Section: New Results
Comparative study of algorithms for synthetic CT generation from MRI: Consequences for MRI-guided radiation planning in the pelvic region
Participants : Hossein Arabi, Jason A. Dowling, Ninon Burgos [Correspondant] , Xiao Han, Peter B. Greer, Nikolaos Koutsouvelis, Habib Zaidi.
Magnetic resonance imaging (MRI)-guided radiation therapy (RT) treatment planning is limited by the fact that the electron density distribution required for dose calculation is not readily provided by MR imaging. We compare a selection of novel synthetic CT generation algorithms recently reported in the literature, including segmentation-based, atlas-based and machine learning techniques, using the same cohort of patients and quantitative evaluation metrics. Six MRI-guided synthetic CT generation algorithms were evaluated: one segmentation technique into a single tissue class (water-only), four atlas-based techniques, namely, median value of atlas images (ALMedian), atlas-based local weighted voting (ALWV), bone enhanced atlas-based local weighted voting (ALWV-Bone), iterative atlas-based local weighted voting (ALWV-Iter), and a machine learning technique using deep convolution neural network (DCNN). Organ auto-contouring from MR images was evaluated for bladder, rectum, bones, and body boundary. Overall, DCNN exhibited higher segmentation accuracy resulting in Dice indices while ALMedian showed the lowest accuracy. DCNN reached the best performance in terms of accurate derivation of synthetic CT values within each organ, followed by the advanced atlas-based methods. ALMedian led to the highest error. Considering the dosimetric evaluation results, ALWV-Iter, ALWV, DCNN and ALWV-Bone led to similar mean dose estimation within each organ at risk and target volume with less than 1% dose discrepancy. However, the two-dimensional gamma analysis demonstrated higher pass rates for ALWV-Bone, DCNN, ALMedian and ALWV-Iter at 1%/1 mm criterion. Overall, machine learning and advanced atlas-based methods exhibited promising performance by achieving reliable organ segmentation and synthetic CT generation. DCNN appears to have slightly better performance by achieving accurate automated organ segmentation and relatively small dosimetric errors (followed closely by advanced atlas-based methods, which in some cases achieved similar performance). However, the DCNN approach showed higher vulnerability to anatomical variation, where a greater number of outliers was observed with this method. Considering the dosimetric results obtained from the evaluated methods, the challenge of electron density estimation from MR images can be resolved with a clinically tolerable error.
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