Keyur D. Shah

Keyur D. Shah, James A. Shackleford, Nagarajan Kandasamy et al.

Purpose: Deformable image registration (DIR) is critical in adaptive radiation therapy (ART) to account for anatomical changes. Conventional intensity-based DIR methods often fail when image intensities differ. This study evaluates a hybrid similarity metric combining intensity and structural information, leveraging CycleGAN-based intensity correction and auto-segmentation across three DIR workflows. Methods: A hybrid similarity metric combining a point-to-distance (PD) score and intensity similarity was implemented. Synthetic CT (sCT) images were generated using a 2D CycleGAN model trained on unpaired CT and CBCT images to enhance soft-tissue contrast. DIR workflows compared included: (1) traditional intensity-based (No PD), (2) auto-segmented contours on sCT (CycleGAN PD), and (3) expert manual contours (Expert PD). A 3D U-Net model trained on 56 images and validated on 14 cases segmented the prostate, bladder, and rectum. DIR accuracy was assessed using Dice Similarity Coefficient (DSC), 95% Hausdorff Distance (HD), and fiducial separation. Results: The hybrid metric improved DIR accuracy. For the prostate, DSC increased from 0.61+/-0.18 (No PD) to 0.82+/-0.13 (CycleGAN PD) and 0.89+/-0.05 (Expert PD), with reductions in 95% HD from 11.75 mm to 4.86 mm and 3.27 mm, respectively. Fiducial separation decreased from 8.95 mm to 4.07 mm (CycleGAN PD) and 4.11 mm (Expert PD) (p < 0.05). Improvements were also observed for the bladder and rectum. Conclusion: This study demonstrates that a hybrid similarity metric using CycleGAN-based auto-segmentation improves DIR accuracy, particularly for low-contrast CBCT images. These findings highlight the potential for integrating AI-based image correction and segmentation into ART workflows to enhance precision and streamline clinical processes.

Mingzhe Hu, Yuan Gao, Yuheng Li et al.

Purpose: Accurate segmentation of clinical target volumes (CTV) and organs-at-risk is crucial for optimizing gynecologic brachytherapy (GYN-BT) treatment planning. However, anatomical variability, low soft-tissue contrast in CT imaging, and limited annotated datasets pose significant challenges. This study presents GynBTNet, a novel multi-stage learning framework designed to enhance segmentation performance through self-supervised pretraining and hierarchical fine-tuning strategies. Methods: GynBTNet employs a three-stage training strategy: (1) self-supervised pretraining on large-scale CT datasets using sparse submanifold convolution to capture robust anatomical representations, (2) supervised fine-tuning on a comprehensive multi-organ segmentation dataset to refine feature extraction, and (3) task-specific fine-tuning on a dedicated GYN-BT dataset to optimize segmentation performance for clinical applications. The model was evaluated against state-of-the-art methods using the Dice Similarity Coefficient (DSC), 95th percentile Hausdorff Distance (HD95), and Average Surface Distance (ASD). Results: Our GynBTNet achieved superior segmentation performance, significantly outperforming nnU-Net and Swin-UNETR. Notably, it yielded a DSC of 0.837 +/- 0.068 for CTV, 0.940 +/- 0.052 for the bladder, 0.842 +/- 0.070 for the rectum, and 0.871 +/- 0.047 for the uterus, with reduced HD95 and ASD compared to baseline models. Self-supervised pretraining led to consistent performance improvements, particularly for structures with complex boundaries. However, segmentation of the sigmoid colon remained challenging, likely due to anatomical ambiguities and inter-patient variability. Statistical significance analysis confirmed that GynBTNet's improvements were significant compared to baseline models.