Fast motion-compensated reconstruction for 4D-CBCT using deep learning-based groupwise registration

<i>Objective</i>. Previous work has that deep learning (DL)-enhanced 4D cone beam computed tomography (4D-CBCT) images improve motion modeling and subsequent motion-compensated (MoCo) reconstruction for 4D-CBCT. However, building the motion model at treatment time via conventional deformable image registration (DIR) methods is not temporally feasible. This work aims to improve the efficiency of 4D-CBCT MoCo reconstruction using DL-based registration for the rapid generation of a motion model prior to treatment.<i>Approach.</i>An artifact-reduction DL model was first used to improve the initial 4D-CBCT reconstruction by reducing streaking artifacts. Based on the artifact-reduced phase images, a groupwise DIR employing DL was used to estimate the inter-phase motion model. Two DL DIR models using different learning strategies were employed: (1) a patient-specific one-shot DIR model which was trained from scratch only using the images to be registered, and (2) a population DIR model which was pre-trained using collected 4D-CT images from 35 patients. The registration accuracy of two DL DIR models was assessed and compared to a conventional groupwise DIR approach implemented in the Elastix toolbox using the publicly available DIR-Lab dataset, a Monte Carlo simulation dataset from the SPARE challenge, and two clinical cases.<i>Main results.</i>The patient-specific DIR model and the population DIR model demonstrated registration accuracy comparable to the conventional state-of-the-art methods on the DIR-Lab dataset. No significant difference in image quality was observed between the final MoCo reconstructions using the patient-specific model and population model for motion modeling, compared to using the conventional approach. The average runtime (hh:mm:ss) of the entire MoCo reconstruction on SPARE dataset was reduced from 01:37:26 using conventional DIR method to 00:10:59 using patient-specific model and 00:01:05 using the pre-trained population model.<i>Significance.</i>DL-based registration methods can improve the efficiency in generating motion models for 4D-CBCT without compromising the performance of final MoCo reconstruction.