title: Effect of deformable registration uncertainty on lung SBRT dose accumulation.
abstract: OBJECTIVE
  Deformable image registration (DIR) plays an important role in dose accumulation, such as incorporating breathing motion into the accumulation of the delivered dose based on daily 4DCBCT images. However, it is not yet well understood how the uncertainties associated with DIR methods affect the dose calculations and resulting clinical metrics. The purpose of this study is to evaluate the impact of DIR uncertainty on the clinical metrics derived from its use in dose accumulation.
  
  
  METHODS
  A biomechanical model based DIR method and a biomechanical-intensity-based hybrid method, which reduced the average registration error by 1.6 mm, were applied to ten lung cancer patients. A clinically relevant dose parameter [minimum dose to 0.5 cm(3) (Dmin)] was calculated for three dose scenarios using both algorithms. Dose scenarios included static (no breathing motion), predicted (breathing motion at the time of planning), and total accumulated (interfraction breathing motion). The relationship between the dose parameter and a combination of DIR uncertainty metrics, tumor volume, and dose heterogeneity of the plan was investigated.
  
  
  RESULTS
  Depending on the dose heterogeneity, tumor volume, and DIR uncertainty, in over 50% of the patients, differences greater than 1.0 Gy were observed in the Dmin of the tumor in the static dose calculation on exhale phase of the 4DCT. Such differences were due to the errors in propagating the tumor contours from the reference planning 4DCT phase onto a subsequent 4DCT phase using each DIR algorithm and calculating the dose on that phase. The differences in predicted dose were more subtle when breathing motion was modeled explicitly at the time of planning with only one patient exhibiting a greater than 1.0 Gy difference in Dmin. Dmin differences of up to 2.5 Gy were found in the total accumulated delivered dose due to difference in quantifying the interfraction variations. Such dose uncertainties could potentially be clinically significant.
  
  
  CONCLUSIONS
  Reductions in average uncertainty in DIR algorithms by 1.6 mm may have a clinically significant impact on the decision-making metrics used in dose planning and dose accumulation assessment.
authors.affiliation: Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Navid
authors.initials: N
authors.lastname: Samavati
authors.affiliation: Institute of Medical Science, University of Toronto, Toronto, Ontario M5S 1A8, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Velec
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan 48109-0010.
authors.forename: Kristy K
authors.initials: KK
authors.lastname: Brock
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011829:Radiation Dosage; D016634:Radiosurgery / Q000379:methods*; D012119:Respiration; D035501:Uncertainty