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Patient respiration induces motion artifacts during cone-beam CT (CBCT) imaging in LINAC-based radiotherapy guidance. This could be relieved by retrospectively sorting the projection images, which could be called as a respiratorycorrelated CBCT or a four-dimensional (4D) CBCT imaging. However, the slowness of the LINAC head gantry rotation limits a rapid scan time so that 4D-CBCT usually involves large amounts of radiation dose. Digital tomosynthesis (DTS) which utilizes limited angular range would present a faster 4D imaging with much lower radiation dose. One drawback of 4D-DTS is strong streak artifacts represented in the tomosynthesis reconstructed images due to sparsely sampled projections in each phase bin. The authors suggest a fast low-dose 4D-DTS image reconstruction method in order to effectively reduce the artifacts in a sparse imaging tomosynthesis condition. We used a flat-panel detector to acquire tomosynthesis projections of respiratory moving phantom in anterior-posterior (AP) and lateral views. We entered a sinusoidal periodic respiratory motion for an input signal to the phantom. An external monitor of Varian real-time position management (RPM) system was used to estimate the input respiratory motion, thereby four respiratory gating phases were determined to retrospectively arrange the projections. For streak line reduction, we introduced a simple iterative scheme suggested by McKinnon and Bates (MKB) and regarded it as a prior input image of the proposed lowdose compressed sensing (CS) method. Three different 4D-DTS image reconstruction schemes of conventional Feldkamp (FDK), MKB, and MKB-CS were implemented to phase-wise projections of both AP and lateral views. All reconstructions were accelerated by using a GPU card to reduce the computation times. For assessment of algorithmic performance, we compared a streak reduction ratio (SRR) and a contrast-to-noise-ratio (CNR) among the outcome images. The results showed that SRRs for MKB and MKB-CS schemes were 0.24 and 0.69, respectively, which indicates that the proposed MKB-CS method provided smaller streaking artifacts than conventional one by factor of 2.88. The resulted CNRs of coronal tomosynthesis images at peak-inhale phase were 3.24, 6.36, and 10.56 for FDK, MKB, and MKB-CS, respectively. This shows that the proposed method provides better image quality compared to others. The reconstruction time for MKB-CS was 196.07 sec, showing that our GPU-accelerated programming would enhance the algorithmic performance to match clinically feasible times (~3 min). In conclusion, the proposed low-dose 4D-DTS reconstruction scheme may provide better outcomes than the conventional methods with fast speed, and could thus it could be applied in practical 4D imaging for radiotherapy.
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