Abstract

For prostate cancer patients, large organ deformations occurring between radiotherapy treatment sessions create uncertainty about the doses delivered to the tumor and surrounding healthy organs. Segmenting those regions on cone beam CT (CBCT) scans acquired on treatment day would reduce such uncertainties. In this work, a 3D U-net deep-learning architecture was trained to segment bladder, rectum, and prostate on CBCT scans. Due to the scarcity of contoured CBCT scans, the training set was augmented with CT scans already contoured in the current clinical workflow. Our network was then tested on 63 CBCT scans. The Dice similarity coefficient (DSC) increased significantly with the number of CBCT and CT scans in the training set, reaching 0.874 ± 0.096 , 0.814 ± 0.055 , and 0.758 ± 0.101 for bladder, rectum, and prostate, respectively. This was about 10% better than conventional approaches based on deformable image registration between planning CT and treatment CBCT scans, except for prostate. Interestingly, adding 74 CT scans to the CBCT training set allowed maintaining high DSCs, while halving the number of CBCT scans. Hence, our work showed that although CBCT scans included artifacts, cross-domain augmentation of the training set was effective and could rely on large datasets available for planning CT scans.

Highlights

  • Fractionated external beam radiotherapy (EBRT) cancer treatment relies on two steps

  • We assess the performance of our algorithm in terms of overlap (i.e., Dice similarity coefficient (DSC) and Jaccard index (JI)), distance (i.e., symmetric mean boundary distance (SMBD)), and volume agreement measurements

  • We further evaluate the performance of our best algorithm (i.e., 3D U-net trained with all available computed tomography (CT) and cone beam computed tomography (CBCT) scans) by assessing whether the predicted organ volumes are in good agreement with the volumes determined by manual segmentation

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Summary

Introduction

Fractionated external beam radiotherapy (EBRT) cancer treatment relies on two steps. In the treatment planning phase, clinicians delineate the tumor and surrounding healthy organs’ volumes on a computed tomography (CT) scan and compute the dose distribution. In the treatment delivery phase, the patient is aligned with a specific treatment planning position, and the dose fraction is delivered. Patient positioning relies on a daily cone beam computed tomography (CBCT) scan acquired in the treatment position before each treatment fraction is delivered. Scattering is an important limitation that could rule out the use of CBCT for radiotherapy treatment planning [1].

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