Fourier PD and PDUNet: Complex-valued networks to speed-up MR Thermometry during Hypterthermia

Hyperthermia (HT) in combination with radio- and/or chemotherapy has become an accepted cancer treatment for distinct solid tumour entities. In HT, tumour tissue is exogenously heated to temperatures of 39 to 43 $\degree$C for 60 minutes. Temperature monitoring can be performed noninvasively using dynamic magnetic resonance imaging (MRI). However, the slow nature of MRI leads to motion artefacts in the images due to the movements of patients during image acquisition time. By discarding parts of the data, the speed of the acquisition can be increased - known as Undersampling. However, due to the invalidation of the Nyquist criterion, the acquired images have lower resolution and can also produce artefacts. The aim of this work was, therefore, to reconstruct highly undersampled MR thermometry acquisitions with better resolution and with less artefacts compared to conventional techniques like compressed sensing. The use of deep learning in the medical field has emerged in recent times, and various studies have shown that deep learning has the potential to solve inverse problems such as MR image reconstruction. However, most of the published work only focusses on the magnitude images, while the phase images are ignored, which are fundamental requirements for MR thermometry. This work, for the first time ever, presents deep learning based solutions for reconstructing undersampled MR thermometry data. Two different deep learning models have been employed here, the Fourier Primal-Dual network and Fourier Primal-Dual UNet, to reconstruct highly undersampled complex images of MR thermometry. It was observed that the method was able to reduce the temperature difference between the undersampled MRIs and the fully sampled MRIs from 1.5 $\degree$C to 0.5 $\degree$C.

A Survey of Incremental Transfer Learning: Combining Peer-to-Peer Federated Learning and Domain Incremental Learning for Multicenter Collaboration

Due to data privacy constraints, data sharing among multiple clinical centers is restricted, which impedes the development of high performance deep learning models from multicenter collaboration. Naive weight transfer methods share intermediate model weights without raw data and hence can bypass data privacy restrictions. However, performance drops are typically observed when the model is transferred from one center to the next because of the forgetting problem. Incremental transfer learning, which combines peer-to-peer federated learning and domain incremental learning, can overcome the data privacy issue and meanwhile preserve model performance by using continual learning techniques. In this work, a conventional domain/task incremental learning framework is adapted for incremental transfer learning. A comprehensive survey on the efficacy of different regularization-based continual learning methods for multicenter collaboration is performed. The influences of data heterogeneity, classifier head setting, network optimizer, model initialization, center order, and weight transfer type have been investigated thoroughly. Our framework is publicly accessible to the research community for further development.

Deep Learning for Cancer Prognosis Prediction Using Portrait Photos by StyleGAN Embedding

Survival prediction for cancer patients is critical for optimal treatment selection and patient management. Current patient survival prediction methods typically extract survival information from patients' clinical record data or biological and imaging data. In practice, experienced clinicians can have a preliminary assessment of patients' health status based on patients' observable physical appearances, which are mainly facial features. However, such assessment is highly subjective. In this work, the efficacy of objectively capturing and using prognostic information contained in conventional portrait photographs using deep learning for survival predication purposes is investigated for the first time. A pre-trained StyleGAN2 model is fine-tuned on a custom dataset of our cancer patients' photos to empower its generator with generative ability suitable for patients' photos. The StyleGAN2 is then used to embed the photographs to its highly expressive latent space. Utilizing the state-of-the-art survival analysis models and based on StyleGAN's latent space photo embeddings, this approach achieved a C-index of 0.677, which is notably higher than chance and evidencing the prognostic value embedded in simple 2D facial images. In addition, thanks to StyleGAN's interpretable latent space, our survival prediction model can be validated for relying on essential facial features, eliminating any biases from extraneous information like clothing or background. Moreover, a health attribute is obtained from regression coefficients, which has important potential value for patient care.

Benchmarking ChatGPT-4 on ACR Radiation Oncology In-Training Exam (TXIT): Potentials and Challenges for AI-Assisted Medical Education and Decision Making in Radiation Oncology

The potential of large language models in medicine for education and decision making purposes has been demonstrated as they achieve decent scores on medical exams such as the United States Medical Licensing Exam (USMLE) and the MedQA exam. In this work, we evaluate the performance of ChatGPT-3.5 and ChatGPT-4 in the specialized field of radiation oncology using the 38th American College of Radiology (ACR) radiation oncology in-training exam (TXIT). ChatGPT-3.5 and ChatGPT-4 have achieved the scores of 63.65% and 74.57%, respectively, highlighting the advantage of the latest ChatGPT-4 model. Based on the TXIT exam, ChatGPT-4's strong and weak areas in radiation oncology are identified to some extent. Specifically, ChatGPT-4 demonstrates good knowledge of statistics, CNS & eye, pediatrics, biology, and physics but has limitations in bone & soft tissue and gynecology, as per the ACR knowledge domain. Regarding clinical care paths, ChatGPT-4 performs well in diagnosis, prognosis, and toxicity but lacks proficiency in topics related to brachytherapy and dosimetry, as well as in-depth questions from clinical trials. While ChatGPT-4 is not yet suitable for clinical decision making in radiation oncology, it has the potential to assist in medical education for the general public and cancer patients. With further fine-tuning, it could assist radiation oncologists in recommending treatment decisions for challenging clinical cases based on the latest guidelines and the existing gray zone database.

The Segment Anything foundation model achieves favorable brain tumor autosegmentation accuracy on MRI to support radiotherapy treatment planning

Background: Tumor segmentation in MRI is crucial in radiotherapy (RT) treatment planning for brain tumor patients. Segment anything (SA), a novel promptable foundation model for autosegmentation, has shown high accuracy for multiple segmentation tasks but was not evaluated on medical datasets yet. Methods: SA was evaluated in a point-to-mask task for glioma brain tumor autosegmentation on 16744 transversal slices from 369 MRI datasets (BraTS 2020). Up to 9 point prompts were placed per slice. Tumor core (enhancing tumor + necrotic core) was segmented on contrast-enhanced T1w sequences. Out of the 3 masks predicted by SA, accuracy was evaluated for the mask with the highest calculated IoU (oracle mask) and with highest model predicted IoU (suggested mask). In addition to assessing SA on whole MRI slices, SA was also evaluated on images cropped to the tumor (max. 3D extent + 2 cm). Results: Mean best IoU (mbIoU) using oracle mask on full MRI slices was 0.762 (IQR 0.713-0.917). Best 2D mask was achieved after a mean of 6.6 point prompts (IQR 5-9). Segmentation accuracy was significantly better for high- compared to low-grade glioma cases (mbIoU 0.789 vs. 0.668). Accuracy was worse using MRI slices cropped to the tumor (mbIoU 0.759) and was much worse using suggested mask (full slices 0.572). For all experiments, accuracy was low on peripheral slices with few tumor voxels (mbIoU, <300: 0.537 vs. >=300: 0.841). Stacking best oracle segmentations from full axial MRI slices, mean 3D DSC for tumor core was 0.872, which was improved to 0.919 by combining axial, sagittal and coronal masks. Conclusions: The Segment Anything foundation model, while trained on photos, can achieve high zero-shot accuracy for glioma brain tumor segmentation on MRI slices. The results suggest that Segment Anything can accelerate and facilitate RT treatment planning, when properly integrated in a clinical application.

Risk Classification of Brain Metastases via Radiomics, Delta-Radiomics and Machine Learning

Stereotactic radiotherapy (SRT) is one of the most important treatment for patients with brain metastases (BM). Conventionally, following SRT patients are monitored by serial imaging and receive salvage treatments in case of significant tumor growth. We hypothesized that using radiomics and machine learning (ML), metastases at high risk for subsequent progression could be identified during follow-up prior to the onset of significant tumor growth, enabling personalized follow-up intervals and early selection for salvage treatment. All experiments are performed on a dataset from clinical routine of the Radiation Oncology department of the University Hospital Erlangen (UKER). The classification is realized via the maximum-relevance minimal-redundancy (MRMR) technique and support vector machines (SVM). The pipeline leads to a classification with a mean area under the curve (AUC) score of 0.83 in internal cross-validation and allows a division of the cohort into two subcohorts that differ significantly in their median time to progression (low-risk metastasis (LRM): 17.3 months, high-risk metastasis (HRM): 9.6 months, p < 0.01). The classification performance is especially enhanced by the analysis of medical images from different points in time (AUC 0.53 -> AUC 0.74). The results indicate that risk stratification of BM based on radiomics and machine learning during post-SRT follow-up is possible with good accuracy and should be further pursued to personalize and improve post-SRT follow-up.

Deep Learning for automatic head and neck lymph node level delineation

Background: Deep learning-based head and neck lymph node level (HN_LNL) autodelineation is of high relevance to radiotherapy research and clinical treatment planning but still understudied in academic literature. Methods: An expert-delineated cohort of 35 planning CTs was used for training of an nnU-net 3D-fullres/2D-ensemble model for autosegmentation of 20 different HN_LNL. Validation was performed in an independent test set (n=20). In a completely blinded evaluation, 3 clinical experts rated the quality of deep learning autosegmentations in a head-to-head comparison with expert-created contours. For a subgroup of 10 cases, intraobserver variability was compared to deep learning autosegmentation performance. The effect of autocontour consistency with CT slice plane orientation on geometric accuracy and expert rating was investigated. Results: Mean blinded expert rating per level was significantly better for deep learning segmentations with CT slice plane adjustment than for expert-created contours (81.0 vs. 79.6, p<0.001), but deep learning segmentations without slice plane adjustment were rated significantly worse than expert-created contours (77.2 vs. 79.6, p<0.001). Geometric accuracy of deep learning segmentations was non-different from intraobserver variability (mean Dice per level, 0.78 vs. 0.77, p=0.064) with variance in accuracy between levels being improved (p<0.001). Clinical significance of contour consistency with CT slice plane orientation was not represented by geometric accuracy metrics (Dice, 0.78 vs. 0.78, p=0.572) Conclusions: We show that a nnU-net 3D-fullres/2D-ensemble model can be used for highly accurate autodelineation of HN_LNL using only a limited training dataset that is ideally suited for large-scale standardized autodelineation of HN_LNL in the research setting. Geometric accuracy metrics are only an imperfect surrogate for blinded expert rating.

Continual Learning for Peer-to-Peer Federated Learning: A Study on Automated Brain Metastasis Identification

Due to data privacy constraints, data sharing among multiple centers is restricted. Continual learning, as one approach to peer-to-peer federated learning, can promote multicenter collaboration on deep learning algorithm development by sharing intermediate models instead of training data. This work aims to investigate the feasibility of continual learning for multicenter collaboration on an exemplary application of brain metastasis identification using DeepMedic. 920 T1 MRI contrast enhanced volumes are split to simulate multicenter collaboration scenarios. A continual learning algorithm, synaptic intelligence (SI), is applied to preserve important model weights for training one center after another. In a bilateral collaboration scenario, continual learning with SI achieves a sensitivity of 0.917, and naive continual learning without SI achieves a sensitivity of 0.906, while two models trained on internal data solely without continual learning achieve sensitivity of 0.853 and 0.831 only. In a seven-center multilateral collaboration scenario, the models trained on internal datasets (100 volumes each center) without continual learning obtain a mean sensitivity value of 0.699. With single-visit continual learning (i.e., the shared model visits each center only once during training), the sensitivity is improved to 0.788 and 0.849 without SI and with SI, respectively. With iterative continual learning (i.e., the shared model revisits each center multiple times during training), the sensitivity is further improved to 0.914, which is identical to the sensitivity using mixed data for training. Our experiments demonstrate that continual learning can improve brain metastasis identification performance for centers with limited data. This study demonstrates the feasibility of applying continual learning for peer-to-peer federated learning in multicenter collaboration.

Learning Perspective Deformation in X-Ray Transmission Imaging

In cone-beam X-ray transmission imaging, due to the divergence of X-rays, imaged structures with different depths have different magnification factors on an X-ray detector, which results in perspective deformation. Perspective deformation causes difficulty in direct, accurate geometric assessments of anatomical structures. In this work, to reduce perspective deformation in X-ray images acquired from regular cone-beam computed tomography (CBCT) systems, we investigate on learning perspective deformation, i.e., converting perspective projections into orthogonal projections. Directly converting a single perspective projection image into an orthogonal projection image is extremely challenging due to the lack of depth information. Therefore, we propose to utilize one additional perspective projection, a complementary (180-degree) or orthogonal (90-degree) view, to provide a certain degree of depth information. Furthermore, learning perspective deformation in different spatial domains is investigated. Our proposed method is evaluated on numerical spherical bead phantoms as well as patients' chest and head X-ray data. The experiments on numerical bead phantom data demonstrate that learning perspective deformation in polar coordinates has significant advantages over learning in Cartesian coordinates, as root-mean-square error (RMSE) decreases from 5.31 to 1.40, while learning in log-polar coordinates has no further considerable improvement (RMSE = 1.85). In addition, using a complementary view (RMSE = 1.40) is better than an orthogonal view (RMSE = 3.87). The experiments on patients' chest and head data demonstrate that learning perspective deformation using dual complementary views is also applicable in anatomical X-ray data, allowing accurate cardiothoracic ratio measurements in chest X-ray images and cephalometric analysis in synthetic cephalograms from cone-beam X-ray projections.