Abdominal synthetic CT reconstruction with intensity projection prior for MRI-only adaptive radiotherapy

TL;DR

This paper introduces a novel paired data-driven deep learning method with an intensity projection prior for synthetic CT reconstruction in MRI-only abdominal radiotherapy, effectively handling intestinal gas variability for improved dose calculation accuracy.

Contribution

The study presents a new deep learning approach utilizing an intensity projection prior to generate well-matched training pairs for abdominal sCT reconstruction, addressing intestinal gas variability.

Findings

Class 1 patients showed minimal dosimetric differences between sCT and clinical plans.

Class 2 patients exhibited significant dose differences due to intestinal gas variability.

The method improves the accuracy of dose calculations in MRI-only abdominal radiotherapy.

Abstract

An MRI-only adaptive radiotherapy (ART) workflow is desirable for managing interfractional changes in anatomy, but producing synthetic CT (sCT) data through paired data-driven deep learning (DL) for abdominal dose calculations remains a challenge due to the highly variable presence of intestinal gas. We present the preliminary dosimetric evaluation of our novel approach to sCT reconstruction that is well suited to handling intestinal gas in abdominal MRI-only ART. We utilize a paired data DL approach enabled by the intensity projection prior, in which well-matching training pairs are created by propagating air from MRI to corresponding CT scans. Evaluations focus on two classes: patients with (1) little involvement of intestinal gas, and (2) notable differences in intestinal gas presence between corresponding scans. Comparisons between sCT-based plans and CT-based clinical plans for both classes are made at the first treatment fraction to highlight the dosimetric impact of the variable presence of intestinal gas. Class 1 patients ($n=13$) demonstrate differences in prescribed dose coverage of the PTV of $1.3 \pm 2.1\%$ between clinical plans and sCT-based plans. Mean DVH differences in all structures for Class 1 patients are found to be statistically insignificant. In Class 2 ($n=20$), target coverage is $13.3 \pm 11.0\%$ higher in the clinical plans and mean DVH differences are found to be statistically significant. Significant deviations in calculated doses arising from the variable presence of intestinal gas in corresponding CT and MRI scans may limit the effectiveness of adaptive dose escalation efforts. We have proposed a paired data-driven DL approach to sCT reconstruction for accurate dose calculations in abdominal ART enabled by the creation of a clinically unavailable training data set with well-matching representations of intestinal gas.