Preliminary evaluation of the dosimetric accuracy of cone-beam computed tomography for cases with respiratory motion

Cone-beam computed tomography (CBCT) images are currently used for patient positioning and adaptive dose calculation; however, the degree of CBCT uncertainty in cases of respiratory motion remains an interesting issue. This study evaluated the uncertainty of CBCT-based dose calculations for a moving target. Using a phantom, we estimated differences in the geometries and the Hounsfield units (HU) between CT and CBCT. The calculated dose distributions based on CT and CBCT images were also compared using a radiation treatment planning system, and the comparison included cases with respiratory motion. The geometrical uncertainties of the CT and the CBCT images were less than 0.15 cm. The HU differences between CT and CBCT images for standard-dose-head, high-quality-head, normal-pelvis, and low-dose-thorax modes were 31, 36, 23, and 33 HU, respectively. The gamma (3%, 0.3 cm)-dose distribution between CT and CBCT was greater than 1 in 99% of the area. The gamma-dose distribution between CT and CBCT during respiratory motion was also greater than 1 in 99% of the area. The uncertainty of the CBCT-based dose calculation was evaluated for cases with respiratory motion. In conclusion, image distortion due to motion did not significantly influence dosimetric parameters.