Impact of deformable image registration on dose accumulation applied electrocardiograph-gated 4DCT in the heart and left ventricular myocardium during esophageal cancer radiotherapy.

Background: The deformable image registration (DIR) technique has the potential to realize the dose accumulation during radiotherapy. This study will analyze the feasibility of evaluating dose-volume parameters for the heart and left ventricular myocardium (LVM) by applying DIR.

Methods: The electrocardiograph-gated four-dimensional CT (ECG-gated 4DCT) data of 21 patients were analyzed retrospectively. The heart and LVM were contoured on 20 phases of 4DCT (0%, 5%,…,95%). The heart and LVM in the minimum volume/dice similarity coefficient (DSC) phase (Volume /DSC ) were deformed to the maximum volume/DSC phase (Volume / DSC ), which used the intensity-based free-form DIR algorithm of MIM software. The dose was deformed according to the deformation vector. The variations in volume, mean dose (D), V, V and V for the heart and LVM before and after DIR were compared, and the reference phase was the Volume /DSC phase.

Results: For the heart, the difference between the pre- and post-registration Volume and Volume were reduced from 13.87 to 1.72%; the DSC was increased from 0.899 to 0.950 between the pre- and post-registration DSC phase relative to the DSC phase. The post-registration D, V, V and V of the heart were statistically significant compared to those in the Volume /DSC phase (p < 0.05). For the LVM, the difference between the pre- and post-registration Volume and Volume were only reduced from 18.77 to 17.38%; the DSC reached only 0.733 in the post-registration DSC phase relative to the DSC phase. The pre- and post-registration volume, D, V, V and V of the LVM were all statistically significant compared to those in the Volume /DSC phase (p < 0.05).

Conclusions: There was no significant relationship between the variation in dose-volume parameters and the variation in the volume and morphology for the heart; however, the inconsistency of the variation in the volume and morphology for the LVM was a major factor that led to uncertainty in the dose-volume evaluation. In addition, the individualized local deformation registration technology should be applied in dose accumulation for the heart and LVM.