Topogram and 3DCT geometry calibration for image-guided proton therapy with in-room CT-on-rails

In-room computer tomography (CT) on-rails scanners are available in proton therapy centers but often limited to control imaging, due to geometric distortion and lack of integration. We present a calibration method combining CT-on-rails with a robotic table to achieve sub-millimeter patient positioning accuracy. Geometric distortions in 3DCT and topogram images were corrected using affine models and validated with laser tracker data. Phantom experiments simulating clinical conditions showed errors below 0.15 mm for 3D/3D and 0.3–0.55 mm for 2D/3D registration, the latter using a novel algorithm for digitally reconstructed topograms. The workflow enables accurate positioning without isocenter verification, supporting high-precision radiotherapy.