Extracting respiratory signals from thoracic cone beam CT projections

Patient respiratory signal associated with the cone beam CT (CBCT) projections is important for lung cancer radiotherapy. In contrast to monitoring an external surrogate of respiration, such signal can be extracted directly from the CBCT projections. In this paper, we propose a novel local principle component analysis (LPCA) method to extract the respiratory signal by distinguishing the respiration motion-induced content change from the gantry rotation-induced content change in the CBCT projections. The LPCA method is evaluated by comparing with three state-of-the-art projection-based methods, namely, the Amsterdam Shroud (AS) method, the intensity analysis (IA) method, and the Fourier-transform based phase analysis (FT-p) method. The clinical CBCT projection data of eight patients, acquired under various clinical scenarios, were used to investigate the performance of each method. We found that the proposed LPCA method has demonstrated the best overall performance for cases tested and thus is a promising technique for extracting respiratory signal. We also identified the applicability of each existing method.Comment: 21 pages, 11 figures, submitted to Phys. Med. Bio

Reconstruction of implanted marker trajectories from cone-beam CT projection images using interdimensional correlation modeling

PURPOSE: Cone-beam CT (CBCT) is a widely used imaging modality for image-guided radiotherapy. Most vendors provide CBCT systems that are mounted on a linac gantry. Thus, CBCT can be used to estimate the actual 3-dimensional (3D) position of moving respiratory targets in the thoracic/abdominal region using 2D projection images. The authors have developed a method for estimating the 3D trajectory of respiratory-induced target motion from CBCT projection images using interdimensional correlation modeling. METHODS: Because the superior-inferior (SI) motion of a target can be easily analyzed on projection images of a gantry-mounted CBCT system, the authors investigated the interdimensional correlation of the SI motion with left-right and anterior-posterior (AP) movements while the gantry is rotating. A simple linear model and a state-augmented model were implemented and applied to the interdimensional correlation analysis, and their performance was compared. The parameters of the interdimensional correlation models were determined by least-square estimation of the 2D error between the actual and estimated projected target position. The method was validated using 160 3D tumor trajectories from 46 thoracic/abdominal cancer patients obtained during CyberKnife treatment. The authors' simulations assumed two application scenarios: (1) retrospective estimation for the purpose of moving tumor setup used just after volumetric matching with CBCT; and (2) on-the-fly estimation for the purpose of real-time target position estimation during gating or tracking delivery, either for full-rotation volumetric-modulated arc therapy (VMAT) in 60 s or a stationary six-field intensity-modulated radiation therapy (IMRT) with a beam delivery time of 20 s. RESULTS: For the retrospective CBCT simulations, the mean 3D root-mean-square error (RMSE) for all 4893 trajectory segments was 0.41 mm (simple linear model) and 0.35 mm (state-augmented model). In the on-the-fly simulations, prior projections over more than 60° appear to be necessary for reliable estimations. The mean 3D RMSE during beam delivery after the simple linear model had established with a prior 90° projection data was 0.42 mm for VMAT and 0.45 mm for IMRT. CONCLUSIONS: The proposed method does not require any internal/external correlation or statistical modeling to estimate the target trajectory and can be used for both retrospective image-guided radiotherapy with CBCT projection images and real-time target position monitoring for respiratory gating or tracking.NHMRC, National Research Foundation of Kore

On the investigation of a novel x-ray imaging techniques in radiation oncology

Radiation therapy is indicated for nearly 50% of cancer patients in Australia. Radiation therapy requires accurate delivery of ionising radiation to the neoplastic tissue and pre-treatment in situ x-ray imaging plays an important role in meeting treatment accuracy requirements. Four dimensional cone-beam computed tomography (4D CBCT) is one such pre-treatment imaging technique that can help to visualise tumour target motion due to breathing at the time of radiation treatment delivery. Measuring and characterising the target motion can help to ensure highly accurate therapeutic x-ray beam delivery. In this thesis, a novel pre-treatment x-ray imaging technique, called Respiratory Triggered 4D cone-beam Computed Tomography (RT 4D CBCT), is conceived and investigated. Specifically, the aim of this work is to progress the 4D CBCT imaging technology by investigating the use of a patient’s breathing signal to improve and optimise the use of imaging radiation in 4D CBCT to facilitate the accurate delivery of radiation therapy. These investigations are presented in three main studies: 1. Introduction to the concept of respiratory triggered four dimensional conebeam computed tomography. 2. A simulation study exploring the behaviour of RT 4D CBCT using patientmeasured respiratory data. 3. The experimental realisation of RT 4D CBCT working in a real-time acquisitions setting. The major finding from this work is that RT 4D CBCT can provide target motion information with a 50% reduction in the x-ray imaging dose applied to the patient

Dynamic CBCT Imaging using Prior Model-Free Spatiotemporal Implicit Neural Representation (PMF-STINR)

Dynamic cone-beam computed tomography (CBCT) can capture high-spatial-resolution, time-varying images for motion monitoring, patient setup, and adaptive planning of radiotherapy. However, dynamic CBCT reconstruction is an extremely ill-posed spatiotemporal inverse problem, as each CBCT volume in the dynamic sequence is only captured by one or a few X-ray projections. We developed a machine learning-based technique, prior-model-free spatiotemporal implicit neural representation (PMF-STINR), to reconstruct dynamic CBCTs from sequentially acquired X-ray projections. PMF-STINR employs a joint image reconstruction and registration approach to address the under-sampling challenge. Specifically, PMF-STINR uses spatial implicit neural representation to reconstruct a reference CBCT volume, and it applies temporal INR to represent the intra-scan dynamic motion with respect to the reference CBCT to yield dynamic CBCTs. PMF-STINR couples the temporal INR with a learning-based B-spline motion model to capture time-varying deformable motion during the reconstruction. Compared with previous methods, the spatial INR, the temporal INR, and the B-spline model of PMF-STINR are all learned on the fly during reconstruction in a one-shot fashion, without using any patient-specific prior knowledge or motion sorting/binning. PMF-STINR was evaluated via digital phantom simulations, physical phantom measurements, and a multi-institutional patient dataset featuring various imaging protocols (half-fan/full-fan, full sampling/sparse sampling, different energy and mAs settings, etc.). The results showed that the one-shot learning-based PMF-STINR can accurately and robustly reconstruct dynamic CBCTs and capture highly irregular motion with high temporal (~0.1s) resolution and sub-millimeter accuracy. It can be a promising tool for motion management by offering richer motion information than traditional 4D-CBCTs

An image-based method to synchronize cone-beam CT and optical surface tracking

open5siThe integration of in-room X-ray imaging and optical surface tracking has gained increasing importance in the field of image guided radiotherapy (IGRT). An essential step for this integration consists of temporally synchronizing the acquisition of X-ray projections and surface data. We present an image-based method for the synchronization of cone-beam computed tomography (CBCT) and optical surface systems, which does not require the use of additional hardware. The method is based on optically tracking the motion of a component of the CBCT/gantry unit, which rotates during the acquisition of the CBCT scan. A calibration procedure was implemented to relate the position of the rotating component identified by the optical system with the time elapsed since the beginning of the CBCT scan, thus obtaining the temporal correspondence between the acquisition of X-ray projections and surface data. The accuracy of the proposed synchronization method was evaluated on a motorized moving phantom, performing eight simultaneous acquisitions with an Elekta Synergy CBCT machine and the AlignRT optical device. The median time difference between the sinusoidal peaks of phantom motion signals extracted from the synchronized CBCT and AlignRT systems ranged between -3.1 and 12.9 msec, with a maximum interquartile range of 14.4 msec. The method was also applied to clinical data acquired from seven lung cancer patients, demonstrating the potential of the proposed approach in estimating the individual and daily variations in respiratory parameters and motion correlation of internal and external structures. The presented synchronization method can be particularly useful for tumor tracking applications in extracranial radiation treatments, especially in the field of patient-specific breathing models, based on the correlation between internal tumor motion and external surface surrogates.Fassi, Aurora; Schaerer, Joël; Riboldi, Marco; Sarrut, David; Baroni, GuidoFassi, Aurora; Schaerer, Joël; Riboldi, Marco; Sarrut, David; Baroni, Guid

Prompt gamma imaging in proton therapy : status, challenges and developments

This paper is an overview of the field of proton therapy monitoring in real time using prompt gamma radiation. Different approaches providing either integrated or differential information are described, and their maturity, limitations and clinical usefulness are discussed. In the second part, the SiFi-CC project is briefly introduced, which aims at the development of a Compton camera for prompt gamma imaging, entirely based on fibres made of a heavy, inorganic scintillator read out by silicon photomultipliers. This compact solution offers very good timing properties, high granularity and a modern data acquisition system, addressing previously identified issues

Real-Time 3D Image Guidance Using a Standard LINAC: Measured Motion, Accuracy, and Precision of the First Prospective Clinical Trial of Kilovoltage Intrafraction Monitoring-Guided Gating for Prostate Cancer Radiation Therapy.

PURPOSE: Kilovoltage intrafraction monitoring (KIM) is a new real-time 3-dimensional image guidance method. Unlike previous real-time image guidance methods, KIM uses a standard linear accelerator without any additional equipment needed. The first prospective clinical trial of KIM is underway for prostate cancer radiation therapy. In this paper we report on the measured motion accuracy and precision using real-time KIM-guided gating. METHODS AND MATERIALS: Imaging and motion information from the first 200 fractions from 6 patient prostate cancer radiation therapy volumetric modulated arc therapy treatments were analyzed. A 3-mm/5-second action threshold was used to trigger a gating event where the beam is paused and the couch position adjusted to realign the prostate to the treatment isocenter. To quantify the in vivo accuracy and precision, KIM was compared with simultaneously acquired kV/MV triangulation for 187 fractions. RESULTS: KIM was successfully used in 197 of 200 fractions. Gating events occurred in 29 fractions (14.5%). In these 29 fractions, the percentage of beam-on time, the prostate displacement was >3 mm from the isocenter position, reduced from 73% without KIM to 24% with KIM-guided gating. Displacements >5 mm were reduced from 16% without KIM to 0% with KIM. The KIM accuracy was measured at <0.3 mm in all 3 dimensions. The KIM precision was <0.6 mm in all 3 dimensions. CONCLUSIONS: Clinical implementation of real-time KIM image guidance combined with gating for prostate cancer eliminates large prostate displacements during treatment delivery. Both in vivo KIM accuracy and precision are well below 1 mm

Real-time intrafraction motion monitoring in external beam radiotherapy

© 2019 Institute of Physics and Engineering in Medicine. Radiotherapy (RT) aims to deliver a spatially conformal dose of radiation to tumours while maximizing the dose sparing to healthy tissues. However, the internal patient anatomy is constantly moving due to respiratory, cardiac, gastrointestinal and urinary activity. The long term goal of the RT community to 'see what we treat, as we treat' and to act on this information instantaneously has resulted in rapid technological innovation. Specialized treatment machines, such as robotic or gimbal-steered linear accelerators (linac) with in-room imaging suites, have been developed specifically for real-time treatment adaptation. Additional equipment, such as stereoscopic kilovoltage (kV) imaging, ultrasound transducers and electromagnetic transponders, has been developed for intrafraction motion monitoring on conventional linacs. Magnetic resonance imaging (MRI) has been integrated with cobalt treatment units and more recently with linacs. In addition to hardware innovation, software development has played a substantial role in the development of motion monitoring methods based on respiratory motion surrogates and planar kV or Megavoltage (MV) imaging that is available on standard equipped linacs. In this paper, we review and compare the different intrafraction motion monitoring methods proposed in the literature and demonstrated in real-time on clinical data as well as their possible future developments. We then discuss general considerations on validation and quality assurance for clinical implementation. Besides photon RT, particle therapy is increasingly used to treat moving targets. However, transferring motion monitoring technologies from linacs to particle beam lines presents substantial challenges. Lessons learned from the implementation of real-time intrafraction monitoring for photon RT will be used as a basis to discuss the implementation of these methods for particle RT

Técnicas de coste reducido para el posicionamiento del paciente en radioterapia percutánea utilizando un sistema de imágenes ópticas

Patient positioning is an important part of radiation therapy which is one of the main solutions for the treatment of malignant tissue in the human body. Currently, the most common patient positioning methods expose healthy tissue of the patient's body to extra dangerous radiations. Other non-invasive positioning methods are either not very accurate or are very costly for an average hospital. In this thesis, we explore the possibility of developing a system comprised of affordable hardware and advanced computer vision algorithms that facilitates patient positioning. Our algorithms are based on the usage of affordable RGB-D sensors, image features, ArUco planar markers, and other geometry registration methods. Furthermore, we take advantage of consumer-level computing hardware to make our systems widely accessible. More specifically, we avoid the usage of approaches that need to take advantage of dedicated GPU hardware for general-purpose computing since they are more costly. In different publications, we explore the usage of the mentioned tools to increase the accuracy of reconstruction/localization of the patient in its pose. We also take into account the visualization of the patient's target position with respect to their current position in order to assist the person who performs patient positioning. Furthermore, we make usage of augmented reality in conjunction with a real-time 3D tracking algorithm for better interaction between the program and the operator. We also solve more fundamental problems about ArUco markers that could be used in the future to improve our systems. These include highquality multi-camera calibration and mapping using ArUco markers plus detection of these markers in event cameras which are very useful in the presence of fast camera movement. In the end, we conclude that it is possible to increase the accuracy of 3D reconstruction and localization by combining current computer vision algorithms with fiducial planar markers with RGB-D sensors. This is reflected in the low amount of error we have achieved in our experiments for patient positioning, pushing forward the state of the art for this application.En el tratamiento de tumores malignos en el cuerpo, el posicionamiento del paciente en las sesiones de radioterapia es una cuestión crucial. Actualmente, los métodos más comunes de posicionamiento del paciente exponen tejido sano del mismo a radiaciones peligrosas debido a que no es posible asegurar que la posición del paciente siempre sea la misma que la que tuvo cuando se planificó la zona a radiar. Los métodos que se usan actualmente, o no son precisos o tienen costes que los hacen inasequibles para ser usados en hospitales con financiación limitada. En esta Tesis hemos analizado la posibilidad de desarrollar un sistema compuesto por hardware de bajo coste y métodos avanzados de visión por ordenador que ayuden a que el posicionamiento del paciente sea el mismo en las diferentes sesiones de radioterapia, con respecto a su pose cuando fue se planificó la zona a radiar. La solución propuesta como resultado de la Tesis se basa en el uso de sensores RGB-D, características extraídas de la imagen, marcadores cuadrados denominados ArUco y métodos de registro de la geometría en la imagen. Además, en la solución propuesta, se aprovecha la existencia de hardware convencional de bajo coste para hacer nuestro sistema ampliamente accesible. Más específicamente, evitamos el uso de enfoques que necesitan aprovechar GPU, de mayores costes, para computación de propósito general. Se han obtenido diferentes publicaciones para conseguir el objetivo final. Las mismas describen métodos para aumentar la precisión de la reconstrucción y la localización del paciente en su pose, teniendo en cuenta la visualización de la posición ideal del paciente con respecto a su posición actual, para ayudar al profesional que realiza la colocación del paciente. También se han propuesto métodos de realidad aumentada junto con algoritmos para seguimiento 3D en tiempo real para conseguir una mejor interacción entre el sistema ideado y el profesional que debe realizar esa labor. De forma añadida, también se han propuesto soluciones para problemas fundamentales relacionados con el uso de marcadores cuadrados que han sido utilizados para conseguir el objetivo de la Tesis. Las soluciones propuestas pueden ser empleadas en el futuro para mejorar otros sistemas. Los problemas citados incluyen la calibración y el mapeo multicámara de alta calidad utilizando los marcadores y la detección de estos marcadores en cámaras de eventos, que son muy útiles en presencia de movimientos rápidos de la cámara. Al final, concluimos que es posible aumentar la precisión de la reconstrucción y localización en 3D combinando los actuales algoritmos de visión por ordenador, que usan marcadores cuadrados de referencia, con sensores RGB-D. Los resultados obtenidos con respecto al error que el sistema obtiene al reproducir el posicionamiento del paciente suponen un importante avance en el estado del arte de este tópico

Dynamic Cone-beam CT Reconstruction using Spatial and Temporal Implicit Neural Representation Learning (STINR)

Objective: Dynamic cone-beam CT (CBCT) imaging is highly desired in image-guided radiation therapy to provide volumetric images with high spatial and temporal resolutions to enable applications including tumor motion tracking/prediction and intra-delivery dose calculation/accumulation. However, the dynamic CBCT reconstruction is a substantially challenging spatiotemporal inverse problem, due to the extremely limited projection sample available for each CBCT reconstruction (one projection for one CBCT volume). Approach: We developed a simultaneous spatial and temporal implicit neural representation (STINR) method for dynamic CBCT reconstruction. STINR mapped the unknown image and the evolution of its motion into spatial and temporal multi-layer perceptrons (MLPs), and iteratively optimized the neuron weighting of the MLPs via acquired projections to represent the dynamic CBCT series. In addition to the MLPs, we also introduced prior knowledge, in form of principal component analysis (PCA)-based patient-specific motion models, to reduce the complexity of the temporal INRs to address the ill-conditioned dynamic CBCT reconstruction problem. We used the extended cardiac torso (XCAT) phantom to simulate different lung motion/anatomy scenarios to evaluate STINR. The scenarios contain motion variations including motion baseline shifts, motion amplitude/frequency variations, and motion non-periodicity. The scenarios also contain inter-scan anatomical variations including tumor shrinkage and tumor position change. Main results: STINR shows consistently higher image reconstruction and motion tracking accuracy than a traditional PCA-based method and a polynomial-fitting based neural representation method. STINR tracks the lung tumor to an averaged center-of-mass error of <2 mm, with corresponding relative errors of reconstructed dynamic CBCTs <10%