Cone-Beam CT image contrast and attenuation-map linearity improvement (CALI) for brain stereotactic radiosurgery procedures.

A Contrast and Attenuation-map Linearity Improvement (CALI) framework is proposed for cone-beam CT (CBCT) images used for brain stereotactic radiosurgery (SRS). The proposed framework is tailored to improve soft tissue contrast of a new point-of-care image-guided SRS system that employs a challenging half cone beam geometry, but can be readily reproduced on any CBCT platform. CALI includes a pre- and post-processing step. In pre-processing we apply a shading and beam hardening artifact correction to the projections, and in post-processing step we correct the dome/capping artifact on reconstructed images caused by the spatial variations in X-ray energy generated by the bowtie-filter. The shading reduction together with the beam hardening and dome artifact correction algorithms aim to improve the linearity and accuracy of the CT-numbers (CT#). The CALI framework was evaluated using CatPhan to quantify linearity, contrast-to-noise (CNR), and CT# accuracy, as well as subjectively on patient images acquired on a clinical system. Linearity of the reconstructed attenuation-map was improved from 0.80 to 0.95. The CT# mean absolute measurement error was reduced from 76.1 to 26.9 HU. The CNR of the acrylic insert in the sensitometry module was improved from 1.8 to 7.8. The resulting clinical brain images showed substantial improvements in soft tissue contrast visibility, revealing structures such as ventricles which were otherwise undetectable in the original clinical images obtained from the system. The proposed reconstruction framework also improved CT# accuracy compared to the original images acquired on the system. For frameless image-guided SRS, improving soft tissue visibility can facilitate evaluation of MR to CBCT co-registration. Moreover, more accurate CT# may enable the use of CBCT for daily dose delivery measurements.