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Shelley CE, Bolt MA, Hollingdale R, Chadwick SJ, Barnard AP, Rashid M, Reinlo SC, Fazel N, Thorpe CR, Stewart AJ, South CP, Adams EJ. Implementing cone-beam computed tomography-guided online adaptive radiotherapy in cervical cancer. Clin Transl Radiat Oncol 2023; 40:100596. [PMID: 36910024 PMCID: PMC9999162 DOI: 10.1016/j.ctro.2023.100596] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023] Open
Abstract
Background and purpose Adaptive radiotherapy (ART) in locally advanced cervical cancer (LACC) has shown promising outcomes. This study investigated the feasibility of cone-beam computed tomography (CBCT)-guided online ART (oART) for the treatment of LACC. Material and methods The quality of the automated radiotherapy treatment plans and artificial intelligence (AI)-driven contour delineation for LACC on a novel CBCT-guided oART system were assessed. Dosimetric analysis of 200 simulated oART sessions were compared with standard treatment. Feasibility of oART was assessed from the delivery of 132 oART fractions for the first five clinical LACC patients. The simulated and live oART sessions compared a fixed planning target volume (PTV) margin of 1.5 cm around the uterus-cervix clinical target volume (CTV) with an internal target volume-based approach. Workflow timing measurements were recorded. Results The automatically-generated 12-field intensity-modulated radiotherapy plans were comparable to manually generated plans. The AI-driven organ-at-risk (OAR) contouring was acceptable requiring, on average, 12.3 min to edit, with the bowel performing least well and rated as unacceptable in 16 % of cases. The treated patients demonstrated a mean PTV D98% (+/-SD) of 96.7 (+/- 0.2)% for the adapted plans and 94.9 (+/- 3.7)% for the non-adapted scheduled plans (p<10-5). The D2cc (+/-SD) for the bowel, bladder and rectum were reduced by 0.07 (+/- 0.03)Gy, 0.04 (+/-0.05)Gy and 0.04 (+/-0.03)Gy per fraction respectively with the adapted plan (p <10-5). In the live.setting, the mean oART session (+/-SD) from CBCT acquisition to beam-on was 29 +/- 5 (range 21-44) minutes. Conclusion CBCT-guided oART was shown to be feasible with dosimetric benefits for patients with LACC. Further work to analyse potential reductions in PTV margins is ongoing.
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Affiliation(s)
- Charlotte E Shelley
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Matthew A Bolt
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Rachel Hollingdale
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Susan J Chadwick
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Andrew P Barnard
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Miriam Rashid
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Selina C Reinlo
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Nawda Fazel
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Charlotte R Thorpe
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Alexandra J Stewart
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK.,University of Surrey, Guildford GU2 7XX, UK
| | - Chris P South
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Elizabeth J Adams
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
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Shelley LEA, Sutcliffe MPF, Harrison K, Scaife JE, Parker MA, Romanchikova M, Thomas SJ, Jena R, Burnet NG. Autosegmentation of the rectum on megavoltage image guidance scans. Biomed Phys Eng Express 2019; 5:025006. [PMID: 31057946 PMCID: PMC6466640 DOI: 10.1088/2057-1976/aaf1db] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 11/12/2022]
Abstract
Autosegmentation of image guidance (IG) scans is crucial for streamlining and optimising delivered dose calculation in radiotherapy. By accounting for interfraction motion, daily delivered dose can be accumulated and incorporated into automated systems for adaptive radiotherapy. Autosegmentation of IG scans is challenging due to poorer image quality than typical planning kilovoltage computed tomography (kVCT) systems, and the resulting reduction of soft tissue contrast in regions such as the pelvis makes organ boundaries less distinguishable. Current autosegmentation solutions generally involve propagation of planning contours to the IG scan by deformable image registration (DIR). Here, we present a novel approach for primary autosegmentation of the rectum on megavoltage IG scans acquired during prostate radiotherapy, based on the Chan-Vese algorithm. Pre-processing steps such as Hounsfield unit/intensity scaling, identifying search regions, dealing with air, and handling the prostate, are detailed. Post-processing features include identification of implausible contours (nominally those affected by muscle or air), 3D self-checking, smoothing, and interpolation. In cases where the algorithm struggles, the best estimate on a given slice may revert to the propagated kVCT rectal contour. Algorithm parameters were optimised systematically for a training cohort of 26 scans, and tested on a validation cohort of 30 scans, from 10 patients. Manual intervention was not required. Comparing Chan-Vese autocontours with contours manually segmented by an experienced clinical oncologist achieved a mean Dice Similarity Coefficient of 0.78 (SE < 0.011). This was comparable with DIR methods for kVCT and CBCT published in the literature. The autosegmentation system was developed within the VoxTox Research Programme for accumulation of delivered dose to the rectum in prostate radiotherapy, but may have applicability to further anatomical sites and imaging modalities.
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Affiliation(s)
- L E A Shelley
- University of Cambridge, Department of Engineering, Cambridge, United Kingdom
- Addenbrooke's Hospital, Department of Medical Physics and Clinical Engineering, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
| | - M P F Sutcliffe
- University of Cambridge, Department of Engineering, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
| | - K Harrison
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- University of Cambridge, Cavendish Laboratory, Cambridge, United Kingdom
| | - J E Scaife
- Gloucestershire Oncology Centre, Cheltenham General Hospital, Cheltenham, United Kingdom
| | - M A Parker
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- University of Cambridge, Cavendish Laboratory, Cambridge, United Kingdom
| | - M Romanchikova
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- National Physical Laboratory, Teddington, United Kingdom
| | - S J Thomas
- Addenbrooke's Hospital, Department of Medical Physics and Clinical Engineering, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
| | - R Jena
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- Addenbrooke's Hospital, Oncology Centre, Cambridge, United Kingdom
| | - N G Burnet
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Czajkowski P, Piotrowski T. Registration methods in radiotherapy. Rep Pract Oncol Radiother 2018; 24:28-34. [PMID: 30337845 DOI: 10.1016/j.rpor.2018.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/06/2018] [Indexed: 12/11/2022] Open
Abstract
Purpose The aim of this study is to present a short and comprehensive review of the methods of medical image registration, their conditions and applications in radiotherapy. A particular focus was placed on the methods of deformable image registration. Methods To structure and deepen the knowledge on medical image registration in radiotherapy, a medical literature analysis was made using the Google Scholar browser and the medical database of the PubMed library. Results Chronological review of image registration methods in radiotherapy based on 34 selected articles. A particular attention was given to show: (i) potential regions of the application of different methods of registration, (ii) mathematical basis of the deformable methods and (iii) the methods of quality control for the registration process. Conclusions The primary aim of the medical image registration process is to connect the contents of images. What we want to achieve is a complementary or extended knowledge that can be used for more precise localisation of pathogenic lesions and continuous improvement of patient treatment. Therefore, the choice of imaging mode is dependent on the type of clinical study. It is impossible to visualise all anatomical details or functional changes using a single modality machine. Therefore, fusion of various modality images is of great clinical relevance. A natural problem in analysing the fusion of medical images is geographical errors related to displacement. The registered images are performed not at the same time and, very often, at different respiratory phases.
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Affiliation(s)
- Paweł Czajkowski
- Department of Medical Physics, Gdynia Oncology Centre, Gdynia, Poland
| | - Tomasz Piotrowski
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland.,Department of Medical Physics, Greater Poland Cancer Centre, Poznan, Poland
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Hysing LB, Ekanger C, Zolnay Á, Helle SI, Rasi M, Heijmen BJ, Sikora M, Söhn M, Muren LP, Thörnqvist S. Statistical motion modelling for robust evaluation of clinically delivered accumulated dose distributions after curative radiotherapy of locally advanced prostate cancer. Radiother Oncol 2018; 128:327-335. [DOI: 10.1016/j.radonc.2018.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 05/16/2018] [Accepted: 06/04/2018] [Indexed: 12/25/2022]
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Segmentation of parotid glands from registered CT and MR images. Phys Med 2018; 52:33-41. [PMID: 30139607 DOI: 10.1016/j.ejmp.2018.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To develop an automatic multimodal method for segmentation of parotid glands (PGs) from pre-registered computed tomography (CT) and magnetic resonance (MR) images and compare its results to the results of an existing state-of-the-art algorithm that segments PGs from CT images only. METHODS Magnetic resonance images of head and neck were registered to the accompanying CT images using two different state-of-the-art registration procedures. The reference domains of registered image pairs were divided on the complementary PG regions and backgrounds according to the manual delineation of PGs on CT images, provided by a physician. Patches of intensity values from both image modalities, centered around randomly sampled voxels from the reference domain, served as positive or negative samples in the training of the convolutional neural network (CNN) classifier. The trained CNN accepted a previously unseen (registered) image pair and classified its voxels according to the resemblance of its patches to the patches used for training. The final segmentation was refined using a graph-cut algorithm, followed by the dilate-erode operations. RESULTS Using the same image dataset, segmentation of PGs was performed using the proposed multimodal algorithm and an existing monomodal algorithm, which segments PGs from CT images only. The mean value of the achieved Dice overlapping coefficient for the proposed algorithm was 78.8%, while the corresponding mean value for the monomodal algorithm was 76.5%. CONCLUSIONS Automatic PG segmentation on the planning CT image can be augmented with the MR image modality, leading to an improved RT planning of head and neck cancer.
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Chapman CH, Polan D, Vineberg K, Jolly S, Maturen KE, Brock KK, Prisciandaro JI. Deformable image registration–based contour propagation yields clinically acceptable plans for MRI-based cervical cancer brachytherapy planning. Brachytherapy 2018; 17:360-367. [DOI: 10.1016/j.brachy.2017.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 11/25/2022]
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Lim-Reinders S, Keller BM, Al-Ward S, Sahgal A, Kim A. Online Adaptive Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 99:994-1003. [DOI: 10.1016/j.ijrobp.2017.04.023] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
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Gui L, Li C, Yang X. Medical image segmentation based on level set and isoperimetric constraint. Phys Med 2017; 42:162-173. [PMID: 29173911 DOI: 10.1016/j.ejmp.2017.09.123] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 12/16/2022] Open
Abstract
Level set based methods are being increasingly used in image segmentation. In these methods, various shape constraints can be incorporated into the energy functionals to obtain the desired shapes of the contours represented by their zero level sets of functions. Motivated by the isoperimetric inequality in differential geometry, we propose a segmentation method in which the isoperimetric constrain is integrated into a level set framework to penalize the ratio of its squared perimeter to its enclosed area of an active contour. The new model can ensure the compactness of segmenting objects and complete missing or/and blurred parts of their boundaries simultaneously. The isoperimetric shape constraint is free of explicit expressions of shapes and scale-invariant. As a result, the proposed method can handle various objects with different scales and does not need to estimate parameters of shapes. Our method can segment lesions with blurred or/and partially missing boundaries in ultrasound, Computed Tomography (CT) and Magnetic Resonance (MR) images efficiently. Quantitative evaluation also confirms that the proposed method can provide more accurate segmentation than two well-known level set methods. Therefore, our proposed method shows potential of accurate segmentation of lesions for applying in diagnoses and surgical planning.
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Affiliation(s)
- Luying Gui
- The Department of Mathematics, Nanjing University of Science and Technology, Nanjing, Jiangsu 210094, China.
| | - Chunming Li
- The School of Electronic Engineering, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China.
| | - Xiaoping Yang
- The Department of Mathematics, Nanjing University, Nanjing, Jiangsu 210093, China.
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Sini C, Noris Chiorda B, Gabriele P, Sanguineti G, Morlino S, Badenchini F, Cante D, Carillo V, Gaetano M, Giandini T, Landoni V, Maggio A, Perna L, Petrucci E, Sacco V, Valdagni R, Rancati T, Fiorino C, Cozzarini C. Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy: First quantification of bowel dose-volume effects. Radiother Oncol 2017; 124:296-301. [PMID: 28739383 DOI: 10.1016/j.radonc.2017.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 06/06/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Intestinal toxicity is commonly experienced during whole-pelvis intensity-modulated radiotherapy (WPRT) for prostate cancer. The aim of the current study was to assess bowel dose-volume relationships for acute patient-reported intestinal symptoms of patients treated with WPRT for prostate cancer. MATERIALS AND METHODS Complete data of 206 patients were available; the median dose to pelvic nodes was 51.8Gy (range 50.4-54.4, 1.7-2Gy/fr). Intestinal symptoms were assessed as changes in the Inflammatory Bowel Disease Questionnaire scores relative to the Bowel Domain (IBDQ-B) between baseline and radiotherapy mid-point/end. The 25th percentiles of the most severe worsening from baseline (ΔIBDQ-B) were set as end-points. The impact of bowel loops and sigmoid colon dose-volume/surface parameters as well as selected clinical parameters were investigated using multivariate logistic regression. RESULTS Analyses were focused on the four questions showing a median ΔIBDQ-B>0. No dose volume/surface parameters were predictive, other than ΔIBDQ5≥3 (loose stools): when grouping patients according to bowel DVHs (high risk: V20>470cc, V30>245cc, V42>110cc; low risk: all the remaining patients), a two-variable model including high-risk DVH-shape (OR: 9.3) and age (protective, OR: 0.94) was assessed. The model showed good calibration (slope: 1.003, R2=0.92) and was found to be robust after bootstrap-based internal validation. CONCLUSIONS Constraining the bowel loops may reduce the risk of loose stools. The risk is higher for younger patients.
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Affiliation(s)
- Carla Sini
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | - Pietro Gabriele
- Radiotherapy Department, Candiolo Cancer Institute - FPO, IRCCS, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, Regina Elena National Cancer Institute, Rome, Italy
| | - Sara Morlino
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Fabio Badenchini
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | - Viviana Carillo
- Radiotherapy, Centro AKTIS Diagnostica e terapia, Napoli, Italy
| | | | - Tommaso Giandini
- Medical Physics, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Valeria Landoni
- Department of Physics, Regina Elena National Cancer Institute, Rome, Italy
| | - Angelo Maggio
- Medical Physics Department, Candiolo Cancer Institute - FPO, IRCCS, Italy
| | - Lucia Perna
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | - Vincenzo Sacco
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Riccardo Valdagni
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy; Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy; UNIV Hematology and Hemato-Oncology, Università degli Studi di Milano, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
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Woerner AJ, Choi M, Harkenrider MM, Roeske JC, Surucu M. Evaluation of Deformable Image Registration-Based Contour Propagation From Planning CT to Cone-Beam CT. Technol Cancer Res Treat 2017; 16:801-810. [PMID: 28699418 PMCID: PMC5762035 DOI: 10.1177/1533034617697242] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: We evaluated the performance of organ contour propagation from a planning computed tomography to cone-beam computed tomography with deformable image registration by comparing contours to manual contouring. Materials and Methods: Sixteen patients were retrospectively identified based on showing considerable physical change throughout the course of treatment. Multiple organs in the 3 regions (head and neck, prostate, and pancreas) were evaluated. A cone-beam computed tomography from the end of treatment was registered to the planning computed tomography using rigid registration, followed by deformable image registration. The contours were copied on cone-beam computed tomography image sets using rigid registration and modified by 2 radiation oncologists. Contours were compared using Dice similarity coefficient, mean surface distance, and Hausdorff distance. Results: The mean physician-to-physician Dice similarity coefficient for all organs was 0.90. When compared to each physician’s contours, the overall mean for rigid was 0.76 (P < .001), and it was improved to 0.79 (P < .001) for deformable image registration. Comparing deformable image registration to physicians resulted in a mean Dice similarity coefficient of 0.77, 0.74, and 0.84 for head and neck, prostate, and pancreas groups, respectively; whereas, the physician-to-physician mean agreement for these sites was 0.87, 0.90, and 0.93 (P < .001, for all sites). The mean surface distance for physician-to-physician contours was 1.01 mm, compared to 2.58 mm for rigid-to-physician contours and 2.24 mm for deformable image registration-to-physician contours. The mean physician-to-physician Hausdorff distance was 11.32 mm, and when compared to any physician’s contours, the mean for rigid and deformable image registration was 12.1 mm and 12.0 mm (P < .001), respectively. Conclusion: The physicians had a high level of agreement via the 3 metrics; however, deformable image registration fell short of this level of agreement. The automatic workflows using deformable image registration to deform contours to cone-beam computed tomography to evaluate the changes during treatment should be used with caution.
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Affiliation(s)
- Andrew J Woerner
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Mehee Choi
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - John C Roeske
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Murat Surucu
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
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11
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Method of evaluating respiratory induced organ motion by vector volume histogram. Phys Med 2016; 32:1570-1574. [DOI: 10.1016/j.ejmp.2016.11.110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/15/2016] [Accepted: 11/15/2016] [Indexed: 12/25/2022] Open
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