (IMBT) is reviewed. The IMBT takes advantage of anisotropic radiation profile generated through intelligent high-density shielding designs incorporated onto sources and applicators such to achieve high quality plans. Second, emerging applications of 3D printing (i.e. additive manufacturing) in brachytherapy are reviewed. With the advent of 3D printing, interest in this technology in brachytherapy has been immense and translation swift due to their potential to tailor applicators and treatments customizable to each individual patient. This is followed by, in third, innovations in treatment planning concerning catheter placement and dwell times where new modelling approaches, solution algorithms, and technological advances are reviewed. And, fourth and lastly, applications of a new machine learning technique, called deep learning, which has the potential to improve and automate all aspects of brachytherapy workflow, are reviewed. We do not expect that all ideas and innovations reviewed in this article will ultimately reach clinic but, nonetheless, this review provides a decent glimpse of what is to come. It would be exciting to monitor as IMBT, 3D printing, novel optimization algorithms, and deep learning technologies evolve over time and translate into pilot testing and sensibly phased clinical trials, and ultimately make a difference for cancer patients. Today’s fancy is tomorrow’s reality. The future is bright for brachytherapy.

PURPOSE/OBJECTIVE(S) To investigate dose sparing of organs at risk (OARs) by using 4pi-optimized arc trajectories in stereotactic body radiation therapy for treating ventricular tachycardia (VT-SBRT). MATERIALS/METHODS Computed tomography (CT) datasets of the thorax of 15 patients were used for contouring and planning. A 4pi algorithm was implemented into a treatment planning system via a specific program for generating the optimized trajectories. Optimization is based on geometric penalty of arc overlap with OARs, weighted by relative OAR priority. Following VMAT optimization applied to optimized trajectories, dosimetric results were compared to a conventional trajectory (two full arc) plans. RESULTS On average, a significant reduction in maximum dose was observed for esophagus (18%), spinal cord (26%) and trachea (22%) with the 4pi-optimized trajectory when compared to the conventional one. Mean doses were also found to decrease for esophagus (19%), spinal cord (33%), skin (18%), liver (59%), lungs (19%), trachea (43%), aorta (11%), inferior vena cava (25%), superior vena cava (33%) and pulmonary trunk (26%). Improvement in dose sparing in terms of median dose was also observed for esophagus (40%), spinal cord (48%), skin (36%), liver (72%), lungs (41%), stomach (45%), trachea (53%), aorta (45%), superior vena cava (38%), pulmonary veins (32%) and pulmonary trunk (39%). No statistically significant differences of maximum dose (P = 0.650) or homogeneity index (P = 0.156) were observed for target volumes. Conformity index was comparable between optimized and non-optimized trajectory plans. CONCLUSION While preserving target volume coverage, 4pi-optimized trajectories can provide significant dose reduction to OARs and cardiac substructures especially in terms of mean and median doses. Ours results show that 4pi-optimized arc trajectories represent a promising delivery option for VT-SBRT.

Purpose To investigate the improvement of combined monoscopic/stereoscopic prostate motion monitoring with room-mounted dual x-ray systems by adopting patient specific methods. Methods The linac couch was used as a motion stage to simulate 40 highly dynamic real patient prostate trajectories. For each trajectory, 40 s pretreatment and 120 s treatment periods were extracted to represent a typical treatment fraction. Motion was monitored via continuous stereoscopic x-ray imaging of a single gold fiducial and images were retrospectively divided into periods of stereoscopic and monoscopic imaging to simulate periodic blocking of the room-mounted system by the gantry during arc-based therapy. The accuracy of the combined motion monitoring was assessed by comparison with the linac couch log files. To estimate 3-D marker position during monoscopic imaging, the use of population statistics was compared to both maximum likelihood estimation and stereoscopic localization based estimation of individualized prostate probability density functions (PDFs) from the pretreatment period. The inclusion of intrafraction updating was compared to pretreatment initialization alone. Results Combined mono/stereoscopic localization was successfully implemented. During the transitions from stereoscopic to monoscopic imaging, fiducial localization exhibits sharp discontinuities when population PDFs were employed. Patient specific PDFs successfully reduced the localization error when estimated from stereoscopic localizations, whereas maximum likelihood estimation (MLE) was too unstable in the room-mounted geometry. Intrafraction stereoscopic updating provided further increases in accuracy. Residual error tended to decrease throughout the treatment fraction, as the patient-specific PDFs became more refined. Conclusions This is the first demonstration of toggled monoscopic/stereoscopic localization using room-mounted dual x-ray imagers, enabling continuous intrafraction motion monitoring for these systems. We showed that both pretreatment individualization and intrafraction updating should be used to provide the most accurate motion monitoring.

PURPOSE The focus of this work was to improve the available kV image quality for continuous intrafraction monitoring of the prostate during volumetric modulated arc therapy. This is investigated using a novel blade collimation system enabling tube current modulated (TCM) volume-of-interest (VOI) imaging of prostate fiducial markers during radiotherapy, and Monte Carlo simulation of MV scatter. MATERIALS AND METHODS A four-blade dynamic kV collimator was used to track a VOI containing gold fiducial markers embedded in a dynamic pelvis phantom during gantry rotation. For each fiducial, a VOI margin around each marker was set to be 2σ of the population covariance matrix characterizing prostate motion. This was used to conform to a single or several fiducials and compared to a static field. DRRs were used to calculate the kV attenuation for each VOI as a function of angle and used to optimize x-ray tube current during acquisition. Image quality was assessed with regard to contrast-to-noise ratio (CNR), fiducial detectability, and imaging dose. Monte Carlo simulations in EGSnrc were used to calculate the imaging dose to the phantom and MV scatter fluence to the imaging panel. RESULTS Fiducials can be accurately located using a VOI containing a single or several fiducials using a relatively high constant kV output. However, when using a 6 × 6 cm2 field the dose can be upwards of 1.5 Gy in bone for constant kV output and 3.1 Gy when applying TCM at 1 Hz imaging over the course of 40 fractions. This can be mitigated through tailoring the imaging field to a single or several fiducials, in which the integral dose is reduced by a factor of 15.6 and 3.7, respectively. For a constant MV treatment field size, the scattered fluence reaching the kV panel varies by less than a factor of two for a completely rotation of the gantry. However, the MV scatter spectrum overlaps with the detector response for a deleterious effect, with a peak MV scatter energy of approximately 100 keV. TCM can be used to overcome the variability in image quality throughout the rotation and therefore improve fiducial CNR and detectability during periods of high kV attenuation. CONCLUSIONS The combination of VOI and TCM introduces an advantageous approach in intrafraction monitoring of the prostate during radiotherapy by both reducing and localizing the imaging dose, while improving image quality and fiducial detectability during periods of high kV attenuation. In addition, the influence of MV scatter has been shown to be most important in low attenuation regions, with a variation by a factor of two.

Brachytherapy accelerated partial breast irradiation (APBI) is well tolerated, but reported acute toxicities including moist desquamation rates range from 7% to 39%. Moist desquamation is correlated to long-term skin toxicity and high skin dose is the main risk factor. This study uses radiochromic films for in vivo skin dosimetry of low dose rate (LDR) APBI brachytherapy and prediction of skin toxicity. Patients participating in a clinical trial assessing skin toxicity of LDR seed brachytherapy were included in this study. Following the seed implantation procedure, patients were asked to wear a customized oval shaped radiochromic film on the skin projection of the planned target volume (PTV) for 24 h. Exposed films were collected, and maximum point doses were measured. In addition, maximum doses to a small skin volume (D0.2cc) were calculated on the pre- and post-implant CT-scan. Acute skin toxicities (redness, pigmentation, induration and dermatitis) were scored by the treating physician for 2 months during follow-up visits. Skin dose measurements and acute toxicity were available for 18 consecutive patients. The post-implant calculated maximum skin doses (D0.2cc), 60.8 Gy (SD ± 41.0), were on average 30% higher than those measured in vivo (Dmax-film), 46.6 Gy (SD ± 19.3), but those values were highly significantly correlated (Spearman's rho 0.827, p < 0.001). Also, dermatitis and induration were significantly correlated with higher in vivo measured and post-implant calculated skin dose. Pre-implant dosimetry was not correlated with measured or post-implant skin dose or side effects. Radiochromic films can reliably diagnose excess dose to the skin during the first 24 h and predict skin toxicity, which enables preventative measures. Trial registration: Nederlands Trial Register (www.trialregister.nl), NTR6549, the trial was registered prospectively on 27 June 2017. ABR number: NL56210.078.16.

International audience

Current generation electronic portal imaging devices (EPID) contain a 1.0 mm copper conversion plate to increase detection efficiency of a therapeutic megavoltage spectrum. When using these EPIDs for low-Z target imaging, the conversion plate largely attenuates the large populations of diagnostic energy photons, thereby decreasing the benefits of low-Z target imaging. In this work we measure directly the effect the variation in thickness of a copper conversion plate has on image quality in planar and cone beam computed tomography imaging. Monte Carlo modeling was used to quantify changes to the diagnostic spectrum and detector response for low-Z target beams generated with 2.35 and 7.00 MeV electrons incident on a carbon target. Planar contrast-to-noise ratio (CNR) measurements were made as a function of copper thickness. Cone beam computed tomography (CBCT) image CNR measurements were made as a function of dose both with and without the copper plate present in the EPID. The presence of copper in the EPID decreased the diagnostic photon population by up to 20% and suppressed the peak detector response at 60 kV by a factor of 6.4. Planar CNR was increased by a factor ranging from 1.4 to 4.0 with no copper present compared to 1.0 mm thickness. Increases in CBCT image CNR ranged from a factor of 1.3 to 2.1 with the copper plate removed. As a result of this we suggest that the copper conversion plate be removed from the EPID when used for low-Z target planar or CBCT imaging.

International audience; Nanoparticles (NPs) made of high atomic number (Z) elements have been shown to sensitize cancer cells to radiation beams generated from linacs in vitro and in vivo. This effect occurs due to the emission of secondary photoelectrons and Auger electrons. Gold (GNP) and gadolinium (GdNP) based nanoparticles are biocompatible, and accumulate passively in tumours due to the enhanced permeability and retention effect, and there is growing evidence that localized radiation-induced tumour vascular damage can be used to clinical advantage.

This investigation focuses on possible dosimetric and efficiency advantages of HybridArc-a novel treatment planning approach combining optimized dynamic arcs with intensity-modulated radiation therapy (IMRT) beams. Application of this technique to two disparate sites, complex cranial tumors, and prostate was examined. HybridArc plans were compared with either dynamic conformal arc (DCA) or IMRT plans to determine whether HybridArc offers a synergy through combination of these 2 techniques. Plans were compared with regard to target volume dose conformity, target volume dose homogeneity, sparing of proximal organs at risk, normal tissue sparing, and monitor unit (MU) efficiency. For cranial cases, HybridArc produced significantly improved dose conformity compared with both DCA and IMRT but did not improve sparing of the brainstem or optic chiasm. For prostate cases, conformity was improved compared with DCA but not IMRT. Compared with IMRT, the dose homogeneity in the planning target volume was improved, and the maximum doses received by the bladder and rectum were reduced. Both arc-based techniques distribute peripheral dose over larger volumes of normal tissue compared with IMRT, whereas HybridArc involved slightly greater volumes of normal tissues compared with DCA. Compared with IMRT, cranial cases required 38% more MUs, whereas for prostate cases, MUs were reduced by 7%. For cranial cases, HybridArc improves dose conformity to the target. For prostate cases, dose conformity and homogeneity are improved compared with DCA and IMRT, respectively. Compared with IMRT, whether required MUs increase or decrease with HybridArc was site-dependent.

R600 phantom and a head phantom were acquired by a Varian 2100EX LINAC with a low-Z (Al) target and low energy x-ray beam (2.5 MeV) at a low-dose level and at a high-dose level. The projections were then processed by minimizing the PWLS objective function. The weighted least square (WLS) term models the noise of measured projection and the penalty term enforces the smoothing constraints of the projection image. The variance of projection data was chosen as the weight for the PWLS objective function and it determined the contribution of each measurement. An anisotropic quadratic form penalty that incorporates the gradient information of projection image was used to preserve edges during noise reduction. Low-Z target MV CBCT images were reconstructed by the FDK algorithm after each projection was processed by the PWLS smoothing. Results: Noise in low-Z target MV CBCT images were greatly suppressed after the PWLS projection smoothing, without noticeable sacrifice of the spatial resolution. Depending on the choice of smoothing parameter, the CNR of selected regions of interest in the PWLS processed low-dose low-Z target MV CBCT image can be higher than the corresponding high-dose image. Conclusion:The CNR of low-Z target MV CBCT images was substantially improved by using PWLS projection smoothing. The PWLS projection smoothing algorithm allows the reconstruction of high contrast low-Z target MV CBCT image with a total dose of as low as 2.3 cGy. © 2012 American Association of Physicists in Medicine .[ http://dx.doi.org/10.1118/1.4737116]

The purpose of this work is to develop a prototype system for continuous, three-dimensional (3D) monitoring of patient cranial motion during stereotactic radiosurgery. Using novel capacitive detector plates, the goal was to provide detection of cranial position inside a thermoplastic immobilizing mask, without relying on skin monitoring or use of ionizing radiation. A novel capacitive detector array was used to detect cranial translations with sub-millimeter accuracy. The array was comprised of four conductive plates arranged around the cranium. One superior plate was positioned at the cranial vertex, two lateral plates were positioned in sagittal planes at the lateral aspects of the cranium and one plate was located in a coronal plane anterior to the face. The system was calibrated by parameterizing a capacitive signal for each dimension as a function of spatial translation. The detector array performance was evaluated with the help of a volunteer in the absence of radiation. Separately, possible effects of electromagnetic interference and irradiation in the linac suite were assessed. Detector plates mounted at 1 cm original distance to the thermoplastic mask can detect sub-millimeter lateral and superior cranial motion. Detection of sub-millimeter anterior motion is possible when the plate is mounted closer to the patient (5-10 mm). No signal interference was observed when the capacitive array was irradiated. Our prototype detector array provides continuous, 3D translation detection with sub-millimeter precision. The signal provides sufficient signal to noise ratio and is stable in linac room environment and in direct radiation beam. The detector plate is sensitive to the position of the cranium inside a mask and offers the advantage of being insensitive to the mask itself. Future work will involve modifying the array to detect patient rotation.

Purpose: Recently, several authors have shown contrast improvements in megavoltage portal imaging and cone-beam computed tomography using low atomic number (Z) targets. This work compliments previous studies by investigating the effects of varying different beam production parameters including target atomic number, target thickness, and incident electron energy on spatial resolution. Methods: Target materials of beryllium, aluminum, and tungsten were investigated over a range of thicknesses between 10% and 100% of the continuous slowing down approximation range of electrons. Incident electron kinetic energies of 4.5 and 7.0 MeV were used, in conjunction with custom targets installed above the carousel of a modern radiotherapy linear accelerator. Monte Carlo simulations of the accelerator were constructed and compared to the experimental results. Results: The results showed that thinner targets, as well higher incident electron energies, generally produce more favorable modulation transfer function (MTF) curves. Due to an MTF dependence of the detector system on the photon energy, the experimental results showed that low-Z targets produced superior MTF curves. Simulations showed 14.5% and 21.5% increases in f{sub 50} for the 7.0 and 4.5 MeV targets (Al; 60%R{sub %CSDA}), respectively, when moved from the carousel to the location of the clinical target. f{sub 50} values formore » the custom targets were compared to the clinical 6 MV beam and were found to be between 10.4% lower (4.5 MeV/W) and 15.5% higher (7.0 MeV/Be). Conclusions: Integration of low-Z external targets into the treatment head of a medical linear was achieved with only minor modifications. It was shown that reasonably high resolution images on par or better than those acquired with the clinical 6 MV beam can be achieved using external low-Z targets.« less

Purpose: The purpose of this study is to investigate the improvement of megavoltage planar and cone-beam CT(CBCT)image quality with the use of low atomic number ( Z ) external targets in the linear accelerator. Methods: In this investigation, two experimental megavoltage imagingbeams were generated by using either 3.5 or 7.0 MeV electrons incident on aluminum targets installed above the level of the carousel in a linear accelerator (2100EX, Varian Medical, Inc., Palo Alto, CA). Images were acquired using an amorphous silicon detector panel. Contrast-to-noise ratio(CNR) in planar and CBCTimages was measured as a function of dose and a comparison was made between the imagingbeams and the standard 6 MV therapy beam. Phantoms of variable diameter were used to examine the loss of contrast due to beam hardening. Porcine imaging was conducted to examine qualitatively the advantages of the low- Z target approach in CBCT. Results: In CBCTimagingCNR increases by factors as high as 2.4 and 4.3 for the 7.0 and 3.5 MeV ∕ Al beams, respectively, compared to images acquired with 6 MV . Similar factors of improvement are observed in planar imaging. For the imagingbeams,beam hardening causes a significant loss of the contrast advantage with increasing phantom diameter; however, for the 3.5 MeV ∕ Al beam and a phantom diameter of 25 cm , a contrast advantage remains, with increases of contrast by factors of 1.5 and 3.4 over 6 MV for bone and lung inhale regions, respectively. The spatial resolution is improved slightly in CBCTimages for the imagingbeams.CBCTimages of a porcine cranium demonstrate qualitatively the advantages of the low- Z target approach, showing greater contrast between tissues and improved visibility of fine detail. Conclusions: The use of low- Z external targets in the linear accelerator improves megavoltage planar and CBCTimage quality significantly. CNR may be increased by a factor of 4 or greater. Improvement of the spatial resolution is also apparent.

Low-atomic number (Z) targets have been shown to improve contrast in megavoltage (MV) images when using film-screen detection systems. This research aims to quantify the effect of low-Z targets on MV image contrast using an amorphous silicon electronic portal image detector (a-Si EPID) through both experimental measurement and Monte Carlo (MC) simulation. Experimental beams were produced with the linac running in the 6 MeV electron mode and with a 1.0 cm aluminum (Al, Z = 13) target replacing flattening filtration in the carousel, (6 MeV/Al). A 2100EX Varian linac equipped with an aS500 EPID was used with the QC3 MV phantom for the majority of contrast measurements. The BEAMnrc/EGSnrc MC package was used to build a model of the full imaging system including beam generation (linac head), the a-Si detector and the contrast phantom. The model accurately reproduces contrast measurements to within 2.5% for both the standard 6 MV therapy beam and the 6 MeV/Al beam. The contrast advantage of 6 MeV/Al over 6 MV, as quantified with the QC3 phantom, ranged from a factor increase of 1.6 +/- 0.1 to 2.8 +/- 0.2. Only a modest improvement in contrast was seen when the incident electron energy was reduced to 4 MeV (up to factor of 1.2 +/- 0.1 over 6 MeV/Al) or with removal of the copper build-up layer in the detector, (up to factor of 1.2 +/- 0.1 over 6 MeV/Al). Further decreasing the target Z, to beryllium (Be, Z = 4), at 4 MeV showed no significant improvement over 4 MeV/Al. Experimentally, the contrast advantage of 6 MeV/Al over 6 MV was found to decrease with increasing patient thickness, as can be expected due to selective attenuation of low-energy photons. At head and neck-like thicknesses, the low-Z advantage is a factor increase of 1.7 +/- 0.1.

Previous studies have introduced gold nanoparticles as vascular-disrupting agents during radiation therapy. Crucial to this concept is the low energy photon content of the therapy radiation beam. The authors introduce a new mode of delivery including a linear accelerator target that can toggle between low Z and high Z targets during beam delivery. In this study, the authors examine the potential increase in tumor blood vessel endothelial cell radiation dose enhancement with the low Z target.The authors use Monte Carlo methods to simulate delivery of three different clinical photon beams: (1) a 6 MV standard (Cu/W) beam, (2) a 6 MV flattening filter free (Cu/W), and (3) a 6 MV (carbon) beam. The photon energy spectra for each scenario are generated for depths in tissue-equivalent material: 2, 10, and 20 cm. The endothelial dose enhancement for each target and depth is calculated using a previously published analytic method.It is found that the carbon target increases the proportion of low energy (150 keV) photons at 10 cm depth to 28% from 8% for the 6 MV standard (Cu/W) beam. This nearly quadrupling of the low energy photon content incident on a gold nanoparticle results in 7.7 times the endothelial dose enhancement as a 6 MV standard (Cu/W) beam at this depth. Increased surface dose from the low Z target can be mitigated by well-spaced beam arrangements.By using the fast-switching target, one can modulate the photon beam during delivery, producing a customized photon energy spectrum for each specific situation.

This planning study evaluates the potential of intensity modulated treatment fields and inverse planning techniques in stereotactic radiosurgery to reduce healthy tissue dose. Twenty patients previously treated with stereotactic radiosurgery for arteriovenous malformation (AVM) were replanned with each of 4 techniques: circular non-coplanar arcs, dynamic arcs, static conformal fields, and intensity modulated radiosurgery (IMRS). Patients were selected having a maximum AVM dimension at least 20 mm, or volume greater than 10 cm(3). Target volumes ranged from 2.12 cm(3) to 13.87 cm(3) with a median of 6.03 cm(3). Resulting dose distributions show a statistically significant improvement in target conformality between circular arcs and all other techniques (p/= 0.001), between conformal and both dynamic arcs and IMRS (p/= 0.03) and with no difference between dynamic arcs and IMRS. However, for AVMs of volume greater than 5.5 cm(3), IMRS gives better conformality than dynamic arcs (p = 0.04). IMRS showed consistently lower dose inhomogeneity compared to both dynamic arcs and conformal fields (p0.001). At low dose levels, the dynamic arc technique irradiates less healthy tissue than the other techniques (p/= 0.001). Both dynamic arcs and IMRS provide increased ability to conform to the AVM, with IMRS showing greater ability to control dose at the periphery.

Purpose: The accuracy of intensity-modulated radiotherapy (IMRT) delivery may be compromised by random spatial error and systematic anatomic changes during the treatment course. We present quantitative measurements of the spatial variability of head-and-neck organs-at-risk and demonstrate the resultant dosimetric effects. Methods and Materials: Fifteen consecutive patients were imaged weekly using computed tomography during the treatment course. Three-dimensional displacements were calculated for the superior and inferior brainstem; C1, C6, and T2 spinal cord; as well as the lateral and medial aspects of the parotid glands. The data were analyzed to show distributions of spatial error and to track temporal changes. The treatment plan was recalculated on all computed tomography sets, and the dosimetric error was quantified in terms of the maximal dose difference (brainstem and spinal cord) or the mean dose difference and the volume receiving 26 Gy (parotid glands). Results: The mean three-dimensional displacement was 2.9 mm for the superior brainstem, 3.4 mm for the inferior brainstem, 3.5 mm for the C1 spine, 5.6 mm for the C6 spine and 6.0 mm for the T2 spine. The lateral aspects of both parotid glands showed a medial translation of 0.85 mm/wk, and glands shrank by 4.9%/wk. The variability of the maximal dose difference was described by standard deviations ranging from 5.6% (upper cord) to 8.0% (lower cord.) The translation of the left parotid resulted in an increase of the mean dose and the volume receiving 26 Gy. Conclusion: Random spatial and dosimetric variability is predominant for the brainstem and spinal cord and increases at more inferior locations. In contrast, the parotid glands demonstrated a systematic medial translation during the treatment course and thus sparing may be compromised.

Purpose: To assess the use of stereotactic fractionated radiotherapy (SRT) for the treatment of meningiomas. Methods and Materials: Between April 1999 and October 2004, 38 patients underwent SRT. Of 34 patients (36 tumors) assessed, the median age was 53 years. The indication was primary treatment in 26 cases (no histology) and postoperative in 10 cases. The most common sites were cavernous sinus (17), optic nerve (6), and cerebellopontine angle (5). The median gross target volume and planning target volume were 8.9 cm 3 and 18.9 cm 3 , respectively. Stereotactic treatment was delivered with 6-MV photons with static conformal fields (custom-made blocks, 9 patients, and micromultileaf collimator, 25 patients). Median number of fields was six. The median dose prescribed was 50 Gy (range, 45–50.4 Gy) in 28 fractions. The median homogeneity and conformality indices were 1.1 and 1.79, respectively. Results: Treatment was well tolerated. Median follow-up was 26 months with 100% progression-free survival. One patient developed an area of possible radionecrosis related to previous radiotherapy, and 2 men developed mild hypogonadism necessitating testosterone replacement. The vision of 5 of 6 patients with optic pathway meningiomas improved or remained static. Conclusions: Stereotactic fractionated radiotherapy for the treatment of meningiomas is practical, and with early follow-up, seems to be effective.

This study compared the clinical functionality of BrainSCAN (BrainLAB) and Helios (Eclipse, Varian) for intensity‐modulated radiation therapy (IMRT) treatment planning with the aim of identifying practical and technical issues. The study considered implementation and commissioning, dose optimization, and plan assessment. Both systems were commissioned for the same 6 MV photon beam equipped with a high‐resolution multileaf collimator (Varian Millennium 120 leaf). The software was applied to three test plans having identical imaging and contour data. Analysis considered 3D axial dose distributions, dose‐volume histograms, and monitor unit calculations. Each system requires somewhat different input data to characterize the beam prior to use, so the same data cannot be used for commissioning. In addition, whereas measured beam data was entered directly into Helios with minimal data processing, the BrainSCAN system required configured beam data to be sent to BrainLAB before clinical use. One key difference with respect to system commissioning was that BrainSCAN required high resolution data, which necessitated the use of detectors with small active volumes. This difference was found to impact on the ability of the systems to accurately calculate dose for highly modulated fields, with BrainSCAN being more successful than Helios. In terms of functionality, the BrainSCAN system uses a dynamically penalized likelihood inverse planning algorithm and calculates four plans at once with various relative weighting of the planning target and organ‐at‐risk volumes. Helios uses a gradient algorithm that allows the user to make changes to some of the input parameters during optimization. An analysis of the dosimetry output shows that, although the systems are different in many respects, they are each capable of producing substantially equivalent dose plans in terms of target coverage and normal tissue sparing. PACS number: 87.53.Tf

This work describes a rapid and objective method of determining repositioning error during the course of precision radiation therapy using off-line CT imaging and automated mutual-information image fusion. The technique eliminates the variability associated with manual identification of anatomical landmarks by observers. A phantom study was conducted to quantify the accuracy of the image co-registration-based analysis itself. For CT voxel dimensions of 0.65 x 0.65 x1.0 mm3, the method is shown to detect translations with an accuracy of 0.5 mm in the anterior-posterior and lateral dimensions and 0.8 mm in the superior-inferior dimension. Phantom rotation in the coronal plane was detected to within 0.5 degrees of expected values. The analysis has been applied to eight radiotherapy patients at two independent clinics, each immobilized by the same system for cranial stereotactic radiotherapy and CT-imaged once per week over the five- to six-week course of treatment. Among all patients, the ranges of translation in the anterior-posterior, lateral, and superior-inferior dimensions were -0.91 mm to 0.77 mm, -0.66 mm to 1.02 mm, and -2.24 mm to 3.47 mm, respectively. Considering all patients and CT scans, the standard deviations of translation were 0.42 mm, 0.47 mm, and 1.36 mm in the anterior-posterior, lateral, and superior-inferior dimensions, respectively. The ranges of patient rotation about the superior-inferior, left-right, and anterior-posterior axes were -2.84 to 2.62 degrees, -1.74 degrees to 1.96 degrees, and -1.78 degrees to 1.42 degrees, respectively.

Purpose: The purpose of this work is to develop a new applicator for administering high dose rate (HDR) brachytherapy using 3D printing technology. Primary advantages of using a 3D printed applicator will be to offer a more streamlined approach for therapists and patients while achieving better conformity, reproducibility, and patient specific applicators. Methods: A phantom study was conducted to measure the effectiveness of a 3D printed surface applicator by analyzing tumours on three locations of the body: the foot, nose, and scalp. The applicator was designed using Eclipse and further modified using Blender to create the catheter tunnels before being printed on a Lulzbot Taz 5 3D printer. A radiation plan was made using Oncentra Brachytherapy for a control treatment option using Freiburg Flaps and one with the novel method of a 3D printed applicator. A comparative analysis was made using D90, D100, V100, V150, and V200 Results: The 3D printed applicator showed comparable dose coverage with significant improvements on highly irregular surfaces when analyzed against a plan made using Freiburg Flaps. Although both plans exhibited complete tumour coverage, the 3D applicator showed improvements in D90 and V150 and the 3D applicator had a dose homogeneity index (DHI) of 0.99 compared to a DHI of 0.97 for the control. Therapist prep time also dropped significantly due to the lack of need for a thermoplastic mesh. Conclusions: 3D printed applicators for treatment of superficial sites proved to offer more patient convenience, less prep time, better conformity and tighter margins.

Background: Standard linear accelerators employ a high-Z target designed for therapeutic treatment, but produce poor image quality. Exchanging the high-Z target for a low-Z one, while reducing the incident electron beam energy recovers a significant component of photons in the diagnostic energy range, providing improved contrast-to-noise (CNR) characteristics.

Purpose: This is a proof-of-concept study of volume of interest (VOI) cone beam CT (CBCT) imaging using an x-ray beam produced by 2.35 MeV electrons incident on a carbon linear accelerator target. Methodology regarding image acquisition and reconstruction is presented and exemplary image data are shown. The dose distribution in a head phantom resulting from the low-Z target VOI method is shown to demonstrate the potential of the technique to minimize dose to peripheral tissues. Methods: A workflow is presented whereby a VOI is designed in the planning system and a dynamic MLC sequence is established to track that volume during imaging. Missing data in truncated CBCT projection images are completed using a priori DRR information generated from the planning CT set. The utility of this approach in reducing truncation artefacts is shown through imaging of the head-and-neck section of a lamb. TLD and Gafchromic film measurements are used to compare the imaging dose distributions for the 2.35 MV/Carbon beam, from VOI and full-field techniques. Results: The feasibility of the low-Z target VOI CBCT is demonstrated. Marked boundary ring truncation artefacts surrounding the imaged VOI in three dimensions are resolved by the DRR filling technique. Dosimetric measurements in the anthropomorphic head phantom demonstrate that the dose to peripheral tissues is reduced to approximately 25% of that inside the VOI. Conclusion: VOI CBCT is viable using a 2.35 MV/Carbon beam. The technique couples the desirable imaging characteristics of the low-Z target beam with the flexibility to localize the imaging dose to the anatomy relevant to the image guidance task.

Purpose: To evaluate the validity of using spine as a surrogate for tumor positioning with ExacTrac stereoscopic imaging in lung stereotactic body radiation therapy (SBRT). Methods: Using the Novalis ExacTrac x-ray system, 39 lung SBRT patients (182 treatments) were aligned before treatment with 6 degrees (6D) of freedom couch (3 translations, 3 rotations) based on spine matching on stereoscopic images. The couch was shifted to treatment isocenter and pre-treatment CBCT was performed based on a soft tissue match around tumor volume. The CBCT data were used to measure residual errors following ExacTrac alignment. The thresholds for re-aligning the patients based on CBCT were 3mm shift or 3° rotation (in any 6D). In order to evaluate the effect of tumor location on residual errors, correlations between tumor distance from spine and individual residual errors were calculated. Results: Residual errors were up to 0.5±2.4mm. Using 3mm/3° thresholds, 80/182 (44%) of the treatments required re-alignment based on CBCT soft tissue matching following ExacTrac spine alignment. Most mismatches were in sup-inf, ant-post, and roll directions which had larger standard deviations. No correlation was found between tumor distance from spine and individual residual errors. Conclusion: ExacTrac stereoscopic imaging offers a quick pre-treatment patient alignment. However, bone matching based on spine is not reliable for aligning lung SBRT patients who require soft tissue image registration from CBCT. Spine can be a poor surrogate for lung SBRT patient alignment even for proximal tumor volumes.

Purpose: During radiotherapy treatment, lung tumors can display substantial respiratory motion. This motion usually necessitates enlarged treatment margins to provide full tumour coverage. Unfortunately, these margins limit the dose that can be prescribed for tumour control and cause complications to normal tissue. Options for real-time methods of direct detection of tumour position, and particularly those that obviate the need for inserted fiducial markers, are limited. We propose a method of tumor tracking without implanted fiducial markers using a novel fast switching-target that toggles between a FFF copper/tungsten therapy mode and a FFF low-Z target mode for imaging. In this work we demonstrate proof-of-concept of this new technology. Methods: The prototype includes two targets: i) a FFF copper/tungsten target equivalent to that in the Varian 2100 EX 6 MV, and ii) a low-Z (carbon) target with a thickness of 110% of continuous slowing down approximation range (CSDA) at 7 MeV. The two targets can be exchanged with a custom made linear slide and motor-driven actuator. The usefulness of the switching-target concept is demonstrated through experimental BEV Planar images acquired with continual treatment and imaging at a user-defined period. Results: The prototype switching-target demonstrates that two recent advances in linac technology (FFF target for therapy and low-Z target) can be combined with synergy. The switching-target approach offers the capacity for rapid switching between treatment and high-contrast imaging modes, allowing intrafractional tracking, as demonstrated in this work with dynamic breathing phantom. By using a single beam-line, the design is streamlined and may obviate the need for an auxiliary imaging system (e.g., kV OBI.) Conclusion: This switching-target approach is a feasible combination of two current advances in linac technology (FFF target for therapy and a FFF low-Z target) allowing new options in on-line IGRT.

Purpose: The focus of this work is to improve the available kV image quality for continuous intra-fraction monitoring of the prostate. This is investigated using a novel blade collimation system enabling modulated volume-of-interest (VOI) imaging of prostate fiducial markers. Methods: A four-blade dynamic kV collimator was used to track a VOI during gantry rotation. Planar image quality was investigated as a function of collimator dimension, while maintaining the same dose to isocenter, for a 22.2 cm diameter cylindrical water phantom with a 9 mm diameter bone insert. A sample prostate anatomy was defined in the planning system, including three fiducial markers within the CTV. The VOI margin around each marker was set to be 2σ of the population covariance matrix characterizing prostate motion. DRRs were used to calculate the kV attenuation for each VOI as a function of angle. The optimal marker and tube current were determined using kV attenuation. Monte Carlo simulations were used to calculate the imaging dose to the phantom and MV scatter dose to the imaging panel. Results: Preliminary measurements show an increase in CNR by a factor of 1.3 with the VOI method, when decreasing from an 6×6 to 2×2 cm2 field. Attenuation calculations show a change in kV fluence at the detector by a factor of 21.6 with fiducial optimization; resultant tube current modulation increases maximum dose by a factor of 1.4 compared to no modulation. MV scatter contribution to the kV detector changes by approximately a factor of two over a complete gantry rotation. Conclusion: The dynamic collimation system allows single fiducial marker tracking at a very low dose, with reduction of scatter and improvement of image quality, compared to imaging the entire prostate. The approach is compatible with tube current modulation, which enables consistent image quality throughout the range of gantry rotation. This project was funded by Varian Medical Systems.

Purpose: The focus of this work is the development of a novel blade collimation system enabling volume-of-interest (VOI) CBCT using the kV source on a TrueBeam linear accelerator (linac). Advantages of the system are assessed, particularly with regard to reduction and localization of dose, as well as improvement of image quality. Methods: A four blade dynamic kV collimator was developed to track a VOI during a CBCT acquisition. The system is controlled using a Raspberry Pi computer placed within the linac gantry. The current prototype is capable of tracking an arbitrary volume defined by the treatment planner for subsequent CBCT guidance. During gantry rotation, the collimator tracks the VOI with adjustment of position and dimension. CBCT image quality was investigated as a function of collimator dimension, while maintaining the same dose to the VOI, for a 20 cm diameter cylindrical water phantom with a 9 mm diameter bone insert centered on isocenter. Dose distributions for various anatomical sites were modeled using a dynamic BEAMnrc library and DOSXYZnrc. The resulting VOI dose distributions were compared to full-field distributions to quantify dose reduction and localization to the target volume. Results: Preliminary measurements show contrast increase by a factor of 1.3 and noise reduction by a factor of 1.7, for CBCT. This results in a increase in contrast-to-noise ratio by a factor of approximately 2.2. Depending upon the anatomical site, dose was reduced to 15%–80% of the full field value along the central axis plane and down to less than 1% along the axial planes. Conclusion: The present system allows CBCT imaging of a planner-defined volume, offering both image quality improvement and reduction of imaging dose for the patient. Current work involves the development of fluence modulation for VOI CBCT. This work was supported through a research partnership with Varian Medical, Incorporated.

Purpose: Recent developments in The Varian Truebeam linac platform allows for the introduction of low-Z targets into the beam line for the imaging purposes. We have proposed using a low-Z target for radiation therapy purposes to enhance the surface dose during radiation treatment. The target arm of the Varian Truebeam accelerator consists of multiple targets with are linearly translated into the beam line. We have designed two Low-Z targets made of carbon: 1) a step target consisting of three steps of 15%, 30% and 60% CSDA range for 2.5 MeV electrons Figure 1a; 2) and a ramp target, an incline plane 2cm long with thicknesses ranging from 0% to 60% CSDA range, Figure 1b. The purpose of this work will determine the spectral characteristics of these target designs and determine if they have practical clinical applications for enhancing surface dose. Methods: To calculate the spectral characteristics of these targets, a standard Monte Carlo model of a Varian Clinac accelerator was used. Simulations were performed with a carbon step target, and a carbon ramp target, located at the same position as the electron foil in the rotating carousel. Simulations were carried out using a 2.5 MeV electron beam. Results: The step target design produced spectral characteristics which were similar to spectral model using a single disk target of the same thickness. The ramp target provides a means to have positional variation of the spectral components of the beam, however, the electron component as 60% CSDA us much broader than the step target. Conclusion: The carbon step-target provides a spectral distribution which is similar to a carbon disk of comparable thickness. The spectral distribution from the ramp-target can be modified as a function of position to provide a wide range of low energy electrons for surface dose enhancement.

Purpose: In this work we describe the development of a new technology allowing volume‐of‐interest (VOI) kV CBCT. A device for dynamic kV beam collimation is described and initial imaging and dosimetric results are given. Methods: We have manufactured a prototype of an iris aperture capable of tracking a chosen VOI during kV CBCTimaging. The aperture and housing is compact and occupies an area comparable to the bow‐tie filter when mounted to the source of an on‐board imaging system. The system allows two‐dimensional translation of the aperture as a function of gantry angle and dynamic adjustment of iris diameter. Iris leaves are non‐overlapping and therefore can be made sufficiently thick to attenuate higher energy kV beams used. The device was tested for functionality on a Varian OBI system. Dose reduction in the VOI was measured and compared to full‐field imaging, for planar and CBCTimaging protocols, as a function of iris dimension. Initial projection and CBCTimages of a head phantom were acquired. Results: The system provides a versatile tool for dynamic collimation of the kV beam during CBCT. While dose reduction in VOI CBCT is achieved primarily by blocking of non‐VOI anatomy, the dose inside the imaged VOI is also reduced substantially, by 5% to 60% for 20 cm and 2 cm iris diameters, respectively. The magnitude of dose reduction increases slightly with increased tube potential, between 65 and 125 kVp. Projection images demonstrate that the iris produces effective collimation with minimal leakage. ReconstructedCBCTimages are affected by truncation artefact, but this may be remedied by data filling techniques or other (e.g. pi‐line) reconstruction algorithms. Conclusions: The technology presented is a novel approach to kV CBCT, localizing imaging dose to a chosen VOI while, compared to full‐field CBCT, reducing dose both inside and outside of the VOI. No conflict of interest exists.