title: An image correlation procedure for digitally reconstructed radiographs and electronic portal images.
abstract: OBJECTIVE
  To study a procedure that uses megavoltage digitally reconstructed radiographs (DRRs) calculated from patient's three-dimensional (3D) computed tomography (CT) data as a reference image for correlation with on-line electronic portal images (EPIs) to detect patient setup errors.
  
  
  METHODS
  Megavoltage DRRs were generated by ray tracing through a modified volumetric CT data set in which CT numbers were converted into linear attenuation coefficients for the therapeutic beam energy. The DRR transmission image was transformed to the grayscale window of the EPI by a histogram-matching technique. An alternative approach was to calibrate the transmission DRR using a measured response curve of the electronic portal imaging device (EPID). This forces the calculated transmission fluence values to be distributed in the same range as that of the EPID image. A cross-correlation technique was used to determine the degree of alignment of the patient anatomy found in the EPID image relative to the reference DRR.
  
  
  RESULTS
  Phantom studies demonstrated that the correlation procedure had a standard deviation of 0.5 mm and 0.5 degrees in aligning translational shifts and in-plane rotations. Systematic errors were found between a reference DRR and a reference EPID image. The automated grayscale image-correlation process was completed within 3 s on a workstation computer or 12 s on a PC.
  
  
  CONCLUSIONS
  The alignment procedure allows the direct comparison of a patient's treatment portal designed with a 3D planning computer with a patient's on-line portal image acquired at the treatment unit. The image registration process is automated to the extent that it requires minimal user intervention, and it is fast and accurate enough for on-line clinical applications.
mesh_terms: D004307:Dose-Response Relationship, Radiation; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted; D014057:Tomography, X-Ray Computed