Image quality of 4D in-treatment CBCT acquired during lung SBRT using FFF beam: a phantom study
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RESEARCH
Image quality of 4D in‑treatment CBCT acquired during lung SBRT using FFF beam: a phantom study Jihun Kim, Ki Chang Keum, Ho Lee, Chae‑Seon Hong, Kwangwoo Park and Jin Sung Kim*
Abstract Background: Rotational beam delivery enables concurrent acquisition of cone-beam CT (CBCT), thereby facilitating further geometric verification of patient setup during radiation treatment. However, it is challenging to acquire CBCT during stereotactic body radiation therapy (SBRT) using flattening-filter free X-ray beams, in which a high radiation dose is delivered. This study presents quantitative evaluation results of the image quality in four-dimensional (4D) intreatment CBCT acquired during SBRT delivery. Methods: The impact of megavoltage (MV) scatter and acquisition parameters on the image quality was evalu‑ ated using Catphan 503 and XSight lung tracking phantoms. The in-treatment CBCT images of the phantoms were acquired while delivering 16 SBRT plans. The uniformity, contrast, and contrast-to-noise ratio (CNR) of the in-treatment CBCT images were calculated and compared to those of CBCT images acquired without SBRT delivery. Furthermore, the localizing accuracy of the moving target in the XSight lung phantom was evaluated for 10 respiratory phases. Results: The CNR of the 3D-reconstucted Catphan CBCT images was reduced from 6.3 to 2.6 due to the effect of MV treatment scatter. Both for the Catphan and XSight phantoms, the CBCT image quality was affected by the tube cur‑ rent and monitor units (MUs) of the treatment plan. The lung target in the XSight tracking phantom was most visible for extreme phases; the mean CNRs of the lung target in the in-treatment CBCT images (with 40 mA tube current) across the SBRT plans were 3.2 for the end-of-exhalation phase and 3.0 for the end-of-inhalation phase. The lung target was localized with sub-millimeter accuracy for the extreme respiratory phases. Conclusions: Full-arc acquisition with an increased tube current (e.g. 40 mA) is recommended to compensate for degradation in the CBCT image quality due to unflattened MV beam scatter. Acquiring in-treatment CBCT with a high-MU treatment beam is also suggested to improve the resulting CBCT image quality. Keywords: Image quality, In-treatment, Cone-beam computed tomography, Stereotactic body radiation therapy, Lung, Flattening filter free Background For lung stereotactic body radiation therapy (SBRT), appropriate management of respiratory motion is critical for accurate delivery of radiation beams to the target. Respiratory motion of lung target has been managed by *Correspondence: [email protected] Department of Radiation Oncology, Yonsei University College of Medicine, 50‑1 Yonsei‑ro, Seodaemoon‑gu, Seoul, South Korea
various techniques, such as motion encompassing, respiratory gating, breath-hold, and forced shallow breathing with abdominal compression as described in the report of the American Association of Physicists in Medicine Task Group 76 [1]. Monitoring during-treatment position of the lung target
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