Clinical implementation of kVCT-guided tomotherapy with ClearRT.
Bin YangHui GengTien Yee Amy ChangMei Yan TseWai Wang LamChen-Yu HuangTungho WuKa Ki LauKin Yin CheungGeorge ChiuSiu Ki YuPublished in: Physical and engineering sciences in medicine (2022)
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 D mean of organ-at-risk. For the treatment planning with kVCT, a systematic dose difference (>ā1%) 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.
Keyphrases
- image quality
- computed tomography
- dual energy
- end stage renal disease
- deep learning
- positron emission tomography
- newly diagnosed
- chronic kidney disease
- ejection fraction
- primary care
- peritoneal dialysis
- prognostic factors
- healthcare
- radiation therapy
- early stage
- randomized controlled trial
- high resolution
- soft tissue
- quality improvement
- combination therapy
- magnetic resonance
- optical coherence tomography
- fluorescence imaging
- electronic health record
- artificial intelligence
- patient reported