GateCT™ surface tracking system for respiratory signal reconstruction in 4DCT imaging

Purpose: To assess the temporal and spatial accuracy of the GateCT™ system (VisionRT, London, UK), a recently released respiratory tracking system for 4DCT, under both ideal and nonideal respiratory conditions. Methods: Three experiments were performed by benchmarking and comparing its results with the ground-truth input data and those generated by the widely used Varian RPM™ system (Real-time Position Management, Varian, Palo Alto, CA). The first experiment used 10 sinusoidal breathing patterns (constant amplitude and frequency using sin⁶ωt), 10 consistent patient breathing patterns, and 10 sporadic patient breathing patterns. Motion was simulated with the quasar Programmable Respiratory Motion Platform (MODUS, London, Canada) as the surrogate. The GateCT™ and RPM™ systems were used to track the breathing patterns. The data from both systems were then analyzed in the Fourier domain, to evaluate temporal/phase accuracy, using the Pearson's correlation coefficient (PCC). The analysis correlated the ground-truth input data against the GateCT™ and RPM™ tracking results, respectively. The second experiment used 10 ideal sinusoidal breathing patterns, five of period 2.0 s, and five of period 5.0 s, with varying abdominal amplitudes found in clinical cases (peak-to-peak range: 1.67-10 mm) to test the sensitivity of the system to reconstruct various range of motion. And, the third experiment used 12 consecutive clinical patients to track the abdominal motion simultaneously by the GateCT™ and RPM™ systems. The baseline of the tracking results from both the two systems was analyzed via the mean-position-estimate (MPE) calculations. All experiments were tracked for at least 120 s. Results: In the first experiment, the average PCC values (±SD) of all thirty breathing patterns were 0.9995 ± 0.00035 and 0.9994 ± 0.00041 for the GateCT™ and the RPM™ system, respectively. These nearly identical results demonstrated similar temporal/phase tracking accuracy for the two systems. The results in the second experiment, however, revealed a pattern for the GateCT™ system in which the uncertainty of its mean-position tracking increased as the amplitude of the breathing pattern decreased. For example, a non-negligible baseline drift of up to 29.3% with respect to the peak-to-peak amplitude of 1.67-mm was observed. On the contrary, the RPM™ system displayed a more consistent recording of amplitudes over time with the greatest drift being <7.7%. The third experiment confirmed these findings in the clinical setting. Consistent decrease in PCC values due to the increase in artificial amplitude drifts, as the breathing amplitude decreased, was found. The lowest PCC value was 0.7239 for a patient with 1.57-mm peak-to-peak amplitude. Conclusions: The GateCT™ system revealed its consistency in temporal/phase tracking but had limitations in accurately tracking the absolute abdominal positions, thus suggesting its appropriateness for phase-sorting of 4DCT rather than amplitude-sorting. In contrast, the RPM™ system demonstrated stable respiratory signal tracking in all ranges and accurately both in phase and amplitude, and is a robust system to use for both phase-sorting and amplitude-sorting techniques. The impact of the observed mean-position drift in the GateCT™ system on the resulting 4DCT image quality, in amplitude-sorting, needs further investigation.