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At least 811 records · Page 45
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DOE OSTI2014

WE-G-18A-05: Cone-Beam CT Reconstruction with Deformed Prior Image

Purpose: Prior image can be incorporated into image reconstruction process to improve the quality of on-treatment cone-beam CT (CBCT) from sparseview or low-dose projections. However, the deformation between the prior image and on-treatment CBCT are not considered in current prior image based reconstructions (e.g., prior image constrained compressed sensing (PICCS)). The purpose of this work is to develop a deformed-prior-imagebased- reconstruction strategy (DPIR) to address the mismatch problem between the prior image and target image. Methods: The deformed prior image is obtained by a projection based registration approach. Specifically, the deformation vector fields (DVF) used to deform the prior image is estimated through matching the forward projection of the prior image and the measured on-treatment projection. The deformed prior image is then used as the prior image in the standard PICCS algorithm. Simulation studies on the XCAT phantom was conducted to evaluate the performance of the projection based registration procedure and the proposed DPIR strategy. Results: The deformed prior image matches the geometry of on-treatment CBCT closer as compared to the original prior image. Using the deformed prior image, the quality of the image reconstructed by DPIR from few-view projection data is greatly improved as compared to the standard PICCS algorithm. The relative image reconstruction error is reduced to 11.13% in the proposed DPIR from 17.57% in the original PICCS. Conclusion: The proposed DPIR approach can solve the mismatch problem between the prior image and target image, which overcomes the limitation of the original PICCS algorithm for CBCT reconstruction from sparse-view or low-dose projections.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-A-18C-01: Design Optimization of Segmented Scintillators for Megavoltage Cone- Beam CT

Purpose: Active matrix flat-panel imagers incorporating thick, segmented scintillators for megavoltage cone-beam CT (MV CBCT) imaging have demonstrated strong potential for facilitating soft-tissue visualization at low, clinically practical doses. In order to identify scintillator design parameters that optimize performance for this purpose, a modeling technique which includes both radiation and optical effects and which lends itself to computationally practical implementation has been developed and explored. Methods: A hybrid modeling technique, based on Monte Carlo event-by-event simulation of radiation transport and separate determination of optical effects, was devised as an alternative to computationally prohibitive event-by- event simulations of both radiation and optical transport. The technique was validated against empirical results from a previously reported 1.13 cm thick, 1.016 mm element-to-element pitch BGO scintillator prototype. Using this technique, the contrast-to-noise ratio (CNR) and spatial resolution performance of numerous scintillator designs, with thicknesses ranging from 0.5 to 6 cm and pitches ranging from 0.508 to 1.524 mm, were examined. Results: CNR and spatial resolution performance for the various scintillator designs demonstrate complex behavior as scintillator thickness and pitch are varied - exhibiting a clear trade-off between these two imaging metrics up to a thickness of ~3 cm. Based on these results, an optimization map highlighting those regions of design that provide a balance between these metrics was created. The map indicates that, for a given set of optical parameters, scintillator thickness and pitch can be judiciously chosen to maximize performance without resorting to thicker, more costly scintillators. Conclusion: Modeling radiation and optical effects in thick, segmented scintillators through use of a hybrid modeling technique provides a practical way to gain insight as to how to optimize the performance of such devices for radiotherapy imaging. Assisted by such modeling, the development of practical designs should greatly facilitate low-dose, soft tissue visualization through MV CBCT imaging. This project was supported in part by NIH grant R01 CA051397.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

TH-A-18C-02: An Electrostatic Model for Assessment of Joint Space Morphology in Cone-Beam CT

Purpose: High-resolution cone-beam CT (CBCT) of the extremities presents a potentially valuable basis for image-based biomarkers of arthritis, trauma, and risk of injury. We present a new method for 3D joint space analysis that exploits the high isotropic spatial resolution of CBCT and is sensitive to small changes in disease-related morphology. Methods: The approach uses an “electrostatic” model in which joint surfaces (e.g., distal femur and proximal tibia) are labeled as charge densities between which the electric field is solved by approximation to the Laplace equation. The method yields a unique solution determined by the field lines across the “capacitor” and is hypothesized to be more sensitive than conventional (Sharp) scores and immune to degeneracies that limit simple distance-along-axis or closest-point analysis. The algorithm was validated in CBCT phantom images and applied in two clinical scenarios: osteoarthritis (OA, change in loadbearing tibiofemoral joint space); and assessment of injury risk (correlation of 3D joint space to tibial slope). Results: Joint space maps computed from the electrostatic model were accurate to within the voxel size (0.26 mm). The method highlighted subtle regions of morphological change that would likely be missed by conventional scalar metrics. Regions of subtle cartilage erosion were well quantified, and the method confidently discriminated OA and non-OA cohorts. 3D joint space maps correlated well with tibial slope and provide a new basis for principal component analysis of loadbearing injury risk. Runtime was less than 5 min (235×235×121 voxel subvolume in Matlab). Conclusion: A new method for joint space assessment was reported as a possible image-based biomarker of subtle articular change. The algorithm yields accurate quantitation of the joint in a manner that is robust against operator and patient setup variation. The method shows promising initial results in ongoing trials of CBCT in osteoarthritis, rheumatoid arthritis, and injury risk assessment. Research supported by R01 and R21 grants from the National Institutes of Health, academic-industry partnership with Carestream Health, and a grant from the US Army Natick Soldier Research, Development and Engineering Center.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

TH-A-18C-04: Ultrafast Cone-Beam CT Scatter Correction with GPU-Based Monte Carlo Simulation

Purpose: Scatter artifacts severely degrade image quality of cone-beam CT (CBCT). We present an ultrafast scatter correction framework by using GPU-based Monte Carlo (MC) simulation and prior patient CT image, aiming at automatically finish the whole process including both scatter correction and reconstructions within 30 seconds. Methods: The method consists of six steps: 1) FDK reconstruction using raw projection data; 2) Rigid Registration of planning CT to the FDK results; 3) MC scatter calculation at sparse view angles using the planning CT; 4) Interpolation of the calculated scatter signals to other angles; 5) Removal of scatter from the raw projections; 6) FDK reconstruction using the scatter-corrected projections. In addition to using GPU to accelerate MC photon simulations, we also use a small number of photons and a down-sampled CT image in simulation to further reduce computation time. A novel denoising algorithm is used to eliminate MC scatter noise caused by low photon numbers. The method is validated on head-and-neck cases with simulated and clinical data. Results: We have studied impacts of photo histories, volume down sampling factors on the accuracy of scatter estimation. The Fourier analysis was conducted to show that scatter images calculated at 31 angles are sufficient to restore those at all angles with <0.1% error. For the simulated case with a resolution of 512×512×100, we simulated 10M photons per angle. The total computation time is 23.77 seconds on a Nvidia GTX Titan GPU. The scatter-induced shading/cupping artifacts are substantially reduced, and the average HU error of a region-of-interest is reduced from 75.9 to 19.0 HU. Similar results were found for a real patient case. Conclusion: A practical ultrafast MC-based CBCT scatter correction scheme is developed. The whole process of scatter correction and reconstruction is accomplished within 30 seconds. This study is supported in part by NIH (1R01CA154747-01), The Core Technology Research in Strategic Emerging Industry, Guangdong, China (2011A081402003)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-A-18C-06: A Scatter Elimination Scheme for Cone Beam CT Using An Oscillating Narrow Beam

Purpose: While cone beam CT (CBCT) has been widely used in image guided radiation therapy, its low image quality, primarily caused by scattered x-rays, hinders advanced clinical applications, e.g., CBCT based on-line adaptive re-planning. We propose in this abstract a new scheme called oscillating narrow beam CBCT (ONB-CBCT) to eliminate scatter signals. Methods: ONB-CBCT consists of two major components. 1) Oscillating narrow beam (ONB) scan and 2) partitioned flat panel containing multiple individual detector strips and their own readouts. Both the beam oscillation and detector partition are along the superior-inferior (SI) direction. During data acquisition, at a given projection, the narrow beam sweep through the detector region, and different portions of the detector acquires projection data in synchrony with the narrow beam. ONB can be generated by a rotating slit collimator design with conventional tube with single focal spot, or by directly using a new source with multiple focal spots. A proof-of-principle study via Monte Carlo simulation is conducted to demonstrate the feasibility of ONB-CBCT. Results: As the beam becomes narrower, more and more scatter signals are eliminated. For the case with a bowtie filter and using 15 ONBs, the maximum and the average intensity error due to scatter are below 20 and 10 HU, respectively. Conclusion: ONB yields a narrowed exposure field at each snapshot and hence an inherently negligible scatter effect. Meanwhile, the individualized detector units guarantee high frame rate detection and hence a same large volume coverage as that in conventional CBCT. In summary, ONB-CBCT is a promising design to achieve high-quality CBCT imaging. This study is supported in part by NIH (1R01CA154747-01)

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2014

TH-A-18C-09: Ultra-Fast Monte Carlo Simulation for Cone Beam CT Imaging of Brain Trauma

Purpose: Application of cone-beam CT (CBCT) to low-contrast soft tissue imaging, such as in detection of traumatic brain injury, is challenged by high levels of scatter. A fast, accurate scatter correction method based on Monte Carlo (MC) estimation is developed for application in high-quality CBCT imaging of acute brain injury. Methods: The correction involves MC scatter estimation executed on an NVIDIA GTX 780 GPU (MC-GPU), with baseline simulation speed of ~1e7 photons/sec. MC-GPU is accelerated by a novel, GPU-optimized implementation of variance reduction (VR) techniques (forced detection and photon splitting). The number of simulated tracks and projections is reduced for additional speed-up. Residual noise is removed and the missing scatter projections are estimated via kernel smoothing (KS) in projection plane and across gantry angles. The method is assessed using CBCT images of a head phantom presenting a realistic simulation of fresh intracranial hemorrhage (100 kVp, 180 mAs, 720 projections, source-detector distance 700 mm, source-axis distance 480 mm). Results: For a fixed run-time of ~1 sec/projection, GPU-optimized VR reduces the noise in MC-GPU scatter estimates by a factor of 4. For scatter correction, MC-GPU with VR is executed with 4-fold angular downsampling and 1e5 photons/projection, yielding 3.5 minute run-time per scan, and de-noised with optimized KS. Corrected CBCT images demonstrate uniformity improvement of 18 HU and contrast improvement of 26 HU compared to no correction, and a 52% increase in contrast-tonoise ratio in simulated hemorrhage compared to “oracle” constant fraction correction. Conclusion: Acceleration of MC-GPU achieved through GPU-optimized variance reduction and kernel smoothing yields an efficient (<5 min/scan) and accurate scatter correction that does not rely on additional hardware or simplifying assumptions about the scatter distribution. The method is undergoing implementation in a novel CBCT dedicated to brain trauma imaging at the point of care in sports and military applications. Research grant from Carestream Health. JY is an employee of Carestream Health.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-E-17A-05: Optimizing Four Dimensional Cone Beam Computed Tomography Projection Allocation to Respiratory Bins

Purpose: Four dimensional cone beam computed tomography (4DCBCT) is an emerging image guidance strategy but it can suffer from poor image quality. To avoid repeating scans it is beneficial to make the best use of the imaging data obtained. For conventional 4DCBCT the location and size of respiratory bins is fixed and projections are allocated to the respiratory bin within which it falls. Strictly adhering to this rule is unnecessary and can compromise image quality. In this study we optimize the size and location of respiratory bins and allow projections to be sourced from adjacent phases of the respiratory cycle. Methods: A mathematical optimization framework using mixed integer quadratic programming has been developed that determines when to source projections from adjacent respiratory bins and optimizes the size and location of the bins. The method, which we will call projection sharing, runs in under 2 seconds of CPU time. Five 4DCBCT datasets of stage III-IV lung cancer patients were used to test the algorithm. The standard deviation of the angular separation between projections (SD-A) and the standard deviation in the volume of the reconstructed fiducial gold coil (SD-V) were used as proxies to measure streaking artefacts and motion blur respectively. Results: The SD-A using displacement binning and projection sharing was 30%–50% smaller than conventional phase based binning and 59%–76% smaller than conventional displacement binning indicating more uniformly spaced projections and fewer streaking artefacts. The SD-V was 20–90% smaller when using projection sharing than using conventional phase based binning suggesting more uniform marker segmentation and less motion blur. Conclusion: Image quality was visibly and significantly improved with projection sharing. Projection sharing does not require any modifications to existing hardware and offers a more robust replacement to phase based binning, or, an option if phase based reconstruction is not of a suitable quality. This project is supported by an NHMRC Australia Fellowship and NHMRC project grant number 1034060.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-E-17A-06: Anatomical-Adaptive Compressed Sensing (AACS) Reconstruction for Thoracic 4-Dimensional Cone-Beam CT

Purpose: The Feldkamp-Davis-Kress (FDK) algorithm currently used for clinical thoracic 4-dimensional (4D) cone-beam CT (CBCT) reconstruction suffers from noise and streaking artifacts due to projection under-sampling. Compressed sensing theory enables reconstruction of under-sampled datasets via total-variation (TV) minimization, but TV-minimization algorithms such as adaptive-steepest-descent-projection-onto-convex-sets (ASD-POCS) often converge slowly and are prone to over-smoothing anatomical details. These disadvantages can be overcome by incorporating general anatomical knowledge via anatomy segmentation. Based on this concept, we have developed an anatomical-adaptive compressed sensing (AACS) algorithm for thoracic 4D-CBCT reconstruction. Methods: AACS is based on the ASD-POCS framework, where each iteration consists of a TV-minimization step and a data fidelity constraint step. Prior to every AACS iteration, four major thoracic anatomical structures - soft tissue, lungs, bony anatomy, and pulmonary details - were segmented from the updated solution image. Based on the segmentation, an anatomical-adaptive weighting was applied to the TV-minimization step, so that TV-minimization was enhanced at noisy/streaky regions and suppressed at anatomical structures of interest. The image quality and convergence speed of AACS was compared to conventional ASD-POCS using an XCAT digital phantom and a patient scan. Results: For the XCAT phantom, the AACS image represented the ground truth better than the ASD-POCS image, giving a higher structural similarity index (0.93 vs. 0.84) and lower absolute difference (1.1*10{sup 4} vs. 1.4*10{sup 4}). For the patient case, while both algorithms resulted in much less noise and streaking than FDK, the AACS image showed considerably better contrast and sharpness of the vessels, tumor, and fiducial marker than the ASD-POCS image. In addition, AACS converged over 50% faster than ASD-POCS in both cases. Conclusions: The proposed AACS algorithm was shown to reconstruct thoracic 4D-CBCT images more accurately and with faster convergence compared to ASD-POCS. The superior image quality and rapid convergence makes AACS promising for future clinical use.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-E-17A-09: High Quality and Artifact-Free 4D Cone Beam CT and Its Application in Adaptive Treatment Planning

Purpose: To develop a high quality 4D cone beam CT (4DCBCT) method that is immune to patient/couch truncations and to investigate its application in adaptive replanning of lung XRT. Methods: In this study, IRB-approved human subject CBCT data was acquired using a Varian on-board imager with 1 minute rotation time. The acquired projection data was retrospectively sorted into 20 respiratory phase bins, from which 4DCBCT images with high SNR and high temporal resolution were generated using Prior Image Constrained Compressed Sensing (PICCS). Couch and patient truncations generate strong data inconsistency in the projection data and artifacts in the 4DCBCT image. They were addressed using an adaptive PICCS method. The artifact-free PICCS-4DCBCT images were used to generate adaptive treatment plans for the same patient at the 10th (day 21) and 30th (day 47) fractions. Dosimetric impacts with and without PICCS- 4DCBCT were evaluated by isodose distributions, DVHs, and other dosimetric factors. Results: The adaptive PICCS-4DCBCT method improves image quality by removing residue truncation artifacts; measured universal image quality increased 37%. The isodose lines and DVHs with PICCS-4DCBCT-based adaptive replanning were significantly more conformal to PTV than without replanning due to changes in patient anatomy caused by progress of the treatment. The mean dose to PTV at the 10th fraction was 63.1Gy with replanning and 64.2Gy without replanning, where the prescribed dose was 60Gy, in 2Gy × 30 fractions. The mean dose to PTV at the 30th fraction was 61.6Gy with replanning and 64.9Gy without replanning. Lung V20 was 37.1%, 41.9% and 43.3% for original plan, 10th fraction plan and 30th fraction plan; with re-planning, Lung V20 was 37.1%, 32%, 27.8%. Conclusion: 4DCBCT imaging using adaptive PICCS is able to generate high quality, artifact-free images that potentially can be used to create replanning for improving radiotherapy of the lung. K Niu, K Li, J Smilowitz: Nothing to Disclose. G Chen: General Electric Company Research funded, Siemens AG Research funded, Varian Medical Systems Research funded, Hologic Research funded.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-C-BRE-05: PTV Margin Determination Based On Tumor Radiobiological Characteristics and Geometric Uncertainties Derived From Daily Cone- Beam CT Images

Purpose: To determine required PTV margins for ≤1% loss in mean population TCP using systematic (Σ) and random (σ) errors calculated from daily cone-beam CT (CBCT) images of head and neck patients. Methods: Daily CBCT images were acquired for 50 head and neck patients. The CBCT image sets acquired at each fraction were registered with planning CT to obtain positional errors for each patient for each fraction. Systematic and random errors were calculated from data collected for 50 patients as described in IPEM On Target report. CTV delineation uncertainty of 2mm is added quadratically to systematic error. Assuming a spherical target volume, the dose in each voxel of target volume is summed for each fraction in the treatment by shifting the dose grid to calculate mean population TCP inclusive of geometric uncertainties using a Monte Carlo method. These simulations were repeated for the set of Σ and σ in each axis for different PTV margins and drop in TCP for each margin are obtained. In order to study the effect of dose-response curve on PTV margins, two different σα of 0.048 Gy-1 and 0.218 Gy-1 representing steep and shallow dose-response curves are studied. Σ were 2.5, 2.5, 2.1 mm and σ were 0.3, 0.3 0.2 mm respectively in x, y and z axis respectively. Results: PTV margins based on tumor radiobiological characteristics are 4.8, 4.8 and 4 mm in x, y and z axis assuming 25 treatment fractions for σα 0.048 Gy-1 (steep) and 4.2,4.2 and 2.2 for σα of 0.218 Gy-1 (shallow). While the TCP-based margins did not differ much in x and y axis, it is considerably smaller in z axis for shallow DRC. Conclusion: TCP based margins are substantially smaller than physical dose-based margin recipes. This study also demonstrates the importance of considering tumor radiobiological characteristics while deriving margins.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Poster — Thur Eve — 08: Rotational errors with on-board cone beam computed tomography

The focus of this study is on the Elekta XVI on-board cone beam computed tomography (CBCT) system. A rotational mismatch as large as 0.5° is observed between clockwise (CW) and counter-clockwise (CCW) CBCT scans. The error could affect non-isocentric treatments (e.g., lung SBRT and acoustic neuroma), as well as off-axis organs-at-risk. The error is caused by mislabeling of the projections with a lagging gantry angle, which is caused by the finite image acquisition time and delays in the imaging system. A 30 cm diameter cylindrical phantom with 5 mm diameter holes is used for the scanning. CW and CCW scans are acquired for five gantry speeds (360 to 120 deg./min.) on six linacs from three generations (MLCi, MLCi2, and Agility). Additional scans are acquired with different x-ray pulse widths for the same mAs. In the automated CBCT analysis (using ImageJ), the CW/CCW mismatch in a series of line profiles is identified and used to calculate the rotational error. Results are consistent among all linacs and indicate that the error varies linearly with gantry speed. The finite width of the x-ray pulses is a major but predictable contributor to the delay causing the error. For 40 ms pulses, the delay is 34 ± 1 ms. A simple solution applied in our clinic is adjusting the gantry angle offset to make the CCW one-minute scans correct. A more involved approach we are currently investigating includes adjustments of pulse width and mA, resulting in focal spot changes, with potential impact on image quality.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Poster — Thur Eve — 12: Implementation of a Clinical Lung Tumour High Dose Containment Verification Procedure using Respiratory Cone-Beam CT (4DCBCT) on a Varian TrueBeam Linac

Lung tumours move due to respiratory motion. This is managed during planning by acquiring a 4DCT and capturing the excursion of the GTV (gross tumour volume) throughout the breathing cycle within an IGTV (Internal Gross Tumour Volume) contour. Patients undergo a verification cone-beam CT (CBCT) scan immediately prior to treatment. 3D reconstructed images do not consider tumour motion, resulting in image artefacts, such as blurring. This may lead to difficulty in identifying the tumour on reconstructed images. It would be valuable to create a 4DCBCT reconstruction of the tumour motion to confirm that does indeed remain within the planned IGTV. CBCT projections of a Quasar Respiratory Motion Phantom are acquired in Treatment mode (half-fan scan) on a Varian TrueBeam accelerator. This phantom contains a mobile, low-density lung insert with an embedded 3cm diameter tumour object. It is programmed to create a 15s periodic, 2cm (sup/inf) displacement. A Varian Real-time Position Management (RPM) tracking-box is placed on the phantom breathing platform. Breathing phase information is automatically integrated into the projection image files. Using in-house Matlab programs and RTK (Reconstruction Tool Kit) open-source toolboxes, the projections are re-binned into 10 phases and a 4DCBCT scan reconstructed. The planning IGTV is registered to the 4DCBCT and the tumour excursion is verified to remain within the planned contour. This technique successfully reconstructs 4DCBCT images using clinical modes for a breathing phantom. UBC-BCCA ethics approval has been obtained to perform 4DCBCT reconstructions on lung patients (REB#H12-00192). Clinical images will be accrued starting April 2014.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Few-view cone-beam CT reconstruction with deformed prior image

Purpose: Prior images can be incorporated into the image reconstruction process to improve the quality of subsequent cone-beam CT (CBCT) images from sparse-view or low-dose projections. The purpose of this work is to develop a deformed prior image-based reconstruction (DPIR) strategy to mitigate the deformation between the prior image and the target image. Methods: The deformed prior image is obtained by a projection-based registration approach. Specifically, the deformation vector fields used to deform the prior image are estimated through iteratively matching the forward projection of the deformed prior image and the measured on-treatment projections. The deformed prior image is then used as the prior image in the standard prior image constrained compressed sensing (PICCS) algorithm. A simulation study on an XCAT phantom and a clinical study on a head-and-neck cancer patient were conducted to evaluate the performance of the proposed DPIR strategy. Results: The deformed prior image matches the geometry of the on-treatment CBCT more closely as compared to the original prior image. Consequently, the performance of the DPIR strategy from few-view projections is improved in comparison to the standard PICCS algorithm, based on both visual inspection and quantitative measures. In the XCAT phantom study using 20 projections, the average root mean squared error is reduced from 14% in PICCS to 10% in DPIR, and the average universal quality index increases from 0.88 in PICCS to 0.92 in DPIR. Conclusions: The present DPIR approach provides a practical solution to the mismatch problem between the prior image and target image, which improves the performance of the original PICCS algorithm for CBCT reconstruction from few-view or low-dose projections.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Moving metal artifact reduction in cone-beam CT scans with implanted cylindrical gold markers

Purpose: Implanted gold markers for image-guided radiotherapy lead to streaking artifacts in cone-beam CT (CBCT) scans. Several methods for metal artifact reduction (MAR) have been published, but they all fail in scans with large motion. Here the authors propose and investigate a method for automatic moving metal artifact reduction (MMAR) in CBCT scans with cylindrical gold markers. Methods: The MMAR CBCT reconstruction method has six steps. (1) Automatic segmentation of the cylindrical markers in the CBCT projections. (2) Removal of each marker in the projections by replacing the pixels within a masked area with interpolated values. (3) Reconstruction of a marker-free CBCT volume from the manipulated CBCT projections. (4) Reconstruction of a standard CBCT volume with metal artifacts from the original CBCT projections. (5) Estimation of the three-dimensional (3D) trajectory during CBCT acquisition for each marker based on the segmentation in Step 1, and identification of the smallest ellipsoidal volume that encompasses 95% of the visited 3D positions. (6) Generation of the final MMAR CBCT reconstruction from the marker-free CBCT volume of Step 3 by replacing the voxels in the 95% ellipsoid with the corresponding voxels of the standard CBCT volume of Step 4. The MMAR reconstruction was performed retrospectively using a half-fan CBCT scan for 29 consecutive stereotactic body radiation therapy patients with 2–3 gold markers implanted in the liver. The metal artifacts of the MMAR reconstructions were scored and compared with a standard MAR reconstruction by counting the streaks and by calculating the standard deviation of the Hounsfield units in a region around each marker. Results: The markers were found with the same autosegmentation settings in 27 CBCT scans, while two scans needed slightly changed settings to find all markers automatically in Step 1 of the MMAR method. MMAR resulted in 15 scans with no streaking artifacts, 11 scans with 1–4 streaks, and 3 scans with severe streaking artifacts. The corresponding numbers for MAR were 8 (no streaks), 1 (1–4 streaks), and 20 (severe streaking artifacts). The MMAR method was superior to MAR in scans with more than 8 mm 3D marker motion and comparable to MAR for scans with less than 8 mm motion. In addition, the MMAR method was tested on a 4D CBCT reconstruction for which it worked equally well as for the 3D case. The markers in the 4D case had very low motion blur. Conclusions: An automatic method for MMAR in CBCT scans was proposed and shown to effectively remove almost all streaking artifacts in a large set of clinical CBCT scans with implanted gold markers in the liver. Residual streaking artifacts observed in three CBCT scans may be removed with better marker segmentation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Robust primary modulation-based scatter estimation for cone-beam CT

Purpose: Scattered radiation is one of the major problems facing image quality in flat detector cone-beam computed tomography (CBCT). Previously, a new scatter estimation and correction method using primary beam modulation has been proposed. The original image processing technique used a frequency-domain-based analysis, which proved to be sensitive to the accuracy of the modulator pattern both spatially and in amplitude as well as to the frequency of the modulation pattern. In addition, it cannot account for penumbra effects that occur, for example, due to the finite focal spot size and the scatter estimate can be degraded by high-frequency components of the primary image. Methods: In this paper, the authors present a new way to estimate the scatter using primary modulation. It is less sensitive to modulator nonidealities and most importantly can handle arbitrary modulator shapes and changes in modulator attenuation. The main idea is that the scatter estimation can be expressed as an optimization problem, which yields a separation of the scatter and the primary image. The method is evaluated using simulated and experimental CBCT data. The scattering properties of the modulator itself are analyzed using a Monte Carlo simulation. Results: All reconstructions show strong improvements of image quality. To quantify the results, all images are compared to reference images (ideal simulations and collimated scans). Conclusions: The proposed modulator-based scatter reduction algorithm may open the field of flat detector-based imaging to become a quantitative modality. This may have significant impact on C-arm imaging and on image-guided radiation therapy.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

Validation of a deformable image registration technique for cone beam CT-based dose verification

Purpose: As radiation therapy evolves toward more adaptive techniques, image guidance plays an increasingly important role, not only in patient setup but also in monitoring the delivered dose and adapting the treatment to patient changes. This study aimed to validate a method for evaluation of delivered intensity modulated radiotherapy (IMRT) dose based on multimodal deformable image registration (DIR) for prostate treatments. Methods: A pelvic phantom was scanned with CT and cone-beam computed tomography (CBCT). Both images were digitally deformed using two realistic patient-based deformation fields. The original CT was then registered to the deformed CBCT resulting in a secondary deformed CT. The registration quality was assessed as the ability of the DIR method to recover the artificially induced deformations. The primary and secondary deformed CT images as well as vector fields were compared to evaluate the efficacy of the registration method and it’s suitability to be used for dose calculation. PLASTIMATCH, a free and open source software was used for deformable image registration. A B-spline algorithm with optimized parameters was used to achieve the best registration quality. Geometric image evaluation was performed through voxel-based Hounsfield unit (HU) and vector field comparison. For dosimetric evaluation, IMRT treatment plans were created and optimized on the original CT image and recomputed on the two warped images to be compared. The dose volume histograms were compared for the warped structures that were identical in both warped images. This procedure was repeated for the phantom with full, half full, and empty bladder. Results: The results indicated mean HU differences of up to 120 between registered and ground-truth deformed CT images. However, when the CBCT intensities were calibrated using a region of interest (ROI)-based calibration curve, these differences were reduced by up to 60%. Similarly, the mean differences in average vector field lengths decreased from 10.1 to 2.5 mm when CBCT was calibrated prior to registration. The results showed no dependence on the level of bladder filling. In comparison with the dose calculated on the primary deformed CT, differences in mean dose averaged over all organs were 0.2% and 3.9% for dose calculated on the secondary deformed CT with and without CBCT calibration, respectively, and 0.5% for dose calculated directly on the calibrated CBCT, for the full-bladder scenario. Gamma analysis for the distance to agreement of 2 mm and 2% of prescribed dose indicated a pass rate of 100% for both cases involving calibrated CBCT and on average 86% without CBCT calibration. Conclusions: Using deformable registration on the planning CT images to evaluate the IMRT dose based on daily CBCTs was found feasible. The proposed method will provide an accurate dose distribution using planning CT and pretreatment CBCT data, avoiding the additional uncertainties introduced by CBCT inhomogeneity and artifacts. This is a necessary initial step toward future image-guided adaptive radiotherapy of the prostate.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Calculating tumor trajectory and dose-of-the-day using cone-beam CT projections

Purpose: Cone-beam CT (CBCT) projection images provide anatomical data in real-time over several respiratory cycles, forming a comprehensive picture of tumor movement. The authors developed and validated a method which uses these projections to determine the trajectory of and dose to highly mobile tumors during each fraction of treatment. Methods: CBCT images of a respiration phantom were acquired, the trajectory of which mimicked a lung tumor with high amplitude (up to 2.5 cm) and hysteresis. A template-matching algorithm was used to identify the location of a steel BB in each CBCT projection, and a Gaussian probability density function for the absolute BB position was calculated which best fit the observed trajectory of the BB in the imager geometry. Two modifications of the trajectory reconstruction were investigated: first, using respiratory phase information to refine the trajectory estimation (Phase), and second, using the Monte Carlo (MC) method to sample the estimated Gaussian tumor position distribution. The accuracies of the proposed methods were evaluated by comparing the known and calculated BB trajectories in phantom-simulated clinical scenarios using abdominal tumor volumes. Results: With all methods, the mean position of the BB was determined with accuracy better than 0.1 mm, and root-mean-square trajectory errors averaged 3.8% ± 1.1% of the marker amplitude. Dosimetric calculations using Phase methods were more accurate, with mean absolute error less than 0.5%, and with error less than 1% in the highest-noise trajectory. MC-based trajectories prevent the overestimation of dose, but when viewed in an absolute sense, add a small amount of dosimetric error (<0.1%). Conclusions: Marker trajectory and target dose-of-the-day were accurately calculated using CBCT projections. This technique provides a method to evaluate highly mobile tumors using ordinary CBCT data, and could facilitate better strategies to mitigate or compensate for motion during stereotactic body radiotherapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Automated planning of breast radiotherapy using cone beam CT imaging

Purpose: Develop and clinically validate a methodology for using cone beam computed tomography (CBCT) imaging in an automated treatment planning framework for breast IMRT. Methods: A technique for intensity correction of CBCT images was developed and evaluated. The technique is based on histogram matching of CBCT image sets, using information from “similar” planning CT image sets from a database of paired CBCT and CT image sets (n = 38). Automated treatment plans were generated for a testing subset (n = 15) on the planning CT and the corrected CBCT. The plans generated on the corrected CBCT were compared to the CT-based plans in terms of beam parameters, dosimetric indices, and dose distributions. Results: The corrected CBCT images showed considerable similarity to their corresponding planning CTs (average mutual information 1.0±0.1, average sum of absolute differences 185 ± 38). The automated CBCT-based plans were clinically acceptable, as well as equivalent to the CT-based plans with average gantry angle difference of 0.99°±1.1°, target volume overlap index (Dice) of 0.89±0.04 although with slightly higher maximum target doses (4482±90 vs 4560±84, P < 0.05). Gamma index analysis (3%, 3 mm) showed that the CBCT-based plans had the same dose distribution as plans calculated with the same beams on the registered planning CTs (average gamma index 0.12±0.04, gamma <1 in 99.4%±0.3%). Conclusions: The proposed method demonstrates the potential for a clinically feasible and efficient online adaptive breast IMRT planning method based on CBCT imaging, integrating automation.

60 APPLIED LIFE SCIENCES↗