Enhancement in the Kv Portal Image Contrast Using Depth Normalization for Accurate Patient Localization

The X-ray imaging modality has played an important role in the daily verification of a patient’s position for accurate radiation treatment (RT), especially in modern RT techniques that require highly precise patient localization. Although cone-beam computer tomography (CBCT) has already been introduced to the RT field, two-dimensional (2D) X-ray portal imagers have been more widely used than CBCT for the daily check of patient localization owing to the lower patient exposure and time consumption. However, the 2D imager practically provide a lower bone-tissue contrast than CBCT. Thus, we propose a method that enhances the image contrast of daily acquired 2D images by using just one CBCT scan during an entire RT course. This method operates on the basis of the depth normalization (DN) technique and requires no artificial data manipulation such as image post-processing filters. We implemented the algorithm for the portal images of a cylindrical phantom and three patients. From DN results, the image contrast for the phantom and the patients increased by factors of 26.3 and 13.4 on average, and their contrast-to-noise ratios were maintained at differences of 8.6% and 7.7% on average, respectively. Moreover, the DN method provided a stronger contrast enhancement at lower doses that could suppress the imaging exposure and thus improve the patient’s safety. Therefore, the verification of RT patient localization is expected to be performed more efficiently and accurately by using the DN method.