FedSynthCT-Brain: A federated learning framework for multi-institutional brain MRI-to-CT synthesis.

The generation of Synthetic Computed Tomography (sCT) images has become a pivotal methodology in modern clinical practice, particularly in the context of Radiotherapy (RT) treatment planning. The use of sCT enables the calculation of doses, pushing towards Magnetic Resonance Imaging (MRI) guided radiotherapy treatments. Moreover, with the introduction of MRI-Positron Emission Tomography (PET) hybrid scanners, the derivation of sCT from MRI can improve the attenuation correction of PET images. Deep learning methods for MRI-to-sCT have shown promising results, but their reliance on single-centre training dataset limits generalisation capabilities to diverse clinical settings. Moreover, creating centralised multi-centre datasets may pose privacy concerns. To address the aforementioned issues, we introduced FedSynthCT-Brain, an approach based on the Federated Learning (FL) paradigm for MRI-to-sCT in brain imaging. This is among the first applications of FL for MRI-to-sCT, employing a cross-silo horizontal FL approach that allows multiple centres to collaboratively train a U-Net-based deep learning model. We validated our method using real multicentre data from four European and American centres, simulating heterogeneous scanner types and acquisition modalities, and tested its performance on an independent dataset from a centre outside the federation. In the case of the unseen centre, the federated model achieved a median Mean Absolute Error (MAE) of 102.0 HU across 23 patients, with an interquartile range of 96.7-110.5 HU. The median (interquartile range) for the Structural Similarity Index (SSIM) and the Peak Signal to Noise Ratio (PNSR) were 0.89 (0.86-0.89) and 26.58 (25.52-27.42), respectively. The analysis of the results showed acceptable performances of the federated approach, thus highlighting the potential of FL to enhance MRI-to-sCT to improve generalisability and advancing safe and equitable clinical applications while fostering collaboration and preserving data privacy.