title: Color intensity projections: a rapid approach for evaluating four-dimensional CT scans in treatment planning.
abstract: OBJECTIVE
  Four-dimensional computerized tomography scans (4DCT) enable intrafractional motion to be determined. Because more than 1500 images can be generated with each 4DCT study, tools for efficient data visualization and evaluation are needed. We describe the use of color intensity projections (CIP) for visualizing mobility.
  
  
  METHODS
  Four-dimensional computerized tomography images of each patient slice were combined into a CIP composite image. Pixels largely unchanged over the component images appear unchanged in the CIP image. However, pixels whose intensity changes over the phases of the 4DCT appear in the CIP image as colored pixels, and the hue encodes the percentage of time the tissue was in each location. CIPs of 18 patients were used to study tumor and surrogate markers, namely the diaphragm and an abdominal marker block.
  
  
  RESULTS
  Color intensity projections permitted mobility of high-contrast features to be quickly visualized and measured. In three selected expiratory phases ("gating phases") that were reviewed in the sagittal plane, gating would have reduced mean tumor mobility from 6.3 +/- 2.0 mm to 1.4 +/- 0.5 mm. Residual tumor mobility in gating phases better correlated with residual mobility of the marker block than that of the diaphragm.
  
  
  CONCLUSIONS
  CIPs permit immediate visualization of mobility in 4DCT images and simplify the selection of appropriate surrogates for gated radiotherapy.
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Cover
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Lagerwaard
authors.forename: Suresh
authors.initials: S
authors.lastname: Senan
mesh_terms: D003116:Color; D003964:Diaphragm / Q000000981:diagnostic imaging; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D009068:Movement; D012119:Respiration; D012984:Software; D014057:Tomography, X-Ray Computed / Q000379:methods*