Registration of CT to pre-treatment MRI for planning of MR-HIFU ablation treatment of painful bone XXXX .

@entity1 @entity79 @entity3
MR-HIFU is a new non-invasive treatment modality that can be used for palliation in @entity1 with painful bone @entity3 . Since treatment strategies are mainly focused on the ablation of periosteal nerves, information on the presence and geometry of cortical bone influences the treatment strategy, both in determining the acoustic power and in avoiding safety issues related to far-field heating. Although MRI is available for imaging during treatment, CT is best used for examining the cortical bone. We present a registration method for registering CT and MR images of @entity1 with bone @entity3 prior to therapy. CT and MRI data were obtained from nine @entity1 with metastatic @entity79 at varying locations. A two-step registration approach was used, performing simultaneous rigid registration of all available MR images in the first step and an affine and deformable registration with an additional bone metric in the second step. The performance was evaluated using landmark annotation by clinical observers. An average registration error of 4.5  mm was obtained, which was comparable to the slice thickness of the data. The performance of the registration algorithm was satisfactory, even with differences in MRI acquisition parameters and for various anatomical sites. The obtained CT overlay is useful for treatment planning, as it allows an assessment of the integrity of the cortical bone. CT-MR registration is therefore recommended for HIFU treatment planning of @entity1 with bone @entity3 .
