Lung cancer radiotherapyVerifying tumor position during stereotactic body radiation therapy delivery using (limited-arc) cone beam computed tomography imaging

Background and purposeProof of tumor position during stereotactic body radiotherapy (SBRT) delivery is desirable. We investigated if cone-beam CT (CBCT) scans reconstructed from (collimated) fluoroscopic kV images acquired during irradiation could show the dominant tumor position.Materials and methodsFull-arc CBCT scans were reconstructed using FDK filtered back projection from 38 kV fluoroscopy datasets (16 patients) continuously acquired during volumetric modulated spine SBRT. CBCT-CT match values were compared to the average spine offset values found using template matching + triangulation of the individual kV images. Multiple limited-arc CBCTs were reconstructed from fluoroscopic images acquired during lung SBRT of an anthropomorphic thorax phantom using 20-180° arc lengths and for 3 breath-hold lung SBRT patients.ResultsDifferences between 3D CBCT-CT match results and average spine offsets found using template matching + triangulation were 0.1 ± 0.1 mm for all directions (range: 0.0-0.5 mm). For limited-arc CBCTs of the thorax phantom, the automatic 3D CBCT-CT match results for arc lengths of 80-180° were ≤1 mm. 20° CBCT reconstruction still allowed for positional verification in 2D.Conclusions(Limited-arc) CBCT reconstructions of kV images acquired during irradiation can identify the dominant position of the tumor during treatment delivery.