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Background: Real‐time tumor tracking is one motion management method to address motion‐induced uncertainty. To date, fiducial markers are often required to reliably track lung tumors with X‐ray imaging, which carries risks of complications and leads to prolonged treatment time. A markerless tracking approach is thus desirable. Deep learning‐based approaches have shown promise for markerless tracking, but systematic evaluation and procedures to investigate applicability in individual cases are missing. Moreover, few efforts have been made to provide bounding box prediction and mask segmentation simultaneously, which could allow either rigid or deformable multi‐leaf collimator tracking. Purpose: The purpose of this study was to implement a deep learning‐based markerless lung tumor tracking model exploiting patient‐specific training which outputs both a bounding box and a mask segmentation simultaneously. We also aimed to compare the two kinds of predictions and to implement a specific procedure to understand the feasibility of markerless tracking on individual cases. Methods: We first trained a Retina U‐Net baseline model on digitally reconstructed radiographs (DRRs) generated from a public dataset containing 875 CT scans and corresponding lung nodule annotations. Afterwards, we used an independent cohort of 97 lung patients to develop a patient‐specific refinement procedure. In order to determine the optimal hyperparameters for automatic patient‐specific training, we selected 13 patients for validation where the baseline model predicted a bounding box on planning CT (PCT)‐DRR with intersection over union (IoU) with the ground‐truth higher than 0.7. The final test set contained the remaining 84 patients with varying PCT‐DRR IoU. For each testing patient, the baseline model was refined on the PCT‐DRR to generate a patient‐specific model, which was then tested on a separate 10‐phase 4DCT‐DRR to mimic the intrafraction motion during treatment. A template matching algorithm served as benchmark model. The testing results were evaluated by four metrics: the center of mass (COM) error and the Dice similarity coefficient (DSC) for segmentation masks, and the center of box (COB) error and the DSC for bounding box detections. Performance was compared to the benchmark model including statistical testing for significance. Results: A PCT‐DRR IoU value of 0.2 was shown to be the threshold dividing inconsistent (68%) and consistent (100%) success (defined as mean bounding box DSC > 0.6) of PS models on 4DCT‐DRRs. Thirty‐seven out of the eighty‐four testing cases had a PCT‐DRR IoU above 0.2. For these 37 cases, the mean COM error was 2.6 mm, the mean segmentation DSC was 0.78, the mean COB error was 2.7 mm, and the mean box DSC was 0.83. Including the validation cases, the model was applicable to 50 out of 97 patients when using the PCT‐DRR IoU threshold of 0.2. The inference time per frame was 170 ms. The model outperformed the benchmark model on all metrics, and the comparison was significant (p < 0.001) over the 37 PCT‐DRR IoU > 0.2 cases, but not over the undifferentiated 84 testing cases. Conclusions: The implemented patient‐specific refinement approach based on a pre‐trained baseline model was shown to be applicable to markerless tumor tracking in simulated radiographs for lung cases. [ABSTRACT FROM AUTHOR]

Background: Cone beam computed tomography (CBCT) is widely used in many medical fields. However, conventional CBCT circular scans suffer from cone beam (CB) artifacts that limit the quality and reliability of the reconstructed images due to incomplete data. Purpose: Saddle trajectories in theory might be able to improve the CBCT image quality by providing a larger region with complete data. Therefore, we investigated the feasibility and performance of saddle trajectory CBCT scans and compared them to circular trajectory scans. Methods: We performed circular and saddle trajectory scans using a novel robotic CBCT scanner (Mobile ImagingRing (IRm); medPhoton, Salzburg, Austria). For the saddle trajectory, the gantry executed yaw motion up to ±10∘$\pm 10^{\circ }$ using motorized wheels driving on the floor. An infrared (IR) tracking device with reflective markers was used for online geometric calibration correction (mainly floor unevenness). All images were reconstructed using penalized least‐squares minimization with the conjugate gradient algorithm from RTK with 0.5×0.5×0.5mm3$0.5 \times 0.5\times 0.5 \text{ mm}^3$ voxel size. A disk phantom and an Alderson phantom were scanned to assess the image quality. Results were correlated with the local incompleteness value represented by tan(ψ)$\tan (\psi)$, which was calculated at each voxel as a function of the source trajectory and the voxel's 3D coordinates. We assessed the magnitude of CB artifacts using the full width half maximum (FWHM) of each disk profile in the axial center of the reconstructed images. Spatial resolution was also quantified by the modulation transfer function at 10% (MTF10). Results: When using the saddle trajectory, the region without CB artifacts was increased from 43 to 190 mm in the SI direction compared to the circular trajectory. This region coincided with low values for tan(ψ)$\tan (\psi)$. When tan(ψ)$\tan (\psi)$ was larger than 0.02, we found there was a linear relationship between the FWHM and tan(ψ)$\tan (\psi)$. For the saddle, IR tracking allowed the increase of MTF10 from 0.37 to 0.98 lp/mm. Conclusions: We achieved saddle trajectory CBCT scans with a novel CBCT system combined with IR tracking. The results show that the saddle trajectory provides a larger region with reliable reconstruction compared to the circular trajectory. The proposed method can be used to evaluate other non‐circular trajectories. [ABSTRACT FROM AUTHOR]

Background: Current commercially available hybrid magnetic resonance linear accelerators (MR‐Linac) use 2D+t cine MR imaging to provide intra‐fractional motion monitoring. However, given the limited temporal resolution of cine MR imaging, target intra‐frame motion deterioration effects, resulting in effective time latency and motion artifacts in the image domain, can be appreciable, especially in the case of fast breathing. Purpose: The aim of this work is to investigate intra‐frame motion deterioration effects in MR‐guided radiotherapy (MRgRT) by simulating the motion‐corrupted image acquisition, and to explore the feasibility of deep‐learning‐based compensation approaches, relying on the intra‐frame motion information which is spatially and temporally encoded in the raw data (k‐space). Methods: An intra‐frame motion model was defined to simulate motion‐corrupted MR images, with 4D anthropomorphic digital phantoms being exploited to provide ground truth 2D+t cine MR sequences. A total number of 10 digital phantoms were generated for lung cancer patients, with randomly selected eight patients for training or validation and the remaining two for testing. The simulation code served as the data generator, and a dedicated motion pattern perturbation scheme was proposed to build the intra‐frame motion database, where three degrees of freedom were designed to guarantee the diversity of intra‐frame motion trajectories, enabling a thorough exploration in the domain of the potential anatomical structure positions. U‐Nets with three types of loss functions: L1 or L2 loss defined in image or Fourier domain, referred to as NNImgLoss‐L1, NNFloss‐L1 and NNL2‐Loss were trained to extract information from the motion‐corrupted image and used to estimate the ground truth final‐position image, corresponding to the end of the acquisition. Images before and after compensation were evaluated in terms of (i) image mean‐squared error (MSE) and mean absolute error (MAE), and (ii) accuracy of gross tumor volume (GTV) contouring, based on optical‐flow image registration. Results: Image degradation caused by intra‐frame motion was observed: for a linearly and fully acquired Cartesian readout k‐space trajectory, intra‐frame motion resulted in an imaging latency of approximately 50% of the acquisition time; in comparison, the motion artifacts exhibited only a negligible contribution to the overall geometric errors. All three compensation models led to a decrease in image MSE/MAE and GTV position offset compared to the motion‐corrupted image. In the investigated testing dataset for GTV contouring, the average dice similarity coefficients (DSC) improved from 88% to 96%, and the 95th percentile Hausdorff distance (HD95) dropped from 4.8 mm to 2.1 mm. Different models showed slight performance variations across different intra‐frame motion amplitude categories: NNImgLoss‐L1 excelled for small/medium amplitudes, whereas NNFloss‐L1 demonstrated higher DSC median values at larger amplitudes. The saliency maps of the motion‐corrupted image highlighted the major contribution of the later acquired k‐space data, as well as the edges of the moving anatomical structures at their final positions, during the model inference stage. Conclusions: Our results demonstrate the deep‐learning‐based approaches have the potential to compensate for intra‐frame motion by utilizing the later acquired data to drive the convergence of the earlier acquired k‐space components. [ABSTRACT FROM AUTHOR]