Accuracy of iView and PIPSpro registration software

In radiotherapy, treatment portal images and digitally reconstructed radiographs (DRRs) are used to monitor patient setup during clinical routine. The output of the registration between the portal image and the reference DRR indicates the patient displacement. If the registration is not reliable, the patient positioning will not be accurate. The aim of this work is to assess the intrinsic and the global accuracy of iView and PIPSpro, two widely used registration software programs that implement a manual and a semiautomatic approach, respectively. The intrinsic accuracy was tested using a computer generated phantom, while the overall accuracy was evaluated registering the portal images and the DRRs of an Alderson RANDO phantom. For DRRs, four treatment planning systems (TPS) and three CT studies with different slice thicknesses were considered.This study demonstrates that the intrinsic accuracy of iView and PIPSpro were within 1 pixel and 1°. Using a DRR extracted from a 2 mm CT study, the overall accuracy of both methods was about 2 mm and 1°. When thicker CT slices are considered, the global accuracy of both methods worsens, and differences larger than 1.5° between the rotation parameters estimated with iView and PIPSpro are evident. The results obtained with iView and PIPSpro were nearly equivalent.