Title: RT-SRTS: Angle-Agnostic Real-Time Simultaneous 3D Reconstruction and Tumor Segmentation from Single X-Ray Projection

Abstract: Radiotherapy is one of the primary treatment methods for tumors, but the organ movement caused by respiratory motion limits its accuracy. Recently, 3D imaging from single X-ray projection receives extensive attentions as a promising way to address this issue. However, current methods can only reconstruct 3D image without direct location of the tumor and are only validated for fixed-angle imaging, which fails to fully meet the requirement of motion control in radiotherapy. In this study, we propose a novel imaging method RT-SRTS which integrates 3D imaging and tumor segmentation into one network based on the multi-task learning (MTL) and achieves real-time simultaneous 3D reconstruction and tumor segmentation from single X-ray projection at any angle. Futhermore, we propose the attention enhanced calibrator (AEC) and uncertain-region elaboration (URE) modules to aid feature extraction and improve segmentation accuracy. We evaluated the proposed method on ten patient cases and compared it with two state-of-the-art methods. Our approach not only delivered superior 3D reconstruction but also demonstrated commendable tumor segmentation results. The simultaneous reconstruction and segmentation could be completed in approximately 70 ms, significantly faster than the required time threshold for real-time tumor tracking. The efficacy of both AEC and URE was also validated through ablation studies.