Quantification of deformable image registration uncertainties for dose accumulation on head and neck cancer proton treatments.

Autor: Amstutz F; Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Physics, ETH Zurich, Switzerland., D'Almeida PG; Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Information Technology & Electrical Engineering, ETH Zurich, Switzerland., Wu X; Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Information Technology & Electrical Engineering, ETH Zurich, Switzerland., Albertini F; Center for Proton Therapy, Paul Scherrer Institute, Switzerland., Bachtiary B; Center for Proton Therapy, Paul Scherrer Institute, Switzerland., Weber DC; Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland; Department of Radiation Oncology, University Hospital Bern, Switzerland., Unkelbach J; Department of Radiation Oncology, University Hospital Zurich, Switzerland., Lomax AJ; Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Physics, ETH Zurich, Switzerland., Zhang Y; Center for Proton Therapy, Paul Scherrer Institute, Switzerland. Electronic address: ye.zhang@psi.ch.
Jazyk: angličtina
Zdroj: Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) [Phys Med] 2024 Jun; Vol. 122, pp. 103386. Date of Electronic Publication: 2024 May 27.
DOI: 10.1016/j.ejmp.2024.103386
Abstrakt: Purpose: Head and neck cancer (HNC) patients in radiotherapy require adaptive treatment plans due to anatomical changes. Deformable image registration (DIR) is used in adaptive radiotherapy, e.g. for deformable dose accumulation (DDA). However, DIR's ill-posedness necessitates addressing uncertainties, often overlooked in clinical implementations. DIR's further clinical implementation is hindered by missing quantitative commissioning and quality assurance tools. This study evaluates one pathway for more quantitative DDA uncertainties.
Methods: For five HNC patients, each with multiple repeated CTs acquired during treatment, a simultaneous-integrated boost (SIB) plan was optimized. Recalculated doses were warped individually using multiple DIRs from repeated to reference CTs, and voxel-by-voxel dose ranges determined an error-bar for DDA. Followed by evaluating, a previously proposed early-stage DDA uncertainty estimation method tested for lung cancer, which combines geometric DIR uncertainties, dose gradients and their directional dependence, in the context of HNC.
Results: Applying multiple DIRs show dose differences, pronounced in high dose gradient regions. The patient with largest anatomical changes (-13.1 % in ROI body volume), exhibited 33 % maximum uncertainty in contralateral parotid, with 54 % of voxels presenting an uncertainty >5 %. Accumulation over multiple CTs partially mitigated uncertainties. The estimation approach predicted 92.6 % of voxels within ±5 % to the reference dose uncertainty across all patients.
Conclusions: DIR variations impact accumulated doses, emphasizing DDA uncertainty quantification's importance for HNC patients. Multiple DIR dose warping aids in quantifying DDA uncertainties. An estimation approach previously described for lung cancer was successfully validated for HNC, for SIB plans, presenting different dose gradients, and for accumulated treatments.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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