Yuen Johnson, Poder Joel, Jameson Michael, Schmidt Laurel, Brown Ryan, Atkinson Charlotte, Deshpande Shrikant, Ralston Anna, Holloway Lois
Cancer Care Centre, Department of Medical Physics, St. George Hospital, Kogarah, NSW, Australia.
South Western Clinical School, University of New South Wales, Sydney, Australia.
Phys Eng Sci Med. 2025 May 14. doi: 10.1007/s13246-025-01541-1.
Deformable image registration (DIR) has proven to be an invaluable tool to maximize the clinical benefits of multimodality imaging in radiation oncology. In contrast to rigid image registration (RIR), which is employed at all stages of diagnosis and treatment, the uptake of DIR has been constrained by concerns over the potential for unsafe use. The AAPM Task Group 132 (TG132) published a report on the use of image registration, including many recommendations on clinical integration of registration in treatment planning and delivery. There is a remaining uncertainty on incorporating registration uncertainties into treatment margins (Sect. 6.A, TG 132), a challenge in clinical practice. The aim of this work was to report our experience in implementing a practical, patient specific quality assurance process based on the AAPM Task Group 132 report recommendations. This work includes refining our process of target contouring using PET with deformable image registration based on our experience of addressing vulnerabilities identified during implementation. A multidisciplinary team created a flowchart for patient specific quality assurance for image registration (RIR or DIR) based on use cases defined in the AAPM TG132 Report on the use of image registration in radiotherapy. Vulnerabilities identified from this implementation were assessed relative to AAPM TG132 recommendations. These findings were used to adapt our patient specific quality assurance to mitigate vulnerabilities. The main vulnerabilities were identified in the last steps of image registration. There was potential for inappropriate use of the registration for clinical use, such as target contouring where the image registration accuracy level was poor. Vulnerabilities were addressed by an adaptation in our quality assurance process. A new physics image registration QA task was introduced that independently checks registration accuracy and appropriateness of target contouring, addressing the vulnerability in the last steps of the AAPM TG132 flowchart. A multi-disciplinary team implemented the image registration process outlined by AAPM TG132. An improved patient specific quality assurance process was developed by introducing an independent physics image registration review that considers the acceptable registration uncertainty for the specific clinical use case in question.
可变形图像配准（DIR）已被证明是一种极具价值的工具，可在放射肿瘤学中最大限度地发挥多模态成像的临床效益。与在诊断和治疗的各个阶段都使用的刚性图像配准（RIR）不同，DIR的应用因对其潜在不安全使用的担忧而受到限制。美国医学物理师协会任务组132（TG132）发表了一份关于图像配准使用的报告，其中包含许多关于配准在治疗计划和实施中的临床整合的建议。在将配准不确定性纳入治疗边界方面仍存在不确定性（第6.A节，TG 132），这是临床实践中的一个挑战。这项工作的目的是报告我们基于美国医学物理师协会任务组132报告建议实施实用的、针对患者的质量保证流程的经验。这项工作包括根据我们在解决实施过程中发现的漏洞的经验，使用PET和可变形图像配准来完善我们的靶区轮廓勾画过程。一个多学科团队根据美国医学物理师协会TG132关于放射治疗中图像配准使用的报告中定义的用例，创建了一个针对患者的图像配准（RIR或DIR）质量保证流程图。相对于美国医学物理师协会TG132的建议，评估了从该实施中识别出的漏洞。这些发现被用于调整我们针对患者的质量保证以减轻漏洞。主要漏洞在图像配准的最后步骤中被识别出来。临床使用中存在不恰当地使用配准的可能性，例如在图像配准精度水平较差的情况下进行靶区轮廓勾画。通过调整我们的质量保证流程来解决漏洞。引入了一项新的物理图像配准质量保证任务，该任务独立检查配准准确性和靶区轮廓勾画的适当性，解决了美国医学物理师协会TG132流程图最后步骤中的漏洞。一个多学科团队实施了美国医学物理师协会TG132概述的图像配准过程。通过引入独立的物理图像配准审查，考虑特定临床用例可接受的配准不确定性，开发了一种改进的针对患者的质量保证流程。
