ITERATIVE CONE-BEAM CT

Improved visualization of soft tissue structures

Cone-beam CT (CBCT) is a fundamental technology of Improved image quality

modern radiotherapy along with modulated treatments
Soft-tissue structures in stationary anatomy**
such as RapidArc® radiotherapy technology and intensity-
• Clearer boundaries; reduced noise and streaks; improved
modulated radiation therapy (IMRT). The ability to verify
HU uniformity; and increased contrast-to-noise ratio
patient position in terms of internal anatomy and to deliver
highly conformal dose distributions has redefined cancer care. • Sharp delineation of structures and edges
As treatment protocols become ever more demanding,
Specific regions
clinicians, physicists and radiation therapists seek higher
• Head and neck: Decreased streaks from dental fillings
image quality to support the required treatment decisions.
(metal artifacts) and vertebrae (cone-beam artifacts);
Iterative cone-beam CT seeks to address these demands by and better uniformity around shoulders
improving upon traditional CBCT methods and achieving
• Pelvis: Reduced noise and streaks due to low beam
new levels of image quality. This award winning* technology
penetration (photon starvation); and better uniformity in
— available on the TrueBeam® system platform — provides
bladder and prostate
greater visibility of soft-tissue structures, confidence in
managing patient and target position, and opportunities for
future applications such as adaptive radiotherapy.

Improved image quality with iterative CBCT

CBCT

Iterative CBCT
Technology overview contribution from acquired projections corrects for scatter.
Acuros CTS has similar accuracy to Monte Carlo methods,
The innovation behind iterative CBCT is the combination
while significantly reducing computation time from hours
of two key technologies: Acuros CTS and statistical
with Monte Carlo to seconds.***
reconstruction.
Statistical reconstruction
Acuros CTS
Statistical reconstruction places more weight on higher fidel-
Acuros CTS (Computed Tomography Scatter) shares much
ity regions of the projection images. If the measured signal
of Varian’s Acuros® XB dose calculation engine. Acuros CTS
is larger, there is more statistical certainty in the signal and
uses deterministic methods to estimate the scatter generated
the larger signals contribute more to the final reconstructed
in each projection image. A standard CBCT reconstruction
image. At the same time, image processing is incorporated
generates a first estimate of the patient anatomy. Acuros
to reduce noise while preserving edges. Graphics process-
CTS then models the kV beam transport through the patient
ing unit (GPU) technology minimizes the time taken for the
model and calculates the primary and scatter components
several iterations needed to produce the final image.
in the projections. Subtracting the calculated scatter

CBCT Iterative CBCT

Figure 1: Less noise and better uniformity in the bladder region

CBCT Iterative CBCT

Figure 2: Reduced cone-beam artifact from high-contrast structures such as vertebrae and skull base

CBCT Iterative CBCT

Figure 3: Reduced metal artifact streaks from dental fillings in head and neck scans
 CBCT

Iterative CBCT

Figure 4: Improved handling of truncation, shading, and streaks in the challenging shoulder region

To view more images, go to varian.com/icbct

References
1 Wang A, et al., “Advanced scatter correction and iterative reconstruction for improved cone-beam CT imaging on the TrueBeam radiotherapy machine [Best in Physics
(Imaging)],” in American Association of Physicists in Medicine (AAPM) Annual Meeting, 2016.
2 Chetty I, et al., “Improving CBCT image quality for daily image guidance of patients with head/neck and prostate cancer,” in European Society for Radiotherapy and Oncology
(ESTRO) Annual Meeting, 2017.
3 Mao W, et al., “A novel iterative reconstruction algorithm for improving CBCT image quality,” in American Association of Physicists in Medicine (AAPM) Annual Meeting, 2017.
Images, acquired using iterative CBCT, are courtesy of Henry Ford Health Systems.
* “Best in Physics (Imaging)” award at 2016 AAPM Annual Meeting; Nomination for “ESTRO Best Poster Award” in the category: “Physics” at ESTRO 36 (2017).
** Iterative CBCT is optimal for stationary anatomy.
*** Image quality and timing are typical cases. Individual results may vary.

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Intended Use Summary
Varian Medical Systems’ linear accelerators are intended to provide stereotactic radiosurgery and precision radiotherapy for lesions, tumors, and conditions
anywhere in the body where radiation treatment is indicated.
Safety Statement
Radiation treatments may cause side effects that can vary depending on the part of the body being treated. The most frequent ones are typically temporary
and may include, but are not limited to, irritation to the respiratory, digestive, urinary or reproductive systems, fatigue, nausea, skin irritation, and hair loss. In
some patients, they can be severe. Treatment sessions may vary in complexity and time. Radiation treatment is not appropriate for all cancers.

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RAD 10465 09/2017