Internal Margin

There are tumor dose specifications for external photon beams. According to the International Commission on Radiation Units and Measurments (ICRU) report number 62, an internal target volume must include an internal margin (IM) in addition to the clinical target volume (CTV).1 The IM compensates for internal physiologic movements and variations in size, shape, and position of the CTV during treatment.1 The IM takes into consideration changes that are not easily controllable, and may cause the CTV to change position, size or shape. Examples would be respiration, deviations in bladder or rectum filling, bowel movement, and swallowing. The IM is normally asymmetric around the CTV.2 The figure below illustrates IM in relation to the CTV.

Image Fusion vs. Image Registration

Image registration can be thought of as 2D, whereas image fusion is 3D; however, they are interchangeable. Image registration is the process of transforming different data sets, by point-by-point correspondences or same geometries, into one coordinate system.3 This transformation maps one data set onto another to allow the user to superimpose two images, as well as establish a coordinate transformation relating the coordinate systems of the two data sets.3 Image registration accounts for slice position, orientation, magnification and thickness. It also accounts for changes in anatomy, and variations in patient setup.3 Image fusion is the process of combining relevant information from two or more images and putting that information together into a single image.4 This is done to achieve high spatial and high spectral information in a single image.4 There is rigid fusion and deformable fusion. Deformable fusion stretches or shrinks the voxels on one data set to allow for everything to align properly on the fusion image. One data set is a base and stays the same, and one data set deforms. Image registration is a prerequisite for image fusion; therefore, a good registration is required for a good fusion.3 Below is a link for an example of image registration: http://www.youtube.com/watch?v=ZOlRVpOj9Vg

Reference: 1. Khan FM. The Physics of Radiation Therapy. 4th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2010. 2. ICRU REPORT 50 and 62: Prescribing, Recording, and Reporting Photon Beam Therapy. http://www.woodscollege.org/MSc2011/LectureNotes/html/ICRU50.html. Accessed March 22, 2012. 3. Pelizzari CA. Image Fusion: Introduction to the Technology. RSNA 2002:Image Fusion. http://www.radonc.uchicago.edu/chuck/fusion2002.pdf. Accessed March 24, 2012. 4. Malandain G. Image registration and fusion. Problems and feasibility. Inria Sophia Antipolis. http://www.maestro-research.org/IGRpresentations/09.MALANDAIN/09.MALANDAIN.pdf. Published January 12, 2007. Accessed March 27, 2012.