Development of Motion Artifact Correction Solutions for the Cone-beam CT Images during Pancreatic Cancer Image-guided Radiotherapy

The cone-beam CT (CBCT) system based on the two-dimensional flat-panel detector technology is widely applied in patient location verification before radiotherapy. However, during the application of intraperitoneal tumor radiotherapy, severe shading and streaking artifacts caused by respiratory movement and intestinal peristalsis make it difficult to distinguish tumor areas from the CBCT images. Due to the non-rigid deformation of flexible organs such as the pancreas under the action of respiratory motion, it is hard to quantify deviation between the body surface motion monitoring results and the actual organ motion, and it is also difficult to monitor irregular motion represented by intestinal peristalsis. There is no effective solution to motion artifact correction in CBCT. Based on theory of biodynamics and common knowledge of human physiology, in this paper we propose a brand new radiotherapy image-guided cone-beam CT motion artifact correction method without motion monitoring or implantation of in-vivo markers. The proposed artifact correction strategy is designed based on the features of the artifact images and fusion of various CT image domain processing algorithms. The results suggest that the image quality of cone beam CT has been significantly improved after the application of this strategy in the clinical abdominal CBCT image processing. The average CT number error in typical soft tissue areas reduces from 90 HU to 30 HU, and the boundary of the intestinal cavity and surrounding soft tissue information are partially recovered. The proposed artifact correction strategy does not require respiratory gating or increase of projections, which can be integrated into existing workflows without marker implantation surgery. The motion-artifact-corrected CBCT images provide more accurate tumor localization information for image-guided radiotherapy of pancreatic carcinoma. The proposed method is proved practical and efficient for clinical applications