Dosimetric and workflow evaluation of first commercial synthetic CT software for clinical use in pelvis Journal Article


Authors: Tyagi, N.; Fontenla, S.; Zhang, J.; Cloutier, M.; Kadbi, M.; Mechalakos, J.; Zelefsky, M.; Deasy, J.; Hunt, M.
Article Title: Dosimetric and workflow evaluation of first commercial synthetic CT software for clinical use in pelvis
Abstract: To evaluate a commercial synthetic CT (syn-CT) software for use in prostate radiotherapy. Twenty-five prostate patients underwent CT and MR simulation scans in treatment position on a 3T MR scanner. A commercially available MR protocol was used that included a T2w turbo spin-echo sequence for soft-tissue contrast and a dual echo 3D mDIXON fast field echo (FFE) sequence for generating syn-CT. A dual-echo 3D FFE B 0 map was used for patient-induced susceptibility distortion analysis and a new 3D balanced-FFE sequence was evaluated for identification of implanted gold fiducial markers and subsequent image-guidance during radiotherapy delivery. Tissues were classified as air, adipose, water, trabecular/spongy bone and compact/cortical bone and assigned bulk HU values. The accuracy of syn-CT for treatment planning was analyzed by transferring the structures and plan from planning CT to syn-CT and recalculating the dose. Accuracy of localization at the treatment machine was evaluated by comparing registration of kV radiographs to either digitally reconstructed radiographs (DRRs) generated from syn-CT or traditional DRRs generated from the planning CT. Similarly, accuracy of setup using CBCT and syn-CT was compared to that using the planning CT. Finally, a MR-only simulation workflow was established and end-to-end testing was completed on five patients undergoing MR-only simulation. Dosimetric comparison between the original CT and syn-CT plans was within 0.5% on average for all structures. The de-novo optimized plans on the syn-CT met institutional clinical objectives for target and normal structures. Patient-induced susceptibility distortion based on B 0 maps was within 1 mm and 0.5 mm in the body and prostate respectively. DRR and CBCT localization based on MR-localized fiducials showed a standard deviation of <1 mm. End-to-end testing and MR simulation workflow was successfully validated. MRI derived synthetic CT can be successfully used for a MR-only planning and treatment for prostate radiotherapy. © 2017 Institute of Physics and Engineering in Medicine.
Keywords: treatment planning; radiotherapy; prostate cancer; computerized tomography; dosimetry; urology; bone; radiography; patient treatment; prostate cancers; diseases; tissue; standard deviation; prostate radiotherapy; clinical workflow; mrcat; synthetic ct; digitally reconstructed radiographs; distortion analysis
Journal Title: Physics in Medicine and Biology
Volume: 62
Issue: 8
ISSN: 0031-9155
Publisher: IOP Publishing Ltd  
Date Published: 2017-04-21
Start Page: 2961
End Page: 2975
Language: English
DOI: 10.1088/1361-6560/aa5452
PROVIDER: scopus
PUBMED: 27983520
PMCID: PMC5541676
DOI/URL:
Notes: Article -- Export Date: 2 May 2017 -- Source: Scopus
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MSK Authors
  1. Michael J Zelefsky
    754 Zelefsky
  2. Joseph Owen Deasy
    524 Deasy
  3. Margie A Hunt
    287 Hunt
  4. Neelam Tyagi
    151 Tyagi
  5. Jing   Zhang
    6 Zhang