AI Synthetic CT for Brain and Prostate MR-Only RT: Image Quality and Geometric Accuracy

AI synthetic CT from MR showed soft-tissue HU differences <50 HU and centroid shifts <2 mm vs reference CT in brain and prostate RT, but bone HU compression reached 347±14 HU in femoral heads.

• Soft-tissue HU agreement: mean differences <50 HU overall, <20 HU in central ROIs.
• Bone HU compression: femoral heads 347±14 HU, sacrum 455±50 HU; implant artifacts caused ~9,000 HU underestimation.
• Small structures (optic nerves, cochleae) had inconsistent auto-segmentation with low Dice scores.

Automated summary

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