Assessing image registration method for synthetic CT evaluation in MRI-only radiotherapy treatment planning
Keywords:
synthetic CT, MRI-only, Rigid image registration, Deformable image registration, Treatment planningAbstract
Background: Image registration is a key process of synthetic CT (sCT) evaluation for clinical MRI-only radiotherapy implementation, which lacks a comparative study investigating appropriate image registration methods.
Objective: To investigate the appropriate image registration methods for the sCT generated by a commercial convolutional neural network-based algorithm by comparing image intensity and dosimetry between sCT and planning CT (pCT) in the head-neck (H&N) and prostate.
Materials and Methods: This retrospective study included 10 patients with H&N (5) and prostate (5) cancer who underwent CT and MRI simulations for volumetric modulated arc therapy. The sCT was generated by the software MRI Planner™. The corresponding pCT was registered to the sCT using rigid image registration (RIR) and deformable image registration (DIR) based on the B-spline, creating rigid pCT (rpCT) and deformed pCT (dpCT), respectively. The pCT plan parameters were transferred and re-calculated with the fixed monitor unit on the registered sCT. The rpCT-sCT was compared to the dpCT-sCT in terms of HU accuracy evaluation using the mean absolute error (MAE), geometric evaluation using the dice similarity coefficient (DSC), and dosimetric evaluation using the dose-volume-histogram and gamma analysis.
Results: The DIR method improved the MAE by an average of 25.56% for the H&N and 61.85% for the prostate compared to the RIR method. The mean DSCs of the H&N of 0.73-0.97 in the RIR method were increased to 0.83-1.00 in the DIR method. The mean DSCs of the prostate of 0.69-0.95 in the RIR method were increased to 0.77-1.00 in the DIR method. The RIR method provided the maximum dose difference of 4.22%, which was decreased to within 2.00% for PTV and OARs using the DIR method for both H&N and prostate, except for high dose differences in the bladder and rectum caused by excessive volume and shape differences uncorrected by the DIR method.
Conclusion: The DIR method achieved better results in image intensity and dosimetry in sCT evaluation compared to the RIR method by minimizing the uncertainty from the anatomical misalignment between pCT and MRI acquisitions for the H&N and prostate.
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