Is model-based dose calculation based on cone-beam computed tomography suitable for adaptive treatment planning in brachytherapy?

Abstract

Model-based dose calculation considering tissue compositions is increasingly being investigated in brachytherapy. The aim of this study was to assess the suitability of modern cone-beam computed tomography (CBCT) imaging compared to conventional computed tomography (CT) scans for this purpose. By means of aphantom study, we evaluated the CT numbers and electron densities measured using amodern CBCT device as well as aconventional CT scanner for various materials. Based on this, we compared dose calculations (using the TG-43 formalism as well as model-based collapsed cone calculations assuming uniform materials [ACEuniform] and considering CT numbers [ACECT#]) on planning CTs and control CBCTs for patients with cervical and breast cancer as well as phantom-simulated skin cancer cases. Assessing dosimetric deviations between the planning CTs and control CBCTs acquired during the treatment course served to estimate interfractional implant variations. The comparison of ACEuniform-ACECT# deviations between planning CTs and control CBCTs revealed no statistically significant difference for almost all examined dose parameters. Dosimetric deviations between model-based dose calculations and TG-43 were partly significant but of small magnitude (< 10 cGy per fraction). Interfractional dosimetric variations were substantially larger than the dosimetric differences found between the various dose calculation procedures. Model-based dose calculation based on modern CBCT imaging was suitable. However, the found differences between these calculations and the TG-43 formalism should be investigated in dose-outcome analyses. The observed interfractional dosimetric variations revealed the importance of performing treatment quality assurance.