The design and implementation of a motion correction scheme for neurological PET

A method is described to monitor the motion of the head during neurological positron emission tomography (PET) acquisitions and to correct the data post acquisition for the recorded motion prior to image reconstruction. The technique uses an optical tracking system, Polaris, to accurately monitor the position of the head during the PET acquisition. The PET data are acquired in list mode where the events are written directly to disk during acquisition. The motion tracking information is aligned to the PET data using a sequence of pseudo-random numbers, which are inserted into the time tags in the list mode event stream through the gating input interface on the tomograph. The position of the head is monitored during the transmission acquisition, and it is assumed that there is minimal head motion during this measurement. Each event, prompt and delayed, in the list mode event stream is corrected for motion and transformed into the transmission space. For a given line of response, normalization, including corrections for detector efficiency, geometry and crystal interference and dead time are applied prior to motion correction and rebinning in the sinogram. A series of phantom experiments were performed to confirm the accuracy of the method: (a) a point source located in three discrete axial positions in the tomograph field of view, 0 mm, 10 mm and 20 mm from a reference point, (b) a multi-line source phantom rotated in both discrete and gradual rotations through +/- 5 degrees and +/- 15 degrees, including a vertical and horizontal movement in the plane. For both phantom experiments images were reconstructed for both the fixed and motion corrected data. Measurements for resolution, full width at half maximum (FWHM) and full width at tenth maximum (FWTM), were calculated from these images and a comparison made between the fixedand motion corrected datasets. From the point source measurements, the FWHM at each axial position was 7.1 mm in the horizontal direction, and increasing from 4.7 mm at the 0 mm position, to 4.8 mm, 20 mm offset, in the vertical direction. The results from the multi-line source phantom with +/- 5 degrees rotations showed a maximum degradation in FWHM, when compared with the stationary phantom, of 0.6 mm, in the horizontal direction, and 0.3 mm in the vertical direction. The corresponding values for the larger rotation, +/- 15 degrees, were 0.7 mm and 1.1 mm, respectively. The performance of the method was confirmed with a Hoffman brain phantom moved continuously, and a clinical acquisition using [11C]raclopride (normal volunteer). A visual comparison of both the motion and non-motion corrected images of the Hoffman brain phantom clearly demonstrated the efficacy of the method. A sample time-activity curve extracted from the clinical study showed irregularities prior to motion correction, which were removed after correction. A method has been developed to accurately monitor the motion of the head during a neurological PET acquisition, and correct for this motion prior to image reconstruction. The method has been demonstrated to be accurate and does not add significantly to either the acquisition or the subsequent data processing.     

Attenuation correction for small animal PET tomographs

Attenuation correction is one of the important corrections required for quantitative positron emission tomography (PET). This work will compare the quantitative accuracy of attenuation correction using a simple global scale factor with traditional transmission-based methods acquired either with a small animal PET or a small animal x-ray computed tomography (CT) scanner. Two phantoms (one mouse-sized and one rat-sized) and two animal subjects (one mouse and one rat) were scanned in CTI Concorde Microsystem's microPET Focus for emission and transmission data and in ImTek's MicroCAT II for transmission data. PET emission image values were calibrated against a scintillation well counter. Results indicate that the scale factor method of attenuation correction places the average measured activity concentration about the expected value, without correcting for the cupping artefact from attenuation. Noise analysis in the phantom studies with the PET-based method shows that noise in the transmission data increases the noise in the corrected emission data. The CT-based method was accurate and delivered low-noise images suitable for both PET data correction and PET tracer localization.     

A motion-incorporated reconstruction method for gated PET studies

Cardiac and respiratory motion artefacts in PET imaging have been traditionally resolved by acquiring the data in gated mode. However, gated PET images are usually characterized by high noise content due to their low photon statistics. In this paper, we present a novel 4D model for the PET imaging system, which can incorporate motion information to generate a motion-free image with all acquired data. A computer simulation and a phantom study were conducted to test the performance of this approach. The computer simulation was based on a digital phantom that was continuously scaled during data acquisition. The phantom study, on the other hand, used two spheres in a tank of water, all of which were filled with (18)F water. One of the spheres was stationary while the other moved in a sinusoidal fashion to simulate tumour motion in the thorax. Data were acquired using both 4D CT and gated PET. Motion information was derived from the 4D CT images and then used in the 4D PET model. Both studies showed that this 4D PET model had a good motion-compensating capability. In the phantom study, this approach reduced quantification error of the radioactivity concentration by 95% when compared to a corresponding static acquisition, while signal-to-noise ratio was improved by 210% when compared to a corresponding gated image.     

Attenuation correction of four dimensional (4D) PET using phase-correlated 4D-computed tomography

The image quality in a conventional positron emission tomography (PET)/computed tomography (CT) scanner is degraded by respiratory motion because of erroneous attenuation correction when three-dimensional image acquisition is used. To overcome this problem, time-resolved data acquisition (4D) is required. For this, a Siemens Biograph 16 PET/CT scanner has been modified and its normal capability has been extended to a true 4D-PET/4D-CT imaging device including phase-correlated attenuation correction. To verify the correct functionality of this device, experiments on a respiratory motion phantom that allowed movement in two dimensions have been performed. The measurements showed good spatial correlation as well as good time synchronization between the PET and CT data. Furthermore, the motion pattern of the phantom and the shape of the activity distribution have been examined, and the volume of the reconstructed PET images has been analyzed. The results demonstrate the feasibility of such a procedure, and we therefore recommend that 4D-PET data should be reconstructed using 4D-CT data, which can be acquired on the same machine.     

Respiratory motion correction for PET oncology applications using affine transformation of list mode data

Respiratory motion is a source of artefacts and reduced image quality in PET. Proposed methodology for correction of respiratory effects involves the use of gated frames, which are however of low signal-to-noise ratio. Therefore a method accounting for respiratory motion effects without affecting the statistical quality of the reconstructed images is necessary. We have implemented an affine transformation of list mode data for the correction of respiratory motion over the thorax. The study was performed using datasets of the NCAT phantom at different points throughout the respiratory cycle. List mode data based PET simulated frames were produced by combining the NCAT datasets with a Monte Carlo simulation. Transformation parameters accounting for respiratory motion were estimated according to an affine registration and were subsequently applied on the original list mode data. The corrected and uncorrected list mode datasets were subsequently reconstructed using the one-pass list mode EM (OPL-EM) algorithm. Comparison of corrected and uncorrected respiratory motion average frames suggests that an affine transformation in the list mode data prior to reconstruction can produce significant improvements in accounting for respiratory motion artefacts in the lungs and heart. However, the application of a common set of transformation parameters across the imaging field of view does not significantly correct the respiratory effects on organs such as the stomach, liver or spleen.     

光学表面成像系统实时运动监测精度研究

目的:探究光学表面成像系统实时运动监测的精度。方法:将30例患者的呼吸曲线输入到模体中模拟呼吸运动， 同时利用Catalyst系统对模体进行实时运动监测，比较系统监测的呼吸曲线与参考曲线，从而得到光学表面成像系统实时 运动监测的精度。结果:光学表面成像系统监测的呼吸曲线与参考曲线具有较高的一致性，相关系数均大于0.99，显著相 关。监测误差的平均值为（0.24±0.04）mm，并且随着呼吸信号频率的增加而减小。结论:光学表面成像系统的实时运动 监测精度较高，可用于对患者呼吸运动的监测。在进行呼吸门控治疗时，应考虑呼吸监测系统引入的误差。     

Artefacts of PET/CT images

Positron emission tomography (PET) is a non-invasive imaging modality, which is clinically widely used both for diagnosis and accessing therapy response in oncology, cardiology and neurology.Fusing PET and CT images in a single dataset would be useful for physicians who could read the functional and the anatomical aspects of a disease in a single shot.The use of fusion software has been replaced in the last few years by integrated PET/CT systems, which combine a PET and a CT scanner in the same gantry. CT images have the double function to correct PET images for attenuation and can fuse with PET for a better visualization and localization of lesions. The use of CT for attenuation correction yields several advantages in terms of accuracy and patient comfort, but can also introduce several artefacts on PET-corrected images.PET/CT image artefacts are due primarily to metallic implants, respiratory motion, use of contrast media and image truncation. This paper reviews different types artefacts and their correction methods.PET/CT improves image quality and image accuracy. However, to avoid possible pitfalls the simultaneous display of both Computed Tomography Attenuation Corrected (CTAC) and non corrected PET images, side by side with CT images is strongly recommended.     

Joint model of motion and anatomy for PET image reconstruction

Anatomy-based positron emission tomography (PET) image enhancement techniques have been shown to have the potential for improving PET image quality. However, these techniques assume an accurate alignment between the anatomical and the functional images, which is not always valid when imaging the chest due to respiratory motion. In this article, we present a joint model of both motion and anatomical information by integrating a motion-incorporated PET imaging system model with an anatomy-based maximum a posteriori image reconstruction algorithm. The mismatched anatomical information due to motion can thus be effectively utilized through this joint model. A computer simulation and a phantom study were conducted to assess the efficacy of the joint model, whereby motion and anatomical information were either modeled separately or combined. The reconstructed images in each case were compared to corresponding reference images obtained using a quadratic image prior based maximum a posteriori reconstruction algorithm for quantitative accuracy. Results of these studies indicated that while modeling anatomical information or motion alone improved the PET image quantitation accuracy, a larger improvement in accuracy was achieved when using the joint model. In the computer simulation study and using similar image noise levels, the improvement in quantitation accuracy compared to the reference images was 5.3% and 19.8% when using anatomical or motion information alone, respectively, and 35.5% when using the joint model. In the phantom study, these results were 5.6%, 5.8%, and 19.8%, respectively. These results suggest that motion compensation is important in order to effectively utilize anatomical information in chest imaging using PET. The joint motion-anatomy model presented in this paper provides a promising solution to this problem.     

Effect of motion on tracer activity determination in CT attenuation corrected PET images: a lung phantom study

Respiratory motion is known to affect the quantitation of 18FDG uptake in lung lesions. The aim of the study was to investigate the magnitude of errors in tracer activity determination due to motion, and its dependence upon CT attenuation at different phases of the motion cycle. To estimate these errors we have compared maximum activity concentrations determined from PET/CT images of a lung phantom at rest and under simulated respiratory motion. The NEMA 2001 IEC body phantom, containing six hollow spheres with diameters 37, 28, 22, 17, 13, and 10 mm, was used in this study. To mimic lung tissue density, the phantom (excluding spheres) was filled with low density polystyrene beads and water. The phantom spheres were filled with 18FDG solution setting the target-to-background activity concentration ratio at 8:1. PET/CT data were acquired with the phantom at rest, and while it was undergoing periodic motion along the longitudinal axis of the scanner with a range of displacement being 2 cm, and a period of 5 s. The phantom at rest and in motion was scanned using manufacturer provided standard helical/clinical protocol, a helical CT scan followed by a PET emission scan. The moving phantom was also scanned using a 4D-CT protocol that provides volume image sets at different phases of the motion cycle. To estimate the effect of motion on quantitation of activities in six spheres, we have examined the activity concentration data for (a) the stationary phantom, (b) the phantom undergoing simulated respiratory motion, and (c) a moving phantom acquired with PET/4D-CT protocol in which attenuation correction was performed with CT images acquired at different phases of motion cycle. The data for the phantom at rest and in motion acquired with the standard helical/clinical protocol showed that the activity concentration in the spheres can be underestimated by as much as 75%, depending on the sphere diameter. We have also demonstrated that fluctuations in sphere's activity concentration from one PET/CT scan to another acquired with standard helical/clinical protocol can arise as a consequence of spatial mismatch between the sphere's location in PET emission and the CT data.     

Accelerated EM reconstruction in total-body PET: potential for improving tumour detectability

Total-body positron emission tomography (PET) is a useful diagnostic tool for evaluating malignant disease. However, tumour detection is limited by image artefacts due to the lack of attenuation correction and noise. Attenuation correction may be possible using transmission data acquired after or simultaneously with emission data. Despite the elimination of attenuation artefacts, however, tumour detection is still hampered by noise, which is amplified during image reconstruction by filtered backprojection (FBP). We have investigated, as an alternative to FBP, an accelerated expectation maximization (EM) algorithm for its potential to improve tumour detectability in total-body PET. Signal to noise ratio (SNR), calculated for a tumour with respect to the surrounding background, is used as a figure of merit. A software tumour phantom, with conditions typical of those encountered in a total-body PET study using simultaneous acquisition, is used to optimize and compare various reconstruction approaches. Accelerated EM reconstruction followed by two-dimensional filtering is shown to yield significantly higher SNR than FBP for a range of tumour sizes, concentrations and counting statistics (deltaSNR = 6.3 +/- 3.9, p < 0.001). The methods developed are illustrated by examples derived from physical phantom and patient data.     

An investigation of inconsistent projections and artefacts in multi-pinhole SPECT with axially aligned pinholes

Multiple pinholes are advantageous for maximizing the use of the available field of view (FOV) of compact small animal single photon emission computed tomography (SPECT) detectors. However, when the pinholes are aligned axially to optimize imaging of extended objects, such as rodents, multiplexing of the pinhole projections can give rise to inconsistent data which leads to 'ghost point' artefacts in the reconstructed volume. A novel four pinhole collimator with a baffle was designed and implemented to eliminate these inconsistent projections. Simulation and physical phantom studies were performed to investigate artefacts from axially aligned pinholes and the efficacy of the baffle in removing inconsistent data and, thus, reducing reconstruction artefacts. SPECT was performed using a Defrise phantom to investigate the impact of collimator design on FOV utilization and axial blurring effects. Multiple pinhole SPECT acquired with a baffle had fewer artefacts and improved quantitative accuracy when compared to SPECT acquired without a baffle. The use of four pinholes positioned in a square maximized the available FOV, increased acquisition sensitivity and reduced axial blurring effects. These findings support the use of a baffle to eliminate inconsistent projection data arising from axially aligned pinholes and improve small animal SPECT reconstructions.     

A stereotactic method for the three-dimensional registration of multi-modality biologic images in animals: NMR, PET, histology, and autoradiography

The objective of this work was to develop and then validate a stereotactic fiduciary marker system for tumor xenografts in rodents which could be used to co-register magnetic resonance imaging (MRI), PET, tissue histology, autoradiography, and measurements from physiologic probes. A Teflon fiduciary template has been designed which allows the precise insertion of small hollow Teflon rods (0.71 mm diameter) into a tumor. These rods can be visualized by MRI and PET as well as by histology and autoradiography on tissue sections. The methodology has been applied and tested on a rigid phantom, on tissue phantom material, and finally on tumor bearing mice. Image registration has been performed between the MRI and PET images for the rigid Teflon phantom and among MRI, digitized microscopy images of tissue histology, and autoradiograms for both tissue phantom and tumor-bearing mice. A registration accuracy, expressed as the average Euclidean distance between the centers of three fiduciary markers among the registered image sets, of 0.2 +/- 0.06 mm was achieved between MRI and microPET image sets of a rigid Teflon phantom. The fiduciary template allows digitized tissue sections to be co-registered with three-dimensional MRI images with an average accuracy of 0.21 and 0.25 mm for the tissue phantoms and tumor xenografts, respectively. Between histology and autoradiograms, it was 0.19 and 0.21 mm for tissue phantoms and tumor xenografts, respectively. The fiduciary marker system provides a coordinate system with which to correlate information from multiple image types, on a voxel-by-voxel basis, with sub-millimeter accuracy--even among imaging modalities with widely disparate spatial resolution and in the absence of identifiable anatomic landmarks.     

基于体模和反卷积算法的PET 呼吸运动模糊校正

呼吸运动会导致PET图像出现运动模糊,影响肿瘤诊断的准确性和放射治疗的精确性。本研究结合高频正弦振动和反卷积技术提出了一种校正PET图像运动模糊的方法。高频正弦振动用于模拟肺部肿瘤的呼吸运动。首先使用雷当变换从运动模糊图像的伪倒谱中识别模糊运动方向,然后将运动模糊图像的模糊方向旋转到垂直模糊方向,利用双谱识别模糊幅度,最后使用Richardson-Lucy迭代算法对运动模糊图像进行校正。体模实验显示,通过校正后PET图像估算出的肿瘤体积和肿瘤内平均标准摄取值（SUV）更接近真实值,与未校正的模糊运动图像相比,其校正后的肿瘤体积误差从40%下降到10%,SUV误差从28%下降到4%。结果表明所使用的方法能够有效校正呼吸运动模糊,使肿瘤诊断更加准确。     

Event-based motion correction for PET transmission measurements with a rotating point source

Accurate attenuation correction is important for quantitative positron emission tomography (PET) studies. When performing transmission measurements using an external rotating radioactive source, object motion during the transmission scan can distort the attenuation correction factors computed as the ratio of the blank to transmission counts, and cause errors and artefacts in reconstructed PET images. In this paper we report a compensation method for rigid body motion during PET transmission measurements, in which list mode transmission data are motion corrected event-by-event, based on known motion, to ensure that all events which traverse the same path through the object are recorded on a common line of response (LOR). As a result, the motion-corrected transmission LOR may record a combination of events originally detected on different LORs. To ensure that the corresponding blank LOR records events from the same combination of contributing LORs, the list mode blank data are spatially transformed event-by-event based on the same motion information. The number of counts recorded on the resulting blank LOR is then equivalent to the number of counts that would have been recorded on the corresponding motion-corrected transmission LOR in the absence of any attenuating object. The proposed method has been verified in phantom studies with both stepwise movements and continuous motion. We found that attenuation maps derived from motion-corrected transmission and blank data agree well with those of the stationary phantom and are significantly better than uncorrected attenuation data.     

Anisotropic diffusion filtering of PET attenuation data to improve emission images

Attenuation correction in positron emission tomography (PET) is an essential part of clinical and research studies. However, correction using noisy transmission data acquired over short scan durations has been a problem as the noise is introduced into emission images. This study investigates the effect of smoothing the two-dimensional projections of the attenuation maps (mu-map) using the nonlinear anisotropic diffusion filtering method. Experiments are presented on a whole-body study to qualitatively evaluate the efficacy of the method in reducing the random noise and streak artefacts. The results show that image quality is significantly improved with minimal resolution loss. A reduction in statistical noise was quantitatively demonstrated when the same approach was applied to a cylindrical phantom dataset.     

A knowledge-based method for reducing attenuation artefacts caused by cardiac appliances in myocardial PET/CT

Attenuation artefacts due to implanted cardiac defibrillator leads have previously been shown to adversely impact cardiac PET/CT imaging. In this study, the severity of the problem is characterized, and an image-based method is described which reduces the resulting artefact in PET. Automatic implantable cardioverter defibrillator (AICD) leads cause a moving-metal artefact in the CT sections from which the PET attenuation correction factors (ACFs) are derived. Fluoroscopic cine images were measured to demonstrate that the defibrillator's highly attenuating distal shocking coil moves rhythmically across distances on the order of 1 cm. Rhythmic motion of this magnitude was created in a phantom with a moving defibrillator lead. A CT study of the phantom showed that the artefact contained regions of incorrect, very high CT values and adjacent regions of incorrect, very low CT values. The study also showed that motion made the artefact more severe. A knowledge-based metal artefact reduction method (MAR) is described that reduces the magnitude of the error in the CT images, without use of the corrupted sinograms. The method modifies the corrupted image through a sequence of artefact detection procedures, morphological operations, adjustments of CT values and three-dimensional filtering. The method treats bone the same as metal. The artefact reduction method is shown to run in a few seconds, and is validated by applying it to a series of phantom studies in which reconstructed PET tracer distribution values are wrong by as much as 60% in regions near the CT artefact when MAR is not applied, but the errors are reduced to about 10% of expected values when MAR is applied. MAR changes PET image values by a few per cent in regions not close to the artefact. The changes can be larger in the vicinity of bone. In patient studies, the PET reconstruction without MAR sometimes results in anomalously high values in the infero-septal wall. Clinical performance of MAR is assessed by two physicians' inspection of images generated in 30 patients with and without MAR. Noticeable image differences are judged in 14 of 28 (50%) observations with AICD leads, and significant clinical impact is judged in 2 of 28 (7%) of those observations. A polar map analysis shows significant differences in 10 of 14 (71%) studies with AICD leads, and 0 of 16 (0%) studies without AICD leads. These results show that the MAR method is successful in reducing the magnitude of the metal artefact without incorrectly altering cases without metal artefact. In spite of profound changes to the CT image from the moving metal, the PET ACF in that study was changed by no more than 20%.     

Benchmarking a novel ultrasound-CT fusion system for respiratory motion management in radiotherapy: assessment of spatio-temporal characteristics and comparison to 4DCT

Management of respiratory motion during radiation therapy requires treatment planning and simulation using imaging modalities that possess sufficient spatio-temporal accuracy and precision. An investigation into the use of a novel ultrasound (US) imaging system for assessment of respiratory motion is presented, exploiting its good soft tissue contrast and temporal precision. The system dynamically superimposes the appropriate image plane sampled from a reference CT data set with the corresponding US B-mode image. An articulating arm is used for spatial registration. While the focus of the study was to quantify the system's ability to track respiratory motion, certain unique spatial calibration procedures were devised that render the software potentially valuable to the general research community. These include direct access to all transformation matrix elements and image scaling factors, a manual latency correction function, and a three-point spatial registration procedure that allows the system to be used in any room possessing a traditional radiotherapy laser localization system. Counter-intuitively, it was discovered that a manual procedure for calibrating certain transformation matrix elements produced superior accuracy to that of an algorithmic Levenberg-Marquardt optimization method. The absolute spatial accuracy was verified by comparing the physical locations of phantom test objects measured using the spatially registered US system, and using data from a 3DCT scan of the phantom as a reference. The spatial accuracy of the display superposition was also tested in a similar manner. The system's dynamic properties were then assessed using three methods. First, the overall system response time was studied using a programmable motion phantom. This included US video update, articulating arm update, CT data set resampling, and image display. The next investigation verified the system's ability to measure the range of motion of a moving anatomical test phantom that possessed both high and low contrast test objects. Finally, the system's performance was compared to that of a four-dimensional CT (4DCT) data set. The absolute spatial and display superposition accuracy was found to be better than 2 mm and typically 1 mm. Overall dynamic system response was adequate to produce a mean relative positional error of less than 1 mm if an empiric latency correction of 3 video frames was incorporated. The dynamic CT/US display mode was able to assess phantom motion for both high and low contrast test objects to within 1 mm, and compared favorably to the 4DCT data. The 4DCT movie loop accurately assessed the target motion for both of the high and low contrast objects tested, but the minimum intensity and average intensity reconstructions did not. This investigation demonstrated that this US system possesses sufficient spatio-temporal accuracy to properly assess respiratory motion. Future work will seek to demonstrate efficacy in its clinical application to respiratory motion assessment, particularly for sites in the upper abdomen, where low tissue contrast is evident.     

Computer-assisted quantification of lung tumors in respiratory gated PET/CT images: phantom study

A computer-aided method was developed to automatically localize tumors in lung PET images of discrete bins within the breathing cycle, followed by an algorithm that registers all the information of a complete respiratory cycle into a single reference bin. Four registration/integration algorithms: Centroid Based, Intensity Based, Rigid Body, and Optical Flow registration were compared as well as two registration schemes: Direct scheme and Successive scheme. Validation was demonstrated by conducting experiments with the computerized 4D NCAT phantom and with a dynamic lung–chest phantom imaged using a GE PET/CT System. Iterations were conducted on different size simulated tumors. Static tumors without respiratory motion were used as gold standard; quantitative results were compared with respect to tumor activity concentration, cross-correlation coefficient, relative noise level, and computation time. After motion correction, the best compromise between short PET scan time and reduced image noise can be achieved, while quantification and clinical analysis become faster and more precise.     

Evaluation of on-board kV cone beam CT (CBCT)-based dose calculation

On-board CBCT images are used to generate patient geometric models to assist patient setup. The image data can also, potentially, be used for dose reconstruction in combination with the fluence maps from treatment plan. Here we evaluate the achievable accuracy in using a kV CBCT for dose calculation. Relative electron density as a function of HU was obtained for both planning CT (pCT) and CBCT using a Catphan-600 calibration phantom. The CBCT calibration stability was monitored weekly for 8 consecutive weeks. A clinical treatment planning system was employed for pCT- and CBCT-based dose calculations and subsequent comparisons. Phantom and patient studies were carried out. In the former study, both Catphan-600 and pelvic phantoms were employed to evaluate the dosimetric performance of the full-fan and half-fan scanning modes. To evaluate the dosimetric influence of motion artefacts commonly seen in CBCT images, the Catphan-600 phantom was scanned with and without cyclic motion using the pCT and CBCT scanners. The doses computed based on the four sets of CT images (pCT and CBCT with/without motion) were compared quantitatively. The patient studies included a lung case and three prostate cases. The lung case was employed to further assess the adverse effect of intra-scan organ motion. Unlike the phantom study, the pCT of a patient is generally acquired at the time of simulation and the anatomy may be different from that of CBCT acquired at the time of treatment delivery because of organ deformation. To tackle the problem, we introduced a set of modified CBCT images (mCBCT) for each patient, which possesses the geometric information of the CBCT but the electronic density distribution mapped from the pCT with the help of a BSpline deformable image registration software. In the patient study, the dose computed with the mCBCT was used as a surrogate of the 'ground truth'. We found that the CBCT electron density calibration curve differs moderately from that of pCT. No significant fluctuation was observed in the calibration over the period of 8 weeks. For the static phantom, the doses computed based on pCT and CBCT agreed to within 1%. A notable difference in CBCT- and pCT-based dose distributions was found for the motion phantom due to the motion artefacts which appeared in the CBCT images (the maximum discrepancy was found to be approximately 3.0% in the high dose region). The motion artefacts-induced dosimetric inaccuracy was also observed in the lung patient study. For the prostate cases, the mCBCT- and CBCT-based dose calculations yielded very close results (<2%). Coupled with the phantom data, it is concluded that the CBCT can be employed directly for dose calculation for a disease site such as the prostate, where there is little motion artefact. In the prostate case study, we also noted a large discrepancy between the original treatment plan and the CBCT (or mCBCT)-based calculation, suggesting the importance of inter-fractional organ movement and the need for adaptive therapy to compensate for the anatomical changes in the future.     

Model-based image reconstruction for four-dimensional PET

Positron emission tonography (PET) is useful in diagnosis and radiation treatment planning for a variety of cancers. For patients with cancers in thoracic or upper abdominal region, the respiratory motion produces large distortions in the tumor shape and size, affecting the accuracy in both diagnosis and treatment. Four-dimensional (4D) (gated) PET aims to reduce the motion artifacts and to provide accurate measurement of the tumor volume and the tracer concentration. A major issue in 4D PET is the lack of statistics. Since the collected photons are divided into several frames in the 4D PET scan, the quality of each reconstructed frame degrades as the number of frames increases. The increased noise in each frame heavily degrades the quantitative accuracy of the PET imaging. In this work, we propose a method to enhance the performance of 4D PET by developing a new technique of 4D PET reconstruction with incorporation of an organ motion model derived from 4D-CT images. The method is based on the well-known maximum-likelihood expectation-maximization (ML-EM) algorithm. During the processes of forward- and backward-projection in the ML-EM iterations, all projection data acquired at different phases are combined together to update the emission map with the aid of deformable model, the statistics is therefore greatly improved. The proposed algorithm was first evaluated with computer simulations using a mathematical dynamic phantom. Experiment with a moving physical phantom was then carried out to demonstrate the accuracy of the proposed method and the increase of signal-to-noise ratio over three-dimensional PET. Finally, the 4D PET reconstruction was applied to a patient case.