Fluid-filled dynamic bowtie filter: Description and comparison with other modulators

Purpose: A dynamic bowtie filter can modulate flux along both fan and view angles for reduced patient dose, scatter, and required photon flux, which is especially important for photon counting detectors (PCDs). Among the proposed dynamic bowtie designs, the piecewise-linear attenuator (Hsieh and Pelc, Med Phys. 2013;40:031910) offers more flexibility than conventional filters, but relies on analog positioning of a limited number of wedges. In this work, we study our previously proposed dynamic attenuator design, the fluid-filled dynamic bowtie filter (FDBF) that has digital control. Specifically, we use computer simulations to study fluence modulation, reconstructed image noise, and radiation dose and to compare it to other attenuators. FDBF is an array of small channels each of which, if it can be filled with dense fluid or emptied quickly, has a binary effect on the flux. The cumulative attenuation from each channel along the x-ray path contributes to the FDBF total attenuation. Methods: An algorithm is proposed for selecting which FDBF channels should be filled. Two optimization metrics are considered: minimizing the maximum-count-rate for PCDs and minimizing peak-variance for energy-integrating detectors (EIDs) at fixed radiation dose (for optimizing dose efficiency). Using simulated chest, abdomen, and shoulder data, the performance is compared with a conventional bowtie and a piecewise-linear attenuator. For minimizing peak-variance, a perfect-attenuator (hypothetical filter capable of adjusting the fluence of each ray individually) and flat-variance attenuator are also included in the comparison. Two possible fluids, solutions of zinc bromide and gadolinium chloride, were tested. Results: To obtain the same SNR as routine clinical protocols, the proposed FDBF reduces the maximum-count-rate (across projection data, averaged over the test objects) of PCDs to 1.2 Mcps/mm², which is 55.8 and 3.3 times lower than the max-count-rate of the conventional bowtie and the piecewise-linear bowtie, respectively. (Averaged across objects for FDBF, the max-count-rate without object and FDBF is 2063.5 Mcps/mm², and the max-count-rate with object without FDBF is 749.8 Mcps/mm².) Moreover, for the peak-variance analysis, the FDBF can reduce entrance-energy-fluence (sum of energy incident on objects, used as a surrogate for dose) to 34% of the entrance-energy-fluence from the conventional filter on average while achieving the same peak noise level. Its entrance-energy-fluence reduction performance is only 7% worse than the perfect-attenuator on average and is 13% better than the piecewise-linear filter for chest and shoulder. Furthermore, the noise-map in reconstructed image domain from the FDBF is more uniform than the piecewise-linear filter, with 3 times less variation across the object. For the dose reduction task, the zinc bromide solution performed slightly poorer than stainless steel but was better than the gadolinium chloride solution. Conclusions: The FDBF allows finer control over flux distribution compared to piecewise-linear and conventional bowtie filters. It can reduce the required maximum-count-rate for PCDs to a level achievable by current detector designs and offers a high dose reduction factor.