Combination of intensity-based image registration with 3D simulation in radiation therapy.

Modern techniques of radiotherapy like intensity modulated radiation therapy (IMRT) make it possible to deliver high dose to tumors of different irregular shapes at the same time sparing surrounding healthy tissue. However, internal tumor motion makes precise calculation of the delivered dose distribution challenging. This makes analysis of tumor motion necessary. One way to describe target motion is using image registration. Many registration methods have already been developed previously. However, most of them belong either to geometric approaches or to intensity approaches. Methods which take account of anatomical information and results of intensity matching can greatly improve the results of image registration. Based on this idea, a combined method of image registration followed by 3D modeling and simulation was introduced in this project. Experiments were carried out for five patients 4DCT lung datasets. In the 3D simulation, models obtained from images of end-exhalation were deformed to the state of end-inhalation. Diaphragm motions were around -25 mm in the cranial-caudal (CC) direction. To verify the quality of our new method, displacements of landmarks were calculated and compared with measurements in the CT images. Improvement of accuracy after simulations has been shown compared to the results obtained only by intensity-based image registration. The average improvement was 0.97 mm. The average Euclidean error of the combined method was around 3.77 mm. Unrealistic motions such as curl-shaped deformations in the results of image registration were corrected. The combined method required less than 30 min. Our method provides information about the deformation of the target volume, which we need for dose optimization and target definition in our planning system.

Fast elastic registration for adaptive radiotherapy.

A new method for elastic mono-modal image registration for adaptive fractionated radiotherapy is presented. Elastic registration is a prerequisite for many medical applications in diagnosis, therapy planning, and therapy. Especially for adaptive radiotherapy efficient and accurate registration is required. Therefore, we developed a fast block matching algorithm for robust image registration. Anatomical landmarks are automatically selected at tissue borders and relocated in the frequency domain. A smooth interpolation is calculated by modified thin-plate splines with local impact. The concept of the algorithm allows different handling of different image structures. Thus, more features were included, like handling of discontinuities (e. g. air cavities in the intestinal track or rectum, observable in only one image), which can not be registered in a conventional way. The planning CT as well as delineated structures of target volume and organs at risks are transformed according to deviations observed in daily acquired verification CTs prior each dose fraction. This way, the time consuming repeated delineation, a prerequisite for adaptive radiotherapy, is avoided. The total calculation time is below 5 minutes and the accurateness is higher than voxel precision, which allows to use this tool in the clinical workflow. We present results of prostate, head-and-neck, and paraspinal tumors with verification by manually selected landmarks. We think this registration technique is not only suitable for adaptive radiotherapy, but also for other applications which require fast registration and possibilities to process special structures (e. g. discontinuities) in a different way.