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Purpose: To evaluate the accuracy of deformable image registration (DIR) between the planning kVCT (pCT) and the daily MVCT combined with the histogram matching (HM) algorithm, and evaluate the deformable dose accumulation using a suggested method for adaptive radiotherapy with Helical Tomotharapy (HT). Methods: For five prostate cancer patients (76 Gy/38 Fr) treated with HT in our institution, seven MVCT series (a total of 35 series) acquired weekly were investigated. First, to minimize the effect of different HU values between pCT and MVCT, this image-processing method adjusts HU values between pCT and MVCT images by using image cumulative histograms of HU values, generating an HM-MVCT. Then, the DIR of the pCT to the HM-MVCT was performed, generating a deformed pCT. Finally, deformable dose accumulation was performed toward the pCT image. Results: The accuracy of DIR was significantly improved by using the HM algorithm, compared with non-HM method for several structures (p < 0.05). The mean dice similarity coefficient of the non-HM method was 0.75 ± 0.05, 0.83 ± 0.06, and 0.90 ± 0.04 for the CTV, rectum, and bladder, respectively, while that of the HM method was 0.81 ± 0.06, 0.81 ± 0.04, and 0.92 ± 0.06, respectively. For the deformable dose accumulation, some difference was observed between the two methods, particularly for the small calculated regions, such as rectum V60 and V70. Conclusion: Adapting the HM method can improve the accuracy of DIR. Furthermore, dose calculation using the deformed pCT using HM methods can be an effective tool for adaptive radiotherapy.

Evaluation of Deformable Image Registration and Dose Accumulation Using Histogram Matching Algorithm between kVCT and MVCT with Helical Tomotherapy