Image preprocessing to improve the accuracy and robustness of mutual-information-based automatic image registration in proton therapy.

PURPOSE: We propose a method that potentially improves the outcome of mutual-information-based automatic image registration by using the contrast enhancement filter (CEF). METHODS: Seventy-six pairs of two-dimensional X-ray images and digitally reconstructed radiographs for 20 head and neck and nine lung cancer patients were analyzed retrospectively. Automatic image registration was performed using the mutual-information-based algorithm in VeriSuite®. Images were preprocessed using the CEF in VeriSuite®. The correction vector for translation and rotation error was calculated and manual image registration was compared with automatic image registration, with and without CEF. In addition, the normalized mutual information (NMI) distribution between two-dimensional images was compared, with and without CEF. RESULTS: In the correction vector comparison between manual and automatic image registration, the average differences in translation error were < 1 mm in most cases in the head and neck region. The average differences in rotation error were 0.71 and 0.16 degrees without and with CEF, respectively, in the head and neck region; they were 2.67 and 1.64 degrees, respectively, in the chest region. When used with oblique projection, the average rotation error was 0.39 degrees with CEF. CEF improved the NMI by 17.9 % in head and neck images and 18.2 % in chest images. CONCLUSIONS: CEF preprocessing improved the NMI and registration accuracy of mutual-information-based automatic image registration on the medical images. The proposed method achieved accuracy equivalent to that achieved by experienced therapists and it will significantly contribute to the standardization of image registration quality.

Impact of Proton Beam Irradiation of an Anatomic Subsegment of the Liver for Hepatocellular Carcinoma.

PURPOSE: The objective of this research was to elucidate the impact on the prognosis, including the survival prognosis, resulting from proton beam irradiation of an anatomic subsegment of the liver (ASPT) for the treatment of hepatocellular carcinoma (HCC). METHODS AND MATERIALS: A total of 110 patients who received a diagnosis of HCC were analyzed in this retrospective study. Definitive proton beam therapy was delivered at a dose of 76 Gy (relative biological effectiveness) in 20 fractions between January 2008 and December 2015. When the HCC widely abutted blood vessels or when multiple HCC tumors occurred within the same liver subsegment, the clinical target volume was outlined as an anatomic subsegment of the liver, according to the portal territory, containing the tumor. In the remaining cases, the clinical target volume was delineated by adding a 5-mm margin around the gross tumor volume. The overall survival (OS), progression-free survival (PFS), and local control rates and adverse events were assessed. A review of the medical charts assessed adverse events that occurred during and after the treatment and were classified according to the Common Terminology Criteria for Adverse Events version 4.0. RESULTS: The median follow-up duration was 36.5 months (range, 1-90.6 months). The median age of the patients was 73 years (range, 48-90 years). ASPT was performed in 31 patients (28%). Three-year OS, PFS, and local control rates were 74.2%, 40.4%, and 91.7%, respectively. Multivariate analysis identified ASPT as a factor that significantly improved PFS (P = .049) but not OS (P = .79). No association was found between ASPT and the frequency of grade ≥3 acute/late adverse events. CONCLUSIONS: ASPT was associated with a reduction in the rate of tumor progression and no significant toxicity but was not associated with OS.

Hypofractionated proton beam therapy for centrally located lung cancer.

INTRODUCTION: To clarify the efficacy and safety of hypofractionated proton beam therapy (PBT) for centrally located lung cancer. METHODS: We retrospectively reviewed 39 patients who received hypofractionated [≧3 Gy (relative biological effectiveness: RBE)/fraction] PBT for centrally located cT1-2N0M0 (8th edition) lung cancer between 1999 and 2015. A tumour within 2 cm of the proximal bronchial tree was defined as a centrally located tumour. RESULTS: Twenty-four patients (62%) were treated with 80 Gy (RBE) in 20 fractions (112 Gy10 ), whereas eight (21%) were treated with 66 Gy (RBE) in 10 fractions (109.56 Gy10 ). The median follow-up period for censored patients was 48 months (range: 4-140). The 2-year progression-free survival (PFS) and overall survival (OS) rates were 86 and 100% for T1 disease and 56 and 94% for T2 disease, respectively. Patients who received 110 Gy10 or higher showed significantly better PFS than those who received less than 110 Gy10 , while no significant difference was noted in OS between the two groups. The sites of the first progression were local in six patients (27%), regional in seven (32%), distant in seven (32%), and local and distant in two (9%). Among the 13 patients with loco-regional recurrence, only two (15%) received treatments with curative intent. Dyspnoea of grade 3 was noted in one patient (3%), and pneumonitis of grade 2 was noted in four patients (10%). CONCLUSION: Hypofractionated PBT may be a very safe and effective treatment option for centrally located early lung cancer.

Investigation of the Section Thickness Measurement in Tomosynthesis by Thin Metal Plate Edge Method.

When performing tomosynthesis, the section thickness needs to be set depending on a radiographic part and its diagnostic purpose. However, the section thickness in tomosynthesis has not been clearly defined and its measurement method has not been established yet. In this study, we devised the alternative measurement method to diagnose the section thickness using an edge of thin metal plate, and compared with the simulation results, the wire and bead method reported in the previous papers. The tomographic image of the thin metal plate positioned on the table top inclining 30 degrees, which showed the edge spread function (ESF) of each tomographic height, was taken, and then the line spread function (LSF) was obtained by differentiating the ESF image. For the next, a profile curve was plotted by maximum values of LSF of each tomographic height, and a section thickness was calculated using the full width at half maximum (FWHM) of the profile curve. The edge method derived the section thickness close to the simulation results than the other methods. Further, the section thickness depends on the thickness of the metal plate and not the material. The thickness of the metal plate suitable for the evaluation of section thickness is 0.3 mm that is equivalent to pixel size of the flat panel detector (FPD). We conducted quantitative verification to establish the measurement method of the section thickness. The edge method is a useful technique as well as the wire and bead method for grasping basic characteristics of an imaging system.