title: Balancing dose and image registration accuracy for cone beam tomosynthesis (CBTS) for breast patient setup.
abstract: OBJECTIVE
  To balance dose reduction and image registration accuracy in breast setup imaging. In particular, the authors demonstrate the relationship between scan angle and dose delivery for cone beam tomosynthesis (CBTS) when employed for setup verification of breast cancer patients with surgical clips.
  
  
  METHODS
  The dose measurements were performed in a female torso phantom for varying scan angles of CBTS. Setup accuracy was measured using three registration methods: Clip centroid localization accuracy and the accuracy of two semiautomatic registration algorithms. The dose to the organs outside of the ipsilateral breast and registration accuracy information were compared to determine the optimal scan angle for CBTS for breast patient setup verification. Isocenter positions at the center of the patient and at the breast-chest wall interface were considered.
  
  
  RESULTS
  Image registration accuracy was within 1 mm for the CBTS scan angles theta above 20 degrees for some scenarios and as large as 80 degrees for the worst case, depending on the imaged breast and registration algorithm. Registration accuracy was highest based on clip centroid localization. For left and right breast imaging with the isocenter at the chest wall, the dose to the contralateral side of the patient was very low (<0.5 cGy) for all scan angles considered. For central isocenter location, the optimal scan angles were 30 degrees - 50 degrees for the left breast imaging and 40 degrees - 50 degrees for the right breast imaging, with the difference due to the geometric asymmetry of the current clinical imaging system.
  
  
  CONCLUSIONS
  The optimal scan angles for CBTS imaging were found to be between 10 degrees and 50 degrees, depending on the isocenter location and ipsilateral breast. Use of the isocenter at the breast-chest wall locations always resulted in greater accuracy of image registration (<1 mm) at smaller angles (10 degrees - 20 degrees) and at lower doses (<0.1 cGy) to the contralateral organs. For chest wall isocenters, doses delivered to organs outside of the target breast were much smaller than the scattered and leakage doses of the treatment beams. The complete volumetric information of all clips in the region of interest, combined with the small dose to the contralateral organs and the small scan angle, could result in an advantage for small angle CBTS with off center isocenters over simple orthogonal pairs.
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts 02115, USA. bwiney@partners.org
authors.forename: B A
authors.initials: BA
authors.lastname: Winey
authors.forename: P
authors.initials: P
authors.lastname: Zygmanski
authors.forename: R A
authors.initials: RA
authors.lastname: Cormack
authors.forename: Y
authors.initials: Y
authors.lastname: Lyatskaya
mesh_terms: D000465:Algorithms; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D006801:Humans; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity