Deep-learning-driven dose prediction and verification for stereotactic radiosurgical treatment of isolated brain metastases.

Purpose: While deep learning has shown promise for automated radiotherapy planning, its application to the specific scenario of stereotactic radiosurgery (SRS) for brain metastases using fixed-field intensity modulated radiation therapy (IMRT) on a linear accelerator remains limited. This work aimed to develop and verify a deep learning-guided automated planning protocol tailored for this scenario. Methods: We collected 70 SRS plans for solitary brain metastases, of which 36 cases were for training and 34 for testing. Test cases were derived from two distinct clinical institutions. The envisioned automated planning process comprised (1): clinical dose prediction facilitated by deep-learning algorithms (2); transformation of the forecasted dose into executable plans via voxel-centric dose emulation (3); validation of the envisaged plan employing a precise dosimeter in conjunction with a linear accelerator. Dose prediction paradigms were established by engineering and refining two three-dimensional UNet architectures (UNet and AttUNet). Input parameters encompassed computed tomography scans from clinical plans and demarcations of the focal point alongside organs at potential risk (OARs); the ensuing output manifested as a 3D dose matrix tailored for each case under scrutiny. Results: Dose estimations rendered by both models mirrored the manual plans and adhered to clinical stipulations. As projected by the dual models, the apex and average doses for OARs did not deviate appreciably from those delineated in the manual plan (P-value≥0.05). AttUNet showed promising results compared to the foundational UNet. Predicted doses showcased a pronounced dose gradient, with peak concentrations localized within the target vicinity. The executable plans conformed to clinical dosimetric benchmarks and aligned with their associated verification assessments (100% gamma approval rate at 3 mm/3%). Conclusion: This study demonstrates an automated planning technique for fixed-field IMRT-based SRS for brain metastases. The envisaged plans met clinical requirements, were reproducible across centers, and achievable in deliveries. This represents progress toward automated paradigms for this specific scenario.