MR-Only Brain Radiation Therapy: Dosimetric Evaluation of Synthetic CTs Generated by a Dilated Convolutional Neural Network

Purpose This work aims to facilitate a fast magnetic resonance (MR)-only workflow for radiation therapy of intracranial tumors. Here, we evaluate whether synthetic computed tomography (sCT) images generated with a dilated convolutional neural network (CNN) enable accurate MR-based dose calculations in the brain. Methods and Materials We conducted a retrospective study of 52 patients with brain tumors who underwent both computed tomography (CT) and MR imaging for radiation therapy treatment planning. To generate the sCTs, a T1-weighted gradient echo MR sequence was selected from the clinical protocol for multiple types of brain tumors. sCTs were created for all 52 patients with a dilated CNN using 2-fold cross validation; in each fold, 26 patients were used for training and the remaining 26 patients were used for evaluation. For each patient, the clinical CT-based treatment plan was recalculated on sCT. We calculated dose differences and gamma pass rates between CT- and sCT-based plans inside body and planning target volume. Geometric fidelity of the sCT and differences in beam depth and equivalent path length were assessed between both treatment plans. Results sCT generation took 1 minute per patient. Over the patient population, the mean absolute error of the sCT within the intersection of body contours was 67 ± 11 HU (±1 standard deviation [SD], range: 51-117 HU), and the mean error was 13 ± 9 HU (±1 SD, range: –2 to 38 HU). Dosimetric analysis showed mean deviations of 0.00% ± 0.02% (±1 SD, range: –0.05 to 0.03) for dose within the body contours and –0.13% ± 0.39% (±1 SD, range: –1.43 to 0.80) inside the planning target volume. Mean γ1mm/1% was 98.8% ± 2.2% for doses >50% of the prescribed dose. Conclusions The presented dilated CNN generated sCTs from conventional MR images without adding scan time to the acquisition. Dosimetric evaluation suggests that dose calculations performed on the sCTs are accurate and can therefore be used for MR-only intracranial radiation therapy treatment planning.