A comparative evaluation of 3 different free-form deformable image registration and contour propagation methods for head and neck MRI : the case of parotid changes radiotherapy

Purpose: To validate and compare the deformable image registration and parotid contour propagation process for head and neck magnetic resonance imaging in patients treated with radiotherapy using 3 different approachesthe commercial MIM, the open-source Elastix software, and an optimized version of it. Materials and Methods: Twelve patients with head and neck cancer previously treated with radiotherapy were considered. Deformable image registration and parotid contour propagation were evaluated by considering the magnetic resonance images acquired before and after the end of the treatment. Deformable image registration, based on free-form deformation method, and contour propagation available on MIM were compared to Elastix. Two different contour propagation approaches were implemented for Elastix software, a conventional one (DIR_Trx) and an optimized homemade version, based on mesh deformation (DIR_Mesh). The accuracy of these 3 approaches was estimated by comparing propagated to manual contours in terms of average symmetric distance, maximum symmetric distance, Dice similarity coefficient, sensitivity, and inclusiveness. Results: A good agreement was generally found between the manual contours and the propagated ones, without differences among the 3 methods; in few critical cases with complex deformations, DIR_Mesh proved to be more accurate, having the lowest values of average symmetric distance and maximum symmetric distance and the highest value of Dice similarity coefficient, although nonsignificant. The average propagation errors with respect to the reference contours are lower than the voxel diagonal (2 mm), and Dice similarity coefficient is around 0.8 for all 3 methods. Conclusion: The 3 free-form deformation approaches were not significantly different in terms of deformable image registration accuracy and can be safely adopted for the registration and parotid contour propagation during radiotherapy on magnetic resonance imaging. More optimized approaches (as DIR_Mesh) could be preferable for critical deformations

Use of Multicomponent Non-Rigid Registration to Improve Alignment of Serial Oncological PET/CT Studies

Non-rigid registration of serial head and neck FDG PET/CT images from a combined scanner can be problematic. Registration techniques typically rely on similarity measures calculated from voxel intensity values; CT-CT registration is superior to PET-PET registration due to the higher quality of anatomical information present in this modality. However, when metal artefacts from dental fillings are present in a pair of CT images, a nonrigid registration will incorrectly attempt to register the two artefacts together since they are strong features compared to the features that represent the actual anatomy. This leads to localised registration errors in the deformation field in the vicinity of the artefacts. Our objective was to develop a registration technique which overcomes these limitations by using combined information from both modalities. To study the effect of artefacts on registration, metal artefacts were simulated with one CT image rotated by a small angle in the sagittal plane. Image pairs containing these simulated artifacts were then registered to evaluate the resulting errors. To improve the registration in the vicinity where there were artefacts, intensity information from the PET images was incorporated using several techniques. A well-established B-splines based non-rigid registration code was reworked to allow multicomponent registration. A similarity measure with four possible weighted components relating to the ways in which the CT and PET information can be combined to drive the registration of a pair of these dual-valued images was employed. Several registration methods based on using this multicomponent similarity measure were implemented with the goal of effectively registering the images containing the simulated artifacts. A method was also developed to swap control point displacements from the PET-derived transformation in the vicinity of the artefact. This method yielded the best result on the simulated images and was evaluated on images where actual dental artifacts were present

Segmentation, tracking, and kinematics of lung parenchyma and lung tumors from 4D CT with application to radiation treatment planning.

This thesis is concerned with development of techniques for efficient computerized analysis of 4-D CT data. The goal is to have a highly automated approach to segmentation of the lung boundary and lung nodules inside the lung. The determination of exact lung tumor location over space and time by image segmentation is an essential step to track thoracic malignancies. Accurate image segmentation helps clinical experts examine the anatomy and structure and determine the disease progress. Since 4-D CT provides structural and anatomical information during tidal breathing, we use the same data to also measure mechanical properties related to deformation of the lung tissue including Jacobian and strain at high resolutions and as a function of time. Radiation Treatment of patients with lung cancer can benefit from knowledge of these measures of regional ventilation. Graph-cuts techniques have been popular for image segmentation since they are able to treat highly textured data via robust global optimization, avoiding local minima in graph based optimization. The graph-cuts methods have been used to extract globally optimal boundaries from images by s/t cut, with energy function based on model-specific visual cues, and useful topological constraints. The method makes N-dimensional globally optimal segmentation possible with good computational efficiency. Even though the graph-cuts method can extract objects where there is a clear intensity difference, segmentation of organs or tumors pose a challenge. For organ segmentation, many segmentation methods using a shape prior have been proposed. However, in the case of lung tumors, the shape varies from patient to patient, and with location. In this thesis, we use a shape prior for tumors through a training step and PCA analysis based on the Active Shape Model (ASM). The method has been tested on real patient data from the Brown Cancer Center at the University of Louisville. We performed temporal B-spline deformable registration of the 4-D CT data - this yielded 3-D deformation fields between successive respiratory phases from which measures of regional lung function were determined. During the respiratory cycle, the lung volume changes and five different lobes of the lung (two in the left and three in the right lung) show different deformation yielding different strain and Jacobian maps. In this thesis, we determine the regional lung mechanics in the Lagrangian frame of reference through different respiratory phases, for example, Phase10 to 20, Phase10 to 30, Phase10 to 40, and Phase10 to 50. Single photon emission computed tomography (SPECT) lung imaging using radioactive tracers with SPECT ventilation and SPECT perfusion imaging also provides functional information. As part of an IRB-approved study therefore, we registered the max-inhale CT volume to both VSPECT and QSPECT data sets using the Demon\u27s non-rigid registration algorithm in patient subjects. Subsequently, statistical correlation between CT ventilation images (Jacobian and strain values), with both VSPECT and QSPECT was undertaken. Through statistical analysis with the Spearman\u27s rank correlation coefficient, we found that Jacobian values have the highest correlation with both VSPECT and QSPECT

Interactive Multigrid Refinement for Deformable Image Registration

Deformable image registration is the spatial mapping of corresponding locations between images and can be used for important applications in radiotherapy. Although numerous methods have attempted to register deformable medical images automatically, such as salient-feature-based registration (SFBR), free-form deformation (FFD), and demons, no automatic method for registration is perfect, and no generic automatic algorithm has shown to work properly for clinical applications due to the fact that the deformation field is often complex and cannot be estimated well by current automatic deformable registration methods. This paper focuses on how to revise registration results interactively for deformable image registration. We can manually revise the transformed image locally in a hierarchical multigrid manner to make the transformed image register well with the reference image. The proposed method is based on multilevel B-spline to interactively revise the deformable transformation in the overlapping region between the reference image and the transformed image. The resulting deformation controls the shape of the transformed image and produces a nice registration or improves the registration results of other registration methods. Experimental results in clinical medical images for adaptive radiotherapy demonstrated the effectiveness of the proposed method

Deformable models for adaptive radiotherapy planning

Radiotherapy is the most widely used treatment for cancer, with 4 out of 10 cancer patients receiving radiotherapy as part of their treatment. The delineation of gross tumour volume (GTV) is crucial in the treatment of radiotherapy. An automatic contouring system would be beneficial in radiotherapy planning in order to generate objective, accurate and reproducible GTV contours. Image guided radiotherapy (IGRT) acquires patient images just before treatment delivery to allow any necessary positional correction. Consequently, real-time contouring system provides an opportunity to adopt radiotherapy on the treatment day. In this thesis, freely deformable models (FDM) and shape constrained deformable models (SCDMs) were used to automatically delineate the GTV for brain cancer and prostate cancer. Level set method (LSM) is a typical FDM which was used to contour glioma on brain MRI. A series of low level image segmentation methodologies are cascaded to form a case-wise fully automatic initialisation pipeline for the level set function. Dice similarity coefficients (DSCs) were used to evaluate the contours. Results shown a good agreement between clinical contours and LSM contours, in 93% of cases the DSCs was found to be between 60% and 80%. The second significant contribution is a novel development to the active shape model (ASM), a profile feature was selected from pre-computed texture features by minimising the Mahalanobis distance (MD) to obtain the most distinct feature for each landmark, instead of conventional image intensity. A new group-wise registration scheme was applied to solve the correspondence definition within the training data. This ASM model was used to delineated prostate GTV on CT. DSCs for this case was found between 0.75 and 0.91 with the mean DSC 0.81. The last contribution is a fully automatic active appearance model (AAM) which captures image appearance near the GTV boundary. The image appearance of inner GTV was discarded to spare the potential disruption caused by brachytherapy seeds or gold markers. This model outperforms conventional AAM at the prostate base and apex region by involving surround organs. The overall mean DSC for this case is 0.85

Non-rigid medical image registration with extended free form deformations: modelling general tissue transitions

Image registration seeks pointwise correspondences between the same or analogous objects in different images. Conventional registration methods generally impose continuity and smoothness throughout the image. However, there are cases in which the deformations may involve discontinuities. In general, the discontinuities can be of different types, depending on the physical properties of the tissue transitions involved and boundary conditions. For instance, in the respiratory motion the lungs slide along the thoracic cage following the tangential direction of their interface. In the normal direction, however, the lungs and the thoracic cage are constrained to be always in contact but they have different material properties producing different compression or expansion rates. In the literature, there is no generic method, which handles different types of discontinuities and considers their directional dependence. The aim of this thesis is to develop a general registration framework that is able to correctly model different types of tissue transitions with a general formalism. This has led to the development of the eXtended Free Form Deformation (XFFD) registration method. XFFD borrows the concept of the interpolation method from the eXtended Finite Element method (XFEM) to incorporate discontinuities by enriching B-spline basis functions, coupled with extra degrees of freedom. XFFD can handle different types of discontinuities and encodes their directional-dependence without any additional constraints. XFFD has been evaluated on digital phantoms, publicly available 3D liver and lung CT images. The experiments show that XFFD improves on previous methods and that it is important to employ the correct model that corresponds to the discontinuity type involved at the tissue transition. The effect of using incorrect models is more evident in the strain, which measures mechanical properties of the tissues

3-D lung deformation and function from respiratory-gated 4-D x-ray CT images : application to radiation treatment planning.

Many lung diseases or injuries can cause biomechanical or material property changes that can alter lung function. While the mechanical changes associated with the change of the material properties originate at a regional level, they remain largely asymptomatic and are invisible to global measures of lung function until they have advanced significantly and have aggregated. In the realm of external beam radiation therapy of patients suffering from lung cancer, determination of patterns of pre- and post-treatment motion, and measures of regional and global lung elasticity and function are clinically relevant. In this dissertation, we demonstrate that 4-D CT derived ventilation images, including mechanical strain, provide an accurate and physiologically relevant assessment of regional pulmonary function which may be incorporated into the treatment planning process. Our contributions are as follows: (i) A new volumetric deformable image registration technique based on 3-D optical flow (MOFID) has been designed and implemented which permits the possibility of enforcing physical constraints on the numerical solutions for computing motion field from respiratory-gated 4-D CT thoracic images. The proposed optical flow framework is an accurate motion model for the thoracic CT registration problem. (ii) A large displacement landmark-base elastic registration method has been devised for thoracic CT volumetric image sets containing large deformations or changes, as encountered for example in registration of pre-treatment and post-treatment images or multi-modality registration. (iii) Based on deformation maps from MOFIO, a novel framework for regional quantification of mechanical strain as an index of lung functionality has been formulated for measurement of regional pulmonary function. (iv) In a cohort consisting of seven patients with non-small cell lung cancer, validation of physiologic accuracy of the 4-0 CT derived quantitative images including Jacobian metric of ventilation, Vjac, and principal strains, (V?1, V?2, V?3, has been performed through correlation of the derived measures with SPECT ventilation and perfusion scans. The statistical correlations with SPECT have shown that the maximum principal strain pulmonary function map derived from MOFIO, outperforms all previously established ventilation metrics from 40-CT. It is hypothesized that use of CT -derived ventilation images in the treatment planning process will help predict and prevent pulmonary toxicity due to radiation treatment. It is also hypothesized that measures of regional and global lung elasticity and function obtained during the course of treatment may be used to adapt radiation treatment. Having objective methods with which to assess pre-treatment global and regional lung function and biomechanical properties, the radiation treatment dose can potentially be escalated to improve tumor response and local control

Predicting Breast Healing Deformation After Cancer Conservative Treatment

De acordo com a Organização Mundial de Saúde, o cancro da mama é o cancro mais frequente entre indivíduos do sexo feminino. Tendo em conta todos os tratamentos actualmente disponíveis, a cirurgia é aplicada maioritariamente usando duas metodologias: Mastectomia, que resulta na remoção total da mama e não apenas do tumor; e Tratamento Conservativo do Cancro da Mama no qual apenas é removido o tumor e uma porção reduzida do tecido da mama circundante. Como esperado, a aplicação de tratamento invasivos como o caso da cirurgia leva à deformação da mama afectando a qualidade de vida dos pacientes. Desta forma, a tecnologia poderá ser utilizada de modo a melhorar a interacção entre os pacientes e médicos clínicos de modo a visualizar as possíveis deformações resultantes e o processo de cicatrização após a cirurgia com o intuito de melhorar a qualidade de vida dos pacientes.De modo a atingir o objectivo acima descrito, é necessário obter modelos de treino capazes de descrever deformações anatómicas ao longo do processo de cicatrização da mama após Tratamento Conservativo do Cancro da Mama. Para que se obtenham modelos de treino viáveis é necessário um dataset com vários modelos 3D. Assim sendo, terá de ser gerado um dataset semi-sintético com modelos 3D representando as mamas das pacientes antes e após a cirurgia. Os modelos pré-cirurgicos serão obtidos com base em informação proveniente de ressonâncias magnéticas das pacientes às quais temos acesso. A informação semi-sintética pré-cirurgica terá em conta a informação real e variações das localizações e volume hipotéticos do tumor e da possível densidade da mama. Os modelos pós-cirurgicos serão simulados com base num modelo biomecânico de cicatrizaçãoPosteriormente, através da utilização de técnicas de aprendizagem computacional, poder-se-á então obter uma relação entre os modelos da mama da paciente antes e após a cirurgia.Por último, de modo a validar os modelos de previsão, os modelos simulados serão comparados o modelo pós-cirurgico previsto usando diversas métricas como distâncias Euclidianas e de Hausdorff.According to the annual report from the World Health Organization, breast cancer is the most frequent cancer among females. Considering all the treatments, surgery is being applied mostly using two methodologies: Mastectomy, that results on removing not only tumor, but also the total breast tissue; and Breast Cancer Conservative Treatment (BCCT) where only the tumor is removed with a thin layer of healthy tissue around it. It is clear that performing invasive treatment such as surgery, will lead to impose deformations on the breast, which can influence patients' quality of life (QoL). In this way, technology can be assisted to provide a framework that would improve the way patients interact with physicians. Enhancing this framework with the tools to visualize deformation and the healing process after the surgery can elevate patients' QoL.In order to accomplish the mentioned aim, this thesis focuses on obtaining training models to describe anatomical deformations during the healing process of the breast after BCCT. To achieve reliable training models, a dataset with several 3D breast models is required. Therefore, a semi-synthetic dataset may be generated, containing 3D breast models representing the patients' breasts before and after the surgery. The pre-surgical models are obtained through MRI data of the few patients' data that we have access. The semi-synthetic data of the pre-surgical stage will be generated taking as input these real data and variations of the hypothetic tumor's location and volume and possible breast densities. The pos-surgical data is simulated by a biomechanical wound healing model. Then by using different machine learning approaches, the relation between the patient's breast before and after the surgery can be obtained and the deformation predicted.Finally, concerning the evaluation, simulated healed breasts will be compared with the pos-surgical 3D breast models in the dataset through several metrics including Euclidean and Hausdorff distances