Image filtering for improved dose resolution in CT polymer gel dosimetry.

X-ray computed tomography (CT) has been established as a feasible method of performing dosimetry using polyacrylamide gels (PAGs). A small density change occurs in PAG upon irradiation that provides contrast in PAG CT images. However, low dose resolution limits the clinical usefulness of the technique. This work investigates the potential of using image filtering techniques on PAG CT images in order to reduce image noise and improve dose resolution. CT image noise for the scanner and protocol used for the gel images is analyzed and found to be Gaussian distributed and independent of the contrast level in the images. As a result, several filters for reducing spatially invariant noise are investigated: mean, median, midpoint, adaptive mean, alpha-trimmed mean, sigma mean, and a relatively new filter called SUSAN (smallest univalue segment assimilating nucleus). All filters are applied, using 3x3, 5x5, and 7x7 pixel masks, to a CT image of a PAG irradiated with a stereotactic radiosurgery dose distribution. The dose resolution within 95% confidence (D(delta)95%) is calculated and compared for each filtered image, as well the unfiltered image. In addition, the ability of the filters to maintain the spatial integrity of the dose distribution is evaluated and compared. Results clearly indicate that the filters are not equal in their ability to improve D(delta)95% or in their effect on the spatial integrity of the dose distribution. In general, increasing mask size improves D(delta)95% but simultaneously degrades spatial dose information. The mean filter provides the greatest improvement in D(delta)95%, but also the greatest loss of spatial dose information. The SUSAN, mean adaptive, and alpha-trimmed mean filters all provide comparable, but slightly poorer dose resolution. In addition, the SUSAN and adaptive filters both excel at maintaining the spatial distribution of dose and overall are the best performing filters for this application. The midpoint filter, normally useful for Gaussian noise, is poor all-round, dramatically distorting the dose distribution for masks greater than 3x3. The median filter, a common edge preserving noise reduction filter, performs moderately well, but artificially increases high dose gradients. The sigma filter preserves the spatial distribution of dose very well but is least effective at improving dose resolution. In summary, dose resolution can be significantly improved in CT PAG dosimetry through postprocessing of CT images using spatial noise reduction filters. However, such filters are not equal in their ability to improve dose resolution or to maintain the spatial integrity of the dose distribution and an appropriate filter must be chosen depending on clinical demands of the application.