Purpose: Current methods for patient specific voxel-level dosimetry in radionuclide therapy suffer from a trade-off between accuracy and computational efficiency. Monte Carlo (MC) radiation transport is considered as the gold standard but is computationally expensive, while faster dose voxel kernel (DVK) convolution can be sub-optimal in the presence of tissue heterogeneities.Furthermore, the accuracies of both these methods are limited by the spatial resolution of the reconstructed emission image. To overcome these limitations, this paper takes a novel approach of constructing a single deep convolutional neural network (CNN) named as DblurDoseNet that learns to produce dose-rate maps while compensating for the limited resolution of SPECT images.
Methods:To mitigate the effects of poor SPECT resolution and reconstruction artifacts on dosimetry, we trained our CNN using MC-generated dose-rate maps that directly corresponded to the true activity maps in virtual patient phantoms. We applied residual learning such that our CNN only learned the difference between the true dose-rate map and DVK dose-rate map with density scaling. The network consists of a depth feature extractor and a 2D U-Net, where the input was 11 slices (3.3 cm) of Lu-177 SPECT/CT images and the output was the dose-rate map corresponding to the center slice. In addition to phantoms, 42 SPECT/CT scans of patients who underwent Lu-177 DOTATATE therapy were also used for testing. Results: In test phantoms, the lesion/organ mean dose-rate error and the normalized root mean square error (NRMSE) relative to ground-truth for the CNN method was consistently lower than DVK and MC. In particular, for CNN compared to DVK/MC, the average improvement in mean dose error was 55%/53% and 66%/56%; and in NRMSE was 18%/17% and 10%/11% for lesion and kidney, respectively. Line profiles and dose-volume histograms demonstrated compensation for SPECT resolution effects in the CNN generated dose-rate maps. Noise, determined from multiple Poisson realizations, showed an average improvement of 21%/27% compared to DVK/MC. In patients, a high concordance was observed between CNN and MC in joint histogram analysis. The trained residual CNN took ~30 seconds on GPU to generate a (512 × 512 × 130) dose-rate map for a patient. Conclusion: The proposed CNN is well-suited for real-time patient-specific dosimetry for clinical treatment planning due to its demonstrated improvement in accuracy, resolution, noise and speed over the current gold-standard.