A Dual Energy CT-Guided Intelligent Radiation Therapy Platform.

Abstract

Purpose: The integration of advanced imaging and artificial intelligence (AI) technologies in radiotherapy has revolutionized cancer treatment by enhancing precision and adaptability. This study introduces a novel Dual Energy CT (DECT)-Guided Intelligent Radiation Therapy (DEIT) platform designed to streamline and optimize the radiotherapy process. The DEIT system combines DECT, a newly designed dual-layer multi-leaf collimator, deep learning algorithms for auto-segmentation, automated planning and QA capabilities.

Methods: The DEIT system integrates an 80-slice CT scanner with an 87 cm bore size, a linear accelerator delivering four photon and five electron energies, and a flat panel imager optimized for MV Cone Beam CT acquisition. A comprehensive evaluation of the system's accuracy was conducted using end-to-end tests. Virtual monoenergetic CT images and electron density images of the DECT were generated and compared on both phantom and patient. The system's auto-segmentation algorithms were tested on five cases for each of the 99 organs at risk, and the automated optimization and planning capabilities were evaluated on clinical cases.

Results: The DEIT system demonstrated systematic errors of less than 1 mm for target localization. DECT reconstruction showed electron density mapping deviations ranging from -0.052 to 0.001, with stable HU consistency across monoenergetic levels above 60 keV, except for high-Z materials at lower energies. Auto-segmentation achieved dice similarity coefficients above 0.9 for most organs with inference time less than 2 seconds. Dose-volume histogram (DVH) comparisons showed improved dose conformity indices and reduced doses to critical structures in Auto-plans compared to Manual Plans across various clinical cases. Additionally, high gamma passing rates at 2%/2mm in both 2D (above 97%) and 3D (above 99%) in vivo analyses further validate the accuracy and reliability of treatment plans.

Conclusions: The DEIT platform represents a viable solution for radiation treatment. The DEIT system utilizes AI-driven automation, real-time adjustments, and CT imaging to enhance the radiotherapy process, improving both efficiency and flexibility.