Fifty-sixth annual meeting of the American association of physicists in medicine
SU-E-J-145: Geometric Uncertainty in CBCT Extrapolation for Head and Neck Adaptive Radiotherapy
One primary limitation of using CBCT images for H' N adaptive radiotherapy (ART) is the limited field of view (FOV) range. We propose a method to extrapolate the CBCT by using a deformed planning CT for the dose of the day calculations. The aim was to estimate the geometric uncertainty of our extrapolation method.
Ten H' N patients, each with a planning CT (CT1) and a subsequent CT (CT2) taken, were selected. Furthermore, a small FOV CBCT (CT2short) was synthetically created by cropping CT2 to the size of a CBCT image. Then, an extrapolated CBCT (CBCTextrp) was generated by deformably registering CT1 to CT2short and resampling with a wider FOV (42mm more from the CT2short borders), where CT1 is deformed through translation, rigid, affine, and b-spline transformations in order. The geometric error is measured as the distance map ||DVF|| produced by a deformable registration between CBCTextrp and CT2. Mean errors were calculated as a function of the distance away from the CBCT borders. The quality of all the registrations was visually verified.
Results were collected based on the average numbers from 10 patients. The extrapolation error increased linearly as a function of the distance (at a rate of 0.7mm per 1 cm) away from the CBCT borders in the S/I direction. The errors (μ±σ) at the superior and inferior boarders were 0.8 ± 0.5mm and 3.0 ± 1.5mm respectively, and increased to 2.7 ± 2.2mm and 5.9 ± 1.9mm at 4.2cm away. The mean error within CBCT borders was 1.16 ± 0.54mm . The overall errors within 4.2cm error expansion were 2.0 ± 1.2mm (sup) and 4.5 ± 1.6mm (inf).
The overall error in inf direction is larger due to more large unpredictable deformations in the chest. The error introduced by extrapolation is plan dependent. The mean error in the expanded region can be large, and must be considered during implementation.
This work is supported in part by Varian Medical Systems, Palo Alto, CA.