Diaphragm motion quantification in megavoltage cone-beam CT projection images

To quantify diaphragm motion in megavoltage (MV) cone-beam computed tomography (CBCT) projections.

User identified ipsilateral hemidiaphragm apex (IHDA) positions in two full exhale and inhale frames were used to create bounding rectangles in all other frames of a CBCT scan. The bounding rectangle was enlarged to create a region of interest (ROI). ROI pixels were associated with a cost function: The product of image gradients and a gradient direction matching function for an ideal hemidiaphragm determined from 40 training sets. A dynamic Hough transform (DHT) models a hemidiaphragm as a contour made of two parabola segments with a common vertex (the IHDA). The images within the ROIs are transformed into Hough space where a contour's Hough value is the sum of the cost function over all contour pixels. Dynamic programming finds the optimal trajectory of the common vertex in Hough space subject to motion constraints between frames, and an active contour model further refines the result. Interpolated ray tracing converts the positions to room coordinates. Root-mean-square (RMS) distances between these positions and those resulting from an expert's identification of the IHDA were determined for 21 Siemens MV CBCT scans.

Computation time on a 2.66 GHz CPU was 30 s. The average craniocaudal RMS error was 1.38 +/- 0.67 mm. While much larger errors occurred in a few near-sagittal frames on one patient's scans, adjustments to algorithm constraints corrected them.

The DHT based algorithm can compute IHDA trajectories immediately prior to radiation therapy on a daily basis using localization MVCBCT projection data. This has potential for calibrating external motion surrogates against diaphragm motion.