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Simulation of pseudo-CT images based on deformable image registration of
ultrasound images: A proof of concept for transabdominal ultrasound imaging of the
prostate during radiotherapy
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Imaging of patient anatomy during treatment is a necessity for
position verification and for adaptive radiotherapy based on daily dose recalculation.
Ultrasound(US)image guided radiotherapy systems are currently available to
collect USimages at the simulation stage (USsim),
coregistered with the simulation computed tomography(CT), and
during all treatment fractions. The authors hypothesize that a deformation field
derived from US-based deformable image registration can be used to create a daily
pseudo-CT (CTps) image that is more representative of
the patients’ geometry during treatment than the CT acquired at
simulation stage (CTsim).
The three prostate patients, considered to evaluate this hypothesis, had
coregistered CT and US scans on various days. In particular, two patients had two
US–CT datasets each and the third one had five US–CT datasets. Deformation fields
were computed between pairs of USimages of the same patient and then applied to the
corresponding USsim scan to yield a new deformed CTps scan.
The original treatment plans were used to recalculate dose distributions in
the simulation, deformed and ground truth CT(CTgt) images to compare dice similarity
coefficients, maximum absolute distance, and mean absolute distance on
delineations and gamma index (γ) evaluations on both the
Hounsfield units (HUs) and the dose.
In the majority, deformation did improve the results for all three evaluation
methods. The change in gamma failure for dose
(γDose, 3%, 3 mm) ranged from an improvement of 11.2%
in the prostate volume to a deterioration of 1.3% in the prostate and bladder. The
change in gamma failure for the CTimages (γCT, 50 HU, 3
mm) ranged from an improvement of 20.5% in the anus and rectum to a deterioration
of 3.2% in the prostate.
This new technique may generate CTpsimages that are more representative of the actual patient
anatomy than the CTsim scan.
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