Automatic segmentation of organs-at-risk (OAR) in computed tomography (CT) is an essential part of planning effective treatment strategies to combat lung and esophageal cancer. Accurate segmentation of organs surrounding tumours helps account for the variation in position and morphology inherent across patients, thereby facilitating adaptive and computer-assisted radiotherapy. Although manual delineation of OARs is still highly prevalent, it is prone to errors due to complex variations in the shape and position of organs across patients, and low soft tissue contrast between neighbouring organs in CT images. Recently, deep convolutional neural networks (CNNs) have gained tremendous traction and achieved state-of-the-art results in medical image segmentation. In this paper, we propose a deep learning framework to segment OARs in thoracic CT images, specifically for the: heart, esophagus, trachea and aorta. Our approach employs dilated convolutions and aggregated residual connections in the bottleneck of a U-Net styled network, which incorporates global context and dense information. Our method achieved an overall Dice score of 91.57% on 20 unseen test samples from the ISBI 2019 SegTHOR challenge.
Chest X-ray (CXR) is the most common X-ray examination performed in daily clinical practice for the diagnosis of various heart and lung abnormalities. The large amount of data to be read and reported, with 100+ studies per day for a single radiologist, poses a challenge in maintaining consistently high interpretation accuracy. In this work, we propose a method for the classification of different abnormalities based on CXR scans of the human body. The system is based on a novel multi-task deep learning architecture that in addition to the abnormality classification, supports the segmentation of the lungs and heart and classification of regions where the abnormality is located. We demonstrate that by training these tasks concurrently, one can increase the classification performance of the model. Experiments were performed on an extensive collection of 297,541 chest X-ray images from 86,876 patients, leading to a state-of-the-art performance level of 0.883 AUC on average for 12 different abnormalities. We also conducted a detailed performance analysis and compared the accuracy of our system with 3 board-certified radiologists. In this context, we highlight the high level of label noise inherent to this problem. On a reduced subset containing only cases with high confidence reference labels based on the consensus of the 3 radiologists, our system reached an average AUC of 0.945.
Tissue loss in the hippocampi has been heavily correlated with the progression of Alzheimer's Disease (AD). The shape and structure of the hippocampus are important factors in terms of early AD diagnosis and prognosis by clinicians. However, manual segmentation of such subcortical structures in MR studies is a challenging and subjective task. In this paper, we investigate variants of the well known 3D U-Net, a type of convolution neural network (CNN) for semantic segmentation tasks. We propose an alternative form of the 3D U-Net, which uses dilated convolutions and deep supervision to incorporate multi-scale information into the model. The proposed method is evaluated on the task of hippocampus head and body segmentation in an MRI dataset, provided as part of the MICCAI 2018 segmentation decathlon challenge. The experimental results show that our approach outperforms other conventional methods in terms of different segmentation accuracy metrics.
Squamous Cell Carcinoma (SCC) is the most common cancer type of the epithelium and is often detected at a late stage. Besides invasive diagnosis of SCC by means of biopsy and histo-pathologic assessment, Confocal Laser Endomicroscopy (CLE) has emerged as noninvasive method that was successfully used to diagnose SCC in vivo. For interpretation of CLE images, however, extensive training is required, which limits its applicability and use in clinical practice of the method. To aid diagnosis of SCC in a broader scope, automatic detection methods have been proposed. This work compares two methods with regard to their applicability in a transfer learning sense, i.e. training on one tissue type (from one clinical team) and applying the learnt classification system to another entity (different anatomy, different clinical team). Besides a previously proposed, patch-based method based on convolutional neural networks, a novel classification method on image level (based on a pre-trained Inception V.3 network with dedicated preprocessing and interpretation of class activation maps) is proposed and evaluated. The newly presented approach improves recognition performance, yielding accuracies of 91.63% on the first data set (oral cavity) and 92.63% on a joint data set. The generalization from oral cavity to the second data set (vocal folds) lead to similar area-under-the-ROC curve values than a direct training on the vocal folds data set, indicating good generalization.
Manual counts of mitotic figures, which are determined in the tumor region with the highest mitotic activity, are a key parameter of most tumor grading schemes. It is however strongly dependent on the area selection. To reduce potential variability of prognosis due to this, we propose to use an algorithmic field of interest prediction to assess the area of highest mitotic activity in a whole-slide image. Methods: We evaluated two state-of-the-art methods, all based on the use of deep convolutional neural networks on their ability to predict the mitotic count in digital histopathology slides. We evaluated them on a novel dataset of 32 completely annotated whole slide images from canine cutaneous mast cell tumors (CMCT) and one publicly available human mamma carcinoma (HMC) dataset. We first compared the mitotic counts (MC) predicted by the two models with the ground truth MC on both data sets. Second, for the CMCT data set, we compared the computationally predicted position and MC of the area of highest mitotic activity with size-equivalent areas selected by eight veterinary pathologists. Results: We found a high correlation between the mitotic count as predicted by the models (Pearson's correlation coefficient between 0.931 and 0.962 for the CMCT data set and between 0.801 and 0.986 for the HMC data set) on the slides. For the CMCT data set, this is also reflected in the predicted position representing mitotic counts in mostly the upper quartile of the slide's ground truth MC distribution. Further, we found strong differences between experts in position selection. Conclusion: While the mitotic counts in areas selected by the experts substantially varied, both algorithmic approaches were consistently able to generate a good estimate of the area of highest mitotic count. To achieve better inter-rater agreement, we propose to use computer-based area selection for manual mitotic count.
Data analysis and machine learning have become an integrative part of the modern scientific methodology, providing automated techniques to predict further information based on observations. One of these classification and regression techniques is the random forest approach. Those decision tree based predictors are best known for their good computational performance and scalability. However, in case of severely imbalanced training data, as often seen in medical studies' data with large control groups, the training algorithm or the sampling process has to be altered in order to improve the prediction quality for minority classes. In this work, a balanced random forest approach for WEKA is proposed. Furthermore, the prediction quality of the unmodified random forest implementation and the new balanced random forest version for WEKA are evaluated against reference implementations in R. Two-class problems on balanced data sets and imbalanced medical studies' data are investigated. A superior prediction quality using the proposed method for imbalanced data is shown compared to the other three techniques.
Talbot-Lau X-ray phase-contrast imaging is a novel imaging modality, which provides not only an X-ray absorption image, but also additionally a differential phase image and a dark-field image. The dark-field image is related to small angle scattering and has an interesting property when canning oriented structures: the recorded signal depends on the relative orientation of the structure in the imaging system. Exactly this property allows to draw conclusions about the orientation and to reconstruct the structure. However, the reconstruction is a complex, non-trivial challenge. A lot of research was conducted towards this goal in the last years and several reconstruction algorithms were proposed. A key step of the reconstruction algorithm is the inversion of a forward projection model. Up until now, only 2-D projection models are available, with effectively limit the scanning trajectory to a 2-D plane. To obtain true 3-D information, this limitation requires to combine several 2-D scans, which leads to quite complex, impractical acquisitions schemes. Furthermore, it is not possible with these models to use 3-D trajectories that might allow simpler protocols, like for example a helical trajectory. To address these limitations, we propose in this work a very general 3-D projection model. Our projection model defines the dark-field signal dependent on an arbitrarily chosen ray and sensitivity direction. We derive the projection model under the assumption that the observed scatter distribution has a Gaussian shape. We theoretically show the consistency of our model with more constrained existing 2-D models. Furthermore, we experimentally show the compatibility of our model with dark-field measurements of two matchsticks. We believe that this 3-D projection model is an important step towards more flexible trajectories and imaging protocols that are much better applicable in practice.
Data-driven respiratory signal extraction from rotational X-ray scans is a challenge as angular effects overlap with respiration-induced change in the scene. In this paper, we use the linearity of the X-ray transform to propose a bilinear model based on a prior 4D scan to separate angular and respiratory variation. The bilinear estimation process is supported by a B-spline interpolation using prior knowledge about the trajectory angle. Consequently, extraction of respiratory features simplifies to a linear problem. Though the need for a prior 4D CT seems steep, our proposed use-case of driving a respiratory motion model in radiation therapy usually meets this requirement. We evaluate on DRRs of 5 patient 4D CTs in a leave-one-phase-out manner and achieve a mean estimation error of 3.01 % in the gray values for unseen viewing angles. We further demonstrate suitability of the extracted weights to drive a motion model for treatments with a continuously rotating gantry.
Registration of pre-operative 3-D volumes to intra-operative 2-D X-ray images is important in minimally invasive medical procedures. Rigid registration can be performed by estimating a global rigid motion that optimizes the alignment of local correspondences. However, inaccurate correspondences challenge the registration performance. To minimize their influence, we estimate optimal weights for correspondences using PointNet. We train the network directly with the criterion to minimize the registration error. We propose an objective function which includes point-to-plane correspondence-based motion estimation and projection error computation, thereby enabling the learning of a weighting strategy that optimally fits the underlying formulation of the registration task in an end-to-end fashion. For single-vertebra registration, we achieve an accuracy of 0.74$\pm$0.26 mm and highly improved robustness. The success rate is increased from 79.3 % to 94.3 % and the capture range from 3 mm to 13 mm.
In this paper, we derive a neural network architecture based on an analytical formulation of the parallel-to-fan beam conversion problem following the concept of precision learning. The network allows to learn the unknown operators in this conversion in a data-driven manner avoiding interpolation and potential loss of resolution. Integration of known operators results in a small number of trainable parameters that can be estimated from synthetic data only. The concept is evaluated in the context of Hybrid MRI/X-ray imaging where transformation of the parallel-beam MRI projections to fan-beam X-ray projections is required. The proposed method is compared to a traditional rebinning method. The results demonstrate that the proposed method is superior to ray-by-ray interpolation and is able to deliver sharper images using the same amount of parallel-beam input projections which is crucial for interventional applications. We believe that this approach forms a basis for further work uniting deep learning, signal processing, physics, and traditional pattern recognition.