Objective To develop high-quality synthetic CT (sCT) generation method from low-dose cone-beam CT (CBCT) images by using attention-guided generative adversarial networks (AGGAN) and apply these images to dose calculations in radiotherapy. Methods The CBCT/planning CT images of 170 patients undergoing thoracic radiotherapy were used for training and testing. The CBCT images were scanned under a fast protocol with 50% less clinical projection frames compared with standard chest M20 protocol. Training with aligned paired images was performed using conditional adversarial networks (so-called pix2pix), and training with unpaired images was carried out with cycle-consistent adversarial networks (cycleGAN) and AGGAN, through which sCT images were generated. The image quality and Hounsfield unit (HU) value of the sCT images generated by the three neural networks were compared. The treatment plan was designed on CT and copied to sCT images to calculated dose distribution. Results The image quality of sCT images by all the three methods are significantly improved compared with original CBCT images. The AGGAN achieves the best image quality in the testing patients with the smallest mean absolute error (MAE, 43.5 ± 6.69), largest structural similarity (SSIM, 93.7 ± 3.88) and peak signal-to-noise ratio (PSNR, 29.5 ± 2.36). The sCT images generated by all the three methods showed superior dose calculation accuracy with higher gamma passing rates compared with original CBCT image. The AGGAN offered the highest gamma passing rates (91.4 ± 3.26) under the strictest criteria of 1 mm/1% compared with other methods. In the phantom study, the sCT images generated by AGGAN demonstrated the best image quality and the highest dose calculation accuracy. Conclusions High-quality sCT images were generated from low-dose thoracic CBCT images by using the proposed AGGAN through unpaired CBCT and CT images. The dose distribution could be calculated accurately based on sCT images in radiotherapy.

Objective: To generate virtual non-contrast (VNC) computed tomography (CT) from intravenous enhanced CT through convolutional neural networks (CNN) and compare calculated dose among enhanced CT, VNC, and real non-contrast scanning. Method: 50 patients who accepted non-contrast and enhanced CT scanning before and after intravenous contrast agent injections were selected, and two sets of CT images were registered. A total of 40 and 10 groups were used as training and test datasets, respectively. The U-Net architecture was applied to learn the relationship between the enhanced and non-contrast CT. VNC images were generated in the test through the trained U-Net. The CT values of non-contrast, enhanced and VNC CT images were compared. The radiotherapy treatment plans for esophageal cancer were designed, and dose calculation was performed. Dose distributions in the three image sets were compared. Results: The mean absolute error of CT values between enhanced and non-contrast CT reached 32.3 ± 2.6 HU, and that between VNC and non-contrast CT totaled 6.7 ± 1.3 HU. The average CT values in enhanced CT of great vessels, heart, lungs, liver, and spinal cord were all significantly higher than those of non-contrast CT (p < 0.05), with the differences reaching 97, 83, 42, 40, and 10 HU, respectively. The average CT values of the organs in VNC CT showed no significant differences from those in non-contrast CT. The relative dose differences of the enhanced and non-contrast CT were −1.2, −1.3, −2.1, and −1.5% in the comparison of mean doses of planned target volume, heart, great vessels, and lungs, respectively. The mean dose calculated by VNC CT showed no significant difference from that by non-contrast CT. The average γ passing rate (2%, 2 mm) of VNC CT image was significantly higher than that of enhanced CT image (0.996 vs. 0.973, p < 0.05). Liugang et al. Non-contrast CT Generated From Enhanced Conclusion: Designing a treatment plan based on enhanced CT will enlarge the dose calculation uncertainty in radiotherapy. This paper proposed the generation of VNC CT images from enhanced CT images based on U-Net architecture. The dose calculated through VNC CT images was identical with that obtained through real non-contrast CT.

This study proposes a new method for removal of metal artifacts from megavoltage cone beam computed tomography (MVCBCT) and kilovoltage CT (kVCT) images. Both images were combined to obtain prior image, which was forward projected to obtain surrogate data and replace metal trace in the uncorrected kVCT image. The corrected image was then reconstructed through filtered back projection. A similar radiotherapy plan was designed using the theoretical CT image, the uncorrected kVCT image, and the corrected image. The corrected images removed most metal artifacts, and the CT values were accurate. The corrected image also distinguished the hollow circular hole at the center of the metal. The uncorrected kVCT image did not display the internal structure of the metal, and the hole was misclassified as metal portion. Dose distribution calculated based on the corrected image was similar to that based on the theoretical CT image. The calculated dose distribution also evidently differed between the uncorrected kVCT image and the theoretical CT image. The use of the combined kVCT and MVCBCT to obtain the prior image can distinctly improve the quality of CT images containing large metal implants.

Magnetic resonance imaging (MRI) plays an important role in clinical diagnosis, but it is susceptible to metal artifacts. The generative adversarial network GatedConv with gated convolution (GC) and contextual attention (CA) was used to inpaint the metal artifact region in MRI images. Methods: MRI images containing or near the teeth of 70 patients were collected, and the scanning sequence was a T1-weighted high-resolution isotropic volume examination sequence. A total of 10 000 slices were obtained after data enhancement, of which 8000 slices were used for training. MRI images were normalized to [−1,1]. Based on the randomly generated mask, U-Net, pix2pix, PConv with partial convolution, and GatedConv were used to inpaint the artifact region of MRI images. The mean absolute error (MAE) and peak signal-to-noise ratio (PSNR) for the mask were used to compare the results of these methods. The inpainting effect on the test dataset using dental masks was also evaluated. Besides, the artifact area of clinical MRI images was inpainted based on the mask sketched by physicians. Finally, the earring artifacts and artifacts caused by abnormal signal foci were inpainted to verify the generalization of the models. Results: GatedConv could directly and effectively inpaint the incomplete MRI images generated by masks in the image domain. For the results of U-Net, pix2pix, PConv, and GatedConv, the masked MAEs were 0.1638, 0.1812, 0.1688, and 0.1596, respectively, and the masked PSNRs were 18.2136, 17.5692, 18.2258, and 18.3035 dB, respectively. Using dental masks, the results of U-Net, pix2pix, and PConv differed more from the real images in terms of alveolar shape and surrounding tissue compared with GatedConv. GatedConv could inpaint the metal artifact region in clinical MRI images more effectively than the other models, but the increase in the mask area could reduce the inpainting effect. Inpainted MRI images by GatedConv and CT images with metal artifact reduction coincided with alveolar and tissue structure, and GatedConv could successfully inpaint artifacts caused by abnormal signal foci, whereas the other models failed. The ablation study demonstrated that GC and CA increased the reliability of the inpainting performance of GatedConv. Conclusion: MRI images are affected by metal, and signal void areas appear near metal. GatedConv can inpaint the MRI metal artifact region in the image domain directly and effectively and improve image quality. Medical image inpainting by GatedConv has potential value for tasks,such as positron emission tomography (PET) attenuation correction in PET/MRI and adaptive radiotherapy of synthetic CT based on MRI.Kai Xie and Liugang Gao equal contribution.

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A 16-bit imaging technology of metal implants can distinguish the computed tomography value of different metal materials. Furthermore, the revised 16-bit imaging technology can improve the dose computational accuracy of radiotherapy plan with high-density metal implants.

Background: Cone-beam computed tomography (CBCT) is widely used for daily image guidance in radiation therapy, enhancing the reproducibility of patient setup. However, its application in adaptive radiotherapy (ART) is limited by many imaging artifacts and inaccurate Hounsfield units (HUs). The correction of CBCT image is necessary and of great value for CBCT-based ART. Purpose: To explore the synthetic CT (sCT) generation from CBCT images of thorax and abdomen patients, which usually surfer from serious artifacts duo to organ state changes. In this study, a streaking artifact reduction network (SARN) is proposed to reduce artifacts and combine with cycleGAN to generate highquality sCT images from CBCT and achieve an accurate dose calculation. Methods: The proposed SARN was trained in a self -supervised manner. Artifact-CT images were generated from planning CT by random deformation and projection replacement, and SARN was trained based on paired artifact-CT and CT images. The planning CT and CBCT images of 260 patients with cancer, including 120 thoracic and 140 abdominal CT scans, were used to train and evaluate neural networks. The CBCT images of another 12 patients in late treatment fractions, which contained large anatomy changes, were also tested by trained models. The trained models include commonly used U-Net, cycle-GAN, attention-gated cycleGAN (cycAT), and cascade models combined SARN with cycleGAN or cycAT. The generated sCT images were compared in terms of image quality and dose calculation accuracy. Results: The sCT images generated by SARN combined with cycleGAN and cycAT showed the best image quality, removed the most artifacts, and retained the normal anatomical structure. The SARN+cycleGAN performed best in streaking artifacts removal with the maximum percent integrity uniformity (PIU m ) of 91.0% and minimum standard deviation (SD) of 35.4 HU for delineated artifact regions among all models. The mean absolute error (MAE) of CBCT images in the thorax and abdomen were 71.6 and 55.2 HU, respectively, using planning CT images after deformable registration as ground truth. Compared with CBCT, the thoracic and abdominal sCT images generated by each model had significantly improved image quality with smaller MAE (p < 0.05). The SARN+cycAT obtained the minimum MAEs of 42.5 HU in the thorax while SARN+cycleGAN got the minimum MAEs of 32.0 HU in the abdomen. The sCT generated by U-Net had a remarkably lower anatomical structure accuracy compared with the other models. The thoracic and abdominal sCT images generated by SARN+cycleGAN showed optimal dose calculation accuracy with gamma passing rates (2 mm/2%) of 98.2% and 96.9%, respectively.

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