title: Automated replication of cone beam CT-guided treatments in the Pinnacle(3) treatment planning system for adaptive radiotherapy.
abstract: Time-consuming manual methods have been required to register cone-beam computed tomography (CBCT) images with plans in the Pinnacle(3) treatment planning system in order to replicate delivered treatments for adaptive radiotherapy. These methods rely on fiducial marker (FM) placement during CBCT acquisition or the image mid-point to localise the image isocentre. A quality assurance study was conducted to validate an automated CBCT-plan registration method utilising the Digital Imaging and Communications in Medicine (DICOM) Structure Set (RS) and Spatial Registration (RE) files created during online image-guided radiotherapy (IGRT).
  
  
  
  CBCTs of a phantom were acquired with FMs and predetermined setup errors using various online IGRT workflows. The CBCTs, DICOM RS and RE files were imported into Pinnacle(3) plans of the phantom and the resulting automated CBCT-plan registrations were compared to existing manual methods. A clinical protocol for the automated method was subsequently developed and tested retrospectively using CBCTs and plans for six bladder patients.
  
  
  
  The automated CBCT-plan registration method was successfully applied to thirty-four phantom CBCT images acquired with an online 0 mm action level workflow. Ten CBCTs acquired with other IGRT workflows required manual workarounds. This was addressed during the development and testing of the clinical protocol using twenty-eight patient CBCTs. The automated CBCT-plan registrations were instantaneous, replicating delivered treatments in Pinnacle(3) with errors of ±0.5 mm. These errors were comparable to mid-point-dependant manual registrations but superior to FM-dependant manual registrations.
  
  
  
  The automated CBCT-plan registration method quickly and reliably replicates delivered treatments in Pinnacle(3) for adaptive radiotherapy.
authors.affiliation: Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia; Faculty of Health School of Clinical Sciences Queensland University of Technology Brisbane Queensland Australia; Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia.
authors.forename: Catriona
authors.initials: C
authors.lastname: Hargrave
authors.affiliation: Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Mason
authors.affiliation: Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Guidi
authors.affiliation: Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia.
authors.forename: Julie-Anne
authors.initials: JA
authors.lastname: Miller
authors.affiliation: Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia.
authors.forename: Jillian
authors.initials: J
authors.lastname: Becker
authors.affiliation: Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia; School of Mathematics, Science and Engineering Queensland University of Technology Brisbane Queensland Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Moores
authors.affiliation: Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia; School of Mathematics, Science and Engineering Queensland University of Technology Brisbane Queensland Australia.
authors.forename: Kerrie
authors.initials: K
authors.lastname: Mengersen
authors.affiliation: Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Poulsen
authors.affiliation: Faculty of Health School of Clinical Sciences Queensland University of Technology Brisbane Queensland Australia; Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Harden
mesh_terms: D002985:Clinical Protocols; D054893:Cone-Beam Computed Tomography; D006801:Humans; D019047:Phantoms, Imaging; D016634:Radiosurgery / Q000379:methods* / Q000592:standards; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods* / Q000592:standards; D061106:Radiotherapy Setup Errors / Q000517:prevention & control; D061089:Radiotherapy, Image-Guided / Q000379:methods* / Q000592:standards; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy*
keywords: Adaptive radiotherapy; automated registration; cone‐beam computed tomography; treatment planning system