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Bosma LS, Hussein M, Jameson MG, Asghar S, Brock KK, McClelland JR, Poeta S, Yuen J, Zachiu C, Yeo AU. Tools and recommendations for commissioning and quality assurance of deformable image registration in radiotherapy. Phys Imaging Radiat Oncol 2024; 32:100647. [PMID: 39328928 PMCID: PMC11424976 DOI: 10.1016/j.phro.2024.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 09/28/2024] Open
Abstract
Multiple tools are available for commissioning and quality assurance of deformable image registration (DIR), each with their own advantages and disadvantages in the context of radiotherapy. The selection of appropriate tools should depend on the DIR application with its corresponding available input, desired output, and time requirement. Discussions were hosted by the ESTRO Physics Workshop 2021 on Commissioning and Quality Assurance for DIR in Radiotherapy. A consensus was reached on what requirements are needed for commissioning and quality assurance for different applications, and what combination of tools is associated with this. For commissioning, we recommend the target registration error of manually annotated anatomical landmarks or the distance-to-agreement of manually delineated contours to evaluate alignment. These should be supplemented by the distance to discordance and/or biomechanical criteria to evaluate consistency and plausibility. Digital phantoms can be useful to evaluate DIR for dose accumulation but are currently only available for a limited range of anatomies, image modalities and types of deformations. For quality assurance of DIR for contour propagation, we recommend at least a visual inspection of the registered image and contour. For quality assurance of DIR for warping quantitative information such as dose, Hounsfield units or positron emission tomography-data, we recommend visual inspection of the registered image together with image similarity to evaluate alignment, supplemented by an inspection of the Jacobian determinant or bending energy to evaluate plausibility, and by the dose (gradient) to evaluate relevance. We acknowledge that some of these metrics are still missing in currently available commercial solutions.
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Affiliation(s)
- Lando S Bosma
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mohammad Hussein
- Metrology for Medical Physics Centre, National Physical Laboratory, Teddington, UK
| | - Michael G Jameson
- GenesisCare, Sydney, Australia
- School of Clinical Medicine, Medicine and Health, University of New South Wales, Sydney, Australia
| | | | - Kristy K Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jamie R McClelland
- Centre for Medical Image Computing and the Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Dept. Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Sara Poeta
- Medical Physics Department, Institut Jules Bordet - Université Libre de Bruxelles, Belgium
| | - Johnson Yuen
- School of Clinical Medicine, Medicine and Health, University of New South Wales, Sydney, Australia
- St. George Hospital Cancer Care Centre, Sydney NSW2217, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Cornel Zachiu
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adam U Yeo
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Sir Peter MacCallum Department of Oncology, the University of Melbourne, Melbourne, VIC, Australia
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Chen J, Chen K, OuYang M, Wang G, Bai P, You H. Evaluation of dose delivery based on deformed CT using a commercial software for lung cancer. Sci Rep 2024; 14:14470. [PMID: 38914766 PMCID: PMC11196743 DOI: 10.1038/s41598-024-65381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
This study employed a commercial software velocity to perform deformable registration and dose calculation on deformed CT images, aiming to assess the accuracy of dose delivery during the radiotherapy for lung cancers. A total of 20 patients with lung cancer were enrolled in this study. Adaptive CT (ACT) was generated by deformed the planning CT (pCT) to the CBCT of initial radiotherapy fraction, followed by contour propagation and dose recalculation. There was not significant difference between volumes of GTV and CTV calculated from the ACT and pCT. However, significant differences in dice similarity coefficient (DSC) and coverage ratio (CR) between GTV and CTV were observed, with lower values for GTV volumes below 15 cc. The mean differences in dose corresponding to 95% of the GTV, GTV-P, CTV, and CTV-P between ACT and pCT were - 0.32%, 4.52%, 2.17%, and 4.71%, respectively. For the dose corresponding to 99%, the discrepancies were - 0.18%, 8.35%, 1.92%, and 24.96%, respectively. These differences in dose primarily appeared at the edges of the target areas. Notably, a significant enhancement of dose corresponding to 1 cc for spinal cord was observed in ACT, compared with pCT. There was no statistical difference in the mean dose of lungs and heart. In general, for lung cancer patients, anatomical motion may result in both CTV and GTV moving outside the original irradiation region. The dose difference within the original target area was small, but the difference in the planning target area was considerable.
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Affiliation(s)
- Jihong Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Kaiqiang Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Min OuYang
- School of Nuclear Science and Technology, University of South China, Hengyang, 421001, China
| | - Guohua Wang
- School of Nuclear Science and Technology, University of South China, Hengyang, 421001, China
| | - Penggang Bai
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Hongqiang You
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China.
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Zhong H, Garcia-Alvarez JA, Kainz K, Tai A, Ahunbay E, Erickson B, Schultz CJ, Li XA. Development of a multi-layer quality assurance program to evaluate the uncertainty of deformable dose accumulation in adaptive radiotherapy. Med Phys 2023; 50:1766-1778. [PMID: 36434751 PMCID: PMC10033340 DOI: 10.1002/mp.16137] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 09/10/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Deformable dose accumulation (DDA) has uncertainties which impede the implementation of DDA-based adaptive radiotherapy (ART) in clinic. The purpose of this study is to develop a multi-layer quality assurance (MLQA) program to evaluate uncertainties in DDA. METHODS A computer program is developed to generate a pseudo-inverse displacement vector field (DVF) for each deformable image registration (DIR) performed in Accuray's PreciseART. The pseudo-inverse DVF is first used to calculate a pseudo-inverse consistency error (PICE) and then implemented in an energy and mass congruent mapping (EMCM) method to reconstruct a deformed dose. The PICE is taken as a metric to estimate DIR uncertainties. A pseudo-inverse dose agreement rate (PIDAR) is used to evaluate the consequence of the DIR uncertainties in DDA and the principle of energy conservation is used to validate the integrity of dose mappings. The developed MLQA program was tested using the data collected from five representative cancer patients treated with tomotherapy. RESULTS DIRs were performed in PreciseART to generate primary DVFs for the five patients. The fidelity index and PICE of these DVFs on average are equal to 0.028 mm and 0.169 mm, respectively. With the criteria of 3 mm/3% and 5 mm/5%, the PIDARs of the PreciseART-reconstructed doses are 73.9 ± 4.4% and 87.2 ± 3.3%, respectively. The PreciseART and EMCM-based dose reconstructions have their deposited energy changed by 5.6 ± 3.9% and 2.6 ± 1.5% in five GTVs, and by 9.2 ± 7.8% and 4.7 ± 3.6% in 30 OARs, respectively. CONCLUSIONS A pseudo-inverse map-based EMCM program has been developed to evaluate DIR and dose mapping uncertainties. This program could also be used as a sanity check tool for DDA-based ART.
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Affiliation(s)
- Hualiang Zhong
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Kristofer Kainz
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ergun Ahunbay
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
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McDonald BA, Zachiu C, Christodouleas J, Naser MA, Ruschin M, Sonke JJ, Thorwarth D, Létourneau D, Tyagi N, Tadic T, Yang J, Li XA, Bernchou U, Hyer DE, Snyder JE, Bubula-Rehm E, Fuller CD, Brock KK. Dose accumulation for MR-guided adaptive radiotherapy: From practical considerations to state-of-the-art clinical implementation. Front Oncol 2023; 12:1086258. [PMID: 36776378 PMCID: PMC9909539 DOI: 10.3389/fonc.2022.1086258] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/21/2022] [Indexed: 01/27/2023] Open
Abstract
MRI-linear accelerator (MR-linac) devices have been introduced into clinical practice in recent years and have enabled MR-guided adaptive radiation therapy (MRgART). However, by accounting for anatomical changes throughout radiation therapy (RT) and delivering different treatment plans at each fraction, adaptive radiation therapy (ART) highlights several challenges in terms of calculating the total delivered dose. Dose accumulation strategies-which typically involve deformable image registration between planning images, deformable dose mapping, and voxel-wise dose summation-can be employed for ART to estimate the delivered dose. In MRgART, plan adaptation on MRI instead of CT necessitates additional considerations in the dose accumulation process because MRI pixel values do not contain the quantitative information used for dose calculation. In this review, we discuss considerations for dose accumulation specific to MRgART and in relation to current MR-linac clinical workflows. We present a general dose accumulation framework for MRgART and discuss relevant quality assurance criteria. Finally, we highlight the clinical importance of dose accumulation in the ART era as well as the possible ways in which dose accumulation can transform clinical practice and improve our ability to deliver personalized RT.
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Affiliation(s)
- Brigid A. McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cornel Zachiu
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Mohamed A. Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mark Ruschin
- Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tuebingen, Tuebingen, Germany
| | - Daniel Létourneau
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Tony Tadic
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - X. Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Uffe Bernchou
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Daniel E. Hyer
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Jeffrey E. Snyder
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | | | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kristy K. Brock
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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5
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Huesa-Berral C, Juan-Cruz C, van Kranen S, Rossi M, Belderbos J, Diego Azcona J, Burguete J, Sonke JJ. Detailed dosimetric evaluation of inter-fraction and respiratory motion in lung stereotactic body radiation therapy based on daily 4D cone beam CT images. Phys Med Biol 2022; 68. [PMID: 36538287 DOI: 10.1088/1361-6560/aca94d] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
Objective. Periodic respiratory motion and inter-fraction variations are sources of geometric uncertainty in stereotactic body radiation therapy (SBRT) of pulmonary lesions. This study extensively evaluates and validates the separate and combined dosimetric effect of both factors using 4D-CT and daily 4D-cone beam CT (CBCT) dose accumulation scenarios.Approach. A first cohort of twenty early stage or metastatic disease lung cancer patients were retrospectively selected to evaluate each scenario. The planned-dose (3DRef) was optimized on a 3D mid-position CT. To estimate the dosimetric impact of respiratory motion (4DRef), inter-fractional variations (3DAcc) and the combined effect of both factors (4DAcc), three dose accumulation scenarios based on 4D-CT, daily mid-cone beam CT (CBCT) position and 4D-CBCT were implemented via CT-CT/CT-CBCT deformable image registration (DIR) techniques. Each scenario was compared to 3DRef.A separate cohort of ten lung SBRT patients was selected to validate DIR techniques. The distance discordance metric (DDM) was implemented per voxel and per patient for tumor and organs at risk (OARs), and the dosimetric impact for CT-CBCT DIR geometric errors was calculated.Main results.Median and interquartile range (IQR) of the dose difference per voxel were 0.05/2.69 Gy and -0.12/2.68 Gy for3DAcc-3DRefand4DAcc-3DRef.For4DRef-3DRefthe IQR was considerably smaller -0.15/0.78 Gy. These findings were confirmed by dose volume histogram parameters calculated in tumor and OARs. For CT-CT/CT-CBCT DIR validation, DDM (95th percentile) was highest for heart (6.26 mm)/spinal cord (8.00 mm), and below 3 mm for tumor and the rest of OARs. The dosimetric impact of CT-CBCT DIR errors was below 2 Gy for tumor and OARs.Significance. The dosimetric impact of inter-fraction variations were shown to dominate those of periodic respiration in SBRT for pulmonary lesions. Therefore, treatment evaluation and dose-effect studies would benefit more from dose accumulation focusing on day-to-day changes then those that focus on respiratory motion.
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Affiliation(s)
- Carlos Huesa-Berral
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.,Physics and Applied Mathematics, School of Science, University of Navarra, E-31008 Pamplona, Navarra, Spain.,Service of Radiation Physics and Radiation Protection, University of Navarra Clinic, E-31008 Pamplona, Navarra, Spain
| | - Celia Juan-Cruz
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Simon van Kranen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Maddalena Rossi
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - José Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Juan Diego Azcona
- Service of Radiation Physics and Radiation Protection, University of Navarra Clinic, E-31008 Pamplona, Navarra, Spain
| | - Javier Burguete
- Physics and Applied Mathematics, School of Science, University of Navarra, E-31008 Pamplona, Navarra, Spain
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Chen J, Frey EC, He Y, Segars WP, Li Y, Du Y. TransMorph: Transformer for unsupervised medical image registration. Med Image Anal 2022; 82:102615. [PMID: 36156420 PMCID: PMC9999483 DOI: 10.1016/j.media.2022.102615] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/29/2022] [Accepted: 09/02/2022] [Indexed: 01/04/2023]
Abstract
In the last decade, convolutional neural networks (ConvNets) have been a major focus of research in medical image analysis. However, the performances of ConvNets may be limited by a lack of explicit consideration of the long-range spatial relationships in an image. Recently, Vision Transformer architectures have been proposed to address the shortcomings of ConvNets and have produced state-of-the-art performances in many medical imaging applications. Transformers may be a strong candidate for image registration because their substantially larger receptive field enables a more precise comprehension of the spatial correspondence between moving and fixed images. Here, we present TransMorph, a hybrid Transformer-ConvNet model for volumetric medical image registration. This paper also presents diffeomorphic and Bayesian variants of TransMorph: the diffeomorphic variants ensure the topology-preserving deformations, and the Bayesian variant produces a well-calibrated registration uncertainty estimate. We extensively validated the proposed models using 3D medical images from three applications: inter-patient and atlas-to-patient brain MRI registration and phantom-to-CT registration. The proposed models are evaluated in comparison to a variety of existing registration methods and Transformer architectures. Qualitative and quantitative results demonstrate that the proposed Transformer-based model leads to a substantial performance improvement over the baseline methods, confirming the effectiveness of Transformers for medical image registration.
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Affiliation(s)
- Junyu Chen
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutes, Baltimore, MD, USA; Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.
| | - Eric C Frey
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutes, Baltimore, MD, USA; Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.
| | - Yufan He
- NVIDIA Corporation, Bethesda, MD, USA.
| | - William P Segars
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, NC, USA.
| | - Ye Li
- Center for Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Yong Du
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutes, Baltimore, MD, USA.
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Bierbrier J, Gueziri HE, Collins DL. Estimating medical image registration error and confidence: A taxonomy and scoping review. Med Image Anal 2022; 81:102531. [PMID: 35858506 DOI: 10.1016/j.media.2022.102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Abstract
Given that image registration is a fundamental and ubiquitous task in both clinical and research domains of the medical field, errors in registration can have serious consequences. Since such errors can mislead clinicians during image-guided therapies or bias the results of a downstream analysis, methods to estimate registration error are becoming more popular. To give structure to this new heterogenous field we developed a taxonomy and performed a scoping review of methods that quantitatively and automatically provide a dense estimation of registration error. The taxonomy breaks down error estimation methods into Approach (Image- or Transformation-based), Framework (Machine Learning or Direct) and Measurement (error or confidence) components. Following the PRISMA guidelines for scoping reviews, the 570 records found were reduced to twenty studies that met inclusion criteria, which were then reviewed according to the proposed taxonomy. Trends in the field, advantages and disadvantages of the methods, and potential sources of bias are also discussed. We provide suggestions for best practices and identify areas of future research.
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Affiliation(s)
- Joshua Bierbrier
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, Montreal, QC, Canada.
| | - Houssem-Eddine Gueziri
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, Montreal, QC, Canada
| | - D Louis Collins
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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Czajkowski P, Piotrowski T. Evaluation of the accuracy of dose delivery in stereotactic radiotherapy using the Velocity commercial software. Phys Med 2022; 95:133-139. [DOI: 10.1016/j.ejmp.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 12/18/2022] Open
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Kainz K, Garcia Alvarez J, Zhong H, Lim S, Ahunbay E, Tai A, Erickson B, Lawton C, Li XA. Use of a DVH overlay technique for quality assurance of deformable image registration-based dose accumulation. Med Phys 2021; 49:611-623. [PMID: 34826153 DOI: 10.1002/mp.15375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/08/2021] [Accepted: 11/11/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE We present a DVH overlay technique as a quality assurance (QA) metric for deformable image registration-based dose accumulation (DIR-DA). We use the technique to estimate the uncertainty in a DIR-DA for a revised treatment plan, and to compare two different DIR algorithms. MATERIALS AND METHODS The required inputs to the DVH overlay workflow are deformably registered primary and secondary images, primary regions-of-interest (ROIs), and secondary dose distribution. The primary ROIs were forward warped to the secondary image, the secondary dose was inversely warped to the primary image, and the DVHs for each image were compiled. Congruent DVHs imply minimal inverse consistency error (ICE) within an ROI. For a pancreas case re-planned after 21 fractions of a 29-fraction course, the workflow was used to quantify dose accumulation error attributable to ICE, based on a hybrid contour-and-intensity-based DIR. The usefulness of the workflow was further demonstrated by assessing the performance of two DIR algorithms (one free-form intensity-based, FFIB, the other using normalized correlation coefficients, NCC, over small neighborhood patches) as applied toward kilovoltage computed tomography (kVCT)-to-megavoltage computed tomography (MVCT) registration and five-fraction dose accumulation of ten male pelvis cases. RESULTS For the re-planned pancreas case, when applying the DVH-overlay-based uncertainties the resulting accumulated dose remained compliant with all but two of the original plan objectives. Among the male pelvis cases, FFIB and NCC DIR showed good invertibility within the planning target volume (PTV), according to the DVH overlay QA results. NCC DIR exhibited better invertibility for the bladder and rectum compared with FFIB. However, compared with FFIB, NCC DIR exhibited less regional deformation for the bladder and a tendency for increased local contraction of the rectum ROI. For the five-fraction summations, ICE for the PTV V100%Rx is comparable for both algorithms (FFIB 0.8 ± 0.7%, NCC 0.7 ± 0.3%). For the bladder and rectum V70%Rx , ICE is greater for FFIB (1.8 ± 0.7% for bladder, 1.7 ± 0.6% for rectum) than for NCC (1.0 ± 0.3% for bladder, 1.0 ± 0.4% for rectum). CONCLUSIONS The DVH overlay technique identified instances in which a DIR exhibits favorable invertibility, implying low ICE in a DIR-based dose accumulation. Differences in the overlaid DVHs can also estimate dose accumulation errors attributable to ICE for given ROIs.
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Affiliation(s)
- Kristofer Kainz
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Juan Garcia Alvarez
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Hualiang Zhong
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sara Lim
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ergun Ahunbay
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Colleen Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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10
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Juan-Cruz C, Fast MF, Sonke JJ. A multivariable study of deformable image registration evaluation metrics in 4DCT of thoracic cancer patients. Phys Med Biol 2021; 66:035019. [PMID: 33227717 DOI: 10.1088/1361-6560/abcd18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Deformable image registration (DIR) accuracy is often validated using manually identified landmarks or known deformations generated using digital or physical phantoms. In daily practice, the application of these approaches is limited since they are time-consuming or require additional equipment. An alternative is the use of metrics automatically derived from the registrations, but their interpretation is not straightforward. In this work we aim to determine the suitability of DIR-derived metrics to validate the accuracy of 4 commonly used DIR algorithms. First, we investigated the DIR accuracy using a landmark-based metric (target registration error (TRE)) and a digital phantom-based metric (known deformation recovery error (KDE)). 4DCT scans of 16 thoracic cancer patients along with corresponding pairwise anatomical landmarks (AL) locations were collected from two public databases. Digital phantoms with known deformations were generated by each DIR algorithm to test all other algorithms and compute KDE. TRE and KDE were evaluated at AL. KDE was additionally quantified in coordinates randomly sampled (RS) inside the lungs. Second, we investigated the associations of 5 DIR-derived metrics (distance discordance metric (DDM), inverse consistency error (ICE), transitivity (TE), spatial (SS) and temporal smoothness (TS)) with DIR accuracy through uni- and multivariable linear regression models. TRE values were found higher compared to KDE values and these varied depending on the phantom used. The algorithm with the best accuracy achieved average values of TRE = 1.1 mm and KDE ranging from 0.3 to 0.8 mm. DDM was the best predictor of DIR accuracy, with moderate correlations (R 2 < 0.61). Poor correlations were obtained at AL for algorithms with better accuracy, which improved when evaluated at RS. Only slight correlation improvement was obtained with a multivariable analysis (R 2 < 0.64). DDM can be a useful metric to identify inaccuracies for different DIR algorithms without employing landmarks or digital phantoms.
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Affiliation(s)
- Celia Juan-Cruz
- The Netherlands Cancer Institute, Radiotherapy Department, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Martin F Fast
- The Netherlands Cancer Institute, Radiotherapy Department, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- The Netherlands Cancer Institute, Radiotherapy Department, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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11
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Marcello M, Denham JW, Kennedy A, Haworth A, Steigler A, Greer PB, Holloway LC, Dowling JA, Jameson MG, Roach D, Joseph DJ, Gulliford SL, Dearnaley DP, Sydes MR, Hall E, Ebert MA. Relationships between rectal and perirectal doses and rectal bleeding or tenesmus in pooled voxel-based analysis of 3 randomised phase III trials. Radiother Oncol 2020; 150:281-292. [PMID: 32745667 DOI: 10.1016/j.radonc.2020.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to identify anatomically-localised regions where planned radiotherapy dose is associated with gastrointestinal toxicities in healthy tissues throughout the pelvic anatomy. MATERIALS AND METHODS Planned dose distributions for up to 657 patients of the Trans Tasman Radiation Oncology Group 03.04 RADAR trial were deformably registered onto a single exemplar computed tomography dataset. Voxel-based multiple comparison permutation dose difference testing, Cox regression modelling and LASSO feature selection were used to identify regions where dose-increase was associated with grade ≥2 rectal bleeding (RB) or tenesmus, according to the LENT/SOMA scale. This was externally validated by registering dose distributions from the RT01 (n = 388) and CHHiP (n = 241) trials onto the same exemplar and repeating the tests on each of these data sets, and on all three datasets combined. RESULTS Voxel-based Cox regression and permutation dose difference testing revealed regions where increased dose was correlated with gastrointestinal toxicity. Grade ≥2 RB was associated with posteriorly extended lateral beams that manifested high doses (>55 Gy) in a small rectal volume adjacent to the clinical target volume. A correlation was found between grade ≥2 tenesmus and increased low-intermediate dose (∼25 Gy) at the posterior beam region, including the posterior rectum and perirectal fat space (PRFS). CONCLUSIONS The serial response of the rectum with respect to RB has been demonstrated in patients with posteriorly extended lateral beams. Similarly, the parallel response of the PRFS with respect to tenesmus has been demonstrated in patients treated with the posterior beam.
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Affiliation(s)
- Marco Marcello
- Department of Physics, University of Western Australia, Crawley, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia.
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Angel Kennedy
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Annette Haworth
- School of Physics, University of Sydney, Camperdown, Australia
| | - Allison Steigler
- Prostate Cancer Trials Group, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Peter B Greer
- School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, Australia; Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, Australia
| | - Lois C Holloway
- Department of Medical Physics, Liverpool Cancer Centre, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia
| | - Jason A Dowling
- School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, Australia; CSIRO, Herston, Australia
| | - Michael G Jameson
- Department of Medical Physics, Liverpool Cancer Centre, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia; Cancer Research Team, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Dale Roach
- Department of Medical Physics, Liverpool Cancer Centre, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Cancer Research Team, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - David J Joseph
- School of Surgery, University of Western Australia, Crawley, Australia; 5D Clinics, Claremont, Australia; GenesisCare WA, Wembley, Australia
| | - Sarah L Gulliford
- Radiotherapy Department, University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom
| | - David P Dearnaley
- Academic UroOncology Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, London, Australia
| | - Mathew R Sydes
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Martin A Ebert
- Department of Physics, University of Western Australia, Crawley, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia; 5D Clinics, Claremont, Australia
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12
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McVicar N, Thomas S, Liu M, Carolan H, Bergman A. Re-irradiation volumetric modulated arc therapy optimization based on cumulative biologically effective dose objectives. J Appl Clin Med Phys 2018; 19:341-345. [PMID: 30371001 PMCID: PMC6236857 DOI: 10.1002/acm2.12481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 12/25/2022] Open
Abstract
The objective of this note is to introduce a clinical tool that generates ideal base plan dose distributions to enable re‐irradiation volumetric modulated arc therapy (VMAT) optimization based on cumulative biological effective dose objectives for specific organs at risk (OARs). The tool is demonstrated with a lung cancer case that required re‐irradiation at our clinic. First, previous treatment dose is deformed onto the retreatment computed tomography (CT) using commercial software. Then, the in‐house Matlab tool alters the deformed previous dose using radiobiological concepts on a voxel‐by‐voxel manner to generate an ideal base plan dose distribution. Ideal base plans that were generated using the in‐house Matlab tool were compatible with the Varian Eclipse™ treatment planning system. The tool enabled optimization of VMAT re‐irradiation plans using cumulative dose limits for OARs and all OAR cumulative dose objectives were met on the first optimization for the recurrent lung cancer case tested.
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Affiliation(s)
- Nevin McVicar
- Department of Medical Physics, BC Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
| | - Steven Thomas
- Department of Medical Physics, BC Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
| | - Mitchell Liu
- Department of Radiation Oncology, BC Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
| | - Hannah Carolan
- Department of Radiation Oncology, BC Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
| | - Alanah Bergman
- Department of Medical Physics, BC Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
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13
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Paganelli C, Meschini G, Molinelli S, Riboldi M, Baroni G. “Patient-specific validation of deformable image registration in radiation therapy: Overview and caveats”. Med Phys 2018; 45:e908-e922. [DOI: 10.1002/mp.13162] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 07/30/2018] [Accepted: 08/24/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Chiara Paganelli
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano 20133 Italy
| | - Giorgia Meschini
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano 20133 Italy
| | | | - Marco Riboldi
- Department of Medical Physics; Ludwig-Maximilians-Universitat Munchen; Munich 80539 Germany
| | - Guido Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano 20133 Italy
- Centro Nazionale di Adroterapia Oncologica; Pavia 27100 Italy
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14
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Vickress JR, Battista J, Barnett R, Yartsev S. Online daily assessment of dose change in head and neck radiotherapy without dose-recalculation. J Appl Clin Med Phys 2018; 19:659-665. [PMID: 30084159 PMCID: PMC6123138 DOI: 10.1002/acm2.12432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/21/2018] [Accepted: 07/17/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Head and neck cancers are commonly treated with radiation therapy, but due to possible volume changes, plan adaptation may be required during the course of treatment. Currently, plan adaptations consume significant clinical resources. Existing methods to evaluate the need for plan adaptation requires deformable image registration (DIR) to a new CT simulation or daily cone beam CT (CBCT) images and the recalculation of the dose distribution. In this study, we explore a tool to assist the decision for plan adaptation using a CBCT without re-computation of dose, allowing for rapid online assessment. METHODS This study involved 18 head and neck cancer patients treated with CBCT image guidance who had their treatment plan modified based on a new CT simulation (ReCT). Dose changes were estimated using different methods and compared to the current gold standard of using DIR between the planning CT scan (PCT) and ReCT with recomputed dose. The first and second methods used DIR between the PCT and daily CBCT with the planned dose or recalculated dose from the ReCT respectively, with the dose transferred to the CBCT using rigid registration. The necessity of plan adaptation was assessed by the change in dose to 95% of the planning target volume (D95) and mean dose to the parotids. RESULTS The treatment plans were adapted clinically for all 18 patients but only 7 actually needed an adaptation yielding 11 unnecessary adaptations. Applying a method using the daily CBCT with the planned dose distribution would have yielded only four unnecessary adaptations and no missed adaptations: a significant improvement from that done clinically. CONCLUSION Using the DIR between the planning CT and daily CBCT can flag cases for plan adaptation before every fraction while not requiring a new re-planning CT scan and dose recalculation.
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Affiliation(s)
| | - Jerry Battista
- Department of Medical BiophysicsWestern UniversityLondonONCanada
- Department of OncologyWestern UniversityLondonONCanada
- London Regional Cancer ProgramLondon Health Sciences CentreLondonONCanada
| | - Rob Barnett
- Department of Medical BiophysicsWestern UniversityLondonONCanada
- Department of OncologyWestern UniversityLondonONCanada
- London Regional Cancer ProgramLondon Health Sciences CentreLondonONCanada
| | - Slav Yartsev
- Department of Medical BiophysicsWestern UniversityLondonONCanada
- Department of OncologyWestern UniversityLondonONCanada
- London Regional Cancer ProgramLondon Health Sciences CentreLondonONCanada
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15
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MacFarlane M, Wong D, Hoover DA, Wong E, Johnson C, Battista JJ, Chen JZ. Patient-specific calibration of cone-beam computed tomography data sets for radiotherapy dose calculations and treatment plan assessment. J Appl Clin Med Phys 2018; 19:249-257. [PMID: 29479821 PMCID: PMC5849848 DOI: 10.1002/acm2.12293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/07/2017] [Accepted: 01/21/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose In this work, we propose a new method of calibrating cone beam computed tomography (CBCT) data sets for radiotherapy dose calculation and plan assessment. The motivation for this patient‐specific calibration (PSC) method is to develop an efficient, robust, and accurate CBCT calibration process that is less susceptible to deformable image registration (DIR) errors. Methods Instead of mapping the CT numbers voxel‐by‐voxel with traditional DIR calibration methods, the PSC methods generates correlation plots between deformably registered planning CT and CBCT voxel values, for each image slice. A linear calibration curve specific to each slice is then obtained by least‐squares fitting, and applied to the CBCT slice's voxel values. This allows each CBCT slice to be corrected using DIR without altering the patient geometry through regional DIR errors. A retrospective study was performed on 15 head‐and‐neck cancer patients, each having routine CBCTs and a middle‐of‐treatment re‐planning CT (reCT). The original treatment plan was re‐calculated on the patient's reCT image set (serving as the gold standard) as well as the image sets produced by voxel‐to‐voxel DIR, density‐overriding, and the new PSC calibration methods. Dose accuracy of each calibration method was compared to the reference reCT data set using common dose‐volume metrics and 3D gamma analysis. A phantom study was also performed to assess the accuracy of the DIR and PSC CBCT calibration methods compared with planning CT. Results Compared with the gold standard using reCT, the average dose metric differences were ≤ 1.1% for all three methods (PSC: −0.3%; DIR: −0.7%; density‐override: −1.1%). The average gamma pass rates with thresholds 3%, 3 mm were also similar among the three techniques (PSC: 95.0%; DIR: 96.1%; density‐override: 94.4%). Conclusions An automated patient‐specific calibration method was developed which yielded strong dosimetric agreement with the results obtained using a re‐planning CT for head‐and‐neck patients.
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Affiliation(s)
- Michael MacFarlane
- London Regional Cancer Program, London Health Science Center, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Daniel Wong
- London Regional Cancer Program, London Health Science Center, London, ON, Canada
| | - Douglas A Hoover
- London Regional Cancer Program, London Health Science Center, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Eugene Wong
- London Regional Cancer Program, London Health Science Center, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Carol Johnson
- London Regional Cancer Program, London Health Science Center, London, ON, Canada
| | - Jerry J Battista
- London Regional Cancer Program, London Health Science Center, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Jeff Z Chen
- London Regional Cancer Program, London Health Science Center, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
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