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

Dynamic Image Processing for Guidance of Off-pump Beating Heart Mitral Valve Repair

Compared to conventional open heart procedures, minimally invasive off-pump beating heart mitral valve repair aims to deliver equivalent treatment for mitral regurgitation with reduced trauma and side effects. However, minimally invasive approaches are often limited by the lack of a direct view to surgical targets and/or tools, a challenge that is compounded by potential movement of the target during the cardiac cycle. For this reason, sophisticated image guidance systems are required in achieving procedural efficiency and therapeutic success. The development of such guidance systems is associated with many challenges. For example, the system should be able to provide high quality visualization of both cardiac anatomy and motion, as well as augmenting it with virtual models of tracked tools and targets. It should have the capability of integrating pre-operative images to the intra-operative scenario through registration techniques. The computation speed must be sufficiently fast to capture the rapid cardiac motion. Meanwhile, the system should be cost effective and easily integrated into standard clinical workflow. This thesis develops image processing techniques to address these challenges, aiming to achieve a safe and efficient guidance system for off-pump beating heart mitral valve repair. These techniques can be divided into two categories, using 3D and 2D image data respectively. When 3D images are accessible, a rapid multi-modal registration approach is proposed to link the pre-operative CT images to the intra-operative ultrasound images. The ultrasound images are used to display the real time cardiac motion, enhanced by CT data serving as high quality 3D context with annotated features. I also developed a method to generate synthetic dynamic CT images, aiming to replace real dynamic CT data in such a guidance system to reduce the radiation dose applied to the patients. When only 2D images are available, an approach is developed to track the feature of interest, i.e. the mitral annulus, based on bi-plane ultrasound images and a magnetic tracking system. The concept of modern GPU-based parallel computing is employed in most of these approaches to accelerate the computation in order to capture the rapid cardiac motion with desired accuracy. Validation experiments were performed on phantom, animal and human data. The overall accuracy of registration and feature tracking with respect to the mitral annulus was about 2-3mm with computation time of 60-400ms per frame, sufficient for one update per cardiac cycle. It was also demonstrated in the results that the synthetic CT images can provide very similar anatomical representations and registration accuracy compared to that of the real dynamic CT images. These results suggest that the approaches developed in the thesis have good potential for a safer and more effective guidance system for off-pump beating heart mitral valve repair

Quantitative Image Reconstruction Methods for Low Signal-To-Noise Ratio Emission Tomography

Novel internal radionuclide therapies such as radioembolization (RE) with Y-90 loaded microspheres and targeted therapies labeled with Lu-177 offer a unique promise for personalized treatment of cancer because imaging-based pre-treatment dosimetry assessment can be used to determine administered activities, which deliver tumoricidal absorbed doses to lesions while sparing critical organs. At present, however, such therapies are administered with fixed or empiric activities with little or no dosimetry planning. The main reason for lack of dosimetry guided personalized treatment in radionuclide therapies is the challenges and impracticality of quantitative emission tomography imaging and the lack of well established dose-effect relationships, potentially due to inaccuracies in quantitative imaging. While radionuclides for therapy have been chosen for their attractive characteristics for cancer treatment, their suitability for emission tomography imaging is less than ideal. For example, imaging of the almost pure beta emitter, Y-90, involves SPECT via bremsstrahlung photons that have a low and tissue dependent yield or PET via a very low abundance positron emission (32 out of 1 million decays) that leads to a very low true coincidence-rate in the presence of high singles events from bremsstrahlung photons. Lu-177 emits gamma-rays suitable for SPECT, but they are low in intensity (113 keV: 6%, 208 keV: 10%), and only the higher energy emission is generally used because of the large downscatter component associated with the lower energy gamma-ray. The main aim of the research in this thesis is to improve accuracy of quantitative PET and SPECT imaging of therapy radionuclides for dosimetry applications. Although PET is generally considered as superior to SPECT for quantitative imaging, PET imaging of `non-pure' positron emitters can be complex. We focus on quantitative SPECT and PET imaging of two widely used therapy radionuclides, Lu-177 and Y-90, that have challenges associated with low count-rates. The long term goal of our work is to apply the methods we develop to patient imaging for dosimetry based planning to optimize the treatment either before therapy or after each cycle of therapy. For Y-90 PET/CT, we developed an image reconstruction formulation that relaxes the conventional image-domain nonnegativity constraint by instead imposing a positivity constraint on the predicted measurement mean that demonstrated improved quantification in simulated patient studies. For Y-90 SPECT/CT, we propose a new SPECT/CT reconstruction formulation including tissue dependent probabilities for bremsstrahlung generation in the system matrix. In addition to above mentioned quantitative image reconstruction methods specifically developed for each modality in Y-90 imaging, we propose a general image reconstruction method using trained regularizer for low-count PET and SPECT that we test on Y-90 and Lu-177 imaging. Our approach starts with the raw projection data and utilizes trained networks in the iterative image formation process. Specifically, we take a mathematics-based approach where we include convolutional neural networks within the iterative reconstruction process arising from an optimization problem. We further extend the trained regularization method by using anatomical side information. The trained regularizer incorporates the anatomical information using the segmentation mask generated by a trained segmentation network where its input is the co-registered CT image. Overall, the emission tomography methods we have proposed in this work are expected to enhance low-count PET and SPECT imaging of therapy radionuclides in patient studies, which will have value in establishing dose – response relationships and developing imaging based dosimetry guided treatment planning strategies in the future.PHDElectrical and Computer EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/155171/1/hongki_1.pd

Evaluating and Improving 4D-CT Image Segmentation for Lung Cancer Radiotherapy

Lung cancer is a high-incidence disease with low survival despite surgical advances and concurrent chemo-radiotherapy strategies. Image-guided radiotherapy provides for treatment measures, however, significant challenges exist for imaging, treatment planning, and delivery of radiation due to the influence of respiratory motion. 4D-CT imaging is capable of improving image quality of thoracic target volumes influenced by respiratory motion. 4D-CT-based treatment planning strategies requires highly accurate anatomical segmentation of tumour volumes for radiotherapy treatment plan optimization. Variable segmentation of tumour volumes significantly contributes to uncertainty in radiotherapy planning due to a lack of knowledge regarding the exact shape of the lesion and difficulty in quantifying variability. As image-segmentation is one of the earliest tasks in the radiotherapy process, inherent geometric uncertainties affect subsequent stages, potentially jeopardizing patient outcomes. Thus, this work assesses and suggests strategies for mitigation of segmentation-related geometric uncertainties in 4D-CT-based lung cancer radiotherapy at pre- and post-treatment planning stages