Abstract
PURPOSE
The purpose of this study was to evaluate and clinically implement a deformable surface-based
magnetic resonance imaging (MRI) to three-dimensional ultrasound (US) image registration
algorithm for prostate brachytherapy (BT) with the aim to reduce operator dependence
and facilitate dose escalation to an MRI-defined target.
METHODS AND MATERIALS
Our surface-based deformable image registration (DIR) algorithm first translates and
scales to align the US- and MR-defined prostate surfaces, followed by deformation
of the MR-defined prostate surface to match the US-defined prostate surface. The algorithm
performance was assessed in a phantom using three deformation levels, followed by
validation in three retrospective high-dose-rate BT clinical cases. For comparison,
manual rigid registration and cognitive fusion by physician were also employed. Registration
accuracy was assessed using the Dice similarity coefficient (DSC) and target registration
error (TRE) for embedded spherical landmarks. The algorithm was then implemented intraoperatively
in a prospective clinical case.
RESULTS
In the phantom, our DIR algorithm demonstrated a mean DSC and TRE of 0.74 ± 0.08 and
0.94 ± 0.49 mm, respectively, significantly improving the performance compared to
manual rigid registration with 0.64 ± 0.16 and 1.88 ± 1.24 mm, respectively. Clinical
results demonstrated reduced variability compared to the current standard of cognitive
fusion by physicians.
CONCLUSIONS
We successfully validated a DIR algorithm allowing for translation of MR-defined target
and organ-at-risk contours into the intraoperative environment. Prospective clinical
implementation demonstrated the intraoperative feasibility of our algorithm, facilitating
targeted biopsies and dose escalation to the MR-defined lesion. This method provides
the potential to standardize the registration procedure between physicians, reducing
operator dependence.
Keywords
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Article info
Publication history
Published online: January 12, 2023
Accepted:
November 28,
2022
Received in revised form:
November 5,
2022
Received:
June 21,
2022
Publication stage
In Press Corrected ProofFootnotes
Disclosure: The authors are grateful for the funding support from the Ontario Institute of Cancer Research (OICR), the Canadian Institutes of Health Research (CIHR, Grant No P.IT.033), and the Natural Sciences and Engineering Research Council of Canada (NSERC). This work was also supported by the London Regional Cancer Program's Catalyst Grants program using funds raised by the London Health Sciences Foundation. D. Hoover is a Clinician-Scientist at the London Health Sciences Centre, with funding support from the London Health Sciences Foundation. Nathan Orlando was supported in part by the Queen Elizabeth II Graduate Scholarship in Science and Technology. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
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© 2023 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
