Towards respiration management in radiation treatment of lung tumors: transferring regions of interest from planning CT to kilovoltage X-ray images.

ABSTRACT

Tracking of lung tumors is imperative for improved radiotherapy treatment. However, the motion of the thoracic organs makes it a complicated task. 4D CT images acquired prior to treatment provide valuable information regarding the motion of organs and tumor, since it is manually annotated. In order to track tumors using treatment-day X-ray images (kV images), we need to find the correspondence with CT images so that projection of tumor region of interest will provide a good estimate about the position of the tumor on the X-ray image. In this study, we propose a method to estimate the alignment and respiration phase corresponding to X-ray images using 4D CT data. Our approach generates Digitally Reconstructed Radiographs (DRRs) using bilateral filter smoothing and computes rigid registration with kV images since the position and orientation of patient might differ between CT and treatment-day image acquisition processes. Instead of using landmark points, our registration method makes use of Kernel Density Estimation over the edges that are not affected much by respiration. To estimate the phase of X-ray, we apply template matching techniques between the lung regions of X-ray and registered DRRs. Our approach gives accurate results for rigid registration and provides a starting point to track tumors using the X-ray images during the treatment.