G Sharp

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.

Yunhe Xie, Kongbin Kang, Gregory Sharp et al.

Image guidance has been widely used in radiation therapy. Correctly identifying the bounding box of the anatomical landmarks from limited field of views is the key to success. In image-guided radiation therapy (IGRT), the detection of those landmarks like the 12th vertebra (T12) still requires tedious manual inspections and annotations; and superior-inferior misalignment to the wrong vertebral body is still relatively common. It is necessary to develop an automated approach to detect those landmarks from images. The challenges of training a model to identify T12 vertebrae automatically mainly are high shape similarity between T12 and neighboring vertebrae, limited annotated data, and class imbalance. This study proposed a novel 3D detection network, requiring only a small amount of training data. Our approach has the following innovations, including 1) the introduction of an auxiliary network to build constraint feature map for improving the model's generalization, especially when the constraint structure is easier to be detected than the main one; 2) an improved detection head and target functions for accurate bounding box detection; and 3) an improved loss functions to address the high class imbalance. Our proposed network was trained, validated and tested on anotated CT images from 55 patients and demonstrated accurate distinguish T12 vertebra from its neighboring vertebrae of high shape similarity. Our proposed algorithm yielded the bounding box center and size errors of 3.98\pm2.04mm and 16.83\pm8.34mm, respectively. Our approach significantly outperformed state-of-the-arts Retina-Net3D in average precision (AP) at IoU thresholds of 0.35 and 0.5, with AP increasing from 0 to 95.4 and 0 to 64.7, respectively. In summary, our approach has a great potential to be integrated into the clinical workflow to improve the safety of IGRT.