A review of dose calculation approaches with cone beam CT in photon and proton therapy

Valentina Giacometti*, Alan R. Hounsell, Conor K. McGarry

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

9 Citations (Scopus)
28 Downloads (Pure)


Background and purpose: The use of cone beam computed tomography (CBCT) for performing dose calculations in radiation therapy has been widely investigated as it could provide a quantitative analysis of the dosimetric impact of changes in patients during the treatment. The aim of this review was to classify different techniques adopted to perform CBCT dose calculation and to report their dosimetric accuracy with respect to the metrics used. Methods and materials: A literature search was carried out in PubMed and ScienceDirect databases, based upon the following keywords: “cone beam computed tomography”, “CBCT”, “cone beam CT”, “dose calculation”, “accuracy”. Sixty-nine peer-reviewed relevant articles were included in this review: thirty-one patient studies, fifteen phantom studies and twenty-three patient & phantom studies. Most studies were found to have focused on head and neck, lung and prostate cancers. Results: The techniques adopted to perform CBCT dose calculation have been grouped in six categories labelled as (1) pCT calibration, (2) CBCT calibration, (3) HU override, (4) Deformable image registration, (5) Dose deformation, and (6) Combined techniques. Differences between CBCT dose and reference dose were reported both for target volumes and OARs. Conclusions: A comparison among the available techniques for CBCT dose calculations is challenging as many variables are involved. Therefore, a set of reporting standards is recommended to enable meaningful comparisons among different studies. The accuracy of the results was strongly dependent on the image quality, regardless of the methods used, highlighting the need for dose validation and quality assurance standards.

Original languageEnglish
Pages (from-to)243-276
Number of pages34
JournalPhysica Medica
Early online date28 Jul 2020
Publication statusPublished - 01 Aug 2020

Bibliographical note

Funding Information:
This work was supported by the Belfast-Manchester Movember Centre of Excellence ( MA-CE018-002 ), funded in partnership with Prostate Cancer UK and by the R & D division of the Public Health Agency (grant number: COM/4965/14 ). Some work was performed using treatment planning workstations purchased through charitable funds provided by Friends of the Cancer Centre (Registered with The Charity Commission for Northern Ireland NIC101345).

Publisher Copyright:
© 2020 Associazione Italiana di Fisica Medica

Copyright 2020 Elsevier B.V., All rights reserved.


  • Cone beam CT
  • Dose calculation
  • Radiotherapy

ASJC Scopus subject areas

  • Biophysics
  • Radiology Nuclear Medicine and imaging
  • Physics and Astronomy(all)


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