Exploring contrast generalisation in deep learning-based brain MRI-to-CT synthesis

Background: Synthetic computed tomography (sCT) has been proposed and increasingly clinically adopted to enable magnetic resonance imaging (MRI)-based radiotherapy. Deep learning (DL) has recently demonstrated the ability to generate accurate sCT from fixed MRI acquisitions. However, MRI protocols may change over time or differ between centres resulting in low-quality sCT due to poor model generalisation. Purpose: investigating domain randomisation (DR) to increase the generalisation of a DL model for brain sCT generation. Methods: CT and corresponding T1-weighted MRI with/without contrast, T2-weighted, and FLAIR MRI from 95 patients undergoing RT were collected, considering FLAIR the unseen sequence where to investigate generalisation. A ``Baseline'' generative adversarial network was trained with/without the FLAIR sequence to test how a model performs without DR. Image similarity and accuracy of sCT-based dose plans were assessed against CT to select the best-performing DR approach against the Baseline. Results: The Baseline model had the poorest performance on FLAIR, with mean absolute error (MAE)=106$\pm$20.7 HU (mean$\pm\sigma$). Performance on FLAIR significantly improved for the DR model with MAE=99.0$\pm$14.9 HU, but still inferior to the performance of the Baseline+FLAIR model (MAE=72.6$\pm$10.1 HU). Similarly, an improvement in $\gamma$-pass rate was obtained for DR vs Baseline. Conclusions: DR improved image similarity and dose accuracy on the unseen sequence compared to training only on acquired MRI. DR makes the model more robust, reducing the need for re-training when applying a model on sequences unseen and unavailable for retraining.Comment: Preprint submitted to Physica Medica on 2023-02-16 for review. Also published in Zenodo at https://doi.org/10.5281/zenodo.774264

SynthRAD2023 Grand Challenge dataset: generating synthetic CT for radiotherapy

Purpose: Medical imaging has become increasingly important in diagnosing and treating oncological patients, particularly in radiotherapy. Recent advances in synthetic computed tomography (sCT) generation have increased interest in public challenges to provide data and evaluation metrics for comparing different approaches openly. This paper describes a dataset of brain and pelvis computed tomography (CT) images with rigidly registered CBCT and MRI images to facilitate the development and evaluation of sCT generation for radiotherapy planning. Acquisition and validation methods: The dataset consists of CT, CBCT, and MRI of 540 brains and 540 pelvic radiotherapy patients from three Dutch university medical centers. Subjects' ages ranged from 3 to 93 years, with a mean age of 60. Various scanner models and acquisition settings were used across patients from the three data-providing centers. Details are available in CSV files provided with the datasets. Data format and usage notes: The data is available on Zenodo (https://doi.org/10.5281/zenodo.7260705) under the SynthRAD2023 collection. The images for each subject are available in nifti format. Potential applications: This dataset will enable the evaluation and development of image synthesis algorithms for radiotherapy purposes on a realistic multi-center dataset with varying acquisition protocols. Synthetic CT generation has numerous applications in radiation therapy, including diagnosis, treatment planning, treatment monitoring, and surgical planning.Comment: 15 pages, 4 figures, 9 tables, pre-print submitted to Medical Physics - dataset. The training dataset is available on Zenodo at https://doi.org/10.5281/zenodo.7260705 from April, 1st 202

Experimental iodine-125 seed irradiation of intracerebral brain tumors in nude mice

<p>Abstract</p> <p>Background</p> <p>High-dose radiotherapy is standard treatment for patients with brain cancer. However, in preclinical research external beam radiotherapy is limited to heterotopic murine models– high-dose radiotherapy to the murine head is fatal due to radiation toxicity. Therefore, we developed a stereotactic brachytherapy mouse model for high-dose focal irradiation of experimental intracerebral (orthotopic) brain tumors.</p> <p>Methods</p> <p>Twenty-one nude mice received a hollow guide-screw implanted in the skull. After three weeks, 5 × 10⁵U251-NG2 human glioblastoma cells were injected. Five days later, a 2 mCi iodine-125 brachytherapy seed was inserted through the guide-screw in 11 randomly selected mice; 10 mice received a sham seed. Mice were euthanized when severe neurological or physical symptoms occurred. The cumulative irradiation dose 5 mm below the active iodine-125 seeds was 23.0 Gy after 13 weeks (BED_tumor= 30.6 Gy).</p> <p>Results</p> <p>In the sham group, 9/10 animals (90%) showed signs of lethal tumor progression within 6 weeks. In the experimental group, 2/11 mice (18%) died of tumor progression within 13 weeks. Acute side effects in terms of weight loss or neurological symptoms were not observed in the irradiated animals.</p> <p>Conclusion</p> <p>The intracerebral implantation of an iodine-125 brachytherapy seed through a stereotactic guide-screw in the skull of mice with implanted brain tumors resulted in a significantly prolonged survival, caused by high-dose irradiation of the brain tumor that is biologically comparable to high-dose fractionated radiotherapy– without fatal irradiation toxicity. This is an excellent mouse model for testing orthotopic brain tumor therapies in combination with radiation therapy.</p

Initial Clinical Experience of MR-Guided Radiotherapy for Non-Small Cell Lung Cancer.

Curative-intent radiotherapy plays an integral role in the treatment of lung cancer and therefore improving its therapeutic index is vital. MR guided radiotherapy (MRgRT) systems are the latest technological advance which may help with achieving this aim. The majority of MRgRT treatments delivered to date have been stereotactic body radiation therapy (SBRT) based and include the treatment of (ultra-) central tumors. However, there is a move to also implement MRgRT as curative-intent treatment for patients with inoperable locally advanced NSCLC. This paper presents the initial clinical experience of using the two commercially available systems to date: the ViewRay MRIdian and Elekta Unity. The challenges and potential solutions associated with MRgRT in lung cancer will also be highlighted

Concerns about anti-angiogenic treatment in patients with glioblastoma multiforme

BACKGROUND: The relevance of angiogenesis inhibition in the treatment of glioblastoma multiforme (GBM) should be considered in the unique context of malignant brain tumours. Although patients benefit greatly from reduced cerebral oedema and intracranial pressure, this important clinical improvement on its own may not be considered as an anti-tumour effect. DISCUSSION: GBM can be roughly separated into an angiogenic component, and an invasive or migratory component. Although this latter component seems inert to anti-angiogenic therapy, it is of major importance for disease progression and survival. We reviewed all relevant literature. Published data support that clinical symptoms are tempered by anti-angiogenic treatment, but that tumour invasion continues. Unfortunately, current imaging modalities are affected by anti-angiogenic treatment too, making it even harder to define tumour margins. To illustrate this we present MRI, biopsy and autopsy specimens from bevacizumab-treated patients. Moreover, while treatment of other tumour types may be improved by combining chemotherapy with anti-angiogenic drugs, inhibiting angiogenesis in GBM may antagonise the efficacy of chemotherapeutic drugs by normalising the blood-brain barrier function. SUMMARY: Although angiogenesis inhibition is of considerable value for symptom reduction in GBM patients, lack of proof of a true anti-tumour effect raises concerns about the place of this type of therapy in the treatment of GBM

Experimental iodine-125 seed irradiation of intracerebral brain tumors in nude mice-3

<p><b>Copyright information:</b></p><p>Taken from "Experimental iodine-125 seed irradiation of intracerebral brain tumors in nude mice"</p><p>http://www.ro-journal.com/content/2/1/38</p><p>Radiation Oncology (London, England) 2007;2():38-38.</p><p>Published online 26 Sep 2007</p><p>PMCID:PMC2174502.</p><p></p>se skull. The inner diameter was 0.9 mm to tightly fit an I brachytherapy seed. Dimensions are given in mm. M3: metric screw thread 3

Experimental iodine-125 seed irradiation of intracerebral brain tumors in nude mice-1

<p><b>Copyright information:</b></p><p>Taken from "Experimental iodine-125 seed irradiation of intracerebral brain tumors in nude mice"</p><p>http://www.ro-journal.com/content/2/1/38</p><p>Radiation Oncology (London, England) 2007;2():38-38.</p><p>Published online 26 Sep 2007</p><p>PMCID:PMC2174502.</p><p></p>mouse brain with a large vital glioblastoma (T) that died 4.6 weeks after sham seed implantation. Normal brain tissue (B). (b) Section of the brain of the only long-surviving mouse in the group that was implanted with a sham seed. The mouse, euthanized 91 days after implantation, showed no vital tumor. (c) Section of the brain of an irradiated mouse that died from tumor progression 18 days after implantation of the I brachytherapy seed. Diffuse infiltration of cells (T) is present in the brain. (d) Section of the brain of an irradiated mouse euthanized at 13 weeks after implantation of a I brachytherapy seed showing regions of mechanical trauma (D), hypovascular brain tissue next to normal brain (B), but no vital tumor

Experimental iodine-125 seed irradiation of intracerebral brain tumors in nude mice-0

<p><b>Copyright information:</b></p><p>Taken from "Experimental iodine-125 seed irradiation of intracerebral brain tumors in nude mice"</p><p>http://www.ro-journal.com/content/2/1/38</p><p>Radiation Oncology (London, England) 2007;2():38-38.</p><p>Published online 26 Sep 2007</p><p>PMCID:PMC2174502.</p><p></p>ly implanted I brachytherapy seed (intermitted line) or a sham seed (uninterrupted line)