SU‐E‐J‐13: Six Degree of Freedom Image Fusion Accuracy for Cranial Target Localization On the Varian Edge Stereotactic Radiosurgery System: Comparison Between 2D/3D and KV CBCT Image Registration

Abstract

Purpose:To determine the 6 degree of freedom systematic deviations between 2D/3D and CBCT image registration with various imaging setups and fusion algorithms on the Varian Edge Linac.Methods:An anthropomorphic head phantom with radio opaque targets embedded was scanned with CT slice thicknesses of 0.8, 1, 2, and 3mm. The 6 DOF systematic errors were assessed by comparing 2D/3D (kV/MV with CT) with 3D/3D (CBCT with CT) image registrations with different offset positions, similarity measures, image filters, and CBCT slice thicknesses (1 and 2 mm). The 2D/3D registration accuracy of 51 fractions for 26 cranial SRS patients was also evaluated by analyzing 2D/3D pre‐treatment verification taken after 3D/3D image registrations.Results:The systematic deviations of 2D/3D image registration using kV‐ kV, MV‐kV and MV‐MV image pairs were within ±0.3mm and ±0.3° for translations and rotations with 95% confidence interval (CI) for a reference CT with 0.8 mm slice thickness. No significant difference (P>0.05) on target localization was observed between 0.8mm, 1mm, and 2mm CT slice thicknesses with CBCT slice thicknesses of 1mm and 2mm. With 3mm CT slice thickness, both 2D/3D and 3D/3D registrations performed less accurately in longitudinal direction than thinner CT slice thickness (0.60±0.12mm and 0.63±0.07mm off, respectively). Using content filter and using similarity measure of pattern intensity instead of mutual information, improved the 2D/3D registration accuracy significantly (P=0.02 and P=0.01, respectively). For the patient study, means and standard deviations of residual errors were 0.09±0.32mm, −0.22±0.51mm and −0.07±0.32mm in VRT, LNG and LAT directions, respectively, and 0.12°±0.46°, −0.12°±0.39° and 0.06°±0.28° in RTN, PITCH, and ROLL directions, respectively. 95% CI of translational and rotational deviations were comparable to those in phantom study.Conclusion:2D/3D image registration provided on the Varian Edge radiosurgery, 6 DOF‐based system provides accurate target positioning for frameless image‐guided cranial stereotactic radiosurgery.