On-line use of three-dimensional marker trajectory estimation from cone-beam computed tomography projections for precise setup in radiotherapy for targets with respiratory motion

Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):e145-51. doi: 10.1016/j.ijrobp.2011.12.007.


Purpose: To develop and evaluate accurate and objective on-line patient setup based on a novel semiautomatic technique in which three-dimensional marker trajectories were estimated from two-dimensional cone-beam computed tomography (CBCT) projections.

Methods and materials: Seven treatment courses of stereotactic body radiotherapy for liver tumors were delivered in 21 fractions in total to 6 patients by a linear accelerator. Each patient had two to three gold markers implanted close to the tumors. Before treatment, a CBCT scan with approximately 675 two-dimensional projections was acquired during a full gantry rotation. The marker positions were segmented in each projection. From this, the three-dimensional marker trajectories were estimated using a probability based method. The required couch shifts for patient setup were calculated from the mean marker positions along the trajectories. A motion phantom moving with known tumor trajectories was used to examine the accuracy of the method. Trajectory-based setup was retrospectively used off-line for the first five treatment courses (15 fractions) and on-line for the last two treatment courses (6 fractions). Automatic marker segmentation was compared with manual segmentation. The trajectory-based setup was compared with setup based on conventional CBCT guidance on the markers (first 15 fractions).

Results: Phantom measurements showed that trajectory-based estimation of the mean marker position was accurate within 0.3 mm. The on-line trajectory-based patient setup was performed within approximately 5 minutes. The automatic marker segmentation agreed with manual segmentation within 0.36 ± 0.50 pixels (mean ± SD; pixel size, 0.26 mm in isocenter). The accuracy of conventional volumetric CBCT guidance was compromised by motion smearing (≤21 mm) that induced an absolute three-dimensional setup error of 1.6 ± 0.9 mm (maximum, 3.2) relative to trajectory-based setup.

Conclusions: The first on-line clinical use of trajectory estimation from CBCT projections for precise setup in stereotactic body radiotherapy was demonstrated. Uncertainty in the conventional CBCT-based setup procedure was eliminated with the new method.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bile Duct Neoplasms
  • Bile Ducts, Intrahepatic
  • Breast Neoplasms
  • Cholangiocarcinoma / diagnostic imaging
  • Cholangiocarcinoma / secondary
  • Cholangiocarcinoma / surgery
  • Colorectal Neoplasms
  • Cone-Beam Computed Tomography*
  • Dose Fractionation, Radiation
  • Female
  • Fiducial Markers*
  • Gold
  • Humans
  • Imaging, Three-Dimensional / methods*
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Movement*
  • Phantoms, Imaging
  • Radiosurgery / methods*
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Respiration


  • Gold