SU-F-J-42: Comparison of Varian TrueBeam Cone-Beam CT and BrainLab ExacTrac X-Ray for Cranial Radiotherapy.

PURPOSE: To compare online image registrations of TrueBeam cone-beam CT (CBCT) and BrainLab ExacTrac x-ray imaging systems for cranial radiotherapy.

METHOD: Phantom and patient studies were performed on a Varian TrueBeam STx linear accelerator (Version 2.5), which is integrated with a BrainLab ExacTrac imaging system (Version 6.1.1). The phantom study was based on a Rando head phantom, which was designed to evaluate isocenter-location dependence of the image registrations. Ten isocenters were selected at various locations in the phantom, which represented clinical treatment sites. CBCT and ExacTrac x-ray images were taken when the phantom was located at each isocenter. The patient study included thirteen patients. CBCT and ExacTrac x-ray images were taken at each patient's treatment position. Six-dimensional image registrations were performed on CBCT and ExacTrac, and residual errors calculated from CBCT and ExacTrac were compared.

RESULTS: In the phantom study, the average residual-error differences between CBCT and ExacTrac image registrations were: 0.16±0.10 mm, 0.35±0.20 mm, and 0.21±0.15 mm, in the vertical, longitudinal, and lateral directions, respectively. The average residual-error differences in the rotation, roll, and pitch were: 0.36±0.11 degree, 0.14±0.10 degree, and 0.12±0.10 degree, respectively. In the patient study, the average residual-error differences in the vertical, longitudinal, and lateral directions were: 0.13±0.13 mm, 0.37±0.21 mm, 0.22±0.17 mm, respectively. The average residual-error differences in the rotation, roll, and pitch were: 0.30±0.10 degree, 0.18±0.11 degree, and 0.22±0.13 degree, respectively. Larger residual-error differences (up to 0.79 mm) were observed in the longitudinal direction in the phantom and patient studies where isocenters were located in or close to frontal lobes, i.e., located superficially.

CONCLUSION: Overall, the average residual-error differences were within 0.4 mm in the translational directions and were within 0.4 degree in the rotational directions.