Image Quality Assessment and Quality Assurance of Advanced Imaging Systems for IGRT. AAPM Penn-Ohio Chapter Sep 25, 2015 Soyoung Lee, PhD

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1 Image Quality Assessment and Quality Assurance of Advanced Imaging Systems for IGRT AAPM Penn-Ohio Chapter Sep 25, 2015 Soyoung Lee, PhD 1

2 Outline q Introduction q Imaging performances in 4D-CBCT Image quality Target motion reconstruction q Clinical applications q Conclusions 2

3 CBCT Utilization for IGRT q Preferred imaging technology for patient setups and target verification 3D volumetric data Submillimeter spatial resolution Soft-tissue visibility q Majority of Linacs are sold with CBCT q Potential validation for delivered dose based on deformable registration + dose re-calculation 3

4 Limits of 3D-CBCT Imaging q X-ray scatter artifacts: image noise due to wide collimation compared to fan-beam CT q Motion artifacts: time-averaged information Acquisition time: 1-2 min q Lack of real-time positioning information q Overestimated Internal target volume (ITV) 4

5 3D-CBCT vs. 4D-CBCT (lung tumor) 3D-CBCT Chest M20F1 4D-CBCT Symmetry ITV* (Elekta Synergy R4.5) The tumor motion is within the planned ITV *ITV: drawn in 4D-CT MIP images 5

6 3D- CBCT vs. 4D- CBCT (hepatic dome) 3D- CBCT Chest M20F1 (purple) Symmetry PTV Fx2 tumor motion is out of PTV Registration with AVG 4D- CT (green) 4D- CBCT Symmetry (Elekta Synergy R4.5) PTV Fx1 tumor motion is within PTV 6

7 Purpose q 4D-CBCT imaging performances assess 4D image quality assess motion reconstruction accuracy Employing regular and irregular breathings To achieve a clinical 4D-CBCT data acquisition improve clinical applicability in IGRT 7

8 Nominal Scan Parameters (Elekta) 3D-CBCT 4D-CBCT 4D-CBCT 4D-CBCT Protocol Chest * Symmetry * 4D-M-slow 4D-M-fast Collimation/Filter M20/F1 S20/F0 M20/F1 M20/F1 Beam area at isocenter (cm 2 ) Gantry rotation (degree) Gantry scan speed(degree/min) Scan time (min) Tube current (ma/ms per frame) 40/40 20/16 20/16 20/16 Nominal imaging exposure(mas) Frames phases * Clinical protocol provided by Elekta ~132 projections per phase 8

9 4D-CBCT Reconstruction (Elekta) Projection view Edge detection & thresholds CC position Coronal view 0º # projections 360º the Amsterdam Shroud FDK End-exhale phase End-inhale phase Variability of 4D-CT patient models d J.-J. SONKE et al. 9

10 x i t = asin 2πi t T i = 1,2,3, SI Displacement (cm) Regular motions Time (sec) The respiratory motion phantom Coronal view Rigid body Moving insert SI Displacement (cm) Irregular motions Time (sec) x i t = a 1 sin 2πi t T 19: 1 for 7 T 8 < i 7 T 8 t t 8;: 8;: x i t = asin 2πi t T 1 19: for 7 T 8 < i 7 T 8 t t 8;: 1 8;: 3D-CBCT with the phantom freezed at two phases 4D-CT with motion (10-phase) 4D-CBCT with motion End-exhale mid-inhale Reference 4D-CT (end-exhalation) 10-phase 4D-CBCT Image registration (XVI) Mask Image registration (XVI) Validation of 4D registration accuracy (3D vs. 4D) Reconstructed target trajectory Calculation of RMSE of target trajectory 10

11 Results q Assessment of 4D image quality 1) CNR (contrast- to- noise ratio) 2) SNR (signal- to- noise ratio) the Quasar phantom 3) MBR (motion- blurring ratio) =(length of target/actual diameter of target ball) 3 cm Target Lung ROI q Accuracy of target trajectory reconstruction 1) RMSE (Root- mean- squared error) 2) Max error Target ROI coronal axial v Uncertainties in 1) phantom motion 2) reference CT image 3) image registration 11 11

12 Results: Image Quality a=10 mm, σ a =0, σ T =0 a=10 mm, σ a =0.16, σ T =0 a=10 mm, σ a =0, σ T =0.7 a=30 mm, σ a =0, σ T =0 a=30 mm, σ a =0.16, σ T =0 a=30 mm, σ a =0, σ T = D-S-slow 4D-M-fast (~1,200 (~1,320 projections) 1.4 Mid-inhale phase (σ a =0, σ T =0) 10 mm (4D-S-slow) 10 mm (4D-M-fast) 30 mm (4D-S-slow) 30 mm (4D-M-fast) CNR Motion Blurring Ratio Breathing period (sec) Breathing Period (sec) 12

13 Results: RMSE & Max error Regular motions Irregular motions Displacement (cm) Periodic breathing motion 4D-S-slow 4D-M-slow 4D-M-fast Reference (σ a=10 mm = 0, σ T=3 sec = 0) Phase (0-90%) Amp = 10 mm, period = 3 sec RMSE MaxE (mm) D-M-fast (~1,200 projections) Amplitude 10 mm 20 mm 30 mm Breathing period (sec) Amplitude 10 mm 20 mm 30 mm Displacement (cm) Aperiodic breathing motion 4D-S-slow 4D-M-slow 4D-M-fast Reference (σ a=10 mm =0.15, σ T=3 sec =0) Phase (0-90%) Amp = 10 mm, mean period (σ = 0.16) = 3 sec RMSE (mm) D-M-fast 4D-M-fast (10 (30 mm mm amplitude) amplitude) σ a = 0.06 σ a = 0.16 σ a = 0.06 σ a = Breathing Breathing period period (sec) (sec) Overall accuracy for regular motion < ~1mm Overall accuracy for irregular motion < ~2mm 13

14 Clinical Applications SI displacement (cm) Actual patient breathing (extracted from Cyberknife) σ = 0.3 (Τ = 3.4 sec), σ = 0.15 (a = 1.44 cm) Τ a Time (sec) 4D-S-slow 4D-M-slow 4D-M-fast CNR/SNR 14.34/ / /31.46 MBR RMSE 0.71± ± ±0.15 MaxE 1.28± ± ±0.26 Displacement (cm) 0.8 Patient breathing motion 4D-S-slow 4D-M-slow 4D-M-fast Reference (σ a=14.4 mm =0.15, σ T=3.4sec =0.3) Phase (0-90%) < within the expected ranges 14

15 Optimal Use of 4D-CBCT q Phase-based sorting (Elekta) Displacement (cm) * Mid-inhalation phase (%) coronal Phase-based sorting algorithm Large amplitude breathing (e.g., 30 mm, 6 sec) 0.6 Displacement (cm) phase (%) Apply amplitude-based sorting algorithm End-exhalation Mid-inhalation 15

16 Optimal Use of 4D-CBCT Amplitude-based sorting algorithm Phase-based sorting algorithm End-exhalation Mid-inhalation End-exhalation Mid-inhalation 16

17 Conclusions q q q q q 4D-CBCT alleviated motion blurring artifacts at the cost of degraded image quality as compared with 3D-CBCT. The new sequence (4D-M-fast) can reduce volume truncation artifacts by utilizing medium FOV, reduce scan time by increasing gantry scan speed, and reduce the spatial noise variations over the introduced breathing signal. Overall, the accuracy of localizing the moving target in 4D-CBCT was within 2 mm under all studied cases. The proposed (4D-M-fast) scanning sequence is suitable for clinical use in lung SBRT. Patient-breathing specific data acquisition is prerequisite to improve image quality in 4D-CBCT. 17

18 Any Question? Thank you 18

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