Title:
Development and validation of a hybrid simulation technique for cone beam CT: application to an oral imaging system.

Abstract:
This paper proposes a hybrid technique to simulate the complete chain of an oral cone beam computed tomography (CBCT) system for the study of both radiation dose and image quality. The model was developed around a 3D Accuitomo 170 unit (J Morita, Japan) with a tube potential range of 60-90 kV. The Monte Carlo technique was adopted to simulate the x-ray generation, filtration and collimation. Exact dimensions of the bow-tie filter were estimated iteratively using experimentally acquired flood images. Non-flat radiation fields for different exposure settings were mediated via 'phase spaces'. Primary projection images were obtained by ray tracing at discrete energies and were fused according to the two-dimensional energy modulation templates derived from the phase space. Coarse Monte Carlo simulations were performed for scatter projections and the resulting noisy images were smoothed by Richardson-Lucy fitting. Resolution and noise characteristics of the flat panel detector were included using the measured modulation transfer function (MTF) and the noise power spectrum (NPS), respectively. The Monte Carlo dose calculation was calibrated in terms of kerma free-in-air about the isocenter, using an ionization chamber, and was subsequently validated by comparison against the measured air kerma in water at various positions of a cylindrical water phantom. The resulting dose discrepancies were found <10% for most cases. Intensity profiles of the experimentally acquired and simulated projection images of the water phantom showed comparable fractional increase over the common area as changing from a small to a large field of view, suggesting that the scatter was accurately accounted. Image validation was conducted using two small phantoms and the built-in quality assurance protocol of the system. The reconstructed simulated images showed high resemblance on contrast resolution, noise appearance and artifact pattern in comparison to experimentally acquired images, with <5% difference for voxel values of the aluminum and air insert regions and <3% difference for voxel uniformity across the homogeneous PMMA region. The detector simulation by use of the MTF and NPS data exhibited a big influence on noise and the sharpness of the resulting images. The hybrid simulation technique is flexible and has wide applicability to CBCT systems.