Improving Deformable Image Registration Accuracy through a Hybrid Similarity Metric and CycleGAN Based Auto-Segmentation

Purpose: Deformable image registration (DIR) is critical in adaptive radiation therapy (ART) to account for anatomical changes. Conventional intensity-based DIR methods often fail when image intensities differ. This study evaluates a hybrid similarity metric combining intensity and structural information, leveraging CycleGAN-based intensity correction and auto-segmentation across three DIR workflows. Methods: A hybrid similarity metric combining a point-to-distance (PD) score and intensity similarity was implemented. Synthetic CT (sCT) images were generated using a 2D CycleGAN model trained on unpaired CT and CBCT images to enhance soft-tissue contrast. DIR workflows compared included: (1) traditional intensity-based (No PD), (2) auto-segmented contours on sCT (CycleGAN PD), and (3) expert manual contours (Expert PD). A 3D U-Net model trained on 56 images and validated on 14 cases segmented the prostate, bladder, and rectum. DIR accuracy was assessed using Dice Similarity Coefficient (DSC), 95% Hausdorff Distance (HD), and fiducial separation. Results: The hybrid metric improved DIR accuracy. For the prostate, DSC increased from 0.61+/-0.18 (No PD) to 0.82+/-0.13 (CycleGAN PD) and 0.89+/-0.05 (Expert PD), with reductions in 95% HD from 11.75 mm to 4.86 mm and 3.27 mm, respectively. Fiducial separation decreased from 8.95 mm to 4.07 mm (CycleGAN PD) and 4.11 mm (Expert PD) (p < 0.05). Improvements were also observed for the bladder and rectum. Conclusion: This study demonstrates that a hybrid similarity metric using CycleGAN-based auto-segmentation improves DIR accuracy, particularly for low-contrast CBCT images. These findings highlight the potential for integrating AI-based image correction and segmentation into ART workflows to enhance precision and streamline clinical processes.

Photon-Counting CT in Cancer Radiotherapy: Technological Advances and Clinical Benefits

Photon-counting computed tomography (PCCT) marks a significant advancement over conventional energy-integrating detector (EID) CT systems. This review highlights PCCT's superior spatial and contrast resolution, reduced radiation dose, and multi-energy imaging capabilities, which address key challenges in radiotherapy, such as accurate tumor delineation, precise dose calculation, and treatment response monitoring. PCCT's improved anatomical clarity enhances tumor targeting while minimizing damage to surrounding healthy tissues. Additionally, metal artifact reduction (MAR) and quantitative imaging capabilities optimize workflows, enabling adaptive radiotherapy and radiomics-driven personalized treatment. Emerging clinical applications in brachytherapy and radiopharmaceutical therapy (RPT) show promising outcomes, although challenges like high costs and limited software integration remain. With advancements in artificial intelligence (AI) and dedicated radiotherapy packages, PCCT is poised to transform precision, safety, and efficacy in cancer radiotherapy, marking it as a pivotal technology for future clinical practice.