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A Fast and Accurate Parallel Algorithm for Non-Linear Image Registration using Normalized Gradient Fields

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  • Ibeo Automotive Systems GmbH

Abstract and Figures

We present a novel parallelized formulation for fast non-linear image registration. By carefully analyzing the mathematical structure of the intensity independent Normalized Gradient Fields distance measure, we obtain a scalable, parallel algo-rithm that combines fast registration and high accuracy to an attractive package. Based on an initial formulation as an opti-mization problem, we derive a per pixel parallel formulation that drastically reduces computational overhead. The method was evaluated on ten publicly available 4DCT lung datasets, achieving an average registration error of only 0.94 mm at a runtime of about 20 s. By omitting the finest level, we obtain a speedup to 6.56 s with a moderate increase of registration error to 1.00 mm. In addition our algorithm shows excellent scalability on a multi-core system.
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A FAST AND ACCURATE PARALLEL ALGORITHM FOR NON-LINEAR IMAGE
REGISTRATION USING NORMALIZED GRADIENT FIELDS
Lars K¨
onig and Jan R¨
uhaak
Fraunhofer MEVIS, Project Group Image Registration, L¨
ubeck, Germany
ABSTRACT
We present a novel parallelized formulation for fast non-linear
image registration. By carefully analyzing the mathematical
structure of the intensity independent Normalized Gradient
Fields distance measure, we obtain a scalable, parallel algo-
rithm that combines fast registration and high accuracy to an
attractive package. Based on an initial formulation as an opti-
mization problem, we derive a per pixel parallel formulation
that drastically reduces computational overhead.
The method was evaluated on ten publicly available 4DCT
lung datasets, achieving an average registration error of only
0.94 mm at a runtime of about 20 s. By omitting the finest
level, we obtain a speedup to 6.56 s with a moderate increase
of registration error to 1.00 mm. In addition our algorithm
shows excellent scalability on a multi-core system.
Index TermsImage registration, Computational effi-
ciency, Parallel algorithms
1. INTRODUCTION
The problem of image registration and generally correspon-
dence detection between two or more images has been ex-
tensively studied [1]. Applications in medical imaging range
from motion compensation to intra-operative fusion of dif-
ferent modalities. In particular, non-linear registration meth-
ods are able to capture complex deformations with high accu-
racy, enabling advanced diagnosis and treatment [2]. Many of
these methods, however, exhibit long processing times or re-
quire special hardware such as GPUs. While both resolutions
and the number of imaging modalities are increasing, efficient
tools that run on available hardware are needed.
In this paper, we present a novel approach to both efficient
and accurate non-linear image registration. We directly target
the underlying mathematical structure of the entire algorithm
instead of only optimizing selected parts. We perform a deep
analysis of the objective function associated with the regis-
tration model, by which we join the major building blocks to
a closed analytical formulation. This allows parallelization
on a per pixel level with close-to-zero memory consumption,
directly executable on standard CPUs.
This work was partly funded by the European Regional Development
Fund (EFRE).
2. RELATED WORK
The efficiency of registration algorithms has been widely dis-
cussed. A general framework for fast registration has been
presented in 2004 [3]. Related approaches try to reduce the
computational complexity using adaptive discretizations [4].
With the ubiquity of multicore systems, parallel imple-
mentations have moved into the focus of the research com-
munity, see [5] for an overview. A detailed approach to data-
distributed parallel registration was presented in [6], whereas
newer work deals with the use of GPUs for accelerating non-
linear registration, e.g. [7] and references therein. A different
approach for rigid registration has been provided in [8], ex-
ploiting the mathematical structure to obtain a fully parallel
algorithm. This idea is picked up in our work and extended to
non-linear image registration.
3. METHOD
To obtain a custom-tailored, efficient algorithm, we first give
a short outline about our registration framework which allows
a thorough analysis of the components and their interaction.
3.1. Registration Framework
The goal of image registration is to establish correspondence
between a reference and a template image [9]. The images
are acquired as discrete arrays RRabc and ˆ
TRˆaˆ
bˆcin
column vectors representing three-dimensional images, Rof
size a×b×cwith grid spacings hx, hy, hz,ˆ
Tanalogously.
Correspondence is established by deforming the template
image onto the reference image using a transformation Y
R3ABC consisting of ABC three-dimensional deformation
coordinates. To be able to evaluate the template at those co-
ordinates, the discrete image is transferred to a continuous
model using trilinear interpolation, obtaining the interpolation
function T:R3abc Rabc, which maps a set of coordinates
to a deformed image in the reference image space.
In our model, the size of the deformation Yis independent
of any image extent. This allows to adapt the deformation res-
olution to the size of the structures to be registered, thus de-
creasing both problem size and registration time. For compar-
ing the deformed template with the reference image, the de-
∂ψ
∂r
z }| {
∂r
∂T
z }| {
∂T
∂P
z }| {
DNGF(Y)=(••••••••••)
•••
•••
•••
•••
•••
•••
•••
•••
•••
•••
·∂P
∂Y
Fig. 1. Schematic view of the sparse matrix structure in the computation of D. Diagonals in ∂r
∂T resulting from neighboring
points in the same direction are shown in the same color.
formation needs to be converted to the reference image extent
using a function P:R3ABC R3abc , so that the deformed
template can be evaluated as T(P(Y)) : R3ABC Rabc.
To quantify correspondence between the two images, we
define a distance measure D(Y) : R3ABC R, which mea-
sures the similarity of reference and deformed template im-
age, depending on the deformation Y. The minimization of D
is an ill-posed problem and needs a regularization term S(Y)
to ensure certain deformation properties, such as smoothness
or specific physical behavior. Combining these two terms, the
registration problem can be written as an optimization prob-
lem J(Y) = D(Y) + αS(Y)Y
min, where αbalances
image similarity and deformation regularity. The optimiza-
tion problem is then solved by Newton-type methods [10].
Since the formulation of each part of this optimization
problem is crucial, we will now look precisely at the compo-
nents and derive specific methods for efficient parallel com-
putation of their function values as well as their derivatives.
3.2. Distance measure
We focus on the Normalized Gradient Fields (NGF) distance
measure [9], that has been successfully proven to be both well
suited for multimodal registration problems and paralleliza-
tion [8]. The general assumption in this distance term is that
intensity changes, which naturally represent edges, are pre-
served across different modalities. The NGF evaluates the
angles between these image gradients and has a lower value
the more parallel the gradients are aligned. The maximum
value is obtained by orthogonal gradients.
In [9] NGF has been introduced in a continuous frame-
work. To obtain a discretized formulation, we use the mid-
point quadrature rule on the reference image domain. With
the product of the image grid spacings ¯
h=hxhyhzand
k·kε=p,·i +ε2we can write the NGF as
D(Y) = ¯
h
2
abc
X
i=1 1h∇Ti(P(Y)),Rii+τ%
k∇Ti(P(Y))kτk∇Rik%2!,
(1)
where τ, % > 0are modality dependent parameters, which
enable the gradient images to be filtered for noise.
3.3. Parallel derivative computation
The most time of the registration is typically spent evaluat-
ing the distance measure and its derivative. While the func-
tion value computation is directly parallelizable using (1), the
gradient computation is more involved. It consists of several
separate steps, that need to be investigated in detail to derive
a joint, parallelizable formulation. The steps can be described
as follows: Convert deformation to reference image grid
Compute deformed template Compute NGF residual
Final summation step. These steps translate to the function
chain
R3ABC P
R3abc T
Rabc r
Rabc ψ
R(2)
with reduction function ψ:Rabc R,(r1, . . . , rabc)>7→
¯
h
2Pabc
i=1(1 r2
i).Using (1), the ith component of rcan be
written as
ri(T) = hg(Ti), g(Ri)i+τ%
kg(Ti)kτkg(Ri)k%
,
where g(Ti)is the image gradient approximation of Tat the
point iusing forward/backward finite differences as in [8].
Mathematically, the derivative of (1) can directly be
computed using the chain-rule, yielding DNGF(Y) =
∂ψ
∂r
∂r
∂T
∂T
∂P
∂P
∂Y . Calculating this in a matrix-based fashion, the
formulation is difficult to parallelize because of dependen-
cies on intermediate results and unknown matrix structures.
Hence, we take a closer look at the structure of the single
components, which is visualized in Fig. 1. Exploiting the
banded structure of r
∂T , which only contains non-zero ele-
ments at neighboring points, we can derive a compact closed
formulation of each gradient element. By evaluating the
complete matrix chain, point-wise, down to its very basic ele-
ments (the images), this formulation can directly be computed
fully in parallel from the input data, eliminating intermediate
memory write accesses and computational overhead.
With the set of offsets to points adjacent to point iin a 3D-
neighborhood defined as M={−z, y, x, 0,+x, +y, +z}
with zero Neumann boundary conditions, using the notation
as in [8] we can first define
ri)l=1
2hlRilRi
kgi(R)k%kgi(T)kτ(hgi(T),gi(R)i+)(TilTi)
kgi(R)k%kgi(T)k3
τ
with Ti:= Ti(P(Y)). Then the i+lth element of the row
vector ∂ri
∂T can be written as
∂ri
∂T i+l
=
ri)l,if l∈ M \ 0
Pj∈M\0ri)j,if l= 0
0,otherwise
.
The final gradient element at position iis given by
(D)i=
X
j∈M
rj∂rj
∂T ij
∂Ti
∂pi+d·abc
,(3)
with d= 0,1,2for derivatives regarding x-,y-,z-coordinates,
respectively. This formulation does not contain dependencies
between single gradient elements and can be calculated with-
out intermediate steps from the input data. Thus it can be
fully parallelized, given a per-element formulation of the in-
terpolation function and grid conversion T(P(Y)). This will
be discussed in the next section.
3.4. Grid conversion
The conversion between deformation and reference image
discretization is performed using trilinear interpolation. As
the interpolation weights only depend on the spacing of
deformation and reference image, not on the current defor-
mation, the conversion is a linear operation with matrix P.
For both NGF function value and gradient, the conversion
from deformation to image grid is needed. This can easily
be implemented in a matrix-free fashion by looping over the
image grid, collecting all adjacent deformation grid points
with their associated interpolation weights and summing up.
Moreover, the computation can directly be parallelized as
there are no write conflicts.
Setting v:= ∂ψ
∂r
∂r
∂T
∂T
∂P , the gradient computation for NGF
is equivalent to the matrix-vector product P>v. We use a red-
black scheme for efficient parallel implementation. The iter-
ation is performed over the deformation grid cells, allowing
write access to eight grid points at the same time. The algo-
rithm is parallelized on the image slices: In the first loop, only
the odd slices are considered, allowing for unconflicted writes
as the slices themselves are computed serially. In the second
loop, the even slices are calculated, finalizing the result. Fig.
2 illustrates our approach.
3.5. Regularizer
The last term in the objective function is the regularizer.
Here, we choose Curvature Regularization [11], which favors
a smooth deformation field. It has successfully been used
in non-linear registration problems [12]. Since its computa-
tion is lightweight and easy parallelizable it is well suited to
accompany the parallelized NGF. Discretized on the transfor-
mation grid and using the decomposition Y=X+U, where
Fig. 2. Red-black scheme for transposed grid conversion in
2D, with deformation (blue) and image grid (white). The red
rows are processed in parallel, followed by the black rows.
Only the adjacent blue nodes are written in each step such
that no write conflicts can occur.
Xis the identity, the curvature regularizer can be written as
SCurv(Y) = ¯
hY
2
ABC
X
i=i(∆iU1)2+ (∆iU2)2+ (∆iU3)2,
where Uirepresents the ith component function of the vector
field deformation U. The function i:RABC Ris a finite
difference approximation to the Laplace operator at point i
iUk=X
j∈{x,y,z}
1
hY
khY
k(Uk)ij2 (Uk)i+ (Uk)i+j,
where i±x, i ±y, i ±zrepresent the neighboring points of
iin the respective directions and hY
kthe grid spacing of Y.
Here, we use zero Neumann boundary conditions. The i-th
element of the gradient of the regularizer is then given by
(SCurv)i=¯
hY(∆iU1+ ∆iU2+ ∆iU3).
Note that due to discretization on the deformation grid, no
grid conversion is needed for the regularizer. With this for-
mulation we have the complete objective function available
as per point parallelizable terms.
3.6. Optimization
To gain additional speedup and avoid being trapped in local
minima, the presented objective function is optimized in a
multi-level approach. For this, the problem is successively
solved on finer representations, using the minimizer from
each coarser level as a starting guess for the next finer level.
On each level the objective function is iteratively minimized
using an L-BFGS approach, which is known for its memory
efficiency and fast convergence [10].
4. EVALUATION
We have evaluated the accuracy and computational efficiency
of our method on the challenging problem of CT lung reg-
istration. Since the air volume inside the lung varies while
Case LME (a) LME (b) Time (a) Time (b)
10.78 ±0.89 0.76 ±0.89 18.71 s 4.12 s
20.79 ±0.90 0.80 ±0.88 19.58 s 5.71 s
30.93 ±1.05 0.96 ±1.07 18.64 s 4.42 s
41.27 ±1.27 1.33 ±1.29 22.95 s 4.05 s
51.07 ±1.46 1.18 ±1.45 18.77 s 5.50 s
60.90 ±0.99 1.03 ±1.04 19.71 s 7.31 s
70.85 ±0.98 0.92 ±0.93 27.34 s 10.12 s
81.03 ±1.23 1.13 ±1.15 24.98 s 9.22 s
90.94 ±0.93 1.00 ±0.96 20.42 s 6.82 s
10 0.86 ±0.97 0.91 ±0.99 17.89 s 8.36 s
Avg. 0.94 ±1.07 1.00 ±1.07 20.90 s 6.56 s
Table 1. DIR-Lab datasets: Comparison of runtime and land-
mark error (LME) with α= 5, τ, % = 100 and finest defor-
mation grid size of 653. Multi-level configuration (a) uses the
full resolution, (b) omits the finest level in the multi-level ap-
proach [12]. All values are given in millimeters. The initial
landmark error ranged from 3.89 ±2.79 mm to 14.99 ±9.01
mm. The registrations were performed on a stock 3.4 GHz
Intel i7-2600 quad-core PC running Ubuntu Linux.
Method Serial Parallel Speedup
NGF 55.08 s 4.13 s 13.34
NGF 94.96 s 7.72 s 12.30
P x 8.98 s 0.76 s 11.82
P>x9.18 s 0.77 s 11.92
Table 2. Higher resolution datasets (5123image resolution,
1293deformation grid size): Scaling of NGF gradient and
grid conversion on a 12-core dual CPU Intel Xeon E5645
breathing, the intensities in the acquired images are not di-
rectly comparable, which makes the datasets appropriate for
the intensity independent NGF. For the evaluation we used the
publicly available DIR-Lab 4DCT datasets [13, 14] and regis-
tered the extreme phases. These phases come with 300 expert
annotated landmark pairs that can be used to assess registra-
tion accuracy. As we are only interested in the deformation of
lung tissue, we segmented the lungs from the images [15].
To show the scalability of our algorithm, we performed
separate calculations of the NGF and the grid change opera-
tors single and multithreaded on a 12-core workstation.
5. RESULTS
On the DIR-Lab data we achieved a mean registration error of
0.94 mm with an average complete runtime of 20.9 seconds.
Omitting the finest level, we obtained a speedup to 6.56 sec-
onds with a moderate increase of average registration error to
1.00 mm. The detailed results of all cases are shown in Table
1. The result deformation fields were automatically checked
and found to be free of singularities.
For eight of the ten cases the landmark errors were equal
to or better than the lowest errors reported in [16]. Addition-
ally the computation time compares very favorably with the
competing algorithms. Comparing the single threaded com-
putation time to a multithreaded calculation on a 12-core sys-
tem, shown in Table 2, speedup factors from 11.82 to 13.34
are obtained, which implies a perfect linear scalability.
Hence, our algorithm combines accuracy and efficiency
to a very attractive package. In addition our method does not
require any special equipment such as multi-CPU servers or
specialized GPUs. It runs on readily available stock hardware
that is already used in the clinic.
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In this paper, we propose new variational model for image registration from tomographic data. First, we employ the topological gradient approach for a tomographic reconstruction that uses the first‐ and the second‐order discontinuities in order to detect important objects of a given observed X‐ray tomographic data (sinograms). Second, we use this geometric information furnished by a high‐order operator in order to define an appropriate fidelity measure for the image registration process. A theoretical study of the proposed model is provided; Gauss–Newton method and multilevel technique are used for its numerical implementation. The performed numerical experiments show the efficiency and effectiveness of our model.
... Depending on the proximity to influencers, one of two approaches will be applied for the propagation of each target structure. For targets impacted by influencer motion due to their proximity, structure-guided deformable image registration is performed using a combination of normalized gradient fields as a similarity measure for edge alignment, a curvature regularizer that penalizes large deformations, and sum-of-squared differences structure guidance terms for the influencer structures that encourage the maximum overlap of the deformed and target structures [37,38]. Alternatively, for targets that are not moving with the influencers and for general organ deformation, an elastic deformation model that requires neighboring voxels to move in unison is employed [39]. ...
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Ethos adaptive radiotherapy is employed frequently in the pelvis to improve treatment accuracy by adapting to daily anatomical changes. The use of this CBCT-guided platform for abdominal treatments is made challenging by motion-related image artifacts that are detrimental to the Ethos auto-contouring process. We present a preliminary in silico study enabled by synthetic CBCT data of Ethos adaptive radiotherapy for pancreatic cancer. Simulation CT and daily CBCT images were collected from nonadaptive patients treated on Ethos. Contoured CBCTs drove structure-guided deformable registration from the CT to daily CBCTs, providing an approximate daily CT used to produce synthetic CBCT data. Two adaptive workflows were simulated using an Ethos emulator. Over 70 fractions across 10 patients in a solely deformation-based workflow, PTV prescription coverage increased by 23.3±9.4% through plan adaptation. Point doses to the stomach were reduced by 10.2±9.3%. Ultimately, un-adapted plans satisfied target coverage and OAR constraints in 0% and 6% of fractions while adapted plans did so in 80% of fractions. Anatomical variation led to poor performance in rigidly aligned un-adapted plans, illustrating the promise of Ethos adaptive radiotherapy in this region. This promise is balanced by the need for artifact reduction and questions regarding auto-contouring performance in the abdomen.
... Traditional MDIR methods (König and Rühaak 2014) use iterative optimization algorithms for image alignment but often face time-consuming issues and local optima (Maintz and Viergever 1998). Recently, deep learning-based methods, including CNNs and Transformers, significantly improve computational efficiency and reduce computing times (Fu et al. 2020), facilitating the MDIR field. ...
Preprint
The challenge of Multimodal Deformable Image Registration (MDIR) lies in the conversion and alignment of features between images of different modalities. Generative models (GMs) cannot retain the necessary information enough from the source modality to the target one, while non-GMs struggle to align features across these two modalities. In this paper, we propose a novel coarse-to-fine MDIR framework,LLM-Morph, which is applicable to various pre-trained Large Language Models (LLMs) to solve these concerns by aligning the deep features from different modal medical images. Specifically, we first utilize a CNN encoder to extract deep visual features from cross-modal image pairs, then we use the first adapter to adjust these tokens, and use LoRA in pre-trained LLMs to fine-tune their weights, both aimed at eliminating the domain gap between the pre-trained LLMs and the MDIR task. Third, for the alignment of tokens, we utilize other four adapters to transform the LLM-encoded tokens into multi-scale visual features, generating multi-scale deformation fields and facilitating the coarse-to-fine MDIR task. Extensive experiments in MR-CT Abdomen and SR-Reg Brain datasets demonstrate the effectiveness of our framework and the potential of pre-trained LLMs for MDIR task. Our code is availabel at: https://github.com/ninjannn/LLM-Morph.
... The architecture is shown in Figure 1. The gradient method is originated in the studies of Haber et al. 2006, Rühaak et al. 2013and König et al. 2014 in the context of image registration. We observe that in the edge of the NPC tumor, if the tumor contrast is enhanced, there will be large gradient change in pixel intensity in this region. ...
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Background Different image modalities capture different aspects of a patient. It is desirable to produce images that capture all such features in a single image. This research investigates the potential of multi-modal image fusion method to enhance magnetic resonance imaging (MRI) tumor contrast and its consistency across different patients, which can capture both the anatomical structures and tumor contrast clearly in one image, making MRI-based target delineation more accurate and efficient. Methods T1-weighted (T1-w) and T2-weighted (T2-w) magnetic resonance (MR) images from 80 nasopharyngeal carcinoma (NPC) patients were used. A novel image fusion method, Pixelwise Gradient Model for Image Fusion (PGMIF), which is based on the pixelwise gradient to capture the shape and a generative adversarial network (GAN) term to capture the image contrast, was introduced. PGMIF is compared with several popular fusion methods. The performance of fusion methods was quantified using two metrics: the tumor contrast-to-noise ratio (CNR), which aims to measure the contrast of the edges, and a Generalized Sobel Operator Analysis, which aims to measure the sharpness of edge. Results The PGMIF method yielded the highest CNR [median (mdn) =1.208, interquartile range (IQR) =1.175–1.381]. It was a statistically significant enhancement compared to both T1-w (mdn =1.044, IQR =0.957–1.042, P<5.60×10⁻⁴) and T2-w MR images (mdn =1.111, IQR =1.023–1.182, P<2.40×10⁻³), and outperformed other fusion models: Gradient Model with Maximum Comparison among Images (GMMCI) (mdn =0.967, IQR =0.795–0.982, P<5.60×10⁻⁴), Deep Learning Model with Weighted Loss (DLMWL) (mdn =0.883, IQR =0.832–0.943, P<5.60×10⁻⁴), Pixelwise Weighted Average (PWA) (mdn =0.875, IQR =0.806–0.972, P<5.60×10⁻⁴) and Maximum of Images (MoI) (mdn =0.863, IQR =0.823–0.991, P<5.60×10⁻⁴). In terms of the Generalized Sobel Operator Analysis, a measure based on Sobel operator to measure contrast enhancement, PGMIF again exhibited the highest Generalized Sobel Operator (mdn =0.594, IQR =0.579–0.607; mdn =0.692, IQR =0.651–0.718 for comparison with T1-w and T2-w images), compared to: GMMCI (mdn =0.491, IQR =0.458–0.507, P<5.60×10⁻⁴; mdn =0.495, IQR =0.487–0.533, P<5.60×10⁻⁴), DLMWL (mdn =0.292, IQR =0.248–0.317, P<5.60×10⁻⁴; mdn =0.191, IQR =0.179–0.243, P<5.60×10⁻⁴), PWA (mdn =0.423, IQR =0.383–0.455, P<5.60×10⁻⁴; mdn =0.448, IQR =0.414–0.463, P<5.60×10⁻⁴) and MoI (mdn =0.437, IQR =0.406–0.479, P<5.60×10⁻⁴; mdn =0.540, IQR =0.521–0.636, P<5.60×10⁻⁴), demonstrating superior contrast enhancement and sharpness compared to other methods. Conclusions Based on the tumor CNR and Generalized Sobel Operator Analysis, the proposed PGMIF method demonstrated its capability of enhancing MRI tumor contrast while keeping the anatomical structures of the input images. It holds promises for NPC tumor delineation in radiotherapy.
... This strategy is mainly dedicated to adaptive radiotherapy for pelvic tumours. The accuracy of the structure-guided DIR, which uses a non-demons algorithm (König and Rühaak 2014), has been evaluated by the vendor. They automatically delineated (and corrected when needed) the volume of influencer structures and target volumes on a CBCT and a CT. ...
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Objective. Radio-opaque markers are recommended for image-guided radiotherapy in liver stereotactic ablative radiotherapy (SABR), but their implantation is invasive. We evaluate in this in-silico study the feasibility of cone-beam computed tomography-guided stereotactic online-adaptive radiotherapy (CBCT-STAR) to propagate the target volumes without implanting radio-opaque markers and assess its consequence on the margin that should be used in that context. Approach. An emulator of a CBCT-STAR-dedicated treatment planning system was used to generate plans for 32 liver SABR patients. Three target volume propagation strategies were compared, analysing the volume difference between the GTVPropagated and the GTVConventional, the vector lengths between their centres of mass (l CoM), and the 95th percentile of the Hausdorff distance between these two volumes (HD95). These propagation strategies were: (1) structure-guided deformable registration with deformable GTV propagation; (2) rigid registration with rigid GTV propagation; and (3) image-guided deformable registration with rigid GTV propagation. Adaptive margin calculation integrated propagation errors, while interfraction position errors were removed. Scheduled plans (PlanNon-adaptive) and daily-adapted plans (PlanAdaptive) were compared for each treatment fraction. Main results. The image-guided deformable registration with rigid GTV propagation was the best propagation strategy regarding to l CoM (mean: 4.3 +/− 2.1 mm), HD95 (mean 4.8 +/− 3.2 mm) and volume preservation between GTVPropagated and GTVConventional. This resulted in a planning target volume (PTV) margin increase (+69.1% in volume on average). Online adaptation (PlanAdaptive) reduced the violation rate of the most important dose constraints (‘priority 1 constraints’, 4.2 versus 0.9%, respectively; p < 0.001) and even improved target volume coverage compared to non-adaptive plans (PlanNon-adaptive). Significance. Markerless CBCT-STAR for liver tumours is feasible using Image-guided deformable registration with rigid GTV propagation. Despite the cost in terms of PTV volumes, daily adaptation reduces constraints violation and restores target volumes coverage.
... These structures were reviewed by the radiation oncologist and adapted if necessary ( Figure 1, number 4). 20,21 After target acceptance, the other OARs are propagated, and dose distributions were calculated for the scheduled treatment plan (TP S ) on the sCT (Figure 1, number 5). The TP S represents the expected dose without plan adaption on the daily patient model (sCT). ...
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