Improving target delineation on 4-dimensional CT scans in stage I NSCLC using a deformable registration tool.

INTRODUCTION: Correct target definition is crucial in stereotactic radiotherapy for lung tumors. We evaluated use of deformable registration (DR) for target contouring on 4-dimensional (4D) CT scans. MATERIALS AND METHODS: Three clinicians contoured gross tumor volume (GTV) in an end-inspiration phase of 4DCT of 6 patients on two occasions. Two clinicians contoured GTVs in all phases of 4DCT and on maximum intensity projections (MIP). The initial GTV was auto-propagated to 9 other phases using a B-spline algorithm (VelocityAI). Internal target volumes (ITVs) generated were (i) ITV(10manual) encompassing all physician-contoured GTVs, (ii) ITV-MIP(optimized) from MIP after review of individual 4DCT phases, (iii) ITV(10deformed) encompassing auto-propagated GTVs using DR, and (iv) ITV(10deformed-optimized), from an ITV(10deformed) target that was modified to form a 'clinically optimal' ITV. Volume-overlaps were scored using Dice's Similarity Coefficients (DSCs). RESULTS: Intra-clinician GTV reproducibility was greater than inter-clinician reproducibility (mean DSC 0.93 vs. 0.88, p