Cone-beam computed tomography noise reduction method based on U-Net with convolutional block attention module in proton therapy

Cone-beam computed tomography(CBCT) is mostly used for position verification during the treatment process. However,severe image artifacts in CBCT hinder its direct use in dose calculation and adaptive radiation therapy re-planning for proton therapy. In this study, an improved U-Net neural network named CBAM-U-Net was proposed for CBCT noise reduction in proton therapy, which is a CBCT denoised U-Net network with convolutional block attention modules. The datasets contained 20 groups of head and neck images. The CT images were registered to CBCT images as ground truth. The original CBCT denoised U-Net network, sCTU-Net, was trained for model performance comparison. The synthetic CT(SCT) images generated by CBAM-U-Net and the original sCTU-Net are called CBAM-SCT and U-Net-SCT images, respectively. The HU accuracies of the CT, CBCT, and SCT images were compared using four metrics: mean absolute error(MAE), root mean square error(RMSE), peak signal-to-noise ratio(PSNR), and structure similarity index measure(SSIM). The mean values of the MAE, RMSE, PSNR, and SSIM of CBAM-SCT images were 23.80 HU, 64.63 HU, 52.27 dB, and 0.9919, respectively,which were superior to those of the U-Net-SCT images. To evaluate dosimetric accuracy, the range accuracy was compared for a single-energy proton beam. The γ-index pass rates of a 4 cm × 4 cm scanned field and simple plan were calculated to compare the effects of the noise reduction capabilities of the original U-Net and CBAM-U-Net on the dose calculation results. CBAM-U-Net reduced noise more effectively than sCTU-Net, particularly in high-density tissues. We proposed a CBAM-U-Net model for CBCT noise reduction in proton therapy. Owing to the excellent noise reduction capabilities of CBAM-U-Net, the proposed model provided relatively explicit information regarding patient tissues. Moreover, it maybe be used in dose calculation and adaptive treatment planning in the future.

利用Cone-Beam CT探讨支抗微螺钉周围骨密度与其稳定性的关系

目的:利用Cone-Beam CT测量支抗微螺钉周围骨密度值,探讨其与微螺钉稳定性的关系。方法:选取颌骨左右对称植入微螺钉后一侧松动而另一侧稳固的7名(共18枚微螺钉)正畸患者。拍摄CBCT,所得三维影像重建后用OnDemand 3DApplication软件对微螺钉骨内部分周围2mm范围内骨密度(以Hounsfield Unit表示)进行测量,自身对照比较分析双侧对称部位所植入微螺钉周围骨密度测量值间的差异。结果:松动微螺钉与稳定微螺钉骨内部分周围2mm范围内骨密度无统计学差异,两侧微螺钉钉尖部1/3、钉中部1/3及钉颈部1/3周围骨密度均无统计学差异。结论:微螺钉种植支抗的稳定性与其周围骨密度间未发现明显相关性。

The Association between Lower Incisal Inclination and Morphology of the Supporting Alveolar Bone—A Cone-Beam CT Study

Aim To investigate the relationship between the positioning of the lower central incisor and physical morphology of the surrounding alveolar bone. Methodology Thirty-eight patients （18 males, 20 females）, with mean age of 13.4 years, were included in this study. As part of orthodontic treatment planning the patients were required to take dental Cone-beam CT （CBCT） covering the region of lower incisors, the sur- rounding alveolar bone and the mandibular symphysis. The cephalometric parameters were designed and measured to indicate the inclination of lower central incisor and physical morphology of the adjacent alveolar bone. Computer-aided descriptive statistical analysis was performed using SPSS 15.0 software package for Windows. A correlation analysis and a linear regression analysis between the incisor inclination and the alveolar bone morphology were performed. Results Significant positive correlations were found between the lower central incisor inclination and the morphological contour of the alveolar bone （P〈0.05）. The lower central incisor root apex was closer to the lingual alveolar crest when it was buccally inclined. Conclusion The morphology of the alveolar bone may be affected by incisal inclination.

Impacted Lower Third Molar Fused with a Supernumerary Tooth—Diagnosis and Treatment Planning Using Cone-Beam Computed Tomography

This paper reported a case of fusion between an impacted third molar and a supernumerary tooth, in which a surgical intervention was carried out, with the objective of removing the dental elements. The panoramic radiography was complemented by the Donovan＇s radiographic technique; but because of the proximity of the dental element to the mandibular ramus, it was not possible to have a final fusion diagnosis. Hence, the Cone-Beam Computed Tomography--which provides precise three- dimensional information--was used to determinate the fusion diagnosis and also to help in the surgical planning. In this case report we observed that the periapical, occlusal and panoramic were not able to show details which could only be examined through the cone-beam computed tomo- graphy.

Validation of a novel imaging approach using multi-slice CT and cone-beam CT to follow-up on condylar remodeling after bimaxillary surgery

The main goal of this study was to introduce a novel three-dimensional procedure to objectively quantify both inner and outer condylar remodelling on preoperative multi-slice computed tomography （MSCT） and postoperative cone-beam computed tomography （CBCT） images. Second, the reliability and accuracy of this condylar volume quantification method was assessed. The mandibles of 20 patients （11 female and 9 male） who underwent bimaxillary surgery were semi-automatically extracted from MSCT/CBCT scans and rendered in 3D. The resulting condyles were spatially matched by using an anatomical landmark-based registration procedure. A standardized sphere was created around each condyle, and the condylar bone volume within this selected region of interest was automatically calculated. To investigate the reproducibility of the method, inter- and intra-observer reliability was calculated for assessments made by two experienced radiologists twice five months apart in a set of ten randomly selected patients. To test the accuracy of the bone segmentation, the inner and outer bone structures of one dry mandible, scanned according to the clinical set-up, were compared with the gold standard, micro-CT. Thirty-eight condyles showed a significant （P〈O.05） mean bone volume decrease of 26.4%_ 11.4% （502.9 mm3＋ 268.1 mm3）. No significant effects of side, sex or age were found. Good to excellent （ICC〉 0.6） intra- and inter-observer reliability was observed for both MSCT and CBCT. Moreover, the bone segmentation accuracy was less than one voxel （0.4 mm） for MSCT （0.3 mm __. 0.2 mm） and CBCT （0.4 mm _ 0.3 mm）, thus indicating the clinical potential of this method for objective follow-up in pathological condylar resorption.

Slice-wise reconstruction for low-dose cone-beam CT using a deep residual convolutional neural network

Because of the growing concern over the radiation dose delivered to patients, X-ray cone-beam CT(CBCT) imaging of low dose is of great interest. It is difficult for traditional reconstruction methods such as Feldkamp to reduce noise and keep resolution at low doses. A typical method to solve this problem is using optimizationbased methods with careful modeling of physics and additional constraints. However, it is computationally expensive and very time-consuming to reach an optimal solution. Recently, some pioneering work applying deep neural networks had some success in characterizing and removing artifacts from a low-dose data set. In this study,we incorporate imaging physics for a cone-beam CT into a residual convolutional neural network and propose a new end-to-end deep learning-based method for slice-wise reconstruction. By transferring 3D projection to a 2D problem with a noise reduction property, we can not only obtain reconstructions of high image quality, but also lower the computational complexity. The proposed network is composed of three serially connected sub-networks: a cone-to-fan transformation sub-network, a 2D analytical inversion sub-network, and an image refinement sub-network. This provides a comprehensive solution for end-to-end reconstruction for CBCT. The advantages of our method are that the network can simplify a 3D reconstruction problem to a 2D slice-wise reconstruction problem and can complete reconstruction in an end-to-end manner with the system matrix integrated into the network design. Furthermore, reconstruction can be less computationally expensive and easily parallelizable compared with iterative reconstruction methods.

Improvements to conventional X-ray tube-based cone-beam computed tomography system

Conventional X-ray tube-based cone-beam computed tomography(CX-CBCT) systems have great potential in industrial applications. Such systems can rapidly obtain a three-dimensional(3D) image of an object.Conventional X-ray tubes fulfill the requirements for industrial applications, because of their high tube voltage and power. Continuous improvements have been made to CX-CBCT systems, such as imaging time shortening,acquisition strategy optimization, and imaging software development, etc. In this study, a CX-CBCT system is developed. Additionally, some improvements to the CX-CBCT system are proposed based on the hardware conditions of the X-ray tube and detector. A near-detector(ND)geometry condition is employed to obtain a sharper image and larger detection area. An improved acquisition strategy is proposed to simplify operations and reduce total imaging time. In the ND geometry condition, a simplified method called FBP slice stacking(SS-FBP) is proposed, which can be applied to 3D image reconstruction. SS-FBP is timesaving relative to traditional methods. Furthermore, imaging software for the CX-CBCT system is developed in the MATLAB environment. Several imaging experiments were performed. The results suggest that the CX-CBCT system works properly, and that the above improvements are feasible and practical.

Scatter correction method for cone-beam CT based on interlacing-slit scan

Cone-beam computed tornography （CBCT） has the notable features of high efficiency and high precision, and is widely used in areas such as medical imaging and industrial non-destructive testing. However, the presence of the ray scatter reduces the quality of CT images. By referencing the slit collimation approach, a scatter correction method for CBCT based on the interlacing-slit scan is proposed. Firstly, according to the characteristics of CBCT imaging, a scatter suppression plate with interlacing slits is designed and fabricated. Then the imaging of the scatter suppression plate is analyzed, and a scatter correction Calculation method for CBCT based on the image fusion is proposed, which can splice out a complete set of scatter suppression projection images according to the interlacing-slit projection images of the left and the right imaging regions in the scatter suppression plate, and simultaneously complete the scatter correction within the fiat panel detector （FPD）. Finally, the overall process of scatter suppression and correction is provided. The experimental results show that this method can significantly improve the clarity of the slice images and achieve a good scatter correction.

Short-term outcomes of radiofrequency ablation for hepatocellular carcinoma using cone-beam computed tomography for planning and image guidance

BACKGROUND Percutaneous radiofrequency ablation(RFA)is an effective treatment for unresectable hepatocellular carcinoma(HCC)and a minimally invasive alternative to hepatectomy for treating tumour recurrence.RFA is often performed using contrast-enhanced computed tomography(CECT)and/or ultrasonography.In recent years,angiographic systems with flat panel image detectors and advanced image reconstruction algorithms have broadened the clinical applications of cone-beam computed tomography(CBCT),including RFA.Several studies have shown the effectiveness of using CBCT for immediate treatment assessments and follow-ups.AIM To assess the treatment response to RFA for HCC using CBCT.METHODS Forty-eight patients(44 men;aged 37-89 years)with solitary HCC[median size:3.2(1.2-6.6)cm]underwent RFA and were followed for 25.6(median;13.5-35.2)mo.Image fusion of CBCT and pre-operative CECT or magnetic resonance imaging(MRI)was used for tumour segmentation and needle path and ablation zone planning.Real-time image guidance was provided by overlaying the threedimensional image of the tumour and needle path on the fluoroscopy image.Treatment response was categorized as complete response(CR),partial response(PR),stable disease(SD),or progressive disease(PD).Disease progression,death,time to progression(TTP),and overall survival(OS)were recorded.Kaplan-Meier and Cox regression analyses were performed.RESULTS Initial post-RFA CECT/MRI showed 38 cases of CR(79.2%),10 of PR(20.8%),0 of SD,and 0 of PD,which strongly correlated with the planning estimation(42 CR,87.5%;6 PR,12.5%;0 SD;and 0 PD;accuracy:91.7%,P<0.01).Ten(20.8%)patients died,and disease progression occurred in 31(35.4%,median TTP:12.8 mo)patients,resulting in 12-,24-,and 35-mo OS rates of 100%,81.2%,and 72.2%,respectively,and progression-free survival(PFS)rates of 54.2%,37.1%,and 37.1%,respectively.The median dose-area product of the procedures was 79.05 Gy*cm2(range 40.95-146.24 Gy*cm2),and the median effective dose was 10.27 mSv(range 5.32-19.01 mSv).Tumour size<2 cm(P=0.008)was a significant factor for OS,while age(P=0.001),tumour size<2 cm(P<0.001),tumour stage(P=0.010),and initial treatment response(P=0.003)were significant factors for PFS.CONCLUSION Reliable RFA treatment planning and satisfactory outcomes can be achieved with CBCT.

Multiple helical scans and the reconstruction of over FOV-sized objects in cone-beam CT

In cone-beam computed tomography （CBCT）, there are often cases where the size of the specimen is larger than the field of view （FOV） （referred to as over FOV-sized （OFS））. To acquire the complete projection data for OFS objects, some scan modes have been developed for long objects and short but over-wide objects. However, these modes still cannot meet the requirements for both longitudinally long and transversely wide objects. In this paper, we propose a multiple helical scan mode and a corresponding reconstruction algorithm for both longitudinally long and transversely wide objects. The simulation results show that our model can deal with the problem and that the results are acceptable, while the OFS object is twice as long compared with the FOV in the same latitude.

Performance evaluation of the simpli¯ed spherical harmonics approximation for cone-beam X-ray luminescence computed tomography imaging

As an emerging molecular imaging modality,cone-beam X-ray luminescence computed tomog-raphy(CB-XLCT)uses X-ray-excitable probes to produce near-infrared(NIR)luminescence and then reconst ructs three-dimensional(3D)distribution of the probes from surface measurements.A proper photon-transportation model is critical to accuracy of XLCT.Here,we presented a systematic comparison between the common-used Monte Carlo model and simplified spherical harmonics(SPN).The performance of the two methods was evaluated over several main spec-trums using a known XLCT material.We designed both a global measurement based on the cosine similarity and a locally-averaged relative error,to quantitatively assess these methods.The results show that the SP_(3) could reach a good balance between the modeling accuracy and computational efficiency for all of the tested emission spectrums.Besides,the SP_(1)(which is equivalent to the difusion equation(DE))can be a reasonable alternative model for emission wavelength over 692nm.In vivo experiment further demonstrates the reconstruction perfor-mance of the SP:and DE.This study would provide a valuable guidance for modeling the photon-transportation in CB-XLCT.

Usefulness of intra-procedural cone-beam computed tomography in modified balloon-occluded retrograde transvenous obliteration of gastric varices

AIM:To evaluate whether intra-procedural conebeam computed tomography(CBCT)performed during modified balloon-occluded retrograde transvenous obliteration(mB RTO)can accurately determine technical success of complete variceal obliteration.METHODS:From June 2012 to December 2014,15 patients who received CBCT during m BRTO for treatment of portal hypertensive gastric variceal bleeding were retrospectively evaluated.Three-dimensional(3D)CBCT images were performed and evaluated prior to the end of the procedure,and these were further analyzed and compared to the pre-procedure contrast-enhanced computed tomography to determine the technical success of m BRTO including:Complete occlusion/obliteration of:(1)gastrorenal shunt(GRS);(2)gastric varices;and(3)afferent feeding veins.Post-mB RTO contrast-enhanced CT was used to confirm the accuracy and diagnostic value of CBCT within 2-3 d.RESULTS:Intra-procedural 3D-CBCT images were 100% accurate in determining the technical success of m BRTO in all 15 cases.CBCT demonstrated complete occlusion/obliteration of GRS,gastric varices,collaterals and afferent feeding veins during m BRTO,which was confirmed with post-m BRTO CT.Two patients showed incomplete obliteration of gastric varices and feeding veins on CBCT,which therefore required additional gelfoam injections to complete the procedure.No patient required additional procedures or other interventions during their follow-up period(684 ± 279 d).CONCLUSION:CBCT during mB RTO appears to accurately and immediately determine the technical success of mB RTO.This may improve the technical and clinical success/outcome of m BRTO and reduce additional procedure time in the future.

Method for Converting Cone-Beam CT Values into Hounsfield Units for Radiation Treatment Planning

Cone-beam CT (CBCT) images acquired during radiation treatment can be used to recalculate the dose distribution as well as to confirm the treatment location. However, it is difficult to obtain the electron densities (EDs) necessary for dose calculation from CBCT images because of the effects of scatter contamination during CBCT image acquisition. This paper presents a mathematical method for converting the pixel values of CBCT images (CBCT values) into Hounsfield units (HUs) of radiation treatment simulation CT (simCT) images for use in radiation treatment planning. CBCT values are converted into HUs by matching the histograms of the CBCT values with the histograms of the HUs for each slice via linear scaling of the CBCT values. For prostate cancer and head-and-neck cancer patients, the EDs obtained from converted CBCT values (mCBCT values) show good agreement with the EDs obtained from HUs, within approximately 3.0%, and the dose calculated on the basis of CBCT images shows good agreement with the dose calculated on the basis of the simCT images, within approximately 2.0%. Because the CBCT values are converted for each slice, this conversion method can account for variation in the CBCT values associated with differences in body size, body shape, and inner tissue structures, as well as in longitudinally displaced positions from the isocenter, unlike conventional methods that use electron density phantoms. This method improves on conventional CBCT-ED conversion and shows considerable potential for improving the accuracy of radiation treatment planning using CBCT images.

Comparison of bone alignment and fiducial marker alignment for online cone-beam computed tomography-guided radiation therapy for prostate cancer

Objective The aim of the study was to evaluate the coverage of the prostate when prostatic implanted fiducial markers are used to verify setup of the patients in comparison to the pelvic bones while using conebeam computed tomography(CBCT). Methods Seventeen patients with prostate cancer were included. For each patient, daily online CBCT was done. CT planning was matched with CBCT with the help of fiducial markers(3–5 markers) and another matching with done the help of pelvic bony landmarks. Registration of clinical target volume(CTV) 1 including prostate plus seminal vesicles and CTV2 including prostate only was done and were used to confirm the target volume during the process of matching. Delineation of the rectum on every CBCT was done. Two automatic margin representing planning target volume(PTV) were created. PTV1 was generated by adding 1 cm in all directions(PTV1a) and 0.7 cm in the posterior direction(PTV1b). PTV2 was generated by adding 0.5 cm in all directions(PTV2a) and 0.3 cm in the posterior direction(PTV2b). PTV1a was prescribed to receive 46 Gy in conventional fractionation with a boost dose of 30 Gy to PTV1b. The same dose was prescribed to PTV2a and PTV2b. Calculation of the percentage of intersection between CTV1and CTV2 created on CBCT with the original CTV scan was done. A comparison between the two CTVs(CTV1and CTV2) mean dose and the original delineated CTV was done. Then a comparison to the mean dose of the original CTV of PTV1a, PTV2a(CTV1a and CTV2a), and for PTV1b and PTV2b(CTV1b and CTV2b). Calculation of the mean rectal dose and also V60, V70 and V74 was done on the delineated rectum on every CBCT, and then a comparison to the planned original rectal dose. Results The created CTV1and CTV2 intersection percentage with the original CTV1and CTV2 significantly increased by 85%(range, 65%–95%, P < 0.05), when fiducial markers were used. The main difference of the received mean dose was significantly less in comparison to pelvic bone alignment(0.03% to 2% vs 0.03% to 11.6% for PTV1a, P < 0.006;0.01% to 1.8% vs 0.03% to 10.2% for PTV2a, P < 0.014;0.08 to 2.11 vs 0.04 to 11.29 for PTV1b, P < 0.015 and 0.01 to 1.79 vs 0.01 to 9.69 for PTV2b, P < 0.004). With the use of less PTV margins, significant decrease of the rectal mean dose, V60, V70 and V74 by P < 0.004, P < 0.004, P < 0.0005 and P < 0.009, respectively. Reduction of the CTV1a and CTV1b mean dose by 1.13% and 0.28% in comparison to the initial CTV1a and CTV2a.Conclusion A significant improvement of prostatic cancer patients alignment when fiducial markers are used, with more homogenous dose distribution, and with significant decrease in PTV margins. The delivered rectal dose is significantly less allowing prostate dose escalation.

HYBRID REGULARIZED CONE-BEAM RECONSTRUCTION FOR AXIALLY SYMMETRIC OBJECT TOMOGRAPHY

In this paper,we consider 3 D tomographic reconstruction for axially symmetric objects from a single radiograph formed by cone-beam X-rays.All contemporary density reconstruction methods in high-energy X-ray radiography are based on the assumption that the cone beam can be treated as fan beams located at parallel planes perpendicular to the symmetric axis,so that the density of the whole object can be recovered layer by layer.Considering the relationship between different layers,we undertake the cone-beam global reconstruction to solve the ambiguity effect at the material interfaces of the reconstruction results.In view of the anisotropy of classical discrete total variations,a new discretization of total variation which yields sharp edges and has better isotropy is introduced in our reconstruction model.Furthermore,considering that the object density consists of continually changing parts and jumps,a high-order regularization term is introduced.The final hybrid regularization model is solved using the alternating proximal gradient method,which was recently applied in image processing.Density reconstruction results are presented for simulated radiographs,which shows that the proposed method has led to an improvement in terms of the preservation of edge location.

A Pilot Survey of Odontomas for Size Constancy Using Cone-Beam Computed Tomography: Effect of Age, Sex, Lesion Location, and Histological Type: A Case Series

Objectives: Odontoma is the most common type of odontogenic tumors. Many studies have analyzed the statistical associations between odontoma location and patient age and sex, according to the histological tumor type. However, few studies have assessed odontoma morphological characteristics using cone-beam computed tomography (CBCT). We aimed to evaluate the association between odontoma location and size. Methods: We performed CBCT on patients with odontomas (19 patients;10 women, 9 men;average age, 12.6 [range, 6 - 34] years) according to the pathology type at a university hospital between April 2008 and February 2017. The locations of the lesions were noted, and their sizes were measured on CBCT images. Buccolingual, mesiodistal, and vertical diameters of the lesions were recorded on the same slice with the greatest diameters on axial, coronal, and sagittal CBCT images. Results: Altogether, 9 (47.4%) and 10 (52.6%) odontomas were located in the mandible and maxilla, respectively. There was no significant difference in the mesiodistal and vertical diameters on the CBCT image between the mandibular and maxillary groups when the odontoma size was compared with location (p < 0.05). However, the average diameters in only the buccolingual diameter were significantly greater in the maxilla. There were no significant differences between the two groups according to sex, age, or histological type. Conclusions: These data suggest that the sizes of odontomas in the maxilla are affected by bone expansion in the buccolingual direction, but they may be invariable in most settings. Three-dimensional assessment across the age groups suggests a lack of variation in size.

Alveolar Ridge Preservation Utilizing Composite (Bioceramics/Collagen) Graft: A Cone-Beam Computed Tomography Assessment in a Randomized Split-Mouth Controlled Trial

Background: The vast percentage of the alveolar bone resorption process happens within the first 12 to 24 weeks post extraction;however, this phenomenon is chronic, and the alveolar ridge continues to resorb. In order to prevent this reduction or at least recompense the loss of bone dimensions, the alveolar ridge preservation (ARP) technique was developed. Objectives: This research studied the vertical and horizontal bone dimensional changes as a result of non-molar teeth extraction alone against extraction with alveolar ridge preservation utilizing composite (bioceramics/collagen) graft by cone-beam computed tomography radiographies analyses. Material and Methods: This research was a randomized split-mouth controlled trial. 12 patients need extraction of the maxillary non-molar teeth were enrolled and allocated into 2 groups. 12 sockets after atraumatic extraction were filled with a composite graft in the role of the test group, 12 sockets left to unassisted healing after atraumatic extraction without any graft materials in the role of the control group. Two CBCT radiographs were taken at baseline and at 4 months after extraction for comparison. Both vertical and horizontal resorptions of the alveolar ridge were analyzed between test and control group by CBCT radiographs. Results: 4 months after extraction, there was a mean of vertical alveolar bone resorption compared with the baseline (0.56 ± 0.15 mm) in the test group and (1.47 ± 0.30 mm) in the control group. Whereas it was a mean of horizontal alveolar bone resorption compared with the baseline (0.90 ± 0.16 mm) in the test group and (2.26 ± 0.30 mm) in the control group. Therefore, there was a significant difference between the two groups. Conclusions: Within the limitations of this research, we demonstrated that the osteogen-plug technique significantly decreased the reduction of the bone dimensional in comparison to the tooth extraction alone, and showed that the dimensional change of the alveolar ridge after tooth extraction was minimized by using an osteogen-plug.

Dosimetric consequences of tumor volume changes after kilovoltage cone-beam computed tomography for non-operative lung cancer during adaptive intensity-modulated radiotherapy or fractionated stereotactic radiotherapy

Objective The aim of this study was to investigate tumor volume changes with kilovoltage cone-beam computed tomography （kV-CBCT） and their dosimetric consequences for non-operative lung cancer during intensity-modulated radiotherapy （IMRT） or fractionated stereotactic radiotherapy. Methods Eighteen patients with non-operative lung cancer who received IMRT consisting of 1.8-2.2 Gy/fraction and five fractions per week or stereotactic radiotherapy with 5-8 Gy/fraction and three fractions a week were studied, kV-CBCT was performed once per week during IMRT and at every fraction during stereotactic radiotherapy. The gross tumor volume （GTV） was contoured on the kV-CBCT images, and adaptive treatment plans were created using merged kV-CBCT and primary planning computed tomogra- phy image sets. Tumor volume changes and dosimetric parameters, including the minimum dose to 95% （D95） or 1% （D1） of the planning target volume （PTV）, mean lung dose （MLD）, and volume of lung tissue that received more than 5 （Vs）, 10 （Vl0）, 20 （V20）, and 30 （V30） Gy were retrospectively analyzed. Results The average maximum change in GTV observed during IMRT or fractionated stereotactic radio- therapy was -25.85% （range, -13.09% --56.76%）. The D95 and Dr of PTV for the adaptive treatment plans in all patients were not significantly different from those for the initial or former adaptive treatment plans. In patients with tumor volume changes of 〉20% in the third or fourth week of treatment during IMRT, adap- tive treatment plans offered clinically meaningful decreases in MLD and V5, V10, V20, and V30; however, in patients with tumor volume changes of 〈 20% in the third or fourth week of treatment as well as in patients with stereotactic radiotherapy, there were no significant or clinically meaningful decreases in the dosimetric parameters. Conclusion Adaptive treatment planning for decreasing tumor volume during IMRT may be beneficial for patients who experience tumor volume changes of 〉20% in the third or fourth week of treatment.

Advanced 4-dimensional cone-beam computed tomography reconstruction by combining motion estimation, motioncompensated reconstruction, biomechanical modeling and deep learning

4-Dimensional cone-beam computed tomography(4D-CBCT)offers several key advantages over conventional 3DCBCT in moving target localization/delineation,structure de-blurring,target motion tracking,treatment dose accumulation and adaptive radiation therapy.However,the use of the 4D-CBCT in current radiation therapy practices has been limited,mostly due to its sub-optimal image quality from limited angular sampling of conebeam projections.In this study,we summarized the recent developments of 4D-CBCT reconstruction techniques for image quality improvement,and introduced our developments of a new 4D-CBCT reconstruction technique which features simultaneous motion estimation and image reconstruction(SMEIR).Based on the original SMEIR scheme,biomechanical modeling-guided SMEIR(SMEIR-Bio)was introduced to further improve the reconstruction accuracy of fine details in lung 4D-CBCTs.To improve the efficiency of reconstruction,we recently developed a U-net-based deformation-vector-field(DVF)optimization technique to leverage a population-based deep learning scheme to improve the accuracy of intra-lung DVFs(SMEIR-Unet),without explicit biomechanical modeling.Details of each of the SMEIR,SMEIR-Bio and SMEIR-Unet techniques were included in this study,along with the corresponding results comparing the reconstruction accuracy in terms of CBCT images and the DVFs.We also discussed the application prospects of the SMEIR-type techniques in image-guided radiation therapy and adaptive radiation therapy,and presented potential schemes on future developments to achieve faster and more accurate 4D-CBCT imaging.

Performance evaluation of the backprojection filtered (BPF) algorithm in circular fan-beam and cone-beam CT

In this article we introduce an exact backprojection filtered (BPF) type reconstruction algorithm for cone-beam scans based on Zou and Pan’s work. The algorithm can reconstruct images using only the projection data passing through the parallel PI-line segments in reduced scans. Computer simulations and practical experiments are carried out to evaluate this algorithm. The BPF algorithm has a higher computational efficiency than the famous FDK algorithm. The BPF algorithm is evaluated using the practical CT projection data on a 450 keV X-ray CT system with a flat-panel detector (FPD). From the practical experiments, we get the spatial resolution of this CT system. The algo- rithm could achieve the spatial resolution of 2.4 lp/mm and satisfies the practical applications in industrial CT inspec- tion.