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      Validation of nonrigid registration in pretreatment and follow‐up PET/CT scans for quantification of tumor residue in lung cancer patients

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          Abstract

          Nonrigid registrations of pre‐ and postradiotherapy (RT) PET/CT scans of NSCLC patients were performed with different algorithms and validated tracking internal landmarks. Dice overlap ratios (DR) of high FDG‐uptake areas in registered PET/CT scans were then calculated to study patterns of relapse. For 22 patients, pre‐ and post‐RT PET/CT scans were registered first rigidly and then nonrigidly. For three patients, two types (based on Demons or Morphons) of nonrigid registration algorithms each with four different parameter settings were applied and assessed using landmark validation. The two best performing methods were tested on all patients, who were then classified into three groups: large (Group 1), minor (Group 2) or insufficient improvement (Group 3) of registration accuracy. For Group 1 and 2, DRs between high FDG‐uptake areas in pre‐ and post‐RT PET scans were determined. Distances between corresponding landmarks on deformed pre‐RT and post‐RT scans decreased for all registration methods. Differences between Demons and Morphons methods were smaller than 1 mm. For Group 1, landmark distance decreased from 9.5 ± 2.1 mm to 3.8 ± 1.2 mm (mean ± 1 SD, p < 0.001), and for Group 3 from 13.6 ± 3.2 mm to 8.0 ± 2.2 mm ( p = 0 . 02 ). No significant change was observed for Group 2 where distances decreased from 5.6 ± 1.3 mm to 4.5 ± 1.1 mm ( p = 0 . 02 ). DRs of high FDG‐uptake areas improved significantly after nonrigid registration for most patients in Group 1. Landmark validation of nonrigid registration methods for follow‐up CT imaging in NSCLC is necessary. Nonrigid registration significantly improves matching between pre‐ and post‐RT CT scans for a subset of patients, although not in all patients. Hence, the quality of the registration needs to be assessed for each patient individually. Successful nonrigid registration increased the overlap between pre‐ and post‐RT high FDG‐uptake regions.

          PACS number: 87.57.Q‐, 87.57.C‐, 87.57.N‐, 87.57.‐s, 87.55.‐x, 87.55.D‐, 87.55.dh, 87.57.uk, 87.57.nj

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          Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non-small-cell lung cancer.

          Induction chemotherapy before surgical resection increases survival compared with surgical resection alone in patients with stage IIIA-N2 non-small-cell lung cancer (NSCLC). We hypothesized that, following a response to induction chemotherapy, surgical resection would be superior to thoracic radiotherapy as locoregional therapy. Selected patients with histologic or cytologic proven stage IIIA-N2 NSCLC were given three cycles of platinum-based induction chemotherapy. Responding patients were subsequently randomly assigned to surgical resection or radiotherapy. Survival curves were estimated using Kaplan-Meier analyses from time of randomization. Induction chemotherapy resulted in a response rate of 61% (95% confidence interval [CI] = 57% to 65%) among the 579 eligible patients. A total of 167 patients were allocated to resection and 165 to radiotherapy. Of the 154 (92%) patients who underwent surgery, 14% had an exploratory thoracotomy, 50% a radical resection, 42% a pathologic downstaging, and 5% a pathologic complete response; 4% died after surgery. Postoperative radiotherapy was administered to 62 (40%) of patients in the surgery arm. Among the 154 (93%) irradiated patients, overall compliance to the radiotherapy prescription was 55%, and grade 3/4 acute and late esophageal and pulmonary toxic effects occurred in 4% and 7%; one patient died of radiation pneumonitis. Median and 5-year overall survival for patients randomly assigned to resection versus radiotherapy were 16.4 versus 17.5 months and 15.7% versus 14%, respectively (hazard ratio = 1.06, 95% CI = 0.84 to 1.35). Rates of progression-free survival were also similar in both groups. In selected patients with pathologically proven stage IIIA-N2 NSCLC and a response to induction chemotherapy, surgical resection did not improve overall or progression-free survival compared with radiotherapy. In view of its low morbidity and mortality, radiotherapy should be considered the preferred locoregional treatment for these patients.
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            Evaluation of registration methods on thoracic CT: the EMPIRE10 challenge.

            EMPIRE10 (Evaluation of Methods for Pulmonary Image REgistration 2010) is a public platform for fair and meaningful comparison of registration algorithms which are applied to a database of intrapatient thoracic CT image pairs. Evaluation of nonrigid registration techniques is a nontrivial task. This is compounded by the fact that researchers typically test only on their own data, which varies widely. For this reason, reliable assessment and comparison of different registration algorithms has been virtually impossible in the past. In this work we present the results of the launch phase of EMPIRE10, which comprised the comprehensive evaluation and comparison of 20 individual algorithms from leading academic and industrial research groups. All algorithms are applied to the same set of 30 thoracic CT pairs. Algorithm settings and parameters are chosen by researchers expert in the configuration of their own method and the evaluation is independent, using the same criteria for all participants. All results are published on the EMPIRE10 website (http://empire10.isi.uu.nl). The challenge remains ongoing and open to new participants. Full results from 24 algorithms have been published at the time of writing. This paper details the organization of the challenge, the data and evaluation methods and the outcome of the initial launch with 20 algorithms. The gain in knowledge and future work are discussed.
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              Results of a multi-institution deformable registration accuracy study (MIDRAS).

              , Kristy Brock (2010)
              To assess the accuracy, reproducibility, and computational performance of deformable image registration algorithms under development at multiple institutions on common datasets. Datasets from a lung patient (four-dimensional computed tomography [4D-CT]), a liver patient (4D-CT and magnetic resonance imaging [MRI] at exhale), and a prostate patient (repeat MRI) were obtained. Radiation oncologists localized anatomic structures for accuracy assessment. Algorithm accuracy was determined by comparing the computer-predicted displacement at each bifurcation point with the displacement computed from the oncologists' annotations. Thirty-seven academic institutions and medical device manufacturers with published evidence of active deformable image registration capabilities were invited to participate. Twenty-seven groups agreed to participate; 6 did not return results. Sixteen completed the liver 4D-CT, 12 the lung 4D-CT, 3 the prostate MRI, and 3 the liver MRI-CT. The range of average absolute error for the lung 4D-CT was 0.6-1.2 mm (left-right [LR]), 0.5-1.8 mm (anterior-posterior [AP]), and 0.7-2.0 mm (superior-inferior [SI]); the liver 4D-CT was 0.8-1.5 mm (LR), 1.0-5.2 mm (AP), and 1.0-5.9 mm (SI); the liver MRI-CT was 1.1-2.6 mm (LR), 2.0-5.0 mm (AP), and 2.2-2.6 mm (SI); and the repeat prostate MRI prostate datasets was 0.5-6.2 mm (LR), 3.1-3.7 mm (AP), and 0.4-2.0 mm (SI). An infrastructure was developed to assess multi-institution deformable registration accuracy. The results indicate large discrepancies in reported shifts, although the majority of deformable registration algorithms performed at an accuracy equivalent to the voxel size, promising to improve treatment planning, delivery, and assessment. Copyright 2010 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                davide.fontanarosa@maastro.nl
                Journal
                J Appl Clin Med Phys
                J Appl Clin Med Phys
                10.1002/(ISSN)1526-9914
                ACM2
                Journal of Applied Clinical Medical Physics
                John Wiley and Sons Inc. (Hoboken )
                1526-9914
                08 July 2014
                July 2014
                : 15
                : 4 ( doiID: 10.1002/acm2.2014.15.issue-4 )
                : 240-250
                Affiliations
                [ 1 ] Department of Radiation Oncology (MAASTRO) GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre Maastricht The Netherlands
                [ 2 ] Oncology Solutions Philips Research Eindhoven The Netherlands
                [ 3 ] Department of Radiology GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre Maastricht The Netherlands
                Author notes
                [*] [* ] a Corresponding author: Davide Fontanarosa, Maastro Clinic, Dr Tanslaan 12, 6229ET Maastricht, the Netherlands; phone: +31 (0) 6 11534106; fax: +31 88 4455667; email: davide.fontanarosa@ 123456maastro.nl

                Article
                ACM20240
                10.1120/jacmp.v15i4.4847
                5875523
                25207414
                3a6be66a-7d85-448c-8fc0-918784e5c508
                © 2014 The Authors.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/3.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 December 2013
                : 20 March 2014
                Page count
                Figures: 3, Tables: 2, References: 33, Pages: 11, Words: 5401
                Categories
                Radiation Oncology Physics
                Radiation Oncology Physics
                Custom metadata
                2.0
                acm20240
                July 2014
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.4 mode:remove_FC converted:29.03.2018

                pet,deformable algorithm,pattern of relapse
                pet, deformable algorithm, pattern of relapse

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