Fast 4D cone-beam CT from 60 s acquisitions

Background & purpose Four dimensional Cone beam CT (CBCT) has many potential benefits for radiotherapy but suffers from poor image quality, long acquisition times, and/or long reconstruction times. In this work we present a fast iterative reconstruction algorithm for 4D reconstruction of fast acquisition cone beam CT, as well as a new method for temporal regularization and compare to state of the art methods for 4D CBCT. Materials & methods Regularization parameters for the iterative algorithms were found automatically via computer optimization on 60 s acquisitions using the XCAT phantom. Nineteen lung cancer patients were scanned with 60 s arcs using the onboard image on a Varian trilogy linear accelerator. Images were reconstructed using an accelerated ordered subset algorithm. A frequency based temporal regularization algorithm was developed and compared to the McKinnon-Bates algorithm, 4D total variation and prior images compressed sensing (PICCS). Results All reconstructions were completed in 60 s or less. The proposed method provided a structural similarity of 0.915, compared with 0.786 for the classic McKinnon-bates method. For the patient study, it provided fewer image artefacts than PICCS, and better spatial resolution than 4D TV. Conclusion Four dimensional iterative CBCT reconstruction was done in less than 60 s, demonstrating the clinical feasibility. The frequency based method outperformed 4D total variation and PICCS on the simulated data, and for patients allowed for tumor location based on 60 s acquisitions, even for slowly breathing patients. It should thus be suitable for routine clinical use.