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Implementation and Validation of a 2D-3D Rigid Registration Algorithm for Proton Gantry and Stereotactic Radiosurgery Systems

M Zhu

M Zhu1*, G Warmerdam2, P Steininger3, M Neuner3, G Sharp1, H Shih1, B Winey1, (1) Massachusetts General Hospital and Harvard Medical School, Boston, MA, (2) Eindhoven University of Technology, Eindhoven, The Netherlands, (3) Paracelsus Medical University, Salzburg, Austria

SU-E-J-22 Sunday 3:00PM - 6:00PM Room: Exhibit Hall

Purpose: To implement and validate the accuracy of an intensity-based 2D to 3D rigid registration algorithm for proton treatment systems.

Methods: A 2D-3D rigid registration algorithm (REG23) was previously validated for linac machines. We adapted REG23 for use in both gantry-based and Stereotactic Alignment in Radiosurgery (STAR) proton treatment systems. REG23 registration was run on NVIDIA Quadra600 GPU card using NCC metrics and AMOEBA optimizer and validated using dual orthogonal kV images acquired during cranial target treatments: 66 fractions to 7 patients in gantry system and 135 fractions to 9 patients in STAR. Rectangle ROIs covering the whole region superior to the base-of-skull were used for REG23 registration and the accuracy was evaluated using clinical utilized fiducial-based 2D-3D ray back-projection rigid registration as the baseline.

Results: For the gantry system, the differences between REG23 and baseline were -0.01±0.63 mm, 0.43±0.61 mm, 0.12±0.60 mm in the left-right, superior-inferior, and anterior-posterior directions; 0.15±0.44°, 0.11±0.23°, and 0.19±0.37° in pitch, roll, and yaw, respectively. The vector difference was 1.04±0.48 mm. For STAR system, the REG23 results were -0.34±0.45 mm, -0.10±0.36 mm, -0.38±0.75 mm, -0.14±0.54°, 0.04±0.18°, and 0.03±0.35° different than the baseline in the left-right, superior-inferior, and anterior-posterior directions, pitch, roll, and yaw. The vector difference was 0.93±0.53 mm. The time for REG23 automatic registration was 29.7±9.5 seconds.

Conclusion: We demonstrated that the intensity based 2D-3D rigid registration algorithm REG23 provided sub-millimeter accuracy and better than 0.5° for both gantry-based and STAR proton treatment systems for cranial patients. This accuracy is within patient setup tolerance for current fractionated proton treatment systems. Given its accuracy and efficiency, we believe REG23 has great potential for clinical utilization in proton radiation therapy by replacing the implanted fiducial or anatomic feature based patient setup method.

Funding Support, Disclosures, and Conflict of Interest: The project was supported by the Federal Share of program income earned by Massachusetts General Hospital on C06 CA059267, Proton Therapy Research and Treatment Center. Conflicts of Interest: None

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