Joint registration and segmentation via multi-task learning for adaptive radiotherapy of prostate cancer

Medical image registration and segmentation are two of the most frequent tasks in medical image analysis. As these tasks are complementary and correlated, it would be beneficial to apply them simultaneously in a joint manner. In this paper, we formulate registration and segmentation as a joint problem via a Multi-Task Learning (MTL) setting, allowing these tasks to leverage their strengths and mitigate their weaknesses through the sharing of beneficial information. We propose to merge these tasks not only on the loss level, but on the architectural level as well. We studied this approach in the context of adaptive image-guided radiotherapy for prostate cancer, where planning and follow-up CT images as well as their corresponding contours are available for training. At testing time the contours of the follow-up scans are not available, which is a common scenario in adaptive radiotherapy. The study involves two datasets from different manufacturers and institutes. The first dataset was divided into training (12 patients) and validation (6 patients), and was used to optimize and validate the methodology, while the second dataset (14 patients) was used as an independent test set. We carried out an extensive quantitative comparison between the quality of the automatically generated contours from different network architectures as well as loss weighting methods. Moreover, we evaluated the quality of the generated deformation vector field (DVF). We show that MTL algorithms outperform their Single-Task Learning (STL) counterparts and achieve better generalization on the independent test set. The best algorithm achieved a mean surface distance of 1.06 +/- 0.3 mm, 1.27 +/- 0.4 mm, 0.91 +/- 0.4 mm, and 1.76 +/- 0.8 mm on the validation set for the prostate, seminal vesicles, bladder, and rectum, respectively. The high accuracy of the proposed method combined with the fast inference speed, makes it a promising method for automatic re-contouring of follow-up scans for adaptive radiotherapy, potentially reducing treatment related complications and therefore improving patients quality-of-life after treatment. The source code is available at https://github.com/moelmahdy/JRS-MTL.Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Uncertainty in multitask learning: joint representations for probabilistic MR-only radiotherapy planning

Multi-task neural network architectures provide a mechanism that jointly integrates information from distinct sources. It is ideal in the context of MR-only radiotherapy planning as it can jointly regress a synthetic CT (synCT) scan and segment organs-at-risk (OAR) from MRI. We propose a probabilistic multi-task network that estimates: 1) intrinsic uncertainty through a heteroscedastic noise model for spatially-adaptive task loss weighting and 2) parameter uncertainty through approximate Bayesian inference. This allows sampling of multiple segmentations and synCTs that share their network representation. We test our model on prostate cancer scans and show that it produces more accurate and consistent synCTs with a better estimation in the variance of the errors, state of the art results in OAR segmentation and a methodology for quality assurance in radiotherapy treatment planning.Comment: Early-accept at MICCAI 2018, 8 pages, 4 figure

Reasoning with Uncertainty in Deep Learning for Safer Medical Image Computing

Deep learning is now ubiquitous in the research field of medical image computing. As such technologies progress towards clinical translation, the question of safety becomes critical. Once deployed, machine learning systems unavoidably face situations where the correct decision or prediction is ambiguous. However, the current methods disproportionately rely on deterministic algorithms, lacking a mechanism to represent and manipulate uncertainty. In safety-critical applications such as medical imaging, reasoning under uncertainty is crucial for developing a reliable decision making system. Probabilistic machine learning provides a natural framework to quantify the degree of uncertainty over different variables of interest, be it the prediction, the model parameters and structures, or the underlying data (images and labels). Probability distributions are used to represent all the uncertain unobserved quantities in a model and how they relate to the data, and probability theory is used as a language to compute and manipulate these distributions. In this thesis, we explore probabilistic modelling as a framework to integrate uncertainty information into deep learning models, and demonstrate its utility in various high-dimensional medical imaging applications. In the process, we make several fundamental enhancements to current methods. We categorise our contributions into three groups according to the types of uncertainties being modelled: (i) predictive; (ii) structural and (iii) human uncertainty. Firstly, we discuss the importance of quantifying predictive uncertainty and understanding its sources for developing a risk-averse and transparent medical image enhancement application. We demonstrate how a measure of predictive uncertainty can be used as a proxy for the predictive accuracy in the absence of ground-truths. Furthermore, assuming the structure of the model is flexible enough for the task, we introduce a way to decompose the predictive uncertainty into its orthogonal sources i.e. aleatoric and parameter uncertainty. We show the potential utility of such decoupling in providing a quantitative “explanations” into the model performance. Secondly, we introduce our recent attempts at learning model structures directly from data. One work proposes a method based on variational inference to learn a posterior distribution over connectivity structures within a neural network architecture for multi-task learning, and share some preliminary results in the MR-only radiotherapy planning application. Another work explores how the training algorithm of decision trees could be extended to grow the architecture of a neural network to adapt to the given availability of data and the complexity of the task. Lastly, we develop methods to model the “measurement noise” (e.g., biases and skill levels) of human annotators, and integrate this information into the learning process of the neural network classifier. In particular, we show that explicitly modelling the uncertainty involved in the annotation process not only leads to an improvement in robustness to label noise, but also yields useful insights into the patterns of errors that characterise individual experts

AutoFuse: Automatic Fusion Networks for Deformable Medical Image Registration

Deformable image registration aims to find a dense non-linear spatial correspondence between a pair of images, which is a crucial step for many medical tasks such as tumor growth monitoring and population analysis. Recently, Deep Neural Networks (DNNs) have been widely recognized for their ability to perform fast end-to-end registration. However, DNN-based registration needs to explore the spatial information of each image and fuse this information to characterize spatial correspondence. This raises an essential question: what is the optimal fusion strategy to characterize spatial correspondence? Existing fusion strategies (e.g., early fusion, late fusion) were empirically designed to fuse information by manually defined prior knowledge, which inevitably constrains the registration performance within the limits of empirical designs. In this study, we depart from existing empirically-designed fusion strategies and develop a data-driven fusion strategy for deformable image registration. To achieve this, we propose an Automatic Fusion network (AutoFuse) that provides flexibility to fuse information at many potential locations within the network. A Fusion Gate (FG) module is also proposed to control how to fuse information at each potential network location based on training data. Our AutoFuse can automatically optimize its fusion strategy during training and can be generalizable to both unsupervised registration (without any labels) and semi-supervised registration (with weak labels provided for partial training data). Extensive experiments on two well-benchmarked medical registration tasks (inter- and intra-patient registration) with eight public datasets show that our AutoFuse outperforms state-of-the-art unsupervised and semi-supervised registration methods.Comment: Under Revie

A Method for Predicting Dose Changes for HN Treatment Using Surface Imaging

Head and neck cancer is commonly treated with a six- to seven-week course of radiotherapy, during which a patient’s anatomy may change substantially, due to target reduction or weight loss. Anatomical changes lead to reduction in treatment quality due to decreased setup reproducibility and altered dose deposition compared to the original plan. Few clinics have developed a standard method for triggering resimulation and replan due to anatomic changes. This work investigates a new method for determining when to resimulate and replan HNC patients by utilizing their topographic anatomical changes to predict differences in planned versus delivered dose distributions. The first part of the work presents a method for deformable image registration of CT to CBCT which addresses the challenges of inaccurate Hounsfield units and truncated field of view present in CBCT. The registration method was validated on 10 HN patients using contour comparison, with average DSC of 0.82, 0.74, 0.72, and 0.69 for mandible, cord, and left and right parotid. The registration method was then used to generate dose maps and surface contours for 47 patients for the second part of this work, the development of a U-Net which takes the original dose distribution, the original surface, and the treatment day surface as input and predicts the treatment day dose distribution as output. The average RMSE and MAE between the true and predicted dose distributions for a test set of 6 patients was 4.25 and 2.15. This work proves feasibility of a dose prediction neural network using surface imaging

Medical Image Analysis using Deep Relational Learning

In the past ten years, with the help of deep learning, especially the rapid development of deep neural networks, medical image analysis has made remarkable progress. However, how to effectively use the relational information between various tissues or organs in medical images is still a very challenging problem, and it has not been fully studied. In this thesis, we propose two novel solutions to this problem based on deep relational learning. First, we propose a context-aware fully convolutional network that effectively models implicit relation information between features to perform medical image segmentation. The network achieves the state-of-the-art segmentation results on the Multi Modal Brain Tumor Segmentation 2017 (BraTS2017) and Multi Modal Brain Tumor Segmentation 2018 (BraTS2018) data sets. Subsequently, we propose a new hierarchical homography estimation network to achieve accurate medical image mosaicing by learning the explicit spatial relationship between adjacent frames. We use the UCL Fetoscopy Placenta dataset to conduct experiments and our hierarchical homography estimation network outperforms the other state-of-the-art mosaicing methods while generating robust and meaningful mosaicing result on unseen frames.Comment: arXiv admin note: substantial text overlap with arXiv:2007.0778