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Real-time direct diaphragm tracking using kV imaging on a standard linear accelerator.

Nicholas Hindley1, Paul Keall1, Jeremy Booth2,3

  • 1ACRF Image X Institute, Central Clinical School, University of Sydney, Eveleigh, NSW, 2015, Australia.

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This study introduces a new real-time diaphragm tracking algorithm for thoracic cancer radiotherapy. The method provides continuous 3D diaphragm position estimates, improving motion management during treatment.

Keywords:
Diaphragmlungradiotherapyreal-timetracking

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Area of Science:

  • Medical Physics
  • Radiotherapy
  • Image-guided therapy

Background:

  • Diaphragm motion is a primary driver of respiratory motion during thoracic cancer irradiation.
  • Current diaphragm tracking methods have limitations, including phase-based estimates, lateral failures, and lack of real-time capability.

Purpose of the Study:

  • To develop and evaluate a novel algorithm for real-time, continuous, three-dimensional (3D) diaphragm position estimation.
  • To utilize kV images acquired on a standard linear accelerator for diaphragm tracking.

Main Methods:

  • Generated patient-specific 3D diaphragm models from 4D-CT scans.
  • Estimated diaphragm motion trajectory using principal motion vector registration.
  • Generated 2D diaphragm masks and determined position by shifting masks and analyzing contrast on difference images.
  • Evaluated algorithm accuracy by tracking implanted markers in 22 CBCT sequences from six lung cancer patients.

Main Results:

  • Mean estimation errors were -0.1 ± 0.7 mm (LR), -0.1 ± 1.8 mm (SI), and 0.2 ± 1.4 mm (AP).
  • 95th percentile absolute errors ranged from 0.5-3.1 mm (LR), 1.6-6.7 mm (SI), and 1.2-4.0 mm (AP).
  • Diaphragm-marker correlations varied by marker position, with high SI-axis correlation (0.91-0.93) for lower lobe markers.

Conclusions:

  • The developed algorithm enables real-time, direct diaphragm tracking in radiotherapy settings.
  • This method facilitates markerless tumor tracking and respiratory gating in 4D-CBCT.
  • The approach offers a significant advancement for motion management in thoracic cancer treatment.