Dose Mapping using Image Registration for Reirradiation: A Systematic Review
Abstract
BACKGROUND
As reirradiation becomes increasingly common due to longer patient survival, accurately mapping previous radiation dose is essential to balance toxicity and tumour control. Image registration (IR) is widely used to align previous dose distributions with current anatomy. However, significant anatomical changes between treatment courses pose unique challenges, and it remains unclear how existing IR practices-largely developed for other contexts-translate to reirradiation. This systematic review aims to report on what is currently being done in the field regarding the use of IR for dose mapping in reirradiation scenarios, identify methodological gaps, and propose recommendations to improve reproducibility and clinical utility.
METHODS
We performed a PRISMA-compliant search for full-length articles (PubMed and Scopus) and conference abstracts (ScienceDirect and AAPM) that explicitly referenced IR for dose mapping in reirradiation. Each article was reviewed by at least two independent reviewers, with key data extracted on IR approaches and evaluation strategies.
RESULTS
As of mid-May 2025, 34 articles and 30 abstracts were selected. Most studies lacked comprehensive evaluation: about one-third reported geometric accuracy metrics, and few included dosimetric assessments or uncertainty estimation. Multimodal reirradiation, non-external beam techniques, and paediatric populations were notably underrepresented.
CONCLUSION
Based on the synthesis of current literature and…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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