Multiple breath-hold CBCT for online image guided radiotherapy of lung tumors: Simulation with a dynamic phantom and first patient data

Background and Purpose: Computer controlled breath-hold effectively reduces organ motion for image-guided precision radiotherapy of lung tumors. However, the acquisition time of 3D cone-beam-CT (CBCT) exceeds maximum breath-hold times. We have developed an approach enabling online verification using CBCT image acquisition with ABC (R)-based breath-hold. Methods: Patient CBCT images were acquired with ABC (R)-based repeat breath-hold. The clinical situation was also simulated with a Motion Phantom. Reconstruction of patient and phantom images with selection of free-breathing and breath-hold projections only was performed. Results: CBCT-imaging in repeat breath-hold resulted in a precisely spherical appearance of a tumor-mimicking structure in the phantom. A faint "ghost" structure (free-breathing phases) can be clearly discriminated. Mean percentage of patient breath-hold time was 66%. Reconstruction based on free-breathing-only shows blurring of both tumor and diaphragm, reconstruction based on breath-hold projections only resulted in sharp contours of the same structures. From the phantom experiments, a maximal repositioning error of 1 mm in each direction can be estimated. Discussion and Conclusion: CBCT during repetitive breath hold provides reliable soft-tissue-based positioning. Fast 3D-imaging during one breath-hold is currently under development and has the potential to accelerate clinical linac-based volume imaging. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 98 (2011) 309-316