Comparison between manual and automatic image registration in image-guided radiation therapy using megavoltage cone-beam computed tomography with an imaging beam line for prostate cancer
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This study aimed to compare and assess the compatibility of the bone-structure-based manual and maximization of mutual information (MMI)-algorithm-based automatic image registration using megavoltage cone-beam computed tomography (MV-CBCT) images acquired with an imaging beam line. A total of 1163 MV-CBCT images from 30 prostate cancer patients were retrospectively analyzed. The differences between setup errors in three directions (left–right, LR; superior–inferior, SI; anterior–posterior, AP) of both registration methods were investigated. Pearson’s correlation coefficients (r) and Bland–Altman agreements were evaluated. Agreements were defined by a bias close to zero and 95% limits of agreement (LoA) less than ± 3 mm. The cumulative frequencies of the absolute differences between the two registration methods were calculated to assess the distributions of the setup error differences. There were significant differences (p < 0.001) in the setup errors between both registration methods. There were moderate (SI, r = 0.45) and strong positive correlation coefficients (LR, r = 0.74; AP, r = 0.72), whereas the 95% LoA (bias ± 1.96 × standard deviation of the setup error differences) were − 1.61 ± 4.29 mm (LR), − 0.41 ± 5.45 mm (SI), and 0.67 ± 4.29 mm (AP), revealing no agreements in all directions. The cumulative frequencies (%) of the cases with absolute setup error differences within 3 mm in each direction were 80.83% (LR), 81.86% (SI), and 90.71% (AP), with all directions having large proportions of > 3-mm differences. The MMI-algorithm-based automatic registration is not compatible with the bone-structure-based manual registration and should not be used alone for prostate cancer.
KeywordsImage registration Maximization of mutual information Cone-beam computed tomography Imaging beam line Image-guided radiation therapy Setup error
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Statement of human/animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the IRB (approval number 15301, Osaka University Ethics Committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed.
For this retrospective study, passive informed consent (opt-out) was obtained from all individual participants.
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