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Applying Multi-Metric Deformable Image Registration for Dose Accumulation in Combined Cervical Cancer Radiotherapy

(1) Purpose: Challenges remain in dose accumulation for cervical cancer radiotherapy combined with external beam radiotherapy (EBRT) and brachytherapy (BT) as there are many large and complex organ deformations between different treatments. This study aims to improve deformable image registration (D...

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Autores principales: Fu, Qi, Xie, Xin, Xu, Yingjie, Zuo, Jing, Yang, Xi, Xia, Wenlong, An, Jusheng, Huang, Manni, Yan, Hui, Dai, Jianrong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963278/
https://www.ncbi.nlm.nih.gov/pubmed/36836556
http://dx.doi.org/10.3390/jpm13020323
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author Fu, Qi
Xie, Xin
Xu, Yingjie
Zuo, Jing
Yang, Xi
Xia, Wenlong
An, Jusheng
Huang, Manni
Yan, Hui
Dai, Jianrong
author_facet Fu, Qi
Xie, Xin
Xu, Yingjie
Zuo, Jing
Yang, Xi
Xia, Wenlong
An, Jusheng
Huang, Manni
Yan, Hui
Dai, Jianrong
author_sort Fu, Qi
collection PubMed
description (1) Purpose: Challenges remain in dose accumulation for cervical cancer radiotherapy combined with external beam radiotherapy (EBRT) and brachytherapy (BT) as there are many large and complex organ deformations between different treatments. This study aims to improve deformable image registration (DIR) accuracy with the introduction of multi-metric objectives for dose accumulation of EBRT and BT. (2) Materials and methods: Twenty cervical cancer patients treated with EBRT (45–50 Gy/25 fractions) and high-dose-rate BT (≥20 Gy in 4 fractions) were included for DIR. The multi-metric DIR algorithm included an intensity-based metric, three contour-based metrics, and a penalty term. Nonrigid B-spine transformation was used to transform the planning CT images from EBRT to the first BT, with a six-level resolution registration strategy. To evaluate its performance, the multi-metric DIR was compared with a hybrid DIR provided by commercial software. The DIR accuracy was measured by the Dice similarity coefficient (DSC) and Hausdorff distance (HD) between deformed and reference organ contours. The accumulated maximum dose of 2 cc (D(2cc)) of the bladder and rectum was calculated and compared to simply addition of D(2cc) from EBRT and BT (ΔD(2cc)). (3) Results: The mean DSC of all organ contours for the multi-metric DIR were significantly higher than those for the hybrid DIR (p ≤ 0.011). In total, 70% of patients had DSC > 0.8 using the multi-metric DIR, while 15% of patients had DSC > 0.8 using the commercial hybrid DIR. The mean ΔD(2cc) of the bladder and rectum for the multi-metric DIR were 3.25 ± 2.29 and 3.54 ± 2.02 Gy(EQD2), respectively, whereas those for the hybrid DIR were 2.68 ± 2.56 and 2.32 ± 3.25 Gy(EQD2), respectively. The multi-metric DIR resulted in a much lower proportion of unrealistic D(2cc) than the hybrid DIR (2.5% vs. 17.5%). (4) Conclusions: Compared with the commercial hybrid DIR, the introduced multi-metric DIR significantly improved the registration accuracy and resulted in a more reasonable accumulated dose distribution.
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spelling pubmed-99632782023-02-26 Applying Multi-Metric Deformable Image Registration for Dose Accumulation in Combined Cervical Cancer Radiotherapy Fu, Qi Xie, Xin Xu, Yingjie Zuo, Jing Yang, Xi Xia, Wenlong An, Jusheng Huang, Manni Yan, Hui Dai, Jianrong J Pers Med Article (1) Purpose: Challenges remain in dose accumulation for cervical cancer radiotherapy combined with external beam radiotherapy (EBRT) and brachytherapy (BT) as there are many large and complex organ deformations between different treatments. This study aims to improve deformable image registration (DIR) accuracy with the introduction of multi-metric objectives for dose accumulation of EBRT and BT. (2) Materials and methods: Twenty cervical cancer patients treated with EBRT (45–50 Gy/25 fractions) and high-dose-rate BT (≥20 Gy in 4 fractions) were included for DIR. The multi-metric DIR algorithm included an intensity-based metric, three contour-based metrics, and a penalty term. Nonrigid B-spine transformation was used to transform the planning CT images from EBRT to the first BT, with a six-level resolution registration strategy. To evaluate its performance, the multi-metric DIR was compared with a hybrid DIR provided by commercial software. The DIR accuracy was measured by the Dice similarity coefficient (DSC) and Hausdorff distance (HD) between deformed and reference organ contours. The accumulated maximum dose of 2 cc (D(2cc)) of the bladder and rectum was calculated and compared to simply addition of D(2cc) from EBRT and BT (ΔD(2cc)). (3) Results: The mean DSC of all organ contours for the multi-metric DIR were significantly higher than those for the hybrid DIR (p ≤ 0.011). In total, 70% of patients had DSC > 0.8 using the multi-metric DIR, while 15% of patients had DSC > 0.8 using the commercial hybrid DIR. The mean ΔD(2cc) of the bladder and rectum for the multi-metric DIR were 3.25 ± 2.29 and 3.54 ± 2.02 Gy(EQD2), respectively, whereas those for the hybrid DIR were 2.68 ± 2.56 and 2.32 ± 3.25 Gy(EQD2), respectively. The multi-metric DIR resulted in a much lower proportion of unrealistic D(2cc) than the hybrid DIR (2.5% vs. 17.5%). (4) Conclusions: Compared with the commercial hybrid DIR, the introduced multi-metric DIR significantly improved the registration accuracy and resulted in a more reasonable accumulated dose distribution. MDPI 2023-02-13 /pmc/articles/PMC9963278/ /pubmed/36836556 http://dx.doi.org/10.3390/jpm13020323 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Fu, Qi
Xie, Xin
Xu, Yingjie
Zuo, Jing
Yang, Xi
Xia, Wenlong
An, Jusheng
Huang, Manni
Yan, Hui
Dai, Jianrong
Applying Multi-Metric Deformable Image Registration for Dose Accumulation in Combined Cervical Cancer Radiotherapy
title Applying Multi-Metric Deformable Image Registration for Dose Accumulation in Combined Cervical Cancer Radiotherapy
title_full Applying Multi-Metric Deformable Image Registration for Dose Accumulation in Combined Cervical Cancer Radiotherapy
title_fullStr Applying Multi-Metric Deformable Image Registration for Dose Accumulation in Combined Cervical Cancer Radiotherapy
title_full_unstemmed Applying Multi-Metric Deformable Image Registration for Dose Accumulation in Combined Cervical Cancer Radiotherapy
title_short Applying Multi-Metric Deformable Image Registration for Dose Accumulation in Combined Cervical Cancer Radiotherapy
title_sort applying multi-metric deformable image registration for dose accumulation in combined cervical cancer radiotherapy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963278/
https://www.ncbi.nlm.nih.gov/pubmed/36836556
http://dx.doi.org/10.3390/jpm13020323
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