Evaluation of a Novel Reconstruction Framework for Gamma Knife Cone-Beam CT - The Impact of Scatter Correction and Noise Filtering on Image Quality and Co-registration Accuracy

Abstract: The Gamma Knife is a non-invasive stereotactic radiosurgery system used for treatments of deep targets in the brain. Accurate patient positioning is needed for precise radiation delivery to the target. The two latest versions of the Gamma Knife allow fractionated treatment by co-registering Cone-beam computed tomography (CBCT) images of the patient's position in the Gamma Knife with a diagnostic magnetic resonance (MR) image used for treatment planning. However, CBCT images often suffer from artifacts that degrade image quality, which may result in less accurate co-registration. This thesis project investigates the potential of a new reconstruction framework developed by Elekta, which incorporates scattering correction and noise filters, for the reconstruction of Gamma Knife CBCT images. The performance of the new reconstruction framework, along with its noise filter and scatter correction, is quantified using image quality metrics of phantoms, including contrast, uniformity, spatial resolution, and CT-number accuracy. Additionally, brain CBCT images of five patients are co-registered with their diagnostic MR images, and the mean target registration error is measured. The results indicate that the new reconstruction framework, without using scatter correction and noise filtering, performs equally well as the current framework in reconstructing Gamma Knife CBCT images, as it achieved similar image quality and co-registration accuracy. However, when the scatter correction was used, there were improvements in image uniformity and CT-number accuracy without compromising spatial resolution. Additionally, the introduction of a noise filter resulted in an improved contrast-to-noise ratio and low contrast visibility with minimal compromise of spatial resolution. Despite these image quality enhancements, there were no consistent improvements in co-registration accuracy, indicating that the co-registration is not sensitive to scatter or noise artefacts.