Multitask 3D CBCT-to-CT Translation and Organs-at-Risk Segmentation Using Physics-Based Data Augmentation

Purpose: In current clinical practice, noisy and artifact-ridden weekly cone-beam computed tomography (CBCT) images are only used for patient setup during radiotherapy. Treatment planning is done once at the beginning of the treatment using high-quality planning CT (pCT) images and manual contours for organs-at-risk (OARs) structures. If the quality of the weekly CBCT images can be improved while simultaneously segmenting OAR structures, this can provide critical information for adapting radiotherapy mid-treatment as well as for deriving biomarkers for treatment response. Methods: Using a novel physics-based data augmentation strategy, we synthesize a large dataset of perfectly/inherently registered planning CT and synthetic-CBCT pairs for locally advanced lung cancer patient cohort, which are then used in a multitask 3D deep learning framework to simultaneously segment and translate real weekly CBCT images to high-quality planning CT-like images. Results: We compared the synthetic CT and OAR segmentations generated by the model to real planning CT and manual OAR segmentations and showed promising results. The real week 1 (baseline) CBCT images which had an average MAE of 162.77 HU compared to pCT images are translated to synthetic CT images that exhibit a drastically improved average MAE of 29.31 HU and average structural similarity of 92% with the pCT images. The average DICE scores of the 3D organs-at-risk segmentations are: lungs 0.96, heart 0.88, spinal cord 0.83 and esophagus 0.66. Conclusions: We demonstrate an approach to translate artifact-ridden CBCT images to high quality synthetic CT images while simultaneously generating good quality segmentation masks for different organs-at-risk. This approach could allow clinicians to adjust treatment plans using only the routine low-quality CBCT images, potentially improving patient outcomes.