Improving target delineation on 4-dimensional CT scans in stage I NSCLC using a deformable registration tool

Radiother Oncol. 2010 Jul;96(1):67-72. doi: 10.1016/j.radonc.2010.05.003.

Abstract

Introduction: Correct target definition is crucial in stereotactic radiotherapy for lung tumors. We evaluated use of deformable registration (DR) for target contouring on 4-dimensional (4D) CT scans.

Materials and methods: Three clinicians contoured gross tumor volume (GTV) in an end-inspiration phase of 4DCT of 6 patients on two occasions. Two clinicians contoured GTVs in all phases of 4DCT and on maximum intensity projections (MIP). The initial GTV was auto-propagated to 9 other phases using a B-spline algorithm (VelocityAI). Internal target volumes (ITVs) generated were (i) ITV(10manual) encompassing all physician-contoured GTVs, (ii) ITV-MIP(optimized) from MIP after review of individual 4DCT phases, (iii) ITV(10deformed) encompassing auto-propagated GTVs using DR, and (iv) ITV(10deformed-optimized), from an ITV(10deformed) target that was modified to form a 'clinically optimal' ITV. Volume-overlaps were scored using Dice's Similarity Coefficients (DSCs).

Results: Intra-clinician GTV reproducibility was greater than inter-clinician reproducibility (mean DSC 0.93 vs. 0.88, p<0.0004). In five of 6 patients, ITV-MIP(optimized) differed from the ITV(10deformed-optimized). In all patients, the DSC between ITV(10deformed-optimized) and ITV(10deformed) was higher than that between ITV(10deformed-optimized) and ITV-MIP(optimized) (p<0.02 T-test).

Conclusion: ITVs created in stage I tumors using DR were closer to 'clinically optimal' ITVs than was the case with a MIP-modified approach.

Publication types

  • Comparative Study

MeSH terms

  • Carcinoma, Non-Small-Cell Lung / diagnostic imaging*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / surgery
  • Female
  • Four-Dimensional Computed Tomography / methods*
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / surgery
  • Male
  • Neoplasm Staging
  • Observer Variation
  • Radiosurgery / methods
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Sampling Studies