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One approach to achieving this goal is to develop imaging techniques to track HDR sources in vivo in reference to surrounding anatomy. This work investigates the feasibility of using an isocentric C\u2010arm x\u2010ray imager and tomosynthesis methods to track Ir\u2010192 HDR brachytherapy sources in vivo over time (4D).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A tomosynthesis imaging workflow was proposed and its achievable source detectability, localization accuracy, and spatiotemporal resolution were investigated <jats:italic>in silico<\/jats:italic>. An anthropomorphic female XCAT phantom was modified to include a vaginal cylinder applicator and Ir\u2010192 HDR source (0.5 \u00d7 0.5 \u00d7 5.0 mm<jats:sup>3<\/jats:sup>), and the workflow was carried out using the MC\u2010GPU Monte Carlo image simulation platform. Source detectability was characterized using the reconstructed source signal\u2010difference\u2010to\u2010noise\u2010ratio (SDNR), localization accuracy by the absolute 3D error in its measured centroid location, and spatiotemporal resolution by the full\u2010width\u2010at\u2010half\u2010maximum (FWHM) of line profiles through the source in each spatial dimension considering a maximum C\u2010arm angular velocity of 30\u00b0 per second. The dependence of these parameters on acquisition angular range (<jats:italic>\u03b8<jats:sub>tot<\/jats:sub><\/jats:italic> = 0\u00b0\u201390\u00b0), number of views, angular increment between views (\u0394<jats:italic>\u03b8<\/jats:italic> = 0\u00b0\u201315\u00b0), and volumetric constraints imposed in reconstruction was evaluated. Organ voxel doses were tallied to derive the workflow's attributable effective dose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The HDR source was readily detected and its centroid was accurately localized with the proposed workflow and method (SDNR: 10\u201340, 3D error: 0\u20130.144 mm). Tradeoffs were demonstrated for various combinations of image acquisition parameters; namely, increasing the tomosynthesis acquisition angular range improved resolution in the depth\u2010encoded direction, for example from 2.5 mm to 1.2 mm between <jats:italic>\u03b8<jats:sub>tot<\/jats:sub><\/jats:italic> = 30<jats:sup>o<\/jats:sup> and <jats:italic>\u03b8<jats:sub>tot<\/jats:sub><\/jats:italic> = 90<jats:sup>o<\/jats:sup>, at the cost of increasing acquisition time from 1 to 3 s. The best\u2010performing acquisition parameters (<jats:italic>\u03b8<jats:sub>tot<\/jats:sub><\/jats:italic> = 90<jats:sup>o<\/jats:sup>, \u0394<jats:italic>\u03b8<\/jats:italic> = 1\u00b0) yielded no centroid localization error, and achieved submillimeter source resolution (0.57 \u00d7 1.21 \u00d7 5.04 mm<jats:sup>3<\/jats:sup> apparent source dimensions, FWHM). The total effective dose for the workflow was 263 \u00b5Sv for its required pre\u2010treatment imaging component and 7.59 \u00b5Sv per mid\u2010treatment acquisition thereafter, which is comparable to common diagnostic radiology exams.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A system and method for tracking HDR brachytherapy sources in vivo using C\u2010arm tomosynthesis was proposed and its performance investigated <jats:italic>in silico<\/jats:italic>. Tradeoffs in source conspicuity, localization accuracy, spatiotemporal resolution, and dose were determined. The results suggest this approach is feasible for localizing an Ir\u2010192 HDR source in vivo with submillimeter spatial resolution, 1\u20133 second temporal resolution and minimal additional dose burden.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.16579","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T11:36:24Z","timestamp":1688470584000},"page":"4695-4709","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Feasibility of 4D HDR brachytherapy source tracking using x\u2010ray tomosynthesis: Monte Carlo investigation"],"prefix":"10.1002","volume":"50","author":[{"given":"Roman","family":"Vasyltsiv","sequence":"first","affiliation":[{"name":"Department of Radiology Stony Brook University, Health Sciences Center L4\u2010120 Stony Brook New York 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