An automated cone-beam CT dosimetric assessment pipeline for adaptive head and neck radiotherapy.

Newton, R.; Russell, E.; Tyyger, M.; O'Hara, C.; Whittam, S.; Speight, R.; Fulton, H.; Andersson, S.; Prestwich, R.; Al-Qaisieh, B.; Bird, D.

An automated cone-beam CT dosimetric assessment pipeline for adaptive head and neck radiotherapy.

All Authors

Newton, R.

Russell, E.

Tyyger, M.

O'Hara, C.

Whittam, S.

Speight, R.

Fulton, H.

Andersson, S.

Prestwich, R.

Al-Qaisieh, B.

Show 1 more

LTHT Author

Newton, Ruth
Russell, Emily
Tyyger, Marcus
O'Hara, Christopher
Whittam, Shona
Speight, Richard
Fulton, Heather
Prestwich, Robin
Al-Qaisieh, Bashar
Bird, David

LTHT Department

Medical Physics & Engineering
Oncology
Leeds Cancer Centre
Clinical Oncology
Radiotherapy Physics

Non Medic

Clinical Scientist
Radiotherapy Physicist
Medical Physicist
Lead Radiotherapy Imaging, R&D

Publication Date

2025

Item Type

Article

Abstract

Background and purpose: Adaptive radiotherapy (ART) is commonly used to mitigate effects of anatomical change during head and neck (H&N) radiotherapy. The process of identifying patients for ART can be subjective and resource-intensive. This feasibility project aims to design and validate a pipeline to automate the process and use it to assess the current clinical pathway for H&N treatments. Method(s): The pipeline analysed patients' on-set cone-beam CT (CBCT) scans to identify inter-fractional anatomical changes. CBCTs were converted into synthetic CTs, contours were automatically generated, and the original plan was recomputed. Each synthetic CT was evaluated against a set of dosimetric goals, with failed goals causing an ART recommendation. To validate pipeline performance, a 'gold standard' was synthesised by recomputing patients' original plans on a rescan-CT acquired during treatment and identifying failed clinical goals. The pipeline sensitivity and specificity compared to this 'gold standard' were calculated for 12 ART patients. The pipeline was then run on a cohort of 12 ART and 14 non-ART patients, and its sensitivity and specificity were instead calculated against the clinical decision made. Result(s): The pipeline showed good agreement with the synthesised 'gold standard' with an optimum sensitivity of 0.83 and specificity of 0.67. When run over a cohort containing both ART and non-ART patients and assessed against the subjective clinical decision made, the pipeline showed no predictive power (sensitivity: 0.58, specificity: 0.47). Conclusion(s): Good agreement with the 'gold standard' gives confidence in pipeline performance and disagreement with clinical decisions implies implementation could help standardise the current clinical pathway.