Unsupervised pseudo CT generation using heterogenous multicentric CT/MR images and CycleGAN: Dosimetric assessment for 3D conformal radiotherapy

Purpose: Absorbed dose calculation in magnetic resonance-guided radiation therapy (MRgRT) is commonly based on pseudo CT (pCT) images. This study investigated the feasibility of unsupervised pCT generation from MRI using a cycle generative adversarial network (CycleGAN) and a heterogenous multicentric dataset. A dosimetric analysis in three-dimensional conformal radiotherapy (3DCRT) planning was also performed. Material and methods: Overall, 87 T1-weighted and 102 T2-weighted MR images alongside with their corre-sponding computed tomography (CT) images of brain cancer patients from multiple centers were used. Initially, images underwent a number of preprocessing steps, including rigid registration, novel CT Masker, N4 bias field correction, resampling, resizing, and rescaling. To overcome the gradient vanishing problem, residual blocks and mean squared error (MSE) loss function were utilized in the generator and in both networks (generator and discriminator), respectively. The CycleGAN was trained and validated using 70 T1 and 80 T2 randomly selected patients in an unsupervised manner. The remaining patients were used as a holdout test set to report final evaluation metrics. The generated pCTs were validated in the context of 3DCRT. Results: The CycleGAN model using masked T2 images achieved better performance with a mean absolute error (MAE) of 61.87 +/- 22.58 HU, peak signal to noise ratio (PSNR) of 27.05 +/- 2.25 (dB), and structural similarity index metric (SSIM) of 0.84 +/- 0.05 on the test dataset. T1-weighted MR images used for dosimetric assessment revealed a gamma index of 3%, 3 mm, 2%, 2 mm and 1%, 1 mm with acceptance criteria of 98.96%+/- 1.1%, 95% +/- 3.68%, 90.1% +/- 6.05%, respectively. The DVH differences between CTs and pCTs were within 2%. Conclusions: A promising pCT generation model capable of handling heterogenous multicenteric datasets was proposed. All MR sequences performed competitively with no significant difference in pCT generation. The proposed CT Masker proved promising in improving the model accuracy and robustness. There was no significant difference between using T1-weighted and T2-weighted MR images for pCT generation.