The first-in-human implementation of adaptive 4D cone beam CT for lung cancer radiotherapy: 4DCBCT in less time with less dose

• Published in: Radiotherapy and oncology 2021-08, Vol.161, p.29-34
• Main Authors: O'Brien, Ricky T., Dillon, Owen, Lau, Benjamin, George, Armia, Smith, Sandie, Wallis, Andrew, Sonke, Jan-Jakob, Keall, Paul J., Vinod, Shalini K.
• Format: Article
• Language: English
• Subjects: 4DCBCT; Adaptive 4DCBCT; Fast 4DCBCT; Low dose 4DCBCT
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2021.05.021

•Adaptive 4DCBCT imaging has been clinically implemented for lung cancer radiotherapy patients for the first time.•Adaptive 4DCBCT imaging has the potential to substantially reduce 4DCBCT scan times and imaging dose.•Adaptive 4DCBCT imaging can be combined with motion compensated image reconstruction techniques for better results. We present the first implementation of Adaptive 4D cone beam CT (4DCBCT) that adapts the image hardware (gantry rotation speed and kV projections) in response to the patient’s real-time respiratory signal. Adaptive 4DCBCT was applied on lung cancer patients to reduce the scan time and imaging dose in the ADaptive CT Acquisition for Personalised Thoracic imaging (ADAPT) trial. The ADAPT technology measures the patient’s real-time respiratory signal and uses mathematical optimisation and external circuitry attached to the linear accelerator to modulate the gantry rotation speed and kV projection rate to reduce scan times and imaging dose. For each patient, ADAPT scans were acquired on two treatment fractions and reconstructed with a motion compensated reconstruction algorithm and compared to the current state-of-the-art four-minute 4DCBCT acquisition (conventional 4DCBCT). We report on the scan time, imaging dose and image quality for the first four adaptive 4DCBCT patients. The ADAPT imaging dose was reduced by 85% and scan times were 73 ± 12 s representing a 70% reduction compared to the 240 s conventional 4DCBCT scan. The contrast-to-noise ratio was improved from 9.2 ± 3.9 with conventional 4DCBCT to 11.7 ± 4.1 with ADAPT. The ADAPT trial represents the first time that gantry rotation speed and projection acquisition have been adapted and optimised in real-time in response to changes in the patient’s breathing. ADAPT demonstrates substantially reduced scan times and imaging dose for clinical 4DCBCT imaging that could enable more efficient and optimised lung cancer radiotherapy.