Surface Reconstruction from Noisy and Sparse Data

We introduce a set of algorithms for registering, filtering and measuring the similarity of unorganized 3d point clouds, usually obtained from multiple views. We contribute a method for computing the similarity between point clouds that represent closed surfaces, specifically segmented tumors from CT scans. We obtain watertight surfaces and utilize volumetric overlap to determine similarity in a volumetric way. This similarity measure is used to quantify treatment variability based on target volume segmentation both prior to and following radiotherapy planning stages. We also contribute an algorithm for the drift-free registration of thin, non- rigid scans, where drift is the build-up of error caused by sequential pairwise registration, which is the alignment of each scan to its neighbor. We construct an average scan using mutual nearest neighbors, each scan is registered to this average scan, after which we update the average scan and continue this process until convergence. The use case herein is for merging scans of plants from multiple views and registering vascular scans together. Our final contribution is a method for filtering noisy point clouds, specif- ically those constructed from merged depth maps as obtained from a range scanner or multiple view stereo (MVS), applying techniques that have been utilized in finding outliers in clustered data, but not in MVS. We utilize ker- nel density estimation to obtain a probability density function over the space of observed points, utilizing variable bandwidths based on the nature of the neighboring points, Mahalanobis and reachability distances that is more dis- criminative than a classical Mahalanobis distance-based metric

Real-time intrafraction motion monitoring in external beam radiotherapy

© 2019 Institute of Physics and Engineering in Medicine. Radiotherapy (RT) aims to deliver a spatially conformal dose of radiation to tumours while maximizing the dose sparing to healthy tissues. However, the internal patient anatomy is constantly moving due to respiratory, cardiac, gastrointestinal and urinary activity. The long term goal of the RT community to 'see what we treat, as we treat' and to act on this information instantaneously has resulted in rapid technological innovation. Specialized treatment machines, such as robotic or gimbal-steered linear accelerators (linac) with in-room imaging suites, have been developed specifically for real-time treatment adaptation. Additional equipment, such as stereoscopic kilovoltage (kV) imaging, ultrasound transducers and electromagnetic transponders, has been developed for intrafraction motion monitoring on conventional linacs. Magnetic resonance imaging (MRI) has been integrated with cobalt treatment units and more recently with linacs. In addition to hardware innovation, software development has played a substantial role in the development of motion monitoring methods based on respiratory motion surrogates and planar kV or Megavoltage (MV) imaging that is available on standard equipped linacs. In this paper, we review and compare the different intrafraction motion monitoring methods proposed in the literature and demonstrated in real-time on clinical data as well as their possible future developments. We then discuss general considerations on validation and quality assurance for clinical implementation. Besides photon RT, particle therapy is increasingly used to treat moving targets. However, transferring motion monitoring technologies from linacs to particle beam lines presents substantial challenges. Lessons learned from the implementation of real-time intrafraction monitoring for photon RT will be used as a basis to discuss the implementation of these methods for particle RT

Interactive medical image segmentation - towards integrating human guidance and deep learning

Medical image segmentation is an essential step in many clinical workflows involving diagnostics and patient treatment planning. Deep learning has advanced the field of medical image segmentation, particularly with respect to automating contouring. However, some anatomical structures, such as tumours, are challenging for fully automated methods. When automatic methods fail, manual contouring is required. In such cases, semi-automatic tools can support clinicians in contouring tasks. The objective of this thesis was to leverage clinicians’ expert knowledge when performing segmentation tasks, allowing for interactions along the segmentation workflow and improving deep learning predictions. In this thesis, a deep learning approach is proposed that produces a 3D segmentation of a structure of interest based on a user-provided input. If trained on a diverse set of structures, state-of-the-art performance was achieved for structures included in the training set. More importantly, the model was also able to generalize and make predictions for unseen structures that were not represented in the training set. Various avenues to guide user interaction and leverage multiple user inputs more effectively were also investigated. These further improved the segmentation performance and demonstrated the ability to accurately segment a broad range of anatomical structures. An evaluation by clinicians demonstrated that time spent contouring was reduced when using the contextual deep learning tool as compared to conventional contouring tools. This evaluation also revealed that the majority of contouring time is observation time, which is only indirectly affected by the segmentation approach. This suggests, that user interface design and guiding the user’s attention to critical areas can have a large impact on time taken on the contouring task. Overall, this thesis proposes an interactive deep learning segmentation method, demonstrates its clinical impact, and highlights the potential synergies between clinicians and artificial intelligence

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

The clinical utility of prostate cancer heterogeneity using texture analysis of multiparametric MRI

Purpose To determine if multiparametric MRI (mpMRI) derived filtration-histogram based texture analysis (TA) can differentiate between different Gleason scores (GS) and the D’Amico risk in prostate cancer. Methods We retrospectively studied patients whose pre-operative 1.5T mpMRI had shown a visible tumour and who subsequently underwent radical prostatectomy (RP). Guided by tumour location from the histopathology report, we drew a region of interest around the dominant visible lesion on a single axial slice on the T2, Apparent Diffusion Coefficient (ADC) map and early arterial phase post-contrast T1 image. We then performed TA with a filtration-histogram software (TexRAD -Feedback Medical Ltd, Cambridge, UK). We correlated GS and D’Amico risk with texture using the Spearman’s rank correlation test. Results We had 26 RP patients with an MR-visible tumour. Mean of positive pixels (MPP) on ADC showed a significant negative correlation with GS at coarse texture scales. MPP showed a significant negative correlation with GS without filtration and with medium filtration. MRI contrast texture without filtration showed a significant, negative correlation with D’Amico score. MR T2 texture showed a significant, negative correlation with the D’Amico risk, particularly at textures without filtration, medium texture scales and coarse texture scales. Conclusion ADC map mpMRI TA correlated negatively with GS, and T2 and post-contrast images with the D’Amico risk score. These associations may allow for better assessment of disease prognosis and a non-invasive method of follow-up for patients on surveillance. Further, identifying clinically significant prostate cancer is essential to reduce harm from over-diagnosis and over-treatment