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We present a technique for continuous generation of volumetric images duringSBRT using periodic kV imaging and an external respiratory surrogate signal todrive a patient-specific PCA motion model. Using the on-board imager, kVradiographs are acquired every 3 seconds and used to fit the parameters of amotion model so that it matches observed changes in internal patient anatomy. Amulti-dimensional correlation model is established between the motion modelparameters and the external surrogate position and velocity, enablingvolumetric image reconstruction between kV imaging time points. Performance ofthe algorithm was evaluated using 10 realistic eXtended CArdiac-Torso (XCAT)digital phantoms including 3D anatomical respiratory deformation programmedwith 3D tumor positions measured with orthogonal kV imaging of implantedfiducial gold markers. The clinically measured ground truth 3D tumor positionsprovided a dataset with realistic breathing irregularities, and the combinationof periodic on-board kV imaging with recorded external respiratory surrogatesignal was used for correlation modeling to account for any changes ininternal-external correlation. The three-dimensional tumor positions arereconstructed with an average root mean square error (RMSE) of 1.47 mm, and anaverage 95th percentile 3D positional error of 2.80 mm compared with theclinically measured ground truth 3D tumor positions. This technique enablescontinuous 3D anatomical image generation based on periodic kV imaging ofinternal anatomy without the additional dose of continuous kV imaging. The 3Danatomical images produced using this method can be used for treatmentverification and delivered dose computation in the presence of irregularrespiratory motion.

Continuous Generation of Volumetric Images During Stereotactic Body  Radiation Therapy Using Periodic kV Imaging and an External Respiratory  Surrogate