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McGeachy P, Watt E, Husain S, Martell K, Martinez P, Sawhney S, Thind K. MRI-TRUS registration methodology for TRUS-guided HDR prostate brachytherapy. J Appl Clin Med Phys 2021; 22:284-294. [PMID: 34318581 PMCID: PMC8364261 DOI: 10.1002/acm2.13292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose High‐dose‐rate (HDR) prostate brachytherapy is an established technique for whole‐gland treatment. For transrectal ultrasound (TRUS)‐guided HDR prostate brachytherapy, image fusion with a magnetic resonance image (MRI) can be performed to make use of its soft‐tissue contrast. The MIM treatment planning system has recently introduced image registration specifically for HDR prostate brachytherapy and has incorporated a Predictive Fusion workflow, which allows clinicians to attempt to compensate for differences in patient positioning between imaging modalities. In this study, we investigate the accuracy of the MIM algorithms for MRI‐TRUS fusion, including the Predictive Fusion workflow. Materials and Methods A radiation oncologist contoured the prostate gland on both TRUS and MRI. Four registration methodologies to fuse the MRI and the TRUS images were considered: rigid registration (RR), contour‐based (CB) deformable registration, Predictive Fusion followed by RR (pfRR), and Predictive Fusion followed by CB deformable registration (pfCB). Registrations were compared using the mean distance to agreement and the Dice similarity coefficient for the prostate as contoured on TRUS and the registered MRI prostate contour. Results Twenty patients treated with HDR prostate brachytherapy at our center were included in this retrospective evaluation. For the cohort, mean distance to agreement was 2.1 ± 0.8 mm, 0.60 ± 0.08 mm, 2.0 ± 0.5 mm, and 0.59 ± 0.06 mm for RR, CB, pfRR, and pfCB, respectively. Dice similarity coefficients were 0.80 ± 0.05, 0.93 ± 0.02, 0.81 ± 0.03, and 0.93 ± 0.01 for RR, CB, pfRR, and pfCB, respectively. The inclusion of the Predictive Fusion workflow did not significantly improve the quality of the registration. Conclusions The CB deformable registration algorithm in the MIM treatment planning system yielded the best geometric registration indices. MIM offers a commercial platform allowing for easier access and integration into clinical departments with the potential to play an integral role in future focal therapy applications for prostate cancer.
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Affiliation(s)
- Philip McGeachy
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada
| | - Elizabeth Watt
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Siraj Husain
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Kevin Martell
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Pedro Martinez
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada
| | - Summit Sawhney
- Department of Radiology and Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Kundan Thind
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada
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Xue H, Qiu B, Wang H, Jiang P, Sukocheva O, Fan R, Xue L, Wang J. Stereotactic Ablative Brachytherapy: Recent Advances in Optimization of Radiobiological Cancer Therapy. Cancers (Basel) 2021; 13:cancers13143493. [PMID: 34298703 PMCID: PMC8304109 DOI: 10.3390/cancers13143493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Brachytherapy (BT), a type of focal anti-cancer radiotherapy, delivers a highly focused radiation dose to localized tumors, sparing surrounding normal tissues. Recent technological advances have helped to increase the accuracy of BT and, thus, improve BT-based cancer treatment. Stereotactic ablative brachytherapy (SABT) was designed to improve the ablative effect of radiation, which was achieved via improved image guidance, and calculation of ablative dose, shorter treatment duration, and better organ preservation. Recently collected data characterized SABT as having the potential to cure various early-stage cancers. The method provides higher tumor control rate levels that were previously achievable only by surgical resection. Notably, SABT is suitable for application with unresectable malignancies. However, the pathological assessment of SABT irradiated tumors is limited due to difficulties in specimen acquisition. Prostate, lung, liver, and gynecological cancers are the most commonly reported SABT-treated malignancies. This study will give an overview of SABT, focusing on the advances in SABT optimization, and provide insights on the future benefits of the combined application of SABT with cancer immunotherapies.
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Affiliation(s)
- Hui Xue
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Bin Qiu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Olga Sukocheva
- Discipline of Health Sciences, College of Nursing and Health Sciences, Flinders University of South Australia, Bedford Park, SA 5042, Australia;
| | - Ruitai Fan
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China;
| | - Lixiang Xue
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
- Correspondence: (L.X.); (J.W.); Tel.: +86-13701076310 (L.X.); +86-13701076310 (J.W.)
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
- Correspondence: (L.X.); (J.W.); Tel.: +86-13701076310 (L.X.); +86-13701076310 (J.W.)
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Dai X, Lei Y, Zhang Y, Qiu RLJ, Wang T, Dresser SA, Curran WJ, Patel P, Liu T, Yang X. Automatic multi-catheter detection using deeply supervised convolutional neural network in MRI-guided HDR prostate brachytherapy. Med Phys 2020; 47:4115-4124. [PMID: 32484573 DOI: 10.1002/mp.14307] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/19/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE High-dose-rate (HDR) brachytherapy is an established technique to be used as monotherapy option or focal boost in conjunction with external beam radiation therapy (EBRT) for treating prostate cancer. Radiation source path reconstruction is a critical procedure in HDR treatment planning. Manually identifying the source path is labor intensive and time inefficient. In recent years, magnetic resonance imaging (MRI) has become a valuable imaging modality for image-guided HDR prostate brachytherapy due to its superb soft-tissue contrast for target delineation and normal tissue contouring. The purpose of this study is to investigate a deep-learning-based method to automatically reconstruct multiple catheters in MRI for prostate cancer HDR brachytherapy treatment planning. METHODS Attention gated U-Net incorporated with total variation (TV) regularization model was developed for multi-catheter segmentation in MRI. The attention gates were used to improve the accuracy of identifying small catheter points, while TV regularization was adopted to encode the natural spatial continuity of catheters into the model. The model was trained using the binary catheter annotation images offered by experienced physicists as ground truth paired with original MRI images. After the network was trained, MR images of a new prostate cancer patient receiving HDR brachytherapy were fed into the model to predict the locations and shapes of all the catheters. Quantitative assessments of our proposed method were based on catheter shaft and tip errors compared to the ground truth. RESULTS Our method detected 299 catheters from 20 patients receiving HDR prostate brachytherapy with a catheter tip error of 0.37 ± 1.68 mm and a catheter shaft error of 0.93 ± 0.50 mm. For detection of catheter tips, our method resulted in 87% of the catheter tips within an error of less than ± 2.0 mm, and more than 71% of the tips can be localized within an absolute error of no >1.0 mm. For catheter shaft localization, 97% of catheters were detected with an error of <2.0 mm, while 63% were within 1.0 mm. CONCLUSIONS In this study, we proposed a novel multi-catheter detection method to precisely localize the tips and shafts of catheters in three-dimensional MRI images of HDR prostate brachytherapy. It paves the way for elevating the quality and outcome of MRI-guided HDR prostate brachytherapy.
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Affiliation(s)
- Xianjin Dai
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30332, USA
| | - Yang Lei
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30332, USA
| | - Yupei Zhang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30332, USA
| | - Richard L J Qiu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30332, USA
| | - Tonghe Wang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30332, USA
| | - Sean A Dresser
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30332, USA
| | - Walter J Curran
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30332, USA
| | - Pretesh Patel
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30332, USA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30332, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30332, USA
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Nagore G, Lopez Guerra JL, Krumina E, Lagos M, Ovalles B, Miró A, Beltran L, Gómez E, Praena-Fernandez JM, Del Campo ER, Azinovic I, Gomez-Iturriaga A. High dose rate brachytherapy for prostate cancer: A prospective toxicity evaluation of a one day schedule including two 13.5 Gy fractions. Radiother Oncol 2018; 127:219-224. [PMID: 29625808 DOI: 10.1016/j.radonc.2018.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE High dose-rate (HDR) brachytherapy (BT) provides a highly conformal method of dose delivery to the prostate. The purpose of this study is to prospectively determine the toxicity of the treatment protocol of 13.5 Gy × 2 fractions. MATERIALS AND METHODS From 2010 through 2017, 119 patients with low (71%) or intermediate-risk prostate cancer were prospectively treated in a single institute with HDR-BT at 13.5 Gy × 2 fractions within one day. Median follow-up time was 4.4 years. RESULTS Actuarial rates of no biochemical evidence of disease, overall survival and metastasis-free survival for all patients were 96%,98% and 98%, respectively. The cumulative incidence of acute grade 2 and 3 genitourinary (GU) toxicity was 9% and 2%, respectively. The corresponding incidences of late GU toxicity were 18% and 1%. No grade ≥4 of either type of toxicity was detected. Multivariate analysis showed that having higher international prostate symptom score (IPSS; P = 0.041) or higher V200 (P = 0.013) was associated with a higher risk of experiencing any grade of acute GU toxicity. In addition, patients having a higher IPSS (P = 0.019) or a higher V150 (P = 0.033) were associated with a higher grade >1 acute GU toxicity. CONCLUSIONS The findings of this study show that HDR-BT 13.5 Gy × 2 as monotherapy was safe and effective for prostate cancer patients with low-intermediate risk.
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Affiliation(s)
- Gorka Nagore
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | | | - Evita Krumina
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | - Mark Lagos
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | - Beatriz Ovalles
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | - Antonio Miró
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | - Lourdes Beltran
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | - Emilia Gómez
- Department of Radiation Oncology, GenesisCare, Alicante, Spain
| | | | | | | | - Alfonso Gomez-Iturriaga
- Department of Radiation Oncology, Hospital Universitario Cruces-Biocruces Health Research Institute, Barakaldo, Spain
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Rink A, Borg J, Simeonov A, O'Leary G, Helou J, Ménard C, Chung P, Jaffray DA, Berlin A. Dosimetric impact of intrafraction changes in MR-guided high-dose-rate (HDR) brachytherapy for prostate cancer. Brachytherapy 2017; 17:59-67. [PMID: 28764881 DOI: 10.1016/j.brachy.2017.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/03/2017] [Accepted: 06/06/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess changes in implant and treatment volumes through the course of a prostate high-dose-rate brachytherapy procedure and their impact on plan quality metrics. METHODS AND MATERIALS Sixteen MRI-guided high-dose-rate procedures included a post-treatment MR (ptMR) immediately after treatment delivery (135 min between MR scans). Target and organs at risk (OARs) were contoured, and catheters were reconstructed. The delivered treatment plan was applied to the ptMR image set. Volumes and dosimetric parameters in the ptMR were evaluated and compared with the delivered plan using a paired two-tailed t-test with p < 0.05 considered statistically significant. RESULTS An average increase of 8.9% in prostate volume was observed for whole-gland treatments, resulting in reduction in coverage for both prostate and planning target volume, reflected in decreased V100 (mean 3.3% and 4.6%, respectively, p < 0.05), and D90 (mean 7.1% and 7.6%, respectively, of prescription dose, p < 0.05). There was no significant change in doses to OARs. For partial-gland treatments, there was an increase in planning target volume (9.1%), resulting in reduced coverage and D90 (mean 3.6% and 12.4%, respectively, p < 0.05). A decrease in D0.5cc for bladder (3%, p < 0.05) was observed, with no significant changes in dose to other OARs. CONCLUSIONS Volumetric changes were observed during the time between planning MR and ptMR. Nonetheless, treatment plans for both whole- and partial-gland therapies remained clinically acceptable. These results apply to clinical settings in which patients remain in the same position and under anesthesia during the entire treatment process.
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Affiliation(s)
- Alexandra Rink
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; TECHNA Institute, Toronto, Canada.
| | - Jette Borg
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Anna Simeonov
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Gerald O'Leary
- Department of Anesthesia, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada
| | - Joelle Helou
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Cynthia Ménard
- TECHNA Institute, Toronto, Canada; University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - David A Jaffray
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; TECHNA Institute, Toronto, Canada; University Health Network, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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Zaorsky NG, Davis BJ, Nguyen PL, Showalter TN, Hoskin PJ, Yoshioka Y, Morton GC, Horwitz EM. The evolution of brachytherapy for prostate cancer. Nat Rev Urol 2017; 14:415-439. [PMID: 28664931 PMCID: PMC7542347 DOI: 10.1038/nrurol.2017.76] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Brachytherapy (BT), using low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation, is an acceptable treatment option for select patients with prostate cancer of any risk group. The benefits of HDR-BT over LDR-BT include the ability to use the same source for other cancers, lower operator dependence, and - typically - fewer acute irritative symptoms. By contrast, the benefits of LDR-BT include more favourable scheduling logistics, lower initial capital equipment costs, no need for a shielded room, completion in a single implant, and more robust data from clinical trials. Prospective reports comparing HDR-BT and LDR-BT to each other or to other treatment options (such as external beam radiotherapy (EBRT) or surgery) suggest similar outcomes. The 5-year freedom from biochemical failure rates for patients with low-risk, intermediate-risk, and high-risk disease are >85%, 69-97%, and 63-80%, respectively. Brachytherapy with EBRT (versus brachytherapy alone) is an appropriate approach in select patients with intermediate-risk and high-risk disease. The 10-year rates of overall survival, distant metastasis, and cancer-specific mortality are >85%, <10%, and <5%, respectively. Grade 3-4 toxicities associated with HDR-BT and LDR-BT are rare, at <4% in most series, and quality of life is improved in patients who receive brachytherapy compared with those who undergo surgery.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Charlton Bldg/Desk R - SL, Rochester, Minnesota 5590, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis St BWH. Radiation Oncology, Boston, Massachusetts 02115, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, 1240 Lee St, Charlottesville, Virginia 22908, USA
| | - Peter J Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Gerard C Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
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Velec M, Moseley JL, Svensson S, Hårdemark B, Jaffray DA, Brock KK. Validation of biomechanical deformable image registration in the abdomen, thorax, and pelvis in a commercial radiotherapy treatment planning system. Med Phys 2017; 44:3407-3417. [PMID: 28453911 DOI: 10.1002/mp.12307] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/20/2017] [Accepted: 04/20/2017] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The accuracy of deformable image registration tools can vary widely between imaging modalities and specific implementations of the same algorithms. A biomechanical model-based algorithm initially developed in-house at an academic institution was translated into a commercial radiotherapy treatment planning system and validated for multiple imaging modalities and anatomic sites. METHODS Biomechanical deformable registration (Morfeus) is a geometry-driven algorithm based on the finite element method. Boundary conditions are derived from the model-based segmentation of controlling structures in each image which establishes a point-to-point surface correspondence. For each controlling structure, material properties and fixed or sliding interfaces are assigned. The displacements of internal volumes for controlling structures and other structures implicitly deformed are solved with finite element analysis. Registration was performed for 74 patients with images (mean vector resolution) of thoracic and abdominal 4DCT (2.8 mm) and MR (5.3 mm), liver CT-MR (4.5 mm), and prostate MR (2.6 mm). Accuracy was quantified between deformed and actual target images using distance-to-agreement (DTA) for structure surfaces and the target registration error (TRE) for internal point landmarks. RESULTS The results of the commercial implementation were as follows. The mean DTA was ≤ 1.0 mm for controlling structures and 1.0-3.5 mm for implicitly deformed structures on average. TRE ranged from 2.0 mm on prostate MR to 5.1 mm on lung MR on average, within 0.1 mm or lower than the image voxel sizes. Accuracy was not overly sensitive to changes in the material properties or variability in structure segmentations, as changing these inputs affected DTA and TRE by ≤ 0.8 mm. Maximum DTA > 5 mm occurred for 88% of the structures evaluated although these were within the inherent segmentation uncertainty for 82% of structures. Differences in accuracy between the commercial and in-house research implementations were ≤ 0.5 mm for mean DTA and ≤ 0.7 mm for mean TRE. CONCLUSIONS Accuracy of biomechanical deformable registration evaluated on a large cohort of images in the thorax, abdomen and prostate was similar to the image voxel resolution on average across multiple modalities. Validation of this treatment planning system implementation supports biomechanical deformable registration as a versatile clinical tool to enable accurate target delineation at planning and treatment adaptation.
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Affiliation(s)
- Michael Velec
- Techna Institute and Princess Margaret Cancer Centre, University Health Network, Toronto, M5G 2M9, Canada
| | - Joanne L Moseley
- Techna Institute and Princess Margaret Cancer Centre, University Health Network, Toronto, M5G 2M9, Canada
| | - Stina Svensson
- RaySearch Laboratories AB, Sveavägen 44, SE-103 65, Stockholm, Sweden
| | - Björn Hårdemark
- RaySearch Laboratories AB, Sveavägen 44, SE-103 65, Stockholm, Sweden
| | - David A Jaffray
- Techna Institute and Princess Margaret Cancer Centre, University Health Network, Toronto, M5G 2M9, Canada.,Department of Radiation Oncology, Medical Biophysics, and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, M5S 3E2, Canada
| | - Kristy K Brock
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
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