An Estimate of Uncertainty in Deformable Image Registration-Based Accumulated Biological Equivalent Dose for Re-Irradiation

Abstract

<h3>Purpose/Objective(s)</h3> We describe a dose volume histogram (DVH) overlay technique to estimate uncertainty in deformable image registration (DIR) based accumulated biologically equivalent dose (BED) for re-irradiation planning. We compare applicability of two DIR methods, contour-based (C-DIR) and image intensity and contour hybrid (H-DIR) DIR for BED accumulation. <h3>Materials/Methods</h3> Patient CT-based re-irradiation plans to the same anatomic regions as in their initial irradiations over a four-year period were analyzed. Among the organs-at-risk (OARs) for which BED was accumulated were stomach, heart, and esophagus. Physical dose distributions were converted to BED using OAR-specific parameters based on a linear-quadratic-linear model. For C-DIR, the registration was based only upon the contours drawn on both images. H-DIR is an image intensity-based DIR technique which includes contour-based registration to augment the DIR results. All prior BEDs were warped to the most recent CT image for accumulation. Data input to the DVH overlay workflow were the two CT images to be registered, the deformation vector field, the BED on the earlier CT, and the contours on the later CT. The later-CT contours were warped to the earlier CT, and the earlier-CT BED was warped to the later CT; BED DVHs from both images were then calculated and overlaid. For a fully invertible DIR, the two DVHs for the OAR should be identical; differences between the DVHs were interpreted as BED uncertainties due to inverse consistency error. For a given DVH point, the uncertainty was obtained from the differences between the overlaid DVHs. <h3>Results</h3> For an abdomen case, the stomach accumulated BED_max is 3% higher using C-DIR versus H-DIR; ΔBED_max is approximately 2% for both DIR methods. The higher isodoses were distal to the stomach for all plans; H-DIR, which accounts for regions distal to the OAR, is appropriate for re-irradiation BED calculations. For a thoracic case, both DIR methods yield similar results for the heart. The difference between H-DIR and C-DIR for accumulated heart BED_max is 2.4%; ΔBED_max is 0.9% and 0.6% for H-DIR and C-DIR, respectively. For the esophagus, accumulated BED_max is 54% higher using H-DIR instead of C-DIR, and ΔBED_max is much lower for C-DIR (0.2%) than for H-DIR (1.7%). Visual inspection showed that the BED distribution on the esophagus using H-DIR is unreasonable, attributed to H-DIR relying too heavily upon image intensity features. For accurate BED accumulation in the esophagus, C-DIR is essential during the re-irradiation planning for this case. <h3>Conclusion</h3> The DVH overlay technique can estimate the uncertainty in accumulated BED for re-irradiation scenarios. Caution should be exercised in using various DIR methods before applying DIR dose accumulation for re-irradiation planning. Contour-based DIR may be the preferred registration method for re-irradiation dose accumulation.