Comparing Digital Tomosynthesis to Cone-Beam CT for Position Verification in Patients Undergoing Partial Breast Irradiation

Junan Zhang, Q. Jackie Wu, Devon J. Godfrey, Toyosi Fatunase, Lawrence B. Marks, Fang Fang Yin

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Purpose: To evaluate digital tomosynthesis (DTS) technology for daily positioning of patients receiving accelerated partial breast irradiation (APBI) and to compare the positioning accuracy of DTS to three-dimensional cone-beam computed tomography (CBCT). Methods and Materials: Ten patients who underwent APBI were scanned daily with on-board CBCT. A subset of the CBCT projections was used to reconstruct a stack of DTS image slices. To optimize soft-tissue visibility, the DTS images were reconstructed in oblique directions so that the tumor bed, breast tissue, ribs, and lungs were well separated. Coronal and sagittal DTS images were also reconstructed. Translational shifts of DTS images were obtained on different days from the same patients and were compared with the translational shifts of corresponding CBCT images. Seventy-seven CBCT scans and 291 DTS scans were obtained from nine evaluable patients. Results: Tumor beds were best visible in the oblique DTS scans. One-dimensional positioning differences between DTS and CBCT images were 0.8-1.7 mm for the six patients with clips present and 1.2-2.0 mm for the three patients without clips. Because of the limited DTS scan angle, the DTS registration accuracy along the off-plane direction is lower than the accuracy along the in-plane directions. Conclusions: For patients receiving APBI, DTS localization offers comparable accuracy to CBCT localization for daily patient positioning while reducing mechanical constraints and imaging dose.

Original languageEnglish (US)
Pages (from-to)952-957
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number3
StatePublished - Mar 1 2009
Externally publishedYes


  • Breast cancer
  • Cone-beam CT
  • Digital tomosynthesis
  • Limited angle cone-beam CT
  • On-board imaging
  • Patient localization

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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