Accuracy and utility of deformable image registration in (68)Ga 4D PET/CT assessment of pulmonary perfusion changes during and after lung radiation therapy

Nicholas Hardcastle, Michael S Hofman, Rodney J Hicks, Jason W Callahan, Tomas Kron, Michael P MacManus, David L Ball, Price Jackson, Shankar Siva

Research output: Contribution to journalArticleResearchpeer-review

13 Citations (Scopus)


PURPOSE: Measuring changes in lung perfusion resulting from radiation therapy dose requires registration of the functional imaging to the radiation therapy treatment planning scan. This study investigates registration accuracy and utility for positron emission tomography (PET)/computed tomography (CT) perfusion imaging in radiation therapy for non-small cell lung cancer. METHODS: (68)Ga 4-dimensional PET/CT ventilation-perfusion imaging was performed before, during, and after radiation therapy for 5 patients. Rigid registration and deformable image registration (DIR) using B-splines and Demons algorithms was performed with the CT data to obtain a deformation map between the functional images and planning CT. Contour propagation accuracy and correspondence of anatomic features were used to assess registration accuracy. Wilcoxon signed-rank test was used to determine statistical significance. Changes in lung perfusion resulting from radiation therapy dose were calculated for each registration method for each patient and averaged over all patients. RESULTS: With B-splines/Demons DIR, median distance to agreement between lung contours reduced modestly by 0.9/1.1 mm, 1.3/1.6 mm, and 1.3/1.6 mm for pretreatment, midtreatment, and posttreatment (P.2). Poorer posttreatment results were likely caused by posttreatment pneumonitis and tumor regression. Up to 80 standardized uptake value loss in perfusion scans was observed. There was limited change in the loss in lung perfusion between registration methods; however, Demons resulted in larger interpatient variation compared with rigid and B-splines registration. CONCLUSIONS: DIR accuracy in the data sets studied was variable depending on anatomic changes resulting from radiation therapy; caution must be exercised when using DIR in regions of low contrast or radiation pneumonitis. Lung perfusion reduces with increasing radiation therapy dose; however, DIR did not translate into significant changes in dose-response assessment.
Original languageEnglish
Pages (from-to)196 - 204
Number of pages9
JournalInternational Journal of Radiation Oncology, Biology, Physics
Issue number1
Publication statusPublished - 2015

Cite this