Feasibility of MRI-only photon and proton dose calculations for pediatric patients with abdominal tumors

The purpose of this study was to develop a method enabling synthetic computed tomography (sCT) generation of the whole abdomen using magnetic resonance imaging (MRI) scans of pediatric patients with abdominal tumors. The proposed method relies on an automatic atlas-based segmentation of bone and lungs followed by an MRI intensity to synthetic Hounsfield unit conversion. Separate conversion algorithms were used for bone, lungs and soft-tissue. Rigidly registered CT and T2-weighted MR images of 30 patients in treatment position and with the same field of view were used for the evaluation of the atlas and the conversion algorithms. The dose calculation accuracy of the generated sCTs was verified for volumetric modulated arc therapy (VMAT) and pencil beam scanning (PBS). VMAT and PBS plans were robust optimized on an internal target volume (ITV) against a patient set-up uncertainty of 5 mm. Average differences between CT and sCT dose calculations for the ITV V 95% were 0.5% (min 0.0%; max 5.0%) and 0.0% (min  -0.1%; max 0.1%) for VMAT and PBS dose distributions, respectively. Average differences for the mean dose to the organs at risk were  <0.2% (min  -0.6%; max 1.2%) and  <0.2% (min  -2.0%; max 2.6%) for VMAT and PBS dose distributions, respectively. Results show that MRI-only photon and proton dose calculations are feasible for children with abdominal tumors.