Cone beam CT based dose calculation in the thorax region

BACKGROUND AND PURPOSE: The limited image quality in Cone Beam CT (CBCT) stemming primarily from scattered radiation hinders accurate CBCT based dose calculation in radiotherapy. We investigated the use of a stoichiometric calibration for dose calculation on CBCT images of lung cancer patients. MATERIALS AND METHODS: CBCT calibrations were performed with thorax scan protocols, using a phantom with approximately the diameter of an average human thorax and a central cavity simulating the thoracic cavity. Thus scatter conditions resembling those in clinical thorax CBCT scans were simulated. A published stoichiometric parametrization was used. A treatment plan was simulated on CBCT and CT scans of an anthropomorphic phantom, the dose distributions were calculated, and clinically relevant DVH parameters were compared. Twelve lung cancer patients had surveillance CT scans (s-CT) taken twice during their treatment course in addition to daily setup CBCTs. Dose calculations were performed on the s-CTs and the corresponding CBCTs taken on the same day, and DVH parameters were compared. RESULTS: Eighty percent of CBCT DVH parameters found for the phantom were within ±1% of CT doses, and 98% were within ±3%. For patients, the median CT/CBCT dose difference was within ±2%, and 98% of DVH parameters were within ±4%. Minimum dose to the tumor was underestimated (median 1.9%) on CBCT, while maximum doses to most organs at risk were slightly overestimated. CONCLUSION: Direct dose calculations on CBCTs of lung cancer patients were feasible within ∼4% accuracy using a simple calibration method, which is easily implemented in a clinical setting.