Use of lung treatment plans to evaluate DIR algorithms

  • Ines-Ana Jurkovic
  • Sotirios Stathakis
  • Ying Li
  • Abhilasha Patel
  • Jill Vincent
  • Nikos Papanikolaou
  • Panayiotis MavroidisEmail author
Scientific Paper


The purpose of the study is to evaluate the accuracy of two deformable image registration algorithms by examining their influence on the dose summation results obtained using 4DCT (four dimensional computed tomography) dose distributions based on ‘4D’ planned and ‘4D optimal’ IMRT (intensity modulated radiation therapy) plans. For ten lung cancer patients, 4D step and shoot IMRT plans were produced. The breathing cycle was divided into ten parts and for each part a set of CT images was acquired. For each patient the treatment plan was copied to the CTs of each phase and subsequently recalculated. Each phase CT was then registered to the average intensity projection (AIP) CT using a deformable image registration (DIR) algorithm and the composite dose distribution was then calculated by summing up the deformed dose distributions from all the phases (‘4D’ treatment plan). The ‘4D optimal’ treatment plan was created by producing an optimal plan on the CTs of each phase of the respiratory cycle and summing up the deformed dose distributions from all the phases. The results indicate that it is possible to map the dose distributions of different breathing phases in lung using DIR, and that different DIR methods and target characteristics (motion amplitude, size, location) affect the differences between original plan, ‘4D’ and ‘4D optimal’ dose distributions. Although the ‘4D optimal’ plans were designed to achieve 95% target coverage, both of the used DIR methods failed to translate that coverage in some instances. The same variation between these methods was also observed in the ‘4D’ plan comparison. This study shows that it is feasible to perform an acceptably accurate calculation of the composite deformed dose. However, it is important to account for tumor motion and body deformation especially when the tumor volume is small and/or located in the lower lobe of the lung.


4DCT Deformable image registration IMRT AIP Respiratory phases Lung 


Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this paper.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Medical University of Warsaw and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants.


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Copyright information

© Australasian College of Physical Scientists and Engineers in Medicine 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity of Texas Health Sciences Center at San AntonioSan AntonioUSA
  2. 2.Department of Radiation OncologyUniversity of North CarolinaChapel HillUSA

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