ArticleJournal of applied clinical medical physics2026
Evaluation of hybrid DIR performance using controlling structures and points of interest in MR-guided adaptive radiotherapy for prostate cancer patients.
Article in Journal of applied clinical medical physics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Evaluation of hybrid DIR performance using controlling structures and points of interest in MR-guided adaptive radiotherapy for prostate cancer patients.Journal of applied clinical medical physics · 2026Article
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11 authors.
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Abstract
backgroundMR-guided adaptive radiotherapy (ART) allows for daily plan optimization based on patient-specific anatomy. Accumulated doses, driven by deformable image registration (DIR), of daily fractions can provide cumulative dose metrics and insights into toxicity and tumor control. In prostate ART, inter- and intra-factional deformations, particularly due to bladder and rectum, pose a challenge to accurate DIR generation. PURPOSE: To quantify geometric and dosimetric accuracy of a proposed prostate MR-to-MR DIR approach to support MR-guided ART dose accumulation.
methodsWe evaluated DIR accuracy in 25 patients treated with 30 Gy in five fractions on a 1.5 T MR-linac using an adaptive workflow. For all patients, a reference MR was used for planning, with three images collected at each fraction: adapt MR for adaptive planning, verify MR for pretreatment position verification and beam-on for capturing anatomy during radiation delivery. We assessed three DIR approaches: intensity-based, intensity-based with controlling structures (CS), and intensity-based with controlling structures and points of interest (CS + P). DIRs were performed between the reference and fraction images and within fractions (adapt-to-verify and adapt-to-beam-on). For the evaluation, we propagated CTV, bladder, and rectum contours using the DIRs and compared each to manually delineated contours using Dice similarity coefficient, mean distance to agreement, and dose-volume metrics.
resultsCS and CS + P improved geometric agreement between manual and propagated contours over intensity-only DIR. For example, mean distance to agreement (DTA
conclusionCS improved geometric and dosimetric accuracy over intensity-only DIR, with CS + P providing further performance improvement, particularly for bladder. However, session image segmentation remains a challenge, which may be addressed with automated contouring.
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