Direct inverse deformation field approach to pelvic-area symmetric image registration

This paper presents a novel technique for a consistent symmetric deformable image registration based on an accurate method for a direct inversion of a large motion model deformation field. The proposed image registration algorithm maintains one-to-one mapping between registered images by symmetrically warping them to another image. This makes the final estimation of forward and backward deformation fields anatomically plausible and applicable to adaptive prostate radiotherapy. The quantitative validation of the method is performed on magnetic resonance data obtained for pelvis area. The experiments demonstrate the improved robustness in terms of inverse consistency error and estimation accuracy of prostate position in comparison to the previously proposed methods

Symmetric image registration with directly calculated inverse deformation field

This paper presents a novel technique for a symmetric deformable image registration based on a new method for fast and accurate direct inversion of a large motion model deformation field. The proposed image registration algorithm maintain a one-to-one mapping between registered images by symmetrically warping them to each other, and by ensuring the inverse consistency criterion at each iteration. This makes the final estimation of forward and backward deformation fields anatomically plausible. The quantitative validation of the method has been performed on magnetic resonance data obtained for a pelvis area demonstrating applicability of the method to adaptive prostate radiotherapy. The experiments demonstrate the improved robustness in terms of inverse consistency error when compared to previously proposed methods for symmetric image registration

Diffeomorphic image registration with applications to deformation modelling between multiple data sets

Over last years, the diffeomorphic image registration algorithms have been successfully introduced into the field of the medical image analysis. At the same time, the particular usability of these techniques, in majority derived from the solid mathematical background, has been only quantitatively explored for the limited applications such as longitudinal studies on treatment quality, or diseases progression. The thesis considers the deformable image registration algorithms, seeking out those that maintain the medical correctness of the estimated dense deformation fields in terms of the preservation of the object and its neighbourhood topology, offer the reasonable computational complexity to satisfy time restrictions coming from the potential applications, and are able to cope with low quality data typically encountered in Adaptive Radiotherapy (ART). The research has led to the main emphasis being laid on the diffeomorphic image registration to achieve one-to-one mapping between images. This involves introduction of the log-domain parameterisation of the deformation field by its approximation via a stationary velocity field. A quantitative and qualitative examination of existing and newly proposed algorithms for pairwise deformable image registration presented in this thesis, shows that the log-Euclidean parameterisation can be successfully utilised in the biomedical applications. Although algorithms utilising the log-domain parameterisation have theoretical justification for maintaining diffeomorphism, in general, the deformation fields produced by them have similar properties as these estimated by classical methods. Having this in mind, the best compromise in terms of the quality of the deformation fields has been found for the consistent image registration framework. The experimental results suggest also that the image registration with the symmetrical warping of the input images outperforms the classical approaches, and simultaneously can be easily introduced to most known algorithms. Furthermore, the log-domain implicit group-wise image registration is proposed. By linking the various sets of images related to the different subjects, the proposed image registration approach establishes a common subject space and between-subject correspondences therein. Although the correspondences between groups of images can be found by performing the classic image registration, the reference image selection (not required in the proposed implementation), may lead to a biased mean image being estimated and the corresponding common subject space not adequate to represent the general properties of the data sets. The approaches to diffeomorphic image registration have been also utilised as the principal elements for estimating the movements of the organs in the pelvic area based on the dense deformation field prediction system driven by the partial information coming from the specific type of the measurements parameterised using the implicit surface representation, and recognising facial expressions where the stationary velocity fields are used as the facial expression descriptors. Both applications have been extensively evaluated based on the real representative data sets of three-dimensional volumes and two-dimensional images, and the obtained results indicate the practical usability of the proposed techniques

On voxel-by-voxel accumulated dose for prostate radiation therapy using deformable image registration.

Since delivered dose is rarely the same with planned, we calculated the delivered total dose to ten prostate radiotherapy patients treated with rectal balloons using deformable dose accumulation (DDA) and compared it with the planned dose. The patients were treated with TomoTherapy using two rectal balloon designs: five patients had the Radiadyne balloon (balloon A), and five patients had the EZ-EM balloon (balloon B). Prostate and rectal wall contours were outlined on each pre-treatment MVCT for all patients. Delivered fractional doses were calculated using the MVCT taken immediately prior to delivery. Dose grids were accumulated to the last MVCT using DDA tools in Pinnacle3 TM (v9.100, Philips Radiation Oncology Systems, Fitchburg, USA). Delivered total doses were compared with planned doses using prostate and rectal wall DVHs. The rectal NTCP was calculated based on total delivered and planned doses for all patients using the Lyman model. For 8/10 patients, the rectal wall NTCP calculated using the delivered total dose was less than planned, with seven patients showing a decrease of more than 5% in NTCP. For 2/10 patients studied, the rectal wall NTCP calculated using total delivered dose was 2% higher than planned. This study indicates that for patients receiving hypofractionated radiotherapy for prostate cancer with a rectal balloon, total delivered doses to prostate is similar with planned while delivered dose to rectal walls may be significantly different from planned doses. 8/10 patients show significant correlation between rectal balloon anterior-posterior positions and some VD values

Medical image registration using unsupervised deep neural network: A scoping literature review

In medicine, image registration is vital in image-guided interventions and other clinical applications. However, it is a difficult subject to be addressed which by the advent of machine learning, there have been considerable progress in algorithmic performance has recently been achieved for medical image registration in this area. The implementation of deep neural networks provides an opportunity for some medical applications such as conducting image registration in less time with high accuracy, playing a key role in countering tumors during the operation. The current study presents a comprehensive scoping review on the state-of-the-art literature of medical image registration studies based on unsupervised deep neural networks is conducted, encompassing all the related studies published in this field to this date. Here, we have tried to summarize the latest developments and applications of unsupervised deep learning-based registration methods in the medical field. Fundamental and main concepts, techniques, statistical analysis from different viewpoints, novelties, and future directions are elaborately discussed and conveyed in the current comprehensive scoping review. Besides, this review hopes to help those active readers, who are riveted by this field, achieve deep insight into this exciting field

Artificial General Intelligence for Radiation Oncology

The emergence of artificial general intelligence (AGI) is transforming radiation oncology. As prominent vanguards of AGI, large language models (LLMs) such as GPT-4 and PaLM 2 can process extensive texts and large vision models (LVMs) such as the Segment Anything Model (SAM) can process extensive imaging data to enhance the efficiency and precision of radiation therapy. This paper explores full-spectrum applications of AGI across radiation oncology including initial consultation, simulation, treatment planning, treatment delivery, treatment verification, and patient follow-up. The fusion of vision data with LLMs also creates powerful multimodal models that elucidate nuanced clinical patterns. Together, AGI promises to catalyze a shift towards data-driven, personalized radiation therapy. However, these models should complement human expertise and care. This paper provides an overview of how AGI can transform radiation oncology to elevate the standard of patient care in radiation oncology, with the key insight being AGI's ability to exploit multimodal clinical data at scale

Segmenting the male pelvic organs from limited angle images with application to ART

Prostate cancer is the second leading cause of cancer deaths in men, and external beam radiotherapy is a common method for treating prostate cancer. In a clinically state-of-the-art radiotherapy protocol, CT images are taken at treatment time and are used to properly position the patient with respect to the treatment device. In adaptive radiotherapy (ART), this image is used to approximate the actual radiation dose delivered to the patient and track the progress of therapy. Doing so, however, requires that the male pelvic organs of interest be segmented and that correspondence be established between the images (registration), such that cumulative delivered dose can be accumulated in a reference coordinate system. Because a typical prostate radiotherapy treatment is delivered over 30-40 daily fractions, there is a large non-therapeutic radiation dose delivered to the patient from daily imaging. In the interest of reducing this dose, gantry mounted limited angle imaging devices have been developed which reduce dose at the expense of image quality. However, in the male pelvis, such limited angle images are not suitable for the ART process using traditional methods. In this work, a patient specific deformation model is developed that is sufficient for use with limited angle images. This model is learned from daily CT images taken during the first several treatment fractions. Limited angle imaging can then be used for the remaining fractions at decreased dose. When the parameters of this model are set, it provides segmentation of the prostate, bladder, and rectum, correspondence between the images, and a CT-like image that can be used for dose accumulation. However, intra-patient deformation in the male pelvis is complex and quality deformation models cannot be developed from a reasonable number of training images using traditional methods. This work solves this issue by partitioning the deformation to be explained into independent sub-models that explain deformation due to articulation, deformation near to the skin, deformation of the prostate bladder, and rectum, and any residual deformation. It is demonstrated that a model that segments the prostate with accuracy comparable to inter-expert variation can be developed from 16 daily images.Doctor of Philosoph

Principal Component Analysis-Based Anatomical Motion Models For Use In Adaptive Radiation Therapy Of Head And Neck Cancer Patients

Purpose: To develop standard and regularized principal component analysis (PCA) models of anatomical changes from daily cone beam CTs (CBCTs) of head and neck (H&N) patients, assess their potential use in adaptive radiation therapy (ART), and to extract quantitative information for treatment response assessment. Methods: Planning CT (pCT) images of H&N patients were artificially deformed to create “digital phantom” images, which modeled systematic anatomical changes during Radiation Therapy (RT). Artificial deformations closely mirrored patients’ actual deformations, and were interpolated to generate 35 synthetic CBCTs, representing evolving anatomy over 35 fractions. Deformation vector fields (DVFs) were acquired between pCT and synthetic CBCTs (i.e., digital phantoms), and between pCT and clinical CBCTs. Patient-specific standard PCA (SPCA) and regularized PCA (RPCA) models were built from these synthetic and clinical DVF sets. Eigenvectors, or eigenDVFs (EDVFs), having the largest eigenvalues were hypothesized to capture the major anatomical deformations during treatment. Modeled anatomies were used to assess the dose deviations with respect to the planned dose distribution. Results: PCA models achieve variable results, depending on the size and location of anatomical change. Random changes prevent or degrade SPCA’s ability to detect underlying systematic change. RPCA is able to detect smaller systematic changes against the background of random fraction-to-fraction changes, and is therefore more successful than SPCA at capturing systematic changes early in treatment. SPCA models were less successful at modeling systematic changes in clinical patient images, which contain a wider range of random motion than synthetic CBCTs, while the regularized approach was able to extract major modes of motion. For dose assessment it has been shown that the modeled dose distribution was different from the planned dose for the parotid glands due to their shrinkage and shift into the higher dose volumes during the radiotherapy course. Modeled DVHs still underestimated the effect of parotid shrinkage due to the large compression factor (CF) used to acquire DVFs. Conclusion: Leading EDVFs from both PCA approaches have the potential to capture systematic anatomical changes during H&N radiotherapy when systematic changes are large enough with respect to random fraction-to-fraction changes. In all cases the RPCA approach appears to be more reliable than SPCA at capturing systematic changes, enabling dosimetric consequences to be projected to the future treatment fractions based on trends established early in a treatment course, or, potentially, based on population models. This work showed that PCA has a potential in identifying the major mode of anatomical changes during the radiotherapy course and subsequent use of this information in future dose predictions is feasible. Use of smaller CF values for DVFs is preferred, otherwise anatomical motion will be underestimated

Artificial Intelligence in Radiation Therapy

Artificial intelligence (AI) has great potential to transform the clinical workflow of radiotherapy. Since the introduction of deep neural networks, many AI-based methods have been proposed to address challenges in different aspects of radiotherapy. Commercial vendors have started to release AI-based tools that can be readily integrated to the established clinical workflow. To show the recent progress in AI-aided radiotherapy, we have reviewed AI-based studies in five major aspects of radiotherapy including image reconstruction, image registration, image segmentation, image synthesis, and automatic treatment planning. In each section, we summarized and categorized the recently published methods, followed by a discussion of the challenges, concerns, and future development. Given the rapid development of AI-aided radiotherapy, the efficiency and effectiveness of radiotherapy in the future could be substantially improved through intelligent automation of various aspects of radiotherapy