Linear Accelerator-Based Radiotherapy Simulation Using On-Board Kilovoltage Cone-Beam Computed Tomography for 3-Dimensional Volumetric Planning and Rapid Treatment in the Palliative Setting.

backgroundPalliation of advanced disease using radiotherapy can create difficult clinical situations where standard computed tomography simulation and immobilization techniques are not feasible. We developed a linear accelerator-based radiotherapy simulation technique using nonstandard patient positioning for head and neck palliation using on-board kilovoltage cone-beam computed tomography for 3-D volumetric planning and rapid treatment. Material and Methods: We proved cone-beam computed tomography simulation feasibility for semi-upright patient positioning using an anthropomorphic phantom on a clinical Elekta-Synergy linear accelerator. Cone-beam computed tomography imaging parameters were optimized for high-resolution image reconstruction and to ensure mechanical clearance. The patient was simulated using a cone-beam computed tomography-based approach and the cone-beam computed tomography digital imaging and communications in medicine file was imported to the treatment planning software to generate radiotherapy target volumes. Rapid planning was achieved by using a 3-level bulk density correction for air, soft tissue, and bone set at 0, 1.0, and 1.4 g/cm

resultsPatient volumetric imaging was obtained through cone-beam computed tomography simulation and treatment was delivered as planned without incident. Bulk density corrections were verified against conventionally simulated patients where differences were less than 1%. Conclusion: We successfully developed and employed a semi-upright kilovoltage cone-beam computed tomography-based head and neck simulation and treatment planning method for 3-D conformal radiotherapy delivery. This approach provides 3-D documentation of the radiotherapy plan and allows tabulation of quantitative spatial dose information which is valuable if additional palliative treatments are needed in the future. This is a potentially valuable technique that has broad clinical applicability for benign and palliative treatments across multiple disease sites-particularly where standard supine simulation and immobilization techniques are not possible.