The study aimed to assess the clinical feasibility of employing an automatic match during cone beam computed tomography (CBCT) imaging using prostatic calcifications within the 95% isodose set as the region of interest.

CBCT images were analysed on the 5th fraction in 34 patients evaluating the difference between standard manual soft tissue anatomy matching versus auto calcification matching. An assessment of the clinical feasibility of using prostatic calcifications during matching alongside considering the effect a more automated matching process has been conducted on interobserver variability.

The standard deviation values of the difference between the soft tissue match (baseline) versus automatic calcification matches fluctuated around 1 mm in all three axes for all of the matches carried out. The interobserver variability observed between the two radiographers was 0·055, 0·065 and 0·045 cm in the vertical, longitudinal and lateral axes, respectively.

The clarity of the calcifications on the CBCT images might explain the low interobserver variability displayed by the two matching radiographers. A calcification provides a clear starting point for image matching before commencing a check of volumetric coverage, if the matching process begins in the same place, it can allow for a standardisation of matching technique between radiographers.