Statistical iterative reconstruction is expected to improve the image quality of megavoltage computed tomography (MVCT). However, one of the challenges of iterative reconstruction is its large computational cost. The purpose of this work is to develop a fast iterative reconstruction algorithm by combining several iterative techniques and by optimizing reconstruction parameters. Megavolt projection data was acquired from a TomoTherapy system and reconstructed using our statistical iterative reconstruction. Total variation was used as the regularization term and the weight of the regularization term was determined by evaluating signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and visual assessment of spatial resolution using Gammex and Cheese phantoms. Gradient decent with an adaptive convergence parameter, ordered subset expectation maximization (OSEM), and CPU/GPU parallelization were applied in order to accelerate the present reconstruction algorithm. The SNR and CNR of the iterative reconstruction were several times better than that of filtered back projection (FBP). The GPU parallelization code combined with the OSEM algorithm reconstructed an image several hundred times faster than a CPU calculation. With 500 iterations, which provided good convergence, our method produced a 512$times$512 pixel image within a few seconds. The image quality of the present algorithm was much better than that of FBP for patient data. An image from the iterative reconstruction in TomoTherapy can be obtained within few seconds by fine-tuning the parameters. The iterative reconstruction with GPU was fast enough for clinical use, and largely improve the MVCT images.
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