Prog Med Phys.  2014 Sep;25(3):167-175. 10.14316/pmp.2014.25.3.167.

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

• Kim WC
• Min CK
• Lee S
• Choi SH
• Cho KH
• Jung JH
• Kim ES
• Yeo SG
• Kwon SI
• Lee KD

• KMID: 1910549
• DOI: http://doi.org/10.14316/pmp.2014.25.3.167

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??.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.

Keyword

Glottic; Deformable image registration; CBCT; Adaptive radiation therapy

MeSH Terms

Glottis*
Humans
Somatotypes
Thyroid Gland

Figure

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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.

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  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.

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  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.

Reference

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