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      Fluence-map generation for prostate intensity-modulated radiotherapy planning using a deep-neural-network

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          Abstract

          A deep-neural-network (DNN) was successfully used to predict clinically-acceptable dose distributions from organ contours for intensity-modulated radiotherapy (IMRT). To provide the next step in the DNN-based plan automation, we propose a DNN that directly generates beam fluence maps from the organ contours and volumetric dose distributions, without inverse planning. We collected 240 prostate IMRT plans and used to train a DNN using organ contours and dose distributions. After training was done, we made 45 synthetic plans (SPs) using the generated fluence-maps and compared them with clinical plans (CP) using various plan quality metrics including homogeneity and conformity indices for the target and dose constraints for organs at risk, including rectum, bladder, and bowel. The network was able to generate fluence maps with small errors. The qualities of the SPs were comparable to the corresponding CPs. The homogeneity index of the target was slightly worse in the SPs, but there was no difference in conformity index of the target, V 60Gy of rectum, the V 60Gy of bladder and the V 45Gy of bowel. The time taken for generating fluence maps and qualities of SPs demonstrated the proposed method will improve efficiency of the treatment planning and help maintain the quality of plans.

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          Most cited references18

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          Loss Functions for Image Restoration With Neural Networks

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            MR-based synthetic CT generation using a deep convolutional neural network method.

            Xiao Han (2017)
            Interests have been rapidly growing in the field of radiotherapy to replace CT with magnetic resonance imaging (MRI), due to superior soft tissue contrast offered by MRI and the desire to reduce unnecessary radiation dose. MR-only radiotherapy also simplifies clinical workflow and avoids uncertainties in aligning MR with CT. Methods, however, are needed to derive CT-equivalent representations, often known as synthetic CT (sCT), from patient MR images for dose calculation and DRR-based patient positioning. Synthetic CT estimation is also important for PET attenuation correction in hybrid PET-MR systems. We propose in this work a novel deep convolutional neural network (DCNN) method for sCT generation and evaluate its performance on a set of brain tumor patient images.
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              Variation in external beam treatment plan quality: An inter-institutional study of planners and planning systems.

              This study quantifies variation in radiation treatment plan quality for plans generated by a population of treatment planners given very specific plan objectives. A "Plan Quality Metric" (PQM) with 14 submetrics, each with a unique value function, was defined for a prostate treatment plan, serving as specific goals of a hypothetical "virtual physician." The exact PQM logic was distributed to a population of treatment planners (to remove ambiguity of plan goals or plan assessment methodology) as was a predefined computed tomographic image set and anatomic structure set (to remove anatomy delineation as a variable). Treatment planners used their clinical treatment planning system (TPS) to generate their best plan based on the specified goals and submitted their results for analysis. One hundred forty datasets were received and 125 plans accepted and analyzed. There was wide variability in treatment plan quality (defined as the ability of the planners and plans to meet the specified goals) quantified by the PQM. Despite the variability, the resulting PQM distributions showed no statistically significant difference between TPS employed, modality (intensity modulated radiation therapy versus arc), or education and certification status of the planner. The PQM results showed negligible correlation to number of beam angles, total monitor units, years of experience of the planner, or planner confidence. The ability of the treatment planners to meet the specified plan objectives (as quantified by the PQM) exhibited no statistical dependence on technologic parameters (TPS, modality, plan complexity), nor was the plan quality statistically different based on planner demographics (years of experience, confidence, certification, and education). Therefore, the wide variation in plan quality could be attributed to a general "planner skill" category that would lend itself to processes of continual improvement where best practices could be derived and disseminated to improve the mean quality and minimize the variation in any population of treatment planners. Copyright © 2012 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                cho.byungchul@gmail.com
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                30 October 2019
                30 October 2019
                2019
                : 9
                : 15671
                Affiliations
                [1 ]ISNI 0000 0001 2292 0500, GRID grid.37172.30, Department of Nuclear and Quantum Engineering, , Korea Advanced Institute of Science and Technology, ; Daejeon, South Korea
                [2 ]ISNI 0000 0004 0533 4667, GRID grid.267370.7, Department of Radiation Oncology, Asan Medical Center, , University of Ulsan College of Medicine, ; Seoul, South Korea
                Author information
                http://orcid.org/0000-0001-7982-8510
                Article
                52262
                10.1038/s41598-019-52262-x
                6821767
                31666647
                0101d023-29c3-4aa3-ab19-9afa5bd8d16e
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 15 January 2019
                : 10 October 2019
                Funding
                Funded by: FundRef https://doi.org/10.13039/501100003725, National Research Foundation of Korea (NRF);
                Award ID: 2013M2A2A7043506
                Award ID: 2013M2A2A7043506
                Award Recipient :
                Categories
                Article
                Custom metadata
                © The Author(s) 2019

                Uncategorized
                prostate cancer,radiotherapy
                Uncategorized
                prostate cancer, radiotherapy

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