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Evaluation of the Dose Delivery Consistency and Its Dependence on Imaging Modality and Deformable Image Registration Algorithm in Prostate Cancer Patients

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Abstract

Purpose

This study aims at investigating the impact of imaging modality, deformable image registration (DIR) algorithm, and dose accumulation interval in the estimation of the cumulative delivered dose distribution.

Methods

This analysis involves 453 fractions of 20 prostate cancer patients treated with IMRT using CT-on-rails (CTOR) or VMAT using cone beam CT (CBCT). Dosimetric comparisons between intensity-based and contour-based DIR were based on mean dose, D1cc and V50.

Results

In the case of CTOR, the deviation of the cumulative mean dose against the planned dose was 1.4 ± 2.1 Gy for bladder and − 3.2 ± 5.3 Gy for rectum for the intensity-based DIR and 1.5 ± 2.0 Gy and − 3.9 ± 2.7 Gy for the contour-based DIR. The respective values for V50 were 3.0 ± 3.2% for bladder and − 6.1 ± 18.3% for rectum for the intensity-based DIR and 3.2 ± 3.8% and − 8.9 ± 8.3% for the contour-based DIR. In the case of CBCT, the deviation of the cumulative mean dose against the planned dose was 14.5 ± 8.6 Gy for bladder and − 1.7 ± 10.6 Gy for rectum for the intensity-based DIR and − 15.2 ± 46.0 Gy and − 31.2 ± 52.4 Gy for the contour-based DIR. The respective values for V50 were 14.8 ± 8.4% for bladder and 56.0 ± 101.8% for rectum for the intensity-based DIR and − 25.7 ± 50.1% and − 39.0 ± 55.4% for the contour-based DIR.

Conclusion

The analysis showed that the contour-based DIR algorithm performed much better than the intensity-based DIR and CTOR image guidance was more consistent than CBCT. Those findings indicate that the estimations of the cumulative delivered dose distribution based on auto-segmentation algorithms are in general less consistent compared to manual contouring (especially when CBCT is used for image guidance).

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Funding

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Authors and Affiliations

  1. Department of Radiation Oncology, University of North Carolina at Chapel Hill, CB#7512, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA

    Jacob Hammers, Daniel Lindsay, Orit Kaidar-Person, Ronald C. Chen, Shiva K. Das & Panayiotis Mavroidis

  2. MIM Software, Cleveland, OH, USA

    Sara Pirozzi

  3. Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Ganesh Narayanasamy

  4. Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC, USA

    Xianming Tan

Authors
  1. Jacob Hammers
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  2. Sara Pirozzi
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  3. Ganesh Narayanasamy
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  4. Daniel Lindsay
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  9. Panayiotis Mavroidis
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Correspondence to Panayiotis Mavroidis.

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This article contains retrospective analysis of anonymized patient data.

Appendix

Appendix

In the results presented in this work, the estimated delivered dose distributions are subject to the uncertainties of (1) calculating the fractional dose distribution to the IGRT scan vs. using the scaled planned dose distribution, which is rigidly translated to the IGRT scan; and (2) the DIR of the examined algorithms. The first source of uncertainty is discussed in point is discussed below. Regarding the second source of uncertainty, its magnitude was estimated through the analysis shown in Figs. 11 and 12. The variations in the fractional dose delivered to bladder and rectum were substantial in many patients due to their deformations (different bladder and rectal fillings) compared to the planned contours (see Fig. 11). Those DVHs are not subject to any of the uncertainties mentioned above. However, when the cumulative dose distributions get calculated from all the fractions the accuracy of the DIR comes into play. One way to estimate this accuracy is by comparing the deformed contours of bladder and rectum with the original planning contours. If the DIR accuracy is low, it will lead to deformed contours that are considerable different than the planning contours and this discrepancy will be reflected on the DVHs. In Fig. 12, it is shown that for the impact of this uncertainty for the contour-based (CBNIB) DIR on the DVHs is very small. As it was shown in another work by this group [25], the accuracy of the intensity-based DIR is lower (especially for the CBCT imaging modality) and affects more the estimated cumulative DVHs. For this reason, the estimated delivered DVHs that were calculated using the CBNIB DIR on CTOR images are considered as our reference in those comparisons.

Fig. 11
figure 11

Dose volume histograms (DVHs) for weekly selected fractions for the bladder (left) and rectum (right) (solid lines). The corresponding planned DVHs are also shown (dashed lines). Both the bladder and rectum demonstrate substantial inter-fractional variation in dose distribution

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Fig. 12
figure 12

Illustration of dose volume histograms of bladder (left) and rectum (right), which were derived by the planned dose distribution on the fractional IGRT contours, which were deformed to the planning CT using the contour-based DIR (solid lines) and the original planning contours (dashed lines). In this example, the DVHs from 36 different fractions throughout the course of the treatment are compared. For both bladder and rectum, the DVH differences are very small

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In this work, the reason of using rigid registration to translate the planned dose distribution to each IGRT scan instead of calculating the dose distribution was mainly practical. The authors aimed to establish this workflow clinically and automation is a key point in this process. To calculate the dose distribution to each IGRT scan required much most manual work and time. In the case of CBCT, the poorer image quality would also have some impact in the accuracy of dose calculation. However, in order to examine the impact of any deformations of the external contour of the patient during the course of the treatment we performed a comparison between two workflows for different fractions of a given patients and the results are shown in Fig. 13. As it can be seen, the differences are minimal and much smaller in order of magnitude than the differences we observe due to the inter-fractional bladder and rectum deformations.

Fig. 13
figure 13

Illustration of dose volume histograms (DVHs) of bladder (left) and rectum (right), which were derived by the dose distributions that were calculated on the IGRT scans (solid lines) or were rigidly translated to the IGRT scan from the planning CT (dashed lines). In this example, the DVHs from seven different fractions throughout the course of the treatment are compared. For both bladder and rectum, the DVH differences are small

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Hammers, J., Pirozzi, S., Narayanasamy, G. et al. Evaluation of the Dose Delivery Consistency and Its Dependence on Imaging Modality and Deformable Image Registration Algorithm in Prostate Cancer Patients. J. Med. Biol. Eng. 42, 74–86 (2022). https://doi.org/10.1007/s40846-021-00673-5

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  • DOI: https://doi.org/10.1007/s40846-021-00673-5

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