ArticlePhysics and imaging in radiation oncology2026
First evaluation of in-patient dose calculation accuracy on a C-arm Linear Accelerator with advanced Cone-Beam computed tomography (CBCT) imaging.
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: Innovations in on-board Cone-Beam Computed Tomography (CBCT) show promise for accurate dose calculation due to higher CT number precision compared to prior C-arm CBCT systems. We prospectively investigated dose calculation accuracy in patients imaged using a C-arm linac equipped with an advanced CBCT imaging solution utilizing iterative reconstruction algorithms. Materials and Methods: For image acquisition, 37 patients underwent both a CT-simulation (CT-sim) and high-quality C-arm CBCT in their treatment position. A total of 39 plans (2 patients multi-site) across four body sites (10 Head/Neck, 9 Thorax, 10 Abdomen, 10 Pelvis) were developed on the clinical CT-sim image and recalculated on the CBCT. Dose distributions were compared using 3D gamma analysis passing rates (GPR) using 1%/1mm local criteria and 10% or 50% low-dose thresholding (10%TH, 50%TH). Percent difference in target dose-volume histogram (DVH) metrics D99%, D Results: The CBCT to CT-sim dose calculation comparisons overall GPR with 10%TH averaged 96.2 ± 3.6% and 50%TH GPR average was 95.0 ± 6.9%. Overall, 36 plans at 10%TH and 32 plans at 50%TH achieved > 90% GPR. Percent difference in target DVH metrics averaged 0.15 ± 1.24%, 0.52 ± 1.01%, 0.86 ± 1.29%, -0.92 ± 4.84%, and -0.31 ± 2.42% for D99%, D Conclusion: C-arm CBCT dose calculation was comparable to standard-of-care CT-sim in most patients, demonstrating the ability to be used for clinical evaluation and decisions. Direct dose calculations in settings of minimal anatomical motion were most robust
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