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Assessment of image co-registration accuracy for frameless gamma knife surgery
Chung Hyun Tai
Kim Jeong Hun
Kim Jin Wook
Paek Sun Ha
Kim Dong Gyu
Chun Kook Jin
Kim Tae Hoon
Kim Yong Kyun
PLos One, 2018, 13(3): e0193809.
Image co-registration is used in frameless gamma knife radiosurgery (GKSRS) to assign a stereotactic coordinate system and verify patient setup before irradiation. The accuracy of co-registration with cone beam computed tomography (CBCT) images of a Gamma Knife Icon TM (GK Icon) was assessed, and the effects of the region of co-registration (ROC) were studied. CBCT-to-CBCT co-registration is used for patient setup verification, and its accuracy was examined by co-registering CBCT images taken at various configurations with a reference CBCT series. The accuracy of stereotactic coordinate assignment was investigated by co-registering stereotactic CT images with CBCT images taken at various configurations. An anthropomorphic phantom was used, and the coordinates of fifteen landmarks inside the phantom were measured. The co-registration accuracy between stereotactic magnetic resonance (MR) and CBCT images was evaluated using images from forty-one patients. The positions of the anterior and posterior commissures were measured in both a fiducial marker-based system and a co-registered system. To assess the effects of MR image distortions, co-registration was performed with four different ranges, and the accuracy of the results was compared. Co-registration between CBCT images gave a mean three-dimensional deviation of 0.2 /- 0.1 mm. The co-registration of stereotactic CT images with CBCT images produced a mean deviation of 0.5 /- 0.2 mm. The co-registration of MR images with CBCT images resulted in the smallest three-dimensional difference (0.8 /- 0.3 mm) when a co-registration region covering the skull base area was applied. The image co-registration errors in frameless GKSRS were similar to the imaging errors of frame-based GKSRS. The lower portion of the patient's head, including the base of the skull, is recommended for the ROC.
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