Apparatus and method for scalable field of view imaging using a multi-source system - Patents.com

Abstract

Multimodal imaging devices and methods include a rotatable gantry system with multiple radiation sources, including those with different energy levels (e.g., kV and MV). High-speed slip-ring techniques and helical scanning allow for combining or utilizing data from multiple radiation sources, including those for IGRT, to produce improved images and workflows. Features include large field of view (LFOV) MV imaging, kV region of interest (ROI) imaging, and scalable field of view (SFOV) dual-energy imaging.

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application is a continuation of U.S. Provisional Patent Application No. 62 / 773,712, filed November 30, 2018 (Attorney Docket No. 38935 / 04001); U.S. Provisional Patent Application No. 62 / 773,700, filed November 30, 2018 (Attorney Docket No. 38935 / 04002); U.S. Provisional Patent Application No. 62 / 796,831, filed January 25, 2019 (Attorney Docket No. No. 38935 / 04004; U.S. Provisional Patent Application No. 62 / 800,287 (Attorney Docket No. 38935 / 04003), filed February 1, 2019; U.S. Provisional Patent Application No. 62 / 801,260 (Attorney Docket No. 38935 / 04006), filed February 5, 2019; U.S. Provisional Patent Application No. 62 / 813,335 (Attorney Docket No. 38935 / 04006), filed March 4, 2019 No. 38935 / 04007; U.S. Provisional Patent Application No. 62 / 821,116, filed March 20, 2019 (Attorney Docket No. 38935 / 04009); U.S. Provisional Patent Application No. 62 / 836,357, filed April 19, 2019 (Attorney Docket No. 38935 / 04016); U.S. Provisional Patent Application No. 62 / 836,352, filed April 19, 2019 No. 62 / 878,364, filed on July 25, 2019 (Attorney Docket No. 38935 / 04008); and U.S. Provisional Application No. 62 / 843,796, filed on May 6, 2019 (Attorney Docket No. 38935 / 04017). This application is also filed in conjunction with Attorney Docket No. 38935 / 04019, entitled "MULTIMODAL RADIATION APPARATUS AND METHODS"; Attorney Docket No. 38935 / 04011, entitled "INTEGRATED HELICAL FAN-BEAM COMPUTED TOMOGRAPHY IN IMAGE-GUIDED RADIATION TREATMENT DEVICE"; Attorney Docket No. 38935 / 04010, entitled "COMPUTED TOMOGRAPHY SYSTEM AND METHOD FOR IMAGE IMPROVEMENT USING PRIOR IMAGE";Attorney Docket No. 38935 / 04013 entitled "OPTIMIZED SCANNING METHODS AND TOMOGRAPHY SYSTEM USING REGION OF INTEREST DATA";Attorney Docket No. 38935 / 04015 entitled "HELICAL CONE-BEAM COMPUTED TOMOGRAPHY IMAGING WITH AN OFF-CENTERED DETECTOR";Attorney Docket No. 38935 / 04021 entitled "MULTI-PASS COMPUTED TOMOGRAPHY SCANS FOR IMPROVED WORKFLOW AND PERFORMANCE";Attorney Docket No. 38935 / 04012 entitled "METHOD AND APPARATUS FOR SCATTER ESTIMATION IN CONE-BEAM COMPUTED TOMOGRAPHY";Attorney Docket No. 38935 / 04013 entitled "ASYMMETRIC SCATTER FITTING FOR OPTIMAL PANEL READOUT IN CONE-BEAM COMPUTED This application relates to ten non-provisional U.S. patent applications filed on the same day, including Attorney Docket No. 38935 / 04014, entitled "METHOD AND APPARATUS FOR IMPROVING SCATTER ESTIMATION AND CORRECTION IN IMAGING," Attorney Docket No. 38935 / 04018, entitled "METHOD AND APPARATUS FOR IMAGE RECONSTRUCTION AND CORRECTION USING INTER-FRACTIONAL INFORMATION," and Attorney Docket No. 38935 / 04022, entitled "METHOD AND APPARATUS FOR IMAGE RECONSTRUCTION AND CORRECTION USING INTER-FRACTIONAL INFORMATION." The contents of all of the above-identified patent application(s) and patent(s) are hereby incorporated by reference in their entirety.

[0002] Aspects of the disclosed techniques relate to utilizing multimodal radiation for imaging, and more particularly, to utilizing a combination of low energy radiation (e.g., kilovoltage x-rays (kV)) and high energy radiation (e.g., megavoltage x-rays (MV)) to enhance imaging, including scalable imaging areas, during computed tomography (CT) scans. [Background technology]

[0003] Pathological anatomical structures such as tumors and lesions can be treated with invasive procedures such as surgery, which can be harmful and risky for the patient. A non-invasive method for treating pathological anatomical structures (e.g., tumors, lesions, vascular malformations, neurological disorders, etc.) is external beam radiation therapy. It typically uses a therapeutic radiation source, such as a linear accelerator (LINAC), to generate radiation beams, such as X-rays. In one type of external beam radiation therapy, the therapeutic radiation source directs a series of X-ray beams at the tumor site from multiple angles in the imaging field. As the angle of the therapeutic radiation source changes, all the beams pass through the tumor site, but pass through different areas of healthy tissue on the way to and from the tumor. As a result, the cumulative radiation dose at the tumor is high and the cumulative radiation dose to the healthy tissue is relatively low.

[0004] The term "surgical irradiation" refers to a procedure in which radiation is applied to a target area at a dose sufficient to necrotize a lesion in fewer treatment sessions or fractions than would be achieved by delivering a low dose per fraction at a mass rate. Surgical irradiation is typically characterized by a relatively high radiation dose per fraction (e.g., 500-2000 centigrays) and hypofractionated radiation (e.g., 1-5 fractions or treatment days) to distinguish it from radiation therapy, which is typically characterized by a low dose per fraction (e.g., 100-200 centigrays) and hyperfractionated radiation (e.g., 30 to 45 fractions). For convenience, the terms "radiation treatment" and "radiation therapy" are used interchangeably herein to mean surgical irradiation and / or radiation therapy, unless otherwise specified.

[0005] Image-guided radiation therapy (IGRT) systems include gantry-based systems and robotic arm-based systems. In a gantry-based system, the gantry rotates the therapeutic radiation source around an axis that passes through the isocenter. The gantry-based system includes a C-arm gantry, in which the therapeutic radiation source is mounted in a cantilever-like manner and rotates around an axis that passes through the isocenter. The gantry-based system further includes a ring gantry, which generally has an annular shape in which the patient's body extends through the bore of the ring / toroid, and the therapeutic radiation source is mounted on the ring circumference and rotates around an axis that passes through the isocenter. Conventional gantry systems (ring or C-arm) deliver therapeutic radiation at set angles defined by the rotational trajectory of the radiation source. In a robotic arm-based system, the therapeutic radiation source is mounted on an articulated robotic arm that extends over and around the patient, and the robotic arm is configured to provide at least five degrees of freedom. The robotic arm based system provides the capability of delivering therapeutic radiation from multiple out-of-plane directions, i.e. non-coplanar delivery.

[0006] Each radiation therapy system is associated with an imaging system that provides intra-treatment images used to set up and, in some embodiments, guide the radiation delivery procedure and track the target's movement during treatment. The MV imaging system may place a detector opposite the treatment source to image the patient for set-up and intra-treatment images, while other approaches utilize a separate and independent imaging radiation source or sources and / or detector or detectors for patient set-up and intra-treatment images. Tracking of the target or target volume during treatment is achieved by comparing the intra-treatment images with prior or pre-treatment image information. Pre-treatment image information may include, for example, CT data, cone-beam CT (CBCT) data, magnetic resonance imaging (MRI) data, positron emission tomography (PET) data, or 3D rotational angiography (3DRA) data, and any information derived from these imaging modalities (e.g., but not limited to, digitally reconstructed simulated images (DRR)).

[0007] In one common scenario, the treatment source is a LINAC that generates treatment radiation (which may be, for example, an MV source), and the imaging system comprises one or more independent X-ray imaging sources that generate lower energy imaging radiation (each of which may be, for example, a kV source). The intra-treatment image may include one or more (preferably at least two) two-dimensional images (typically X-rays) acquired at one or more different viewpoints (e.g., a stereoscopic X-ray image). This may be compared, for example, to a two-dimensional DRR derived from the three-dimensional pre-treatment image information. The DRR is a synthetic X-ray image generated by projecting a virtual X-ray through the 3D imaging data. In this case, the direction and orientation of the virtual X-ray simulates the geometry of the intra-treatment X-ray imaging system. The resulting DRR then has approximately the same scale and viewpoint as the intra-treatment X-ray imaging system and can be compared to the intra-treatment X-ray image to determine the location and orientation of the target. This may then be used to guide the delivery of radiation to the target.

[0008] In another common scenario, either a gantry-mounted therapeutic radiation source or a separate x-ray imaging source (e.g., kV source) is used to acquire multiple fields of view and reconstruct volumetric images, i.e., CT images. The views, also called projections, are acquired with the imaging beam fan angle at least 180 degrees to provide full mathematical support for reconstructing a 3D volume or individual axial slices. The imaging detector mounted on the opposite side of the x-ray source can be a single-row detector used to acquire data for a single slice at a time, or a multi-row detector or full 2D panel detector to acquire data for many slices at once.

[0009] CBCT has also been proposed as an intra-treatment imaging modality for use in conjunction with radiation therapy systems, in some cases as a kV imaging modality and in other cases as a MV (portal) imaging modality. CBCT treatment planning images can be acquired prior to treatment for treatment planning. Then, prior to each treatment session, a CBCT image can be acquired and compared to the CBCT pre-treatment planning image. The results of this comparison can be used to modify the treatment plan during treatment to compensate for setup errors between treatments and / or organ movement between treatments.

[0010] While conventional CT imaging reconstructs 2D slices from 1D projections through the target volume, which are then stacked to form a 3D volumetric image, CBCT imaging constructs a 3D volumetric image directly from the 2D projections of the target volume. As known in the art, CBCT offers the ability to form a 3D image volume from a single gantry rotation (more specifically, at least 180 degrees plus a fan beam angle) around the target volume. On the other hand, conventional CT requires one rotation per slice (for a single-row detector) or 1 / M rotations per slice (for a quasi-linear multi-row detector with M rows). CBCT also offers more isotropic spatial resolution. On the other hand, conventional CT limits spatial resolution in the longitudinal direction to the slice thickness. However, scattering noise and artifacts are a greater challenge for CBCT systems than conventional CT systems, since conventional CT systems usually offer substantially higher collimation angles near linear or quasi-linear row detectors than can usually be offered by CBCT systems near their own two-dimensional detectors. Another major problem (besides scatter) with (single rotation, non-helical) CBCT is insufficient sampling in all slices (planes containing the source trajectory) except the central slice.

[0011] There are also cases where the projection data is truncated laterally (i.e., the projection data captures only a transaxial portion of the object). For example, the transaxial field of view (FOV) of a typical CT system ranges from 40cm to 70cm. This may not be large enough to cover the entire patient, resulting in transaxial data truncation. Another example is imaging of a small region of interest (ROI) to reduce x-ray scatter contamination (and thus improve visibility of soft tissues). This transverse truncation of the projection data can result in problems such as insufficient data, which can significantly bias the CT numbers in the reconstructed images.

[0012] Solutions are needed to adequately deal with the laterally truncated data of extended FOV CT. Because most CT scanners have a single x-ray source, approximations to the missing data by extrapolating the available data are possible but inadequate. Such approximations may involve assumptions about the shape and material of the scanned object, or the shape of the projection data. More advanced approximations may involve data consistency conditions or issues. Summary of the Invention

[0013] In one embodiment, a multimodal imaging device includes a rotatable gantry system positioned at least partially around a patient support, a first radiation source coupled to the rotatable gantry system and configured for imaging radiation, a first beamformer configured to adjust a shape of a first radiation beam emitted by the first radiation source, a second radiation source coupled to the rotatable gantry system and configured for at least one of imaging radiation or therapeutic radiation, the second beamformer configured to adjust a shape of a second radiation beam emitted by the second radiation source, and at least one radiation detector coupled to the rotatable gantry system and positioned to receive radiation from at least one of the first radiation source or the second radiation source, wherein the device acquires first measured projection data related to a first region of the patient from the first radiation source and second measured projection data related to a second region of the patient from the second radiation source during a scan.

[0014] Features described and / or illustrated with respect to one embodiment may be used in one or more other embodiments in the same or similar manner and / or in combination with or in place of features of the other embodiments.

[0015] The description of the invention is not intended to limit in any way the words used in the claims or the scope of the claims or the invention. Terms used in the claims have all of their full ordinary meanings.

[0016] In the accompanying drawings, which are incorporated in and constitute a part of this specification, embodiments of the present specification are illustrated, and together with the general description of the present invention provided above and the detailed description provided below, they contribute to illustrating embodiments of the present invention. It will be understood that the ranges of elements illustrated in the figures (e.g., boxes, groups of boxes, or other shapes) represent one embodiment of the ranges. In some embodiments, an element may be designed as multiple elements. Or multiple elements may be designed as one element. In some embodiments, an element shown as an internal component of another component may be implemented as an external component, and vice versa. Furthermore, the elements may not be drawn to scale. [Brief description of the drawings]

[0017] [Figure 1] FIG. 1 is a perspective view of an exemplary multi-modal radiation therapy device in accordance with one aspect of the disclosed technique. [Diagram 2] FIG. 1 is a schematic diagram of an exemplary multi-modal radiation therapy device in accordance with one aspect of the disclosed technique. [Diagram 3] 1 illustrates an exemplary radiation treatment environment. [Figure 4] 1 shows an illustration of an exemplary multi-modal scanning configuration. [Diagram 5] 13 shows an illustration of another exemplary multi-modal scanning configuration. [Figure 6] 1 shows an illustration of an exemplary multi-modal scanning configuration projecting through an exemplary large patient in the transaxial plane. [Figure 7] 7 illustrates another illustration of the exemplary multi-modal scanning configuration shown in FIG. 6 projecting through an exemplary large patient in the axial plane with an overlaid view of the radiation system. [Figure 8] 8 illustrates an illustration of a zoomed-in portion of the target shown in FIG. 7. [Figure 9] 1 is a flow chart depicting an exemplary method for combining scan data from multiple radiological modalities to approximate missing MV projection data using kV projection data. [Figure 10] 1 shows an illustration of an exemplary multi-modal scanning configuration projecting through an exemplary patient in the transaxial plane. [Figure 11] 11 illustrates an illustration of the MV subsystem of the example multi-modal scanning configuration shown in FIG. 10. [Figure 12] 11 illustrates an illustration of the kV subsystem of the example multi-modal scanning configuration shown in FIG. 10. [Figure 13] 11 shows an illustration of various FOV regions produced by the multi-modal scanning configuration shown in FIG. 10 in an overlay view. [Figure 14] 1 is a flow chart depicting an exemplary method for combining scan data from multiple radiological modalities to approximate missing kV projection data using MV projection data. [Figure 15] 1 shows an illustration of an exemplary multi-modal scanning configuration projecting through an exemplary patient in the axial plane with an overlaid view of the radiation system. [Figure 16] 16 shows an illustration of an exemplary kV radiation source in the multi-modal scanning configuration shown in FIG. 15 projecting through an exemplary patient in the transaxial plane during an exemplary rotation. [Figure 17] 16 illustrates an illustration of the exemplary kV radiation source in the multi-modal scanning configuration shown in FIG. 15 projecting through an exemplary patient in the transaxial plane during another exemplary rotation. [Figure 18] 18 shows, in an overlay view, an illustration of the various FOV regions produced by the kV radiation source shown in FIG. 16 and FIG. 17. [Figure 19]1 is a flow chart illustrating an exemplary method for combining scan data from multiple radiological diagnostic modalities to approximate missing MV and / or kV projection data based on corresponding projection data from another diagnostic modality. [Figure 20] 1 is a flow chart illustrating an exemplary method of IGRT using a radiation therapy device. [Figure 21] FIG. 13 is a block diagram depicting exemplary image-based pre-delivery steps / options. [Figure 22] FIG. 1 is a block diagram representing exemplary data sources that may be utilized during imaging and / or subsequent image-based pre-delivery steps. [Figure 23] 1 is a flow chart illustrating an exemplary method including patient setup or alignment with a radiation therapy device. [Figure 24] 1 is a flow chart illustrating an exemplary method including adaptive IGRT using a radiation therapy device. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0018] The following include definitions of exemplary terms that may be used throughout this disclosure: Both the singular and plural forms of all words are within the scope of each meaning.

[0019] As used herein, a "component" may be defined as a portion of hardware, a portion of software, or a combination thereof. A portion of hardware includes at least a processor and a portion of memory, which includes instructions for execution. A component may be associated with an apparatus.

[0020] As used herein, "logic," which is synonymous with "circuitry," includes, but is not limited to, hardware, firmware, software, and / or combinations of each for performing one or more functions or one or more operations. For example, based on a desired application or need, logic may include discrete logic such as a software controlled microprocessor, an application specific integrated circuit (ASIC), or other programmed logic device and / or controller. Logic may also be embodied entirely as software.

[0021] As used herein, a "processor" includes, but is not limited to, one or more of substantially any number of processor systems, such as microprocessors, microcontrollers, central processing units (CPUs), and digital signal processors (DSPs), in any combination, or stand-alone processors. A processor may be associated with various other circuits that support the operation of the processor, such as random access memory (RAM), read-only memory (ROM), programmable read-only memory (PROM), erasable programmable read-only memory (EPROM), clocks, decoders, memory controllers, or interrupt controllers. These support circuits may be internal or external to the processor or its associated electronic package. The support circuits are in operative communication with the processor. The support circuits are not necessarily shown in block diagrams or other diagrams as separate from the processor.

[0022] As used herein, a "signal" includes, but is not limited to, an analog or digital signal, one or more electrical signals containing one or more computer instructions, a bit or bitstream, or the like.

[0023] As used herein, "software" includes, but is not limited to, one or more computer-readable and / or executable instructions that cause a computer, processor, logic, and / or other electronic device to perform a function, operation, and / or operate in a desired manner. Instructions may be embodied in various forms, such as routines, algorithms, modules, or programs with specific applications, or may be coded from dynamically linked sources or libraries.

[0024] Although exemplary definitions are provided above, it is Applicant's intention that these and other terms be given the broadest reasonable interpretation consistent with this specification.

[0025] As described in more detail below, embodiments of the disclosed approach relate to multimodal imaging / radiation therapy devices and methods. In some embodiments, the radiation therapy delivery devices and methods can utilize an integrated low-energy radiation source for imaging and a high-energy radiation source for therapy and / or imaging in conjunction with or as part of IGRT. In particular, for example, the radiation therapy delivery devices and methods can use rotational (e.g., helical or step-and-shoot) image acquisition in conjunction with a high-energy radiation source for therapy treatment, combined with a low-energy focused radiation source for imaging at the gantry. Complementary information and advantages can be utilized from low-energy radiation sources (e.g., kV) and from high-energy radiation sources (e.g., MV). For example, the inherent contrast of soft tissues can be higher at low energy, whereas at high energy there is no depletion of primary photons through extensive or dense structures. To obtain higher quality images, KV imaging data and MV imaging data can be used to complement each other. High quality volumetric imaging can be required for visualization of targets and organs at risk (OARS) for adaptive therapy monitoring purposes and for treatment planning / treatment replanning purposes. In some embodiments, the multi-modal system may also be used for localization, motion tracking and / or characterization or correction capabilities.

[0026] Image acquisition techniques can include, but are not limited to, multiple rotational scans, which can be, for example, continuous (e.g., having a helical source trajectory about a central axis with longitudinal movement of the patient support through the gantry bore), non-continuous stop-and-reverse circumferential scans with incremental longitudinal movement of the patient support, step-and-shoot circumferential scans, etc.

[0027] In connection with various embodiments, the multimodal device focuses the radiation source, for example using a beamformer (which may include a collimator) to limit the beam, for example into a cone beam or fan beam. In one embodiment, the focused beam is combined with a gantry that rotates continuously while the patient moves, thereby allowing for helical image acquisition.

[0028] In some embodiments, the time associated with increased scan rotations to complete a high quality volumetric image can be reduced by using high gantry rates / speeds (e.g., using high speed slip ring rotation, including, e.g., up to 10 revolutions per minute (rpm), up to 20 rpm, up to 60 rpm, or more rpm), high frame rates, and / or sparse data reconstruction techniques to provide CT quality imaging on a radiation therapy delivery platform. Detectors (with various row / slice sizes, configurations, dynamic ranges, etc.), scan pitch, and / or dynamic collimation are additional features in various embodiments. This includes selectively irradiating portions of the detector and selectively defining the active readout region.

[0029] Multimodal devices and methods can provide selective and variable collimation of a radiation beam emitted by a source of radiation, including adjusting the shape of the radiation beam to irradiate less than the entire active area of ​​an associated radiation detector (e.g., a radiation detector positioned to receive radiation from an X-ray radiation source). Furthermore, by only exposing the primary region of the detector to direct radiation, the shadow region of the detector can receive only scatter. In some embodiments, scatter measurements in the shadow region of the detector (and in some embodiments, measurements in the peripheral region) can be used to evaluate scatter in the primary region of the detector receiving the projection data.

[0030] The multimodal device and method provide selective and variable detector readout area and range, including adjusting the detector readout range to limit the effective area of ​​the detector for improved readout speed. For example, less data than the available shadow area can be read out and used for scatter evaluation. Combining selective readout with beamforming allows for various optimizations of scatter fitting techniques.

[0031] With reference to Figures 1 and 2, a multimodal device 10 is shown. The multimodal device 10 may be associated with and / or incorporated into a radiation therapy device (as shown in Figure 2). It will be appreciated that it may be used for a variety of applications including, but not limited to, IGRT, for example, as an IGRT delivery system (e.g., IGRT delivery system 104 shown in Figure 3 and described in detail below). The multimodal device 10 includes a rotatable gantry system, referred to as a gantry 12, supported or otherwise housed by a support unit or housing 14. Gantry herein refers to a gantry system that includes one or more gantries (e.g., rings or C-arms) that may support one or more radiation sources and / or associated detectors as they rotate around a target. For example, in one embodiment, a first radiation source and its associated detector may be mounted to a first gantry of the gantry system, and a second radiation source and its associated detector may be mounted to a second gantry of the gantry system. In another embodiment, more than one radiation source and one or more associated detectors can be mounted on the same gantry of the gantry system. This includes, for example, when the gantry system consists of only one gantry. Various combinations of gantries, radiation sources, and radiation detectors can be combined into various gantry system configurations for imaging and / or treating the same volume within the same device. For example, kV radiation sources and MV radiation sources can be mounted on the same or different gantry of the gantry system and selectively used to image and / or treat as part of an IGRT system. When mounted on different gantries, the radiation sources can be independently rotatable. However, it is still possible to simultaneously image the same (or nearly the same) volume. The rotatable ring gantry 12 can have a 10 rpm or greater capability as described above. The rotatable gantry 12 defines a gantry bore 16 into and through which a patient can be moved and positioned for imaging and / or treatment.According to one embodiment, the rotatable gantry 12 is configured as a slip-ring gantry, providing continuous rotation of the radiation source and associated radiation detector(s) while providing sufficient bandwidth for high quality imaging data received by the detector(s). The slip-ring gantry can eliminate gantry rotation in alternating directions for winding and unwinding cables carrying power and signals associated with the device. Such a configuration allows continuous helical tomography, including CBCT, even when incorporated into an IGRT system. As mentioned above, the main problem with single rotation CBCT is insufficient sampling in all slices except the central slice (the slice containing the rotation). This problem can be overcome by cone beam imaging of a helical trajectory.

[0032] The patient support 18 is positioned adjacent to the rotatable gantry 12 and is configured to support a patient for longitudinal movement into and within the rotatable gantry 12, typically in a horizontal position. The patient support 18 can move the patient, for example, in a direction perpendicular to the plane of rotation of the gantry 12 (along or parallel to the axis of rotation of the gantry 12). The patient support 18 can be operatively coupled to a patient support controller for controlling the movement of the patient and the patient support 18. The patient support controller can be synchronized with the rotatable gantry 12 and the radiation source attached to the rotating gantry for rotation about the patient's longitudinal axis according to a commanded imaging and / or treatment plan. The patient support can also be moved up and down and left and right within a limited range when the patient support is within the bore 16 to adjust the patient position for optimal treatment. As viewed from the front of the gantry 12, axes x, y and z are indicated. The x-axis is horizontal and points to the right, the y-axis points into the gantry plane, and the z-axis is vertical and points up. The x-, y-, and z-axes follow the right-hand rule.

[0033] As shown in FIG. 2, the multimodal device 10 includes a low energy radiation source (e.g., kV) 30 coupled to or otherwise supported by the rotatable gantry 12. In this embodiment, the low energy radiation source 30 is an imaging radiation source that emits a radiation beam (generally shown as 32) for generating high quality images. In this embodiment, the imaging radiation source is an X-ray source 30 that is configured as a kilovoltage (kV) source (e.g., a medical X-ray source having an energy level ranging from about 20 kV to about 150 kV). In one embodiment, the kV source of radiation includes a kiloelectron volt peak photon energy (keV) of up to 150 keV. The imaging radiation source can be any type of transmission source suitable for imaging. For example, the imaging radiation source may be, for example, an X-ray source (including those for CT) or other methods that generate photons with sufficient energy and flux (e.g., a gamma ray source (e.g., Cobalt-57, energy peak at 122 keV), an X-ray fluorescence source (e.g., a Pb k-ray passing fluorescence source, two peaks at about 70 keV and about 82 keV), etc.). References herein to X-ray, X-ray imaging, X-ray imaging sources, etc. are exemplary for certain embodiments. Other imaging transmission sources may be used interchangeably in various other embodiments. An X-ray detector 34 (e.g., a two-dimensional flat detector or a curved detector) may be coupled to or otherwise supported by the rotatable gantry 12. The X-ray detector 34 is positioned to receive radiation from the X-ray source 30 and is rotatable in conjunction with the X-ray source 30.

[0034] It will be appreciated that the X-ray detector 34 may take on numerous configurations without departing from the scope of the disclosed techniques. As illustrated in FIG. 2, the X-ray detector 34 may be configured as a flat panel detector (e.g., a multi-slice flat panel detector). According to another exemplary embodiment, the X-ray detector 34 may be configured as a curved detector. The detector 34 may detect or measure the amount of unattenuated radiation. Thus, it is possible to infer what was actually attenuated by the patient or the associated patient ROI (compared to that originally generated). The detector 34 may detect or otherwise collect attenuation data from different angles as the low energy radiation source 30 rotates around and emits radiation to the patient.

[0035] Although FIGS. 1 and 2 depict a multimodal device 10 having a radiation source 30 mounted on a ring gantry 12, other embodiments may include other types of rotatable imaging devices, including, for example, C-arm gantry and robotic arm based systems. In a gantry based system, the gantry rotates the imaging radiation source 30 around an axis passing through the isocenter. The gantry based system includes a C-arm gantry, in which the imaging radiation source 30 is mounted in a cantilever-like manner and rotates around an axis passing through the isocenter. The gantry based system further includes a ring gantry, for example the rotatable gantry 12, which generally has an annular shape in which the patient's body extends through the bore of the ring / toroid. Also, the imaging radiation source 30 is mounted on the ring circumference and rotates around an axis passing through the isocenter. In some embodiments, the gantry 12 rotates continuously. In other embodiments, the gantry 12 utilizes a cable based system that rotates and counter-rotates repeatedly.

[0036] A collimator or beamformer assembly (generally shown as 36) is positioned relative to the x-ray source 30 to selectively control and adjust the shape of the radiation beam 32 emitted by the x-ray source 30 to selectively irradiate locations or areas of the active area of ​​the x-ray detector 34. The beamformer can also control how the radiation beam 32 is positioned on the x-ray detector 34. In one embodiment, the beamformer 36 may have a single degree / dimension of motion (e.g., to create thinner or thicker slits). In another embodiment, the beamformer 36 may have two degrees / dimensions of motion (e.g., to create variously sized rectangles). In other embodiments, the beamformer 36 may have the capability of a variety of other dynamically controlled shapes, including, for example, a parallelogram. All of these shapes may be dynamically adjusted during a scan. In some embodiments, blocking portions of the beamformer may be rotated and / or translated.

[0037] The beamformer 36 can be controlled to dynamically adjust the shape of the radiation beam 32 emitted by the x-ray source 30 in many geometries, including but not limited to fan beams or cone beams having low beam thicknesses (widths) as well as those including single row detectors or multi-row detectors (which may only be a fraction of the active area of ​​the detector). In various embodiments, the beam thickness may illuminate several centimeters of the active area of ​​a larger detector. For example, of a 5-6 centimeter detector, 3-4 centimeters (measured in the long direction of the detector face) may be selectively illuminated with imaging radiation 32. In this embodiment, 3-4 centimeters of projection image data may be captured using approximately 1-2 centimeters of non-illuminated detector area on one or each side, which may be used to capture scatter data with respective readings, as described below.

[0038] In other embodiments, a majority of the active detector may be selectively exposed to imaging radiation. For example, in some embodiments, the beam thickness may be reduced to about 2 centimeters, about 1 centimeter, less than 1 centimeter, or a similar size range. This includes smaller detectors. In other embodiments, the beam thickness may be increased to about 4 centimeters, about 5 centimeters, more than 5 centimeters, or a similar size range. This includes larger detectors. In various embodiments, the ratio of illumination to active detector area may be 30-90%, or 50-75%. In other embodiments, the ratio of illumination to active detector area may be 60-70%, although various other illumination area and active area sizes or ratios of illumination to active detector area may be suitable in other embodiments. The beam and detector may be configured such that the shadow area (active but not directly exposed to radiation) of the detector is sufficient to capture scatter data beyond the edge area.

[0039] Various embodiments may include optimizing the features that control the selective illumination of the detector (e.g., beam size, beam / aperture center, collimation, collimation, pitch, detector readout range, detector readout center, etc.) so that measurement data is sufficient for primary (illuminated) and shadow regions, but also optimized for speed and dose control. The shape / position of the beamformer 36 and the readout range of the detector 34 may be controlled so that the radiation beam 32 from the X-ray source 30 ranges an equivalent or smaller X-ray detector 34 based on the particular imaging task and scatter evaluation process being performed, including, for example, a combination of narrow and wide FOV scans. The instrument 10 has the capability of acquiring both single rotation cone beam images, and wide and narrow beam angle cone beam images, helical or otherwise.

[0040] The beamformer 36 may be configured in a variety of ways that allow the beamformer 36 to adjust the shape of the radiation beam 32 emitted by the x-ray source 30. For example, the beamformer 36 may be configured to include a series of jaws or other suitable members that define and selectively adjust the size of an aperture through which the radiation beam from the x-ray source 30 may pass in a focused manner. In accordance with one exemplary configuration, the beamformer 36 may include upper and lower jaws that are movable in different directions (e.g., parallel directions) to adjust the size of the aperture through which the radiation beam from the x-ray source 30 passes, and also adjust the position of the beam 32 relative to the patient to irradiate only a portion of the patient being imaged for optimized imaging and minimized patient dose.

[0041] According to one embodiment, the shape of the radiation beam 32 from the X-ray source 30 may be altered during image acquisition. Stated differently, according to one exemplary embodiment, the leaf position and / or aperture width of the beamformer 36 may be adjusted before or during a scan. For example, according to one embodiment, the beamformer 36 may be selectively controlled and dynamically adjusted during rotation of the X-ray source 30 such that the radiation beam 32 has a shape with sufficient primary / shadow regions and is adjusted to include only the subject of interest (e.g., the prostate) during imaging. The shape of the radiation beam 32 emitted by the X-ray source 30 may be altered during or after a scan depending on the desired image acquisition. This may be based on imaging feedback and / or therapeutic feedback, as described in more detail below.

[0042] As shown in FIG. 2, the multimodal device 10 may be integrated with a radiation therapy device including a high energy radiation source (e.g., MV) 20 coupled to or otherwise supported by the rotatable gantry 12. According to one embodiment, the high energy radiation source 20 is configured as a therapeutic radiation source, such as a high energy radiation source used to treat a tumor inside a patient within a region of interest. In other embodiments, the high energy radiation source 20 is also configured as or at least utilized as an imaging radiation source. It will be appreciated that the therapeutic radiation source may be a high energy X-ray beam (e.g., MV X-ray beam), and / or a high energy particle beam (e.g., an electron beam, a photon beam, or a beam of heavy ions such as carbon) or another suitable form of high energy radiation. In one embodiment, the high energy radiation source 20 includes a megaelectron volt peak photon energy (MeV) of 1 MeV or greater. In one embodiment, the high energy X-ray beam has an average energy greater than 0.8 MeV. In another embodiment, the high energy X-ray beam has an average energy greater than 0.2 MeV. In another embodiment, the high energy x-ray beam has an average energy greater than 150 keV. Generally, the high energy radiation source 20 has a higher energy level (e.g., peak and / or average) than the low energy radiation source 30.

[0043] In one embodiment, the high energy radiation source 20 is a LINAC that generates therapeutic radiation (e.g., MV), and the imaging system includes a separate low energy radiation source 30 that generates relatively low intensity, low energy imaging radiation (e.g., kV). In other embodiments, the therapeutic radiation source 20 may be a radioisotope, such as Co-60, that may typically have an energy greater than 1 MeV. The high energy radiation source 20 is capable of emitting one or more radiation beams (generally indicated by 22) to a region of interest (ROI) within a patient supported on a patient support 18 according to a treatment plan.

[0044] In various embodiments, the high-energy radiation source 20 is utilized as a therapeutic radiation source and an imaging radiation source. As described in detail below, the radiation sources 20, 30 may be used in conjunction with one another to provide high quality and better utilization images. References herein to the therapeutic radiation source 20 are intended to distinguish between the high-energy radiation source 20 and the low-energy radiation source 30, which may be used only for imaging. However, references to the therapeutic radiation source 20 include embodiments in which the therapeutic radiation source 20 (high-energy radiation source) may be utilized for treatment and / or imaging. In other embodiments, at least one additional radiation source may be coupled to the rotatable gantry 12 and operated to acquire projection data at a peak photon energy other than the peak photon energy of the radiation sources 20, 30.

[0045] The detector 24 may be coupled to or otherwise supported by the rotatable gantry 12 and positioned to receive radiation 22 from the therapeutic radiation source 20. The detector 24 may detect or measure the amount of unattenuated radiation. Thus, it is possible to infer what was actually attenuated by the patient or the associated patient ROI (compared to that originally generated). The detector 24 may detect or otherwise collect attenuation data from different angles as the therapeutic radiation source 20 rotates around and emits radiation to the patient.

[0046] It will be understood that the therapeutic radiation source 20 may include or otherwise be associated with a beamformer or collimator. The beamformer associated with the therapeutic radiation source 20 may be configured in many ways, similar to the beamformer 36 for the imaging source 30. For example, the beamformer may be configured as a multi-leaf collimator (MLC). This may include a plurality of interdigitated leaves operable to move to one or more positions between a minimally open or closed position and a maximally open position. It will be understood that the leaves may be moved to desired positions to obtain a desired shape of the radiation beam emitted by the radiation source. In one embodiment, the MLC allows for sub-millimeter targeting accuracy.

[0047] The therapeutic radiation source 20 may be mounted, configured, and / or moved in the same plane as the imaging source 30 or in a different plane (offset). In some embodiments, the scattering caused by simultaneous activation of the radiation sources 20, 30 may be gradually reduced by offsetting the emission plane. In other embodiments, scattering can be avoided by interleaving the activations. For example, for simultaneous multimodal imaging, the acquisition may be simultaneous and not have simultaneous individual pulses. In another embodiment, the use of shadow-based scatter correction may be used to address issues such as MV scattering in kV detectors.

[0048] When integrated with a radiation therapy machine, the multimodal device 10 can provide images that are used to set up (e.g., align and / or register), plan and / or manage the radiation delivery procedure (treatment). A typical set up is accomplished by comparing the current (in-treatment) image with pre-treatment image information. Pre-treatment image information may include, for example, CT data, cone-beam CT data, MRI data, PET data, or 3D rotational angiography (3DRA) data and / or any information obtained from the devices mentioned above or other imaging diagnostic modalities. In some embodiments, the multimodal device 10 may track the movement of the patient, target or ROI during treatment.

[0049] The reconstruction processor 40 may be operatively coupled to the detector 24 and / or the detector 34. In one embodiment, the reconstruction processor 40 is configured to generate patient images based on radiation from the radiation sources 20, 30 received by the detectors 24, 34. It will be understood that the reconstruction processor 40 may be configured to be used to perform methods described more fully below. The apparatus 10 may also include a memory 44 suitable for storing information including, but not limited to, processing and reconstruction algorithms and software, imaging parameters, image data (e.g., planning images) from prior or otherwise pre-acquired images, treatment plans, and the like.

[0050] The multimodal device 10 may include an operator / user interface 48, in which an operator of the device 10 may interact with or otherwise control the device 10, provide input related to a scan or imaging parameters, and the like. The operator interface 48 may include any suitable input device, such as a keyboard, mouse, voice-activated controller, and the like. The device 10 may also include a display 52 or other human readable element to provide output to an operator of the device 10. For example, the display 52 may enable the operator to observe reconstructed patient images and other information related to the operation of the device 10, such as imaging or scan parameters.

[0051] As shown in FIG. 2, the multimodal device 10 includes a controller (generally shown as 60) operatively coupled to one or more components of the device 10. The controller 60 controls the overall function and operation of the device 10, including providing power and timing signals to the x-ray source 30 and / or therapeutic radiation source 20, as well as a gantry motor controller that controls the rotational speed and position of the rotatable gantry 12. It will be appreciated that the controller 60 can encompass one or more of a patient support controller, a gantry controller, a controller coupled to the therapeutic radiation source 20 and / or x-ray source 30, a beamformer controller, a controller coupled to the detector 24 and / or x-ray detector 34, etc. In one embodiment, the controller 60 is a system controller capable of controlling other components, devices and / or controllers.

[0052] In various embodiments, the reconstruction processor 40, the operator interface 48, the display 52, the controller 60 and / or other components may be combined into one or more components or devices.

[0053] The device 10 may include various components, logic, and software. In one embodiment, the controller 60 includes a processor, memory, and software. By way of example and not limitation, the multimodal device and / or radiation therapy system may include various other devices and components (e.g., gantry, radiation source, collimator, detector, controller, power supply, patient support, among others) capable of performing one or more routines or steps related to imaging and / or IGRT for a particular application. Routines may include imaging, image-based pre-delivery steps, and / or treatment delivery including settings, configurations, and / or positions (e.g., paths / trajectories) of individual devices, which may be stored in memory. Furthermore, one or more controllers may directly or indirectly control one or more devices and / or components according to one or more routines or processes stored in the memory. An example of direct control is the setting of various radiation source or collimator parameters (power, speed, position, timing, adjustment, etc.) related to imaging or treatment. An example of indirect control is the communication of positions, paths, speeds, etc. to a controller of a patient support or other peripheral devices. The hierarchy of the various controllers that may be associated with the device may be arranged in any suitable manner to convey appropriate commands and / or information to the desired devices and components.

[0054] In addition, those skilled in the art will appreciate that the system and method may be implemented in other computer system configurations. The illustrated aspects of the present invention may be practiced in a distributed computing environment, where certain tasks are performed by local or remote processing devices connected through a communications network. For example, in one embodiment, the reconstruction processor 40 may be associated with a separate system. In a distributed computing environment, program modules may be located in both local and remote memory storage devices. For example, a remote database, a local database, a cloud computing platform, a cloud database, or a combination thereof may be utilized with the device 10.

[0055] The multimodal device 10 can utilize an exemplary environment for implementing various aspects of the present invention, including a computer. The computer includes a controller 60 (including a processor and memory, which may be memory 44, for example) and a system bus. The system bus can couple to system components, including but not limited to memory to the processor, and can communicate with other systems, controllers, components, devices, and processors. The memory can include read-only memory (ROM), random access memory (RAM), hard drives, flash drives, and other forms of computer-readable media. The memory can store various software, including routines and parameters, and data, which may include, for example, a treatment plan.

[0056] The therapeutic radiation source 20 and / or the X-ray source 30 may be operably coupled to a controller 60 configured to control the relative operation of the therapeutic radiation source 20 and the X-ray source 30. For example, the X-ray source 30 may be controlled by and operated simultaneously with the therapeutic radiation source 20. Additionally or alternatively, the X-ray source 30 may be controlled by and operated sequentially with the therapeutic radiation source 20 depending on the particular treatment and / or imaging plan being performed. For example, in various embodiments, the radiation sources 20, 30 may be operated such that measured projection data from the radiation sources 20, 30 are acquired simultaneously (or essentially / nearly (to some degree) simultaneously, e.g., within about 50 ms of each other) or sequentially (e.g., separated by seconds, minutes, etc.).

[0057] It will be appreciated that the radiation source 20, 30 and the one or more detectors 24, 34 may be configured to provide rotation around the patient during imaging and / or treatment scanning in many ways. In one embodiment, the movement and irradiation of the radiation source 20, 30 may be synchronized with the longitudinal movement of the patient support 18 to provide continuous helical acquisition or scanning of patient images during treatment. In addition to continuous rotation of the radiation source 20, 30 and the one or more detectors 24, 34 (e.g., continuous and constant rotation of the gantry with a continuous patient motion speed), it will be appreciated that other variations may be used without departing from the scope of the disclosed techniques. For example, the rotatable gantry 12 and patient support may be controlled such that the gantry 12 rotates around a patient supported on the patient support in a "reciprocating" manner (e.g., alternating clockwise and counterclockwise rotations) as the support is controlled to move (at a constant or variable speed) relative to the rotatable gantry 12 (as opposed to a continuous manner, as described above). In another embodiment, continuous step-and-shoot circumferential scanning is used, where movement of the patient support 18 in the longitudinal direction (step) is alternated with scanning rotation by the rotatable gantry 12 (shoot) until the desired volume is captured. The multi-modal device 10 has the capability of performing volumetric and planar based image acquisition. For example, in various embodiments, the multi-modal device 10 can be used to acquire volumetric and / or planar images and perform associated processing, including the scatter assessment / scatter correction methods described below.

[0058] Various other types of radiation source and / or patient support movements may be used to obtain relative motion of the radiation source and the patient for generation of projection data. Non-continuous motion of the radiation source and / or patient support, continuous but variable / non-constant (including linear and non-linear) movements, velocities, and / or trajectories, etc., and combinations thereof, may be used, including in combination with various embodiments of the apparatus 10 described above.

[0059] In one embodiment, the rotational speed of the gantry 12, the speed of the patient support 18, the beamformer geometry, and / or the detector readings may all be constant during image acquisition. In other embodiments, one or more of these variables may change dynamically during image acquisition and / or treatment. The rotational speed of the gantry 12, the speed of the patient support 18, the beamformer geometry, and / or the detector readings may be altered to balance different factors, including, for example, image quality, image acquisition time, dose, workflow, etc.

[0060] In other embodiments, these features are combined with one or more other image-based actions or procedures, including, for example, patient setup, adaptive therapy monitoring, therapy planning, and the like.

[0061] 3 illustrates an exemplary radiation treatment environment 300. The radiation treatment environment 300 includes a reference imaging system 102 and an IGRT system 104. The IGRT system 104 may include, for example, the multimodal device 10 and its various components and devices described above.

[0062] In one embodiment, the reference imaging system 102 may include a high-precision volumetric imaging system, such as a CT system or an MRI system. In terms of cost and workflow considerations in many clinical environments, the reference imaging system 102 is a general purpose vehicle used for a variety of different purposes in a clinical or hospital environment, and is not specialized to the IGRT system 104 or environment 300. Rather, the reference imaging system 102 may be located in its own individual room or archway and is purchased, installed and / or maintained on a separate, more generalized basis from the IGRT system 104. Thus, in the embodiment of FIG. 3, the reference imaging system 102 is illustrated as being distinct from the IGRT system 104. In other embodiments, the reference imaging system 102 may be considered an integral component of the IGRT system 104. For example, the multimodal device 10 has the capability to function as the reference imaging system 102 and the IGRT system 104.

[0063] In this embodiment, the IGRT system 104 comprises a high-energy radiation therapy (MV) source 108 that selectively applies high-energy X-ray therapeutic radiation to a target volume of a patient P positioned on a patient support or treatment couch TC. The MV source 108 applies the therapeutic radiation under the control of a system controller 114, and more particularly, in one embodiment, a therapeutic radiation control subsystem 128. The system controller 114 further comprises processing circuitry 120, a detector controller 122, a couch position controller 124, and a kV radiation controller 126, each programmed and configured to achieve one or more functions further described herein. One or more imaging (kV) radiation sources 110 selectively emit relatively low-energy X-ray imaging radiation under the control of the kV radiation controller 126, which is captured by one or more detectors 112. The one or more detectors 112 can capture the high-energy X-ray therapeutic radiation from the MV source 108 propagated through the target volume.

[0064] Each kV radiation source 110 and MV radiation source 108 is dynamically movable and therefore has a precisely measurable and / or precisely determinable geometry relative to the (x, y, z) coordinate system of the IGRT system 104 and / or treatment room.

[0065] The couch positioner 130 can be actuated by the couch position controller 124 to position the couch TC. In some embodiments, the non-X-ray based position sensing system 134 detects the position and / or movement of one or more external markers strategically attached to the patient and / or the position and / or movement of the patient's skin surface itself using one or more methods that do not involve ionizing radiation, such as optical-based or ultrasound-based methods. The IGRT system 104 further includes an operator workstation 116 and a treatment planning system 118.

[0066] In typical clinical practice, treatment planning is performed on pre-acquired treatment planning images or pre-image data 106 generated by a reference imaging system 102. The pre-acquired treatment planning images 106 are often high-resolution three-dimensional CT images acquired substantially in advance (e.g., 1-2 days prior) of one or more radiation treatments that the patient will receive. In contrast to the (x, y, z) treatment room coordinate system illustrated for the treatment room of the IGRT system 104, there is generally no pre-existing or inherent alignment or registration between the treatment planning image 106 coordinate system and the treatment room coordinate system, as shown in FIG. 3 by illustrating the (i, j, k) coordinate system of the pre-acquired treatment planning image 106. During the treatment planning process, the physician typically establishes a coordinate system in the treatment planning image (e.g., i, j, k in the treatment planning image 106). This may also be referred to herein as the planning image coordinate system or planning image reference frame. The radiation treatment plan is developed in a planning image coordinate system which determines the various orientations, sizes, durations, etc. of the high energy therapeutic radiation beams applied by the MV source 108 during each treatment session. Accurate delivery of the therapeutic radiation to the target requires alignment of the treatment room coordinate system with the planning image coordinate system, since the entire delivery and tracking system (if present) is calibrated to the treatment room coordinate system. It will be appreciated that this alignment does not need to be precise and couch adjustments or beam delivery adjustments can be used to account for offsets in the alignment between the two coordinate systems.

[0067] In one embodiment, immediately prior to each treatment time, an image-based pre-delivery step may be performed under image guidance by the kV imaging radiation source 110, including according to one or more embodiments further described herein below. For example, the patient may be physically positioned or aligned such that the planning image coordinate system (defined by the physician during treatment planning, for example but not limited to, on a CT image or planning image) is positioned in initial alignment with the treatment room coordinate system, referred to herein as initial treatment alignment or initial treatment position. This alignment is commonly referred to as patient setup or patient alignment. Depending on the location of the target volume, the target volume may change position and orientation and / or undergo volume deformation due to patient movement and / or physiological cycles such as breathing. As used herein, the terms variation in alignment during treatment or variation in position during treatment are used to refer to variations in position, orientation and / or volume shape where the current state of the target volume differs from the initial treatment position alignment. Due to the known relationship between the treatment planning coordinate system and the treatment room coordinate system, the term variation in registration during treatment can also be used to refer to variations in position, orientation, or volume shape where the current state of the target volume differs from that of the treatment planning coordinate system. More generally, the term initial treatment registration or initial treatment position, as used herein, refers to a particular physical posture or arrangement (including position, orientation, and volume shape) of a patient's body parts during patient setup, at the start of treatment.

[0068] A non-X-ray based position sensing system 134 may also be provided. This may include, for example, an external marker fixed in some manner to the patient's chest that moves in response to breathing. This may precisely determine the target location. Other mechanisms for monitoring breathing may also be used. Other non-respiratory position sensing systems 134 may also be used, including, for example, quasi-static position positioning, EKG for cardiac gating, etc. The system 134 may correlate the movement of the external marker with the movement of the target, as determined, for example, by monocular or stereoscopic X-ray projection. The non-X-ray based position sensing system 134 thus allows the system controller 114 to monitor the movement of the external marker and use a correlation model to precisely predict in real time (e.g., ∼60 Hz) where the target will be located and direct the treatment beam to the target. As treatment of the moving target progresses, additional X-ray images may be acquired and used to validate and update the correlation model.

[0069] As used herein, "registration" of medical images refers to the determination of mathematical relationships of corresponding anatomical or other (e.g., fiducial) features occurring in those medical images. Registration can include, but is not limited to, the determination of one or more spatial transformations that, when applied to one or both of the medical images, cause overlay of corresponding anatomical features. The spatial transformations can include rigid and / or deformable transformations. Also, differences in the coordinate systems or reference frames can be taken into account if the medical images are from different coordinate systems or reference frames. If the medical images are not acquired using the same imaging system and are not acquired simultaneously, the registration process can include, but is not limited to, both the determination of a first transformation that takes into account differences between the imaging modalities, imaging geometries, and / or reference frames of the different imaging systems, and the determination of a second transformation that takes into account underlying anatomical differences in the body part that occurred between acquisition times (e.g., positioning differences, global translation, relative motion between different structures within the body part, global deformation, local deformation within the body part, etc.).

[0070] Image registration may be performed between the reference imaging system 102 and the IGRT delivery system 104, and / or between data and / or images derived from various diagnostic modalities of the multi-modal IGRT delivery system 104, including one or more low-energy radiation sources 110 and high-energy radiation sources 108 (and their associated detectors 112). In particular, referring back to the apparatus 10, registration may be performed between data and / or images derived from the radiation sources 20, 30 and the detectors 24, 34.

[0071] Dual source system (e.g., kV-MV) imaging, including in the context of IGRT, can address and resolve some of the issues and limitations of typical imaging systems used in these environments. In general, various improvements can be obtained by combining data acquisition from the kV subsystem with data acquisition from the MV subsystem. For example, in some embodiments, kV projection data can be used to complete MV projection data, and vice versa. In other embodiments, MV projection data can be used for ROI kV imaging. In still other embodiments, data from both diagnostic modalities can be used to complement each other. This method can be beneficial for scanning obese patients, ROI imaging, etc., due to improved image quality (e.g., reduced x-ray scatter, and thus improved soft tissue contrast).

[0072] For example, in one embodiment, projection data corresponding to a target ROI acquired using a primary imaging system can be combined with additional projection data acquired using a secondary imaging system corresponding to a region outside the scan FOV of the primary imaging system. In one embodiment, the projection data from the secondary imaging system can then be used to evaluate missing or incomplete data outside the scan FOV of the primary imaging system required for image reconstruction. For example, for a scan of an obese patient, the MV subsystem can be used to acquire a central region of the patient (truncated laterally) and the kV subsystem can be used to acquire a peripheral region of the patient. The kV projection data can then be used to assist in evaluating the missing MV projection data to improve the quality of the image reconstruction.

[0073] Several other exemplary embodiments will be described in detail below, each of which may use one or more exemplary scanning configurations.

[0074] In one embodiment, FIG. 4 shows a diagram of an exemplary multi-modal scanning configuration 400. Looking at the front of the ring gantry 410, FIG. 4 shows a high-energy radiation source 420 (e.g., MV) and a low-energy radiation source 430 (e.g., kV) mounted on the ring gantry 410. Although the radiation sources 420, 430 are shown mounted orthogonal to each other, other embodiments may include other angular relationships and additional radiation sources and / or detectors. The high-energy radiation source 420 is shown projecting radiation by a collimator or beamformer 426 to generate a radiation beam 422 that projects onto a portion of the detector 424. In this configuration, the high-energy radiation source 420 has a transaxial FOV 428. The low-energy radiation source 430 is shown projecting radiation by a beamformer 436 to generate a radiation beam 432 that projects onto a portion of the detector 434. In this configuration, the low-energy radiation source 430 has a transaxial FOV 438. Detector 434 is shown centered within its range 435. In this manner, radiation sources 420, 430 project radiation through overlapping transaxial FOVs. In this embodiment, multi-modal scanning configuration 400 exhibits a high-energy FOV 428 having a larger transaxial FOV than a low-energy FOV 438.

[0075] In another embodiment, FIG. 5 shows an illustration of an exemplary multimodal scanning configuration 500. Looking at the front of the ring gantry 410, FIG. 5 also shows a high-energy radiation source 420 and a low-energy radiation source 430 mounted orthogonally to the ring gantry 410. The high-energy radiation source 420 is shown projecting radiation by a beamformer 526 to generate a radiation beam 522 that projects to a detector 524. In this configuration, the high-energy radiation source 420 has a transaxial FOV 528. The low-energy radiation source 430 is shown projecting radiation by a beamformer 536 to generate a radiation beam 532 that projects to an offset detector 534. In this configuration, the low-energy radiation source 430 has a transaxial FOV 538 with at least 180 degrees of rotation. In this manner, the radiation sources 420, 430 also project radiation through overlapping transaxial FOVs. In this embodiment, the multi-modal scanning configuration 500 exhibits a low-energy FOV 538 that has a larger transaxial FOV than the high-energy FOV 528 .

[0076] In these and other embodiments, the multimodal system may consist of two or more sub-imaging systems, for example MV (e.g., MVCT) and kV (e.g., kVCT). The MV imaging system consists of a MV radiation source (e.g., 420) and a MV radiation detector (e.g., 424), and the kV imaging system consists of a kV radiation source (e.g., 430) and a kV radiation detector (e.g., 434). Respective beamformers (e.g., 426 and / or 436) may also be included in the subsystems. The MV imaging system and the kV imaging system are not necessarily coplanar. For example, a short longitudinal distance between the two subsystems may be tolerated. The kV system may be approximately 90 degrees away from the MV system.

[0077] In some embodiments, the MV detector can be fixed, resulting in a fixed scan FOV, while the kV detector is translatable along a line in the gantry plane such that the corresponding scan FOV of the kV imaging system is adaptable, as shown in Figures 4-5 above. Such an adaptable scan FOV can be implemented with an operable beamformer to avoid unnecessary x-ray dose to the patient. The system may also include other filters pre-patient and post-patient.

[0078] For example, various factors can be used to control the FOV (e.g., transaxial and axial) of each of the radiation sources including beamformer configuration, radiation source angle, detector position, etc. In some embodiments, the radiation sources 420, 430 may be physically offset longitudinally (along the y-axis) and may scan the patient at different times (offset in time).

[0079] In one embodiment, Figure 6 shows an illustration of an exemplary multi-modal scanning configuration 600 projecting through an exemplary large patient 605 in a transaxial plane 615. This embodiment may be applicable for imaging large patients that extend beyond the transaxial FOV of the MV system and / or to reduce x-ray dose to the patient. Looking at the front of the ring gantry 610, Figure 6 also shows an MV radiation source 620 and a kV radiation source 630 mounted orthogonally to the ring gantry 610.

[0080] MV radiation source 620 is shown projecting radiation through a beamformer 626 to generate a radiation beam 622 that projects onto a detector 624. In this configuration, the MV radiation source 620 has a transaxial FOV in a central region 627 bounded by 628.

[0081] A kV radiation source 630 is shown projecting radiation through a beamformer 636 to generate a radiation beam 632 that projects onto an offset detector 634. The flat panel detector 634 is shown within its range 635 and offset with a non-irradiated region 633 (due to the beamformer 636). In this configuration, the kV radiation source 630 has a transaxial FOV in a peripheral region 637 bounded by 638 and 639 with at least 180 degrees of rotation.

[0082] In this manner, radiation sources 620, 630 project radiation through adjacent or overlapping transaxial FOVs (i.e., where central region 627 and peripheral region 637 overlap). In some embodiments, a bowtie filter (not shown) may be utilized to allow for a larger dynamic range of detector 634.

[0083] 7 shows another illustration of an exemplary multi-modal scanning configuration 600 projecting through an exemplary large patient 605 in an axial (longitudinal) plane 715 with superimposed views of the radiation system. Looking at the side of a ring gantry (not shown), FIG. 7 shows the positions of an MV radiation source 620 and a kV radiation source 630 rotated and superimposed in the same axial plane 715. The radiation sources 620, 630 are not necessarily mounted in the same plane, and are not typically mounted relative to one another (e.g., they may be mounted on a gantry system 90 degrees apart), but are shown superimposed in FIG. 7 to show an exemplary overlap of the respective views and features. Other embodiments can include other angular relationships as well as additional radiation sources and / or detectors.

[0084] The MV radiation source 620 is shown projecting radiation by a beamformer 626 to generate a radiation beam 622 that projects onto a detector 624. In this configuration, the MV radiation source 620 has a body axial FOV 727. The kV radiation source 630 is shown projecting radiation by a beamformer 636 to generate a radiation beam 632 that projects onto a portion of the detector 634. In this configuration, the kV radiation source 630 has a body axial FOV 737. The detector 634 is shown with a shadow region 633 that is blocked from direct radiation by the beamformer 636. The detector may have a shadow region in the axial and / or transaxial directions. In this manner, the radiation sources 620, 630 project radiation through overlapping axial FOVs.

[0085] Figure 8 shows a zoomed-in portion 800 of the axial plane 715 shown in Figure 7. The radiation beams 622, 632 are shown passing through the patient 605. The MV system axial FOV region 727 is bounded by 828 and the kV system axial FOV region 737 is bounded by 838 and provides overlapping imaging data, where the kV system axial FOV 737 provides imaging data beyond the MV system axial FOV 727, shown as region 840.

[0086] As mentioned above, this configuration can be designed for large field of view (LFOV) MV imaging, including imaging of large or obese patients. Both the MV and kV subsystems of a multimodal system can be used. In one embodiment, the MV system is used to acquire projection data corresponding to a central region 627 of the scanned patient 605, as shown in the transaxial plane 615 of FIG. 6. The MV projection data is truncated due to the large size of the patient 605 and the limited transaxial FOV 628 of the MV detector 624. The kV system is used to acquire projection data corresponding to a peripheral region 637 of the scanned patient 605. The kV projection data is also truncated inside a boundary 639 that is within the boundary 628 of the central region 627. It is required that there is an overlap between the kV projection data and the MV projection data at the same angular positions (which may correspond to different timings). The design of the two subsystems is also shown in the transaxial (longitudinal) direction in FIGS. 7-8.

[0087] The following flow charts and block diagrams illustrate example configurations and methodologies associated with the multimodal radiation system described above. The example methodologies may be implemented in logic, software, hardware, or combinations thereof. Additionally, although the procedures and methods are depicted in sequence, the blocks may be executed in different orders, including serial and / or parallel. Furthermore, additional or fewer steps may be used.

[0088] FIG. 9 is a flow chart depicting an exemplary method 900 of combining scan data from multiple radiological diagnostic modalities, such as those listed above, to approximate missing MV projection data in peripheral regions using kV projection data. In step 910, the method 900 determines a scan configuration, including a scan design for each diagnostic modality of the multimodal system. In step 920, an MV scan of the central region is performed. In step 930, a kV scan of the peripheral region is performed. As described above, each scan generates MV scan data 922 (truncated in the peripheral region) and kV scan data 932 (truncated in the central region). Then, in step 940, the method 900 uses or combines the kV scan data 932 to complete the MV scan data 922 to form a complete MV projection or untruncated MV data 942. Then, in step 950, the method 900 processes the untruncated MV data 942, for example, to reconstruct an MV image. In step 960, the reconstructed MV image can be output.

[0089] In another embodiment, Figure 10 shows an illustration of an exemplary multi-modal scanning configuration 1000 projecting through an exemplary patient 1005 in a transaxial plane 1015. This embodiment may be applicable for imaging to reduce x-ray dose to the patient, reduce x-ray scatter, and / or improve kV image quality, particularly for visualization of soft tissues, for example. Looking at the front of the ring gantry 1010, Figure 10 also shows an MV radiation source 1020 and a kV radiation source 1030 mounted orthogonally to the ring gantry 1010.

[0090] The MV radiation source 1020 is shown generating a radiation beam 1022 that projects radiation through a beamformer 1026 and onto a detector 1024. The detector 1024 is shown with a shadow region 1023 that is blocked from direct radiation by the beamformer 1026. In this configuration, the MV radiation source 1020 has a transaxial FOV in an intermediate region 1027 bounded by 1028 and 1029. FIG. 11 shows an illustration of the MV subsystem 1100 of the exemplary multi-modal scanning configuration 1000.

[0091] A kV radiation source 1030 is shown to generate one or more radiation beams 1032 that project radiation through a two aperture beamformer 1036 and onto offset detector portions 1034 and 1044. A flat panel detector is shown within its range 1035 and offset with a non-irradiated region 1033 (due to the beamformer 1036). In this configuration, the kV radiation source 1030 has a transaxial FOV with respect to the portion of interest and at least 180 degrees of rotation in a central region 1047 bounded by 1048 and a peripheral region 1037 bounded by 1038 and 1039. In some embodiments, the central region 1047 can include a target region of the patient. FIG. 12 illustrates an illustration of a kV subsystem 1200 of an exemplary multimodal scanning configuration 1000. This embodiment includes both a kV central region 1047 and a kV peripheral region, although other embodiments need not include both. For example, another embodiment includes only the central region 1047 (having one kV aperture).

[0092] In this manner, radiation sources 1020, 1030 project radiation through adjacent or overlapping transaxial FOVs (i.e., where MV intermediate region 1027 overlaps with kV peripheral region 1037 and kV central region 1047). Figure 13 shows an illustration of the MV FOV intermediate region 1027 as well as the kV FOV peripheral region 1037 and FOV central region 1047 created by multimodal scanning configuration 1000 in an overlap diagram 1300. In particular, the MV FOV intermediate region 1027 and the kV FOV central region 1047 overlap in region 1310 (shaded portion), and the MV FOV intermediate region 1027 and the kV FOV peripheral region 1037 overlap in region 1312 (shaded portion).

[0093] As described above, this configuration can be designed for kV region of interest (ROI) imaging, including reducing x-ray dose, reducing x-ray scatter, and / or improving kV image quality. In other embodiments, a similar configuration can be used for MV ROI imaging. Both MV and kV subsystems of a multimodal system can be used. In one embodiment, as shown in the transaxial plane 1015 of FIG. 10 and FIG. 12, the kV subsystem 1200 provides two scan FOVs 1037, 1047. The central region 1047 is donut-shaped with the peripheral region 1037 located at the periphery and the central region 1047 located at the center. The central region 1047 may be a target ROI for the patient. Meanwhile, the peripheral region 1037 may be for auxiliary purposes. Since the two scan FOVs 1037, 1047 are truncated, projection data between the two scan FOVs 1037, 1047 required for accurate image reconstruction is missing. In one embodiment, the evaluation of these missing kV data may be based on available kV projection data, for example, by interpolation. The kV projection data of the surrounding region 1037 is important for the evaluation of this missing data because it provides range information for the patient, although, as described above, in one more simplified ROI embodiment, the surrounding region 1037 is not used.

[0094] In this embodiment, the portion of the kV beamformer 1036 corresponding to the peripheral scan FOV 1037 may be adaptable to the patient geometry to reduce dose (which may include the use of prior CT data). MV projection data may or may not be required depending on the application. In one embodiment, as shown in the transaxial plane 1015 of Figures 10 and 11, the MV subsystem 1100 may provide projection data within the scan FOV 1027 that may correct or complement the kV scan FOVs 1037, 1047 to provide information for better kV data completion. Note that a bowtie filter may be included to allow for a larger dynamic range of the flat panel detector.

[0095] FIG. 14 is a flow chart depicting an exemplary method 1400 of combining scan data from multiple radiological modalities as described above to approximate missing kV projection data in the intermediate region using MV projection data. In step 1410, the method 1400 determines a scan configuration, including a scan design for each modality of the multimodal system. In step 1420, an MV scan of the intermediate region is performed. In step 1430, a kV scan of the peripheral region is performed (for embodiments including the peripheral region). In step 1440, a kV scan of the central region is performed. As described above, each scan generates MV intermediate scan data 1422 (truncated at the peripheral and central regions), kV peripheral scan data 1432 (truncated at the intermediate region), and kV central scan data 1442 (truncated at the intermediate region). KV projection data is missing between the kV peripheral and central regions. Next, in step 1450, the method 1500 uses or combines the MV scan data 1422 to complete the kV scan data 1432, 1442 to form a complete kV projection or untruncated MV data 1452. Step 1450 may also include interpolation of the kV scan data 1432, 1442 (e.g., optimized with the MV scan data 1422), prior CT data (pCT) if available, etc., in addition to or instead of using the MV scan data 1422. Registration, rebinning, and / or other processes (e.g., normalization of attenuation constants, scatter correction, scaling, etc.) may also be involved in step 1450. In embodiments without a kV peripheral scan 1430, the kV data 1432 is unavailable and is not used. Next, in step 1460, the method 1400 processes the untruncated kV data 1452, for example to reconstruct a kV image. In step 1470, the reconstructed kV image may be output.

[0096] In embodiments where MV scan data 1422 (e.g., via step 1420) and / or pCT data are available, they can be used in step 1450 to improve the evaluation of the missing kV data. The use of the evaluated data may be for the global filtration operator to be primarily involved in the reconstruction. In some embodiments, it may be recommended to only perform image reconstruction in the ROI region.

[0097] As described above, in some embodiments, the beamformer 1036 portion corresponding to the kV peripheral scan FOV 1037 may be adaptive to further reduce patient dose according to the patient shape. The rough patient shape can be assessed, for example, by pCT, scout view, adaptive feedback from projections, etc. In some embodiments, the beamformer 1036 portion corresponding to the central scan FOV 1047 is adaptive to non-central ROIs to provide flexibility in ROI selection. Other embodiments may use a combination of both adaptation approaches.

[0098] To provide a more accurate assessment of the missing kV projection data, the MV subsystem 1100 may be used to provide a scatter-reduced scan and / or a dose-reduced scan 1420 having a scan FOV 1027 disposed between the kV peripheral scan FOV 1037 and the central scan FOV 1047. This process (e.g., at step 1450) may involve registration, rebinning, and / or mapping between the MV data and the kV data. Available pCT data may be used to improve the accuracy of the assessment of the missing kV projection data. This process (e.g., at step 1450) may involve registration, rebinning, and / or mapping between the pCT data and the kV data.

[0099] In another embodiment, FIG. 15 shows an illustration of an exemplary multimodal scanning configuration 1500 projecting through an exemplary patient 1505 in an axial (longitudinal) plane 1515 with an overlapping view of the radiation system. This embodiment is applicable to scalable FOV (SFOV) dual energy imaging, which provides various options including, for example, SFOV configuration for IGRT. This embodiment is an example of both scalable transaxial FOV and scalable axial FOV. In general, a wider kV axial FOV allows better modeling of MV projections across finite cell dimensions. This is important for single row MV detectors, which improves slice thickness for multimodal images. Looking at the side of the ring gantry (not shown), FIG. 15 shows the positions of the MV radiation source 1520 and the kV radiation source 1530 rotated and overlapped in the same axial plane 1515. The radiation sources 1520, 1530 are not necessarily mounted in the same plane, and typically are not mounted relative to one another (e.g., they may be mounted on a gantry 90 degrees apart), but are shown superimposed in Figure 15 to show an exemplary overlap of the respective views and features. Other embodiments may include other angular relationships as well as additional radiation sources and / or detectors.

[0100] The MV radiation source 1520 is shown projecting radiation by a beamformer 1526 to generate a radiation beam 1522 that projects to a detector 1524. In this configuration, the MV radiation source 1520 has a body axis FOV 1527 bounded by 1528 at an angular position λ. During a previous rotation, the MV radiation source designated as 1520' has an adjacent body axis FOV 1527' bounded by 1528' at an angular position that is λ-2π radians (a difference of one full rotation). During a later rotation, the MV radiation source designated as 1520'' has an adjacent body axis FOV 1527'' bounded by 1528'' at an angular position that is λ+2π radians. The prime notation (') is used to indicate that a component of the system has moved or changed as compared to a non-prime form or another prime form or position. For example, "1520", "1520'" and "1520''" all refer to the MV radiation source 1520, but at different angular positions.

[0101] A kV radiation source 1530 is shown projecting radiation through a beamformer 1536 to generate a radiation beam 1532 that projects onto a portion of a detector 1534. In this configuration, the kV radiation source 1530 has an axial FOV 1537 bounded by 1538. The detector 1534 is shown with a shadow region 1533 that is blocked from direct radiation by the beamformer 1536. The detector may have a shadow region in the axial and / or transaxial directions.

[0102] In this manner, the radiation sources 1520, 1530 project radiation through overlapping axial FOVs (e.g., axial MV FOV 1527'+1527+1527''=axial kV FOV 1537). In this embodiment, the MV radiation source 1520 requires three rotations, while the kV radiation source requires one rotation to accumulate the same axial FOV width. As discussed above, the overlapping view of the radiation sources 1520, 1530 in FIG. 15 is for illustrative purposes only. The kV and MV subsystems may reach the illustrated angular positions at different times. Also, at this angular position, these subsystems may have different longitudinal positions. The kV subsystem provides a longitudinal scan FOV 1537 that is much larger than the MV subsystem FOV 1527. This provides additional time for the kV subsystem to complete a larger in-plane (transaxial) scan FOV, for example, during multiple rotations, as described below.

[0103] 16 and 17 show illustrations of an exemplary kV radiation source 1530 in a multi-modal scanning configuration 1500 projecting through an exemplary patient 1505 in a transaxial plane 1615 during different rotations.

[0104] Looking at the front of the ring gantry 1610, FIG. 16 shows a kV radiation source 1530 mounted on the ring gantry 1610 during rotation A. The kV radiation source 1530 is shown projecting radiation through a beamformer 1536, generating a radiation beam 1532 projecting onto an offset detector 1534. The flat panel detector 1534 is shown within its range 1635 and offset with a non-irradiated region 1533 (due to the beamformer 1536). The detector may have shadow regions in the axial and / or transaxial directions. In this configuration during rotation A, the kV radiation source 1530 has a transaxial FOV in a peripheral region 1537 bounded by 1538 and 1539 at least 360 degrees of rotation.

[0105] FIG. 17 shows a kV radiation source 1530 mounted on the ring gantry 1610 during rotation B. The kV radiation source 1530 is shown projecting radiation through a beamformer 1536', generating a radiation beam 1532' projecting onto an offset detector 1534. A flat panel detector 1534' is shown within its range 1635 and centered with a non-irradiated region 1533 (by the beamformer 1536'). In this configuration during rotation B, the kV radiation source 1530 has a transaxial FOV in a central region 1537' bounded by 1538'. The central region 1537' may correspond to a target ROI of the patient 1505. In embodiments where the target ROI is away from the isocenter, dynamic collimation of the beamformer 1536' is required.

[0106] In this manner, the radiation source 1530 projects radiation through adjacent or overlapping transaxial FOVs (i.e., where the peripheral region 1537 and the central region 1537' overlap). The peripheral kV scan FOV 1537 (donut shaped) corresponds to the off-center detector position 1534, while the central kV scan FOV 1537' (disk shaped) corresponds to the centered detector position 1534'. The combination of the two kV scan FOVs 1537, 1537' results in a complete, large kV scan FOV. In this embodiment, during each of rotations A and B, the kV transaxial FOVs 1537, 1537' overlap at region 1810 as shown in the overlap diagram 1800 of FIG. 18. In different embodiments, the kV radiation source 1530 can be turned on or off as the beamformer 1536 transitions between projecting onto a peripheral region 1537 in the transaxial plane 1615 of the patient 1505 and projecting onto a central region 1537'.

[0107] The transaxial views 1615, 1615' shown in Figures 16 and 17 can be matched with the axial view 1515 shown in Figure 15 at various angular positions (λ-2π, λ, λ+2π) during rotations A and B. The FOV has time-matched axial and transaxial characteristics shown separately in different perspectives of the figures. For example, the FOV 1537 of the kV radiation source 1530 simultaneously encompasses the axial characteristics shown in Figure 15 and the transaxial characteristics shown in Figures 16 and 17 during various rotations.

[0108] In this embodiment, the kV detector 1534 can be much larger in the longitudinal direction (e.g., as shown in FIG. 15) than the MV detector 1524. By using a longitudinal kV scan FOV 1537 that is much larger than the MV scan FOV 1527, the kV subsystem has more time to provide a larger in-plane (transaxial) scan FOV.

[0109] In some embodiments, an important design parameter may be how much larger the illuminated kV detector 1534 is than the smaller MV detector 1524. For example, let H be the MV detector width at isocenter. Let sH be the illuminated kV detector width at isocenter, such that it is a scalar greater than 1. In one embodiment, the criterion for determining the value of s is that at any rotation angle, 1) any point that is within the target in-plane scan FOV, and 2) any point that is visible by the MV radiation source 1520 must be visible by the kV radiation source 1530 at least once at any azimuth angle. This requirement may be achieved by combining the movement of the kV detector 1534 with the use of a dynamic beamformer 1536. In this embodiment, it is also important to ensure that the movements of the kV detector 1534 and the kV beamformer 1536 are both continuous.

[0110] 15-18 show an exemplary embodiment that meets this requirement. In this embodiment, the axial (longitudinal) kV FOV 1537 is approximately three times larger than the axial MV FOV 1527. A rotation angle (λ) is such that the currently MV illuminated portion of the object (indicated by boundary 1528) is visualized at the same azimuthal angle by the previous rotation (λ-2π), the current rotation (λ) and the next rotation (λ+2π) as shown in 1528', 1528 and 1528'', respectively. Among these three rotations, one rotation (e.g., rotation A as shown in FIG. 16) is limited to only peripheral kV scans with kV FOV 1537, and another rotation (e.g., rotation B as shown in FIG. 17) is limited to only central kV scans with kV FOV 1537'. A rotational (left) edge can be used to ensure a smooth transition between the peripheral region 1537 and the central region 1537'. This configuration 1500 can be used to provide both MV and kV projection data for the same ROI, allowing dual energy imaging for the ROI.

[0111] In this embodiment, the two kV scan FOVs 1537, 1537' shown in Figures 16-18 do not have to be acquired consecutively. A certain amount of time may be required to translate the detector from one position to the other. However, as described above, because the kV subsystem provides a much larger axial FOV 1537 than the MV subsystem FOV 1527, additional time is available for the kV subsystem to complete the larger transaxial scan FOV for the same amount of time required for a complete axial MV scan. For example, in one embodiment, in step 1-first full rotation (number of rotations 0→1.0), the first kV scan full rotation (e.g., rotation B shown in FIG. 17, with the kV beamformer focused on the central transaxial FOV) can be coincident with the first MV scan full rotation (e.g., λ-2π rotation shown in FIG. 15); in step 2-next half rotation (number of rotations 1.0→1.5), the translation of the kV beamformer and / or kV detector to the peripheral transaxial region can be coincident with the first half rotation of the second MV scan rotation (e.g., first half λ rotation shown in FIG. 15); in step 3-next full rotation (number of rotations 1.5→2.5), The second kV scan full rotation (e.g., rotation A shown in FIG. 16, with the kV beamformer focused on the peripheral transaxial FOV) can be coincident with the second half rotation of the second MV scan rotation (e.g., the second half rotation of the λ rotation shown in FIG. 15) and the first half rotation of the third MV scan rotation (e.g., the first half rotation of the λ+2π rotation shown in FIG. 15); step 4--in the next half rotation (number of rotations 2.5→3.0), the translation of the kV beamformer and / or the kV detector in the backward direction to the central transaxial region can be coincident with the second half rotation of the third MV scan rotation (e.g., the second half rotation of the λ+2π rotation shown in FIG. 15). These four steps can be repeated as a cycle. In this way, full axial and transaxial coverage can be obtained from the dual energy sources 1520, 1530 during the overlap period (e.g., during three full rotations).As noted above, the timing of kV and MV scans of the same region may be offset somewhat depending on the mounting location of the radiation sources 1520 , 1530 within the ring gantry 1610 .

[0112] 19 is a flow chart depicting an example method 1900 of combining scan data from multiple radiological diagnostic modalities, such as those listed above, to approximate missing MV and / or kV projection data based on corresponding projection data from another diagnostic modality. In step 1910, the method 1900 determines a scan configuration, including a scan design for each diagnostic modality of the multimodal system. In step 1920, an example MV scan of a central region is performed. In step 1930, an example kV scan of a peripheral region is performed. As above, each scan generates MV scan data 1922 (which may be truncated at the peripheral region) and kV scan data 1932 (which may be truncated at the central region).

[0113] In step 1940, the method 1900 determines whether the MV scan data 1922 is missing projection data. If so, in step 1950, the method 1900 completes (e.g., evaluates) the MV scan data 1922 using or combining the kV scan data 1932 to form complete MV projection data or untruncated MV data 1952. If the MV scan data 1922 is not missing projection data, the MV scan data 1922 is untruncated MV data 1952. Next, in step 1970, the method 1900 processes the untruncated MV data 1952, for example, to reconstruct an MV image. In step 1972, the reconstructed MV image may be output.

[0114] In step 1945, the method 1900 determines whether the kV scan data 1932 is missing projection data. If yes, in step 1960, the method 1900 completes (e.g., evaluates) the kV scan data 1932 using or combining the MV scan data 1922 to form complete kV projection data or non-truncated kV data 1962. If the kV scan data 1932 is not missing projection data, the kV scan data 1932 is non-truncated kV data 1962. Then, in step 1980, the method 1900 processes the non-truncated kV data 1962, for example, to reconstruct a kV image. In step 1982, the reconstructed kV image may be output. Data evaluation during method steps 1950 and / or 1960 may include registration, rebinning, mapping, and / or other processes as described above.

[0115] Method 1900 may also include step 1990 of utilizing a material inverse engine to decompose the reconstructed image into its component materials. In one embodiment, the output image or images are used for material separation within the overlap region of the kV radiation source and the transaxial FOV of the MV radiation source to obtain component material images. The component material images may then be output in step 1995.

[0116] While specific embodiments have been described, it should be understood that in other embodiments, both the transaxial FOV and the axial FOV are scalable for each radiation source of the multimodal system in various combinations (i.e., each diagnostic modality of the multimodal system can have a scalable transaxial FOV and / or axial FOV). In some embodiments, the FOVs of the same and / or different diagnostic modalities may be the same (e.g., transaxial and / or axial). Additionally, in further embodiments, the FOVs may be adjacent but non-overlapping, may have spaces between them, may be grouped such that one FOV is within another FOV without overlapping, or combinations thereof.

[0117] In some embodiments, one or more radiation sources may be used for sparse data and may utilize different resolutions, speeds, trajectories, frequencies, power levels, doses, FOVs, etc. In any case, data from two or more radiological modalities may be used in combination to improve image quality, speed, dose, workflow, treatment accuracy / precision, etc.

[0118] In various embodiments, the exemplary scanning configurations (e.g., 400, 500, 600, 1000, 1500) and methods (e.g., 900, 1400, 1900) above and those described below may be implemented using the multimodal device 10, including via the radiation treatment environment 300.

[0119] In some embodiments, the scan configuration includes a helical scan trajectory. The geometry of helical fan-beam MVCT (MVCT) acquisition can provide multiple advantages, including, for example, a wide transverse image (e.g., about 40 cm at isocenter), sufficient data for accurate and stable image reconstruction, and reduced scattering in the projection images. These features can improve the quality of the reconstructed image over the clinical state-of-the-art cone-beam MVCT. In particular, for example, these advantages are due to the fan-squeezed MV treatment / imaging beam and the fact that the MV source and detector are mounted on a continuously rotating slip-ring system that allows imaging from all directions, as described above. In operation, the system (e.g., instrument 10) can image continuously over more than 2π radians and move the source and detector in a helical trajectory with respect to the patient on the couch translating without stopping to unwind the cables or use an irregular imaging trajectory.

[0120] In various embodiments, the multimodal device 10 can include an N-tuple source and detector CT system (where N sources and N or another number of detectors are positioned such that each projection image data can be acquired simultaneously) having a source providing multi-energy (e.g., low-energy and high-energy) projection data. The use of a fan-beam imaging geometry (e.g., using a helical scan trajectory) in combination with a simultaneous multi-energy kV / MV imaging device provides the advantages described herein. Typical existing systems are limited to cone-beam imaging geometries of either kV or MV sources individually. This has significant disadvantages over fan-beam imaging geometries, as discussed above.

[0121] In various embodiments, high-energy MV fan-beam projections and low-energy kV fan-beam or cone-beam projections can be acquired in a simultaneous CT reconstruction. In some embodiments, the MV projections can be used as a priori information to correct kVCT artifacts or can be used in dual-energy CT reconstruction for quantitative imaging and material separation. Furthermore, multi-leaf collimator (MLC) modulated MV projection data is always available during treatment and can affect the kVCT reconstruction that occurs simultaneously with treatment delivery. Electron density images obtained from dual-energy reconstructions can be used for both online and offline dosimetry applications.

[0122] In some embodiments, the methods described above can be performed simultaneously or in an interleaved manner based on a preferred workflow, for example, a multi-modal scan can be performed and the resulting scan data can be utilized for two or more of the various features and advantages described above.

[0123] When using the above apparatus and methods in the projection domain, scatter correction can be applied to each projection viewpoint when each projection viewpoint is a planar image. Various embodiments can utilize different scan geometries, detector positioning (including offset detectors), and / or beamformer window shapes.

[0124] As noted above, aspects of the disclosed techniques are intended for use in conjunction with or as part of radiation therapy devices and IGRT, and may be utilized in methods utilizing multi-modal radiation sources, including integrated low-energy (e.g., kV) and high-energy (e.g., MV) sources. According to one embodiment, the image acquisition methodology may include or otherwise utilize helical source trajectory (e.g., continuous source rotation about a central axis accompanied by longitudinal translation of a patient support through a gantry bore) accompanied by high speed slip ring rotation, or full-circle scanning, for example, to provide kV CT imaging in a radiation therapy delivery platform.

[0125] It will be appreciated that in some embodiments, any potential scan time increase associated with multiple beam rotations to complete a volumetric image may be mitigated or otherwise offset by a high kV frame rate, high gantry rate, and / or sparse data reconstruction approach. It will be further appreciated that providing a selectively controllable collimator / beamformer as described above allows the system to allow the user to trade off or otherwise vary image acquisition time against image quality depending on the particular application and / or medical need. It will also be appreciated that the radiation therapy delivery device can be controlled to provide half-rotation or single-rotation cone beam CT scans (with the potential for reduced image quality due to scattering) with fast image acquisition times (e.g., for motion tracking), and full-circle or continuous helical acquisitions with narrow / slit fan beams with longer acquisition times but increased image quality due to reduced scattering. One or more optimization processes are also applicable to all of the above embodiments to determine scan design, determine beam positioning, determine readout range, evaluate scatter, etc.

[0126] FIG. 20 is a flow chart depicting an exemplary method 2000 of IGRT using a radiation therapy device (e.g., including a multimodal device 10). The prior data 2005 can include patient images (e.g., prior images, which may be pre-acquired planning images, including prior CT images), treatment plans, phantom information, models, a priori information, etc. In some embodiments, the prior data 2005 is created by a similar radiation therapy device, but at an earlier time. In step 2010, imaging of the patient is performed using a radiation source (e.g., kV radiation from source 30 and / or MV radiation from source 20 of the multimodal device 10). In various embodiments, imaging includes helical or circumferential scanning with fan beam or cone beam geometry. Step 2010 uses the techniques described above to generate one or more images or imaging / scan data 2015 of high quality (HQ). In some embodiments, the image quality may be adjusted to optimize the balance between image quality / resolution and dose. In other words, not all images need to be of the highest quality. Or image quality may be adjusted to optimize or trade off image quality / resolution versus image acquisition time. The imaging step 2010 also includes image processing 2020 to generate a patient image based on the imaging / scan data 2015 (e.g., according to the methods described above). The image processing step 2020 is shown as part of the imaging step 2010. In some embodiments, the image processing step 2020 is a separate step, including where image processing is performed by a separate device.

[0127] Next, in step 2030, one or more image-based pre-delivery steps described below are performed based at least in part on the imaging / scan data 2015 from step 2010. As described in more detail below, step 2030 may include determining various parameters related to the treatment procedure and (subsequent) imaging planning. In some embodiments, the image-based pre-delivery step (2030) may require more imaging (2010) before treatment delivery (2040). Step 2030 may include adapting the treatment plan based on the imaging data 2015 as part of an adaptive radiation treatment routine. In some embodiments, the image-based pre-delivery step 2030 may include real-time treatment planning. Embodiments may also include simultaneous, overlapping and / or alternating activation of imaging and therapeutic radiation sources, as described above. Real-time treatment planning may involve any or all of these types of imaging and therapeutic radiation activation techniques (simultaneous, overlapping and / or alternating).

[0128] Next, in step 2040, delivery of the therapeutic treatment is performed using a source of high energy radiation (e.g., MV radiation from radiation source 20). Step 2040 delivers a therapeutic dose 2045 to the patient according to the treatment plan. In some embodiments, the IGRT method 2000 may include returning to step 2010 for additional imaging at various intervals (e.g., between fractions), followed by image-based pre-delivery steps (2030) and / or treatment delivery (2040) as needed. In this manner, high quality imaging data 2015 may be generated and utilized during IGRT using an adaptive therapy capable device 10. As described above, steps 2010, 2030 and / or 2040 may be performed simultaneously, overlapping, and / or alternating.

[0129] IGRT may include at least two general goals: (i) to deliver a highly conformal dose distribution to the target volume, and (ii) to deliver the treatment beam with high precision throughout the entire treatment. A third goal may be to achieve the two general goals in the least amount of time per portion possible. Accurate delivery of the treatment beam requires the ability to identify and / or track the position of the target volume using high quality images. The ability to increase delivery rate requires the ability to move the radiation source accurately, precisely, and rapidly according to the treatment plan.

[0130] FIG. 21 is a block diagram 2100 depicting an exemplary image-based pre-delivery step / option that may be related to step 2030 above. It will be understood that the multimodal device 10 (e.g., as part of a radiation therapy device) described above can generate low-energy (e.g., kV) and high-energy (e.g., MV) images that may be used in a variety of ways, including for the purposes of the image-based pre-delivery step (2030), without departing from the scope of the present invention. For example, images 2015 generated by the radiation therapy device may be used to set up or align the patient prior to treatment (2110). Aligning the patient may include correlating or registering the current imaging data 2015 with imaging data related to the plan, including earlier pre-treatment scans and / or the treatment plan. Aligning the patient may also include feedback on the patient's physical position relative to the radiation source to verify if the patient is physically within range of the delivery system. If necessary, the patient may be adjusted accordingly. In some embodiments, patient alignment imaging may be intentionally lower quality to minimize dose but provide proper alignment information. An exemplary patient registration process is described below.

[0131] The images generated by the multimodal device 10 may also be used for treatment planning or treatment re-planning (2120). In various embodiments, step 2120 may include reviewing the treatment plan, modifying the treatment plan, creating a new treatment plan, and / or selecting a treatment plan from a set of treatment plans (sometimes referred to as a "daily plan"). For example, the imaging data 2015 indicates that the target volume or ROI is similar to that of the developed treatment plan. The treatment plan may then be reviewed. However, if the target volume or ROI is not the same, re-planning of the treatment procedure may be required. In the case of re-planning, since the imaging data 2015 (generated by the multimodal device 10 in step 2010) is of high quality, the imaging data 2015 may be used for treatment planning or treatment re-planning (e.g., creating a new or revised treatment plan). In this way, pre-treatment CT imaging with a different device is not required. In some embodiments, review and / or treatment re-planning may be an ongoing procedure before and / or after various treatments.

[0132] According to another exemplary use case, images generated by the multimodal device 10 can be used to calculate an imaging dose (2130), which may be used to determine an overall dose to the patient on-the-fly and / or for subsequent imaging planning. The quality of the subsequent imaging may also be determined as part of the treatment planning, e.g., to balance quality and dose. According to another exemplary use case, images generated by the multimodal device 10 can be used to calculate a treatment dose (2140), which may be used to determine an overall dose to the patient on-the-fly and / or may be included as part of the treatment planning or treatment re-planning.

[0133] According to other exemplary use cases, images generated by the multimodal device 10 may be used in connection with planning or adjusting other imaging (2150) and / or other treatment (2160) parameters or plans, such as included as part of creating an adaptive treatment and / or treatment plan. According to another exemplary use case, images generated by the multimodal device 10 may be used in connection with adaptive treatment monitoring (2170), which may include monitoring and adapting treatment delivery as needed.

[0134] The image-based pre-delivery steps (2030) are not mutually exclusive. For example, in various embodiments, calculated treatment dose (2140) may be a stand-alone step and / or may be part of adaptive treatment monitoring (2170) and / or treatment planning (2120). In various embodiments, the image-based pre-delivery steps (2030) may be performed automatically and / or manually with human intervention.

[0135] FIG. 22 is a block diagram 2200 representing exemplary data sources that may be utilized during imaging (2010) and / or during the subsequent image-based pre-delivery step (2030). Detector data 2210 represents data received by a radiation detector (e.g., 24, 34). Projection data 2220 is data generated by radiation incident in a narrowed beam region, referred to above as the active region. Penumbra data 2230 is data generated by radiation incident in the penumbra region. Scatter data 2240 is data generated by radiation incident in a peripheral region outside the penumbra region and / or the determined scatter as described above. In another embodiment, the scatter data 2240 can be used to determine residual effects of scatter from a therapeutic radiation source 20 (e.g., MV) when two sources 20, 30 are operated simultaneously or in an interleaved manner.

[0136] In this manner, the penumbra data 2230 and / or the scatter data 2240 may be utilized to improve the quality of the image generated by the imaging step 2010. In some embodiments, the penumbra data 2230 and / or the scatter data 2240 may be combined with the projection data 2220 and / or analyzed at the time of data collection at the detectors (e.g., 24, 34) in terms of the applicable imaging settings 2250, treatment settings 2260 (e.g., in the case of simultaneous imaging and / or treatment radiation), and any other data 2270 related to the multimodal device 10. In other embodiments, the data may be used for the treatment planning step 2030.

[0137] 23 and 24 depict exemplary embodiments of the imaging 2010, image-based pre-delivery steps 2030, and therapy delivery 2040 use cases, including examples of various forward and feedback sequences associated with on-board imaging using the multimodal device 10 during IGRT, including use of the methods described above.

[0138] FIG. 23 is a flow chart depicting an exemplary method 2300 including patient setup or alignment with a radiation therapy device (e.g., including multimodal device 10). Prior data 2305 can include images of the patient (e.g., prior images including prior CT images as described above, which may be pre-acquired planning images). In some embodiments, prior data 2305 is created at an earlier time by a similar radiation therapy device. In step 2310, an initial or preliminary alignment of the patient can be performed. Next, in step 2320, an on-board imaging scan is performed using a low-energy radiation source and / or a high-energy radiation source (e.g., kV radiation from source 30 and / or MV radiation from source 20) of multimodal device 10, including, for example, as described in step 2010 above. In various embodiments, on-board imaging includes a helical scan or a full-circle scan with a fan-beam geometry or a cone-beam geometry. Step 2320 generates online imaging / scan data 2330 using the techniques described above. The imaging step 2320 may also include image processing to generate patient images based on the imaging / scan data 2330 (eg, according to the methods described above), including, for example, those described in block 2020 above.

[0139] Next, step 2340 determines whether alignment correction is needed based at least in part on the online scan data 2330, including, for example, as described in block 2110 above. If alignment correction or adjustment is needed, method 2300 proceeds to step 2350 for alignment correction based at least in part on the online scan data 2330. After alignment correction, the method can then return to step 2320 for additional imaging as a confirmation or further refinement loop. If alignment correction or adjustment is not needed from step 2340, method 2300 proceeds to step 2360 for treatment delivery. After treatment, method 2300 can then return to step 2320 for additional imaging as a confirmation or further refinement loop.

[0140] FIG. 24 is a flow chart depicting an exemplary method 2400 of adaptive IGRT using a radiation therapy device (e.g., including multimodal device 10). Pre-treatment planning data 2405 can include treatment plans and patient images (e.g., pre-images, which may be pre-acquired planning images, including pre-CT images as described above), phantom information, models, a priori information, and the like. In some embodiments, the pre-data 2405 is created by a similar radiation therapy device, but at an earlier time. In step 2410, an initial or preliminary treatment plan can be adopted, for example, based on the pre-treatment plan and any additional information. Next, in step 2420, an on-board imaging scan is performed using a low-energy radiation source and / or a high-energy radiation source (e.g., kV radiation from source 30 and / or MV radiation from source 20) of multimodal device 10, including, for example, as described in step 2010 above. In various embodiments, the on-board imaging includes a helical scan or a full-circle scan with a fan-beam geometry or a cone-beam geometry. Step 2420 uses techniques described above to generate online imaging / scan data 2430. Imaging step 2420 may also include image processing to generate patient images based on the imaging / scan data 2430 (e.g., according to methods described above), including, for example, those described in block 2020 above.

[0141] Step 2440 then determines whether the treatment plan needs to be re-planned or adapted based at least in part on the online scan data 2430, including, for example, as described in block 2120 above. If the treatment plan does not need to be adapted or re-planned, method 2400 proceeds to step 2450 for treatment delivery. If the treatment plan needs to be adapted or re-planned, method 2400 proceeds to step 2460 of adapting the treatment plan based at least in part on the online scan data 2430. After adapting the treatment plan, the method can proceed to step 2450 for treatment delivery. After treatment, method 2400 can then return to step 2420 for additional imaging as a confirmation or further refinement loop.

[0142] In some embodiments, methods 2300, 2400 and other methods may be performed simultaneously or in an interleaved manner based on a preferred workflow. For example, an on-board imaging scan may be performed and utilized as both 2320 and 2420 scans, and the same data may be used to simultaneously verify treatment and sequential registration. In other embodiments, two or more of the image-based pre-delivery steps 2030 may be performed simultaneously or in an interleaved manner based on a preferred workflow, including when the same imaging data 2015 and / or image processing 2020 are utilized for more than one of the image-based pre-delivery steps 2030.

[0143] Various other embodiments include other use cases with on-board imaging using the multimodal device 10 during IGRT. For example, images are "merged" with treatment planning CT (pCT) for delivery analysis and / or re-planning with MVCT. In this dose calculation embodiment, the kV scan can be a narrow, very low dose "pilot" beam to find the skin-air interface at each angle so that the pCT can be properly transformed to the body contours at each segment time point.

[0144] Although the disclosed methodology has been shown and described with respect to certain aspects, embodiments or embodiments, it will be apparent that equivalent changes and modifications will occur to those skilled in the art upon reading and understanding this specification and the accompanying drawings. In particular, with respect to the various functions performed by the above-mentioned elements (components, assemblies, devices, members, compositions, etc.), the terms used to describe such elements (including references to "means") are intended to correspond to any element that performs the specified function of the described element (i.e., functionally equivalent), even if it is not structurally equivalent to the disclosed structure that performs that function in the exemplary aspects, embodiments or embodiments of the disclosed technology shown herein, unless otherwise indicated. Moreover, although certain features of the disclosed methodology may be described above with respect to only one or more of some illustrated aspects or embodiments, such features can be combined with one or more other features of other embodiments, as may be desired and advantageous for any given or particular application.

[0145] Although the embodiments described herein relate to the above systems and methods, these embodiments are intended to be exemplary and are not intended to limit the applicability of these embodiments to only the descriptions set forth herein. Although the present invention has been illustrated by the description of its embodiments, and the embodiments have been described in some detail, it is not the intention of the applicant to limit, or in any way limit, the scope of the appended claims to such details. Further advantages and modifications will be readily apparent to those skilled in the art. Thus, the broader aspects of the present invention are not limited to the specific details, exemplary apparatus and methods, and illustrative examples shown and described. Thus, departures may be made from such details without departing from the spirit or scope of the applicant's general inventive concept.

Claims

1. 1. A multimodal imaging device comprising: a rotatable gantry system positioned at least partially about a patient support; a first radiation source coupled to the rotatable gantry system and configured for imaging radiation; and a first beamformer configured to adjust a shape of a first radiation beam emitted by the first radiation source; and a second radiation source coupled to the rotatable gantry system, the second radiation source configured for at least MV radiation and including a higher energy level than the first radiation source; a second beamformer configured to adjust a shape of a second radiation beam emitted by the second radiation source; and at least one radiation detector coupled to the rotatable gantry system and positioned to receive radiation from at least one of the first radiation source and the second radiation source during a continuous scan having a helical source trajectory; the multi-modal imaging device acquires, during the scan, first measured projection data related to a first region of a patient from the first radiation source and second measured projection data related to a second region of the patient from the second radiation source; complementing the first measured projection data with the second measured projection data; and and complementing the second measured projection data with the first measured projection data.

2. 10. The instrument of claim 1, wherein the first radiation source comprises a kiloelectron volt peak photon energy (keV) up to 150 keV and the second radiation source comprises a megaelectron volt peak photon energy (MeV) of 1 MeV or greater.

3. 10. The apparatus of claim 1, wherein the second radiation source comprises a peak energy of 3 MeV and an average energy of about 1 MeV.

4. 1. A data processing system comprising: receiving the first measured projection data and the second measured projection data; 10. The apparatus of claim 1, further comprising a data processing system configured to combine the first measured projection data and the second measured projection data for processing data or reconstructing an image of the patient.

5. The apparatus of claim 1 , wherein the first measured projection data and the second measured projection data are acquired simultaneously or within 50 ms or less of each other.

6. The device of claim 1 , wherein the first region and the second region overlap one another.

7. The apparatus of claim 1 , wherein the first measured projection data is truncated at the second domain or the second measured projection data is truncated at the first domain.

8. The at least one radiation detector comprises: a first detector coupled to the rotatable gantry system and positioned to receive radiation from the first radiation source; and a second detector coupled to the rotatable gantry system and positioned to receive radiation from the second radiation source; the second beamformer and the second detector are configured such that the second radiation beam projects through the second region in the transaxial plane of the patient and does not project through all of the first region in the transaxial plane of the patient; the first beamformer and the first detector are configured to project the first radiation beam through the first region of the patient; the evaluated second measured projection data from the second radiation source in the first region is based on the first measured projection data.

10. The device of claim 1.

9. The device of claim 8 , wherein the first region comprises a peripheral region of the patient and the second region comprises a central region of the patient.

10. The device of claim 8 , wherein the first radiation beam and the second radiation beam overlap in the transaxial plane.

11. The apparatus of claim 8 , wherein a maximum transaxial imaging area available by the second detector is less than a width of the patient in the transaxial plane.

12. The first beamformer comprises: a first aperture configured to project the first radiation beam through the first aperture and through a target region in a transaxial plane of the patient; a second aperture configured to project the first radiation beam through the second aperture and through a peripheral region in the transaxial plane of the patient; the target region and the peripheral region do not overlap in the transaxial plane; 2. The apparatus of claim 1, wherein the at least one radiation detector comprises a first detector coupled to the rotatable gantry system and positioned to receive radiation from the first radiation source, the first detector being in a fixed position with an outermost edge of the first detector positioned outside an outermost projected patient boundary during the scan.

13. The apparatus of claim 12 , wherein the estimated projection data from the first radiation source between the target region and the surrounding region is based on the second measured projection data.

14. the at least one radiation detector comprises a second detector coupled to the rotatable gantry system and positioned to receive radiation from the second radiation source; the second beamformer and the second detector are configured to project the second radiation beam through an intermediate region between the target region and the peripheral region in the transaxial plane of the patient; the intermediate region overlaps with the target region and the peripheral region in the transaxial cross-section; 14. The device of claim 13.

15. the at least one radiation detector comprises a first detector coupled to the rotatable gantry system and positioned to receive radiation from the first radiation source, the first beamformer and the first detector being configured in a transaxial plane such that the first radiation beam projects through all points of a target region of the patient during the scan; for any angular position of the first radiation source, any transaxial point in the target region of the patient is visualized by the first radiation source at any sampled azimuth angle, and the first beamformer is dynamically throttled during the scan.

10. The device of claim 1.

16. the first beamformer and the first detector are configured axially such that a first axial field of view (FOV) associated with the first radiation source is larger than a second axial field of view (FOV) associated with the second radiation source; the first beamformer and the first detector are configured in a transaxial direction such that for any angular position of the first radiation source, any point in a first transaxial FOV associated with the first radiation source and any point in a second transaxial FOV associated with the second radiation source are visualized by the first radiation source at any sampled azimuth angle; estimated projection data from the second radiation source based on the first measured projection data when the patient's projection extends beyond a second transaxial FOV; the images are used for material separation within an overlap region of the first transaxial FOV and the second transaxial FOV to produce component material images.

16. The device of claim 15.

17. 2. The apparatus of claim 1, wherein the first radiation source is coupled to a first rotatable gantry of the rotatable gantry system and the second radiation source is coupled to a second rotatable gantry of the rotatable gantry system.

18. 1. A method for acquiring projection data from a multi-modal imaging device, comprising: receiving first measured projection data associated with a first region of a patient during a continuous scan having a helical source trajectory from a first radiation source configured for imaging radiation; receiving second measured projection data associated with a second region of the patient during a continuous scan having a helical source trajectory from a second radiation source configured for at least MV radiation and having a higher energy level than the first radiation source; providing the first measured projection data and the second measured projection data to reconstruct an image of the patient; augmenting the first measured projection data with the second measured projection data; and augmenting the second measured projection data with the first measured projection data.

19. 20. The method of claim 18, wherein the first measured projection data and the second measured projection data are acquired simultaneously or within 50 ms of each other.

20. 1. A radiation therapy delivery device comprising: a rotatable gantry system positioned at least partially about a patient support; a first radiation source coupled to the rotatable gantry system and configured for imaging radiation; and a first beamformer configured to adjust a shape of a first radiation beam emitted by the first radiation source; and a second radiation source coupled to the rotatable gantry system, the second radiation source configured for at least MV radiation and comprising a higher energy level than the first radiation source; a second beamformer configured to adjust a shape of a second radiation beam emitted by the second radiation source; and at least one radiation detector coupled to the rotatable gantry system and positioned to receive radiation from at least one of the first radiation source and the second radiation source during a continuous scan having a helical source trajectory; 1. A data processing system comprising: receiving first measured projection data from the first radiation source and second measured projection data from the second radiation source; configured to combine the first measured projection data and the second measured projection data to reconstruct an image for online adaptive IGRT; augmenting the first measured projection data with the second measured projection data; and augmenting the second measured projection data with the first measured projection data.

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