title: Deformable image registration for adaptive radiotherapy with guaranteed local rigidity constraints.
abstract: BACKGROUND
  Deformable image registration (DIR) is a key component in many radiotherapy applications. However, often resulting deformations are not satisfying, since varying deformation properties of different anatomical regions are not considered. To improve the plausibility of DIR in adaptive radiotherapy in the male pelvic area, this work integrates a local rigidity deformation model into a DIR algorithm.
  
  
  METHODS
  A DIR framework is extended by constraints, enforcing locally rigid deformation behavior for arbitrary delineated structures. The approach restricts those structures to rigid deformations, while surrounding tissue is still allowed to deform elastically. The algorithm is tested on ten CT/CBCT male pelvis datasets with active rigidity constraints on bones and prostate and compared to the Varian SmartAdapt deformable registration (VSA) on delineations of bladder, prostate and bones.
  
  
  RESULTS
  The approach with no rigid structures (REG0) obtains an average dice similarity coefficient (DSC) of 0.87 ± 0.06 and a Hausdorff-Distance (HD) of 8.74 ± 5.95 mm. The new approach with rigid bones (REG1) yields a DSC of 0.87 ± 0.07, HD 8.91 ± 5.89 mm. Rigid deformation of bones and prostate (REG2) obtains 0.87 ± 0.06, HD 8.73 ± 6.01 mm, while VSA yields a DSC of 0.86 ± 0.07, HD 10.22 ± 6.62 mm. No deformation grid foldings are observed for REG0 and REG1 in 7 of 10 cases; for REG2 in 8 of 10 cases, with no grid foldings in prostate, an average of 0.08 % in bladder (REG2: no foldings) and 0.01 % inside the body contour. VSA exhibits grid foldings in each case, with an average percentage of 1.81 % for prostate, 1.74 % for bladder and 0.12 % for the body contour. While REG1 and REG2 keep bones rigid, elastic bone deformations are observed with REG0 and VSA. An average runtime of 26.2 s was achieved with REG1; 31.1 s with REG2, compared to 10.5 s with REG0 and 10.7 s with VMS.
  
  
  CONCLUSIONS
  With accuracy in the range of VSA, the new approach with constraints delivers physically more plausible deformations in the pelvic area with guaranteed rigidity of arbitrary structures. Although the algorithm uses an advanced deformation model, clinically feasible runtimes are achieved.
authors.affiliation: Fraunhofer MEVIS, Maria-Goeppert-Str. 3, Lübeck, 23562, Germany. lars.koenig@mevis.fraunhofer.de.
authors.forename: Lars
authors.identifier: http://orcid.org/0000-0002-3750-9287
authors.initials: L
authors.lastname: König
authors.affiliation: Fraunhofer MEVIS, Maria-Goeppert-Str. 3, Lübeck, 23562, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Derksen
authors.affiliation: Fraunhofer MEVIS, Maria-Goeppert-Str. 3, Lübeck, 23562, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Papenberg
authors.affiliation: Varian Medical Systems, Imaging Laboratory GmbH, Täfernstr. 7, Baden, 5405, Switzerland.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Haas
mesh_terms: D000465:Algorithms; D001842:Bone and Bones / Q000000981:diagnostic imaging; D054893:Cone-Beam Computed Tomography; D016208:Databases, Factual; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D011467:Prostate / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011878:Radiotherapy / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed; D001743:Urinary Bladder / Q000000981:diagnostic imaging
keywords: Adaptive radiotherapy; CBCT; CT; Deformable image registration; Local rigidity; Prostate cancer