A Preliminary Study on Deep Learning-Based Plan Quality Prediction in Gamma Knife Radiosurgery for Brain Metastases.

Background/objectives: GK plan quality is strongly affected by lesion size and shape, and the same evaluation metrics may not be directly comparable across patients with different anatomies. This study proposes a deep learning-based method to predict achievable, clinically acceptable plan quality from patient-specific geometry.

Methods: A hierarchically densely connected U-Net (HD-U-Net) was trained at the lesion level to predict 3D dose distributions for the estimation of plan quality metrics, including coverage, selectivity, gradient index (GI), and conformity index at a 50% prescription dose (CI50). To improve the prediction accuracy of plan quality metrics, Dice similarity coefficient losses for the 100% and 50% isodose lines were incorporated with conventional mean squared error (MSE) loss.

Results: Ten-fold cross-validation on 463 brain metastases (BMs) from 175 patients showed that our method achieved smaller mean absolute errors across all four metrics than the HD-U-Net baseline trained with MSE loss. Improvements were pronounced in all metrics for small metastases, and were observed primarily in GI and CI50 for medium and large lesions. Paired Wilcoxon signed-rank tests confirmed the statistical significance of these improvements (p < 0.05).

Conclusions: The proposed method outperformed the baseline model in capturing overall trends, improving per-lesion accuracy, and enhancing robustness to dataset variability. It can serve as a pre-planning tool to guide planners in constraint setting and priority tuning, a post-planning quality control tool to identify subpar plans that could be substantially improved, and as a foundation for developing deep reinforcement learning-based automated planning of GK treatments for brain metastases.