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Volumetric 3D Display for Radiation Therapy Planning


Jason Geng, Senior Member, IEEE
(Invited Paper)

AbstractIn current clinical practice, radiation therapy planning (RTP) has often been treated as a two-dimensional (2D) problem, mainly due to the limitations in visualization technology available to date. The slice-by-slice display format makes it difcult to visualize the path of radiation beam not perpendicular to the axis of the CT slices. This discourages consideration of treatment plans that utilize radiation beam out of the transverse plane. Human body anatomical structures are inherently three-dimensional (3D) objects, and tumors and tissues/organs involved in the RTP are all of 3D shapes. A clear understanding of 3D spatial relationships among these structures, as well as the anatomic impact of 3D dose distributions, is essential for designing and evaluating radiation therapy plans. We have recently made an important breakthrough in the highresolution volumetric 3D display technology and have made an initial attempt to apply it to RTP applications. By volumetric 3D display, we mean that each voxel in the displayed 3D images ) spatial position where it is is located physically at the ( supposed to be, and emits light from that position to form real 3D images in the eyes of viewers. We have demonstrated the feasibility of our system design by building full-scale prototypes and achieved a multi-color, large display volume, true volumetric 3D display system with a high resolution of over 10 million voxels in a portable design. This type of true 3D display system is able to present a 3D image of a patients anatomy with transparent skin, providing both physiological and psychological depth cues to oncologists in perceiving and manipulating radiation beam conguration in true 3D fashion, thus offering a unique visualization tool to ensure the safety, effectiveness, and speed of the RTP process. The volumetric 3D display technology holds promise to signicantly enhance the accuracy, safety, and speed of RTP procedures. Such an understanding at a glance capability is necessary to keep the clinicians from becoming bogged down in details, as he/she would be if provided only with conventional 2D display of CT slices with overlaid isodose lines. The main focus of this paper is to provide technical details on the volumetric 3D display system we developed, and present some initial results on its capability of displaying true 3D images. While the system design framework of applying such technology into RTP is introduced, its full scale clinical applications to RTP is still an ongoing effort and will be reported later in other publications.
Manuscript received January 08, 2007; revised February 21, 2008. First published June 10, 2008; current version published November 19, 2008. This work was supported in part by the National Institutes of Health under Grant R44 CA80577-02A1, by the Department of Energy DE-FG02-98ER82588, by the U.S. Air Force F08635-97-C-0034, by DARPA DAAH01-97-C-R169, BMDO DASC60-98-C-0018, by the National Science Foundation DMI-0124322, and by NASA NAS13-01039. The content of this document does not necessarily reect the position or the policy of the sponsors, and no ofcial endorsement should be inferred. The author resides in Rockville, MD 20852 USA (e-mail: jason.geng@ieee. org). Color versions of one or more of the gures in this paper are available online at http://ieeexplore.ieee.org. Digital Object Identier 10.1109/JDT.2008.922413

Index TermsInteractive visualization, medical imaging, radiation therapy planning, volumetric 3D display.

I. INTRODUCTION HIS paper documents our theoretical study and experimental demonstration of a revolutionary volumetric threedimensional (3D) display technique. We also present a framework for applying this true 3D display technology to radiation therapy planning (RTP). Although we are still in the early stage of development, the ultimate goal of this investigation is to develop a clinically viable volumetric 3D display technology for medical image visualization in general. The proposed volumetric life-like 3D image display technique relies upon a display media that is a true 3D volume instead of a 2D at screen. Each volume element (called voxel, analogous to a pixel in a 2D image) in the displayed 3D im) spatial position where it ages locates physically at the ( is supposed to be and emits light from that position to form real 3D images in the eyes of viewers. The volumetric 3D display we developed is fundamentally different from conventional 3D rendering visualization technique, where the object is displayed on a 2D at screen with 3D rendering for depth perception. It is also different from 3D stereo video or head-mounted display (HMD), where the 3D perception is created with a pair of polarized glasses or display screens. The volumetric 3D display technology projects 3D images directly into true 3D space that does not require special 3D glasses to view it. Viewers can walk around the 3D image and look at it from all different directions with realistic depth just as looking at the real physical object. Such 3D display provides both physiological and psychological depth cues to human viewers for truthfully perceiving objects in 3D space. Furthermore, with realistic 3D representations of medical images in many imaging modalities (CT, MRI, PET, Ultrasound, etc), viewers can interact with the life-sized volumetric 3D images being displayed, via handheld pointer and/or other userinterface devices, as if the true 3D virtual patient were there with a transparent skin and visible internal anatomic structures. The unique capabilities of walk-around viewing and direct interaction with the displayed 3D images could greatly simplify our understanding of the complexity of 3D objects and spatial relationship among them. We have recently made an important technical breakthrough in implementing the high-resolution volumetric 3D display. Using the spatial light modulator (SLM), high power visible lasers and precision fabrication of helical screen, we have

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achieved a multi-color, large display volume, true lifelike 3D display system with a high resolution of over 10 million voxels in a portable design. We have demonstrated our high-resolution volumetric 3D display concept by building a full-scale prototype that can display complex 3D images. The volumetric 3D display is a revolutionary concept for RTP and medical image visualization in general. The major innovations of our approach are twofold. 1) We have developed a functional hardware platform and a high-speed data interface that enables a high-resolution volumetric 3D image with over 10 million voxels to be displayed at a rate of 20 frames per second. We have designed, fabricated, and tested all hardware components and software package associated with the display prototype system. The dynamic volumetric 3D display capability not only makes the interactive RTP possible, but also opens doors to many new applications in medical image visualization arena. 2) We have developed a novel conceptual framework of the Interactive RTP Environment, and built a set of prototype hardware/software. The Interactive RTP Environment enables direct interactions between the displayed volumetric 3D image of patient anatomic structure and tumor, and the simulated treatment beam conguration. The intuitive interactions help radiation therapy planners determine suitable beam directions and parameters to maximize the tumor coverage and minimize the exposure of normal tissues during a planning session. II. BRIEF SURVEY OF PRIOR ART ON VOLUMETRIC 3D DISPLAY TECHNIQUES In this section, we provide a brief survey of a number of 3D volumetric display techniques that have been intensively developed in the past. A. Solid-State Up-Conversion One of the fundamental requirements for a volumetric 3D display system is to have entire display volume lled with materials that can be selectively excited at any desired locations. To achieve this goal, one can have two independently controlled radiation beams which activate a voxel only when they intersect. While an electron beam cannot be used for such purpose, a laser beam can, provided that a suitable material of display medium can be found. A process known as two-photon up-conversion can achieve this objective (U.S. Patent 4 041 476 by Swainson, 1977, U.S. Patent 5 684 621 by Downing, 1997). Briey, this process uses the energy of two infrared (IR) photons to pump a material into an excited level, from which it can make a visible uoresce transition to a low level. For this process to be useful as a display medium it must exhibit two-photon absorption from two different wavelengths so that a voxel is turned on only at the intersection of two independently scanned laser sources. The materials of choice at the present time are the rare earths doped into a glass host known as ZBLAN. ZBLAN is a urozirconate glass whose chemical name stands for ZrF4BaF2-LaF3-AlF3-NaF. The two-photon up-conversion concept for 3D volumetric display is quite promising, since it requires no

moving parts. Major difculties to produce a practically useful 3D display using this approach are its scale-up capability and ability to display multiple colors. B. Gas Medium Up-Conversion Another 3D display based on the up-conversion concept employs the intersection of two laser beams in an atomic vapor, and subsequent omnidirectional orescence from the intersection point (U.S. Patent 4 881 068 by Korevaar, 1989). Two lasers are directed via mirrors and - scanners towards an enclosure containing an appropriate gaseous species (rubidium vapor, for example), where they intersect at 90 deg. By itself, either laser causes no visible uorescence. However, where both lasers are incident on the same gas atoms, two step excitation results in orescence at the intersecting point. By scanning the intersection point fast enough, a 3D image can be drawn in the vapor. The eye cannot see changes faster than about 15 Hz, so that if the image to be displayed, it is repeatedly drawn faster than this rate; the image will appear to be steady, even though light may be originating from any one point in the volume from only a small fraction of the time. The advantage of this 3D display concept is its scalability: It can be built in almost any desirable size without signicantly increasing the complexity of the system. The technical difculties in implementing this concept including the requirement of vacuums chamber, requirement for maintaining certain temperature, limitation of number of voxels by the speed of the scanners, and eye-safe problem of laser beams. C. Rotating LEDs Array One of the earliest volumetric 3D displays was designed by Schipper in 1963 (U.S. Patent 3 097 261). It consists of a rotating electroluminenscent panel with embedded high-speed light emitter array. By controlling the timing of - addressing of the light emitter array and the rotation of the panel, 3D images can be formed within the volume swept by the rotating panel. In 1979, Berlin developed an innovative approach to solving the high-bandwidth data transmission problem of this design using optical link and replaced the light emitters with high speed light-emitting diode (LED) matrix (U.S. Patent 4 160 973 by Berlin, 1979). This system uses LEDs arrays that are rotated to sweep out a 3D volume. The resolution of this volume is a function of number and density of LEDs mounted on the rotating planar array, the speed of rotation and the rate at which the LED can be pulsed. D. Cathode-Ray Sphere (CRS) The Cathode-Ray Sphere (CRS) concept was originally developed by Ketchpel in 1960s (U.S. Patent 3 140 415 by Ketchpel, 1960) and recently implemented by researchers at New Zealand (US Patent 5 703 606 by Blundell, 1997). The voxels are created by addressing a rapidly rotating phosphor-coated target screen in vacuum by electron beams synchronized to the screens rotation. The view of this rotating multi-planar surface depends on the clarity of the glass enclosure and the translucency of the rotating screen. Another image quality issue is the interaction between the phosphor decay ray and the speed of the rotation of the screen.

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Fig. 1. A brief survey of various 3D display technologies.

E. Varifocal Mirror and High Speed Monitor A very clever method of 3D display employs the strategy of forming optical virtual 3D images in space in front of viewer (U.S. Patent 4 130 832 by Sher, 1978). The varifocal mirror system consists of a vibrating circular mirror along with a high-speed monitor. The monitor is connected to a woofer such that the woofer can be synchronized to the monitor. A exible, circular mirror is attached to the front of the woofer, and the monitor is pointed toward the mirror. With the vibrations from the woofer, the mirror changes focal length and the different points being displayed on the monitor seem to appear at different physical locations in space, giving the appearance of different depths to different objects in the scene being displayed. Variable mirror based 3D display systems are primarily limited by the size of the mirror and updating rate of images, since this mirror has to vibrate. F. Laser Scanning Rotating Helix 3D Display Extensive attempts have been made by researchers at Texas Instruments Incorporated (US Patent 5 042 909, 5 162 787, by Garcia, 1991) to develop a 3D display device based on laser scanning and rotating (helical) surface. Lasers scanning 3D displays operate by deecting a beam of coherent light generated by a laser to a rotating helical surface. Timing modulation of the laser beam controls the height of the light spot that is produced by the laser on the rotating surface. The deectors include devices such as polygonal mirrors, galvanometer, acousto- optics modulated deectors, and micro-deformable mirrors. There are several problems with this 3D display mechanism that have prevented it from becoming commercially feasible. The most serious problem is the limitation on the maximum number of voxels that can be displayed. Due to the nature of sequential (non-parallel) laser scanning, only one spot of light can be displayed at any given moment. All the activated image voxels have to be addressed, one by one, by the scanning of single laser beam in time-multiplex fashion. The time needed for steering the laser beam and to stay on the voxel position to produce sufcient brightness poses an upper limit to how many voxels it can display. To increase the number of voxels, multiple channel lasers and scanners could be used. However, many

attempts to increase the spatial resolution have hampered with high cost and bulky hardware design. Fig. 1 summarizes various research and development efforts on 3D display. Recently, there is a surge of research activities on volumetric 3D display that promise to bring high resolution ( 100 million voxels) display into reality [1][11]. III. VOLUMEVIEWER 3D DISPLAY CONCEPTP In this section, we provide detailed technical discussions on the VolumeViewer 3D display design and its implementation. A. Principle of the Multi-Planar Volumetric 3D Display Fig. 2 illustrates the principle of the Multi-planar volumetric 3D image display using a high-speed 2D image projector and a moving screen. Suppose that a sweeping screen can be controlled to move back and forth along the direction at a frequency higher than 20 Hz. Within the time period of each sweeping motion, frames of 2D image patterns are projected by the high-speed 2D image projector. The moving screen intercepts 2D image projections at different positions along axis, forming a stack of spatial image layers in true 3D space. If the cycling speed of the moving screen is sufciently high, and the 2D image projector can produce sufcient number of 2D image sections during each pass, human observers are able to perceive a true volumetric 3D image oating in the 3D space without icker, due to the residual effect of human eyes. The multi-planar volumetric 3D display principle is by no means a complex concept. However, implementation has been difcult due to lack of suitable high-speed image projector, clever mechanism to produce sweeping screen motion, and high brightness light sources. There has been a number of attempts been made to build such cumbersome system without success. A physically at screen sweeping at 20 Hz creates serious problems of mechanical design, balance, vibration, and noise. Conventional liquid crystal projector can only achieve a switching rate of few hundred hertz, leading to a very low spatial resolution. High power light source has been very expensive and cumbersome. All these factors contribute to a slow progress of volumetric 3D display techniques using multi-planar principle.

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Fig. 2. Principle of the multi-planar volumetric 3D display using fast 2D projection and a moving screen.

Fig. 3. Volumetric 3D display concept using a fast SLM and a rotating helix screen.

B. Concept of the VolumeViewer 3D Display We propose a new generation of the multi-planar volumetric 3D display system, taking advantages of rapid advances in material, laser, and semiconductor fabrication technologies. With the newly developed ferrorelectric liquid crystal spatial light modulator (SLM) technology, the switching speed of SLM reaches over 3000 fps for a SLM of 256 by 256 pixels or higher resolutions. Such a fast SLM can be used as a high-speed image pattern generator to produce volumetric 3D pictures, providing a powerful tool to revolutionize the state-of-the-art of 3D display. Fig. 3 illustrates a design concept of our SLM/helix volumetric 3D display.

In Fig. 3, light rays produced by a light source projector , passing through lter and collimating lenses , impinge on a polarizing beam splitter cube . Due to the polarization characteristics of the beam splitter, the polarized light rays are reected by the beam splitter and projected onto a SLM . The image data shown on the SLM is generated by a host computer . The SLM is able to alternate image patterns at high frame rate (i.e., over 3000 fps). When a pixel on SLM is turned ON, the light will be reected back to the beamsplitter cube, while when the pixel is turned OFF, the projected light on this pixel will be absorbed by the SLM and will not be reected. The patterns on the SLM are therefore able to control the patterns of the

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reected light rays. The reected light rays with encoded SLM image patterns transmit through the beam splitter cube. is employed to project An optical projection lens system the image patterns towards a spinning helix screen, marked as . The light spots projected on the helix screen intersect the helix surface at different heights depending on different rotating angles of the helix, thus form 3D voxels in 3D space (the display volume ). Each section of the helix surface is described by the following mathematical equations:

Fig. 4. Prototype of the VolumeViewer 3D display.

If rotation is synchronized via a motor driving the helix screen with the switching timing of the SLM , such that 3D image patterns are shown in the 3D space with a high refresh rate (e.g., 20 Hz), naked eyes perceive it as a 3D volumetric image. No special eyewear is required to view such 3D image oating in true 3D space, just as a real object is placed there. C. Advantages of the Proposed SLM/Helix 3D Display System Inherent Parallel Architecture for Voxel-Addressing: Instead of using single laser beam to address all the voxels (such as the NRaD scanning laser system) the SLM/Helix system use 256 by 256 (or more) light rays to address simultaneously voxels, thus overcomes the bottleneck in producing high resolution 3D images encountered by other approaches. High Spatial Resolution: The maximum number of voxels that can be generated by the SLM/Helix display depends upon the spatial resolution of SLM and the spinning speed of helix. With the currently available SLM technology, a SLM with 1024 by 1024 pixel and 300 000 frames per second switching speed is available. The resolution of proposed 3D display can take advantage of the rapid advances of SLM technology. Simple Structure and Easy to Build: Other than the rotating helix, there is no other scanning or moving part. The optical design and alignment are not difcult. The system can be built using commercial off-the-shelf (COTS) products, which leads to shorter development period and low cost. No Special Viewing Glasses or Helmet are Needed by Viewers: The volumetric images are displayed in true 3D space with almost 360 degree viewing angle, which preserve all physiological and psychological depth cues of human visual system. Viewers can walk freely around the monitor to see the 3D images, just as if the real 3D object were sitting there. Implementation of Full Color Display is Straightforward: Just use three SLMs for Red, Green, and Blue respectively, and the color of voxels can be automatically controlled. Another way to implement color display is even simpler: use Red, Green, and Blue light projector, and synchronize the timing of three projectors with a high speed SLM. D. VolumeViewer 3D Display Prototype Fig. 4 presents an overall system design conguration of the newly designed and prototyped volumetric 3D display. We

TABLE I PERFORMANCE OF THE VOLUMETRIC 3D DISPLAY PROTOTYPE

dubbed this prototype system the VolumeViewer. Inside the transparent hemispherical dome is a rotating helix forming a 3D image display volume of 7 height and 20 in diameter. There are nine pieces of reective mirrors with large dimensions of optic surfaces. If fabricated using conventional thick glasses, these mirrors would be heavy-weighted, fragile, and difcult to assembly with acceptable accuracy of optical alignment. We adopted a state-of-the-art mirror fabrication technology that forms large piece of at mirror using framed thin lms with high reectivity. These thin-lm mirrors have only 10% of weights as their glass mirror counterparts, and can be built to t various difcult geometric dimensions. Due to their light weight and exible dimensions, we can easily mount them into optically aligned modules, thus saves us tremendous effort in the nal stage of the optical alignment in the system integration. Table I lists major performance specication of the VolumeViewer Prototype system.

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Fig. 5. SLM structure.

IV. DESIGN AND FABRICATION OF THE PCI INTERFACE BOARD ALLOWING FOR DYNAMIC 3D IMAGE DISPLAY A. Primary Objectives of the PCI Interface Board Design Although our initial success in developing the original prototype system represented the state-of-the-art true volumetric 3D display technology then in terms of achieving high spatial resolution, the updating rate of 3D images in original system was still slow. To update a displayed 3D image into a new frame of 3D image, the host PC has to upload the data set of the new 3D image to the SLM driver via a parallel port. This data transmission of a single frame of 3D image usually takes about 20 s, due to the size of 3D dataset and the slow speed of the PC parallel port. Such a low updating rate certainly prevents our current 3D display system design from being used in many dynamic interactive 3D display applications, such as radiation therapy planning sessions. Therefore, one of the main efforts of this investigation is to design and fabricate a PCI interface board to eliminate the bottleneck of 3D image transmission between host PC and SLM chip. Primary goals of this PCI interface board are: 1) to achieve 3D image updating at a rate up to 20 images per second from host PC to SLM chip; 2) to increase the frame rate of 2D image displayed on the SLM; 3) to allow for multiple color 3D display. B. Spatial Light Modulator (SLM) SLMs, devices that alter the temporal and spatial character of a light beam, can be either optically or electrically addressed. Optically addressed SLMs often require bulky support equipment and additional light sources. To obtain high frame rate of image projection for volumetric 3D display, we propose to use the electronically controllable, fast ferroelectric liquid crystal (FLC) reective spatial light modulator. The device is built atop a planarized 0.6 m CMOS SRAM backplane with 15 m pixel pitch and 87% ll factor. A thin layer of FLC material is sandwiched between a metal conductor and a glass window coated with a transparent conductive layer such as indiumtinoxide (ITO). When a voltage is applied across the FLC layer the fast axis of the bi-refringent FLC material is forced into one of two possible states: ON or OFF (the image on the SLM is binary). The structure of a SLM is depicted in Fig. 5. It is a specially designed integrated circuit housed in a 49-pin ceramic PGA package. The effective area of the SLM consists of 65 536 FLC

cells arranged as a square of 256 by 256 array with total dimension of 5 5 mm approximately. The device achieves better than 25% optical throughput when used with collimated laser light and better than 100:1 contrast ratio when oriented for amplitude modulation. A better than 100:1 contrast ratio of SLM provides a fairly good image quality. The device can be operated as fast as 5 kHz with complete switching of the liquid crystal. C. Design the PCI Interface Board to Control the SLM Chip Controlling the SLMs operation is very similar to addressing a Static Random Access Memory (SRAM) chip. The interface board contains an on-board microprocessor, memory for up to 512 frame 2D images, circuitry for controlling the SLM, and circuitry for communicating with host PC computer. We use C++ and VXD (a low-level assembly) software to manipulate the image data and to transfer them into the image buffer on the controller, which in turn sends the image sequence to the SLM in a predetermined high frame rate. Fig. 6 illustrates the block diagram of our Interface Board design. 1) Microprocessor: The size of 3D data sets is inherently huge. In order to transfer huge amount of 3D data in higher speed among the host computer, on-board image memory, and the SLM chip, the microprocessor must have the high-speed data transferring unit, such as DMA, Interrupt Unit etc. The microprocessor must also have a PCI interface and other control units for connecting with PC and communicating with other standard facilities. By careful design comparison, we selected the Intel 80960RP as the CPU of the board. The 80960RP is a PCI IO processor with 352 BGA pins. It has many units for data communication. Its DMA Controller, Address Translation Unit (ATU), Message Unit (MU), Memory Controller and other control units are suitable for the design, and it has an available and completed embedded software system, so it fullls the design features. 2) Memory: We need a higher speed RAM on the board as a buffer to store 3D images. In the design two memory groups are used to display dynamic 3D images and make the other display functions. By considering the speed, volume and stability, we chose eight SRAM, MCM6246 chips, as the image memory on the board and divided them into two groups, each has 2 Mbytes. This image memory can implement all features described above. 3) FPGA (Field Programmable Gate Array): Due to complex operation of the PCI interface board, thousands of gates and ip-ops are needed to fulll the desired functions. Dozens of buses with 32 bits have to switch each other, which is impossible to be laid on an area-limited printed circuit board directly.

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Fig. 6. Block diagram of the PCI interface board.

D. Fabrication and Test the PCI Interface Board Using the newly designed SLM device interface board, we have achieved a maximum transmission rate of about 2200 fps and the resolution of each frame of 2D images is 256 by 256 pixels. At the target 3D image refreshing rate of 7 images per second, we are able to produce 157 frames of 2D images for each 3D image cube. This enhanced speed of image transfer effectively increases the spatial resolution of our volumetric by by million voxels. 3D display to In comparison to the use of original SLM drive unit, the maximum spatial resolution is about by by million voxels. Furthermore, the 3D image-refreshing rate was about 20 seconds per image versus the 20 images per second of current system equipped with the new PCI interface board. The success of the PCI interface board allows us to perform dynamic 3D image display, and makes the application of our 3D display technology to RTP practically possible. E. Software Drive Development Using VXD Techniques The software for the board is divided into host computer programs and the 80960RP microprocessor programs. The host computer programs include a Windows based work studio and a VxD (Virtual Device Driver) program, as shown in Fig. 10. The 80960-based program includes the embedded programs stored in PROM or the executable code downloaded from the host computer to the 80960RP program RAM. In fact the board can be controlled from host computer and 80960RP. When the host computer is turn on, BIOS of the computer nds the PCI board, so that the Windows 95/98 can get the information from the Intel 80960RP. Then the model of (Operation System) OS loads the GTI3DD.VxD into the computer memory. During loading GTI3DD.VxD, OS communicates with the VxD to decide the resources allocation. After all VxDs are loaded, OS builds up a table to save the results.

Fig. 7. Block diagram of FPGA1.

Fig. 8. Block diagram of FPGA2.

We employed advanced FPGA technology which allows for a software programmable functionality on hardware chips. Two Xilinx XCS40 (each with 40,000 gates) are used and their functions are illustrated in Figs. 7 and 8. Due to space limit, a total of 24 complex circuit diagrams implemented by FPGAs cannot be included. Fig. 9 gives an example of programmable functions implemented by the FPGA1. Powerful FPGAs make it possible for us to design a compact PCI board with the desired features.

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Fig. 9. An example of detailed design diagram inside the FPGAs.

Fig. 10. Operation of the VxD for the PCI interface board.

V. SWITCHABLE DISPLAY VOLUMEA NEW OPTICAL DESIGN ENABLING BOTH FULL AND HALF HELIX DISPLAY VOLUMES In our previous system design and experiments, we projected the 3D images onto a small portion (less than one half of a helix, see the left drawing in Fig. 11) of the sweeping volume produced by the helix. A large portion of the useful volume produced by the sweeping helix was wasted. In our latest effort, we have signicantly improved the system optical design to project the 3D images into the entire helix volume (see the right drawing in Fig. 11), thus increasing the size of the display volume to entire sweeping volume of the rotating helix 20 (508 mm) in diameter and 7 (178 mm) in height.

Fig. 11. Comparison of previous and current 3D image projection schemes.

A. Overall Optical Conguration Design and Tradeoff: Front Projection Versus Rear Projection There are two possible overall optic congurations for the SLM/Helix system design: Front projection conguration (FPC) versus rear projection conguration (RPC). Previous 3D display systems, such as NRaD 3D display, use the front projection conguration. This means that laser beams are projected onto the rotating helix surface in the same side as viewers view the 3D images [Fig. 12(a)]. The front projection conguration makes it easier to implement a driving system

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(a)

(b)

Fig. 12. Comparison of overall optical conguration for the SLM/helix 3D display. (a) Front Projection Conguration (FPC). (b) Rear Projection Conguration (RPC).

for the rotating helix. It also provides convenience in adjusting optical system setups and modifying other components or subsystems. However, the disadvantages of the front projection conguration include the following. (1) It leads naturally to an overhead projection conguration so a compact system design (as a portable desktop display, for instance) is difcult to achieve. (2) Viewers may possibly block the projection of laser beams. (3) Since system components are spread out, maintaining an accurate optical alignment is difcult. We have developed the rear projection system (RPS) design for our SLM/Helix 3D display. In a RPS conguration, laser beams are projected onto the rotating helix screen from below, while viewers look 3D images from above [see Fig. 12(b)]. The helix surface is made of semi-transparent material so it transmits 50% light and reects 50% light. This rear-projection approach eliminates the unwieldy overhead mirrors from the NRaDs design and allows the lasers, scanners, optics, and the helix to be packaged together as a single compact mobile 3D display unit. Since the helix surface transmits as well as reects light in omni-direction, the viewing angle of the voxels in a 3D image is very large (almost true walk-around viewing angle and group viewing capability). A major advantage of using the RPS conguration is that it is possible to achieve a compact system design. All the components of the SLM/Helix system can be packaged into a cabinet with 3D display volume on the top. From the viewpoint of nal commercial product design, RPS is a much better system design conguration for a volumetric 3D display device. Compact and stylish desktop 3D display unit can be built. B. Optical Layout of the SLM/Helix System With a Full Helix 3D Display Volume Due to structural constraints of the Rear Projection Conguration, entire displayable volume of the helix cannot be fully

Fig. 13. Optical layout of switchable 3D display volume: When the electronically controlled swing mirror is On, the 3D image occupies the entire helix volume, while when the swing mirror is Off, the 3D image occupies one half of the helical display volume.

illuminated by an image projector via single light path. The motion control components (motors, encoders, etc.) would block portion of images located close to the rotating axis of the helix. To solve this problem, we invented a new optical layout that employs split light paths. As shown in the Fig. 13(a), the image projection coming out from the SLM projector is rst reected by the electronically controllable swing mirror (labeled as M), to a 45 mirror A towards upward. The image is then split in half by a pair of mirrors B and B. The light path on the left subsequently goes through mirrors C, D and E to illuminate the left half of the helix volume. In a similar fashion, a symmetric light path on the right goes through mirrors C, D, and E to illuminate the right half of the helix volume. Fig. 13(b) presents a 3D view of this dual light path arrangement. The dual light path optical layout bypasses the motion control unit (motor and encoder) and is able to deliver the image projection that covers entire displayable volume on the helix (except for the central axis). When the swing mirror is on the off position, the light projection coming out from the SLM projector is reected by the mirror , and the entire image ray will pass only the path

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Fig. 14. (a) 3D image data consisting of a voxel cube. (b) 3D image data is sliced into helical slices conformal to the shape of helix screen at different locations.

Fig. 15. Pictures of a volumetric 3D image (human head) displayed on our VolumeViewer prototype system.

of A, B, C, D, E, towards to the one half of the helix volume. This display mode is often needed to offer viewers the exibility of seeing 3D image in a higher voxel density and higher image brightness. With the same projected light energy, smaller the display volume, brighter the image. C. Real-Time Dynamic 3D Image Data Generation Although we have developed the dynamic 3D display capability for our volumetric 3D display, fast 3D image data preparation for real-time applications remains a challenging task. The 3D image preparation for our display can be illustrated in Fig. 14. A set of 3D data is represented as a 3D data cube, as shown in Fig. 14(a). The preparation tasks include scaling and orientating the image, and slicing the 3D data cube using helical surfaces, as shown in Fig. 14(b). The sliced data set (a stack of 2D images) can then be sent directly to SLM chip for projection. In general, the size of 3D image is inherently huge (20 Mbytes each, for example) and most 3D image processing tasks takes a long time to complete using off-the-shelf PC computer. In this project, we have discovered a new approach to greatly increase the speed of the 3D data processing for displaying the dose distribution. In RTP application, the locations of tumor and critical organs are known via preprocessing. In the real-time display operation, we only need to adjust the color of voxels on these objects to reect the dose values on these voxels resulting from real-time dose calculation. We call these voxels the active voxels. Usually, the number of the active voxels is only a small percentage (i.e., 5%) of all voxels. All the data corresponding to other voxels remain unchanged. By processing only the active voxels, signicant amount of time can be saved, thus real-time dynamic display of the changing 3D image is feasible. We have preliminarily implemented this active voxels approach on a prostate tumor visualization experiment. The tumor can be tuned On and Off by viewer using a mouse at a response time of about 0.1 s. D. Example of Volumetric 3D Display Images Fig. 15 shows an example of true 3D image displayed on the VolumeViewer prototype. Note that due to the nature of true 3D image, it is very difcult to present the true 3D nature of the display on at media such as on a at paper. However, the observers who have had opportunity to see the true 3D display all appreciate the unprecedented capability of providing both physiological and psychological depth cues to human viewers to truthfully perceive 3D objects in volumetric images.
Fig. 16. Radiation therapy planning: irradiate a tumor using multiple radiation beams while sparing neighboring tissues from radiation damage.

VI. TRUE 3D DISPLAY FOR RADIOTHERAPY PLANNING A. Basic Concept of Radiation Therapy Planning The primary goal of a radiation therapy treatment is to deliver a high and uniform dose to the tumor while keeping the dose to the neighboring healthy tissues and radiation-sensitive organs as low as possible. Fig. 16 schematically illustrates the basic concept and constraints in the radiation therapy planning. A cross section of a body anatomy with a circular tumor is shown. If the tumor is irradiated from only one direction with a cylinder beam (labeled as beam1), all the healthy tissue along the beam path are exposed to approximately the same dose as the tumor. If, instead, we use multiple beams (the beam1 and beam2, for example), the dose deposited on the tumor would be approximately several times of the dose exposed to the healthy tissue. Using more beams in different directions can lead to further improvements of the dose distribution, and a very sharp dropoff of the dose in the tissue surrounding the tumor region can be achieved. The planner(s) of a radiation therapy procedure should carefully select the beam conguration in order to achieve the best treatment result. By beam conguration we mean a set of parameters including the number of beams, spatial orientation of each beam, beam angels, intensity, beam weights and cross-section shape of each beam, etc. The best treatment result is judged by the maximum dose distribution on the tumor and the minimum dose distribution on surrounding healthy tissues. The radiation therapy planning is an interactive process where the planner has to produce, evaluate, modify, and compare several alternative plans based on available information regarding the patients anatomy, tumor characteristics and planners knowledge and clinical experience [12][21]. B. Why Use True Volumetric 3D Display in Radiation Therapy Planning? 1) Human Anatomy is Inherently 3D: The true volumetric 3D display technology offers unambiguous spatial relation-

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ship among the 3D structures allowing viewers to perceive 3D anatomical structure correctly and quickly. In the radiation therapy applications, the ability to visualize 3D internal structures, as if the patient had transparent skin, allows the oncologist to select beam angles, weights, and eld shapes that will minimize inclusion of radiosensitive organ/tissues with the beam. More importantly, the volumetric 3D display capability reveals the complex spatial relationship among these body parts in a true 3D physical space, providing the planner a much more effective way to comprehend the complex spatial relationships between tumor and surrounding healthy organs, as well as the dose distribution in 3D space. Displaying dose coverage as color objects also has signicant advantages over existing technology. In existing practice, dose distribution can either be viewed slice-by-slice on sectional images or as a 3D rendered color object displayed on a computer screen. Therefore, the operators either view all slices to get the dose coverage or perform 3D rendering at many viewing angles to get the complete picture of dose coverage. Either way, it would take a long time or the picture has to be completed in the operators mind since neither method can show the complete picture at once. In contrary, when displayed with an interactive lifelike 3D display monitor, the complete picture of dose coverage could be presented for the planner. 2) Limitation of Conventional Display Techniques: In conventional RTP practice, planning has often been treated as a two-dimensional (2D) problem, mainly due to the limitations in imaging/display technology and resources. Conventional slice-by-slice display of CT or MRI data while providing detailed anatomic information imposes serious limitations on the radiation treatment planning process. First, the slice-by-slice display format makes it difcult to visualize the path of any radiation beam not perpendicular to the axis of the CT slices. This discourages the consideration of all treatment plans that utilize radiation beam out of the transverse plane. Second, by displaying the radiation iso-doses on each CT slice, the merits of multiple competing treatment plans can be compared only in a piecewise fashion. Experience has shown that under these conditions, it is not always easy either to recognize the best treatment plan or to suggest useful modications. Finally, for brachy therapy treatment, the conventional CT format may offer ambiguous information as to the location of the implant. It may be impossible to determine whether a radioactive seed seen on one CT slice is the same as that seen on an adjacent slice. There have been rapid advances recently in 3D visualization techniques (both software and hardware) to produce 3D effect on 2D display screens. However, CT/MRI data is inherently of 3D nature, yet all conventional displays use at 2D screens or lms (e.g., CRTs, LCDs, and slices) that lack important depth cues. This fundamental restriction greatly limits the capability of oncologist to perceive the complexity of the anatomy and radiation beam conguration, therefore affects the safety, speed and accuracy of the radiation treatment planning process. 3) Understanding at a Glance: We believe that the true volumetric 3D display technique holds the potential to revolutionize current clinical practice of 3D treatment planning, and is a logical evolutionary step to the fth generation technology in

Fig. 17. Hardware setup of the interactive RTP environment.

the history of radiation therapy treatment planning. The inherent capability of displaying 3D data with true 3D cues allows clinicians to understand the spatial radiation dose distribution much more quickly and easily. Such an understanding at a glance is necessary to keep the clinician from becoming bogged down in endless details, as he would be if provided only with conventional 2D display of CT slices with overlaid iso-dose lines. The 3D RTP techniques have received broad clinical acceptance and has shown in improve clinical outcomes. It is evident that improved visualization tools in RTP can make signicant improvements in patient care. The lifelike 3D display provides signicant advancement over the existing 3D rendering technique in that the inherent capability of displaying 3D data with most true 3D cues allows clinicians to understand the spatial radiation dose distribution much more quickly and easily. Such an understanding at a glance is necessary to keep the clinician from becoming bogged down in endless details, as he would be if provided only with conventional 2D display of CT slices with overlaid iso-dose lines. We believe that the true volumetric 3D display technique holds the potential to revolutionize current clinical practice of 3D treatment planning, and is a logical evolutionary step to the next generation visualization technology in the history of radiation therapy treatment planning. VII. FRAMEWORK OF THE INTERACTIVE RADIATION THERAPY PLANNING ENVIRONMENT We propose an interactive RTP environment framework that takes full advantage of the true volumetric 3D display capability, as shown in Fig. 17, which illustrates a prototype of the Interactive RTP Environment with gantry, beam simulator, and the dynamic volumetric 3D display. Note that the gantry can rotate around the hemisphere display volume, and the beam simulator can adjust its angular position, thus realizing a two degree-of-freedom positioning capability, which is able to simulate typical beam positions used in RTP. Fig. 18 provides a owchart of the interactive RTP process using our volumetric 3D display technology. Images of patients anatomy and cancer/organs are acquired and processed to provide 3D digital models of anatomic structures and cancer organs. These data are sent to the volumetric 3D display for visualization. An oncologist/planner starts his/her planning process

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Fig. 18. Interactive radiotherapy planning environment using volumetric 3D display.

by visualizing directly the true 3D images displayed on the volumetric 3D display monitor, just like he can view the patient with transparent skins. The oncologist can specify the beam conguration by dene beam parameters or by using the simulated beam simulator hardware that shines a simulated radiation beam directly on the anatomic structure and tumor location. The spatial position and orientation of the simulated beam can be totally controlled by the oncologist/planner so he/she has entire 3D freedom to place and adjust the beam conguration. Beam Eyes View (BEV) and Room View can be provided for the visualization. Once the planner selects the beam conguration, dose distribution corresponding to this set of beam conguration will be calculated and the results will be sent to the volumetric 3D display monitor for visualization. Should the planner decide to modify the beam conguration based on the visualization results, he can go back to the beam conguration planning stage and dene the modied beams. After the dose distribution of a plan meets the requirement, the system automatically performs the collision avoidance verication, based on the kinematics relationship among the treatment machine, couch, and patients body shape. The collision avoidance verication process can be animated and displayed on the volumetric 3D display so the oncologist can visually conrm the collision-free treatment plan. Finally, the system will formulate a nal radiation therapy plan and compute various quantitative gure of merits (FOM), such as dose-volume histogram, dose statistics, normal tissue complication probability (NTCP), and tumor control probability

(TCP), etc. These data can be displayed on the 2D/3D monitors simultaneously. We have performed experiments to demonstrate the feasibility of this novel Interactive RTP Environment concept. Components of the Interactive RTP Environment are described in the following paragraphs. Results of our initial experiments are promising, as judged by a number of radiation physicists who observed the experimental demonstrations in our prototype system. The 3D volumetric images of patients anatomic structure and tumor site are displayed on the volumetric 3D display monitor, and a simulated radiation beam mounted on a gantry structure and controlled by the oncologist can illuminate directly the displayed tumor to observe the radiation effect. Such a beam simulator is able to duplicate the motion similar to that achieves by the treatment machine and it has position tracking sensors that record the motion of the beam head. On the other hand, the conguration (orientation and position) of the displayed patient anatomic image can be controlled by the planner to simulate the realistic patient setup conguration. The combination of the displayed volumetric 3D image and the simulated radiation beam mechanism allows the oncologist to adjust and select interactively the conguration and parameters of a beam (divergence, orientation, intensity, and shape) as well as the patients setup position to achieve the best gure of merits and to avoid the beam paths that could cause potential damages of neighboring healthy tissues. After beams are selected, computer will generate a treatment plan, and the 3D dose distribution will be calculated. The 3D

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display monitor then superimposes the dose distribution maps with anatomical structure, allowing the radiation oncologists to further review, modify, and approve the radiation therapy plan. The entire planning process is highly intuitive and interactive thus is very easy to learn and master, takes much less time from oncologists to the RTP, and can achieve better quality of the resulting plan. We now describe individual components of the proposed framework for the interactive RTP environment. A. Volumetric 3D Display Monitor Using a volumetric 3D display monitor in the proposed Interactive RTP Environment has unique advantages. The 3D images of anatomy and tumor organ are oating in the true 3D space, with the correct 3D spatial relationship as true objects. The images can be viewed from all directions without needing any special eyeglasses, and independence from observers capability of stereo-vision. These features offer the planner high degree of intuition and easiness to comprehend patients specic anatomic situation. The volumetric 3D display is the only information display media that allows for the true 3D interaction between the displayed anatomy and tumor organ images and the simulated radiation beams. RTP Planner can interactively congure the patient position and beams congurations. The interactive nature of the volumetric 3D display allows the planner to modify geometric parameters while viewing directly at the 3D images of anatomic organs, as if the true object is there. 3D images are not really useful unless the viewer is able to interact with display in a convenient way. The 3D images displayed on our volumetric 3D monitor possess the see-through feature. This means that the foreground images of organs would not occlude the background images. This transparency feature allows viewers to see both the tumor and surrounding healthy organ as well as the treatment beams simultaneously, thus greatly increase the understanding of 3D spatial relationship among these elements. B. Gantry Motion Fixture In a single iso-center radiation treatment plan, all beams intersect at the accelerators iso-center. To meet this requirement in our Interactive RTP Environment, we have designed the system similar to that of gantry on the treatment machine, with one degree-of-freedom motion xture along the gantry (as shown in Fig. 17) that hosts the simulated beam head. The beam head can be moved freely around the patient by the planner during the interactive planning session. The 3D image of the patients anatomy can be manipulated by the planner to simulate the realistic setup position of the patient in the radiation therapy planning session. A position tracking sensor is installed on the gantry to track the location of the beam head on the gantry. The sensor output will be send to the central computer to calculate the beam conguration. Fig. 19 shows a set of interactive visualization of anatomical structure of a prostate and treatment beam conguration. Note that the simulated beam controlled by a planner is able

Fig. 19. Interactive visualization of anatomic structure/prostate and beam conguration.

to directly interact with the life-size 3D anatomic structure of a patient, and an optimal beam conguration can be selected intuitively via interactions. The unique direct interaction capability offered by the volumetric 3D display makes it an ideal tool for radiation therapy planning. VIII. CONCLUSION In this paper, we presented a novel design of true volumetric three-dimensional display systems that is able to show true volumetric 3D images with high volumetric spatial resolution. We documented some of our effort in designing, prototyping and testing the volumetric 3D display systems, and our initial attempt to apply this unique 3D display technology as an augmented visualization tool to helping oncologists in selecting the best radiation treatment plan. Although exciting progresses have been made in terms of developing the volumetric 3D display technology, we are still far away from achieving our ultimate goal, which is to develop a clinically viable hardware and software that will provide unique capability of volumetric 3D visualization to aid oncologists in radiation therapy planning with higher accuracy, effectiveness, convenience, and speed. Good radiation treatment planning requires that the target volume be treated with a high and uniform dose of radiation while irradiating normal tissue as little as possible. Judging the merits of a given treatment plan from the conventional 2D display screen can be difcult for radiation oncologists to select the best of several alternative treatment plans. The problem becomes even more difcult if the entire spatial distribution of

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the radiation dosage is to be considered, because of the enormous amount of 3D data that must be evaluated. We believe that lack of suitable method to simultaneously display 3D dose distribution superimposed on the relevant anatomy has greatly contributed to the slow incorporation of 3D considerations into routine radiation treatment planning. The drawbacks of conventional CT or MRI displays can be largely overcome by employing the true volumetric 3D display technology. Such true 3D display system is able to provide both physiological and psychological depth cues to oncologists in perceiving and manipulating radiation beam conguration in a true 3D fashion, thus providing unique visualization tool to ensure the safety, effectiveness, and speed of radiation treatment planning process. The main focus of this paper is to provide technical details on the volumetric 3D display system we developed, and present some initial results on its capability of displaying true 3D images. While the system design framework of applying such technology into RTP is introduced, its full scale clinical applications to RTP is still an ongoing effort and will be reported later in other publications. The eld of true 3D display technology is still quite young, comparing to its 2D counterpart that has developed over several decades with multi-billion dollar investments. It is our hope that our preliminary work could provide some stimulations and attractions to more talented researchers from both technical and clinical background to this fascinating eld of research and development. ACKNOWLEDGMENT The authors would like to thank many collaborators and supporters who contributed in part to the success of this study, among them Dr. J. Rogers, Dr. M. Freedman, Dr. T. DeWeese, Dr. M. Vannier, Dr. S. Li, Dr. D. Frassica, Dr. J. Wong, J. Russell, M. Deis, Dr. P. Zhunag, Dr. Y. Feng, Dr. H. Li, Dr. J. Qiao, Dr. G. Ying, Dr. S. Nerlove, Dr. J. Hennessey, Dr. R. Coryells, Dr. K. Narayanan, Dr. P. Srivastava, Dr. L. Quatrano, Dr. H. Baker, and Dr. B. Donoff. REFERENCES
[1] B. Barry, Enhanced Visualization. Hoboken, NJ: Wiley-Interscience, 2007. [2] A. Sullivan, 3 Deep, IEEE Spectr., vol. 42, no. 4, Apr. 2005. [3] G. E. Favalora et al., 100 million-voxel volumetric display, in Proc. SPIE Cockpit-Displays IX: Displays for Defense Appl, 2002, vol. 4712. [4] X. Gong et al., Evaluation of volumetric display for radiation therapy treatment planning, Med. Phys., vol. 33, no. 6, p. 2209, 2006. [5] J. Chu et al., 3D display of treatment planning and anatomy data: Initial observation using a promising technical advance, in IFMBE Proc.World Congress on Med. Physics and BioEng., 2006, vol. 14, pp. 17291732. [6] Z. J. Geng, Method and apparatus for high resolution three dimensional display, U.S. Patent 6 064 423, May 16, 2000.

[7] J. Geng, Method and apparatus for an interactive volumetric three dimensional display, U.S. Patent 7 098 872. [8] D. L. Macfarlane, A volumetric three dimensional display, Appl. Opt., vol. 33, no. 31, pp. 74537457, 1994. [9] W. Matusik and H. Pster, 3D TV: A scalable system for real-time acquisition, transmission, and autostereoscopic display of dynamic scenes, ACM Trans. Graphics, vol. 23, no. 3, pp. 814824, 2004. [10] T. Okoshi, Three-Dimensional Imaging Techniques. San Diego, CA: Academic, 1976. [11] K. Perlin, S. Paxia, and J. S. Kollin, An autostereoscopic display, in Proc. ACM SIGGRAPH, 2000, pp. 319326. [12] G. C. Bentel, Radiation Therapy Planning, 2nd ed. New York: McGraw-Hill, 1996. [13] W. Hendee and G. S. Gazelle, Biomedical imaging research opportunities workshop III: White paper, Ann. Biomed. Eng., vol. 34, no. 2, pp. 188198, Feb. 2006. [14] K. G. Vosburgh and F. A. Jolesz, The concept of image-guided therapy, Acad. Radiol., vol. 10, pp. 176179, 2003. [15] M. W. Vannier and J. L. Marsh, Three-dimensional imaging, surgical planning, and image-guided therapy, Radiol. Clin. North Amer., vol. 34, pp. 545563, 1996. [16] T. R. Mackie et al., Image guidance for precise conformal radiotherapy, Int. J. Radiat. Oncol. Biol. Phys., vol. 56, pp. 89105, 2003. [17] D. Yan, D. Lockman, A. Martinez, J. Wong, D. Brabbins, F. Vicini, J. Liang, and L. Kestin, Computed tomography guided management of interfractional patient variation, Semin Radiat Oncol., vol. 15, no. 3, pp. 16879, Jul. 2005. [18] F. Laerum, Demand for a new main speciality in image-guided therapy, Comput. Methods Programs Biomed., vol. 66, pp. 8185, 2001. [19] D. M. Coldwell and P. E. Sewell, The expanding role of interventional radiology in the supportive care of the oncology patient from diagnosis to therapy, Semin. Oncol., vol. 32, pp. 169173, 2005. [20] D. A. Jaffray, J. H. Siewerdsen, J. W. Wong, and A. A. Martinez, Flat-panel cone-beam computed tomography for image-guided radiation therapy, Int. J. Radiat. Oncol. Biol. Phys., vol. 53, pp. 13371349, 2002. [21] Zerhouni and E. Medicine, The NIH roadmap, Science, vol. 302, pp. 6372, 2003.

Jason Geng (SM89) has over two decades of experience in leading the research, development and commercialization of advanced imaging technologies. He has over 80 technical papers and one book published in the related elds. In 1995, he solely founded and served as CEO of Genex Technologies Inc, a Maryland-based U.S. company specialized in advanced 3D/360-degree imaging and display technologies and products. He has served on review panels for National Science Foundation, National Institutes of Health, and US Army Medical Research Commands. He taught as adjunct professor in George Washington University, Washington, DC, and New Jersey Institute of Technology, Newark. He is inventor of 20 issued patents and over 20 patent applications. Dr. Geng received the Rising Star award and ranked #291 by Deloitte & Touch on the lists of Fast 500 Growing companies in US and Canada. He also received prestigious national honors, including the Tibbetts Award from U.S. Government and was ranked #257 as INC magazines INC 500 company in 2002. He was honored by DARPA as one of the 200 top scientists in USA as the Scientist helping America. He currently serves as the Vice President for IEEE Intelligent Transportation Systems Society (ITSS) and is the chairman of ITSS standard committee and ITSS publications committee.

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