A new method of diaphragm apex motion detection from 2D projection images of mega-voltage cone beam CT.

To present a new method of estimating 3D positions of the ipsi-lateral hemi-diaphragm apex (IHDA) from 2D projection images of mega-voltage cone beam CT (MVCBCT). The detection framework reconstructs a 3D volume from all the 2D projection images. An initial estimated 3D IHDA position is determined in this volume based on an imaging processing pipeline, including Otsu thresholding, connected component labeling and template matching. This initial position is then projected onto each 2D projection image to create a region of interest (ROI). To accurately detect the IHDA position in 2D projection space, two methods, dynamic Hough transform (DHT) and a tracking approach based on a joint probability density function (PDF) are developed. Both methods utilize a double-parabola model to fit the 2D diaphragm boundary. The 3D IHDA motion in the superior-inferior (SI) direction is estimated from the initial static 3D position and the detected 2D positions in projection space. The two Hough-based detection methods are tested on 35 MVCBCT scans from 15 patients. The detection is compared to manually identified IHDA positions in 2D projection space by three clinicians. An average and standard deviation of 4.252 ± 3.354 and 2.485 ± 1.750 mm was achieved for DHT and tracking-based approaches respectively, compared with the inter-expert variance among three experts of 1.822 ± 1.106 mm. Based on the results of the scans, the PDF tracking-based approach appears more robust than the DHT. The combination of the automatic ROI localization and the tracking-based approach is a quicker and more accurate method of extracting 3D IHDA motion from 2D projection images.