Ari Hietanen

Jorma Järnstedt, Jaakko Sahlsten, Joel Jaskari et al.

Deep learning approach has been demonstrated to automatically segment the bilateral mandibular canals from CBCT scans, yet systematic studies of its clinical and technical validation are scarce. To validate the mandibular canal localization accuracy of a deep learning system (DLS) we trained it with 982 CBCT scans and evaluated using 150 scans of five scanners from clinical workflow patients of European and Southeast Asian Institutes, annotated by four radiologists. The interobserver variability was compared to the variability between the DLS and the radiologists. In addition, the generalization of DLS to CBCT scans from scanners not used in the training data was examined to evaluate the out-of-distribution generalization capability. The DLS had lower variability to the radiologists than the interobserver variability between them and it was able to generalize to three new devices. For the radiologists' consensus segmentation, used as gold standard, the DLS had a symmetric mean curve distance of 0.39 mm compared to those of the individual radiologists with 0.62 mm, 0.55 mm, 0.47 mm, and 0.42 mm. The DLS showed comparable or slightly better performance in the segmentation of the mandibular canal with the radiologists and generalization capability to new scanners.

Jorma Järnstedt, Jaakko Sahlsten, Joel Jaskari et al.

Preoperative radiological identification of mandibular canals is essential for maxillofacial surgery. This study demonstrates the reproducibility of a deep learning system (DLS) by evaluating its localisation performance on 165 heterogeneous cone beam computed tomography (CBCT) scans from 72 patients in comparison to an experienced radiologist's annotations. We evaluated the performance of the DLS using the symmetric mean curve distance (SMCD), the average symmetric surface distance (ASSD), and the Dice similarity coefficient (DSC). The reproducibility of the SMCD was assessed using the within-subject coefficient of repeatability (RC). Three other experts rated the diagnostic validity twice using a 0-4 Likert scale. The reproducibility of the Likert scoring was assessed using the repeatability measure (RM). The RC of SMCD was 0.969 mm, the median (interquartile range) SMCD and ASSD were 0.643 (0.186) mm and 0.351 (0.135) mm, respectively, and the mean (standard deviation) DSC was 0.548 (0.138). The DLS performance was most affected by postoperative changes. The RM of the Likert scoring was 0.923 for the radiologist and 0.877 for the DLS. The mean (standard deviation) Likert score was 3.94 (0.27) for the radiologist and 3.84 (0.65) for the DLS. The DLS demonstrated proficient qualitative and quantitative reproducibility, temporal generalisability, and clinical validity.

Harshit Agrawal, Ari Hietanen, Simo Särkkä

Metal artifact correction is a challenging problem in cone beam computed tomography (CBCT) scanning. Metal implants inserted into the anatomy cause severe artifacts in reconstructed images. Widely used inpainting-based metal artifact reduction (MAR) methods require segmentation of metal traces in the projections as a first step, which is a challenging task. One approach is to use a deep learning method to segment metals in the projections. However, the success of deep learning methods is limited by the availability of realistic training data. It is laborious and time consuming to get reliable ground truth annotations due to unclear implant boundaries and large numbers of projections. We propose to use X-ray simulations to generate synthetic metal segmentation training dataset from clinical CBCT scans. We compare the effect of simulations with different numbers of photons and also compare several training strategies to augment the available data. We compare our model's performance on real clinical scans with conventional region growing threshold-based MAR, moving metal artifact reduction method, and a recent deep learning method. We show that simulations with relatively small number of photons are suitable for the metal segmentation task and that training the deep learning model with full size and cropped projections together improves the robustness of the model. We show substantial improvement in the image quality affected by severe motion, voxel size under-sampling, and out-of-FOV metals. Our method can be easily integrated into the existing projection-based MAR pipeline to get improved image quality. This method can provide a novel paradigm to accurately segment metals in CBCT projections.

Harshit Agrawal, Ari Hietanen, Simo Särkkä

Purpose: Scatter artifacts drastically degrade the image quality of cone-beam computed tomography (CBCT) scans. Although deep learning-based methods show promise in estimating scatter from CBCT measurements, their deployment in mobile CBCT systems or edge devices is still limited due to the large memory footprint of the networks. This study addresses the issue by applying networks at varying resolutions and suggesting an optimal one, based on speed and accuracy. Methods: First, the reconstruction error in down-up sampling of CBCT scatter signal was examined at six resolutions by comparing four interpolation methods. Next, a recent state-of-the-art method was trained across five image resolutions and evaluated for the reductions in floating-point operations (FLOPs), inference times, and GPU memory requirements. Results: Reducing the input size and network parameters achieved a 78-fold reduction in FLOPs compared to the baseline method, while maintaining comarable performance in terms of mean-absolute-percentage-error (MAPE) and mean-square-error (MSE). Specifically, the MAPE decreased to 3.85% compared to 4.42%, and the MSE decreased to 1.34 \times 10^{-2} compared to 2.01 \times 10^{-2}. Inference time and GPU memory usage were reduced by factors of 16 and 12, respectively. Further experiments comparing scatter-corrected reconstructions on a large, simulated dataset and real CBCT scans from water and Sedentex CT phantoms clearly demonstrated the robustness of our method. Conclusion: This study highlights the underappreciated role of downsampling in deep learning-based scatter estimation. The substantial reduction in FLOPs and GPU memory requirements achieved by our method enables scatter correction in resource-constrained environments, such as mobile CBCT and edge devices.