SU-E-J-101: Improved CT to CBCT Deformable Registration Accuracy by Incorporating Multiple CBCTs

Purpose: Combining prior day CBCT contours with STAPLE was previously shown to improve automated prostate contouring. These accurate STAPLE contours are now used to guide the planning CT to pre-treatment CBCT deformable registration. Methods: Six IGRT prostate patients with daily kilovoltage CBCT had their original planning CT and 9 CBCTs contoured by the same physician. These physician contours for the planning CT and each prior CBCT are deformed to match the current CBCT anatomy, producing multiple contour sets. These sets are then combined using STAPLE into one optimal set (e.g. for day 3 CBCT, combine contours produced using the plan plus day 1 and 2 CBCTs). STAPLE computes a probabilistic estimate of the true contour from this collection of contours by maximizing sensitivity and specificity. The deformation field from planning CT to CBCT registration is then refined by matching its deformed contours to the STAPLE contours. ADMIRE (Elekta Inc.) was used for this. The refinement does not force perfect agreement of the contours, typically Dice's Coefficient (DC) of > 0.9 is obtained, and the image difference metric remains in the optimization of the deformable registration. Results: The average DC between physician delineated CBCT contours and deformed planning CT contours for the bladder, rectum and prostate was 0.80, 0.79 and 0.75, respectively. The accuracy significantly improved to 0.89, 0.84 and 0.84 (P<0.001 for all) when using the refined deformation field. The average time to run STAPLE with five scans and refine the planning CT deformation was 66 seconds on a Telsa K20c GPU. Conclusion: Accurate contours generated from multiple CBCTs provided guidance for CT to CBCT deformable registration, significantly improving registration accuracy as measured by contour DC. A more accurate deformation field is now available for transferring dose or electron density to the CBCT for adaptive planning. Research grant from Elekta