First linac‐mounted photon counting detector for image guided radiotherapy: Planar image quality characterization

Image guided radiotherapy (IGRT) with cone-beam computed tomography (CBCT) is limited by the sub-optimal soft-tissue contrast and spatial resolution of energy-integrating flat panel detectors (FPDs) which produce quasi-quantitative CT numbers. Spectral CT with high resolution photon-counting detectors (PCDs) could improve tumor delineation by enhancing the soft-tissue contrast, spatial resolution, dose-efficiency, and CT number accuracy. This study presents the first linac-mounted PCD. On the journey to developing spectral cone-beam CT for IGRT, the planar image quality of a linac-mounted PCD is first fundamentally characterized and compared to an FPD in terms of the 2D spatial resolution, noise, and contrast. A Medipix3RX-based PCD was mounted to the kV FPD of an x-ray volume imaging (XVI) system on an Elekta linac and the PCD acquisition was synchronized with the pulsed kV source. The energy calibration of the Medipix3RX was determined with various radioisotope gamma emissions up to 60 keV. To compare the 2D spatial resolution and noise between the PCD and FPD, the pre-sampling modulation transfer function (MTF) and normalized noise power spectrum (NPS) were measured using an RQA5 spectrum and a fluoroscopy phantom was imaged to determine the limiting resolution of line pairs. Spectral planar images of phantom inserts containing two different concentrations of calcium (60 and 240 mg/cc) and iodine (5 and 15 mg/cc) were optimally energy weighted to maximize the contrast using tube voltages of 60, 80, 100, and 120 kV. To account for drifts in the sensor temperature, the PCD was dynamically translated in and out of the insert shadow during acquisitions to obtain flat field corrections per frame. The raw contrast of the resultant planar images was compared to the energy-integrating FPD. The energy calibration of the Medipix3RX was observed to be linear up to 60 keV. The limiting resolution observed on the fluoroscopy phantom was 2 lp/mm for the FPD and 5 lp/mm for the PCD. The pre-sampling MTF was higher across all frequencies comparing the PCD to the FPD. The normalized NPS of the PCD did not vary with frequency, whereas the spectrum for the FPD decreased monotonically and was lower than the PCD noise power across most of the spatial frequency range studied due to optical light spreading. Optimal energy weights were applied to the dynamically acquired PCD images and the raw contrast of the 60 mg/cc calcium insert increased by factors of 1.12±0.09$1.12\pm 0.09$ and 1.52±0.22$1.52\pm 0.22$ at 60 and 120 kV respectively compared to the FPD. A Medipix3RX-based PCD was successfully integrated with the kilovoltage imaging system on an Elekta linac. The initial planar image quality characterization indicated improvements in the MTF and energy-weighted contrast compared to the FPD. Future work will focus on obtaining linac-mounted spectral CBCT images with a translate-rotate geometry, however this initial study indicates that variations in the PCD sensor response during acquisitions must be addressed to realise the full potential of linac-mounted spectral CBCT.