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The CyberKnife system, incorporating both fiducial\u2010based and fiducial\u2010free tracking modalities, aims to mitigate these challenges, yet tumor recognition can be compromised by overlapping bone structures. This study introduces a novel bone suppression imaging technique for kilovolt X\u2010ray imaging using generative adversarial networks (GANs) to enhance tumor tracking in SBRT by reducing interference from bony structures. Computed tomography (CT) images, both with and without bone structures, were generated using a four\u2010dimensional extended cardiac\u2010torso phantom (XCAT phantom) across 56 cases. X\u2010ray projections were captured from left and right oblique 45\u00b0 angles and divided into nine segments, producing 1120 images. These images were processed through six pre\u2010trained GAN models\u2014CycleGAN, DualGAN, CUT, FastCUT, DCLGAN, and SimDCL\u2014yielding bone\u2010suppressed images on the XCAT phantom (BSI<jats:sub>phantom<\/jats:sub>). The resulting images were evaluated against bone\u2010shadow\u2010free images using structural similarity index measure (SSIM), peak signal\u2010to\u2010noise ratio (PSNR), and Frechet inception distance (FID). Additionally, bone\u2010suppressed images (BSI<jats:sub>patient<\/jats:sub>) were derived from 1000 non\u2010simulated patient images. BSI<jats:sub>phantom<\/jats:sub> images achieved SSIM and PSNR values of 0.96 \u00b1\u20090.02 and 36.93 \u00b1\u20093.93, respectively. SimDCL exhibited optimal performance with an FID score of 68.93, indicative of superior image generation quality. This GAN\u2010based bone suppression imaging technique markedly improved image recognition and refined dynamic tumor tracking, enhancing the accuracy and efficacy of SBRT.<\/jats:p>","DOI":"10.1111\/1759-7714.70014","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T13:01:33Z","timestamp":1741698093000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of Various <scp>GAN<\/scp>\u2010Based Bone Suppression Imaging for High\u2010Accurate Markerless Motion Tracking of Lung Tumors in <scp>CyberKnife<\/scp> Treatment"],"prefix":"10.1111","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5146-3158","authenticated-orcid":false,"given":"Zennosuke","family":"Mochizuki","sequence":"first","affiliation":[{"name":"Department of Radiology Kasugai General Rehabilitation Hospital  Yamanashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8636-4045","authenticated-orcid":false,"given":"Masahide","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Yamanashi  Chuo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshihiro","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Radiology Kasugai General Rehabilitation Hospital  Yamanashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Mochizuki","sequence":"additional","affiliation":[{"name":"Department of Radiology Kasugai General Rehabilitation Hospital  Yamanashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikaru","family":"Nemoto","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Yamanashi  Chuo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Onishi","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Yamanashi  Chuo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Radiology Kasugai General Rehabilitation Hospital  Yamanashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,24]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.07.1751"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2017.05.013"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2017.05.016"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1586\/erd.12.35"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cviu.2003.07.003"},{"issue":"2","key":"e_1_2_12_7_1","first-page":"209","article-title":"Current Status and Optimal Use of Radiosurgery","volume":"15","author":"Chang S. 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