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Register a new userComprehensive Evaluations of Cone-beam CT dose in Image-guided Radiation Therapy via GPU-based Monte Carlo simulations
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Cone beam CT (CBCT) has been widely used for patient setup in image guided radiation therapy (IGRT). Radiation dose from CBCT scans has become a clinical concern. The purposes of this study are 1) to commission a GPU-based Monte Carlo (MC) dose calculation package gCTD for Varian On-Board Imaging (OBI) system and test the calculation accuracy, and 2) to quantitatively evaluate CBCT dose from the OBI system in typical IGRT scan protocols. We first conducted dose measurements in a water phantom. X-ray source model parameters used in gCTD are obtained through a commissioning process. gCTD accuracy is demonstrated by comparing calculations with measurements in water and in CTDI phantoms. 25 brain cancer patients are used to study dose in a standard-dose head protocol, and 25 prostate cancer patients are used to study dose in pelvis protocol and pelvis spotlight protocol. Mean dose to each organ is calculated. Mean dose to 2% voxels that have the highest dose is also computed to quantify the maximum dose. It is found that the mean dose value to an organ varies largely among patients. Moreover, dose distribution is highly non-homogeneous inside an organ. The maximum dose is found to be 1~3 times higher than the mean dose depending on the organ, and is up to 8 times higher for the entire body due to the very high dose region in bony structures. High computational efficiency has also been observed in our studies, such that MC dose calculation time is less than 5 min for a typical case.
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While compressed sensing (CS) based reconstructions have been developed for low-dose CBCT, a clear understanding on the relationship between the image quality and imaging dose at low dose levels is needed. In this paper, we qualitatively investigate this subject in a comprehensive manner with extensive experimental and simulation studies. The basic idea is to plot image quality and imaging dose together as functions of number of projections and mAs per projection over the whole clinically relevant range. A clear understanding on the tradeoff between image quality and dose can be achieved and optimal low-dose CBCT scan protocols can be developed for various imaging tasks in IGRT. Main findings of this work include: 1) Under the CS framework, image quality has little degradation over a large dose range, and the degradation becomes evident when the dose < 100 total mAs. A dose < 40 total mAs leads to a dramatic image degradation. Optimal low-dose CBCT scan protocols likely fall in the dose range of 40-100 total mAs, depending on the specific IGRT applications. 2) Among different scan protocols at a constant low-dose level, the super sparse-view reconstruction with projection number less than 50 is the most challenging case, even with strong regularization. Better image quality can be acquired with other low mAs protocols. 3) The optimal scan protocol is the combination of a medium number of projections and a medium level of mAs/view. This is more evident when the dose is around 72.8 total mAs or below and when the ROI is a low-contrast or high-resolution object. Based on our results, the optimal number of projections is around 90 to 120. 4) The clinically acceptable lowest dose level is task dependent. In our study, 72.8mAs is a safe dose level for visualizing low-contrast objects, while 12.2 total mAs is sufficient for detecting high-contrast objects of diameter greater than 3 mm.
Adaptive radiotherapy (ART), especially online ART, effectively accounts for positioning errors and anatomical changes. One key component of online ART is accurately and efficiently delineating organs at risk (OARs) and targets on online images, such as CBCT, to meet the online demands of plan evaluation and adaptation. Deep learning (DL)-based automatic segmentation has gained great success in segmenting planning CT, but its applications to CBCT yielded inferior results due to the low image quality and limited available contour labels for training. To overcome these obstacles to online CBCT segmentation, we propose a registration-guided DL (RgDL) segmentation framework that integrates image registration algorithms and DL segmentation models. The registration algorithm generates initial contours, which were used as guidance by DL model to obtain accurate final segmentations. We had two implementations the proposed framework--Rig-RgDL (Rig for rigid body) and Def-RgDL (Def for deformable)--with rigid body (RB) registration or deformable image registration (DIR) as the registration algorithm respectively and U-Net as DL model architecture. The two implementations of RgDL framework were trained and evaluated on seven OARs in an institutional clinical Head and Neck (HN) dataset. Compared to the baseline approaches using the registration or the DL alone, RgDL achieved more accurate segmentation, as measured by higher mean Dice similarity coefficients (DSC) and other distance-based metrics. Rig-RgDL achieved a DSC of 84.5% on seven OARs on average, higher than RB or DL alone by 4.5% and 4.7%. The DSC of Def-RgDL is 86.5%, higher than DIR or DL alone by 2.4% and 6.7%. The inference time took by the DL model to generate final segmentations of seven OARs is less than one second in RgDL. The resulting segmentation accuracy and efficiency show the promise of applying RgDL framework for online ART.
High radiation dose in CT scans increases a lifetime risk of cancer and has become a major clinical concern. Recently, iterative reconstruction algorithms with Total Variation (TV) regularization have been developed to reconstruct CT images from highly undersampled data acquired at low mAs levels in order to reduce the imaging dose. Nonetheless, TV regularization may lead to over-smoothed images and lost edge information. To solve this problem, in this work we develop an iterative CT reconstruction algorithm with edge-preserving TV regularization to reconstruct CT images from highly undersampled data obtained at low mAs levels. The CT image is reconstructed by minimizing an energy consisting of an edge-preserving TV norm and a data fidelity term posed by the x-ray projections. The edge-preserving TV term is proposed to preferentially perform smoothing only on non-edge part of the image in order to avoid over-smoothing, which is realized by introducing a penalty weight to the original total variation norm. Our iterative algorithm is implemented on GPU to improve its speed. We test our reconstruction algorithm on a digital NCAT phantom, a physical chest phantom, and a Catphan phantom. Reconstruction results from a conventional FBP algorithm and a TV regularization method without edge preserving penalty are also presented for comparison purpose. The experimental results illustrate that both TV-based algorithm and our edge-preserving TV algorithm outperform the conventional FBP algorithm in suppressing the streaking artifacts and image noise under the low dose context. Our edge-preserving algorithm is superior to the TV-based algorithm in that it can preserve more information of fine structures and therefore maintain acceptable spatial resolution.
Purpose: This paper describes a new method to apply deep-learning algorithms for automatic segmentation of radiosensitive organs from 3D tomographic CT images before computing organ doses using a GPU-based Monte Carlo code. Methods: A deep convolutional neural network (CNN) for organ segmentation is trained to automatically delineate radiosensitive organs from CT. With a GPU-based Monte Carlo dose engine (ARCHER) to derive CT dose of a phantom made from a subjects CT scan, we are then able to compute the patient-specific CT dose for each of the segmented organs. The developed tool is validated by using Relative Dose Error (RDE) against the organ doses calculated by ARCHER with manual segmentation performed by radiologists. The dose computation results are also compared against organ doses from population-average phantoms to demonstrate the improvement achieved by using the developed tool. In this study, two datasets were used: The Lung CT Segmentation Challenge 2017 (LCTSC) dataset, which contains 60 thoracic CT scan patients each with 5 segmented organs, and the Pancreas-CT (PCT) dataset, which contains 43 abdominal CT scan patients each with 8 segmented organs. Five-fold cross-validation of the new method is performed on both datasets. Results: Comparing with the traditional organ dose evaluation method that based on population-average phantom, our proposed method achieved the smaller RDE range on all organs with -4.3%~1.5% vs -31.5%~33.9% (lung), -7.0%~2.3% vs -15.2%~125.1% (heart), -18.8%~40.2% vs -10.3%~124.1% (esophagus) in the LCTSC dataset and -5.6%~1.6% vs -20.3%~57.4% (spleen), -4.5%~4.6% vs -19.5%~61.0% (pancreas), -2.3%~4.4% vs -37.8%~75.8% (left kidney), -14.9%~5.4% vs -39.9% ~14.6% (gall bladder), -0.9%~1.6% vs -30.1%~72.5% (liver), and -23.0%~11.1% vs -52.5%~-1.3% (stomach) in the PCT dataset.
Cancer is a primary cause of morbidity and mortality worldwide. The radiotherapy plays a more and more important role in cancer treatment. In the radiotherapy, the dose distribution maps in patient need to be calculated and evaluated for the purpose of killing tumor and protecting healthy tissue. Monte Carlo (MC) radiation transport calculation is able to account for all aspects of radiological physics within 3D heterogeneous media such as the human body and generate the dose distribution maps accurately. However, an MC calculation for doses in radiotherapy usually takes a great mass of time to achieve acceptable statistical uncertainty, impeding the MC methods from wider clinic applications. Here we introduce a convolutional neural network (CNN), termed as Monte Carlo Denoising Net (MCDNet), to achieve the acceleration of the MC dose calculations in radiotherapy, which is trained to directly predict the high-photon (noise-free) dose maps from the low-photon (noise-much) dose maps. Thirty patients with postoperative rectal cancer who accepted intensity-modulated radiation therapy (IMRT) were enrolled in this study. 3D Gamma Index Passing Rate (GIPR) is used to evaluate the performance of predicted dose maps. The experimental results demonstrate that the MCDNet can improve the GIPR of dose maps of 1x107 photons over that of 1x108 photons, yielding over 10x speed-up in terms of photon numbers used in the MC simulations of IMRT. It is of great potential to investigate the performance of this method on the other tumor sites and treatment modalities.
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