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Updated: May 9, 2026
Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy
Published on: June 7, 2015
Structure visibility and online adaptation suitability of a new high-performance ring-gantry cone-beam computed
Agustinus J A J van de Schoot1, Joan J Penninkhof1, Britt Kunnen1
1Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
Background And Purpose:
A recently introduced high-performance ring-gantry cone-beam computed tomography (CBCTH) imaging system promises superior image quality compared with conventional ring-gantry CBCT imaging (CBCTC), however, it incurs additional costs. Our aim was to determine the added value of CBCTH compared with CBCTC in thoracic radiotherapy by quantifying structure visibility and online adaptive radiotherapy (oART) suitability.
Materials And Methods:
Twenty lung cancer patients treated in free-breathing and twenty left-sided breast cancer patients treated in deep-inspiration breath-hold were included in this prospective clinical study. Three CBCT imaging pairs per patient, consisting of CBCTH and CBCTC acquired on consecutive days, were included. Four observers independently scored all 240 CBCT datasets on structure visibility and oART suitability (1-5 scale). The effect of respiratory motion management on image quality enhancement was determined by comparing cohort-specific score differences.
Results:
In total, 4440 structure visibility and 960 oART suitability scores were collected. Patient-averaged scores favored CBCTH in 82% (100%) of the cases in the lung (breast) cohort. Compared with CBCTC, CBCTH-based scores increased significantly (p < 0.05) in both cohorts for structure visibility (lung: 2.8 to 3.1; breast: 3.1 to 3.8) and oART suitability (lung: 2.6 to 2.9; breast: 3.1 to 3.9). Structure visibility (oART suitability) score differences increased with deep-inspiration breath-hold (p < 0.001) compared with free-breathing, by on average 0.38 (0.39).
Conclusion:
In thoracic radiotherapy, CBCTH yielded statistically significant improvements in structure visibility and oART suitability where the largest improvements were obtained for CBCTH in deep-inspiration breath-hold. These results can contribute to informed decision-making regarding cost-effectiveness of CBCTH.
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