Comparison of rigid and deformable image registration for nasopharyngeal carcinoma radiotherapy planning with diagnostic position PET/CT

Purpose: This observer study aimed to compare rigid image registration (RIR) with deformable image registration (DIR) for diagnostic position (DP) positron emission tomography/computed tomography (PET/CT) images in the delineation of gross tumor volumes (GTVs) in nasopharyngeal carcinoma (NPC) radiotherapy planning. Materials and methods: Four radiation oncologists individually delineated the GTVs, GTV_RIR, and GTV_DIR, on planning CT (pCT) images registered with DP-PET/CT images using RIR and B-spline-based DIR, respectively. Reference GTVs were independently delineated by all radiation oncologists using radiotherapy position (RP)-PET/CT images. DP- and RP-PET/CT images for 14 patients with NPC were acquired using early and delayed scans, respectively. Dice’s similarity coefficient (DSC), mean distance to agreement, and volume agreement with reference GTVs were compared by considering the interobserver variability in reference contours. Results: The average DSCs for GTV_RIR and GTV_DIR were 0.77 and 0.77, which were acceptable for GTV delineation. There were no statistically significant differences between GTV_RIR and GTV_DIR in all evaluation indexes (p > 0.05). Furthermore, the correlation between neck flexion angle differences and GTV accuracy was not statistically significant (p > 0.05). Conclusion: RIR was a feasible choice compared with the B-spline-based DIR in GTV delineation for NPC under variations of neck flexion angle.