Robustness and Generalizability of Deep Learning Synthetic Computed Tomography for Positron Emission Tomography/Magnetic Resonance Imaging–Based Radiation Therapy Planning of Patients With Head and Neck Cancer

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Purpose: Radiotherapy planning based only on positron emission tomography/magnetic resonance imaging (PET/MRI) lacks computed tomography (CT) information required for dose calculations. In this study, a previously developed deep learning model for creating synthetic CT (sCT) from MRI in patients with head and neck cancer was evaluated in 2 scenarios: (1) using an independent external dataset, and (2) using a local dataset after an update of the model related to scanner software-induced changes to the input MRI. Methods and Materials: Six patients from an external site and 17 patients from a local cohort were analyzed separately. Each patient underwent a CT and a PET/MRI with a Dixon MRI sequence over either one (external) or 2 (local) bed positions. For the external cohort, a previously developed deep learning model for deriving sCT from Dixon MRI was directly applied. For the local cohort, we adapted the model for an upgraded MRI acquisition using transfer learning and evaluated it in a leave-one-out process. The sCT mean absolute error for each patient was assessed. Radiotherapy dose plans based on sCT and CT were compared by assessing relevant absorbed dose differences in target volumes and organs at risk. Results: The MAEs were 78 ± 13 HU and 76 ± 12 HU for the external and local cohort, respectively. For the external cohort, absorbed dose differences in target volumes were within ± 2.3% and within ± 1% in 95% of the cases. Differences in organs at risk were <2%. Similar results were obtained for the local cohort. Conclusions: We have demonstrated a robust performance of a deep learning model for deriving sCT from MRI when applied to an independent external dataset. We updated the model to accommodate a larger axial field of view and software-induced changes to the input MRI. In both scenarios dose calculations based on sCT were similar to those of CT suggesting a robust and reliable method.

OriginalsprogEngelsk
Artikelnummer100762
TidsskriftAdvances in Radiation Oncology
Vol/bind6
Udgave nummer6
ISSN2452-1094
DOI
StatusUdgivet - 2021

Bibliografisk note

Funding Information:
Disclosures: A.B.O. reports grants from the Danish Cancer Society and grants from Siemens Healthineers, during the conduct of the study. B.J. is an employee of Siemens Healthineers. K.H. reports grants from Varian Medical Systems, outside the submitted work. I.R.V. reports grants from Varian Medical Systems, and from ViewRay Inc., outside the submitted work. L.S. reports personal fees from Takeda, personal fees from Kyowa Kirin, nonfinancial support from MSD, grants from Varian, and grants from VewRay, outside the submitted work. S.F.B. reports grants from National Institute for Health Research and Social Care, during the conduct of the study; grants from Bristol Myers Squibb international corporation, grants from Pfizer Inc, grants from Amgen Ltd, outside the submitted work. C.T., A.E.H., J.H.R., G.K., T.G.U., A.M., C.N.L., A.K.B., F.L.A., and B.M.F. have nothing to disclose.

Funding Information:
Sources of support: This work was partially supported by the Danish Cancer Society (R134-A8543) and Siemens Healthineers. Support is also acknowledged from the National Institute for Health Research and Social Care (NIHR) (RP-2-16-07-001). King's College London and UCL Comprehensive Cancer Imaging Centre is funded by the CRUK and EPSRC in association with the MRC and Department of Health and Social Care (England). This work was also supported by the Wellcome/EPSRC Centre for Medical Engineering at King's College London (WT 203148/Z/16/Z). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

Publisher Copyright:
© 2021 The Authors

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