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Feasibility of Latest-Generation Cone-Beam CT for Thoracic Imaging: A Pilot Study
Sylvain Bodard1, Paul Segui2, Florent Poirier3
1Memorial Sloan Kettering Cancer Center (MSK), Department of Radiology, Cornell University, 1275 York Avenue, New York, NY 10065 (S.B.); Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (S.B.); Université de Paris Cité, Hôpital Universitaire Necker Enfants Malades, Service d'Imagerie Adulte, AP-HP, F-75015, Paris, France (S.B.); CNRS UMR 7371, INSERM U 1146, Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, F-75006, Paris, France (S.B.).
Background:
Lung cancer remains the leading cause of cancer-related death worldwide. Low-dose computed tomography (LDCT) is the current gold standard for screening, but radiation exposure remains a concern. Cone-Beam Computed Tomography (CBCT) offers ultra-low-dose acquisition but has not yet been tested for thoracic screening.
Purpose:
To evaluate the feasibility of using a latest-generation CBCT system for thoracic imaging in a lung cancer screening context.
Materials And Methods:
88 patients, current or former smokers, were retrospectively included. They underwent thoracic CBCT (7 G Dual Energy system, NewTom, Italy) between July 2024 and April 2025 at a preventive health center, with either a standard-dose protocol (n = 48) or a low-dose protocol (n = 40). Two board-certified radiologists independently assessed pulmonary findings and image quality. Radiation doses were compared. Statistical analysis included mixed-effects models and interobserver agreement.
Results:
The radiation exposure was significantly lower in the low-dose group, with a median cumulative DLP of 42.8 mGy·cm, compared to 107.7 mGy·cm, representing a 2.5-fold reduction in radiation (p<0.001). Nodule detection occurred in 41% of patients overall. Overall image quality was rated good/excellent in 85% (low-dose) vs 83% (standard-dose); Risk Difference (RD) = +2% [IC95% -12; +16], Risk Ratio (RR) = 1.03. Diagnostic confidence was high in 82% vs 83%; RD = -1% [-14; +12], RR = 0.99. Spatial resolution was slightly lower in the low-dose group (OR = 0.51, p = 0.04). Interobserver agreement for nodule detection was substantial across both groups (κ = 0.73-0.83).
Conclusion:
Low-dose CBCT offers substantial radiation dose reduction without compromising diagnostic confidence or interobserver reliability. CBCT may represent a promising, cost-effective alternative or complement to low-dose CT in preventive lung imaging programs, but prospective studies comparing CBCT to LDCT are warranted.
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