Superiorization of projection algorithms for linearly constrained inverse radiotherapy treatment planning

Objective

We apply the superiorization methodology to the constrained intensity-modulated radiation therapy (IMRT) treatment planning problem. Superiorization combines a feasibility-seeking projection algorithm with objective function reduction: The underlying projection algorithm is perturbed with gradient descent steps to steer the algorithm towards a solution with a lower objective function value compared to one obtained solely through feasibility-seeking.

Approach

Within the open-source inverse planning toolkit matRad, we implement a prototypical algorithmic framework for superiorization using the well-established Agmon, Motzkin, and Schoenberg (AMS) feasibility-seeking projection algorithm and common nonlinear dose optimization objective functions. Based on this prototype, we apply superiorization to intensity-modulated radiation therapy treatment planning and compare it with (i) bare feasibility-seeking (i.e., without any objective function) and (ii) nonlinear constrained optimization using first-order derivatives. For these comparisons, we use the TG119 water phantom, the head-and-neck and the prostate patient of the CORT dataset.

Main results

Bare feasibility-seeking with AMS confirms previous studies, showing it can find solutions that are nearly equivalent to those found by the established piece-wise least-squares optimization approach. The superiorization prototype solved the linearly constrained planning problem with similar dosimetric performance to that of a general-purpose nonlinear constrained optimizer while showing smooth convergence in both constraint proximity and objective function reduction.

Significance

Superiorization is a useful alternative to constrained optimization in radiotherapy inverse treatment planning. Future extensions with other approaches to feasibility-seeking, e.g., with dose-volume constraints and more sophisticated perturbations, may unlock its full potential for high performant inverse treatment planning.

Ionization detail parameters and cluster dose: a mathematical model for selection of nanodosimetric quantities for use in treatment planning in charged particle radiotherapy

Objective. To propose a mathematical model for applying ionization detail (ID), the detailed spatial distribution of ionization along a particle track, to proton and ion beam radiotherapy treatment planning (RTP).Approach. Our model provides for selection of preferred ID parameters (Ip) for RTP, that associate closest to biological effects. Cluster dose is proposed to bridge the large gap between nanoscopicIpand macroscopic RTP. Selection ofIpis demonstrated using published cell survival measurements for protons through argon, comparing results for nineteenIp:Nk,k= 2, 3, …, 10, the number of ionizations in clusters ofkor more per particle, andFk,k= 1, 2, …, 10, the number of clusters ofkor more per particle. We then describe application of the model to ID-based RTP and propose a path to clinical translation.Main results. The preferredIpwereN4andF5for aerobic cells,N5andF7for hypoxic cells. Significant differences were found in cell survival for beams having the same LET or the preferredNk. Conversely, there was no significant difference forF5for aerobic cells andF7for hypoxic cells, regardless of ion beam atomic number or energy. Further, cells irradiated with the same cluster dose for theseIphad the same cell survival. Based on these preliminary results and other compelling results in nanodosimetry, it is reasonable to assert thatIpexist that are more closely associated with biological effects than current LET-based approaches and microdosimetric RBE-based models used in particle RTP. However, more biological variables such as cell line and cycle phase, as well as ion beam pulse structure and rate still need investigation.Significance. Our model provides a practical means to select preferredIpfrom radiobiological data, and to convertIpto the macroscopic cluster dose for particle RTP.

Dynamic string-averaging CQ-methods for the split feasibility problem with percentage violation constraints arising in radiation therapy treatment planning

We study a feasibility-seeking problem with percentage violation constraints (PVCs). These are additional constraints that are appended to an existing family of constraints, which single out certain subsets of the existing constraints and declare that up to a specified fraction of the number of constraints in each subset is allowed to be violated by up to a specified percentage of the existing bounds. Our motivation to investigate problems with PVCs comes from the field of radiation therapy treatment planning (RTTP) wherein the fully discretized inverse planning problem is formulated as a split feasibility problem and the PVCs give rise to nonconvex constraints. Following the CQ algorithm of Byrne (2002, Inverse Problems, Vol. 18, pp. 441-53), we develop a string-averaging CQ-method that uses only projections onto the individual sets that are half-spaces represented by linear inequalities. The question of extending our theoretical results to the nonconvex sets case is still open. We describe how our results apply to RTTP and provide a numerical example.

An Improved Method of Total Variation Superiorization Applied to Reconstruction in Proton Computed Tomography

Previous work has shown that total variation superiorization (TVS) improves reconstructed image quality in proton computed tomography (pCT). The structure of the TVS algorithm has evolved since then and this paper investigated if this new algorithmic structure provides additional benefits to pCT image quality. Structural and parametric changes introduced to the original TVS algorithm included: (1) inclusion or exclusion of TV reduction requirement, (2) a variable number, N , of TV perturbation steps per feasibility-seeking iteration, and (3) introduction of a perturbation kernel . The structural change of excluding the TV reduction requirement check tended to have a beneficial effect for 3 ≤ N ≤ 6 and allows full parallelization of the TVS algorithm. Repeated perturbations per feasibility-seeking iterations reduced total variation (TV) and material dependent standard deviations for 3 ≤ N ≤ 6 . The perturbation kernel α , effectively equal to α = 0.5 in the original TVS algorithm, reduced TV and standard deviations as α was increased beyond α = 0.5 , but negatively impacted reconstructed relative stopping power (RSP) values for . The reductions in TV and standard deviations allowed feasibility-seeking with a larger relaxation parameter λ than previously used, without the corresponding increases in standard deviations experienced with the original TVS algorithm. This paper demonstrates that the modifications related to the evolution of the original TVS algorithm provide benefits in terms of both pCT image quality and computational efficiency for appropriately chosen parameter values.

Derivative-free superiorization with component-wise perturbations

Superiorization reduces, not necessarily minimizes, the value of a target function while seeking constraints compatibility. This is done by taking a solely feasibility-seeking algorithm, analyzing its perturbation resilience, and proactively perturbing its iterates accordingly to steer them toward a feasible point with reduced value of the target function. When the perturbation steps are computationally efficient, this enables generation of a superior result with essentially the same computational cost as that of the original feasibility-seeking algorithm. In this work, we refine previous formulations of the superiorization method to create a more general framework, enabling target function reduction steps that do not require partial derivatives of the target function. In perturbations that use partial derivatives, the step-sizes in the perturbation phase of the superiorization method are chosen independently from the choice of the nonascent directions. This is no longer true when component-wise perturbations are employed. In that case, the step-sizes must be linked to the choice of the nonascent direction in every step. Besides presenting and validating these notions, we give a computational demonstration of superiorization with component-wise perturbations for a problem of computerized tomography image reconstruction.

Sparsity constrained split feasibility for dose-volume constraints in inverse planning of intensity-modulated photon or proton therapy

A split feasibility formulation for the inverse problem of intensity-modulated radiation therapy treatment planning with dose-volume constraints included in the planning algorithm is presented. It involves a new type of sparsity constraint that enables the inclusion of a percentage-violation constraint in the model problem and its handling by continuous (as opposed to integer) methods. We propose an iterative algorithmic framework for solving such a problem by applying the feasibility-seeking CQ-algorithm of Byrne combined with the automatic relaxation method that uses cyclic projections. Detailed implementation instructions are furnished. Functionality of the algorithm was demonstrated through the creation of an intensity-modulated proton therapy plan for a simple 2D C-shaped geometry and also for a realistic base-of-skull chordoma treatment site. Monte Carlo simulations of proton pencil beams of varying energy were conducted to obtain dose distributions for the 2D test case. A research release of the Pinnacle ³ proton treatment planning system was used to extract pencil beam doses for a clinical base-of-skull chordoma case. In both cases the beamlet doses were calculated to satisfy dose-volume constraints according to our new algorithm. Examination of the dose-volume histograms following inverse planning with our algorithm demonstrated that it performed as intended. The application of our proposed algorithm to dose-volume constraint inverse planning was successfully demonstrated. Comparison with optimized dose distributions from the research release of the Pinnacle ³ treatment planning system showed the algorithm could achieve equivalent or superior results.

Can Linear Superiorization Be Useful for Linear Optimization Problems?

Linear superiorization considers linear programming problems but instead of attempting to solve them with linear optimization methods it employs perturbation resilient feasibility-seeking algorithms and steers them toward reduced (not necessarily minimal) target function values. The two questions that we set out to explore experimentally are (i) Does linear superiorization provide a feasible point whose linear target function value is lower than that obtained by running the same feasibility-seeking algorithm without superiorization under identical conditions? and (ii) How does linear superiorization fare in comparison with the Simplex method for solving linear programming problems? Based on our computational experiments presented here, the answers to these two questions are: "yes" and "very well", respectively.

Toward truly optimal IMRT dose distribution: inverse planning with voxel-specific penalty

PURPOSE

To establish an inverse planning framework with adjustable voxel penalty for more conformal IMRT dose distribution as well as improved interactive controllability over the regional dose distribution of the resultant plan.

MATERIALS AND METHOD

In the proposed coarse-to-fine planning scheme, a conventional inverse planning with organ specific parameters is first performed. The voxel penalty scheme is then "switched on" by allowing the prescription dose to change on an individual voxel scale according to the deviation of the actual voxel dose from the ideally desired dose. The rationale here is intuitive: when the dose at a voxel does not meet its ideal dose, it simply implies that this voxel is not competitive enough when compared with the ones that have met their planning goal. In this case, increasing the penalty of the voxel by varying the prescription can boost its competitiveness and thus improve its dose. After the prescription adjustment, the plan is re-optimized. The dose adjustment/re-optimization procedure is repeated until the resultant dose distribution cannot be improved anymore. The prescription adjustment on a finer scale can be accomplished either automatically or manually. In the latter case, the regions/voxels where a dose improvement is needed are selected visually, unlike in the automatic case where the selection is done purely based on the difference of the actual dose at a given voxel and its ideal prescription. The performance of the proposed method is evaluated using a head and neck and a prostate case.

RESULTS

An inverse planning framework with the voxel-specific penalty is established. By adjusting voxel prescriptions iteratively to boost the region where large mismatch between the actual calculated and desired doses occurs, substantial improvements can be achieved in the final dose distribution. The proposed method is applied to a head and neck case and a prostate case. For the former case, a significant reduction in the maximum dose to the brainstem is achieved while the PTV dose coverage is greatly improved. The doses to other organs at risk are also reduced, ranging from 10% to 30%. For the prostate case, the use of the voxel penalty scheme also results in vast improvements to the final dose distribution. The PTV experiences improved dose uniformity and the mean dose to the rectum and bladder is reduced by as much as 15%.

CONCLUSION

Introduction of the spatially non-uniform and adjustable prescription provides room for further improvements of currently achievable dose distributions and equips the planner with an effective tool to modify IMRT dose distributions interactively. The technique is easily implementable in any existing inverse planning platform, which should facilitate clinical IMRT planning process and, in future, off-line/on-line adaptive IMRT.

The Subgradient Extragradient Method for Solving Variational Inequalities in Hilbert Space

We present a subgradient extragradient method for solving variational inequalities in Hilbert space. In addition, we propose a modified version of our algorithm that finds a solution of a variational inequality which is also a fixed point of a given nonexpansive mapping. We establish weak convergence theorems for both algorithms.

Total variation superiorization schemes in proton computed tomography image reconstruction

PURPOSE

Iterative projection reconstruction algorithms are currently the preferred reconstruction method in proton computed tomography (pCT). However, due to inconsistencies in the measured data arising from proton energy straggling and multiple Coulomb scattering, the noise in the reconstructed image increases with successive iterations. In the current work, the authors investigated the use of total variation superiorization (TVS) schemes that can be applied as an algorithmic add-on to perturbation-resilient iterative projection algorithms for pCT image reconstruction.

METHODS

The block-iterative diagonally relaxed orthogonal projections (DROP) algorithm was used for reconstructing GEANT4 Monte Carlo simulated pCT data sets. Two TVS schemes added on to DROP were investigated; the first carried out the superiorization steps once per cycle and the second once per block. Simplifications of these schemes, involving the elimination of the computationally expensive feasibility proximity checking step of the TVS framework, were also investigated. The modulation transfer function and contrast discrimination function were used to quantify spatial and density resolution, respectively.

RESULTS

With both TVS schemes, superior spatial and density resolution was achieved compared to the standard DROP algorithm. Eliminating the feasibility proximity check improved the image quality, in particular image noise, in the once-per-block superiorization, while also halving image reconstruction time. Overall, the greatest image quality was observed when carrying out the superiorization once per block and eliminating the feasibility proximity check.

CONCLUSIONS

The low-contrast imaging made possible with TVS holds a promise for its incorporation into future pCT studies.

Perturbation Resilience and Superiorization of Iterative Algorithms

Iterative algorithms aimed at solving some problems are discussed. For certain problems, such as finding a common point in the intersection of a finite number of convex sets, there often exist iterative algorithms that impose very little demand on computer resources. For other problems, such as finding that point in the intersection at which the value of a given function is optimal, algorithms tend to need more computer memory and longer execution time. A methodology is presented whose aim is to produce automatically for an iterative algorithm of the first kind a "superiorized version" of it that retains its computational efficiency but nevertheless goes a long way towards solving an optimization problem. This is possible to do if the original algorithm is "perturbation resilient," which is shown to be the case for various projection algorithms for solving the consistent convex feasibility problem. The superiorized versions of such algorithms use perturbations that steer the process in the direction of a superior feasible point, which is not necessarily optimal, with respect to the given function. After presenting these intuitive ideas in a precise mathematical form, they are illustrated in image reconstruction from projections for two different projection algorithms superiorized for the function whose value is the total variation of the image.

The Split Common Fixed Point Problem for Directed Operators

We propose the split common fixed point problem that requires to find a common fixed point of a family of operators in one space whose image under a linear transformation is a common fixed point of another family of operators in the image space. We formulate and analyze a parallel algorithm for solving this split common fixed point problem for the class of directed operators and note how it unifies and generalizes previously discussed problems and algorithms.

A Note on the Behavior of the Randomized Kaczmarz Algorithm of Strohmer and Vershynin

In a recent paper by T. Strohmer and R. Vershynin ["A Randomized Kaczmarz Algorithm with Exponential Convergence", Journal of Fourier Analysis and Applications, published online on April 25, 2008] a "randomized Kaczmarz algorithm" is proposed for solving systems of linear equations [Formula: see text] . In that algorithm the next equation to be used in an iterative Kaczmarz process is selected with a probability proportional to ‖a(i)‖ (2). The paper illustrates the superiority of this selection method for the reconstruction of a bandlimited function from its nonuniformly spaced sampling values.In this note we point out that the reported success of the algorithm of Strohmer and Vershynin in their numerical simulation depends on the specific choices that are made in translating the underlying problem, whose geometrical nature is "find a common point of a set of hyperplanes", into a system of algebraic equations. If this translation is carefully done, as in the numerical simulation provided by Strohmer and Vershynin for the reconstruction of a bandlimited function from its nonuniformly spaced sampling values, then indeed good performance may result. However, there will always be legitimate algebraic representations of the underlying problem (so that the set of solutions of the system of algebraic equations is exactly the set of points in the intersection of the hyperplanes), for which the selection method of Strohmer and Vershynin will perform in an inferior manner.

Perturbation-resilient block-iterative projection methods with application to image reconstruction from projections

A block-iterative projection algorithm for solving the consistent convex feasibility problem in a finite-dimensional Euclidean space that is resilient to bounded and summable perturbations (in the sense that convergence to a feasible point is retained even if such perturbations are introduced in each iterative step of the algorithm) is proposed. This resilience can be used to steer the iterative process towards a feasible point that is superior in the sense of some functional on the points in the Euclidean space having a small value. The potential usefulness of this is illustrated in image reconstruction from projections, using both total variation and negative entropy as the functional.

On the String Averaging Method for Sparse Common Fixed Points Problems

We study the common fixed point problem for the class of directed operators. This class is important because many commonly used nonlinear operators in convex optimization belong to it. We propose a definition of sparseness of a family of operators and investigate a string-averaging algorithmic scheme that favorably handles the common fixed points problem when the family of operators is sparse. The convex feasibility problem is treated as a special case and a new subgradient projections algorithmic scheme is obtained.

Projections Onto Super-Half-Spaces for Monotone Variational Inequality Problems in Finite-Dimensional Space

The variational inequality problem (VIP) is considered here. We present a general algorithmic scheme which employs projections onto hyperplanes that separate balls from the feasible set of the VIP instead of projections onto the feasible set itself. Our algorithmic scheme includes the classical projection method and Fukushima's subgradient projection method as special cases.

On The Behavior of Subgradient Projections Methods for Convex Feasibility Problems in Euclidean Spaces

We study some methods of subgradient projections for solving a convex feasibility problem with general (not necessarily hyperplanes or half-spaces) convex sets in the inconsistent case and propose a strategy that controls the relaxation parameters in a specific self-adapting manner. This strategy leaves enough user-flexibility but gives a mathematical guarantee for the algorithm's behavior in the inconsistent case. We present numerical results of computational experiments that illustrate the computational advantage of the new method.

On Linear Infeasibility Arising in Intensity-Modulated Radiation Therapy Inverse Planning

Intensity-modulated radiation therapy (IMRT) gives rise to systems of linear inequalities, representing the effects of radiation on the irradiated body. These systems are often infeasible, in which case one settles for an approximate solution, such as an {α, β}-relaxation, meaning that no more than α percent of the inequalities are violated by no more than β percent. For real-world IMRT problems, there is a feasible {α, β}-relaxation for sufficiently large α, β > 0, however large values of these parameters may be unacceptable medically.The {α, β}-relaxation problem is combinatorial, and for given values of the parameters can be solved exactly by Mixed Integer Programming (MIP), but this may be impractical because of problem size, and the need for repeated solutions as the treatment progresses.As a practical alternative to the MIP approach we present a heuristic non-combinatorial method for finding an approximate relaxation. The method solves a Linear Program (LP) for each pair of values of the parameters {α, β} and progresses through successively increasing values until an acceptable solution is found, or is determined non-existent. The method is fast and reliable, since it consists of solving a sequence of LP's.

General Algorithmic Frameworks for Online Problem

We study general algorithmic frameworks for online learning tasks. These include binary classification, regression, multiclass problems and cost-sensitive multiclass classification. The theorems that we present give loss bounds on the behavior of our algorithms which depend on general conditions on the iterative step sizes.

A unified approach for inversion problems in intensity-modulated radiation therapy

We propose and study a unified model for handling dose constraints (physical dose, equivalent uniform dose (EUD), etc) and radiation source constraints in a single mathematical framework based on the split feasibility problem. The model does not impose on the constraints an exogenous objective (merit) function. The optimization algorithm minimizes a weighted proximity function that measures the sum of the squares of the distances to the constraint sets. This guarantees convergence to a feasible solution point if the split feasibility problem is consistent (i.e., has a solution), or, otherwise, convergence to a solution that minimally violates the physical dose constraints and EUD constraints. We present computational results that demonstrate the validity of the model and the power of the proposed algorithmic scheme.

Inherent smoothness of intensity patterns for intensity modulated radiation therapy generated by simultaneous projection algorithms

The efficient delivery of intensity modulated radiation therapy (IMRT) depends on finding optimized beam intensity patterns that produce dose distributions, which meet given constraints for the tumour as well as any critical organs to be spared. Many optimization algorithms that are used for beamlet-based inverse planning are susceptible to large variations of neighbouring intensities. Accurately delivering an intensity pattern with a large number of extrema can prove impossible given the mechanical limitations of standard multileaf collimator (MLC) delivery systems. In this study, we apply Cimmino's simultaneous projection algorithm to the beamlet-based inverse planning problem, modelled mathematically as a system of linear inequalities. We show that using this method allows us to arrive at a smoother intensity pattern. Including nonlinear terms in the simultaneous projection algorithm to deal with dose-volume histogram (DVH) constraints does not compromise this property from our experimental observation. The smoothness properties are compared with those from other optimization algorithms which include simulated annealing and the gradient descent method. The simultaneous property of these algorithms is ideally suited to parallel computing technologies.

The dose–volume constraint satisfaction problem for inverse treatment planning with field segments

The prescribed goals of radiation treatment planning are often expressed in terms of dose-volume constraints. We present a novel formulation of a dose-volume constraint satisfaction search for the discretized radiation therapy model. This approach does not rely on any explicit cost function. Inverse treatment planning uses the aperture-based approach with predefined, according to geometric rules, segmental fields. The solver utilizes the simultaneous version of the cyclic subgradient projection algorithm. This is a deterministic iterative method designed for solving the convex feasibility problems. A prescription is expressed with the set of inequalities imposed on the dose at the voxel resolution. Additional constraint functions control the compliance with selected points of the expected cumulative dose-volume histograms. The performance of this method is tested on prostate and head-and-neck cases. The relationships with other models and algorithms of similar conceptual origin are discussed. The demonstrated advantages of the method are: the equivalence of the algorithmic and prescription parameters, the intuitive setup of free parameters, and the improved speed of the method as compared to similar iterative as well as other techniques. The technique reported here will deliver approximate solutions for inconsistent prescriptions.

Transfer function restoration in 3D electron microscopy via iterative data refinement

Three-dimensional electron microscopy (3D-EM) is a powerful tool for visualizing complex biological systems. As with any other imaging device, the electron microscope introduces a transfer function (called in this field the contrast transfer function, CTF) into the image acquisition process that modulates the various frequencies of the signal. Thus, the 3D reconstructions performed with these CTF-affected projections are also affected by an implicit 3D transfer function. For high-resolution electron microscopy, the effect of the CTF is quite dramatic and limits severely the achievable resolution. In this work we make use of the iterative data refinement (IDR) technique to ameliorate the effect of the CTF. It is demonstrated that the approach can be successfully applied to noisy data.

BICAV: a block-iterative parallel algorithm for sparse systems with pixel-related weighting

Component averaging (CAV) was recently introduced by Censor, Gordon, and Gordon as a new iterative parallel technique suitable for large and sparse unstructured systems of linear equations. Based on earlier work of Byrne and Censor, it uses diagonal weighting matrices, with pixel-related weights determined by the sparsity of the system matrix. CAV is inherently parallel (similar to the very slowly converging Cimmino method) but its practical convergence on problems of image reconstruction from projections is similar to that of the algebraic reconstruction technique (ART). Parallel techniques are becoming more important for practical image reconstruction since they are relevant not only for supercomputers but also for the increasingly prevalent multiprocessor workstations. This paper reports on experimental results with a block-iterative version of component averraging (BICAV). When BICAV is optimized for block size and relaxation parameters, its very first iterates are far superior to those of and more or less on a par with ART. Similar to CAV, BICAV is also inherently parallel. The fast convergence is demonstrated on problems of image reconstruction from projections, using the SNARK93 image reconstruction software package. Detailed plots of various measures of convergence, and reconstructed images are presented.

An iterative approach to plan combination in radiotherapy

Radiation therapy concerns the delivery of a proper dose of radiation to a tumor volume without causing irreparable damage to surrounding healthy tissue and critical organs. The problem of plan combination in radiation therapy treatment planning (RTTP) proposed, formulated and studied here, addresses a situation when for a specific clinical case, a set of several treatment plans is proposed, but each one of them violates the prescribed dose in at least one significant region of the volume that has to be treated. We represent treatment plans as vectors in the Euclidean space, and define their equivalence, acceptability and realizability. A simple linear algebraic model for combining them is then used in order to derive, from the given set of approximate plans, a combined treatment plan, which will be both acceptable, and technically realizable. In the event that such a combined plan dose not exist, the alternatives for relaxing the treatment requirements can be systematically considered.

Semi-automated radiotherapy treatment planning with a mathematical model to satisfy treatment goals

Iterative algorithms can provide a feasible solution, if any exists, to specified treatment goals. Our model subdivides both the patient's cross section into a fine grid of points and the radiation beam into a set of "pencil" rays. The anatomy, treatment machine parameters, dose limits and homogeneity, are all defined. This process of subdivision leads to a large system of linear inequalities with a solution that provides a radiation intensity distribution that will deliver a prescribed dose distribution. The clinical results from two different algorithms will be presented and contrasted. Once the anatomy, treatment, and machine parameters have been entered, the computerized algorithms yield an answer in several minutes. The Cimmino algorithm also allows "weights" or priority assignments of the treatment goals. The resulting solution is biased towards fulfilling the specified doses for the anatomic regions which were given greater weight. It is desirable to have a systematic search of possible treatment alternatives in complex clinical situations, including 3-dimensional radiation therapy treatment planning (RTTP). Our method has been applied to 2-D RTTP, but is equally applicable to 3-D RTTP with minor modifications.

Demonstration of a software package for the reconstruction of the dynamically changing structure of the human heart from cone beam x-ray projections

The Dynamic Spatial Reconstructor (DSR) is a device constructed at the Biodynamics Research Unit of the Mayo Clinic for (among other things) the visualization of the beating heart inside the intact thorax. The device consists of 28 rotating X-ray sources arranged on a circular arc at 6 degrees intervals (total span 162 degrees) and a matching set of 28 imaging systems. The whole thorax of the patient is projected onto the two-dimensional screen of the imaging systems by cone beams of X rays from the sources. All of the X-ray sources are switched on and off within a total period of 10 milliseconds. The Medical Image Processing Group at the State University of New York at Buffalo has developed a software package for the design and evaluation of algorithms to be used by the DSR. In this paper we illustrate the operation of the package and a particular algorithm for the reconstruction of the dynamically changing structure of the heart from data collected by the DSR.