Predicting voxel-level dose distributions of single-isocenter volumetric modulated arc therapy treatment plan for multiple brain metastases

Abstract

Purpose: Brain metastasis is a common, life-threatening neurological problem for patients with cancer. Single-isocenter volumetric modulated arc therapy (VMAT) has been popularly used due to its highly conformal dose and short treatment time. Accurate prediction of its dose distribution can provide a general standard for evaluating the quality of treatment plan. In this study, a deep learning model is applied to the dose prediction of a single-isocenter VMAT treatment plan for radiotherapy of multiple brain metastases.

Method: A U-net with residual networks (U-ResNet) is employed for the task of dose prediction. The deep learning model is first trained from a database consisting of hundreds of historical treatment plans. The 3D dose distribution is then predicted with the input of the CT image and contours of regions of interest (ROIs). A total of 150 single-isocenter VMAT plans for multiple brain metastases are used for training and testing. The model performance is evaluated based on mean absolute error (MAE) and mean absolute differences of multiple dosimetric indexes (DIs), including (D _max and D _mean) for OARs, (D ₉₈, D ₉₅, D ₅₀, and D ₂) for PTVs, homogeneity index, and conformity index. The similarity between the predicted and clinically approved plan dose distribution is also evaluated.

Result: For 20 tested patients, the largest and smallest MAEs are 3.3% ± 3.6% and 1.3% ± 1.5%, respectively. The mean MAE for the 20 tested patients is 2.2% ± 0.7%. The mean absolute differences of D ₉₈, D ₉₅, D ₅₀, and D₂ for PTV60, PTV52, PTV50, and PTV40 are less than 2.5%, 3.0%, 2.0%, and 3.0%, respectively. The prediction accuracy of OARs for D _max and D _mean is within 3.2% and 1.2%, respectively. The average DSC ranges from 0.86 to 1 for all tested patients.

Conclusion: U-ResNet is viable to produce accurate dose distribution that is comparable to those of the clinically approved treatment plans. The predicted results can be used to improve current treatment planning design, plan quality, efficiency, etc.

Keywords: deep learning; dose prediction; multiple brain metastases; radiotherapy; volumetric modulated arc therapy.