{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:02:06Z","timestamp":1789700526510,"version":"4.0.1"},"reference-count":17,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"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>Cone\u2010beam computed tomography (CBCT) is integral to image\u2010guided radiation therapy and increasingly used for adaptive radiotherapy and CBCT\u2010based dose calculation. Conventional kV\u2010CBCT systems on C\u2010arm TrueBeam linacs with Feldkamp\u2013Davis\u2013Kress (FDK) reconstruction have historically been limited by reduced Hounsfield Unit (HU) accuracy, scatter contamination, image noise and reconstruction artefacts. Iterative CBCT (iCBCT) reconstruction has improved image quality and HU consistency relative to the conventional FDK reconstruction. HyperSight represents a further evolution through software and hardware development with an enhanced detector design, advanced reconstruction algorithms and gantry rotation speeds up to 9\u00b0\/s.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study reports commissioning and evaluation of HyperSight iterative CBCT (HS\u2010iCBCT) acquired on a Varian TrueBeam (v4.1), to support adaptive workflows in comparison with standard (Std\u2010FDK) and iterative CBCT (Std\u2010iCBCT) on a TrueBeam (v2.7).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>CBCT images were acquired on a Varian TrueBeam using the conventional kV On\u2010board Imager (OBI) for Std\u2010FDK and Std\u2010iCBCT reconstructions and the HyperSight kV\u2010imaging system for HS\u2010iCBCT. Commissioning included CBCT dose calculation protocol optimization, CT\u2010to\u2010electron density (CT\u2013ED) calibration and validation using STEEV, Rando and the CIRS Dynamic Thorax phantoms. CBCT images of anthropomorphic Head, Thorax\/Spine, Rib and Lung phantoms were rigidly registered to the planning CT (pCT) and resampled using Velocity AI (v4.2). Voxel\u2010wise HU difference histograms were generated, with peak position used to quantify systematic HU bias. Treatment plans (20\u00a0Gy\/1# for Brain SRS\/Spine, 24\u00a0Gy\/2# for Rib and 54\u00a0Gy\/3# for Lung) were optimized on the pCT and recalculated on the CBCT datasets. Dose\u2013volume histogram (DVH) metrics were assessed and 3D\u2010gamma analysis (2%\/1\u00a0mm to 1%\/1\u00a0mm; 10%\/70% dose thresholds) was performed and compared with Std\u2010FDK and Std\u2010iCBCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      HS\u2010iCBCT showed improved HU accuracy compared with Std\u2010iCBCT and Std\u2010FDK when benchmarked against the pCT. For materials \u2264 1.08\u00a0g\/cm\n                      <jats:sup>3<\/jats:sup>\n                      , the mean HU difference was lowest for HS\u2010iCBCT at 7.7\u00a0\u00b1\u00a04.1 HU, compared with 23.6\u00a0\u00b1\u00a013.5 HU for Std\u2010iCBCT and 38.0\u00a0\u00b1\u00a019.7 HU for Std\u2010FDK (Friedman\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05). For higher\u2010density materials, HS\u2010iCBCT demonstrated mean HU differences of 33.5\u00a0\u00b1\u00a022.9 HU, compared with 46.2\u00a0\u00b1\u00a022.2 HU for Std\u2010iCBCT and 93.4\u00a0\u00b1\u00a057.6 HU for Std\u2010FDK. HS\u2010iCBCT improved image quality with HU difference histograms demonstrating peak values closest to zero (\u2206HU within 15HU). An optimized CBCT acquisition protocol (140\u00a0kV) combined with a single baseline 120\u00a0kV pCT HU\u2013ED calibration curve proved feasible for CBCT\u2010based dose calculation. Dose calculation agreement was strongest for HS\u2010iCBCT (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05) with median target dose differences measuring\u00a0&lt;\u00a00.3%,\u00a0&lt;\u00a00.6%, 0.6% and\u00a0&lt;\u00a00.4% for the Brain, Thorax\/Spine, Rib, and Lung anatomies, respectively. Median (min\u2010max) gamma passing rates across all anatomical sites were 98.8% (97.8\u201399.8), 98.7% (96.7\u201399.6), and 96.0% (94.5\u201399.5) with 2%\/1\u00a0mm passing criteria for HS\u2010iCBCT, Std\u2010iCBCT, and Std\u2010FDK, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HyperSight reduces HU variability, improves image quality, and enhances CBCT\u2010based dose calculation relative to conventional CBCT implementations. Use of a single optimized CBCT dose calculation protocol and baseline HU\u2013ED calibration curve proved feasible across multiple anatomical sites, supporting implementation of HS\u2010iCBCT for adaptive radiotherapy workflows on conventional C\u2010arm TrueBeam linacs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70786","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:12:56Z","timestamp":1789024376000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Towards adaptive radiotherapy: Comparing HyperSight and standard CBCT reconstructions on a C\u2010Arm Linac"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7699-2741","authenticated-orcid":false,"given":"Niamh L.","family":"Clarke","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Peter MacCallum Cancer Centre  Melbourne Victoria 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