ArticlePhysics and imaging in radiation oncology2026
Assessing the technical capability of a room- and a gantry-mounted kV imaging device for intra-fractional fluoroscopy during stereotactic lung radiotherapy at a C-arm linear accelerator.
Article in Physics and imaging in radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Purpose: Monitoring lung tumors during stereotactic radiotherapy is important for managing breathing motion, yet the high-performance imaging modules on C-arm linear accelerators are mainly used for patient positioning. This study benchmarked a room-mounted against a gantry-mounted kilovolt (kV) imaging device to assess their potential for lung tumor fluoroscopy. Materials and Methods: The investigated systems were the ExacTrac Dynamic (ETD, Brainlab, Germany) and the X-ray Volumetric Imaging (XVI, Elekta, Sweden). Contrast-to-Noise Ratio (CNR) and entrance air kerma were measured for different imaging settings - tube voltage (70 kV to 130 kV), current (10 mA to 320 mA), exposure time (100 ms and 40 ms) - using two anthropomorphic thorax phantoms housing three tumors. Additionally, CNR change as a function of time, achievable fluoroscopy imaging duration based on X-ray generator and anode heat and X-ray tube cool-down were evaluated. Results: CNRs agreed within 15% for the two systems and changed less than 2% over the investigated fluoroscopy durations. Using default imaging settings and considering the average clinical duration of stereotactic lung treatments, entrance air kermas were 44 mGy (room-mounted) and 41 mGy (gantry-mounted). Achievable fluoroscopy durations with default settings were 87 s and 1350 s, respectively. Anode cool-down times were 125 min (room-mounted) and 215 min (gantry-mounted). Conclusion: The performance metrics of the room-mounted imaging system aligned with those of the gantry-mounted device with regard to CNR and air kerma. The room-mounted system showed a preferable cool-down behavior. However, adaptation of imaging settings is necessary to increase the fluoroscopy duration and avoid overheating.
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