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Updated: Aug 12, 2026

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Four-Dimensional CT Analysis Using Sequential 3D-3D Registration
Published on: November 23, 2019
Improved synthetic CT generation using surface scan information integrated into a deformable registration algorithm
Joachim Marichal1,2, Stina Svensson3, Geert De Kerf1,2
1Faculty of Medicine and Health Sciences, Universiteit Antwerpen, Antwerpen, Belgium.
Physics and Imaging in Radiation Oncology
|August 11, 2026
Summary
Integrating surface imaging with Cone-Beam Computed Tomography (CBCT) improves synthetic CT accuracy for radiotherapy. This enhances dose calculations for breast cancer patients with missing tissue data on CBCT scans.
Area of Science:
- Medical Physics
- Radiotherapy Technology
- Image Reconstruction
Background:
- Cone-Beam Computed Tomography (CBCT) generates synthetic CTs for radiotherapy dose calculations.
- Limited CBCT Field-of-View (FOV) can lead to inaccuracies, especially when tissues are missing.
- Surface-guided radiotherapy (SGRT) offers potential to augment CBCT data.
Purpose of the Study:
- To evaluate the integration of SGRT information to enhance synthetic CT generation.
- To address inaccuracies in breast cancer cases due to missing tissues on limited FOV CBCT.
- To improve the accuracy of synthetic CTs for adaptive radiotherapy workflows.
Main Methods:
- Retrospective analysis of 20 breast cancer patients.
- Acquisition of CBCT and simultaneous surface scans.
- Generation of standard and SGRT-guided synthetic CTs using limited FOV CBCT data.
- Comparison of image similarity, contour geometry, and dose distribution against a reference full FOV CBCT.
Main Results:
- SGRT-guided synthetic CT demonstrated superior agreement with the reference across nine metrics.
- Significant reduction in Mean Squared Error (MSE) by 1963 HU² (p=0.002).
- Identified potential for hot spots in dose distribution with the SGRT approach.
Conclusions:
- SGRT integration improves synthetic CT generation for limited FOV CBCT in breast cases.
- Enhanced accuracy in imaging and dose distribution precision is achieved.
- Potential for broader application in other anatomical sites and adaptive radiotherapy.
Keywords:
Breast radiotherapyDaily dose computationInter-fraction motion managementSGRTSurface scanSynthetic CT
