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Open source deformable image registration system for treatment planning and recurrence CT scans

Validation in the head and neck region

Open-Source-System für die deformierbare Bildregistrierung von Planungs- und Rezidiv-CT-Datensätzen

Validierung im Kopf-Hals-Bereich

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Abstract

Background

Clinical application of deformable registration (DIR) of medical images remains limited due to sparse validation of DIR methods in specific situations, e. g. in case of cancer recurrences. In this study the accuracy of DIR for registration of planning CT (pCT) and recurrence CT (rCT) images of head and neck squamous cell carcinoma (HNSCC) patients was evaluated.

Patients and materials

Twenty patients treated with definitive IMRT for HNSCC in 2010–2012 were included. For each patient, a pCT and an rCT scan were used. Median interval between the scans was 8.5 months. One observer manually contoured eight anatomical regions-of-interest (ROI) twice on pCT and once on rCT.

Methods

pCT and rCT images were deformably registered using the open source software elastix. Mean surface distance (MSD) and Dice similarity coefficient (DSC) between contours were used for validation of DIR. A measure for delineation uncertainty was estimated by assessing MSD from the re-delineations of the same ROI on pCT. DIR and manual contouring uncertainties were correlated with tissue volume and rigidity.

Results

MSD varied 1–3 mm for different ROIs for DIR and 1–1.5 mm for re-delineated ROIs performed on pCT. DSC for DIR varied between 0.58 and 0.79 for soft tissues and was 0.79 or higher for bony structures, and correlated with the volumes of ROIs (r = 0.5, p < 0.001) and tissue rigidity (r = 0.54, p < 0.001).

Conclusion

DIR using elastix in HNSCC on planning and recurrence CT scans is feasible; an uncertainty of the method is close to the voxel size length of the planning CT images.

Zusammenfassung

Hintergrund

Die klinische Anwendung der deformierbaren Bildregistrierung (DIR) ist aufgrund geringer Erfahrungswerte in speziellen Situationen noch eingeschränkt (z. B. Karzinomrezidive). Die Studie evaluiert die Treffsicherheit der DIR bei der Registrierung von Planungs-CT-Bildern (pCT) und CT-Scans des Rezidivs (rCT) bei Patienten mit Plattenepithelkarzinomen im Kopf-Hals-Bereich (HNSCC).

Patienten und Methoden

Mithilfe der DIR wurden Planungs-CT und Rezidiv-Scans von 20 HNSCC-Patienten analysiert; alle waren zwischen 2010 und 2012 mit intensitätsmodulierter Strahlentherapie behandelt worden. Das mediane Intervall zwischen den Aufnahmen betrug 8,5 Monate. Jeweils 8 ROI („regions of interest“) wurden auf den pCT- und rCT-Datensätzen manuell definiert. Die Registrierung der Bilder wurde mit der Open Source Software elastix durchgeführt. Zur Beurteilung der Güte der Registrierung wurden MSD („mean surface distance“) und der Dice-Koeffizient (DSC) zwischen den Konturen bestimmt. Um etwaige Unsicherheiten bei der Konturierung abschätzen zu können, wurde der MSD der ROI im pCT als auch in der Wiedereinzeichnung verglichen. DIR und manuelle Konturierungsunsicherheiten wurden mit Gewebsvolumen und -rigidität korreliert.

Ergebnisse

Der MSD liegt zwischen 1–3 mm für verschiedene ROI in der DIR und zwischen 1 und 1,5 mm für wiederholt eingezeichnete ROIs auf dem pCT. Der DSC bei DIR variierte zwischen 0,58 und 0,79 für Weichteilgewebe und war ≥0,79 für knöcherne Strukturen, er korrelierte mit den Volumina der ROI (r = 0,5, p < 0,001) und mit der Gewebsrigidität (r = 0,54, p = 0,001).

Schlussfolgerung

Die deformierbare Bildregistrierung HNSCC-Patienten ist an pCT und rCT durchführbar. Die Methodenunsicherheit liegt in der Größenordnung der Voxelgröße des Planungs-CT.

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Acknowledgements

This project was supported by the Region of Southern Denmark, The Danish Cancer Research Foundation, and the Department of Oncology, Odense University Hospital.

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Authors and Affiliations

  1. Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

    Ruta Zukauskaite & Carsten Brink

  2. Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, C 5000, Odense, Denmark

    Ruta Zukauskaite, Jørgen Johansen & Jesper Grau Eriksen

  3. Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark

    Carsten Brink, Christian Rønn Hansen & Anders Bertelsen

  4. Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, Australia

    Christian Rønn Hansen & Anders Bertelsen

  5. Department of Oncology, Aarhus University Hospital, Aarhus, Denmark

    Cai Grau

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  1. Ruta Zukauskaite
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Correspondence to Ruta Zukauskaite.

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R. Zukauskaite, C. Brink, C.R. Hansen, A. Bertelsen, J. Johansen, C. Grau and J.G. Eriksen state that there are no conflicts of interest.

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The accompanying manuscript does not include studies on humans or animals performed by any of the authors.

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Zukauskaite, R., Brink, C., Hansen, C.R. et al. Open source deformable image registration system for treatment planning and recurrence CT scans. Strahlenther Onkol 192, 545–551 (2016). https://doi.org/10.1007/s00066-016-0998-4

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  • DOI: https://doi.org/10.1007/s00066-016-0998-4

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