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Digital Tomosynthesis for Improved Daily Setup in Treatment of Liver Lesions

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H Armstrong

H Armstrong*, B Jones , M Miften , University of Colorado School of Medicine, Aurora, CO


SU-D-BRF-4 Sunday 2:05PM - 3:00PM Room: Ballroom F

Purpose: Daily localization of liver lesions with cone-beam CT (CBCT) is difficult due to poor image quality caused by scatter, respiratory motion, and the lack of radiographic contrast between the liver parenchyma and the lesion(s). Digital tomosynthesis (DTS) is investigated as a modality to improve liver visualization and lesion/parenchyma contrast for daily setup.

Methods: An in-house tool was developed to generate DTS images using a point-by-point filtered back-projection method from on-board CBCT projection data. DTS image planes are generated in a user defined orientation to visualize the anatomy at various depths. Reference DTS images are obtained from forward projection of the planning CT dataset at each projection angle. The CBCT DTS image set can then be registered to the reference DTS image set as a means for localization. Contour data from the planning CT’s associate RT Structure file and forward projected similarly to the planning CT data. DTS images are created for each contoured structure, which can then be overlaid onto the DTS images for organ volume visualization.

Results: High resolution DTS images generated from CBCT projections show fine anatomical detail, including small blood vessels, within the patient. However, the reference DTS images generated from forward projection of the planning CT lacks this level of detail due to the low resolution of the CT voxels as compared to the pixel size in the projection images; typically 1mm-by-1mm-by-3mm (lat, vrt, lng) for the planning CT vs. 0.4mm-by-0.4mm for CBCT projections. Overlaying of the contours onto the DTS image allows for visualization of structures of interest.

Conclusion: The ability to generate DTS images over a limited range of projection angles allows for reduction in the amount of respiratory motion within each acquisition. DTS may provide improved visualization of structures and lesions as compared to CBCT for highly mobile tumors.

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