Variations in size-specific effective dose with patient stature and beam width for kV cone beam CT imaging in radiotherapy

The facilities now available on linear accelerators for external beam radiotherapy enable radiation fields to be conformed to the shapes of tumours with a high level of precision. However, in order for the treatment delivered to take advantage of this, the patient must be positioned on the couch with the same degree of accuracy. Kilovoltage cone beam computed tomography systems are now incorporated into radiotherapy linear accelerators to allow imaging to be performed at the time of treatment, and image-guided radiation therapy is now standard in most radiotherapy departments throughout the world. However, because doses from imaging are much lower than therapy doses, less effort has been put into optimising radiological protection of imaging protocols. Standard imaging protocols supplied by the equipment vendor are often used with little adaptation to the stature of individual patients, and exposure factors and field sizes are frequently larger than necessary. In this study, the impact of using standard protocols for imaging anatomical phantoms of varying size from a library of 193 adult phantoms has been evaluated. Monte Carlo simulations were used to calculate doses for organs and tissues for each phantom, and results combined in terms of size-specific effective dose (SED). Values of SED from pelvic scans ranged from 11 mSv to 22 mSv for male phantoms and 8 mSv to 18 mSv for female phantoms, and for chest scans from 3.8 mSv to 7.6 mSv for male phantoms and 4.6 mSv to 9.5 mSv for female phantoms. Analysis of the results showed that if the same exposure parameters and field sizes are used, a person who is 5 cm shorter will receive a size SED that is 3%–10% greater, while a person who is 10 kg lighter will receive a dose that is 10%–14% greater compared with the average size.