Inverse Consistency Research Articles

The effect on dose accumulation accuracy of inverse-consistency and transitivity error reduced deformation maps

It has previously been shown that deformable image registrations (DIRs) often result in deformation maps that are neither inverse-consistent nor transitive, and that the dose accumulation based on these deformation maps can be inconsistent if different image pathways are used for dose accumulation. A method presented to reduce inverse consistency and transitivity errors has been shown to result in more consistent dose accumulation, regardless of the image pathway selected for dose accumulation. The present study investigates the effect on the dose accumulation accuracy of deformation maps processed to reduce inverse consistency and transitivity errors. A set of lung 4DCT phases were analysed, consisting of four images on which a dose grid was created. Dose to 75 corresponding anatomical locations was manually tracked. Dose accumulation was performed between all image sets with Demons derived deformation maps as well as deformation maps processed to reduce inverse consistency and transitivity errors. The ground truth accumulated dose was then compared with the accumulated dose derived from DIR. Two dose accumulation image pathways were considered. The post-processing method to reduce inverse consistency and transitivity errors had minimal effect on the dose accumulation accuracy. There was a statistically significant improvement in dose accumulation accuracy for one pathway, but for the other pathway there was no statistically significant difference. A post-processing technique to reduce inverse consistency and transitivity errors has a positive, yet minimal effect on the dose accumulation accuracy. Thus the post-processing technique improves consistency of dose accumulation with minimal effect on dose accumulation accuracy.

The distance discordance metric—a novel approach to quantifying spatial uncertainties in intra- and inter-patient deformable image registration

Previous methods to estimate the inherent accuracy of deformable image registration (DIR) have typically been performed relative to a known ground truth, such as tracking of anatomic landmarks or known deformations in a physical or virtual phantom. In this study, we propose a new approach to estimate the spatial geometric uncertainty of DIR using statistical sampling techniques that can be applied to the resulting deformation vector fields (DVFs) for a given registration. The proposed DIR performance metric, the distance discordance metric (DDM), is based on the variability in the distance between corresponding voxels from different images, which are co-registered to the same voxel at location (X) in an arbitrarily chosen ‘reference’ image. The DDM value, at location (X) in the reference image, represents the mean dispersion between voxels, when these images are registered to other images in the image set. The method requires at least four registered images to estimate the uncertainty of the DIRs, both for inter- and intra-patient DIR. To validate the proposed method, we generated an image set by deforming a software phantom with known DVFs. The registration error was computed at each voxel in the ‘reference’ phantom and then compared to DDM, inverse consistency error (ICE), and transitivity error (TE) over the entire phantom. The DDM showed a higher Pearson correlation (Rp) with the actual error (Rp ranged from 0.6 to 0.9) in comparison with ICE and TE (Rp ranged from 0.2 to 0.8). In the resulting spatial DDM map, regions with distinct intensity gradients had a lower discordance and therefore, less variability relative to regions with uniform intensity. Subsequently, we applied DDM for intra-patient DIR in an image set of ten longitudinal computed tomography (CT) scans of one prostate cancer patient and for inter-patient DIR in an image set of ten planning CT scans of different head and neck cancer patients. For both intra- and inter-patient DIR, the spatial DDM map showed large variation over the volume of interest (the pelvis for the prostate patient and the head for the head and neck patients). The highest discordance was observed in the soft tissues, such as the brain, bladder, and rectum, due to higher variability in the registration. The smallest DDM values were observed in the bony structures in the pelvis and the base of the skull. The proposed metric, DDM, provides a quantitative tool to evaluate the performance of DIR when a set of images is available. Therefore, DDM can be used to estimate and visualize the uncertainty of intra- and/or inter-patient DIR based on the variability of the registration rather than the absolute registration error.

4D-CT Lung registration using anatomy-based multi-level multi-resolution optical flow analysis and thin-plate splines

The accuracy of 4D-CT registration is limited by inconsistent Hounsfield unit (HU) values in the 4D-CT data from one respiratory phase to another and lower image contrast for lung substructures. This paper presents an optical flow and thin-plate spline (TPS)-based 4D-CT registration method to account for these limitations. The use of unified HU values on multiple anatomy levels (e.g., the lung contour, blood vessels, and parenchyma) accounts for registration errors by inconsistent landmark HU value. While 3D multi-resolution optical flow analysis registers each anatomical level, TPS is employed for propagating the results from one anatomical level to another ultimately leading to the 4D-CT registration. 4D-CT registration was validated using target registration error (TRE), inverse consistency error (ICE) metrics, and a statistical image comparison using Gamma criteria of 1 % intensity difference in 2 mm(3) window range. Validation results showed that the proposed method was able to register CT lung datasets with TRE and ICE values <3 mm. In addition, the average number of voxel that failed the Gamma criteria was <3 %, which supports the clinical applicability of the propose registration mechanism. The proposed 4D-CT registration computes the volumetric lung deformations within clinically viable accuracy.

Inverse consistent non-rigid image registration based on robust point set matching.

BackgroundRobust point matching (RPM) has been extensively used in non-rigid registration of images to robustly register two sets of image points. However, except for the location at control points, RPM cannot estimate the consistent correspondence between two images because RPM is a unidirectional image matching approach. Therefore, it is an important issue to make an improvement in image registration based on RPM.MethodsIn our work, a consistent image registration approach based on the point sets matching is proposed to incorporate the property of inverse consistency and improve registration accuracy. Instead of only estimating the forward transformation between the source point sets and the target point sets in state-of-the-art RPM algorithms, the forward and backward transformations between two point sets are estimated concurrently in our algorithm. The inverse consistency constraints are introduced to the cost function of RPM and the fuzzy correspondences between two point sets are estimated based on both the forward and backward transformations simultaneously. A modified consistent landmark thin-plate spline registration is discussed in detail to find the forward and backward transformations during the optimization of RPM. The similarity of image content is also incorporated into point matching in order to improve image matching.ResultsSynthetic data sets, medical images are employed to demonstrate and validate the performance of our approach. The inverse consistent errors of our algorithm are smaller than RPM. Especially, the topology of transformations is preserved well for our algorithm for the large deformation between point sets. Moreover, the distance errors of our algorithm are similar to that of RPM, and they maintain a downward trend as whole, which demonstrates the convergence of our algorithm. The registration errors for image registrations are evaluated also. Again, our algorithm achieves the lower registration errors in same iteration number. The determinant of the Jacobian matrix of the deformation field is used to analyse the smoothness of the forward and backward transformations. The forward and backward transformations estimated by our algorithm are smooth for small deformation. For registration of lung slices and individual brain slices, large or small determinant of the Jacobian matrix of the deformation fields are observed.ConclusionsResults indicate the improvement of the proposed algorithm in bi-directional image registration and the decrease of the inverse consistent errors of the forward and the reverse transformations between two images.

Voxel-based statistical analysis of uncertainties associated with deformable image registration

Deformable image registration (DIR) algorithms have inherent uncertainties in their displacement vector fields (DVFs).The purpose of this study is to develop an optimal metric to estimate DIR uncertainties. Six computational phantoms have been developed from the CT images of lung cancer patients using a finite element method (FEM). The FEM generated DVFs were used as a standard for registrations performed on each of these phantoms. A mechanics-based metric, unbalanced energy (UE), was developed to evaluate these registration DVFs. The potential correlation between UE and DIR errors was explored using multivariate analysis, and the results were validated by landmark approach and compared with two other error metrics: DVF inverse consistency (IC) and image intensity difference (ID). Landmark-based validation was performed using the POPI-model. The results show that the Pearson correlation coefficient between UE and DIR error is rUE-error = 0.50. This is higher than rIC-error = 0.29 for IC and DIR error and rID-error = 0.37 for ID and DIR error. The Pearson correlation coefficient between UE and the product of the DIR displacements and errors is rUE-error × DVF = 0.62 for the six patients and rUE-error × DVF = 0.73 for the POPI-model data. It has been demonstrated that UE has a strong correlation with DIR errors, and the UE metric outperforms the IC and ID metrics in estimating DIR uncertainties. The quantified UE metric can be a useful tool for adaptive treatment strategies, including probability-based adaptive treatment planning.

Control over structure-specific flexibility improves anatomical accuracy for point-based deformable registration in bladder cancer radiotherapy

Future developments in image guided adaptive radiotherapy (IGART) for bladder cancer require accurate deformable image registration techniques for the precise assessment of tumor and bladder motion and deformation that occur as a result of large bladder volume changes during the course of radiotherapy treatment. The aim was to employ an extended version of a point-based deformable registration algorithm that allows control over tissue-specific flexibility in combination with the authors' unique patient dataset, in order to overcome two major challenges of bladder cancer registration, i.e., the difficulty in accounting for the difference in flexibility between the bladder wall and tumor and the lack of visible anatomical landmarks for validation. The registration algorithm used in the current study is an extension of the symmetric-thin plate splines-robust point matching (S-TPS-RPM) algorithm, a symmetric feature-based registration method. The S-TPS-RPM algorithm has been previously extended to allow control over the degree of flexibility of different structures via a weight parameter. The extended weighted S-TPS-RPM algorithm was tested and validated on CT data (planning- and four to five repeat-CTs) of five urinary bladder cancer patients who received lipiodol injections before radiotherapy. The performance of the weighted S-TPS-RPM method, applied to bladder and tumor structures simultaneously, was compared with a previous version of the S-TPS-RPM algorithm applied to bladder wall structure alone and with a simultaneous nonweighted S-TPS-RPM registration of the bladder and tumor structures. Performance was assessed in terms of anatomical and geometric accuracy. The anatomical accuracy was calculated as the residual distance error (RDE) of the lipiodol markers and the geometric accuracy was determined by the surface distance, surface coverage, and inverse consistency errors. Optimal parameter values for the flexibility and bladder weight parameters were determined for the weighted S-TPS-RPM. The weighted S-TPS-RPM registration algorithm with optimal parameters significantly improved the anatomical accuracy as compared to S-TPS-RPM registration of the bladder alone and reduced the range of the anatomical errors by half as compared with the simultaneous nonweighted S-TPS-RPM registration of the bladder and tumor structures. The weighted algorithm reduced the RDE range of lipiodol markers from 0.9-14 mm after rigid bone match to 0.9-4.0 mm, compared to a range of 1.1-9.1 mm with S-TPS-RPM of bladder alone and 0.9-9.4 mm for simultaneous nonweighted registration. All registration methods resulted in good geometric accuracy on the bladder; average error values were all below 1.2 mm. The weighted S-TPS-RPM registration algorithm with additional weight parameter allowed indirect control over structure-specific flexibility in multistructure registrations of bladder and bladder tumor, enabling anatomically coherent registrations. The availability of an anatomically validated deformable registration method opens up the horizon for improvements in IGART for bladder cancer.

A framework for deformable image registration validation in radiotherapy clinical applications.

Quantitative validation of deformable image registration (DIR) algorithms is extremely difficult because of the complexity involved in constructing a deformable phantom that can duplicate various clinical scenarios. The purpose of this study is to describe a framework to test the accuracy of DIR based on computational modeling and evaluating using inverse consistency and other methods. Three clinically relevant organ deformations were created in prostate (distended rectum and rectal gas), head and neck (large neck flexion), and lung (inhale and exhale lung volumes with variable contrast enhancement) study sets. DIR was performed using both B‐spline and diffeomorphic demons algorithms in the forward and inverse direction. A compositive accumulation of forward and inverse deformation vector fields was done to quantify the inverse consistency error (ICE). The anatomical correspondence of tumor and organs at risk was quantified by comparing the original RT structures with those obtained after DIR. Further, the physical characteristics of the deformation field, namely the Jacobian and harmonic energy, were computed to quantify the preservation of image topology and regularity of spatial transformation obtained in DIR. The ICE was comparable in prostate case but the B‐spline algorithm had significantly better anatomical correspondence for rectum and prostate than diffeomorphic demons algorithm. The ICE was 6.5 mm for demons algorithm for head and neck case when compared to 0.7 mm for B‐spline. Since the induced neck flexion was large, the average Dice similarity coefficient between both algorithms was only 0.87, 0.52, 0.81, and 0.67 for tumor, cord, parotids, and mandible, respectively. The B‐spline algorithm accurately estimated deformations between images with variable contrast in our lung study, while diffeomorphic demons algorithm led to gross errors on structures affected by contrast variation. The proposed framework offers the application of known deformations on any image datasets, to evaluate the overall accuracy and limitations of a DIR algorithm used in radiation oncology. The evaluation based on anatomical correspondence, physical characteristics of deformation field, and image characteristics can facilitate DIR verification with the ultimate goal of implementing adaptive radiotherapy. The suitability of application of a particular evaluation metric in validating DIR is dependent on the clinical deformation observed.PACS numbers: 87.57 nj, 87.55‐x,87.55 Qr

Testing Accuracy of Deformable Registration Studies Using Computational Modeling and Inverse Consistency Metrics

Testing Accuracy of Deformable Registration Studies Using Computational Modeling and Inverse Consistency Metrics

Combining Boundary-Based Methods With Tensor-Based Morphometry in the Measurement of Longitudinal Brain Change

Tensor-based morphometry is a powerful tool for automatically computing longitudinal change in brain structure. Because of bias in images and in the algorithm itself, however, a penalty term and inverse consistency are needed to control the over-reporting of nonbiological change. These may force a tradeoff between the intrinsic sensitivity and specificity, potentially leading to an under-reporting of authentic biological change with time. We propose a new method incorporating prior information about tissue boundaries (where biological change is likely to exist) that aims to keep the robustness and specificity contributed by the penalty term and inverse consistency while maintaining localization and sensitivity. Results indicate that this method has improved sensitivity without increased noise. Thus it will have enhanced power to detect differences within normal aging and along the spectrum of cognitive impairment.

WE-E-213CD-03: Inverse-Consistent Symmetric Registration of Inner Colon Surfaces Derived from Prone and Supine CT Colonography.

Robust registration of prone and supine colonie surfaces acquired during CT colonography may lead to faster and more accurate detection of colorectal cancer and polyps. Any directional bias when registering one surface to the other could precipitate incorrect anatomical correspondence and engender reader error. Despite this, non-rigid registration methods are often implemented asymmetrically, which could negatively influence the registration. We aimed to reduce directional bias and so increase robustness by adapting a cylindrical registration algorithm to be both symmetric and inverse-consistent. The registration task can be simplified by mapping both prone and supine colonie surfaces onto regular cylinders. Spatial correspondence can then be established in cylindrical space using the original surfaces' local shape indices. We implemented a symmetric formulation of the popular non-rigid B-spline image registration method in cylindrical space. A symmetric similarity measure computes the sum of squared differences between both cylindrical representations of prone-to-supine and supine-to-prone directions simultaneously. Inverse consistency of the transformation is enforced by adding an appropriately weighted penalty term to the optimisation function. We selected 8 CT colonography patient cases with marked variation in luminal distension and surface morphology. We randomly allocated 4 of these for tuning an optimal set of registration parameters and 4 for validation. The mean inverse-consistency error was reduced by 32% from 4.8mm to 3.2mm by the new symmetric formulation. The mean registration error improved from 8.2mm to 7.3mm for 330 manually chosen reference points on the 4 validation sets. A symmetric formulation of prone and supine surface registration improves the quality of registration. Information from both prone-to-supine and supine-to-prone directions helps enforce convergence towards a more accurate solution due to reduced directional bias. A more robust and accurate registration will facilitate interpretation of CT colonography and has the potential to improve existing computer-aided detection methods. The authors gratefully acknowledge financial support for this work from the NIHR program: “Imaging diagnosis of colorectal cancer: Interventions for efficient and acceptable diagnosis in symptomatic and screening populationsâ€.

On the dosimetric effect and reduction of inverse consistency and transitivity errors in deformable image registration for dose accumulation

Deformable image registration (DIR) is necessary for accurate dose accumulation between multiple radiotherapy image sets. DIR algorithms can suffer from inverse and transitivity inconsistencies. When using deformation vector fields (DVFs) that exhibit inverse-inconsistency and are nontransitive, dose accumulation on a given image set via different image pathways will lead to different accumulated doses. The purpose of this study was to investigate the dosimetric effect of and propose a postprocessing solution to reduce inverse consistency and transitivity errors. Four MVCT images and four phases of a lung 4DCT, each with an associated calculated dose, were selected for analysis. DVFs between all four images in each data set were created using the Fast Symmetric Demons algorithm. Dose was accumulated on the fourth image in each set using DIR via two different image pathways. The two accumulated doses on the fourth image were compared. The inverse consistency and transitivity errors in the DVFs were then reduced. The dose accumulation was repeated using the processed DVFs, the results of which were compared with the accumulated dose from the original DVFs. To evaluate the influence of the postprocessing technique on DVF accuracy, the original and processed DVF accuracy was evaluated on the lung 4DCT data on which anatomical landmarks had been identified by an expert. Dose accumulation to the same image via different image pathways resulted in two different accumulated dose results. After the inverse consistency errors were reduced, the difference between the accumulated doses diminished. The difference was further reduced after reducing the transitivity errors. The postprocessing technique had minimal effect on the accuracy of the DVF for the lung 4DCT images. This study shows that inverse consistency and transitivity errors in DIR have a significant dosimetric effect in dose accumulation; Depending on the image pathway taken to accumulate the dose, different results may be obtained. A postprocessing technique that reduces inverse consistency and transitivity error is presented, which allows for consistent dose accumulation regardless of the image pathway followed.

Consistent multi-time-point brain atrophy estimation from the boundary shift integral

Brain atrophy measurement is increasingly important in studies of neurodegenerative diseases such as Alzheimer's disease (AD), with particular relevance to trials of potential disease-modifying drugs. Automated registration-based methods such as the boundary shift integral (BSI) have been developed to provide more precise measures of change from a pair of serial MR scans. However, when a method treats one image of the pair (typically the baseline) as the reference to which the other is compared, this systematic asymmetry risks introducing bias into the measurement. Recent concern about potential biases in longitudinal studies has led to several suggestions to use symmetric image registration, though some of these methods are limited to two time-points per subject. Therapeutic trials and natural history studies increasingly involve several serial scans, it would therefore be useful to have a method that can consistently estimate brain atrophy over multiple time-points. Here, we use the log-Euclidean concept of a within-subject average to develop affine registration and differential bias correction methods suitable for any number of time-points, yielding a longitudinally consistent multi-time-point BSI technique. Baseline, 12-month and 24-month MR scans of healthy controls, subjects with mild cognitive impairment and AD patients from the Alzheimer's Disease Neuroimaging Initiative are used for testing the bias in processing scans with different amounts of atrophy. Four tests are used to assess bias in brain volume loss from BSI: (a) inverse consistency with respect to ordering of pairs of scans 12 months apart; (b) transitivity consistency over three time-points; (c) randomly ordered back-to-back scans, expected to show no consistent change over subjects; and (d) linear regression of the atrophy rates calculated from the baseline and 12-month scans and the baseline and 24-month scans, where any additive bias should be indicated by a non-zero intercept. Results indicate that the traditional BSI processing pipeline does not exhibit significant bias due to its use of windowed sinc interpolation, but with linear interpolation and asymmetric registration, bias can be pronounced. Either improved interpolation or symmetric registration alone can greatly reduce this bias, and our proposed method combining both aspects shows no significant bias in any of the four experiments.

Image Similarity and Tissue Overlaps as Surrogates for Image Registration Accuracy: Widely Used but Unreliable

The accuracy of nonrigid image registrations is commonly approximated using surrogate measures such as tissue label overlap scores, image similarity, image difference, or transformation inverse consistency error. This paper provides experimental evidence that these measures, even when used in combination, cannot distinguish accurate from inaccurate registrations. To this end, we introduce a "registration" algorithm that generates highly inaccurate image transformations, yet performs extremely well in terms of the surrogate measures. Of the tested criteria, only overlap scores of localized anatomical regions reliably distinguish reasonable from inaccurate registrations, whereas image similarity and tissue overlap do not. We conclude that tissue overlap and image similarity, whether used alone or together, do not provide valid evidence for accurate registrations and should thus not be reported or accepted as such.

Adaptive Neighborhood Inverse Consistency as Lookahead for Non-Binary CSPs

Freuder and Elfe (1996) introduced Neighborhood Inverse Consistency (NIC) for binary CSPs. In this paper, we introduce RNIC, the extension of NIC to non-binary CSPs, and describe a practical algorithm for enforcing it. We propose an adaptive strategy to weaken or strengthen this property based on the connectivity of the network. We demonstrate the effectiveness of RNIC as a full lookahead strategy during search for solving difficult benchmark problems.

Solving Difficult CSPs with Relational Neighborhood Inverse Consistency

Freuder and Elfe (1996) introduced Neighborhood Inverse Consistency (NIC) as a strong local consistency property for binary CSPs. While enforcing NIC can significantly filter the variables domains, the proposed algorithm is too costly to be used on dense graphs or for lookahead during search. In this paper, we introduce and characterize Relational Neighborhood Inverse Consistency (RNIC) as a local consistency property that operates on the dual graph of a non-binary CSP. We describe and characterize a practical algorithm for enforcing it. We argue that defining RNIC on the dual graph unveils unsuspected opportunities to reduce the computational cost of our algorithm and increase its filtering effectiveness. We show how to achieve those effects by modifying the topology of the dual graph, yielding new variations the RNIC property. We also introduce an adaptive strategy to automatically select the appropriate property to enforce given the connectivity of the dual graph. We integrate the resulting techniques as full lookahead strategies in a backtrack search procedure for solving CSPs, and demonstrate the effectiveness of our approach for solving known difficult benchmark problems.

Clinical validation of a 4D-CT based method for lung ventilation measurement in phantoms and patients

Background. Lung cancer patients referred to radiotherapy (RT) often present with regional lung function deficits, and it is therefore of interest to image their lung function prior to treatment. In this study a method was developed that uses a deformable image registration (DIR) between the peak-inhale and peak-exhale phases of a thoracic four-dimensional computed tomography (4D-CT) scan to extract ventilation information. The method calculates the displacement vector fields (DVFs) resulting from the DIR using the Jacobian map approach in order to extract information regarding regional lung volume change. Material and methods. The DVFs resulting from DIRs were analysed to compute the Jacobian determinant of vectors in the field, thus obtaining a map of the vector gradients of the entire registered CT image, i.e. voxel-wise local volume change. Geometric and quantitative validation was achieved using images of both phantoms and patients. In the phantom studies, translations and deformations of known size and direction were introduced to validate both the DIR algorithm and the method as a whole. Furthermore, five patients underwent 4D-CT for planning of stereotactic body RT (SBRT). The patients were immobilised in a stereotactic body frame (SBF) and for each patient, two thoracic 4D-CT scans were acquired, one scan with respiration restricted by an abdominal compression plate and the other under free breathing. Results. In the phantom studies deformation errors were found to be of the order of the expected precision of 3 mm, corresponding to the image slice distance, in lateral and vertical directions. For the longitudinal direction a more pronounced discrepancy was observed, with the algorithm predicting displacement lengths of less than half of the physically introduced deformation. Qualitatively the method performed as expected. In the patient study an inverse consistency test showed deviations of up to 5.8 mm, i.e. almost twice the image slice separation. Jacobian maps of the patient images indicated well-ventilated areas as anatomically expected. Conclusion. The established method provides a means of using a (commercially available) DIR algorithm to obtain a quantitative measure of local lung volume change. With further phantom and patient validation studies, quantitative maps of specific ventilation should be possible to produce and use in a clinical setting.

TH-A-220-03: On the Dosimetric Effect and Correction of Inverse Consistency and Transitivity Errors in Dose Accumulation

Purpose: To investigate the dosimetric effect of deformable image registration (DIR) inverse consistency and transitivity errors in dose accumulation and to propose a correction strategy to reduce the impact of these errors. Methods: Given three images, A, B and C, deformation maps are defined as third‐order transitive if the deformation A‐>B‐>C‐>A results in the image A. Four tomotherapy MVCT images from a head and neck treatment were selected representing the anatomical change over the duration of the treatment course. A research version of the Pinnacle RTPS (v9.1) was used for all planning, DIR and dose warping. A seven‐field IMRT plan was created delivering 69.3Gy, 60 & 56Gy to the high, intermediate and low‐dose PTVs respectively. This plan was copied to each of the other three images and the dose calculated on all images. All images were deformed to each other using the fast symmetric Demons algorithm. This algorithm is not inverse‐consistent or transitive error‐free. The dose from each image was warped to and accumulated on the fourth image to result in ‘D_AC1’. The dose from each image was then warped to and accumulated on the third image to result in ‘C_AC1’. ‘C_AC1’ was then warped to the fourth image to result in ‘DAC2’. The difference in between ‘D ACT’ and ‘D_AC2’ was measured. This dose accumulation process was then repeated after all deformation maps were made inverse consistent and then transitive. Results: Inverse consistency and transitivity errors lead to an observable difference between ‘D_AC1’ and ‘D_AC2’. The difference decreased with inverse‐consistent DVFs and decreased further with transitive DVFs. Conclusion: Inverse consistency and transitivity errors lead to discrepancies between doses warped to the same image via different pathways. These discrepancies can be significantly reduced by enforcing inverse consistency and transitivity between all DVFs used in dose accumulation. N Hardcastle is funded by Philips Healthcare

WE‐E‐BRC‐11: Towards Subject Specific Head and Neck Biomechanical Models Using Multi‐Level Multi‐Resolution and Inverse Consistent Registration Algorithms for Radiotherapy

Purpose: The proposed work focuses on addressing the impact with which the patientˈs treatment delivery can be monitored and documented in real time taking into account the interfraction and intrafraction motion and effective optimizations for the treatment can be conceived and implemented. The first step towards establishing the radiation delivered to the head and neck tumor and the surrounding tissues in real‐time is the development of subject specific biomechanical head and neck models. The complexity in developing such a biomechanical model arises from the human musculoskeletal system, which includes approximately 57 articular bones and many more muscle actuators and their closed kinematic loops. Methods: We present a subject specific model, which is developed using cancer patientsˈ 3D CT scans (simulation CT, cone‐beam CT), a validated generic biomechanical model and registration algorithms that incorporate biomechanical properties from the generic model into the static patient anatomy to facilitate subject‐specific biomechanical model. For illustration purposes, we take as input a subject specific anatomy from a 3DCT acquired during the simulation stage. For analysis purposes, free‐form deformation (FFD), demons, the symmetric force demons, and optical flow (OF) registration methods are used within the multi‐level multi‐resolution (MLMR) and additional Inverse Consistency (MLMRIC) for comparing the registration accuracy. Once registered, the biomechanical generic model is warped using the registration results to closely fit the patient anatomy thereby facilitating a patient specific biomechanical model. Results: Validation studies showed that among the eight 3D registration methods, the MLMR symmetric demons registration is quantitatively more accurate as compared to the other methods and facilitates the development of a more appropriate subject specific biomechanical head and neck model. Conclusions: The development of subject specific biomechanical models is made possible by MLMR symmetric demons registration of generic validated biomechanical models to subject anatomy.

Technical note: DIRART--A software suite for deformable image registration and adaptive radiotherapy research.

Recent years have witnessed tremendous progress in image guide radiotherapy technology and a growing interest in the possibilities for adapting treatment planning and delivery over the course of treatment. One obstacle faced by the research community has been the lack of a comprehensive open-source software toolkit dedicated for adaptive radiotherapy (ART). To address this need, the authors have developed a software suite called the Deformable Image Registration and Adaptive Radiotherapy Toolkit (DIRART). DIRART is an open-source toolkit developed in MATLAB. It is designed in an object-oriented style with focus on user-friendliness, features, and flexibility. It contains four classes of DIR algorithms, including the newer inverse consistency algorithms to provide consistent displacement vector field in both directions. It also contains common ART functions, an integrated graphical user interface, a variety of visualization and image-processing features, dose metric analysis functions, and interface routines. These interface routines make DIRART a powerful complement to the Computational Environment for Radiotherapy Research (CERR) and popular image-processing toolkits such as ITK. DIRART provides a set of image processing/registration algorithms and postprocessing functions to facilitate the development and testing of DIR algorithms. It also offers a good amount of options for DIR results visualization, evaluation, and validation. By exchanging data with treatment planning systems via DICOM-RT files and CERR, and by bringing image registration algorithms closer to radiotherapy applications, DIRART is potentially a convenient and flexible platform that may facilitate ART and DIR research. 0 2011 Ameri-

Image registration and atlas-based segmentation of cardiac outflow velocity profiles

Cardiovascular disease is the leading cause of death worldwide and for this reason computer-based diagnosis of cardiac diseases is a very important task. In this article, a method for segmentation of aortic outflow velocity profiles from cardiac Doppler ultrasound images is presented. The proposed method is based on the statistical image atlas derived from ultrasound images of healthy volunteers. The ultrasound image segmentation is done by registration of the input image to the atlas, followed by a propagation of the segmentation result from the atlas onto the input image. In the registration process, the normalized mutual information is used as an image similarity measure, while optimization is performed using a multiresolution gradient ascent method. The registration method is evaluated using an in-silico phantom, real data from 30 volunteers, and an inverse consistency test. The segmentation method is evaluated using 59 images from healthy volunteers and 89 images from patients, and using cardiac parameters extracted from the segmented image. Experimental validation is conducted using a set of healthy volunteers and patients and has shown excellent results. Cardiac parameter segmentation evaluation showed that the variability of the automated segmentation relative to the manual is comparable to the intra-observer variability. The proposed method is useful for computer aided diagnosis and extraction of cardiac parameters.