Evaluation of tumor localization accuracy on fast ring-gantry cone-beam computed tomography using patient-specific breathing curves and a dynamic anthropomorphic thorax phantom

Daenen LH, Lustermans D, Stassen TH, Szkitsak J, Abdulrahim R, Goossens J, Rishmawi G, Canters R, Rinaldi I, Verhaegen F, Fonseca GP (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Physics and Imaging in Radiation Oncology Elsevier

Book Volume: 39

Article Number: 101014

DOI: 10.1016/j.phro.2026.101014

Abstract

Background and purpose: Fast cone beam computed tomography (CBCT) on ring-gantry systems allows for improved image quality and fast 6-second acquisition. However, 6-second acquisition might pose challenges regarding target delineation and capturing the full range of motion of moving lung tumors. Especially, in patients with slow (period > 6 s) or irregular breathing, capturing the entire tumor motion might not be guaranteed. Materials and methods: This study evaluated localization and volumetric accuracy of 6- and 60-second CBCT scans in an in-house dynamic anthropomorphic thorax phantom, with synchronized imaging capabilities. The phantom was scanned for a sinusoidal and four patient-derived breathing patterns, including regular, slow or irregular breathing. Target position and volume for 6- and 60-second acquisitions were compared to ground truth delineation on time-averaged 4D computed tomography (4DCT) reconstruction, assessing if 6-second acquisition is sufficient to accurately capture the tumor motion. Results: For sinusoidal and regular patient-derived motion, both 6- and 60-second CBCT acquisition captured target motion, compared to 4DCT (Dice Similarity Coefficient, DSC > 0.9). For large amplitudes, only one out of three 6-second scans fully captured target motion (DSC > 0.85). For slow and irregular patient-derived patterns, localization errors and volume differences up to 10.3 mm and 119% were observed using 6-second acquisition, compared to 4DCT, with superior localization and volumetric accuracy of the 60-second acquisition. Conclusion: The 6-second protocol showed accurate results, capturing full target motion for regular breathing patterns. Adaptive protocols, taking into account patient-specific breathing periods and irregularities may be preferred in patients exhibiting slow or irregular breathing.

Authors with CRIS profile

Juliane Szkitsak Department of Radiation Oncology

Involved external institutions

Maastricht University Medical Center (UMC+) NL Netherlands (NL) University of Antwerp / Universiteit Antwerpen BE Belgium (BE)

How to cite

APA:

Daenen, L.H., Lustermans, D., Stassen, T.H., Szkitsak, J., Abdulrahim, R., Goossens, J.,... Fonseca, G.P. (2026). Evaluation of tumor localization accuracy on fast ring-gantry cone-beam computed tomography using patient-specific breathing curves and a dynamic anthropomorphic thorax phantom. Physics and Imaging in Radiation Oncology, 39. https://doi.org/10.1016/j.phro.2026.101014

MLA:

Daenen, Lars H.B.A., et al. "Evaluation of tumor localization accuracy on fast ring-gantry cone-beam computed tomography using patient-specific breathing curves and a dynamic anthropomorphic thorax phantom." Physics and Imaging in Radiation Oncology 39 (2026).

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