ArticleJournal of applied clinical medical physics2026
Towards adaptive radiotherapy: Comparing HyperSight and standard CBCT reconstructions on a C-Arm Linac.
Article in Journal of applied clinical medical physics, 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
backgroundCone-beam computed tomography (CBCT) is integral to image-guided radiation therapy and increasingly used for adaptive radiotherapy and CBCT-based dose calculation. Conventional kV-CBCT systems on C-arm TrueBeam linacs with Feldkamp-Davis-Kress (FDK) reconstruction have historically been limited by reduced Hounsfield Unit (HU) accuracy, scatter contamination, image noise and reconstruction artefacts. Iterative CBCT (iCBCT) reconstruction has improved image quality and HU consistency relative to the conventional FDK reconstruction. HyperSight represents a further evolution through software and hardware development with an enhanced detector design, advanced reconstruction algorithms and gantry rotation speeds up to 9°/s. PURPOSE: This study reports commissioning and evaluation of HyperSight iterative CBCT (HS-iCBCT) acquired on a Varian TrueBeam (v4.1), to support adaptive workflows in comparison with standard (Std-FDK) and iterative CBCT (Std-iCBCT) on a TrueBeam (v2.7). MATERIAL AND
methodsCBCT images were acquired on a Varian TrueBeam using the conventional kV On-board Imager (OBI) for Std-FDK and Std-iCBCT reconstructions and the HyperSight kV-imaging system for HS-iCBCT. Commissioning included CBCT dose calculation protocol optimization, CT-to-electron density (CT-ED) calibration and validation using STEEV, Rando and the CIRS Dynamic Thorax phantoms. CBCT images of anthropomorphic Head, Thorax/Spine, Rib and Lung phantoms were rigidly registered to the planning CT (pCT) and resampled using Velocity AI (v4.2). Voxel-wise HU difference histograms were generated, with peak position used to quantify systematic HU bias. Treatment plans (20 Gy/1# for Brain SRS/Spine, 24 Gy/2# for Rib and 54 Gy/3# for Lung) were optimized on the pCT and recalculated on the CBCT datasets. Dose-volume histogram (DVH) metrics were assessed and 3D-gamma analysis (2%/1 mm to 1%/1 mm; 10%/70% dose thresholds) was performed and compared with Std-FDK and Std-iCBCT.
resultsHS-iCBCT showed improved HU accuracy compared with Std-iCBCT and Std-FDK when benchmarked against the pCT. For materials ≤ 1.08 g/cm
conclusionsHyperSight reduces HU variability, improves image quality, and enhances CBCT-based dose calculation relative to conventional CBCT implementations. Use of a single optimized CBCT dose calculation protocol and baseline HU-ED calibration curve proved feasible across multiple anatomical sites, supporting implementation of HS-iCBCT for adaptive radiotherapy workflows on conventional C-arm TrueBeam linacs.
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