A patient-independent CT intensity matching method using conditional generative adversarial networks (cGAN) for single x-ray projection-based tumor localization.

A convolutional neural network (CNN)-based tumor localization method with a single x-ray projection was previously developed by us. One finding is that the discrepancy in the discrepancy in the intensity between a digitally reconstructed radiograph (DRR) of a three-dimensional computed tomography (3D-CT) and the measured x-ray projection has an impact on the performance. To address this issue, a patient-dependent intensity matching process for 3D-CT was performed using 3D-cone-beam computed tomography (3D-CBCT) from the same patient, which was sometimes inefficient and could adversely affect the clinical implementation of the framework. To circumvent this, in this work, we propose and validate a patient-independent intensity matching method based on a conditional generative adversarial network (cGAN). A 3D cGAN was trained to approximate the mapping from 3D-CT to 3D-CBCT from previous patient data. By applying the trained network to a new patient, a synthetic 3D-CBCT could be generated without the need to perform an actual CBCT scan on that patient. The DRR of the synthetic 3D-CBCT was subsequently utilized in our CNN-based tumor localization scheme. The method was tested using data from 12 patients with the same imaging parameters. The resulting 3D-CBCT and DRR were compared with real ones to demonstrate the efficacy of the proposed method. The tumor localization errors were also analyzed. The difference between the synthetic and real 3D-CBCT had a median value of no more than 10 HU for all patients. The relative error between the DRR and the measured x-ray projection was less than 4.8% ± 2.0% for all patients. For the three patients with a visible tumor in the x-ray projections, the average tumor localization errors were below 1.7 and 0.9 mm in the superior-inferior and lateral directions, resepectively. A patient-independent CT intensity matching method was developed, based on which accurate tumor localization was achieved. It does not require an actual CBCT scan to be performed before treatment for each patient, therefore making it more efficient in the clinical workflow.

Real-time tumor localization with single x-ray projection at arbitrary gantry angles using a convolutional neural network (CNN).

For tumor tracking therapy, precise knowledge of tumor position in real-time is very important. A technique using single x-ray projection based on a convolutional neural network (CNN) was recently developed which can achieve accurate tumor localization in real-time. However, this method was only validated at fixed gantry angles. In this study, an improved technique is developed to handle arbitrary gantry angles for rotational radiotherapy. To evaluate the highly complex relationship between x-ray projections at arbitrary angles and tumor motion, a special CNN was proposed. In this network, a binary region of interest (ROI) mask was applied on every extracted feature map. This avoids the overfitting problem due to gantry rotation by directing the network to neglect those irrelevant pixels whose intensity variation had nothing to do with breathing motion. In addition, an angle-dependent fully connection layer (ADFCL) was utilized to recover the mapping from extracted feature maps to tumor motion, which would vary with the gantry angles. The method was tested with images from 15 realistic patients and compared with a variant network of VGG, developed by Oxford University's Visual Geometry Group. The tumors were clearly visible on x-ray projections for five patients only. The average tumor localization error was under 1.8 mm and 1.0 mm in superior-inferior and lateral directions. For the other ten patients whose tumors were not clearly visible in the x-ray projection, a feature point localization error was computed to evaluate the proposed method, the mean value of which was no more than 1.5 mm and 1.0 mm in both directions for all patients. A tumor localization method for single x-ray projection at arbitrary angles based on a novel CNN was developed and validated in this study for real-time operation. This greatly expanded the applicability of the tumor localization framework to the rotation therapy.

Efficient Multiple Organ Localization in CT Image using 3D Region Proposal Network.

Organ localization is an essential preprocessing step for many medical image analysis tasks such as image registration, organ segmentation and lesion detection. In this work, we propose an efficient method for multiple organ localization in CT image using 3D region proposal network. Compared with other convolutional neural network based methods that successively detect the target organs in all slices to assemble the final 3D bounding box, our method is fully implemented in 3D manner, thus can take full advantages of the spatial context information in CT image to perform efficient organ localization with only one prediction. We also propose a novel backbone network architecture that generates high-resolution feature maps to further improve the localization performance on small organs. We evaluate our method on two clinical datasets, where 11 body organs and 12 head organs (or anatomical structures) are included. As our results shown, the proposed method achieves higher detection precision and localization accuracy than the current state-of-theart methods with approximate 4 to 18 times faster processing speed. Additionally, we have established a public dataset dedicated for organ localization on http://dx. doi.org/10.21227/df8g-pq27. The full implementation of the proposed method have also been made publicly available on https://github.com/superxuang/caffe_3d_faster_rcnn.

A probabilistic framework based on hidden markov model for fiducial identification in image-guided radiation treatments.

Fiducial tracking is a common target tracking method widely used in image-guided procedures such as radiotherapy and radiosurgery. In this paper, we present a multifiducial identification method that incorporates context information in the process. We first convert the problem into a state sequence problem by establishing a probabilistic framework based on a hidden Markov model (HMM), where prior probability represents an individual candidate's resemblance to a fiducial; transition probability quantifies the similarity of a candidate set to the fiducials' geometrical configuration; and the Viterbi algorithm provides an efficient solution. We then discuss the problem of identifying fiducials using stereo projections, and propose a special, higher order HMM, which consists of two parallel HMMs, connected by an association measure that captures the inherent correlation between the two projections. A novel algorithm, the concurrent viterbi with association (CVA) algorithm, is introduced to efficiently identify fiducials in the two projections simultaneously. This probabilistic framework is highly flexible and provides a buffer to accommodate deformations. A simple implementation of the CVA algorithm is presented to evaluate the efficacy of the framework. Experiments were carried out using clinical images acquired during patient treatments, and several examples are presented to illustrate a variety of clinical situations. In the experiments, the algorithm demonstrated a large tracking range, computational efficiency, ease of use, and robustness that meet the requirements for clinical use.

A fast, accurate, and automatic 2D-3D image registration for image-guided cranial radiosurgery.

The authors developed a fast and accurate two-dimensional (2D)-three-dimensional (3D) image registration method to perform precise initial patient setup and frequent detection and correction for patient movement during image-guided cranial radiosurgery treatment. In this method, an approximate geometric relationship is first established to decompose a 3D rigid transformation in the 3D patient coordinate into in-plane transformations and out-of-plane rotations in two orthogonal 2D projections. Digitally reconstructed radiographs are generated offline from a preoperative computed tomography volume prior to treatment and used as the reference for patient position. A multiphase framework is designed to register the digitally reconstructed radiographs with the x-ray images periodically acquired during patient setup and treatment. The registration in each projection is performed independently; the results in the two projections are then combined and converted to a 3D rigid transformation by 2D-3D geometric backprojection. The in-plane transformation and the out-of-plane rotation are estimated using different search methods, including multiresolution matching, steepest descent minimization, and one-dimensional search. Two similarity measures, optimized pattern intensity and sum of squared difference, are applied at different registration phases to optimize accuracy and computation speed. Various experiments on an anthropomorphic head-and-neck phantom showed that, using fiducial registration as a gold standard, the registration errors were 0.33 +/- 0.16 mm (s.d.) in overall translation and 0.29 degrees +/- 0.11 degrees (s.d.) in overall rotation. The total targeting errors were 0.34 +/- 0.16 mm (s.d.), 0.40 +/- 0.2 mm (s.d.), and 0.51 +/- 0.26 mm (s.d.) for the targets at the distances of 2, 6, and 10 cm from the rotation center, respectively. The computation time was less than 3 s on a computer with an Intel Pentium 3.0 GHz dual processor.

A study of the accuracy of cyberknife spinal radiosurgery using skeletal structure tracking.

OBJECTIVE: New technology has enabled the increasing use of radiosurgery to ablate spinal lesions. The first generation of the CyberKnife (Accuray, Inc., Sunnyvale, CA) image-guided radiosurgery system required implanted radiopaque markers (fiducials) to localize spinal targets. A recently developed and now commercially available spine tracking technology called Xsight (Accuray, Inc.) tracks skeletal structures and eliminates the need for implanted fiducials. The Xsight system localizes spinal targets by direct reference to the adjacent vertebral elements. This study sought to measure the accuracy of Xsight spine tracking and provide a qualitative assessment of overall system performance. METHODS: Total system error, which is defined as the distance between the centroids of the planned and delivered dose distributions and represents all possible treatment planning and delivery errors, was measured using a realistic, anthropomorphic head-and-neck phantom. The Xsight tracking system error component of total system error was also computed by retrospectively analyzing image data obtained from eleven patients with a total of 44 implanted fiducials who underwent CyberKnife spinal radiosurgery. RESULTS: The total system error of the Xsight targeting technology was measured to be 0.61 mm. The tracking system error component was found to be 0.49 mm. CONCLUSION: The Xsight spine tracking system is practically important because it is accurate and eliminates the use of implanted fiducials. Experience has shown this technology to be robust under a wide range of clinical circumstances.