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Oncol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Repeated cone-beam CT (CBCT) scans for image-guided radiotherapy (IGRT) increase the health risk of radiation-induced malignancies. Patient-enrolled studies to optimize scan protocols are inadequate. We proposed a virtual clinical trial-based approach to evaluate projection-reduced low-dose CBCT for IGRT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>A total of 71 patients were virtually enrolled with 26 head, 23 thorax and 22 pelvis scans. Projection numbers of full-dose CBCT scans were reduced to 1\/2, 1\/4, and 1\/8 of the original to simulate low-dose scans. Contrast-to-noise ratio (CNR) values in fat and muscle were measured in the full-dose and low-dose images. CBCT images were registered to planning CT to derive 6-degree-of-freedom couch shifts. Registration errors were statistically analyzed with the Wilcoxon paired signed-rank test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>As projection numbers were reduced, CNR values descended and the magnitude of registration errors increased. The mean CNR values of full-dose and half-dose CBCT were &amp;gt;3.0. For full-dose and low-dose CBCT (i.e. 1\/2, 1\/4 and 1\/8 full-dose), the mean registration errors were&amp;lt; \u00b1 0.4 mm in translational directions (LAT, LNG, VRT) and \u00b10.2 degree in rotational directions (Pitch, Roll, Yaw); the mean magnitude of registration errors were&amp;lt; 1 mm in translation and&amp;lt; 0.5 degree in rotation. The couch shift differences between full-dose and low-dose CBCT were not statistically significant (p&amp;gt;0.05) in all the directions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results indicate that while the impact of dose-reduction on CBCT couch shifts is not significant, the impact on CNR values is significant. Further validation on optimizing CBCT imaging dose is required.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2024.1369603","type":"journal-article","created":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T07:55:28Z","timestamp":1720166128000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Virtual clinical trial-based study for clinical evaluation of projection-reduced low-dose cone-beam CT for image guided 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