Fast Patient-Specific Breast CT Dosimetry: 22-Fold Acceleration of Monte Carlo MGD Estimation

Abstract

Accurate patient-specific mean glandular dose (MGD) estimation in breast computed tomography (BCT) requires anatomically realistic models, but high-resolution patient-derived phantoms impose high computational demands on Monte Carlo (MC) dosimetry. We previously developed and validated an EGSnrc-based framework for synchrotron propagation-based phase-contrast BCT (PB-PCT) for the first-in-human study at the Australian Synchrotron. With participant imaging commencing, this study aimed to optimize phantom spatial resolution and MC efficiency while maintaining MGD accuracy, for a rapid patient-specific dosimetry. Four patient-specific heterogeneous breast phantoms with varying volume and glandularity were generated from PB-PCT images of mastectomy specimens acquired at 35 keV. The highest-resolution phantom for each specimen served as the reference. Phantoms were downsampled by increasing in-plane voxel size and slice thickness, and MGD was recalculated using EGSnrc/DOSXYZnrc. A 4.5% difference from reference MGD was adopted as the accuracy criterion. Primary photon histories were then reduced to determine the minimum required for acceptable MC precision. A common voxel size of 0.30 x 0.30 x 3.00 mm3 maintained MGD within 4.5% of reference for all four phantoms while reducing voxel number by approximately 20-31-fold. MGD was more sensitive to in-plane voxel size than slice thickness, supporting anisotropic downsampling. Reduced-resolution phantoms enabled a 15-fold reduction in photon histories to 2 x 10^8 while maintaining acceptable statistical uncertainty. Combined optimization reduced computation time from approximately 1600 to 72 min, a 22-fold acceleration. Patient-specific phantoms can be substantially downsampled while maintaining MGD accuracy and markedly reducing computational burden. This optimization provides a foundation for future real-time patient-specific BCT dosimetry.