Evaluating the impact of cone-beam computed tomography scatter mitigation strategies on radiotherapy dose calculation accuracy.

CBCT scans of two patient cohorts (C1, C2) were reconstructed using a uniform (USC) and an iterative scatter correction (ISC) method, combined with an anti-scatter grid (ASG). Head and neck (H&N), lung, pelvic region, and prostate patients were included. To achieve a high accuracy Hounsfield unit and physical density calibrations were performed. The dose distributions of the original treatment plans were analyzed with the γ evaluation method using criteria of 1%/2 mm using the planning CT as the reference. The investigated parameters were the mean γ (γ_mean), the points in agreement (P_γ≤1) and the 99th percentile (γ_1%).

The introduced method demonstrated high dosimetric accuracy for H&N, prostate and pelvic region if an ASG is applied. A significantly lower accuracy was seen for lung. The ISC yielded a higher robustness against scatter variations than the USC.

Significant differences between USC and ISC in C1 were found for the lung and prostate, where the latter using the ISC produced the best results with medians of 0.38, 98%, and 1.1 for γ_mean, P_γ≤1 and γ_1%, respectively. For C2 the ISC with ASG showed an improvement for all imaging sites. The lung demonstrated the largest relative increase in accuracy with improvements between 48% and 54% for the medians of γ_mean, P_γ≤1 and γ_1%.

The scatter induced image quality degradation of cone-beam computed tomography (CBCT) prevents more advanced applications in radiotherapy. We evaluated the dose calculation accuracy on CBCT of various disease sites using different scatter mitigation strategies.