Characterization of kilovoltage x-ray image guidance system with a novel post-processing algorithm on a new slip ring-mounted radiotherapy system.

Purpose: This study evaluates the performance of a kilovoltage x-ray image-guidance system equipped with a novel post-processing optimization algorithm on the newly introduced TAICHI linear accelerator (Linac).

Methods: A comparative study involving image quality tests and radiation dose measurements was conducted across six scanning protocols of the kV-cone beam computed tomography (CBCT) system on the TAICHI Linac. The performance assessment utilized the conventional Feldkamp-Davis-Kress (FDK) algorithm and a novel Non-Local Means denoising and adaptive scattering correction (NLM-ASC) algorithm. Image quality metrics, including spatial resolution, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR), were evaluated using a Catphan 604 phantom. Radiation doses for low-dose and standard protocols were measured using a computed tomography dose index (CTDI) phantom, with comparative measurements from the Halcyon Linac's iterative CBCT (iCBCT).

Results: The NLM-ASC algorithm significantly improved image quality, achieving a 300%-1000% increase in CNR and SNR over the FDK-only images and it also showed a 100%-200% improvement over the iCBCT images from Halcyon's head protocol. The optimized low-dose protocols yielded higher image quality than the standard FDK protocols, indicating potential for reduced radiation exposure. Clinical implementation confirmed the TAICHI system's utility for precise and adaptive radiotherapy.

Conclusion: The kV-IGRT system on the TAICHI Linac, with its novel post-processing algorithm, demonstrated superior image quality suitable for routine clinical use, effectively reducing image noise without compromising other quality metrics.