Individualized gating windows based on four-dimensional CT information for respiration-gated radiotherapy.

The purpose of this work is to relate the gating window and displacement of a moving tumor target and develop a systematic method to individualize the gating window for respiration-gated radiation therapy (RT). As the relationship between patient anatomy and respiration phase is contained in 4D images, we aim to quantify this information and utilize the data to guide gated treatment planning. After 4D image acquisition, the target and organs at risk were delineated manually on the selected gating phase. The contours were propagated automatically onto every phase-specific image set using a control volume-based contour mapping technique. The mean and maximum distances between the contours in the gating phase and each of other phases were evaluated in three dimensions. The gating window was determined in such a way that the residual movement of the target within the window is smaller or equal to the patient's setup error. The proposed method was applied to plan the gated treatments of 12 lung cancer patients. As a result of this work, a method to calculate patient-specific gating windows has been developed. The general reference drawn from this study is that, with the aide of 4D images and automated 4D contour propagation, it is feasible to individualize the gating widow selection. As compared with the current practice, the proposed technique has a potential to eliminate the guesswork involved in choosing a gating window and avoid dosimetric error in planning gated RT. In conclusion, individualization of gating windows reduces the subjectivity in respiration-gated RT and improves the treatment of moving targets.

Respiratory correlated cone-beam computed tomography on an isocentric C-arm.

A methodology for 3D image reconstruction from retrospectively gated cone-beam CT projection data has been developed. A mobile x-ray cone-beam device consisting of an isocentric C-arm equipped with a flat panel detector was used to image a moving phantom. Frames for reconstruction were retrospectively selected from complete datasets based on the known rotation of the C-arm and a signal from a respiratory monitor. Different sizes of gating windows were tested. A numerical criterion for blur on the reconstructed image was suggested. The criterion is based on minimization of an Ising energy function, similar to approaches used in image segmentation or restoration. It is shown that this criterion can be used for the determination of the optimal gating window size. Images reconstructed from the retrospectively gated projection sequences using the optimal gating window data showed a significant improvement compared to images reconstructed from the complete projection datasets.

Optimization of multi-slice helical respiration-correlated CT: the effects of table speed and rotation time.

While respiration-correlated CT is gaining acceptance in clinical radiotherapy, the effect of scanning parameters on the image quality has yet to be addressed. The intent of this study was to characterize the effects of gantry rotation and table speed on various image quality characteristics in multi-slice, helical, retrospectively-gated CT images. Images of stationary and moving phantoms were obtained in helical mode on a 20-slice CT scanner. Motion was generated by a computer-controlled platform capable of moving simultaneously in two dimensions. Motion was monitored using a pressure gauge inserted inside an adjustable belt. Selected scans were retrospectively gated into ten phases based on the monitored motion. Gantry rotation speeds of 0.5 s and 1.0 s were evaluated with pitches ranging from 0.1 to 0.45. Several parameters, including calculated object volumes, trajectory (movement from peak to trough), deformation (actual volume divided by volume created with the maximum diameter of contoured object) and z-axis resolution, were used to characterize image quality. These studies indicate that for objects in the peak phase of a movement pattern that simulates breathing, retrospectively gated scans using fast gantry rotation speeds produce volume, trajectory, deformation and z-axis resolution results comparable with those of a stationary object.