Adaptive assessment based on fractional CBCT images for cervical cancer

Abstract Purpose Anatomical and other changes during radiotherapy will cause inaccuracy of dose distributions, therefore the expectation for online adaptive radiation therapy (ART) is high in effectively reducing uncertainties due to intra‐variation. However, ART requires extensive time and effort. This study investigated an adaptive assessment workflow based on fractional cone‐beam computed tomography (CBCT) images. Methods Image registration, synthetic CT (sCT) generation, auto‐segmentation, and dose calculation were implemented and integrated into ArcherQA Adaptive Check. The rigid registration was based on ITK open source. The deformable image registration (DIR) method was based on a 3D multistage registration network, and the sCT generation method was performed based on a 2D cycle‐consistent adversarial network (CycleGAN). The auto‐segmentation of organs at risk (OARs) on sCT images was finished by a deep learning‐based auto‐segmentation software, DeepViewer. The contours of targets were obtained by the structure‐guided registration. Finally, the dose calculation was based on a GPU‐based Monte Carlo (MC) dose code, ArcherQA. Results The dice similarity coefficient (DSCs) were over 0.86 for target volumes and over 0.79 for OARs. The gamma pass rate of ArcherQA versus Eclipse treatment planning system was more than 99% at the 2%/2 mm criterion with a low‐dose threshold of 10%. The time for the whole process was less than 3 min. The dosimetric results of ArcherQA Adaptive Check were consistent with the Ethos scheduled plan, which can effectively identify the fractions that need the implementation of the Ethos adaptive plan. Conclusion This study integrated AI‐based technologies and GPU‐based MC technology to evaluate the dose distributions using fractional CBCT images, demonstrating remarkably high efficiency and precision to support future ART processes.