title: [Potential uncertainty about image registration in thoracic image-guided radiotherapy].
abstract: OBJECTIVE
  Although image-guided radiotherapy (IGRT) is widely used to determine and correct daily setup errors, the additional interpretation for image registration would provide another error. We evaluated the uncertainty in image registration in IGRT.
  
  
  METHODS
  The subjects consisted of 12 consecutive patients treated with IGRT for thoracic esophageal cancer. Two radiation therapists had consensually achieved daily 3D registration between planning computed tomography (CT) and cone beam CT (CBCT). The original data sets of image registration in all fractions except for boost irradiations with a change in the isocenter positions were selected for evaluation. There were 20 to 32 data sets for each patient: a total of 318 data sets. To evaluate daily setup errors, the mean 3D displacement vector was calculated for each patient. To assess the reproducibility of image registration, two other radiation therapists reviewed the data sets and recorded geometric differences as uncertainty in the image registration.
  
  
  RESULTS
  The mean 3D displacement vector for each patient ranged from 4.9 to 15.5 mm for setup errors and 0.7 to 2.2 mm for uncertainty in image registration. There was a positive correlation between the 3D vectors for setup error and uncertainty in image registration (r = 0.487, p = 0.016).
  
  
  CONCLUSIONS
  Although IGRT can correct the setup errors, potential uncertainty exists in image registration. The setup error would disturb the image registration in IGRT.
authors.affiliation: Department of Radiological Technology, Kumamoto University Hospital.
authors.forename: Yudai
authors.initials: Y
authors.lastname: Kai
authors.forename: Naoki
authors.initials: N
authors.lastname: Kai
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Fujita
authors.forename: Masato
authors.initials: M
authors.lastname: Maruyama
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nakaguchi
authors.forename: Akiko
authors.initials: A
authors.lastname: Kuraoka
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Saito
authors.forename: Ryuji
authors.initials: R
authors.lastname: Murakami
mesh_terms: D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D013902:Radiography, Thoracic / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D035501:Uncertainty