Multitask 3D CBCT-to-CT Translation and Organs-at-Risk Segmentation Using Physics-Based Data Augmentation
This addresses the need for better mid-treatment adaptation in radiotherapy for lung cancer patients by enhancing low-quality CBCT images, though it is incremental as it builds on existing translation and segmentation methods.
The paper tackled the problem of improving noisy weekly CBCT images for radiotherapy by developing a multitask 3D deep learning framework that simultaneously translates CBCT to high-quality CT-like images and segments organs-at-risk, reducing mean absolute error from 162.77 HU to 29.31 HU and achieving DICE scores up to 0.96 for lungs.
In current clinical practice, noisy and artifact-ridden weekly cone-beam computed tomography (CBCT) images are only used for patient setup during radiotherapy. Treatment planning is done once at the beginning of the treatment using high-quality planning CT (pCT) images and manual contours for organs-at-risk (OARs) structures. If the quality of the weekly CBCT images can be improved while simultaneously segmenting OAR structures, this can provide critical information for adapting radiotherapy mid-treatment as well as for deriving biomarkers for treatment response. Using a novel physics-based data augmentation strategy, we synthesize a large dataset of perfectly/inherently registered planning CT and synthetic-CBCT pairs for locally advanced lung cancer patient cohort, which are then used in a multitask 3D deep learning framework to simultaneously segment and translate real weekly CBCT images to high-quality planning CT-like images. We compared the synthetic CT and OAR segmentations generated by the model to real planning CT and manual OAR segmentations and showed promising results. The real week 1 (baseline) CBCT images which had an average MAE of 162.77 HU compared to pCT images are translated to synthetic CT images that exhibit a drastically improved average MAE of 29.31 HU and average structural similarity of 92% with the pCT images. The average DICE scores of the 3D organs-at-risk segmentations are: lungs 0.96, heart 0.88, spinal cord 0.83 and esophagus 0.66. This approach could allow clinicians to adjust treatment plans using only the routine low-quality CBCT images, potentially improving patient outcomes. Our code, data, and pre-trained models will be made available via our physics-based data augmentation library, Physics-ArX, at https://github.com/nadeemlab/Physics-ArX.