title: On the need for comprehensive validation of deformable image registration, investigated with a novel 3-dimensional deformable dosimeter.
abstract: OBJECTIVE
  To introduce and evaluate a novel deformable 3-dimensional (3D) dosimetry system (Presage-Def/Optical-CT) and its application toward investigating the accuracy of dose deformation in a commercial deformable image registration (DIR) package.
  
  
  METHODS
  Presage-Def is a new dosimetry material consisting of an elastic polyurethane matrix doped with radiochromic leuco dye. Radiologic and mechanical properties were characterized using standard techniques. Dose-tracking feasibility was evaluated by comparing dose distributions between dosimeters irradiated with and without 27% lateral compression. A checkerboard plan of 5-mm square fields enabled precise measurement of true deformation using 3D dosimetry. Predicted deformation was determined from a commercial DIR algorithm.
  
  
  RESULTS
  Presage-Def exhibited a linear dose response with sensitivity of 0.0032 ΔOD/(Gy∙cm). Mass density is 1.02 g/cm(3), and effective atomic number is within 1.5% of water over a broad (0.03-10 MeV) energy range, indicating good water-equivalence. Elastic characteristics were close to that of liver tissue, with Young's modulus of 13.5-887 kPa over a stress range of 0.233-303 kPa, and Poisson's ratio of 0.475 (SE, 0.036). The Presage-Def/Optical-CT system successfully imaged the nondeformed and deformed dose distributions, with isotropic resolution of 1 mm. Comparison with the predicted deformed 3D dose distribution identified inaccuracies in the commercial DIR algorithm. Although external contours were accurately deformed (submillimeter accuracy), volumetric dose deformation was poor. Checkerboard field positioning and dimension errors of up to 9 and 14 mm, respectively, were identified, and the 3D DIR-deformed dose γ passing rate was only γ(3%/3 mm) = 60.0%.
  
  
  CONCLUSIONS
  The Presage-Def/Optical-CT system shows strong potential for comprehensive investigation of DIR algorithm accuracy. Substantial errors in a commercial DIR were found in the conditions evaluated. This work highlights the critical importance of careful validation of DIR algorithms before clinical implementation.
authors.affiliation: Medical Physics Graduate Program, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Titania
authors.initials: T
authors.lastname: Juang
authors.forename: Shiva
authors.initials: S
authors.lastname: Das
authors.forename: John
authors.initials: J
authors.lastname: Adamovics
authors.forename: Ron
authors.initials: R
authors.lastname: Benning
authors.forename: Mark
authors.initials: M
authors.lastname: Oldham
mesh_terms: D000465:Algorithms; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D054459:Elasticity Imaging Techniques / Q000295:instrumentation / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008099:Liver; D015203:Reproducibility of Results