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Patient doses in image-guided radiotherapy: status in Europe for cone-beam CT imaging in the pelvic region

dc.contributor.authorKansanoja, Toni
dc.contributor.authorBrovchuk, Serhii
dc.contributor.authorVezirovic, Milana
dc.contributor.authorPetrovic, Borislava
dc.contributor.authorAmico, Antonio Giuseppe
dc.contributor.authorSapignoli, Sonia
dc.contributor.authorPaiusco, Marta
dc.contributor.authorFerrari, Paolo
dc.contributor.authorSá, Ana Cravo
dc.contributor.authorDias, Anabela G.
dc.contributor.authorTeles, Pedro
dc.contributor.authorSiiskonen, Teemu
dc.date.accessioned2026-05-13T13:49:49Z
dc.date.available2026-05-13T13:49:49Z
dc.date.issued2026-03-24
dc.description.abstractOrgan absorbed doses in cone-beam CT (CBCT) imaging are often neglected in image-guided radiation therapy (IGRT). However, frequent imaging for patient positioning can result in significant and unrecorded additional radiation exposure. This study aims to evaluate organ doses from kV-CBCT and assess if they are optimized and how, in prostate and pelvic patient positioning protocols across Europe. Status of quality assurance in IGRT CBCT imaging is assessed in general. Data collected from a survey distributed across Europe on IGRT practices were compiled and analysed. A representative set of imaging protocols were simulated using Monte Carlo based ImpactMC software to assess mean absorbed doses in various organs in the International Commission on Radiological Protection (ICRP) standard phantom. Absorbed doses to red bone marrow were estimated with a three-parameter mass-energy absorption coefficient method. The simulations were validated against measurements with MOSFET detectors and radiochromic film. Simulated prostate absorbed doses ranged from 12 mGy to 34 mGy per imaged fraction for pelvic protocols, and 4 mGy to 26 mGy for prostate protocols. The selected length of the imaging region influenced doses to the femur and sacral red bone marrow. Overall, 74% of treatments involved positioning imaging at every fraction, indicating substantial cumulative doses from kV-CBCT imaging. Quality assurance was performed by 90% of responders, but good practice guides and national protocols do not exist. The results of this study suggest that clear guidelines and standardized protocols for CBCT imaging in IGRT are lacking. There is significant potential to optimize the patient doses resulting from imaging. Given that most clinics already perform regular quality assurance for imaging equipment, including dosimetry and positioning accuracy verification, establishing diagnostic reference levels for CBCT imaging in IGRT could help promote further dose optimization.eng
dc.identifier.citationKansanoja, T., Brovchuk, S., Vezirovic, M., Petrovic, B., Amico, A. G., Sapignoli, S., Paiusco, M., Ferrari, P., Sá, A. C., Dias, A. G., Teles, P., & Siiskonen, T. (2026). Patient doses in image-guided radiotherapy: Status in Europe for cone-beam CT imaging in the pelvic region. Radiology and Oncology, 60(1), 141–152. https://doi.org/10.2478/raon-2026-0012
dc.identifier.doi10.2478/raon-2026-0012
dc.identifier.eissn1581-3207
dc.identifier.issn1318-2099
dc.identifier.urihttp://hdl.handle.net/10400.22/32363
dc.language.isoeng
dc.peerreviewedyes
dc.publisherParadigm
dc.relation.hasversionhttps://reference-global.com/article/10.2478/raon-2026-0012
dc.rights.uriN/A
dc.subjectCBCT
dc.subjectImage-guided radiotherapy
dc.subjectOptimization
dc.subjectOrgan dose
dc.subjectDiagnostic reference level (DRL)
dc.titlePatient doses in image-guided radiotherapy: status in Europe for cone-beam CT imaging in the pelvic regioneng
dc.typeresearch article
dspace.entity.typePublication
oaire.citation.endPage152
oaire.citation.issue1
oaire.citation.startPage141
oaire.citation.titleRadiology and Oncology
oaire.citation.volume60
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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