Reconstruction and registration of multispectral X-ray images for reliable alignment correction in radiation treatment devices

To align patients in radiation devices in six degrees of freedom (DoF), image-guided approaches perform the task of correction computation for the patient position. Digital radiography (DR) images are compared to projections of a CT series to estimate misalignments. A problem is that digital reconstructed radiographs (DRRs) have to be created from the CT to be registered with the DRs. Depending on the X-ray tube energy, detector sensitivity and body part involved, DRRs and DRs may look very different and often cannot be registered. We present a method that reconstructs multi-spectral DRRs for different X-ray settings, which can be registered to real X-ray images. As short rendering times are crucial, multiple spectra of a DRR are generated in one ray-tracing process. We register our multi-spectral DRR with the DR and add a further DoF to find a best match not only for the translations and in-plane rotation, but also the best fitting spectral planes. The results are used to identify patient misalignments and show that higher reliability can be achieved compared to conventional approaches. Misalignments can be identified even if ineligible X-ray settings have been used. As our approach allows application of lower X-ray energies for DR creation, an additional benefit is the reduction of the delivered dose.