{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T17:14:36Z","timestamp":1763226876686},"reference-count":23,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T00:00:00Z","timestamp":1603756800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>The use of optical surface systems (OSSs) for patient setup verification in external radiation therapy is increasing. To manage potential deformations in a patient\u2019s anatomy, a novel deformable image registration (DIR) tool has been applied in a commercial OSS. In this study we investigate the accuracy of the DIR as compared to rigid image registration (RR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Materials<\/jats:title><jats:p>The positioning accuracy of the DIR and RR implemented in the OSS was investigated using an <jats:italic>ad hoc<\/jats:italic>\u2010developed anthropomorphic deformable phantom, named Mary.<\/jats:p><jats:p>The phantom consists of 33 slices of expanded polystyrene slabs shaped thus to simulate part of a female body. Anatomical details, simulating the ribs and spinal cord, together with 10 inner targets at different depths are included in thorax and abdominal parts. Mary is capable of realistic body movements and deformations, such as head and arm rotations, body torsion and moderate breast\/abdomen swelling. The accuracy of DIR and RR was investigated for four internal targets after deliberately deforming the phantom nine times. Breast and abdomen enlargements and torsions around x, y, and z axes were applied. For reference purposes, rigid displacements (where Mary\u2019s anatomy was kept intact) were included. The phantom was positioned on the linac couch under the OSS guidance and for each target and displacement a CBCT was acquired. The accuracy of DIR and RR was assessed evaluating the difference in means of absolute values between CBCT and the OSS registration parameters (lateral, longitudinal, vertical, rot, pitch, and roll), using both a reference surface extracted from CT (CTr) or acquired with the OSS (OSSr). A comparison of the four different combinations, DIR\u00a0+\u00a0OSSr, DIR\u00a0+\u00a0CTr, RR\u00a0+\u00a0OSSr, and RR\u00a0+\u00a0CTr, was carried out to evaluate the position accuracy for the various combinations. Finally, the positioning accuracy of the different target positions using only OSSr was investigated for the DIR. A paired sample Wilcoxon signed\u2010rank test (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05) and a two\u2010tailed Mann\u2013Whitney test (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05) were carried out.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The DIR in combination with OSSr showed significantly (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05) improved positioning accuracy in the lateral and longitudinal directions and in pitch, compared to RR, when deformations were applied to Mary. The positioning accuracy improved from 1.9\u00a0\u00b1\u00a01.5\u00a0mm, 1.1\u00a0\u00b1\u00a00.8\u00a0mm to 1.1\u00a0\u00b1\u00a01.2\u00a0mm, 0.6\u00a0\u00b1\u00a00.5\u00a0mm in lateral and longitudinal directions, respectively, and from 0.8\u00a0\u00b1\u00a00.6\u00b0 to 0.4\u00a0\u00b1\u00a00.4\u00b0 in pitch, using DIR compared to RR. Both the DIR and RR showed a similar positioning accuracy when rigid displacements of Mary were applied. For DIR, the OSSr generally showed improved calculation accuracy compared to CTr.<\/jats:p><jats:p>Independent of the reference image used, the target position influenced the registration accuracy, and hence, one target could not be evaluated using RR due to its inability to calculate the correct position.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Improved positioning accuracy was observed for DIR with respect to RR when deformations of Mary\u2019s anatomy were applied. For both DIR and RR, improved positioning accuracy was observed using OSSr as compared to CTr. The position of the target inside the phantom influenced the positioning accuracy for DIR.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.14527","type":"journal-article","created":{"date-parts":[[2020,10,9]],"date-time":"2020-10-09T02:39:35Z","timestamp":1602211175000},"page":"6310-6318","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Validation of a commercial deformable image registration for surface\u2010guided radiotherapy using an ad hoc\u2010developed deformable phantom"],"prefix":"10.1002","volume":"47","author":[{"given":"Stefania","family":"Pallotta","sequence":"first","affiliation":[{"name":"Department of Biomedical, Experimental and Clinical Sciences \u201cMario Serio\u201d University of Florence Florence Italy"},{"name":"Medical Physics Unit AOU Careggi Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malin","family":"Kugele","sequence":"additional","affiliation":[{"name":"Department of Hematology, Oncology and Radiation Physics Sk\u00e5ne University Hospital Lund Sweden"},{"name":"Medical Radiation Physics Department of Clinical Sciences Lund University Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Redapi","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Experimental and Clinical Sciences \u201cMario Serio\u201d University of Florence Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofie","family":"Ceberg","sequence":"additional","affiliation":[{"name":"Medical Radiation Physics Department of Clinical Sciences Lund University Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,10,27]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014-020-01629-w"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semradonc.2018.02.003"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12700"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-25644-w"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rpor.2017.12.007"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12321"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1120\/jacmp.v17i5.6041"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1120\/jacmp.v16i4.5416"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12611"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2011.04.005"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.1984263"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3675973"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00066-013-0441-z"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12498"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4769428"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00066-015-0861-z"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12183"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014-016-0728-1"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1109\/34.121791"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-8659.2008.01282.x"},{"key":"e_1_2_6_22_1","unstructured":"NuttiB Kronander\u00c5 NilsingM et al.Depth Sensor\u2010Based Realtime Tumor Tracking for Accurate Radiation Therapy. 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