Respiration tracking in radiosurgery without fiducials.

In robotic radiosurgery, a focused beam of radiation is moved by a robot arm. We investigated methods for soft-tissue navigation using robotic radiosurgery. In previous work we described a method for real-time tracking based on correlation between the motion of implanted fiducial markers and external skin markers. In this work we extend our method of correlation-based tracking to tracking without implanted fiducials. We propose to use deformation algorithms on CT data sets combined with registration of digitally reconstructed radiographs and intra-treatment X-ray images to obtain intermittent information on the target location. This information is then combined with our basic correlation method to achieve real-time tracking. Our study investigates the feasibility of this approach from the point of view of computing time and required level of user interaction. The term 7D registration is coined to describe the underlying method for performing this task.