3D radiotherapy dose prediction on head and neck cancer patients with a hierarchically densely connected U-net deep learning architecture

The treatment planning process for patients with head and neck (H and N) cancer is regarded as one of the most complicated due to large target volume, multiple prescription dose levels, and many radiation-sensitive critical structures near the target. Treatment planning for this site requires a high level of human expertise and a tremendous amount of effort to produce personalized high quality plans, taking as long as a week, which deteriorates the chances of tumor control and patient survival. To solve this problem, we propose to investigate a deep learning-based dose prediction model, Hierarchically Densely Connected U-net, based on two highly popular network architectures: U-net and DenseNet. We find that this new architecture is able to accurately and efficiently predict the dose distribution, outperforming the other two models, the Standard U-net and DenseNet, in homogeneity, dose conformity, and dose coverage on the test data. Averaging across all organs at risk, our proposed model is capable of predicting the organ-at-risk max dose within 6.3% and mean dose within 5.1% of the prescription dose on the test data. The other models, the Standard U-net and DenseNet, performed worse, having an averaged organ-at-risk max dose prediction error of 8.2% and 9.3%, respectively, and averaged mean dose prediction error of 6.4% and 6.8%, respectively. In addition, our proposed model used 12 times less trainable parameters than the Standard U-net, and predicted the patient dose 4 times faster than DenseNet. (paper)