A deep learning model for inter-fraction head and neck anatomical changes in proton therapy.

To assess the performance of a probabilistic deep learning based algorithm for predicting inter-fraction anatomical changes in head and neck patients.A probabilistic daily anatomy model (DAM) for head and neck patients DAM (DAM) is built on the variational autoencoder architecture. The model approximates the generative joint conditional probability distribution of the repeat computed tomography (rCT) images and their corresponding masks on the planning CT images (pCT) and their masks. The model outputs deformation vector fields, which are used to produce possible rCTs and associated masks. The dataset is composed of 93 patients (i.e. 315 pCT-rCT pairs), 9 (i.e. 27 pairs) of which were set aside for final testing. The performance of the model is assessed based on the reconstruction accuracy and the generative performance for the set aside patients.The model achieves a DICE score of 0.83 and an image similarity score normalized cross-correlation of 0.60 on the test set. The generated parotid glands, spinal cord and constrictor muscle volume change distributions and center of mass shift distributions were also assessed. For all organs, the medians of the distributions are close to the true ones, and the distributions are broad enough to encompass the real observed changes. Moreover, the generated images display anatomical changes in line with the literature reported ones, such as the medial shifts of the parotids glands.DAMis capable of generating realistic anatomies observed during the course of the treatment and has applications in anatomical robust optimization, treatment planning based on plan library approaches and robustness evaluation against inter-fractional changes.