The treatment planning process for patients with head and neck (H&N) cancer is regarded as one of the most complicated due to large target volume, multiple prescription dose levels, and many radiation-sensitive critical structures near the target. Treatment planning for this site requires a high level of human expertise and a tremendous amount of effort to produce personalized high quality plans, taking as long as a week, which deteriorates the chances of tumor control and patient survival. To solve this problem, we propose to investigate a deep learning-based dose prediction model, Hierarchically Densely Connected U-net, based on two highly popular network architectures: U-net and DenseNet. We find that this new architecture is able to accurately and efficiently predict the dose distribution, outperforming the other two models, the Standard U-net and DenseNet, in homogeneity, dose conformity, and dose coverage on the test data. Averaging across all organs at risk, our proposed model is capable of predicting the organ-at-risk max dose within 6.3% and mean dose within 5.1% of the prescription dose on the test data. The other models, the Standard U-net and DenseNet, performed worse, having an averaged organ-at-risk max dose prediction error of 8.2% and 9.3%, respectively, and averaged mean dose prediction error of 6.4% and 6.8%, respectively. In addition, our proposed model used 12 times less trainable parameters than the Standard U-net, and predicted the patient dose 4 times faster than DenseNet.reduce the vanishing gradient issue, and decrease the number of trainable parameters needed. While the term "densely connected" was historically used to described fully connected neural network layers, this publication by Huang et al. had adopted this terminology to describe how his convolutional layers were connected. While requiring more memory to use, the authors showed that the DenseNet was capable of achieving a better performance while having far less parameters in the neural network. For example, they were able to have comparable accuracy with ResNet, which had 10 million parameters, using their DenseNet, which had 0.8M parameters. This indicates that DenseNet is far more efficient in feature calculation than existing network architectures. For its contribution to the AI community, the DenseNet publication was awarded for the CVPR 2017 best publication. However, it is recognized that DenseNet, while efficient in parameter usage, actually utilizes considerably more GPU RAM, rendering a 3D U-net with fully densely connected convolutional connections infeasible for today's current GPU technologies.Motivated by a 3D densely connected U-net, but requiring less memory usage, we developed a neural network architecture that combines the essence of these two influential neural network architectures into our proposed network while maintaining a respectable RAM usage, which we call Hierarchically Densely Connected U-net (HD U-net). The term "hierarchically" is used here to describe the different levels of resolution in the U-n...

With the advancement of treatment modalities in radiation therapy for cancer patients, outcomes have improved, but at the cost of increased treatment plan complexity and planning time. The accurate prediction of dose distributions would alleviate this issue by guiding clinical plan optimization to save time and maintain high quality plans. We have modified a convolutional deep network model, U-net (originally designed for segmentation purposes), for predicting dose from patient image contours of the planning target volume (PTV) and organs at risk (OAR). We show that, as an example, we are able to accurately predict the dose of intensity-modulated radiation therapy (IMRT) for prostate cancer patients, where the average Dice similarity coefficient is 0.91 when comparing the predicted vs. true isodose volumes between 0% and 100% of the prescription dose. The average value of the absolute differences in [max, mean] dose is found to be under 5% of the prescription dose, specifically for each structure is [1.80%, 1.03%](PTV), [1.94%, 4.22%](Bladder), [1.80%, 0.48%](Body), [3.87%, 1.79%](L Femoral Head), [5.07%, 2.55%](R Femoral Head), and [1.26%, 1.62%](Rectum) of the prescription dose. We thus managed to map a desired radiation dose distribution from a patient’s PTV and OAR contours. As an additional advantage, relatively little data was used in the techniques and models described in this paper.

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High radiation dose in CT scans increases a lifetime risk of cancer and has become a major clinical concern. Recently, iterative reconstruction algorithms with Total Variation (TV) regularization have been developed to reconstruct CT images from highly undersampled data acquired at low mAs levels in order to reduce the imaging dose. Nonetheless, the low contrast structures tend to be smoothed out by the TV regularization, posing a great challenge for the TV method. To solve this problem, in this work we develop an iterative CT reconstruction algorithm with edge-preserving TV regularization to reconstruct CT images from highly undersampled data obtained at low mAs levels. The CT image is reconstructed by minimizing an energy consisting of an edge-preserving TV norm and a data fidelity term posed by the x-ray projections. The edge-preserving TV term is proposed to preferentially perform smoothing only on non-edge part of the image in order to better preserve the edges, which is realized by introducing a penalty weight to the original total variation norm. During the reconstruction process, the pixels at edges would be gradually identified and given small penalty weight. Our iterative algorithm is implemented on GPU to improve its speed. We test our reconstruction algorithm on a digital NCAT phantom, a physical chest phantom, and a Catphan phantom. Reconstruction results from a conventional FBP algorithm and a TV regularization method without edge preserving penalty are also presented for comparison purpose. The experimental results illustrate that both TV-based algorithm and our edge-preserving TV algorithm outperform the conventional FBP algorithm in suppressing the streaking artifacts and image noise under the low dose context. Our edge-preserving algorithm is superior to the TV-based algorithm in that it can preserve more information of low contrast structures and therefore maintain acceptable spatial resolution.

Purpose: Cone-beam CT (CBCT) plays an important role in image guided radiation therapy (IGRT). However, the large radiation dose from serial CBCT 15 scans in most IGRT procedures raises a clinical concern, especially for pediatric patients who are essentially excluded from receiving IGRT for this reason. The goal of this work is to develop a fast GPU-based algorithm to reconstruct CBCT from undersampled and noisy projection data so as to lower the imaging dose. Methods: The CBCT is reconstructed by minimizing an energy functional 20 consisting of a data fidelity term and a total variation regularization term. We developed a GPU-friendly version of the forward-backward splitting algorithm to solve this model. A multi-grid technique is also employed. Results: It is found that 20~40 x-ray projections are sufficient to reconstruct images with satisfactory quality for IGRT. The reconstruction time ranges from 25 77 to 130 sec on a NVIDIA Tesla C1060 GPU card, depending on the number of projections used, which is estimated about 100 times faster than similar iterative reconstruction approaches. Moreover, phantom studies indicate that our algorithm enables the CBCT to be reconstructed under a scanning protocol with as low as 0.1 mAs/projection. Comparing with currently widely used full-fan 30 head and neck scanning protocol of ~360 projections with 0.4 mAs/projection, it is estimated that an overall 36~72 times dose reduction has been achieved in our fast CBCT reconstruction algorithm. Conclusions: This work indicates that the developed GPU-based CBCT reconstruction algorithm is capable of lowering imaging dose considerably. The 35 high computation efficiency in this algorithm makes the iterative CBCT reconstruction approach applicable in real clinical environments.