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Objective. Cachexia is a devastating condition, characterized by involuntary loss of muscle mass with or without loss of adipose tissue mass. It affects more than half of patients with lung cancer, diminishing treatment effects and increasing mortality. Cone-beam computed tomography (CBCT) images, routinely acquired during radiotherapy treatment, might contain valuable anatomical information for monitoring body composition changes associated with cachexia. For this purpose, we propose an automatic artificial intelligence (AI)-based workflow, consisting of CBCT to CT conversion, followed by segmentation of pectoralis muscles. Approach. Data from 140 stage III non-small cell lung cancer patients was used. Two deep learning models, cycle-consistent generative adversarial network (CycleGAN) and contrastive unpaired translation (CUT), were used for unpaired training of CBCT to CT conversion, to generate synthetic CT (sCT) images. The no-new U-Net (nnU-Net) model was used for automatic pectoralis muscle segmentation. To evaluate tissue segmentation performance in the absence of ground truth labels, an uncertainty metric (UM) based on Monte Carlo dropout was developed and validated. Main results. Both CycleGAN and CUT restored the Hounsfield unit fidelity of the CBCT images compared to the planning CT (pCT) images and visually reduced streaking artefacts. The nnU-Net model achieved a Dice similarity coefficient (DSC) of 0.93, 0.94, 0.92 for the CT, sCT and CBCT images, respectively, on an independent test set. The UM showed a high correlation with DSC with a correlation coefficient of −0.84 for the pCT dataset and −0.89 for the sCT dataset. Significance. This paper shows a proof-of-concept for automatic AI-based monitoring of the pectoralis muscle area of lung cancer patients during radiotherapy treatment based on CBCT images, which provides an unprecedented time resolution of muscle mass loss during cachexia progression. Ultimately, the proposed workflow could provide valuable information for early intervention of cachexia, ideally resulting in improved cancer treatment outcome. [ABSTRACT FROM AUTHOR]

Objective. This study aims at investigating a novel super resolution CBCT imaging approach with a dual-layer flat panel detector (DL-FPD). Approach. With DL-FPD, the low-energy and high-energy projections acquired from the top and bottom detector layers contain over-sampled spatial information, from which super-resolution CT images can be reconstructed. A simple mathematical model is proposed to explain the signal formation procedure in DL-FPD, and a dedicated recurrent neural network, named suRi-Net, is developed based upon the above imaging model to nonlinearly retrieve the high-resolution dual-energy information. Physical benchtop experiments are conducted to validate the performance of this newly developed super-resolution CBCT imaging method. Main Results. The results demonstrate that the proposed suRi-Net can accurately retrieve high spatial resolution information from the low-energy and high-energy projections of low spatial resolution. Quantitatively, the spatial resolution of the reconstructed CBCT images from the top and bottom detector layers is increased by about 45% and 54%, respectively. Significance. In the future, suRi-Net will provide a new approach to perform high spatial resolution dual-energy imaging in DL-FPD-based CBCT systems. [ABSTRACT FROM AUTHOR]