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Morris ED, Price RG, Kim J, Schultz L, Siddiqui MS, Chetty I, Glide-Hurst C. Using synthetic CT for partial brain radiation therapy: Impact on image guidance. Pract Radiat Oncol 2018; 8:342-350. [PMID: 29861348 PMCID: PMC6123249 DOI: 10.1016/j.prro.2018.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/22/2018] [Accepted: 04/02/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Recent advancements in synthetic computed tomography (synCT) from magnetic resonance (MR) imaging data have made MRI-only treatment planning feasible in the brain, although synCT performance for image guided radiation therapy (IGRT) is not well understood. This work compares geometric equivalence of digitally reconstructed radiographs (DRRs) from CTs and synCTs for brain cancer patients and quantifies performance for partial brain IGRT. METHODS AND MATERIALS Ten brain cancer patients (12 lesions, 7 postsurgical) underwent MR-SIM and CT-SIM. SynCTs were generated by combining ultra-short echo time, T1, T2, and fluid attenuation inversion recovery datasets using voxel-based weighted summation. SynCT and CT DRRs were compared using patient-specific thresholding and assessed via overlap index, Dice similarity coefficient, and Jaccard index. Planar IGRT images for 22 fractions were evaluated to quantify differences between CT-generated DRRs and synCT-generated DRRs in 6 quadrants. Previously validated software was implemented to perform 2-dimensional (2D)-2D rigid registrations using normalized mutual information. Absolute (planar image/DRR registration) and relative (differences between synCT and CT DRR registrations) shifts were calculated for each axis and 3-dimensional vector difference. A total of 1490 rigid registrations were assessed. RESULTS DRR agreements in anteroposterior and lateral views for overlap index, Dice similarity coefficient, and Jaccard index were >0.95. Normalized mutual information results were equivalent in 75% of quadrants. Rotational registration results were negligible (<0.07°). Statistically significant differences between CT and synCT registrations were observed in 9/18 matched quadrants/axes (P < .05). The population average absolute shifts were 0.77 ± 0.58 and 0.76 ± 0.59 mm for CT and synCT, respectively, for all axes/quadrants. Three-dimensional vectors were <2 mm in 77.7 ± 10.8% and 76.5 ± 7.2% of CT and synCT registrations, respectively. SynCT DRRs were sensitive in postsurgical cases (vector displacements >2 mm in affected quadrants). CONCLUSIONS DRR synCT geometry was robust. Although statistically significant differences were observed between CT and synCT registrations, results were not clinically significant. Future work will address synCT generation in postsurgical settings.
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Affiliation(s)
- Eric D Morris
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan; Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Ryan G Price
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Joshua Kim
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Lonni Schultz
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - M Salim Siddiqui
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Indrin Chetty
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan; Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Carri Glide-Hurst
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan; Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan.
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Abstract
Upper extremity neuropathic pain states greatly impact patient functionality and quality of life, despite appropriate surgical intervention. This article focuses on the advanced therapies that may improve pain care, including advanced treatment strategies that are available. The article also surveys therapies on the immediate horizon, such as spinal cord stimulation, peripheral nerve stimulation, and dorsal root ganglion spinal cord stimulation. As these therapies evolve, so too will their placement within the pain care algorithm grounded by a foundation of evidence to improve patient safety and management of patients with difficult neuropathic pain.
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Affiliation(s)
- Jason E Pope
- Summit Pain Alliance, 392 Tesconi Court, Santa Rosa, CA 95401, USA.
| | - David Provenzano
- Pain Diagnostics and Interventional Care, Sewickley, PA 15143, USA
| | | | - Timothy Deer
- Center for Pain Relief, Charleston, WV 25304, USA
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Van de Velde J, Wouters J, Vercauteren T, De Gersem W, Achten E, De Neve W, Van Hoof T. Optimal number of atlases and label fusion for automatic multi-atlas-based brachial plexus contouring in radiotherapy treatment planning. Radiat Oncol 2016; 11:1. [PMID: 26743131 PMCID: PMC4705618 DOI: 10.1186/s13014-015-0579-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 12/30/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The present study aimed to define the optimal number of atlases for automatic multi-atlas-based brachial plexus (BP) segmentation and to compare Simultaneous Truth and Performance Level Estimation (STAPLE) label fusion with Patch label fusion using the ADMIRE® software. The accuracy of the autosegmentations was measured by comparing all of the generated autosegmentations with the anatomically validated gold standard segmentations that were developed using cadavers. MATERIALS AND METHODS Twelve cadaver computed tomography (CT) atlases were used for automatic multi-atlas-based segmentation. To determine the optimal number of atlases, one atlas was selected as a patient and the 11 remaining atlases were registered onto this patient using a deformable image registration algorithm. Next, label fusion was performed by using every possible combination of 2 to 11 atlases, once using STAPLE and once using Patch. This procedure was repeated for every atlas as a patient. The similarity of the generated automatic BP segmentations and the gold standard segmentation was measured by calculating the average Dice similarity (DSC), Jaccard (JI) and True positive rate (TPR) for each number of atlases. These similarity indices were compared for the different number of atlases using an equivalence trial and for the two label fusion groups using an independent sample-t test. RESULTS DSC's and JI's were highest when using nine atlases with both STAPLE (average DSC = 0,532; JI = 0,369) and Patch (average DSC = 0,530; JI = 0,370). When comparing both label fusion algorithms using 9 atlases for both, DSC and JI values were not significantly different. However, significantly higher TPR values were achieved in favour of STAPLE (p < 0,001). When fewer than four atlases were used, STAPLE produced significantly lower DSC, JI and TPR values than did Patch (p = 0,0048). CONCLUSIONS Using 9 atlases with STAPLE label fusion resulted in the most accurate BP autosegmentations (average DSC = 0,532; JI = 0,369 and TPR = 0,760). Only when using fewer than four atlases did the Patch label fusion results in a significantly more accurate autosegmentation than STAPLE.
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Affiliation(s)
- Joris Van de Velde
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Johan Wouters
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Tom Vercauteren
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Werner De Gersem
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Eric Achten
- Department of Radiology, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Wilfried De Neve
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Tom Van Hoof
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
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Van de Velde J, Wouters J, Vercauteren T, De Gersem W, Achten E, De Neve W, Van Hoof T. The effect of morphometric atlas selection on multi-atlas-based automatic brachial plexus segmentation. Radiat Oncol 2015; 10:260. [PMID: 26696278 PMCID: PMC4688981 DOI: 10.1186/s13014-015-0570-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022] Open
Abstract
Purpose The present study aimed to measure the effect of a morphometric atlas selection strategy on the accuracy of multi-atlas-based BP autosegmentation using the commercially available software package ADMIRE® and to determine the optimal number of selected atlases to use. Autosegmentation accuracy was measured by comparing all generated automatic BP segmentations with anatomically validated gold standard segmentations that were developed using cadavers. Materials and methods Twelve cadaver computed tomography (CT) atlases were included in the study. One atlas was selected as a patient in ADMIRE®, and multi-atlas-based BP autosegmentation was first performed with a group of morphometrically preselected atlases. In this group, the atlases were selected on the basis of similarity in the shoulder protraction position with the patient. The number of selected atlases used started at two and increased up to eight. Subsequently, a group of randomly chosen, non-selected atlases were taken. In this second group, every possible combination of 2 to 8 random atlases was used for multi-atlas-based BP autosegmentation. For both groups, the average Dice similarity coefficient (DSC), Jaccard index (JI) and Inclusion index (INI) were calculated, measuring the similarity of the generated automatic BP segmentations and the gold standard segmentation. Similarity indices of both groups were compared using an independent sample t-test, and the optimal number of selected atlases was investigated using an equivalence trial. Results For each number of atlases, average similarity indices of the morphometrically selected atlas group were significantly higher than the random group (p < 0,05). In this study, the highest similarity indices were achieved using multi-atlas autosegmentation with 6 selected atlases (average DSC = 0,598; average JI = 0,434; average INI = 0,733). Conclusions Morphometric atlas selection on the basis of the protraction position of the patient significantly improves multi-atlas-based BP autosegmentation accuracy. In this study, the optimal number of selected atlases used was six, but for definitive conclusions about the optimal number of atlases and to improve the autosegmentation accuracy for clinical use, more atlases need to be included.
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Affiliation(s)
- Joris Van de Velde
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Johan Wouters
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Tom Vercauteren
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Werner De Gersem
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Eric Achten
- Department of Radiology, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Wilfried De Neve
- Department of Radiotherapy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Tom Van Hoof
- Department of Anatomy, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
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