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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Imaging

Background:

  • Image-guided radiation therapy (IGRT) relies on accurate image registration for precise tumor targeting.
  • Current qualitative image review processes can be subjective and inconsistent, potentially impacting treatment safety.
  • Objective quality control metrics are needed to enhance the reliability of IGRT image review.

Purpose of the Study:

  • To develop and demonstrate an objective quality control framework for the image review process in radiotherapy.
  • To establish a system for objectively monitoring image registration quality throughout cancer treatment.

Main Methods:

  • Retrospective analysis of 927 cone-beam computed tomography (CBCT) registrations from 33 head and neck cancer patients.
  • Utilized cervical spine (C-spine) and mandible as registration tracking volumes (RTVs) to calculate similarity metrics (NCC and MI).
  • Implemented statistical process control (SPC) with patient-specific and population control charts to monitor registration quality and identify deviations.

Main Results:

  • Normalized cross-correlation (NCC) proved more effective than mutual information (MI) in identifying suboptimal registrations within the SPC framework.
  • Patient-specific control charts using NCC successfully identified statistically significant daily variations and deviations.
  • The proposed framework identified registrations requiring expert evaluation and demonstrated good agreement (±1 mm) between effective displacements and couch adjustments.

Conclusions:

  • Qualitative image review alone can lead to inconsistent feedback in IGRT.
  • Registration tracking using NCC objectively identifies statistically significant deviations, improving IGRT process safety and consistency.
  • This objective tool complements the current image review process, enhancing overall treatment quality.