Abstract
The combination external-beam radiotherapy and high-dose-rate brachytherapy is a standard form of treatment for patients with locally advanced uterine cervical cancer. Personalized radiotherapy in cervical cancer requires efficient and accurate dose planning and assessment across these types of treatment. To achieve radiation dose assessment, accurate mapping of the dose distribution from HDR-BT onto EBRT is extremely important. However, few systems can achieve robust dose fusion and determine the accumulated dose distribution during the entire course of treatment. We have therefore developed a toolbox (FZUImageReg), which is a user-friendly dose fusion system based on hybrid image registration for radiation dose assessment in cervical cancer radiotherapy. The main part of the software consists of a collection of medical image registration algorithms and a modular design with a user-friendly interface, which allows users to quickly configure, test, monitor, and compare different registration methods for a specific application. Owing to the large deformation, the direct application of conventional state-of-the-art image registration methods is not sufficient for the accurate alignment of EBRT and HDR-BT images. To solve this problem, a multi-phase non-rigid registration method using local landmark-based free-form deformation is proposed for locally large deformation between EBRT and HDR-BT images, followed by intensity-based free-form deformation. With the transformation, the software also provides a dose mapping function according to the deformation field. The total dose distribution during the entire course of treatment can then be presented. Experimental results clearly show that the proposed system can achieve accurate registration between EBRT and HDR-BT images and provide radiation dose warping and fusion results for dose assessment in cervical cancer radiotherapy in terms of high accuracy and efficiency.
Highlights
Cervical cancer is the second most common malignant form of cancers in women worldwide [1]
We have developed a toolbox for medical image registration and dose fusion, which is applied in the registration of external-beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDR-BT) computed tomography (CT) images and the mapping of radiotherapy doses in cervical cancer, providing a convenient and robust system for the assessment of radiotherapy doses
A framework of computer-aided dose fusion is proposed for use in the technology of image-guided intensity-modulated radiotherapy combined with 3D after-loading brachytherapy
Summary
Cervical cancer is the second most common malignant form of cancers in women worldwide [1]. Referred to as radiotherapy, is a common form of treatment for cervical cancer [3]. In clinical practice these two methods are implemented individually, which results in multiple dose distributions associated with the corresponding anatomical image. It is extremely difficult for radiation oncologists to calculate the accumulated dose across multiple treatments [11,12,13,14], which may limit the advantages of the combination of EBRT and HDR-BT. It is important for radiation oncologists to investigate a method that can accumulate the dose distribution across multiple treatments in cervical cancer as accurately as possible
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