Taisa Polishchuk

March 28, 2015

Conformal Terminology discussion
Image fusion vs image registration
Medical imaging plays a critical role when it comes to diagnose, plan and deliver
radiation therapy treatment.1 Anatomic images of high quality are essential in accurate
delineation of target volumes and normal structures.2 Some of the imaging modalities utilized in
treatment planning are computed tomography (CT), magnetic resonance imaging (MRI),
ultrasound (US), single photon emission tomography (SPECT), and positron emission
tomography (PET). Combining images of different modalities digitally is known as image
fusion.1 Image fusion is the process that matches two or more image datasets resulting in a single
image dataset. Fusion can provide additional diagnostic information that could benefit in
treatment planning process. Fusing two image datasets can increase the accuracy of delineating
tumor volumes and therefore increase the quality of the treatment plan by achieving tumor dose
and limiting the dose to other critical structures outlined through fusion.
CT is the primary dataset utilized for radiation therapy treatment planning.1 Fusing CT
with MRI provides better visualization of tumors or tissue abnormalities due to MRI being
superior to CT in soft tissue discrimination.2

Image 1. CT/MRI Fusion

Fusing CT with PET or SPECT provides physiological information such as tumor metabolism
and tissue function.3 PET is rather useful when it comes to discriminating between tumor
recurrence and radiation necrosis.

Image 2. CT/PET Fusion

Fusing CT with Ultrasound produces real-time images that help delineate the soft tissue
interfaces.

Image 3. CT/US Fusion

Image registration is the process of correlating different image data sets to identify
corresponding structures or regions.2 This process involves comparison of images from one
study to another and then fuses them into one dataset. Image registration defines a one-to-one
mapping between the coordinates of a point in one space with a corresponding point in the
second space.4 Image registration consists of two main tasks: data registration and structure
mapping.3 Data registration refers to establishing parameters of coordinate points of 2 studies.
Structure mapping is a process of combining the greyscale data from the 2 studies. Some of the
registration techniques include point-to-point fitting, interactively superimposing images in the
two data sets, and surface or topography matching.2 Daily image-guided radiation therapy

depend on registration of the daily anatomy as defined by pretreatment images.4 Image

registration is used for visualization, delineation of anatomical and functional structures,
pretreatment patient positioning, and evaluation of treatment response.
References:
1. Leaver D, Miller AC. Medical imaging. In: Washington CM, Leaver D, eds. Principles and
Practice of Radiation Therapy. 3rd ed. St. Louis, MO: Mosby Elsevier; 2010:103-132.
2. Khan FM. The Physics of Radiation Therapy. 4th ed. Baltimore, MD: Lippincott Williams and
Wilkins; 2010:413-419.
3. Lenards N. The role of image fusion in medical dosimetry. Eradimaging Web site.
http://www.eradimaging.com/site/article.cfm?ID=745#.VRajhym4n-Y. May 1, 2014. Accessed
March 27, 2015.
4. Khan FM. Treatment Planning in Radiation Oncology. 2nd ed. Baltimore, MD: Lippincott
Williams and Wilkins; 2007:28-31.