Comparison of different treatment planning approaches using VMAT for head and neck cancer patients with metallic dental fillings

A novel approach for eliminating metal artifacts based on MVCBCT and CycleGAN

PURPOSE

To develop a metal artifact reduction (MAR) algorithm and eliminate the adverse effects of metal artifacts on imaging diagnosis and radiotherapy dose calculations.

METHODS

Cycle-consistent adversarial network (CycleGAN) was used to generate synthetic CT (sCT) images from megavoltage cone beam CT (MVCBCT) images. In this study, there were 140 head cases with paired CT and MVCBCT images, from which 97 metal-free cases were used for training. Based on the trained model, metal-free sCT (sCT_MF) images and metal-containing sCT (sCT_M) images were generated from the MVCBCT images of 29 metal-free cases and 14 metal cases, respectively. Then, the sCT_MF and sCT_M images were quantitatively evaluated for imaging and dosimetry accuracy.

RESULTS

The structural similarity (SSIM) index of the sCT_MF and metal-free CT (CT_MF) images were 0.9484, and the peak signal-to-noise ratio (PSNR) was 31.4 dB. Compared with the CT images, the sCT_MF images had similar relative electron density (RED) and dose distribution, and their gamma pass rate (1 mm/1%) reached 97.99% ± 1.14%. The sCT_M images had high tissue resolution with no metal artifacts, and the RED distribution accuracy in the range of 1.003 to 1.056 was improved significantly. The RED and dose corrections were most significant for the planning target volume (PTV), mandible and oral cavity. The maximum correction of Dmean and D50 for the oral cavity reached 90 cGy.

CONCLUSIONS

Accurate sCT_M images were generated from MVCBCT images based on CycleGAN, which eliminated the metal artifacts in clinical images completely and corrected the RED and dose distributions accurately for clinical application.