Étude de l’impact d’une correction d’atténuation par tomodensitométrie en scintigraphie myocardique

Myocardial perfusion SPECT is a routine for the assessment of patients with coronary artery disease (CAD). However, attenuation artifacts may decrease the specificity of the test. These artifacts can be corrected with an attenuation correction. We prospectively included 70 patients who underwent myocardial perfusion SPECT with (IRAC) and without (IRNC) attenuation correction using transmission CT imaging integrated in the acquisition system in patients with low prevalence of CAD. Automatic quantitative analysis with summed stress score (SSS) and rest (SRS) and summed difference score (SDS) was used as interpretation criteria. The results showed a specificity of 80% for IRAC and 56% for IRNC, a positive predictive value of 40% for IRAC and 23% for IRNC, without any significant change in sensitivity. An unpaired t-test showed no significant difference between the overall population and one where an artifact was corrected for heart rate and breath rate during the acquisition effort, the body mass index, chest and abdomen circumferences, and the ratio of these two parameters. Attenuation correction significantly improves the specificity of myocardial scintigraphy with no significant difference in sensitivity. The majority of corrections were for artifacts from the inferior wall in men. There is no correlation between the anthropomorphic and physiological parameters and the occurrence of an artifact of attenuation corrected with CT data.     

Iterative Beam Hardening Correction for Multi-Material Objects

In this paper, we propose an iterative beam hardening correction method that is applicable for the case with multiple materials. By assuming that the materials composing scanned object are known and that they are distinguishable by their linear attenuation coefficients at some given energy, the beam hardening correction problem is converted into a nonlinear system problem, which is then solved iteratively. The reconstructed image is the distribution of linear attenuation coefficient of the scanned object at a given energy. So there are no beam hardening artifacts in the image theoretically. The proposed iterative scheme combines an accurate polychromatic forward projection with a linearized backprojection. Both forward projection and backprojection have high degree of parallelism, and are suitable for acceleration on parallel systems. Numerical experiments with both simulated data and real data verifies the validity of the proposed method. The beam hardening artifacts are alleviated effectively. In addition, the proposed method has a good tolerance on the error of the estimated x-ray spectrum.     

Toward a dedicated system for quantitative SPECT mammotomography

This work extends our previous quantitative brain SPECT research to breast imaging-SPECT mammotomography. A cost-effective dedicated SPECT mammotomography system is presented, which aims to acquire sufficient information for efficient reconstruction of large volumetric images. A very short focal-length fan-beam collimation is designed to maximize the information collected from a relitively small vital organ that has a uniform attenuation property. Data noise of a Poisson nature is accurately modeled and effectively treated in sinogram space, followed by efficient compensation for Compton scattering, uniform attenuation, and collimater response. This sinogram-space statistical approach has the potential to reconstruct high-resolution images at a very fast speed. Yet it provides the same image quality as iterative reconstruction algorithms did, in terms of abnormality detectability by observer studies.     

Quantitative evaluation of transmission properties of breast tissue equivalent materials under Compton scatter imaging setup

To explore the potential of utilizing Compton scattered x-ray photons for imaging applications, it is critical to accurately evaluate scattered x-ray transmission properties of targeted tissue materials. In this study, scattered x-ray transmission of breast tissue equivalent phantoms was evaluated. Firstly, two validations were carried out using a primary x-ray beam at 80 kVp with both experimental measurement (ion chamber with narrow-beam setup) and analytical calculation (Spektr toolkit). The tungsten-anode x-ray spectrum model was thus validated by measuring and calculating the transmission through increasing thickness of 1100 Aluminum filters. Similarly, the composition models of breast tissue equivalent phantoms (CIRS, 012A) were validated by measuring and calculating x-ray transmission for three different breast compositions (BR30/70, BR50/50, and BR70/30). Following validation, transmission properties of Compton scattered x-ray photons were measured with a GOS based linear array detector at the 90° angle from the primary beam. The same study was performed through three independent approaches: experimental measurement, analytical calculation, and Monte Carlo simulation (GEANT4). For all three methods, the scattered x-ray photon transmission as functions of phantom thickness were determined and fit into exponential functions. The transmission curves from all three methods matched reasonably well, with a maximum difference of 6.3% for the estimated effective attenuation coefficients of the BR50/50 phantom. The relative difference among the three methods of estimated attenuation is under 3.5%. As an initial step to develop a novel Compton scatter-based breast imaging system, the quantitative results from this study paved a fundamental base for future work.     

Attenuation correction for rotating multi-segment slant-hole SPECT in breast imaging

Rotating multi-segment slant-hole (RMSSH) SPECT is suitable for detecting small and low-contrast breast lesions since it has much higher detection efficiency compared with parallel-hole SPECT for the same resolution and can image the breast at a closer distance.Our RMSSH SPECT image reconstruction extends a previous rotation-shear transformation based 3D iterative reconstruction method to include non-uniform attenuation compensation. Reconstructed RMSSH SPECT images with attenuation compensation show much improved quantitative accuracy and less image artifacts than without. We conclude that attenuation compensation provides RMSSH SPECT images with improved quality and quantitative accuracy.     

Magnetic resonace-based attenuation correction for micro-single-photon emission computed tomography

Attenuation correction is necessary for quantification in micro-single-photon emission computed tomography (micro-SPECT). In general, this is done based on micro-computed tomographic (micro-CT) images. Derivation of the attenuation map from magnetic resonance (MR) images is difficult because bone and lung are invisible in conventional MR images and hence indistinguishable from air. An ultrashort echo time (UTE) sequence yields signal in bone and lungs. Micro-SPECT, micro-CT, and MR images of 18 rats were acquired. Different tracers were used: hexamethylpropyleneamine oxime (brain), dimercaptosuccinic acid (kidney), colloids (liver and spleen), and macroaggregated albumin (lung). The micro-SPECT images were reconstructed without attenuation correction, with micro-CT-based attenuation maps, and with three MR-based attenuation maps: uniform, non-UTE-MR based (air, soft tissue), and UTE-MR based (air, lung, soft tissue, bone). The average difference with the micro-CT-based reconstruction was calculated. The UTE-MR-based attenuation correction performed best, with average errors ≤ 8% in the brain scans and ≤ 3% in the body scans. It yields nonsignificant differences for the body scans. The uniform map yields errors of ≤ 6% in the body scans. No attenuation correction yields errors ≥ 15% in the brain scans and ≥ 25% in the body scans. Attenuation correction should always be performed for quantification. The feasibility of MR-based attenuation correction was shown. When accurate quantification is necessary, a UTE-MR-based attenuation correction should be used.     

Cone-beam breast computed tomography using ultra-fast image reconstruction with constrained,total-variation minimization for suppression of artifacts

Compressed sensing based iterative reconstruction algorithms for computed tomography such as adaptive steepest descent-projection on convex sets (ASD-POCS) are attractive due to their applicability in incomplete datasets such as sparse-view data and can reduce radiation dose to the patients while preserving image quality. Although IR algorithms reduce image noise compared to analytical Feldkamp-Davis-Kress (FDK) algorithm, they may generate artifacts, particularly along the periphery of the object. One popular solution is to use finer image-grid followed by down-sampling. This approach is computationally intensive but may be compensated by reducing the field of view. Our proposed solution is to replace the algebraic reconstruction technique within the original ASD-POCS by ordered subsets-simultaneous algebraic reconstruction technique (OS-SART) and with initialization using FDK image. We refer to this method as Fast, Iterative, TV-Regularized, Statistical reconstruction Technique (FIRST). In this study, we investigate FIRST for cone-beam dedicated breast CT with large image matrix. The signal-difference to noise ratio (SDNR), the difference of the mean value and the variance of adipose and fibroglandular tissues for both FDK and FIRST reconstructions were determined. With FDK serving as the reference, the root-mean-square error (RMSE), bias, and the full-width at half-maximum (FWHM) of microcalcifications in two orthogonal directions were also computed. Our results suggest that FIRST is competitive to the finer image-grid method with shorter reconstruction time. Images reconstructed using the FIRST do not exhibit artifacts and outperformed FDK in terms of image noise. This suggests the potential of this approach for radiation dose reduction in cone-beam breast CT.     

Comparison of ring artifact removal methods using flat panel detector based CT images

Background

Ring artifacts are the concentric rings superimposed on the tomographic images often caused by the defective and insufficient calibrated detector elements as well as by the damaged scintillator crystals of the flat panel detector. It may be also generated by objects attenuating X-rays very differently in different projection direction. Ring artifact reduction techniques so far reported in the literature can be broadly classified into two groups. One category of the approaches is based on the sinogram processing also known as the pre-processing techniques and the other category of techniques perform processing on the 2-D reconstructed images, recognized as the post-processing techniques in the literature. The strength and weakness of these categories of approaches are yet to be explored from a common platform.

Method

In this paper, a comparative study of the two categories of ring artifact reduction techniques basically designed for the multi-slice CT instruments is presented from a common platform. For comparison, two representative algorithms from each of the two categories are selected from the published literature. A very recently reported state-of-the-art sinogram domain ring artifact correction method that classifies the ring artifacts according to their strength and then corrects the artifacts using class adaptive correction schemes is also included in this comparative study. The first sinogram domain correction method uses a wavelet based technique to detect the corrupted pixels and then using a simple linear interpolation technique estimates the responses of the bad pixels. The second sinogram based correction method performs all the filtering operations in the transform domain, i.e., in the wavelet and Fourier domain. On the other hand, the two post-processing based correction techniques actually operate on the polar transform domain of the reconstructed CT images. The first method extracts the ring artifact template vector using a homogeneity test and then corrects the CT images by subtracting the artifact template vector from the uncorrected images. The second post-processing based correction technique performs median and mean filtering on the reconstructed images to produce the corrected images.

Results

The performances of the comparing algorithms have been tested by using both quantitative and perceptual measures. For quantitative analysis, two different numerical performance indices are chosen. On the other hand, different types of artifact patterns, e.g., single/band ring, artifacts from defective and mis-calibrated detector elements, rings in highly structural object and also in hard object, rings from different flat-panel detectors are analyzed to perceptually investigate the strength and weakness of the five methods. An investigation has been also carried out to compare the efficacy of these algorithms in correcting the volume images from a cone beam CT with the parameters determined from one particular slice. Finally, the capability of each correction technique in retaining the image information (e.g., small object at the iso-center) accurately in the corrected CT image has been also tested.

Conclusions

The results show that the performances of the algorithms are limited and none is fully suitable for correcting different types of ring artifacts without introducing processing distortion to the image structure. To achieve the diagnostic quality of the corrected slices a combination of the two approaches (sinogram- and post-processing) can be used. Also the comparing methods are not suitable for correcting the volume images from a cone beam flat-panel detector based CT.     

Kilovoltage beam model for flat panel imaging system with bow-tie filter for scatter prediction and correction

PurposeKilovoltage flat-panel imaging systems are used for cone-beam Computed Tomography (CBCT) and digital Tomosynthesis (DTS). Hereby, the presence of scatter and relatively large dose from imaging are challenging factors. In this study a phenomenological beam model was developed to characterize imager response to imaging beams with a bow-tie filter (Varian OBI system).Materials and methodThe kilovoltage beam model was based on dose ratio formalism and thus was using standard concepts of megavoltage dose calculation such as scatter factors, tissue maximum ratio and off-axis ratio. Primary and scatter (head and phantom scatter) were modeled with three Gaussian kernels. Parameters were based on measured transmission images for slabs of solid water of different total thickness and various jaw settings.ResultsThe beam model was used to evaluate contributions from primary, secondary and tertiary contributions for different geometrical objects such as cylinders and step-like phantoms. Theoretical predictions of radiographs using the model for known objects are consistent with the measurements.ConclusionSecondary and tertiary contributions were interpreted as scatter and can be subtracted from CBCT projections based on the analytical model. Therefore our model can provide a basis for improvement of image quality (less artifacts due to scatter, better contrast and resolution) in CBCT reconstruction.     

Optimization of SPECT-CT Hybrid Imaging Using Iterative Image Reconstruction for Low-Dose CT: A Phantom Study

Background

Hybrid imaging combines nuclear medicine imaging such as single photon emission computed tomography (SPECT) or positron emission tomography (PET) with computed tomography (CT). Through this hybrid design, scanned patients accumulate radiation exposure from both applications. Imaging modalities have been the subject of long-term optimization efforts, focusing on diagnostic applications. It was the aim of this study to investigate the influence of an iterative CT image reconstruction algorithm (ASIR) on the image quality of the low-dose CT images.

Methodology/Principal Findings

Examinations were performed with a SPECT-CT scanner with standardized CT and SPECT-phantom geometries and CT protocols with systematically reduced X-ray tube currents. Analyses included image quality with respect to photon flux. Results were compared to the standard FBP reconstructed images. The general impact of the CT-based attenuation maps used during SPECT reconstruction was examined for two SPECT phantoms. Using ASIR for image reconstructions, image noise was reduced compared to FBP reconstructions for the same X-ray tube current. The Hounsfield unit (HU) values reconstructed by ASIR were correlated to the FBP HU values(R² ≥ 0.88) and the contrast-to-noise ratio (CNR) was improved by ASIR. However, for a phantom with increased attenuation, the HU values shifted for low X-ray tube currents I ≤ 60 mA (p ≤ 0.04). In addition, the shift of the HU values was observed within the attenuation corrected SPECT images for very low X-ray tube currents (I ≤ 20 mA, p ≤ 0.001).

Conclusion/Significance

In general, the decrease in X-ray tube current up to 30 mA in combination with ASIR led to a reduction of CT-related radiation exposure without a significant decrease in image quality.     

3D Algebraic Iterative Reconstruction for Cone-Beam X-Ray Differential Phase-Contrast Computed Tomography

Due to the potential of compact imaging systems with magnified spatial resolution and contrast, cone-beam x-ray differential phase-contrast computed tomography (DPC-CT) has attracted significant interest. The current proposed FDK reconstruction algorithm with the Hilbert imaginary filter will induce severe cone-beam artifacts when the cone-beam angle becomes large. In this paper, we propose an algebraic iterative reconstruction (AIR) method for cone-beam DPC-CT and report its experiment results. This approach considers the reconstruction process as the optimization of a discrete representation of the object function to satisfy a system of equations that describes the cone-beam DPC-CT imaging modality. Unlike the conventional iterative algorithms for absorption-based CT, it involves the derivative operation to the forward projections of the reconstructed intermediate image to take into account the differential nature of the DPC projections. This method is based on the algebraic reconstruction technique, reconstructs the image ray by ray, and is expected to provide better derivative estimates in iterations. This work comprises a numerical study of the algorithm and its experimental verification using a dataset measured with a three-grating interferometer and a mini-focus x-ray tube source. It is shown that the proposed method can reduce the cone-beam artifacts and performs better than FDK under large cone-beam angles. This algorithm is of interest for future cone-beam DPC-CT applications.     

CT iterative reconstruction in image space: A phantom study

Although iterative reconstruction is widely applied in SPECT/PET, its introduction in clinical CT is quite recent, in the past the demand for extensive computer power and long image reconstruction times have stopped the diffusion of this technique. Recently Iterative Reconstruction in Image Space (IRIS) has been introduced on Siemens top CT scanners. This recon method works on image data area, reducing the time-consuming loops on raw data and noise removal is obtained in subsequent iterative steps with a smoothing process. We evaluated image noise, low contrast resolution, CT number linearity and accuracy, transverse and z-axis spatial resolution using some dedicated phantoms in single, dual source and cardiac mode. We reconstructed images with a traditional filtered back-projection algorithm and with IRIS. The iterative procedure preserves spatial resolution, CT number accuracy and linearity moreover decreases image noise. These preliminary results support the idea that dose reduction with preserved image quality is possible with IRIS, even if studies on patients are necessary to confirm these data.     

Characterization of Scattered X-Ray Photons in Dental Cone-Beam Computed Tomography

Purpose

Scatter is a very important artifact causing factor in dental cone-beam CT (CBCT), which has a major influence on the detectability of details within images. This work aimed to improve the image quality of dental CBCT through scatter correction.

Methods

Scatter was estimated in the projection domain from the low frequency component of the difference between the raw CBCT projection and the projection obtained by extrapolating the model fitted to the raw projections acquired with 2 different sizes of axial field-of-view (FOV). The function for curve fitting was optimized by using Monte Carlo simulation. To validate the proposed method, an anthropomorphic phantom and a water-filled cylindrical phantom with rod inserts simulating different tissue materials were scanned using 120 kVp, 5 mA and 9-second scanning time covering an axial FOV of 4 cm and 13 cm. The detectability of the CT image was evaluated by calculating the contrast-to-noise ratio (CNR).

Results

Beam hardening and cupping artifacts were observed in CBCT images without scatter correction, especially in those acquired with 13 cm FOV. These artifacts were reduced in CBCT images corrected by the proposed method, demonstrating its efficacy on scatter correction. After scatter correction, the image quality of CBCT was improved in terms of target detectability which was quantified as the CNR for rod inserts in the cylindrical phantom.

Conclusions

Hopefully the calculations performed in this work can provide a route to reach a high level of diagnostic image quality for CBCT imaging used in oral and maxillofacial structures whilst ensuring patient dose as low as reasonably achievable, which may ultimately make CBCT scan a reliable and safe tool in clinical practice.     

Illustrations pratiques — Pièges et artefacts/Trucs et astuces

Artifacts result from discrepancy between the estimated density values coming from the reconstructed CT image and the real value. They may come from many reasons (patient, device, algorithm, RX physical) and lead to deterioration of image quality and bad attenuation correction for SPECT or PET.     

An empirical artifact correction for proton computed tomography

Purpose: To reduce image artifacts of proton computed tomography (pCT) from a preclinical scanner, for imaging of the relative stopping power (RSP) needed for particle therapy treatment planning using a simple empirical artifact correction method.Methods: We adapted and employed a correction method previously used for beam-hardening correction in x-ray CT which makes use of a single scan of a custom-built homogeneous phantom with known RSP. Exploiting the linearity of the filtered backprojection operation, a function was found which corrects water-equivalent path lengths (RSP line integrals) in experimental scans using a prototype pCT scanner. The correction function was applied to projection values of subsequent scans of a homogeneous water phantom, a sensitometric phantom with various inserts and an anthropomorphic head phantom. Data were acquired at two different incident proton energies to test the robustness of the method.Results: Inaccuracies in the detection process caused an offset and known ring artifacts in the water phantom which were considerably reduced using the proposed method. The mean absolute percentage error (MAPE) of mean RSP values of all inserts of the sensitometric phantom and the water phantom was reduced from 0.87% to 0.44% and from 0.86% to 0.48% for the two incident energies respectively. In the head phantom a clear reduction of artifacts was observed.Conclusions: Image artifacts of experimental pCT scans with a prototype scanner could substantially be reduced both in homogeneous, heterogeneous and anthropomorphic phantoms. RSP accuracy was also improved.     

A Deep Learning-based correction to EPID dosimetry for attenuation and scatter in the Unity MR-Linac system

PurposeEPID dosimetry in the Unity MR-Linac system allows for reconstruction of absolute dose distributions within the patient geometry. Dose reconstruction is accurate for the parts of the beam arriving at the EPID through the MRI central unattenuated region, free of gradient coils, resulting in a maximum field size of ~10 × 22 cm² at isocentre. The purpose of this study is to develop a Deep Learning-based method to improve the accuracy of 2D EPID reconstructed dose distributions outside this central region, accounting for the effects of the extra attenuation and scatter.MethodsA U-Net was trained to correct EPID dose images calculated at the isocenter inside a cylindrical phantom using the corresponding TPS dose images as ground truth for training. The model was evaluated using a 5-fold cross validation procedure. The clinical validity of the U-Net corrected dose images (the so-called DEEPID dose images) was assessed with in vivo verification data of 45 large rectum IMRT fields. The sensitivity of DEEPID to leaf bank position errors (±1.5 mm) and ±5% MU delivery errors was also tested.ResultsCompared to the TPS, in vivo 2D DEEPID dose images showed an average γ-pass rate of 90.2% (72.6%–99.4%) outside the central unattenuated region. Without DEEPID correction, this number was 44.5% (4.0%–78.4%). DEEPID correctly detected the introduced delivery errors.ConclusionsDEEPID allows for accurate dose reconstruction using the entire EPID image, thus enabling dosimetric verification for field sizes up to ~19 × 22 cm² at isocentre. The method can be used to detect clinically relevant errors.     

Monte Carlo evaluation of glandular dose in cone-beam X-ray computed tomography dedicated to the breast: Homogeneous and heterogeneous breast models

PurposeIn cone-beam computed tomography dedicated to the breast (BCT), the mean glandular dose (MGD) is the dose metric of reference, evaluated from the measured air kerma by means of normalized glandular dose coefficients (DgN_CT). This work aimed at computing, for a simple breast model, a set of DgN_CT values for monoenergetic and polyenergetic X-ray beams, and at validating the results vs. those for patient specific digital phantoms from BCT scans.MethodsWe developed a Monte Carlo code for calculation of monoenergetic DgN_CT coefficients (energy range 4.25–82.25 keV). The pendant breast was modelled as a cylinder of a homogeneous mixture of adipose and glandular tissue with glandular fractions by mass of 0.1%, 14.3%, 25%, 50% or 100%, enveloped by a 1.45 mm-thick skin layer. The breast diameter ranged between 8 cm and 18 cm. Then, polyenergetic DgN_CT coefficients were analytically derived for 49-kVp W-anode spectra (half value layer 1.25–1.50 mm Al), as in a commercial BCT scanner. We compared the homogeneous models to 20 digital phantoms produced from classified 3D breast images.ResultsPolyenergetic DgN_CT resulted 13% lower than most recent published data. The comparison vs. patient specific breast phantoms showed that the homogeneous cylindrical model leads to a DgN_CT percentage difference between −15% and +27%, with an average overestimation of 8%.ConclusionsA dataset of monoenergetic and polyenergetic DgN_CT coefficients for BCT was provided. Patient specific breast models showed a different volume distribution of glandular dose and determined a DgN_CT 8% lower, on average, than homogeneous breast model.     

Three-dimensional visualization and morphometry of small airways from microfocal X-ray computed tomography

Physiological morphometry is a critical factor in the flow dynamics in small airways. In this study, we visualized and analyzed the three-dimensional structure of the small airways without dehydration and fixation. We developed a two-step method to visualize small airways in detail by staining the lung tissue with a radiopaque solution and then visualizing the tissue with a cone-beam microfocal X-ray computed tomographic (CT) system. To verify the applicability of this staining and CT imaging (SCT) method, we used the method to visualize small airways in excised rat lungs. By using the SCT method to obtain continuous CT images, three-dimensional branching and merging bronchi ranging from 500 to 150 microm (the airway generation=8-16) were successfully reconstructed. The morphometry of the small airways (diameter, length, branching angle and gravity angle between the gravity direction and airway vector) was analyzed using the three-dimensional thinning algorithm. The diameter and length exponentially decreased with the airway generation. The asymmetry of the bifurcation decreased with generation and one branching angle decided the other pair branching angle. The SCT method is the first reported method that yields faithful high-resolution images of soft tissue geometry without fixation and the three-dimensional morphometry of small airways is useful for studying the biomechanical dynamics in small airways.     

Image reconstruction of optical computed tomography by using the algebraic reconstruction technique for dose readouts of polymer gel dosimeters

Optical computed tomography (optical CT) has been proven to be a useful tool for dose readouts of polymer gel dosimeters. In this study, the algebraic reconstruction technique (ART) for image reconstruction of gel dosimeters was used to improve the image quality of optical CT. Cylindrical phantoms filled with N-isopropyl-acrylamide polymer gels were irradiated using a medical linear accelerator. A circular dose distribution and a hexagonal dose distribution were produced by applying the VMAT technique and the six-field dose delivery, respectively. The phantoms were scanned using optical CT, and the images were reconstructed using the filtered back-projection (FBP) algorithm and the ART. For the circular dose distribution, the ART successfully reduced the ring artifacts and noise in the reconstructed image. For the hexagonal dose distribution, the ART reduced the hot spots at the entrances of the beams and increased the dose uniformity in the central region. Within 50% isodose line, the gamma pass rates for the 2 mm/3% criteria for the ART and FBP were 99.2% and 88.1%, respectively. The ART could be used for the reconstruction of optical CT images to improve image quality and provide accurate dose conversion for polymer gel dosimeters.     

Investigation of the dose distribution for a cone beam CT system dedicated to breast imaging

Cone-beam breast Computed Tomography (bCT) is an X-ray imaging technique for breast cancer diagnosis, in principle capable of delivering a much more homogeneous dose spatial pattern to the breast volume than conventional mammography, at dose levels comparable to two-view mammography. We present an investigation of the three-dimensional dose distribution for a cone-beam CT system dedicated to breast imaging. We employed Monte Carlo simulations for estimating the dose deposited within a breast phantom having a hemiellipsoidal shape placed on a cylinder of 3.5 cm thickness that simulates the chest wall. This phantom represents a pendulant breast in a bCT exam with the average diameter at chest wall, assumed to correspond to a 5-cm-thick compressed breast in mammography. The phantom is irradiated in a circular orbit with an X-ray cone beam selected from four different techniques: 50, 60, 70, and 80 kVp from a tube with tungsten anode, 1.8 mm Al inherent filtration and additional filtration of 0.2 mm Cu. Using the Monte Carlo code GEANT4 we simulated a system similar to the experimental apparatus available in our lab. Simulations were performed at a constant free-in-air air kerma at the isocenter (1 μGy); the corresponding total number of photon histories per scan was 288 million at 80 kVp. We found that the more energetic beams provide a more uniform dose distribution than at low energy: the 50 kVp beam presents a frequency distribution of absorbed dose values with a coefficient of variation almost double than that for the 80 kVp beam. This is confirmed by the analysis of the relative dose profiles along the radial (i.e. parallel to the “chest wall”) and longitudinal (i.e. from “chest wall” to “nipple”) directions. Maximum radial deviations are on the order of 25% for the 80 kVp beam, whereas for the 50 kVp beam variations around 43% were observed, with the lowest dose values being found along the central longitudinal axis of the phantom.