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Clinical use, challenges, and barriers to implementation of deformable image registration in radiotherapy – the need for guidance and QA tools

Hussein, M; Akintonde, A; McClelland, J; Speight, R; Clark, CH; (2021) Clinical use, challenges, and barriers to implementation of deformable image registration in radiotherapy – the need for guidance and QA tools. British Journal of Radiology 10.1259/bjr.20210001. (In press). Green open access

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Abstract

OBJECTIVE: The aim of this study was to evaluate the current status of the clinical use of deformable image registration (DIR) in radiotherapy and to gain an understanding of the challenges faced by centres in clinical implementation of DIR, including commissioning and quality assurance (QA), and to determine the barriers faced. The goal was to inform whether additional guidance and QA tools were needed. METHODS: A survey focussed on clinical use, metrics used, how centres would like to use DIR in the future and challenges faced, was designed and sent to 71 radiotherapy centres in the UK. Data were gathered specifically on which centres we using DIR clinically, which applications were being used, what commissioning and QA tests were performed, and what barriers were preventing the integration of DIR into the clinical workflow. Centres that did not use DIR clinically were encouraged to fill in the survey and were asked if they have any future plans and in what timescale. RESULTS: 51 out of 71 (70%) radiotherapy centres responded. 47 centres reported access to a commercial software that could perform DIR. 20 centres already used DIR clinically, and 22 centres had plans to implement an application of DIR within 3 years of the survey. The most common clinical application of DIR was to propagate contours from one scan to another (19 centres). In each of the applications, the types of commissioning and QA tests performed varied depending on the type of application and between centres. Some of the key barriers were determining when a DIR was satisfactory including which metrics to use, and lack of resources. CONCLUSION: The survey results highlighted that there is a need for additional guidelines, training, better tools for commissioning DIR software and for the QA of registration results, which should include developing or recommending which quantitative metrics to use. ADVANCES IN KNOWLEDGE: This survey has given a useful picture of the clinical use and lack of use of DIR in UK radiotherapy centres. The survey provided useful insight into how centres commission and QA DIR applications, especially the variability among centres. It was also possible to highlight key barriers to implementation and determine factors that may help overcome this which include the need for additional guidance specific to different applications, better tools and metrics.

Type: Article
Title: Clinical use, challenges, and barriers to implementation of deformable image registration in radiotherapy – the need for guidance and QA tools
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1259/bjr.20210001
Publisher version: https://doi.org/10.1259/bjr.20210001
Language: English
Additional information: Copyright © 2021 The Authors. Published by the British Institute of Radiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Med Phys and Biomedical Eng
URI: https://discovery.ucl.ac.uk/id/eprint/10127265
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