Joint Head and Neck Radiotherapy-MRI Development Cooperative, Travis Salzillo, M. Alex Dresner, Ashley Way, Kareem Wahid, Brigid McDonald, Sam Mulder, Mohamed Naser, Renjie He, Yao Ding, Alison Yoder, Sara Ahmed, Kelsey Corrigan, Gohar Manzar, Lauren Andring, Chelsea Pinnix, R. Jason Stafford, Abdallah S. Mohamed, John Christodouleas, Jihong Wang, Clifton David Fuller
PurposeTo improve segmentation accuracy in head and neck cancer (HNC) radiotherapy treatment planning for the 1.5T hybrid magnetic resonance imaging/linear accelerator (MR-Linac), three-dimensional (3D), T2-weighted, fat-suppressed magnetic resonance imaging sequences were developed and optimized.ApproachAfter initial testing, spectral attenuated inversion recovery (SPAIR) was chosen as the fat suppression technique. Five candidate SPAIR sequences and a nonsuppressed, T2-weighted sequence were acquired for five HNC patients using a 1.5T MR-Linac. MR physicists identified persistent artifacts in two of the SPAIR sequences, so the remaining three SPAIR sequences were further analyzed. The gross primary tumor volume, metastatic lymph nodes, parotid glands, and pterygoid muscles were delineated using five segmentors. A robust image quality analysis platform was developed to objectively score the SPAIR sequences on the basis of qualitative and quantitative metrics.ResultsSequences were analyzed for the signal-to-noise ratio and the contrast-to-noise ratio and compared with fat and muscle, conspicuity, pairwise distance metrics, and segmentor assessments. In this analysis, the nonsuppressed sequence was inferior to each of the SPAIR sequences for the primary tumor, lymph nodes, and parotid glands, but it was superior for the pterygoid muscles. The SPAIR sequence that received the highest combined score among the analysis categories was recommended to Unity MR-Linac users for HNC radiotherapy treatment planning.ConclusionsOur study led to two developments: an optimized, 3D, T2-weighted, fat-suppressed sequence that can be disseminated to Unity MR-Linac users and a robust image quality analysis pathway that can be used to objectively score SPAIR sequences and can be customized and generalized to any image quality optimization protocol. Improved segmentation accuracy with the proposed SPAIR sequence will potentially lead to improved treatment outcomes and reduced toxicity for patients by maximizing the target coverage and minimizing the radiation exposure of organs at risk.
Diana Lin, Kareem Wahid, Benjamin Nelms, Renjie He, Mohamed Naser, Simon Duke, Michael Sherer, John Christodouleas, Abdallah S. R. Mohamed, Michael Cislo, James Murphy, Clifton Fuller, Erin Gillespie
PurposeContouring Collaborative for Consensus in Radiation Oncology (C3RO) is a crowdsourced challenge engaging radiation oncologists across various expertise levels in segmentation. An obstacle to artificial intelligence (AI) development is the paucity of multiexpert datasets; consequently, we sought to characterize whether aggregate segmentations generated from multiple nonexperts could meet or exceed recognized expert agreement.ApproachParticipants who contoured ≥1 region of interest (ROI) for the breast, sarcoma, head and neck (H&N), gynecologic (GYN), or gastrointestinal (GI) cases were identified as a nonexpert or recognized expert. Cohort-specific ROIs were combined into single simultaneous truth and performance level estimation (STAPLE) consensus segmentations. STAPLEnonexpert ROIs were evaluated against STAPLEexpert contours using Dice similarity coefficient (DSC). The expert interobserver DSC (IODSCexpert) was calculated as an acceptability threshold between STAPLEnonexpert and STAPLEexpert. To determine the number of nonexperts required to match the IODSCexpert for each ROI, a single consensus contour was generated using variable numbers of nonexperts and then compared to the IODSCexpert.ResultsFor all cases, the DSC values for STAPLEnonexpert versus STAPLEexpert were higher than comparator expert IODSCexpert for most ROIs. The minimum number of nonexpert segmentations needed for a consensus ROI to achieve IODSCexpert acceptability criteria ranged between 2 and 4 for breast, 3 and 5 for sarcoma, 3 and 5 for H&N, 3 and 5 for GYN, and 3 for GI.ConclusionsMultiple nonexpert-generated consensus ROIs met or exceeded expert-derived acceptability thresholds. Five nonexperts could potentially generate consensus segmentations for most ROIs with performance approximating experts, suggesting nonexpert segmentations as feasible cost-effective AI inputs.
KEYWORDS: Computed tomography, Image registration, Magnetic resonance imaging, 3D image processing, Image segmentation, Tissues, In vivo imaging, Optical coherence tomography, Positron emission tomography, Medical imaging
Histopathology is the accepted gold standard for identifying cancerous tissues. Validation of in vivo imaging signals with precisely correlated histopathology can potentially improve the delineation of tumors in medical images for focal therapy planning, guidance, and assessment. Registration of histopathology with other imaging modalities is challenging due to soft tissue deformations that occur between imaging and histological processing of tissue. In this paper, a framework for precise registration of medical images and pathology using white-light images (photographs) is presented. A euthanized normal mouse was imaged using four imaging modalities: CBCT, PET-CT, MRI and micro CT. The mouse was then fixed in an embedding medium, optical cutting temperature (OCT) compound, with co-registration markers and sliced at 50 m intervals in a cryostatmicrotome. The device automatically photographed each slice with a mounted camera and reconstructed the 3D white-light image of the mouse through co-registering of consecutive slices. The white-light image was registered to the four imaging modalities based on the external contours of the mouse. Six organs (brain, liver, stomach, pancreas, kidneys and bladder) were contoured on the MR image while the skeletal structure and lungs were segmented on the CBCT image. The contours of these structures were propagated to the additional imaging modalities based on the registrations to the white-light image and were analyzed qualitatively by developing an anatomical atlas of normal mouse defined using three imaging modalities. This work will serve as the foundation to include histopathology through the transfer of the imaged slice onto tape for histological processing.
KEYWORDS: Magnetic resonance imaging, Signal to noise ratio, Motion models, Tissues, Convex optimization, Reconstruction algorithms, Image filtering, Data modeling
In many applications based on kinetic evaluation analysis and model fitting, quantitative mapping retrieved on data series from modalites such as MRI is completed on a voxel-by-voxel basis, where motion and low signal to noise ratio (SNR) would considerably degenerate the reliability of estimations. The coherence of image series in space and time can be used as prior knowledge to mitigate this occurrence. In this study, spatial and temporal higher-order total variations (HOTVs) are applied on a data series of MRI signal (e.g. dynamic contrast-enhanced (DCE) MRI and intravoxel incoherent motion (IVIM) MRI) to exploit the coherence of signal in space and time to minimize the variabilities caused by motion as well as improving quality of images with low SNR while retaining the physical details of original data properly. Simultaneously applying spatial and temporal HOTVs on images is non-trivial in implementation since it is a non-smooth optimization problem with multiple regularizers. Therefore, we use the proximal gradient method as well as a primal-dual split proximal mechanism to address the problem properly. In addition to increase the reliability of quantitative parametric map estimations, this preprocessing procedure can be included into many existing map estimation algorithms and pipelines effortlessly. We demonstrate our method on the parametric maps estimation for DCE MRI and IVIM MRI.
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