Minimizing 4DCBCT imaging dose and scan time with Respiratory Motion Guided 4DCBCT: A pre-clinical investigation.

Current conventional 4D Cone Beam Computed Tomography (4DCBCT) imaging is hampered by inconsistent patient breathing that leads to long scan times, reduced image quality and high imaging dose. To address these limitations, Respiratory Motion Guided 4D cone beam computed tomography (RMG-4DCBCT) uses mathematical optimization to adapt the gantry rotation speed and projection acquisition rate in real-time in response to changes in the patient's breathing rate. Here, RMG-4DCBCT is implemented on an Elekta Synergy linear accelerator to determine the minimum achievable imaging dose. 8 patient-measured breathing traces were programmed into a 1D motion stage supporting a 3D-printed anthropomorphic thorax phantom. The respiratory phase and current gantry position were calculated in real-time with the RMG-4DCBCT software, which in turn modulated the gantry rotation speed and suppressed projection acquisition. Specifically, the effect of acquiring 20, 25, 30, 35 and 40 projections/respiratory phase bin RMG scans on scan time and image quality was assessed. Reconstructed image quality was assessed via the contrast-to-noise ratio (CNR) and the Edge Response Width (ERW) metrics. The performance of the system in terms of gantry control accuracy was also assessed via an analysis of the angular separation between adjacent projections. The median CNR increased linearly from 5.90 (20 projections/bin) to 8.39 (40 projections/bin). The ERW did not significantly change from 1.08 mm (20 projections/bin) to 1.07 mm (40 projections/bin), indicating the sharpness is not dependent on the total number of projections acquired. Scan times increased with increasing total projections and slower breathing rates. Across all 40 RMG-4DCBCT scans performed, the average difference in the acquired and desired angular separation between projections was 0.64°. RMG-4DCBCT provides the opportunity to enable fast low-dose 4DCBCT (~70 s, 200 projections), without compromising on current clinical image quality.