MD-Dose: A Diffusion Model based on the Mamba for Radiotherapy Dose Prediction

Radiation therapy is crucial in cancer treatment. Experienced experts typically iteratively generate high-quality dose distribution maps, forming the basis for excellent radiation therapy plans. Therefore, automated prediction of dose distribution maps is significant in expediting the treatment process and providing a better starting point for developing radiation therapy plans. With the remarkable results of diffusion models in predicting high-frequency regions of dose distribution maps, dose prediction methods based on diffusion models have been extensively studied. However, existing methods mainly utilize CNNs or Transformers as denoising networks. CNNs lack the capture of global receptive fields, resulting in suboptimal prediction performance. Transformers excel in global modeling but face quadratic complexity with image size, resulting in significant computational overhead. To tackle these challenges, we introduce a novel diffusion model, MD-Dose, based on the Mamba architecture for predicting radiation therapy dose distribution in thoracic cancer patients. In the forward process, MD-Dose adds Gaussian noise to dose distribution maps to obtain pure noise images. In the backward process, MD-Dose utilizes a noise predictor based on the Mamba to predict the noise, ultimately outputting the dose distribution maps. Furthermore, We develop a Mamba encoder to extract structural information and integrate it into the noise predictor for localizing dose regions in the planning target volume (PTV) and organs at risk (OARs). Through extensive experiments on a dataset of 300 thoracic tumor patients, we showcase the superiority of MD-Dose in various metrics and time consumption.

Bayesian Random Semantic Data Augmentation for Medical Image Classification

Data augmentation is a critical regularization technique for deep neural networks, particularly in medical image classification. Popular data augmentation approaches include image transformation-based methods, generative data augmentation, and automatic data augmentation. However, these approaches encounter notable limitations: image transformation-based and automated data augmentation techniques cannot implement semantic transformations, leading to a constrained variety of augmented samples, and generative data augmentation methods are computationally expensive. In response to these challenges, we proposed Bayesian Random Semantic Data Augmentation (BRSDA), a novel, efficient, and plug-and-play semantic data augmentation method. BRSDA is motivated by a simple translation in the feature space along specific directions that can effectuate semantic transformations. When given a feature, we define its augmentable semantic magnitude as a random variable and estimate its distribution using variational Bayesian, then sample semantic magnitude and add to the randomly selected semantic direction to achieve semantic data augmentation. We demonstrate the effectiveness of BRSDA on five 2D and six 3D medical image datasets covering nine modalities. We also test BRSDA with mainstream neural network architectures, showcasing its robustness. Furthermore, combining BRSDA with other leading data augmentation methods achieves superior performance. Code is available online at \url{https://github.com/YaoyaoZhu19/BRSDA}.

SP-DiffDose: A Conditional Diffusion Model for Radiation Dose Prediction Based on Multi-Scale Fusion of Anatomical Structures, Guided by SwinTransformer and Projector

Radiation therapy serves as an effective and standard method for cancer treatment. Excellent radiation therapy plans always rely on high-quality dose distribution maps obtained through repeated trial and error by experienced experts. However, due to individual differences and complex clinical situations, even seasoned expert teams may need help to achieve the best treatment plan every time quickly. Many automatic dose distribution prediction methods have been proposed recently to accelerate the radiation therapy planning process and have achieved good results. However, these results suffer from over-smoothing issues, with the obtained dose distribution maps needing more high-frequency details, limiting their clinical application. To address these limitations, we propose a dose prediction diffusion model based on SwinTransformer and a projector, SP-DiffDose. To capture the direct correlation between anatomical structure and dose distribution maps, SP-DiffDose uses a structural encoder to extract features from anatomical images, then employs a conditional diffusion process to blend noise and anatomical images at multiple scales and gradually map them to dose distribution maps. To enhance the dose prediction distribution for organs at risk, SP-DiffDose utilizes SwinTransformer in the deeper layers of the network to capture features at different scales in the image. To learn good representations from the fused features, SP-DiffDose passes the fused features through a designed projector, improving dose prediction accuracy. Finally, we evaluate SP-DiffDose on an internal dataset. The results show that SP-DiffDose outperforms existing methods on multiple evaluation metrics, demonstrating the superiority and generalizability of our method.

Energy-Guided Diffusion Model for CBCT-to-CT Synthesis

Cone Beam CT (CBCT) plays a crucial role in Adaptive Radiation Therapy (ART) by accurately providing radiation treatment when organ anatomy changes occur. However, CBCT images suffer from scatter noise and artifacts, making relying solely on CBCT for precise dose calculation and accurate tissue localization challenging. Therefore, there is a need to improve CBCT image quality and Hounsfield Unit (HU) accuracy while preserving anatomical structures. To enhance the role and application value of CBCT in ART, we propose an energy-guided diffusion model (EGDiff) and conduct experiments on a chest tumor dataset to generate synthetic CT (sCT) from CBCT. The experimental results demonstrate impressive performance with an average absolute error of 26.87$\pm$6.14 HU, a structural similarity index measurement of 0.850$\pm$0.03, a peak signal-to-noise ratio of the sCT of 19.83$\pm$1.39 dB, and a normalized cross-correlation of the sCT of 0.874$\pm$0.04. These results indicate that our method outperforms state-of-the-art unsupervised synthesis methods in accuracy and visual quality, producing superior sCT images.

Towards Safe Propofol Dosing during General Anesthesia Using Deep Offline Reinforcement Learning

Automated anesthesia promises to enable more precise and personalized anesthetic administration and free anesthesiologists from repetitive tasks, allowing them to focus on the most critical aspects of a patient's surgical care. Current research has typically focused on creating simulated environments from which agents can learn. These approaches have demonstrated good experimental results, but are still far from clinical application. In this paper, Policy Constraint Q-Learning (PCQL), a data-driven reinforcement learning algorithm for solving the problem of learning anesthesia strategies on real clinical datasets, is proposed. Conservative Q-Learning was first introduced to alleviate the problem of Q function overestimation in an offline context. A policy constraint term is added to agent training to keep the policy distribution of the agent and the anesthesiologist consistent to ensure safer decisions made by the agent in anesthesia scenarios. The effectiveness of PCQL was validated by extensive experiments on a real clinical anesthesia dataset. Experimental results show that PCQL is predicted to achieve higher gains than the baseline approach while maintaining good agreement with the reference dose given by the anesthesiologist, using less total dose, and being more responsive to the patient's vital signs. In addition, the confidence intervals of the agent were investigated, which were able to cover most of the clinical decisions of the anesthesiologist. Finally, an interpretable method, SHAP, was used to analyze the contributing components of the model predictions to increase the transparency of the model.

Constraining Multi-scale Pairwise Features between Encoder and Decoder Using Contrastive Learning for Unpaired Image-to-Image Translation

Contrastive learning (CL) has shown great potential in image-to-image translation (I2I). Current CL-based I2I methods usually re-exploit the encoder of the generator to maximize the mutual information between the input and generated images, which does not exert an active effect on the decoder part. In addition, though negative samples play a crucial role in CL, most existing methods adopt a random sampling strategy, which may be less effective. In this paper, we rethink the CL paradigm in the unpaired I2I tasks from two perspectives and propose a new one-sided image translation framework called EnCo. First, we present an explicit constraint on the multi-scale pairwise features between the encoder and decoder of the generator to guarantee the semantic consistency of the input and generated images. Second, we propose a discriminative attention-guided negative sampling strategy to replace the random negative sampling, which significantly improves the performance of the generative model with an almost negligible computational overhead. Compared with existing methods, EnCo acts more effective and efficient. Extensive experiments on several popular I2I datasets demonstrate the effectiveness and advantages of our proposed approach, and we achieve several state-of-the-art compared to previous methods.