AI-Based Detection of In-Treatment Changes from Prostate MR-Linac Images

Purpose: To investigate whether routinely acquired longitudinal MR-Linac images can be leveraged to characterize treatment-induced changes during radiotherapy, particularly subtle inter-fraction changes over short intervals (average of 2 days). Materials and Methods: This retrospective study included a series of 0.35T MR-Linac images from 761 patients. An artificial intelligence (deep learning) model was used to characterize treatment-induced changes by predicting the temporal order of paired images. The model was first trained with the images from the first and the last fractions (F1-FL), then with all pairs (All-pairs). Model performance was assessed using quantitative metrics (accuracy and AUC), compared to a radiologist's performance, and qualitative analyses - the saliency map evaluation to investigate affected anatomical regions. Input ablation experiments were performed to identify the anatomical regions altered by radiotherapy. The radiologist conducted an additional task on partial images reconstructed by saliency map regions, reporting observations as well. Quantitative image analysis was conducted to investigate the results from the model and the radiologist. Results: The F1-FL model yielded near-perfect performance (AUC of 0.99), significantly outperforming the radiologist. The All-pairs model yielded an AUC of 0.97. This performance reflects therapy-induced changes, supported by the performance correlation to fraction intervals, ablation tests and expert's interpretation. Primary regions driving the predictions were prostate, bladder, and pubic symphysis. Conclusion: The model accurately predicts temporal order of MR-Linac fractions and detects radiation-induced changes over one or a few days, including prostate and adjacent organ alterations confirmed by experts. This underscores MR-Linac's potential for advanced image analysis beyond image guidance.

Segmentation Regularized Training for Multi-Domain Deep Learning Registration applied to MR-Guided Prostate Cancer Radiotherapy

Background: Accurate deformable image registration (DIR) is required for contour propagation and dose accumulation in MR-guided adaptive radiotherapy (MRgART). This study trained and evaluated a deep learning DIR method for domain invariant MR-MR registration. Methods: A progressively refined registration and segmentation (ProRSeg) method was trained with 262 pairs of 3T MR simulation scans from prostate cancer patients using weighted segmentation consistency loss. ProRSeg was tested on same- (58 pairs), cross- (72 1.5T MR Linac pairs), and mixed-domain (42 MRSim-MRL pairs) datasets for contour propagation accuracy of clinical target volume (CTV), bladder, and rectum. Dose accumulation was performed for 42 patients undergoing 5-fraction MRgART. Results: ProRSeg demonstrated generalization for bladder with similar Dice Similarity Coefficients across domains (0.88, 0.87, 0.86). For rectum and CTV, performance was domain-dependent with higher accuracy on cross-domain MRL dataset (DSCs 0.89) versus same-domain data. The model's strong cross-domain performance prompted us to study the feasibility of using it for dose accumulation. Dose accumulation showed 83.3% of patients met CTV coverage (D95 >= 40.0 Gy) and bladder sparing (D50 <= 20.0 Gy) constraints. All patients achieved minimum mean target dose (>40.4 Gy), but only 9.5% remained under upper limit (<42.0 Gy). Conclusions: ProRSeg showed reasonable multi-domain MR-MR registration performance for prostate cancer patients with preliminary feasibility for evaluating treatment compliance to clinical constraints.