RootPainter3D: Interactive-machine-learning enables rapid and accurate contouring for radiotherapy

Deep learning-assisted interactive contouring of lung cancer: Impact on contouring time and consistency

BACKGROUND AND PURPOSE

To evaluate the impact of a deep learning (DL)-assisted interactive contouring tool on inter-observer variability and the time taken to complete tumour contouring.

MATERIALS AND METHODS

Nine clinicians contoured the gross tumour volume (GTV) using the PET-CT scans of 10 non-small cell lung cancer (NSCLC) patients, either using DL-assisted or manual contouring tools. After contouring a case using one contouring method, the same case was contoured one week later using the other method. The contours and time taken were compared.

RESULTS

Use of the DL-assisted tool led to a statistically significant decrease in active contouring time of 23 % relative to the standard manual segmentation method (p < 0.01). The mean observation time for all clinicians and cases made up nearly 60 % of interaction time for both contouring approaches. On average the time spent contouring per case was reduced from 22 min to 19 min when using the DL-assisted tool. Additionally, the DL-assisted tool reduced contour variability in the parts of tumour where clinicians tended to disagree the most, while the consensus contour was similar whichever of the two contouring approaches was used.

CONCLUSIONS

A DL-assisted interactive contouring approach decreased active contouring time and local inter-observer variability when used to delineate lung cancer GTVs compared to a standard manual method. Integration of this tool into the clinical workflow could assist clinicians in contouring tasks and improve contouring efficiency.

3D U-Net Segmentation Improves Root System Reconstruction from 3D MRI Images in Automated and Manual Virtual Reality Work Flows

Magnetic resonance imaging (MRI) is used to image root systems grown in opaque soil. However, reconstruction of root system architecture (RSA) from 3-dimensional (3D) MRI images is challenging. Low resolution and poor contrast-to-noise ratios (CNRs) hinder automated reconstruction. Hence, manual reconstruction is still widely used. Here, we evaluate a novel 2-step work flow for automated RSA reconstruction. In the first step, a 3D U-Net segments MRI images into root and soil in super-resolution. In the second step, an automated tracing algorithm reconstructs the root systems from the segmented images. We evaluated the merits of both steps for an MRI dataset of 8 lupine root systems, by comparing the automated reconstructions to manual reconstructions of unaltered and segmented MRI images derived with a novel virtual reality system. We found that the U-Net segmentation offers profound benefits in manual reconstruction: reconstruction speed was doubled (+97%) for images with low CNR and increased by 27% for images with high CNR. Reconstructed root lengths were increased by 20% and 3%, respectively. Therefore, we propose to use U-Net segmentation as a principal image preprocessing step in manual work flows. The root length derived by the tracing algorithm was lower than in both manual reconstruction methods, but segmentation allowed automated processing of otherwise not readily usable MRI images. Nonetheless, model-based functional root traits revealed similar hydraulic behavior of automated and manual reconstructions. Future studies will aim to establish a hybrid work flow that utilizes automated reconstructions as scaffolds that can be manually corrected.

Prediction of Radiation-induced Lymphopenia following Exposure of the Thoracic Region and Associated Risk of Infections and Mortality

AIMS

Large blood volumes are irradiated when the heart is exposed to radiation. The mean heart dose (MHD) may be a good surrogate for circulating lymphocytes exposure. We investigated the association between MHD and radiation-induced lymphopenia and explored the impact of the end-of-radiation-therapy (EoRT) lymphocyte count on clinical outcomes.

MATERIALS AND METHODS

In total, 915 patients were analysed: 303 patients with breast cancer and 612 with intrathoracic tumours: oesophageal cancer (291), non-small cell lung cancer (265) and small cell lung cancer (56). Heart contours were generated using an interactive deep learning delineation process and an individual dose volume histogram for each heart was obtained. A dose volume histogram for the body was extracted from the clinical systems. We compared different models analysing the effect of heart dosimetry on the EoRT lymphocyte count using multivariable linear regression and assessed goodness of fit. We published interactive nomograms for the best models. The association of the degree of EoRT lymphopenia with clinical outcomes (overall survival, cancer treatment failure and infection) was investigated.

RESULTS

An increasing low dose bath to the body and MHD were associated with a low EoRT lymphocyte count. The best models for intrathoracic tumours included dosimetric parameters, age, gender, number of fractions, concomitant chemotherapy and pre-treatment lymphocyte count. Models for patients with breast cancer showed no improvement when adding dosimetric variables to the clinical predictors. EoRT lymphopenia grade ≥3 was associated with decreased survival and increased risk of infections among patients with intrathoracic tumours.

CONCLUSION

Among patients with intrathoracic tumours, radiation exposure to the heart contributes to lymphopenia and low levels of peripheral lymphocytes after radiotherapy are associated with worse clinical outcomes.

A simple single-cycle interactive strategy to improve deep learning-based segmentation of organs-at-risk in head-and-neck cancer

Background and purpose

Interactive segmentation seeks to incorporate human knowledge into segmentation models and thereby reducing the total amount of editing of auto-segmentations. By performing only interactions which provide new information, segmentation performance may increase cost-effectively. The aim of this study was to develop, evaluate and test feasibility of a deep learning-based single-cycle interactive segmentation model with the input being computer tomography (CT) and a small amount of information rich contours.

Methods and Materials

A single-cycle interactive segmentation model, which took CT and the most cranial and caudal contour slices for each of 16 organs-at-risk for head-and-neck cancer as input, was developed. A CT-only model served as control. The models were evaluated with Dice similarity coefficient, Hausdorff Distance 95th percentile and average symmetric surface distance. A subset of 8 organs-at-risk were selected for a feasibility test. In this, a designated radiation oncologist used both single-cycle interactive segmentation and atlas-based auto-contouring for three cases. Contouring time and added path length were recorded.

Results

The medians of Dice coefficients increased with single-cycle interactive segmentation in the range of 0.004 (Brain)-0.90 (EyeBack_merged) when compared to CT-only. In the feasibility test, contouring time and added path length were reduced for all three cases as compared to editing atlas-based auto-segmentations.

Conclusion

Single-cycle interactive segmentation improved segmentation metrics when compared to the CT-only model and was clinically feasible from a technical and usability point of view. The study suggests that it may be cost-effective to add a small amount of contouring input to deep learning-based segmentation models.

Towards interactive deep-learning for tumour segmentation in head and neck cancer radiotherapy

Background and purpose

With deep-learning, gross tumour volume (GTV) auto-segmentation has substantially been improved, but still substantial manual corrections are needed. With interactive deep-learning (iDL), manual corrections can be used to update a deep-learning tool while delineating, minimising the input to achieve acceptable segmentations. We present an iDL tool for GTV segmentation that took annotated slices as input and simulated its performance on a head and neck cancer (HNC) dataset.

Materials and methods

Multimodal image data of 204 HNC patients with clinical tumour and lymph node GTV delineations were used. A baseline convolutional neural network (CNN) was trained (n = 107 training, n = 22 validation) and tested (n = 24). Subsequently, user input was simulated on initial test set by replacing one or more of predicted slices with ground truth delineation, followed by re-training the CNN. The objective was to optimise re-training parameters and simulate slice selection scenarios while limiting annotations to maximally-five slices. The remaining 51 patients were used as an independent test set, where Dice similarity coefficient (DSC), mean surface distance (MSD), and 95% Hausdorff distance (HD_95%) were assessed at baseline and after every update.

Results

Median segmentation accuracy at baseline was DSC = 0.65, MSD = 4.3 mm, HD_95% = 17.5 mm. Updating CNN using three slices equally sampled from the craniocaudal axis of the GTV in the first round, followed by two rounds of annotating one extra slice, gave the best results. The accuracy improved to DSC = 0.82, MSD = 1.6 mm, HD_95% = 4.8 mm. Every CNN update took 30 s.

Conclusions

The presented iDL tool achieved substantial segmentation improvement with only five annotated slices.

Interfractional dose accumulation for MR-guided liver SBRT: Variation among algorithms is highly patient- and fraction-dependent

BACKGROUND AND PURPOSE

Daily plan adaptations could take the dose delivered in previous fractions into account. Due to high dose delivered per fraction, low number of fractions, steep dose gradients, and large interfractional organ deformations, this might be particularly important for liver SBRT. This study investigates inter-algorithm variation of interfractional dose accumulation for MR-guided liver SBRT.

MATERIALS AND METHODS

We assessed 27 consecutive MR-guided liver SBRT treatments of 67.5 Gy in three (n = 15) or 50 Gy in five fractions (n = 12), both prescribed to the GTV. We calculated fraction doses on daily patient anatomy, warped these doses to the simulation MRI using seven different algorithms, and accumulated the warped doses. Thus, we obtained differences in planned doses and warped or accumulated doses for each algorithm. This enabled us to calculate the inter-algorithm variations in warped doses per fraction and in accumulated doses per treatment course.

RESULTS

The four intensity-based algorithms were more consistent with planned PTV dose than affine or contour-based algorithms. The mean (range) variation of the dose difference for PTV D_95% due to dose warping by these intensity-based algorithms was 10.4 percentage points (0.3 to 43.7) between fractions and 8.6 (0.3 to 24.9) between accumulated treatment doses. As seen by these ranges, the variation was very dependent on the patient and the fraction being analyzed. Nevertheless, no correlations between patient or plan characteristics on the one hand and inter-algorithm dose warping variation on the other hand was found.

CONCLUSION

Inter-algorithm dose accumulation variation is highly patient- and fraction-dependent for MR-guided liver SBRT. We advise against trusting a single algorithm for dose accumulation in liver SBRT.

On Acquisition Parameters and Processing Techniques for Interparticle Contact Detection in Granular Packings Using Synchrotron Computed Tomography

X-ray computed tomography (XCT) is regularly employed in geomechanics to non-destructively measure the solid and pore fractions of soil and rock from reconstructed 3D images. With the increasing availability of high-resolution XCT imaging systems, researchers now seek to measure microfabric parameters such as the number and area of interparticle contacts, which can then be used to inform soil behaviour modelling techniques. However, recent research has evidenced that conventional image processing methods consistently overestimate the number and area of interparticle contacts, mainly due to acquisition-driven image artefacts. The present study seeks to address this issue by systematically assessing the role of XCT acquisition parameters in the accurate detection of interparticle contacts. To this end, synchrotron XCT has been applied to a hexagonal close-packed arrangement of glass pellets with and without a prescribed separation between lattice layers. Different values for the number of projections, exposure time, and rotation range have been evaluated. Conventional global grey value thresholding and novel U-Net segmentation methods have been assessed, followed by local refinements at the presumptive contacts, as per recently proposed contact detection routines. The effect of the different acquisition set-ups and segmentation techniques on contact detection performance is presented and discussed, and optimised workflows are proposed.

Optimisation of root traits to provide enhanced ecosystem services in agricultural systems: A focus on cover crops

Roots are the interface between the plant and the soil and play a central role in multiple ecosystem processes. With intensification of agricultural practices, rhizosphere processes are being disrupted and are causing degradation of the physical, chemical and biotic properties of soil. However, cover crops, a group of plants that provide ecosystem services, can be utilised during fallow periods or used as an intercrop to restore soil health. The effectiveness of ecosystem services provided by cover crops varies widely as very little breeding has occurred in these species. Improvement of ecosystem service performance is rarely considered as a breeding trait due to the complexities and challenges of belowground evaluation. Advancements in root phenotyping and genetic tools are critical in accelerating ecosystem service improvement in cover crops. In this study, we provide an overview of the range of belowground ecosystem services provided by cover crop roots: (1) soil structural remediation, (2) capture of soil resources and (3) maintenance of the rhizosphere and building of organic matter content. Based on the ecosystem services described, we outline current and promising phenotyping technologies and breeding strategies in cover crops that can enhance agricultural sustainability through improvement of root traits.