To develop a non-coplanar cone-beam computed tomography (CBCT) image reconstruction method using projections within a limited angle range for non-coplanar radiotherapy. A generative adversarial network (GAN) was utilized to reconstruct non-coplanar CBCT images. Data from 40 patients with brain tumors and two head phantoms were used in this study. In the training stage, the generator of the GAN used coplanar CBCT and non-coplanar projections as the input, and an encoder with a dual-branch structure was utilized to extract features from the coplanar CBCT and non-coplanar projections separately. Non-coplanar CBCT images were then reconstructed using a decoder by combining the extracted features. To improve the reconstruction accuracy of the image details, the generator was adversarially trained using a patch-based convolutional neural network as the discriminator. A newly designed joint loss was used to improve the global structure consistency rather than the conventional GAN loss. The proposed model was evaluated using data from eight patients and two phantoms at four couch angles (±45°,±90°) that are most commonly used for brain non-coplanar radiotherapy in our department. The reconstructed accuracy was evaluated by calculating the root mean square error (RMSE) and an overall registration error ε, computed by integrating the rigid transformation parameters. In both patient data and phantom data studies, the qualitative and quantitative metrics results indicated that±45° couch angle models performed better than±90° couch angle models and had statistical differences. In the patient data study, the mean RMSE and ε values of couch angle at 45°, -45°, 90°, and -90° were 58.5 HU and 0.42mm, 56.8 HU and 0.41mm, 73.6 HU and 0.48mm, and 65.3 HU and 0.46mm, respectively. In the phantom data study, the mean RMSE and ε values of couch angle at 45°, -45°, 90°, and -90° were 91.2 HU and 0.46mm, 95.0 HU and 0.45mm, 114.6 HU and 0.58mm, and 102.9 HU and 0.52mm, respectively. The results show that the reconstructed non-coplanar CBCT images can potentially enable intra-treatment three-dimensional position verification for non-coplanar radiotherapy.
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