title: Feasibility of fully automated detection of fiducial markers implanted into the prostate using electronic portal imaging: a comparison of methods.
abstract: OBJECTIVE
  To investigate the feasibility of fully automated detection of fiducial markers implanted into the prostate using portal images acquired with an electronic portal imaging device.
  
  
  METHODS
  We have made a direct comparison of 4 different methods (2 template matching-based methods, a method incorporating attenuation and constellation analyses and a cross correlation method) that have been published in the literature for the automatic detection of fiducial markers. The cross-correlation technique requires a-priory information from the portal images, therefore the technique is not fully automated for the first treatment fraction. Images of 7 patients implanted with gold fiducial markers (8 mm in length and 1 mm in diameter) were acquired before treatment (set-up images) and during treatment (movie images) using 1MU and 15MU per image respectively. Images included: 75 anterior (AP) and 69 lateral (LAT) set-up images and 51 AP and 83 LAT movie images. Using the different methods described in the literature, marker positions were automatically identified.
  
  
  RESULTS
  The method based upon cross correlation techniques gave the highest percentage detection success rate of 99% (AP) and 83% (LAT) set-up (1MU) images. The methods gave detection success rates of less than 91% (AP) and 42% (LAT) set-up images. The amount of a-priory information used and how it affects the way the techniques are implemented, is discussed.
  
  
  CONCLUSIONS
  Fully automated marker detection in set-up images for the first treatment fraction is unachievable using these methods and that using cross-correlation is the best technique for automatic detection on subsequent radiotherapy treatment fractions.
authors.affiliation: Joint Department of Physics, Institute of Cancer Research, Sutton, Surrey, United Kingdom. eharris@icr.ac.uk
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Harris
authors.forename: Helen A
authors.initials: HA
authors.lastname: McNair
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Evans
mesh_terms: D005240:Feasibility Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D011856:Radiographic Image Enhancement / Q000295:instrumentation* / Q000379:methods*; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity