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Kim, Min, Lee, Choi, Cho, Jung, Kim, Yeo, Kwon, and Lee: Evaluation of Dose Change by Using the Deformable Image Registration (DIR) on the Intensity Modulated Radiation Therapy (IMRT) with Glottis Cancer
Original Article

Progress in Medical Physics 2015;25(3):167-175.

Published online: 20 September 2015

DOI: https://doi.org/10.14316/pmp.2015.25.3.167'

Evaluation of Dose Change by Using the Deformable Image Registration (DIR) on the Intensity Modulated Radiation Therapy (IMRT) with Glottis Cancer

Woo Chul Kim∗, †, Chul Kee Min∗, Suk Lee‡, Sang Hyoun Choi§, Kwang Hwan Cho∗, Jae Hong Jung∗, ∥, Eun Seog Kim∗, Seung-Gu Yeo∗, Soo-II Kwon†, , Kil-Dong Lee†, ¶,

∗Department of Radiation Oncology, Soonchunhyang University College of Medicine, Cheonan, Korea

†Department of Medical Physics, Kyonggi University, Suwon, Korea

‡Department of Radiation Oncology, College of Medicine, Korea University, Korea

§Research Center for Radiotherapy, Korea Institute of Radiological and Medical Science, Korea

∥Department of Biomedical Engineering and Research Institute of Biomedical Engineering, The Catholic University, Seoul, Korea

Department of Electrophysics, Kyonggi University, Suwon, Korea

Correspondence:Kil-Dong Lee(gdlee@kyonggi.ac.kr) Tel:82-31-253-9621, Fax:82-31-253-1165

Received 14 August 2014       Revised 11 September 2014       Accepted 12 September 2014

Copyright © 2015 Korean Society of Medical Physics

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The purpose of this study is to evaluate the variation of the dose which is delivered to the patients with glottis cancer under IMRT (intensity modulated radiation therapy) by using the 3D registration with CBCT (cone beam CT) images and the DIR (deformable image registration) techniques. The CBCT images which were obtained at a one-week interval were reconstructed by using B-spline algorithm in DIR system, and doses were recalculated based on the newly obtained CBCT images. The dose distributions to the tumor and the critical organs were compared with reference. For the change of volume depending on weight at 3 to 5 weeks, there was increased of 1.38∼2.04 kg on average. For the body surface depending on weight, there was decreased of 2.1 mm. The dose with transmitted to the carotid since three weeks was increased compared be more than 8.76% planned, and the thyroid gland was decreased to 26.4%. For the physical evaluation factors of the tumor, PITV, TCI, rDHI, mDHI, and CN were decreased to 4.32%, 5.78%, 44.54%, 12.32%, and 7.11%, respectively. Moreover, Dmax, Dmean, V67.50, and D95 for PTV were increased or decreased to 2.99%, 1.52%, 5.78%, and 11.94%, respectively. Although there was no change of volume depending on weight, the change of body types occurred, and IMRT with the narrow composure margin sensitively responded to such a changing. For the glottis IMRT, the patient's weight changes should be observed and recorded to evaluate the actual dose distribution by using the DIR techniques, and more the adaptive treatment planning during the treatment course is needed to deliver the accurate dose to the patients.

Keywords: Glottic, Deformable image registration, CBCT, Adaptive radiation therapy

References

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Fig. 1.
The change of weight during the period of treatment. The difference of weight change for 1∼5 weeks after commencing the treatment based on the weight when the planning-kVCT has been acquired for the treatment plan.
pmp-25-167f1.tif
Fig. 2.
Measurement and comparison of the distances between skin surface and each 4 points (OARs) in a typical patient. The change of body type occurs owing to the changing weight according to the progress of treatment. (a) planning-kVCT, (b) 1week, (c) 3week, (d) 5 week. (1) The distance between the anterior surface of thyroid cartilage and the skin. (2) The distance between the lateral surface of thyroid cartilage and the skin. (3) The distance between the anterior surface of carotid artery and the skin. (4) The distance between the lateral surface of carotid artery and the skin.
pmp-25-167f2.tif
Fig. 3.
Comparison of dose volume histogram (DVHs) for different plans (original Vs. recalculation) from experimental data in a typical patient. (a) PTV, (b) thyroid gland, (c) carotid artery.
pmp-25-167f3.tif
Table 1.
Average of volume change on PTV and OARs.
Weekly PTV±SD [cc] Carotid A.±SD [cc] Thyroid gland±SD [cc]
Planning-kVCT 71.63±24.19 12.25±3.28 14.18±4.97
1 week 71.16±24.19 12.10±3.42 13.99±4.95
2 week 70.85±24.04 11.91±3.33 13.70±4.35
3 week 70.26±25.04 11.88±3.27 13.66±4.62
4 week 71.69±22.69 11.93±3.22 13.43±4.43
5 week 71.39±23.28 11.91±3.28 13.34±4.37

Note: The volume of the PTV, carotid artery and thyroid gland on planning-kVCT images and the average of volume change on CBCT images acquired at 1 week intervals during the course of treatment.

Table 2.
Dose evaluation of PTV during the course of treatment.
Factor Planning-kVCT 1 week 2 week 3 week 4 week 5 week
Dmax 76.49±3.22 79.61±6.51 77.41±3.56 79.27±8.72 77.26±4.05 80.64±6.33
Dmean 71.55±1.73 70.93±1.34 70.36±1.42 70.87±1.35 70.02±1.45 70.03±1.43
V67.50 (%) 95.00±0.00 93.35±2.24 92.78±4.45 88.94±4.03 88.27±3.82 85.19±5.70
D95 (Gy) 67.50±0.00 64.55±6.04 63.88±6.49 54.73±18.36 55.57±13.74 58.48±9.91
PITV 0.99±0.01 0.97±0.03 0.96±0.04 0.94±0.04 0.93±0.05 0.92±0.05
TCI 0.95±0.00 0.93±0.02 0.92±0.04 0.89±0.04 0.88±0.04 0.85±0.06
rDHI 0.67±0.13 0.49±0.24 0.52±0.27 0.33±0.26 0.336±0.26 0.31±0.18
mDHI 0.91±0.03 0.87±0.10 0.86±0.11 0.74±0.26 0.75±0.20 0.78±0.15
CN 0.91±0.01 0.90±0.02 0.88±0.05 0.84±0.07 0.84±0.04 0.79±0.10

Note: V67.50=the volume included in 67.50 Gy, D95=the dose included in 95% volume. PITV=PIV/PTV (PIV is the prescription isodose volume coverage for the target and normal tissues. PITV＞1 and PITV＜1 refers to the over treatment and under treatment regions, repectively.), TCI=PTVpd/PTV (PTVpd is the PTV coverage at PD, and PTV has usual meaning), rDHI=Dmin/Dmax, mDHI=D95/D5, CN=TCI/TR (CN accounts for the relative measurement of dosimetric target coverage and sparing of normal tissues in a treatment plan).

Table 3.
Dose evaluation of carotid artery.
Weekly V40 (cc) V50 (cc) Dmax (Gy) Dmean (Gy)
Planning-kVCT 20.19±9.62 11.39±8.23 72.79±8.41 17.90±6.5
1 week 20.42±8.29 11.27±7.91 73.87±5.17 17.95±6.38
2 week 20.22±9.49 11.55±7.34 73.62±8.48 17.73±6.52
3 week 21.20±9.27 12.04±8.58 74.03±5.46 17.87±6.90
4 week 21.12±11.31 11.98±8.88 74.85±5.51 18.66±7.36
5 week 21.88±10.16 12.39±10.58 74.32±4.55 18.31±7.58
Average 20.84±9.70 11.77±8.59 73.91±6.26 18.07±6.87

Note: V40=the volume (cc) of 40 Gy, V50=the volume of 50 Gy.

Table 4.
Dose evaluation of thyroid gland.
Weekly V30 (cc) V40 (cc) Dmax (Gy) Dmean (Gy)
Planning-kVCT 28.44±22.39 25.15±21.30 75.57±2.60 20.77±14.86
1 week 27.35±19.17 24.22±17.71 75.35±2.56 18.53±12.70
2 week 27.34±20.59 23.25±18.02 74.98±2.78 19.29±12.68
3 week 24.17±18.34 21.33±17.16 74.98±2.59 17.76±11.90
4 week 24.23±21.80 20.92±20.45 74.97±2.72 17.70±14.31
5 week 20.96±15.60 17.92±13.54 74.59±2.86 15.45±9.59
Average 25.42±19.65 22.13±18.03 74.85±2.67 18.25±12.67

Note: V30=the volume of 30 Gy, V40=the volume of 40 Gy.

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