title: Using a handheld stereo depth camera to overcome limited field-of-view in simulation imaging for radiation therapy treatment planning.
abstract: OBJECTIVE
  A correct body contour is essential for reliable treatment planning in radiation therapy. While modern medical imaging technologies provide highly accurate patient modeling, there are times when a patient's anatomy cannot be fully captured or there is a lack of easy access to computed tomography (CT) simulation. Here, we provide a practical solution to the surface contour truncation problem by using a handheld stereo depth camera (HSDC) to obtain the missing surface anatomy and a surface-surface image registration to stich the surface data into the CT dataset for treatment planning.
  
  
  METHODS
  For a subject with truncated simulation CT images, a HSDC is used to capture the surface information of the truncated anatomy. A mesh surface model is created using a software tool provided by the camera manufacturer. A surface-to-surface registration technique is used to merge the mesh model with the CT and fill in the missing surface information thereby obtaining a complete surface model of the subject. To evaluate the accuracy of the proposed approach, experiments were performed with the following steps. First, we selected three previously treated patients and fabricated a phantom mimicking each patient using the corresponding CT images and a 3D printer. Second, we removed part of the CT images of each patient to create hypothetical cases with image truncations. Next, a HSDC was used to image the 3D-printed phantoms and the HSDC-derived surface models were registered with the hypothetically truncated CT images. The contours obtained using the approach were then compared with the ground truth contours derived from the original simulation CT without image truncation. The distance between the two contours was calculated in order to evaluate the accuracy of the method. Finally, the dosimetric impact of the approach is assessed by comparing the volume within the 95% isodose line and global maximum dose (Dmax) computed based on the two surface contours for the breast case that exhibited the largest contour variation in the treated breast.
  
  
  RESULTS
  A systematic strategy of using a 3D HSDC to compensate for missing surface information caused by the truncation of CT images was established. Our study showed that the proposed technique was able to reliably provide the full contours for treatment planning in the case of severe CT image truncation(s). The root-mean-square error for the registration between the aligned HDSC surface model and the ground truth data was found to be 2.1 mm. The average distance between the two models was 0.4 ± 1.7 mm (mean ± SD). Maximum deviations occurred in areas of high concavity or when the skin was close to the couch. The breast tissue covered by 95% isodose line decreased by 3% and Dmaxincreased by 0.2% with the use of the HSDC model.
  
  
  CONCLUSIONS
  The use of HSDC for obtaining missing surface data during simulation has a number of advantages, such as, ease of use, low cost, and no additional ionizing radiation. It may provide a clinically practical solution to deal with the longstanding problem of CT image truncations in radiation therapy treatment planning.
authors.affiliation: Departments of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA.|Departments of Mechanical Engineering, Stanford University, Stanford, CA, 94305, USA.
authors.forename: Cesare
authors.initials: C
authors.lastname: Jenkins
authors.affiliation: Departments of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Xing
authors.affiliation: Departments of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Yu
mesh_terms: D006801:Humans; D019047:Phantoms, Imaging; D011874:Radiometry; D014057:Tomography, X-Ray Computed
keywords: CT simulation; camera; extended field-of-view; obese; treatment planning