Verification of In-Treatment Tumor Position Using Kilovoltage Cone-Beam Computed Tomography: A Preliminary Study

Three-dimensional tumor position during rotational dose delivery was evaluated by acquiring in-treatment kilovoltage (kV) cone-beam CT (CBCT) to ensure treatment quality. The CBCT projection data of a phantom were acquired during rotational megavoltage (MV) dose delivery up to 6 Gy to evaluate image quality under MV beam irradiation. A lung tumor patient was treated with a total dose of 48 Gy in four fractions, each fraction including seven coplanar and noncoplanar beams, as well as a full-angle rotational beam. Tumor registration was performed between a planning CT image and a CBCT image immediately after patient setup. The patient couch was adjusted according to the registration results, and then the registration was repeated three times: immediately before treatment, during treatment, and immediately after treatment. The phantom image quality of the kV CBCT was not visually degraded up to the rotational MV dose of 6 Gy. Tumor position during rotational dose delivery was verified for the first time using kV CBCT.