title: Improving image-guided target localization through deformable registration.
abstract: OBJECTIVE
  To quantify the improvements in online target localization using kV cone beam CT (CBCT) with deformable registration.
  
  
  METHODS
  Twelve patients treated under a 6 fraction liver cancer radiation therapy protocol were imaged in breath hold using kV CBCT at each treatment fraction. The images were imported into the treatment planning software and rigidly registered by fitting the liver, identified on the daily kV CBCT image, into the liver contours, previously drawn on the planning CT. The liver was then manually contoured on each CBCT image. Deformable registration was automatically performed, aligning the CT liver to the liver on each CBCT image using MORFEUS, a biomechanical model based deformable registration algorithm. The tumor, defined on planning CT, was mapped onto the CBCT, through MORFEUS. The center of mass (COM) displacement of the tumor was computed.
  
  
  RESULTS
  The mean (SD) displacement magnitude (absolute value) of the COM following deformable registration was 0.08 (0.07), 0.10 (0.11), and 0.10 (0.17) cm in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions, respectively. The maximum displacement of the COM was 0.34, 0.65, and 0.97 cm in the LR, AP, and SI directions, respectively. Fifteen percent of the treatment fractions had a COM displacement of greater than 0.3 cm and 33% of patients had at least 1 fraction with a displacement of greater than 0.3 cm. The deformable registration, excluding the manual contouring of the liver, was performed in less than 1 minute, on average.
  
  
  CONCLUSIONS
  Rigid registration of the liver volume between planning CT and verification kV CBCT localizes the tumor to within 0.3 cm for the majority (66%) of patients; however, larger offsets in tumor position can be observed due to liver deformation.
authors.affiliation: Radiation Medicine Program, Princess Margaret Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada. kristy.brock@rmp.uhn.on.ca
authors.forename: Kristy K
authors.initials: KK
authors.lastname: Brock
authors.forename: Maria
authors.initials: M
authors.lastname: Hawkins
authors.forename: Cynthia
authors.initials: C
authors.lastname: Eccles
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Moseley
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Moseley
authors.forename: David A
authors.initials: DA
authors.lastname: Jaffray
authors.forename: Laura A
authors.initials: LA
authors.lastname: Dawson