{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:01:57Z","timestamp":1789700517602,"version":"4.0.1"},"reference-count":47,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007210","name":"Varian Medical Systems","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007210","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Novel cone\u2010beam computed tomography (CBCT) has become available on standard C\u2010arm linacs, making it widely applicable in photon\u2010based radiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate CT number stability of novel CBCT systems installed on seven C\u2010arm linacs within a single institution, across CBCT systems and over time, and to assess the CBCT\u2010based dose calculation accuracy in head\u2010and\u2010neck, lung, and pelvic cancer patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Gammex Advanced Electron Density phantom (Sun Nuclear) was scanned at installation of eleven CBCT imaging panels at seven TrueBeam C\u2010arm linacs (Varian Medical Systems, A Siemens Healthineers Company), and after three and six months. Three CBCT protocols were evaluated, a head protocol (tube voltage of 100 kVp, iterative reconstruction, denoted iCBCT), a thorax protocol (tube voltage of 125 kVp; filtered back projection with Feldkamp\u2010Davis\u2010Kress (FDK) algorithm), and a pelvis protocol (tube voltage of 125 kVp; iCBCT).<\/jats:p>\n                    <jats:p>Fifteen tissue\u2010equivalent phantom inserts were scanned individually, placed centrally in the phantom. The mean CT number was extracted, and CT number stability was assessed across imaging panels and timepoints. CT number stability was compared to a previous CBCT detector model. Moreover, routine measurements using four inserts were performed until 18 months after installation. Conversion curves for mass density estimation were generated, following a consensus guide. The spread of the curves due to CT number variation across imaging panels was assessed.<\/jats:p>\n                    <jats:p>Treatment plans created on planning CT (pCT) scans of 10 head\u2010and\u2010neck, 22 lung, and 15 pelvic cancer patients were recalculated on CBCT scans, selected to match the anatomy seen on the pCT. Dose\u2010volume parameters for targets and organs\u2010at\u2010risk were compared between pCT and CBCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The CT numbers were consistent across the imaging panels and over time for iCBCT reconstruction, but to a lesser degree for FDK reconstruction. The CT number variation increased with the density of the phantom inserts. Still, for the high\u2010density bone insert the range\/interquartile range of the CT numbers across imaging panels were 51\/29 HU (head protocol), 140\/41 HU (thorax protocol), and 27\/16 HU (pelvis protocol). For the longitudinal measurements, the median differences were 4 HU, \u20109 HU, and \u20108 HU after three months and \u20108 HU, \u201032 HU, and \u201026 HU after six months, for the head, thorax, and pelvis protocol, respectively.<\/jats:p>\n                    <jats:p>For the routine measurements, no clear time dependence was seen for the CT number differences. It was found that a single conversion curve per CBCT protocol could be used for all imaging panels. For iCBCT, median dose differences between pCT and CBCT were within 0.5% for head\u2010and\u2010neck and pelvis and 1.5% for lung, while FDK lung was within 2.5%. The largest deviations with iCBCT were \u20101.3% for head\u2010and\u2010neck, \u20101.1% for pelvis, and \u20103.8% for thorax, but \u201018.0% for thorax FDK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The CT number stability was sufficient to allow for a single conversion curve per CBCT protocol to be applied across all CBCT imaging panels. A high dose calculation accuracy was found for 36 patients with iCBCT scans, while larger deviations were seen for eleven thorax FDK scans.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70752","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:31:36Z","timestamp":1787635896000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative stability of CT numbers in novel cone\u2010beam CT: An intra\u2010institution cross\u2010scanner and longitudinal analysis"],"prefix":"10.1002","volume":"27","author":[{"given":"Vicki Trier","family":"Taasti","sequence":"first","affiliation":[{"name":"Danish Centre for Particle Therapy Aarhus University Hospital  Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University  Aarhus 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