AI-Based Quantification of Planned Radiation Therapy Dose to Cardiac Structures and Coronary Arteries in Patients With Breast Cancer

Abstract

The purpose of this work is to develop and evaluate an automatic deep learning method for segmentation of cardiac chambers and large arteries, and localization of the 3 main coronary arteries in radiation therapy planning on computed tomography (CT). In addition, a second purpose is to determine the planned radiation therapy dose to cardiac structures for breast cancer therapy. Eighteen contrast-enhanced cardiac scans acquired with a dual-layer-detector CT scanner were included for method development. Manual reference annotations of cardiac chambers, large arteries, and coronary artery locations were made in the contrast scans and transferred to virtual noncontrast images, mimicking noncontrast-enhanced CT. In addition, 31 noncontrast-enhanced radiation therapy treatment planning CTs with corresponding dose-distribution maps of breast cancer cases were included for evaluation. For reference, cardiac chambers and large vessels were manually annotated in two 2-dimensional (2D) slices per scan (26 scans, totaling 52 slices) and in 3-dimensional (3D) scan volumes in 5 scans. Coronary artery locations were annotated on 3D imaging. The method uses an ensemble of convolutional neural networks with 2 output branches that perform 2 distinct tasks: (1) segmentation of the cardiac chambers and large arteries and (2) localization of coronary arteries. Training was performed using reference annotations and virtual noncontrast cardiac scans. Automatic segmentation of the cardiac chambers and large vessels and the coronary artery locations was evaluated in radiation therapy planning CT with Dice score (DSC) and average symmetrical surface distance (ASSD). The correlation between dosimetric parameters derived from the automatic and reference segmentations was evaluated with R2. For cardiac chambers and large arteries, median DSC was 0.76 to 0.88, and the median ASSD was 0.17 to 0.27 cm in 2D slice evaluation. 3D evaluation found a DSC of 0.87 to 0.93 and an ASSD of 0.07 to 0.10 cm. Median DSC of the coronary artery locations ranged from 0.80 to 0.91. R2 values of dosimetric parameters were 0.77 to 1.00 for the cardiac chambers and large vessels, and 0.76 to 0.95 for the coronary arteries. The developed and evaluated method can automatically obtain accurate estimates of planned radiation dose and dosimetric parameters for the cardiac chambers, large arteries, and coronary arteries.