Virtual dosimetry study with three cone-beam breast computed tomography scanners using a fast GPU based Monte Carlo code

: To compare the dosimetric performance of three cone-beam breast computed tomography (BCT) scanners, using real-time Monte Carlo-based dose estimates obtained with the VCT-BREAST GPU-accelerated platform dedicated to virtual clinical trials (VCT) in breast imaging. Approach: A GPU-based Monte Carlo code was developed for replicating in silico the geometric, x-ray spectra and detector setups adopted respectively in two research scanners and one commercial scanner, adopting 80 kV, 60 kV and 49 kV tube voltage, respectively. Our cohort of virtual breasts included 16 anthropomorphic voxelized breast phantoms from a publicly available dataset. For each virtual patient, we simulated exams on the three scanners, up to a nominal simulated mean glandular dose of 5 mGy (primary photons launched, in the order of 10111012 per scan). Simulated 3D dose maps (recorded for skin, adipose and glandular tissues) were compared for the same phantom, on the three scanners. MC simulations were implemented on a single NVIDIA GeForce RTX 3090 graphics card. Main results: Using the spread of the dose distribution as a figure of merit, we showed that, in the investigated phantoms, the glandular dose is more uniform with less dense breasts, and it is more uniformly distributed for scans at 80 kV and 60 kV than at 49 kV. A realistic virtual study of each breast phantom was completed in about 3.0 h with less than 1% statistical uncertainty, with 109 primary photons processed in 3.6 s. Significance: We reported the first dosimetric study of the VCT-BREAST platform, a fast simulation tool for real-time virtual dosimetry and imaging trials in BCT, investigating the dose delivery performance of three clinical BCT scanners. This tool can be adopted to investigate also the effects on the 3D dose distribution produced by changes in the geometrical and spectrum characteristics of a cone-beam BCT scanner.