Generation of deep learning based virtual non-contrast CT using dual-layer dual-energy CT and its application to planning CT for radiotherapy

This paper presents a novel approach for generating virtual non-contrast planning computed tomography (VNC-pCT) images from contrast-enhanced planning CT (CE-pCT) scans using a deep learning model. Unlike previous studies, which often lacked sufficient data pairs of contrast-enhanced and non-contrast CT images, we trained our model on dual-energy CT (DECT) images, using virtual non-contrast CT (VNC CT) images as outputs instead of true non-contrast CT images. We used a deterministic method to convert CE-pCT images into pseudo DECT images for model application. Model training and evaluation were conducted on 45 patients. The performance of our model, 'VNC-Net', was evaluated using various metrics, demonstrating high scores for quantitative performance. Moreover, our model accurately replicated target VNC CT images, showing close correspondence in CT numbers. The versatility of our model was further demonstrated by applying it to pseudo VNC DECT generation, followed by conversion to VNC-pCT. CE-pCT images of ten liver cancer patients and ten left-sided breast cancer patients were used. A quantitative comparison with true non-contrast planning CT (TNC-pCT) images validated the accuracy of the generated VNC-pCT images. Furthermore, dose calculations on CE-pCT and VNC-pCT images from patients undergoing volumetric modulated arc therapy for liver and breast cancer treatment showed the clinical relevance of our approach. Despite the model's overall good performance, limitations remained, particularly in maintaining CT numbers of bone and soft tissue less influenced by contrast agent. Future research should address these challenges to further improve the model's accuracy and applicability in radiotherapy planning. Overall, our study highlights the potential of deep learning models to improve imaging protocols and accuracy in radiotherapy planning.