Outline

An Brief Introduction to
Problems with free breathing 3D scanning
4D CT Scanning
What is 4D CT? How does it work?
Steve B. Jiang, Ph.D.
Dept of Radiation Oncology
Univ of California San Diego

Acknowledgements
Paul Keall, George Chen,
Dan Low, Gig Mageras,
Ken Foster

Three Types of Motion Artifacts CT Artifacts in Free Breathing 3D Scan

If CT scanning speed << tumor motion speed,

smeared tumor image

If CT scanning speed >> tumor motion speed, Tumor

tumor position and shape captured at an
arbitrary breathing phase

If CT scanning speed ~ tumor motion speed,

tumor position and shape heavily distorted Helical light breathing scan 4DCT 1 phase
Courtesy of Eike Rietzel and George T.Y. Chen

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 Interplay: Tumor Motion and Couch Motion Moving Objects during CT A Phantom Study

Video courtesy of George T.Y. Chen

Courtesy of Kevin Beaudette and

Chen, Kung, Beaudette, Artifacts in computed tomography scanning of moving objects, Semin Radiat Oncol. 14(1):19-26, 2004.
George T.Y. Chen

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Motion Artifacts Motion Induced Artifacts

Respiratory organ motion can cause severe

geometrical distortion in free breathing CT
scanning
Distortions along the axis of motion could either
lengthen or shorten the target, kind of random
In addition to shape distortion, the center of the
imaged target can be displaced by as much as
the amplitude of the motion
Photo Static Moving / HS mode HQ
Courtesy of George Chen
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Considerations of Organ Motion in CT Sim Basic Idea of 4D CT Scan
Breath-hold CT scan Over-sampling images at every
Voluntary breath hold position of interest along the
Active breathing control patients long axis
Combine inhale and exhale GTVs to get ITV Each image is tagged with
Slow CT san breathing signals
4 seconds per slice in axial mode Images are sorted
Gated CT scan retrospectively based on the
images at only 1 phase, acquisition times 4-5x longer corresponding breathing signals Photo Courtesy of Gig Mageras

4D CT scan Many 3-D CT sets are obtained, each corresponding to a particular

3D scans at multiple phases breathing phase
Together, they constitute a 4-D CT set that covers the entire
breathing cycle

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Resorting 500-1500 CT Slices Acquisition of 4D CT Images

Image acquisition can be performed in either

Cin mode: repeated image acquisition at each couch
position, or
Helical mode: with small pitch
Breathing signals can be obtained using either
A monitor such as RPM, an abdominal belt, or
variation of the patient anterior surface in the CT
images

Courtesy of Eike Rietzel and

George T.Y. Chen

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Sorting of 4D CT Images 4D Image Acquisition in Cine Mode
X-ray Tube

Retrospective sorting can be done in either

Sinogram space (before reconstruction), or Table location
00.0 cm
Image space (after reconstruction)

Images can be sorted using either

Breathing phase, or
Amplitude
Acq. Time
0:01 4 x 2.5 mm Multi Slice
(10 mm total coverage)

Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode

X-ray Tube X-ray Tube

Table location Table location

00.0 cm 00.0 cm

Acq. Time Acq. Time

0:02 4 x 2.5 mm Multi Slice 0:03 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode
X-ray Tube X-ray Tube

Table location Table location

00.0 cm 00.0 cm

Acq. Time Acq. Time

0:04 4 x 2.5 mm Multi Slice 0:05 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode

X-ray Tube X-ray Tube

Table location Table location

01.0 cm 01.0 cm

Acq. Time Acq. Time

0:06 4 x 2.5 mm Multi Slice 0:07 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode
X-ray Tube X-ray Tube

Table location Table location

01.0 cm 01.0 cm

Acq. Time Acq. Time

0:08 4 x 2.5 mm Multi Slice 0:09 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode

X-ray Tube X-ray Tube

Table location Table location

01.0 cm 01.0 cm

Acq. Time Acq. Time

0:10 4 x 2.5 mm Multi Slice 0:11 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode
X-ray Tube X-ray Tube

Table location Table location

02.0 cm 02.0 cm

Acq. Time Acq. Time

0:12 4 x 2.5 mm Multi Slice 0:13 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode

X-ray Tube X-ray Tube

Table location Table location

02.0 cm 02.0 cm

Acq. Time Acq. Time

0:14 4 x 2.5 mm Multi Slice 0:15 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode
X-ray Tube X-ray Tube

Table location Table location

02.0 cm 02.0 cm

Acq. Time Acq. Time

0:16 4 x 2.5 mm Multi Slice 0:17 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode

X-ray Tube X-ray Tube

Table location Table location

03.0 cm 03.0 cm

Acq. Time Acq. Time

0:18 4 x 2.5 mm Multi Slice 0:19 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode
X-ray Tube X-ray Tube

Table location Table location

03.0 cm 03.0 cm

Acq. Time Acq. Time

0:20 4 x 2.5 mm Multi Slice 0:21 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode

X-ray Tube X-ray Tube

Table location Table location

03.0 cm 03.0 cm

Acq. Time Acq. Time

0:22 4 x 2.5 mm Multi Slice 0:23 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

35 36

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4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode
X-ray Tube X-ray Tube

Table location Table location

04.0 cm 04.0 cm

Acq. Time Acq. Time

0:24 4 x 2.5 mm Multi Slice 0:25 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

37 38

4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode

X-ray Tube X-ray Tube

Table location Table location

04.0 cm 04.0 cm

Acq. Time Acq. Time

0:26 4 x 2.5 mm Multi Slice 0:27 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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 4D Image Acquisition in Cine Mode 4D Image Acquisition in Cine Mode
X-ray Tube X-ray Tube

Table location Table location

04.0 cm 04.0 cm

Acq. Time Acq. Time

0:28 4 x 2.5 mm Multi Slice 0:29 4 x 2.5 mm Multi Slice
(10 mm total coverage) (10 mm total coverage)

Courtesy of Ken Foster Courtesy of Ken Foster

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4D Image Acquisition in Cine Mode

Sorted Slices
Respiratory tracking with Varian RPM
optical monitor

Breathing
Signal

X-ray on Signal

First couch position Second couch position Third couch position

Courtesy of Ken Courtesy of Gig Mageras

Foster

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 4DCT Scan of A Phantom 4DCT Scan of A Lung Tumor

Courtesy of Eike Rietzel and

George T.Y. Chen

Courtesy of Eike Rietzel and George T.Y. Chen

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4DCT Scan of A Liver Tumor Summary

Respiratory organ motion can cause severe
geometrical distortion in free breathing CT
scanning
Distortions along patient long axis could either
lengthen or shorten the target
The center of the imaged target can be displaced
by as much as the amplitude of the motion
4D CT has been developed to
reduce motion artifacts

Courtesy of Eike Rietzel and George T.Y. Chen give the tumor/organ motion information

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Patient 5618

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 What kind of artifacts can be caused by respiratory
motion in free breathing helical CT scanning? Answer: 5 All of the above
6% 1. Lengthen the target along the patients long axis References
2% 2. Shorten the target along the patients long axis
3. Displace the target center along the patients long Chen G T, Kung J H and Beaudette K P 2004
10% Artifacts in computed tomography scanning of
axis by as much as the motion amplitude
4% 4. None of the above moving objects
Semin Radiat Oncol 14(1): 19-26.
78% 5. All of the above

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4D CT scan can be used to: Answer: 5 All of the above

2% 1. Reduce motion artifact References

0% 2. Estimate motion range
Keall P 2004
1% 3. Reconstruct tumor motion trajectory 4-dimensional computed tomography imaging and
2% 4. Design ITV treatment planning
96% 5. All of the above Semin Radiat Oncol 14(1): 81-90.

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