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Clinical implementation of kVCT-guided tomotherapy with ClearRT

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Abstract

A helical fan-beam kilovoltage computed tomography (kVCT) was recently introduced into Tomotherapy units. This study aims to share the initial experience of kVCT in clinical workflow, compare its performance with that of the existing megavoltage computed tomography (MVCT), and explore its potential in adaptive planning. We retrospectively enrolled 23 patients who underwent both MVCT and kVCT scans. The clinical performance data regarding image acquisition time, nominal dose length product (DLP), registration time and registration corrections were extracted and compared. Image quality was scored by six experienced radiation therapists and quantified based on phantom measurements. CT number stability and the implementation of adaptive radiotherapy were dosimetrically evaluated by performing the dose recalculation on kVCT. Compared to MVCT, kVCT significantly reduced DLP (except the highest kVp protocol), image acquisition and registration time. KVCT obtained higher scores than MVCT on all criteria except artifacts. Phantom measurements also revealed a better image performance characterization of kVCT except for image uniformity. The CT number variation could lead to a dose difference of 0.5% for D95% of target and Dmean of organ-at-risk. For the treatment planning with kVCT, a systematic dose difference (> 1%) in PTV dose metrics was observed at regions with large longitudinal density discontinuities compared to the reference plans. The new kVCT imaging provides enhanced soft-tissue visualization. The improved efficiency with kVCT-guided treatment will allow more patients to be treated each day. In most cases, the dose calculation accuracy of kVCT images is acceptable except for regions with severe artifacts.

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Funding

The authors have no funding to disclose.

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Authors and Affiliations

  1. Medical Physics Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China

    Bin Yang, Hui Geng, Mei Yan Tse, Wai Wang Lam, Chen-Yu Huang, Ka Ki Lau, Kin Yin Cheung & Siu Ki Yu

  2. Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China

    Tien Yee Amy Chang

  3. Department of Radiotherapy, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China

    George Chiu

  4. TMU Proton Center, Taipei Medical University Hospital, 252 Wuxing Street, Xinyi District, Taipei, Taiwan

    Tungho Wu

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  1. Bin Yang
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  2. Hui Geng
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Correspondence to Bin Yang.

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This retrospective study involving human participates was reviewed and approved by HKSH Medical Group Research Committee (RC-2021-24).

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Yang, B., Geng, H., Chang, T.Y.A. et al. Clinical implementation of kVCT-guided tomotherapy with ClearRT. Phys Eng Sci Med 45, 915–924 (2022). https://doi.org/10.1007/s13246-022-01162-y

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  • DOI: https://doi.org/10.1007/s13246-022-01162-y

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