Automatic tracking of implanted fiducial markers in cone beam CT projection images

Purpose: This paper describes a novel method for simultaneous intrafraction tracking of multiple fiducial markers. Although the proposed method is generic and can be adopted for a number of applications including fluoroscopy based patient position monitoring and gated radiotherapy, the tracking results presented in this paper are specific to tracking fiducial markers in a sequence of cone beam CT projection images. Methods: The proposed method is accurate and robust thanks to utilizing the mean shift and random sampling principles, respectively. The performance of the proposed method was evaluated with qualitative and quantitative methods, using data from two pancreatic and one prostate cancer patients and a moving phantom. The ground truth, for quantitative evaluation, was calculated based on manual tracking preformed by three observers. Results: The average dispersion of marker position error calculated from the tracking results for pancreas data (six markers tracked over 640 frames, 3840 marker identifications) was 0.25 mm (at iscoenter), compared with an average dispersion for the manual ground truth estimated at 0.22 mm. For prostate data (three markers tracked over 366 frames, 1098 marker identifications), the average error was 0.34 mm. The estimated tracking error in the pancreas data was