Impact of cone-beam computed tomography artifacts on dose calculation accuracy for lung cancer.

BACKGROUND: To implement image-guided adaptive radiotherapy (IGART), many studies investigated dose calculations on cone-beam computed tomography (CBCT). A high HU accuracy is crucial for a high dose calculation accuracy and many imaging sites showed satisfactory results. It has been shown that the dose calculation accuracy for lung cancer lags behind. PURPOSE: To examine why the dose calculation accuracy for lung is insufficient, the relative effects of the field-of-view (FOV), breathing motion, and scatter on dose calculation accuracy were studied. METHODS: A framework was built to simulate CBCT scans for lung cancer patients by forward projecting repeat CT (rCT) scans for two scan geometries: small (SFOV) and medium FOV (MFOV). Breathing motion was modeled by applying a 4D deformation vector field to the mid-position rCT. Scatter was modeled by Monte-Carlo simulations with/without an anti-scatter grid (ASG). Simulated projections were reconstructed using filtered back-projection with/without scatter correction. In case of the SFOV, the CBCT images were patched with the planning CT scan in axial direction. The treatment plan was recalculated on the rCT and simulated CBCT. The mean Hounsfield unit (HU) difference (ΔHUmean ), the structural similarity index measure (SSIM), and γ metrics were calculated for the CBCT datasets of various imaging settings. RESULTS: The differences in HU, SSIM and dose calculation accuracy for CBCTs with and without breathing motion were negligible (mean ΔHUmean  = 6.4 vs. 13.7, mean SSIM = 0.941 vs. 0.957, mean γ (ref = MFOV) = 0.75). The SFOV resulted in a lower HU (mean ΔHUmean  = -9.2 vs. 13.7) and SSIM (mean SSIM = 0.912 vs. 0.957), and therefore in dose differences compared to the MFOV (mean γ = 1.22). Scatter led to considerable discrepancies in all metrics. Adding only the ASG improved the results more than only applying a scatter correction algorithm. Combining ASG and scatter correction algorithm resulted in an even higher dose calculation accuracy. CONCLUSIONS: Scatter and FOV are the main contributors to dose inaccuracies and motion has only a minor effect on dose calculation accuracy. Therefore, utilizing an appropriate scatter correction and FOV is important to achieve sufficient dose calculation accuracy to facilitate IGART for lung.

Assessment of intra-fraction motion during frameless image guided Gamma Knife stereotactic radiosurgery.

As frameless stereotactic radiosurgery increase in use, the aim of this study was to evaluate intra-fraction motion through cone-beam CT (CBCT) and high-definition motion management (HDMM) systems. Intra-fraction motion measured between localization, repeat localization and post-treatment CBCTs were correlated to intra-faction motion indicated by the HDMM files using the Pearson coefficient (r). A total of 302 plans were reviewed from 263 patients (114 male, 149 female); 216 pairs of localization-repeat localization, and 260 localization-post-treatment CBCTs were analyzed against HDMM logs. We found the magnitude of intra-fraction motion detected by the HDMM system were larger than the corresponding CBCT results.

A combined dose calculation and verification method for a small animal precision irradiator based on onboard imaging.

PURPOSE: Novel small animal precision microirradiators (micro-IR) are becoming available for preclinical use and are often equipped with onboard imaging (OBI) devices. We investigated the use of OBI as a means to infer the accuracy of the delivered treatment plan. METHODS: Monte Carlo modeling of the micro-IR including an elliptical Gaussian electron beam incident on the x-ray tube was used to score dose and to continue photon transport to the plane of the OBI device. A model of the OBI detector response was used to generate simulated onboard images. Experimental OBI was performed at 225 kVp, gain∕offset and scatter-glare were corrected. Simulated and experimentally obtained onboard images of phantoms and a mouse specimen were compared for a range of photon beam sizes from 2.5 cm down to 0.1 cm. RESULTS: Simulated OBI can be used in small animal radiotherapy to determine if a treatment plan was delivered according to the prescription within an uncertainty of 5% for beams as small as 4 mm in diameter. For collimated beams smaller than 4 mm, beam profile differences remain primarily in the penumbra region of the smallest beams, which may be tolerable for specific preclinical micro-IR investigations. CONCLUSIONS: Comparing simulated to acquired OBI during small animal treatment radiotherapy represents a useful treatment delivery tool.

Monte Carlo analysis of beam blocking grid design parameters: Scatter estimation and the importance of electron backscatter.

PURPOSE: Beam blocking grids provide a simple and direct measurement of the scattered photon signal which degrades image quality in x-ray imaging systems, such as cone-beam CT (CBCT). This study evaluates the scatter estimation accuracy of the beam blocking method to optimize the design parameters of the grid system (e.g., grid thickness, source-to-grid distance (SGD), septa width, air interspace, and grid ratio) using Monte Carlo (MC) simulations. METHOD: A MC model of a CBCT imaging system with a beam blocking grid in place is made using code based on EGSnrc, with the x-ray tube portion of the simulation including electron backscatter between the anode and cathode. The inclusion of the electron backscatter allowed a more complete model of the contamination signal to be estimated. The contamination signal consists of the off-focal radiation (OFR) and source component scatter (photon scatter in source components such as tube housing, filters, and collimators). The MC model was validated against measurements collected on a bench top imaging system with a grid in place. The MC model was used to simulate 11 different grid design configurations in addition to a case with no grid. For each design a simulated projection with and without a phantom in place was computed. The simulated projections were then used to estimate the scatter and contamination portion of the signal using the signal behind the grid septa. The estimated signals from the grid data were compared to the actual signals labeled during the MC simulation. RESULTS: Simulated results showed good agreeance with measured results with the importance of including electron backscatter resulting in off-focal radiation in the simulation being highlighted. When the source was free of contamination photons all grids performed with an error less than 8% when estimating just the scatter from the object. When the contamination photons were included in the simulation, the error in estimating both the scatter and contamination signal rose by a factor of 4 on average. In the case when both signals are present, increasing the grid thickness, changing the SGD, and reducing septa width and air interspace sizes all showed the ability to improve the grid-based estimates of the object scatter and contamination portion signal. CONCLUSIONS: The inclusion of the contamination signal in MC simulations of x-ray imaging systems is important in the design, validation, and evaluation of measurement-based scatter methods. Beam blocking grids show potential not only in object scatter estimation but in the estimation of the contamination signal, but appropriate interpolation functions must be used to account for higher frequencies found in contamination signal.

Preliminary Evaluation of a Novel Thermoplastic Mask System with Intra-fraction Motion Monitoring for Future Use with Image-Guided Gamma Knife.

UNLABELLED: OBJECTIVES : A non-invasive immobilization system consisting of a thermoplastic mask with image-guidance using cone-beam CT (CBCT) and infrared (IR) tracking has been developed to ensure minimal inter- and intra-fractional movement during Gamma Knife radiosurgery. Prior to clinical use for patients on a Gamma Knife, this study clinically evaluates the accuracy and stability of this novel immobilization system with image-guidance in patients treated with standard fractionated radiation therapy on a linear accelerator. MATERIALS & METHODS: This prospective cohort study evaluated adult patients planned for fractionated brain radiotherapy. Patients were immobilized with a thermoplastic mask (with the nose cut out) and customized head cushion. A reflective marker was placed on the patient's nose tip and tracked with a stereoscopic IR camera throughout treatment. For each fraction, a pre-treatment, verification (after any translational correction for inter-fraction set-up variation), and post-treatment CBCT was acquired to evaluate inter- and intra-fraction movement of the target and nose. Intra-fraction motion of the nose tip measured on CBCT and IR tracking were compared. RESULTS : Corresponding data from 123 CBCT and IR datasets from six patients are summarized. The mean ± standard deviation (SD) intra-fraction motion of the nose tip was 0.41±0.36 mm based on pre- and post-treatment CBCT data compared with 0.56±0.51 mm using IR tracking. The maximum intra-fraction motion of the nose tip was 1.7 mm using CBCT and 3.2 mm using IR tracking. The mean ± SD intra-fraction motion of the target was 0.34±0.25 mm, and the maximum intra-fraction motion was 1.5 mm. CONCLUSIONS: This initial clinical evaluation of the thermoplastic mask immobilization system using both IR tracking and CBCT demonstrate that mean intra-fraction motion of the nose and target is small. The presence of isolated measures of larger intra-fraction motion supports the need for image-guidance and intra-fraction motion management when using this mask-based immobilization system for radiosurgery.

Automated 3-D reconstruction of the surface of live early-stage amphibian embryos.

Although three-dimensional (3-D) reconstructions of the surfaces of live embyos are vital to understanding embryo development, morphogenetic tissue movements and other factors have prevented the automation of this task. Here, we report an integrated set of software algorithms that overcome these challenges, making it possible to completely automate the reconstruction of embryo surfaces and other textured surfaces from multiview images. The process involves: 1) building accurate point correspondences using a robust deformable template block matching algorithm; 2) removing outliers using fundamental matrix calculations in conjunction with a RANSAC algorithm; 3) generating 3-D point clouds using a bundle adjustment algorithm that includes camera position and distortion corrections; 4) meshing the point clouds into triangulated surfaces using a Tight Cocone algorithm that produces water tight models; 5) refining surfaces using midpoint insertion and Laplacian smoothing algorithms; and 6) repeating these steps until a measure of convergence G, the rms difference between successive reconstructions, is below a specified threshold. Reconstructions were made of 2.2-mm diameter, neurulation-stage axolotl (amphibian) embryos using 44 multiview images collected with a robotic microscope. A typical final model (sixth iteration) contained 3787 points and 7562 triangles and had an error measure of G = 5.9 microm.

Cone beam computed tomography image guidance system for a dedicated intracranial radiosurgery treatment unit.

PURPOSE: Image guidance has improved the precision of fractionated radiation treatment delivery on linear accelerators. Precise radiation delivery is particularly critical when high doses are delivered to complex shapes with steep dose gradients near critical structures, as is the case for intracranial radiosurgery. To reduce potential geometric uncertainties, a cone beam computed tomography (CT) image guidance system was developed in-house to generate high-resolution images of the head at the time of treatment, using a dedicated radiosurgery unit. The performance and initial clinical use of this imaging system are described. METHODS AND MATERIALS: A kilovoltage cone beam CT system was integrated with a Leksell Gamma Knife Perfexion radiosurgery unit. The X-ray tube and flat-panel detector are mounted on a translational arm, which is parked above the treatment unit when not in use. Upon descent, a rotational axis provides 210° of rotation for cone beam CT scans. Mechanical integrity of the system was evaluated over a 6-month period. Subsequent clinical commissioning included end-to-end testing of targeting performance and subjective image quality performance in phantoms. The system has been used to image 2 patients, 1 of whom received single-fraction radiosurgery and 1 who received 3 fractions, using a relocatable head frame. RESULTS: Images of phantoms demonstrated soft tissue contrast visibility and submillimeter spatial resolution. A contrast difference of 35 HU was easily detected at a calibration dose of 1.2 cGy (center of head phantom). The shape of the mechanical flex vs scan angle was highly reproducible and exhibited <0.2 mm peak-to-peak variation. With a 0.5-mm voxel pitch, the maximum targeting error was 0.4 mm. Images of 2 patients were analyzed offline and submillimeter agreement was confirmed with conventional frame. CONCLUSIONS: A cone beam CT image guidance system was successfully adapted to a radiosurgery unit. The system is capable of producing high-resolution images of bone and soft tissue. The system is in clinical use and provides excellent image guidance without invasive frames.

Geometric performance and efficiency of an optical tracking system for daily pre-treatment positioning in pelvic radiotherapy patients.

The purpose of this study was to characterize the accuracy of a novel in-house optical tracking system (OTS), and to determine its efficiency for daily pre-treatment positioning of pelvic radiotherapy patients compared to conventional optical distance indicator (ODI) methodology. The OTS is comprised of a passive infrared stereoscopic camera, and custom control software for use in assisting radiotherapy patient setup. Initially, the system was calibrated and tested for stability inside a radiation therapy treatment room. Subsequently, under an ethics approved protocol, the clinical efficiency of the OTS was compared to conventional ODI setup methodology through 17 pelvic radiotherapy patients. Differences between orthogonal source-to-skin distance (SSD) readings and overall set-up time resultant from both systems were compared. The precision of the OTS was 0.01 ± 0.01 mm, 0.02 ± 0.02 mm, and -0.01 ± 0.06 mm in the left/right (L/R), anterior/posterior (A/P), and cranial/caudal (C/C) directions, respectively. Discrepancies measured between the linac radiographic center in the treatment room and the calibrated origin of the camera (OTS) by two independent observers was submillimeter. Analysis of 146 fractions from 17 patients showed a high correlation between the SSD readings of the OTS and ODI setup methodologies (r = 0.99). The average time for pre-treatment positioning using the OTS couch shift calculation was 2.60 ± 0.69 minutes, and for conventional ODI setup, 3.62 ± 0.82 minutes; the difference of 1.02 minutes was statistically significant (p < 0.001). In conclusion, the OTS is a precise and robust tool for use as an independent check of treatment room patient positioning. The system is indicated as geometrically equivalent to current methods of daily pre-treatment patient positioning with potential for gains in efficiency by decreasing setup times in the treatment room.

Initial investigation of an automatic registration algorithm for surgical navigation.

The procedure required for registering a surgical navigation system prior to use in a surgical procedure is conventionally a time-consuming manual process that is prone to human errors and must be repeated as necessary through the course of a procedure. The conventional procedure becomes even more time consuming when intra-operative 3D imaging such as the C-arm cone-beam CT (CBCT) is introduced, as each updated volume set requires a new registration. To improve the speed and accuracy of registering image and world reference frames in image-guided surgery, a novel automatic registration algorithm was developed and investigated. The surgical navigation system consists of either Polaris (Northern Digital Inc., Waterloo, ON) or MicronTracker (Claron Technology Inc., Toronto, ON) tracking camera(s), custom software (Cogito running on a PC), and a prototype CBCT imaging system based on a mobile isocentric C-arm (Siemens, Erlangen, Germany). Experiments were conducted to test the accuracy of automatic registration methods for both the MicronTracker and Polaris tracking cameras. Results indicate the automated registration performs as well as the manual registration procedure using either the Claron or Polaris camera. The average root-mean-squared (rms) observed target registration error (TRE) for the manual procedure was 2.58 +/- 0.42 mm and 1.76 +/- 0.49 mm for the Polaris and MicronTracker, respectively. The mean observed TRE for the automatic algorithm was 2.11 +/- 0.13 and 2.03 +/- 0.3 mm for the Polaris and MicronTracker, respectively. Implementation and optimization of the automatic registration technique in Carm CBCT guidance of surgical procedures is underway.

Multiview robotic microscope reveals the in-plane kinematics of amphibian neurulation.

A new robotic microscope system, called the Frogatron 3000, was developed to collect time-lapse images from arbitrary viewing angles over the surface of live embryos. Embryos are mounted at the center of a horizontal, fluid-filled, cylindrical glass chamber around which a camera with special optics traverses. To hold them at the center of the chamber and revolve them about a vertical axis, the embryos are placed on the end of a small vertical glass tube that is rotated under computer control. To demonstrate operation of the system, it was used to capture time-lapse images of developing axolotl (amphibian) embryos from 63 viewing angles during the process of neurulation and the in-plane kinematics of the epithelia visible at the center of each view was calculated. The motions of points on the surface of the embryo were determined by digital tracking of their natural surface texture, and a least-squares algorithm was developed to calculate the deformation-rate tensor from the motions of these surface points. Principal strain rates and directions were extracted from this tensor using decomposition and eigenvector techniques. The highest observed principal true strain rate was 28 +/- 5% per hour, along the midline of the neural plate during developmental stage 14, while the greatest contractile true strain rate was--35 +/- 5% per hour, normal to the embryo midline during stage 15.