Delineation of moving targets with slow MVCT scans: implications for adaptive non-gated lung tomotherapy

Accurate imaging is a prerequisite for adaptive radiation therapy of mobile tumours. We present an evaluation of the performance of slow computed tomography (CT) for mapping and delineating the excursion boundary of a moving object using a tumour phantom scanned with the helical MVCT scanner of a tomotherapy unit. A spherical test object driven by sinusoidal motion in both the lateral and cranial-caudal directions was used to determine how well MVCT images depict the true envelope of the motion. Such information is useful in interpreting the CT images relative to the static object case when radiotherapy gating is to be used or in determining the internal target volume (ITV) when beam gating is not possible. A computer simulation of the CT imaging process was developed which incorporates the third generation fan beam geometry and helical acquisition technique of the tomotherapy MVCT system. Motion artefacts are mainly characterized by the parameter alpha=Tgantry/Trespiration which is interpreted as the period of the gantry rotation (Tgantry) in units of the respiratory period (Trespiration). Experimental tests were performed using a fixed gantry period of 10 s per full rotation and respiratory period ranging from 4.0 (alpha=2.5) to 1.0 (alpha=10) s. These cases represent typical clinical imaging conditions on the tomotherapy unit, as well as an extreme test case where the gantry period is intentionally set to be much greater than the respiratory period (termed an 'ultra-slow' scan). The accuracy of target (ITV) delineation is evaluated by comparing volumes generated using iso-density contours on the MVCT images to the true motion envelope, known a priori in this phantom study. As expected, motion artefacts are present in clinical MVCT images and they are not averaged over the slow gantry period of rotation. Furthermore, artefacts are not significantly affected by scanning with different helical pitch values. Greater distortions from the true density distribution are observed for lateral motion compared to cranial-caudal motion. Volumes generated by iso-density contours yield better agreement with the motion envelope for scans performed under ultra-slow conditions (alpha=10) compared to typical clinical imaging conditions (alpha=2.5). If the MVCT gantry cannot be rotated very quickly due to engineering constraints in order to achieve ultra-fast CT, we suggest an opposite approach as an interim measure for mapping the ITV. Adjusting MVCT scan conditions to a very slow acquisition (alpha=10) may be a good compromise for determining the ITV for non-gated adaptive tomotherapy of moving lung tumours.