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Optimizing 3DCT image registration for interfractional changes in carbon-ion prostate radiotherapy.

Ryusuke Hirai1,2,3, Shinichiro Mori4, Hiroki Suyari3

  • 1National Institutes for Quantum Science and Technology, Quantum Life and Medical Science Directorate, Institute for Quantum Medical Science, Inage-ku, Chiba, 263-8555, Japan.

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Summary

A new water equivalent pathlength (WEPL)-based image registration algorithm improved target coverage and reduced rectal dose in carbon-ion prostate cancer radiotherapy. This method enhances setup accuracy for precise treatment delivery.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Image Guidance

Background:

  • Accurate patient setup is crucial for effective radiotherapy, especially with advanced techniques like carbon-ion pencil beam scanning.
  • Traditional image registration methods (intensity-based, target-based) may have limitations in accounting for anatomical and density changes during treatment.
  • Water Equivalent Pathlength (WEPL) considers the cumulative effect of tissue density on the particle's path, potentially improving registration accuracy.

Purpose of the Study:

  • To develop and evaluate a novel CT-CT rigid image registration algorithm based on WEPL for carbon-ion prostate cancer radiotherapy.
  • To compare the dosimetric outcomes of WEPL-based registration against intensity-based and target-based registration methods.
  • To assess the impact of different registration algorithms on clinical target volume (CTV) coverage and organ-at-risk (rectal) dose.

Main Methods:

  • A WEPL-based CT-CT rigid image registration algorithm was developed and compared with intensity-based and target-based methods.
  • The algorithms were applied to planning CT and weekly treatment CT data from 19 prostate cancer patients undergoing carbon-ion therapy.
  • Dosimetric parameters, including CTV-D95 and rectal dose (V20, V30, V40), were calculated and statistically analyzed.

Main Results:

  • WEPL-based registration demonstrated improved CTV coverage (mean CTV-D95 of 99.0%) compared to intensity-based (95.8%) and target-based (98.8%) methods.
  • WEPL-based registration resulted in a lower rectal maximum dose (51.9 Gy RBE) compared to intensity-based (49.4 Gy RBE) and target-based (52.2 Gy RBE) registration.
  • While WEPL-based registration improved target coverage and reduced rectal dose, it also showed an increase in the magnitude of interfractional variation.

Conclusions:

  • The WEPL-based image registration algorithm offers superior target coverage and reduced rectal dose in carbon-ion prostate cancer radiotherapy.
  • This WEPL approach provides a promising advancement for image-guided setup procedures, enhancing treatment precision.
  • Further investigation into managing the increased interfractional variation associated with WEPL-based registration is warranted.