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Since the emergence of convolutional neural networks (CNNs), and later vision transformers (ViTs), the common paradigm for model development has always been using a set of identical block types with varying parameters/hyper-parameters. To leverage the benefits of different architectural designs (e.g. CNNs and ViTs), we propose to alternate structurally different types of blocks to generate a new architecture, mimicking how Lego blocks can be assembled together. Using two CNN-based and one SwinViT-based blocks, we investigate three variations to the so-called LegoNet that applies the new concept of block alternation for the segmentation task in medical imaging. We also study a new clinical problem which has not been investigated before, namely the right internal mammary artery (RIMA) and perivascular space segmentation from computed tomography angiography (CTA) which has demonstrated a prognostic value to major cardiovascular outcomes. We compare the model performance against popular CNN and ViT architectures using two large datasets (e.g. achieving 0.749 dice similarity coefficient (DSC) on the larger dataset). We evaluate the performance of the model on three external testing cohorts as well, where an expert clinician made corrections to the model segmented results (DSC>0.90 for the three cohorts). To assess our proposed model for suitability in clinical use, we perform intra- and inter-observer variability analysis. Finally, we investigate a joint self-supervised learning approach to assess its impact on model performance. The code and the pretrained model weights will be available upon acceptance., 12 pages, 5 figures, 4 tables

Federated learning (FL) is a distributed machine learning (ML) approach that allows data to be trained without being centralized. This approach is particularly beneficial for medical applications because it addresses some key challenges associated with medical data, such as privacy, security, and data ownership. On top of that, FL can improve the quality of ML models used in medical applications. Medical data is often diverse and can vary significantly depending on the patient population, making it challenging to develop ML models that are accurate and generalizable. FL allows medical data to be used from multiple sources, which can help to improve the quality and generalizability of ML models. Differential privacy (DP) is a go-to algorithmic tool to make this process secure and private. In this work, we show that the model performance can be further improved by employing local steps, a popular approach to improving the communication efficiency of FL, and tuning the number of communication rounds. Concretely, given the privacy budget, we show an optimal number of local steps and communications rounds. We provide theoretical motivations further corroborated with experimental evaluations on real-world medical imaging tasks.

The number of studies on deep learning for medical diagnosis is expanding, and these systems are often claimed to outperform clinicians. However, only a few systems have shown medical efficacy. From this perspective, we examine a wide range of deep learning algorithms for the assessment of glioblastoma - a common brain tumor in older adults that is lethal. Surgery, chemotherapy, and radiation are the standard treatments for glioblastoma patients. The methylation status of the MGMT promoter, a specific genetic sequence found in the tumor, affects chemotherapy's effectiveness. MGMT promoter methylation improves chemotherapy response and survival in several cancers. MGMT promoter methylation is determined by a tumor tissue biopsy, which is then genetically tested. This lengthy and invasive procedure increases the risk of infection and other complications. Thus, researchers have used deep learning models to examine the tumor from brain MRI scans to determine the MGMT promoter's methylation state. We employ deep learning models and one of the largest public MRI datasets of 585 participants to predict the methylation status of the MGMT promoter in glioblastoma tumors using MRI scans. We test these models using Grad-CAM, occlusion sensitivity, feature visualizations, and training loss landscapes. Our results show no correlation between these two, indicating that external cohort data should be used to verify these models' performance to assure the accuracy and reliability of deep learning systems in cancer diagnosis., 12 pages, 10 figures, MedIA

Nuclear detection, segmentation and morphometric profiling are essential in helping us further understand the relationship between histology and patient outcome. To drive innovation in this area, we setup a community-wide challenge using the largest available dataset of its kind to assess nuclear segmentation and cellular composition. Our challenge, named CoNIC, stimulated the development of reproducible algorithms for cellular recognition with real-time result inspection on public leaderboards. We conducted an extensive post-challenge analysis based on the top-performing models using 1,658 whole-slide images of colon tissue. With around 700 million detected nuclei per model, associated features were used for dysplasia grading and survival analysis, where we demonstrated that the challenge's improvement over the previous state-of-the-art led to significant boosts in downstream performance. Our findings also suggest that eosinophils and neutrophils play an important role in the tumour microevironment. We release challenge models and WSI-level results to foster the development of further methods for biomarker discovery.

Deep learning models have been effective for various fetal ultrasound segmentation tasks. However, generalization to new unseen data has raised questions about their effectiveness for clinical adoption. Normally, a transition to new unseen data requires time-consuming and costly quality assurance processes to validate the segmentation performance post-transition. Segmentation quality assessment efforts have focused on natural images, where the problem has been typically formulated as a dice score regression task. In this paper, we propose a simplified Fetal Ultrasound Segmentation Quality Assessment (FUSQA) model to tackle the segmentation quality assessment when no masks exist to compare with. We formulate the segmentation quality assessment process as an automated classification task to distinguish between good and poor-quality segmentation masks for more accurate gestational age estimation. We validate the performance of our proposed approach on two datasets we collect from two hospitals using different ultrasound machines. We compare different architectures, with our best-performing architecture achieving over 90% classification accuracy on distinguishing between good and poor-quality segmentation masks from an unseen dataset. Additionally, there was only a 1.45-day difference between the gestational age reported by doctors and estimated based on CRL measurements using well-segmented masks. On the other hand, this difference increased and reached up to 7.73 days when we calculated CRL from the poorly segmented masks. As a result, AI-based approaches can potentially aid fetal ultrasound segmentation quality assessment and might detect poor segmentation in real-time screening in the future., 13 pages, 3 figures, 3 tables

Vestibular schwannoma (VS) is a non-cancerous tumor located next to the ear that can cause hearing loss. Most brain MRI images acquired from patients are contrast-enhanced T1 (ceT1), with a growing interest in high-resolution T2 images (hrT2) to replace ceT1, which involves the use of a contrast agent. As hrT2 images are currently scarce, it is less likely to train robust machine learning models to segment VS or other brain structures. In this work, we propose a weakly supervised machine learning approach that learns from only ceT1 scans and adapts to segment two structures from hrT2 scans: the VS and the cochlea from the crossMoDA dataset. Our model 1) generates fake hrT2 scans from ceT1 images and segmentation masks, 2) is trained using the fake hrT2 scans, 3) predicts the augmented real hrT2 scans, and 4) is retrained again using both the fake and real hrT2. The final result of this model has been computed on an unseen testing dataset provided by the 2022 crossMoDA challenge organizers. The mean dice score and average symmetric surface distance (ASSD) are 0.78 and 0.46, respectively. The predicted segmentation masks achieved a dice score of 0.83 and an ASSD of 0.56 on the VS, and a dice score of 0.74 and an ASSD of 0.35 on the cochleas.

Medical image segmentation is a vital healthcare endeavor requiring precise and efficient models for appropriate diagnosis and treatment. Vision transformer-based segmentation models have shown great performance in accomplishing this task. However, to build a powerful backbone, the self-attention block of ViT requires large-scale pre-training data. The present method of modifying pre-trained models entails updating all or some of the backbone parameters. This paper proposes a novel fine-tuning strategy for adapting a pretrained transformer-based segmentation model on data from a new medical center. This method introduces a small number of learnable parameters, termed prompts, into the input space (less than 1\% of model parameters) while keeping the rest of the model parameters frozen. Extensive studies employing data from new unseen medical centers show that prompts-based fine-tuning of medical segmentation models provides excellent performance on the new center data with a negligible drop on the old centers. Additionally, our strategy delivers great accuracy with minimum re-training on new center data, significantly decreasing the computational and time costs of fine-tuning pre-trained models.

The ability to automatically detect and track surgical instruments in endoscopic videos can enable transformational interventions. Assessing surgical performance and efficiency, identifying skilled tool use and choreography, and planning operational and logistical aspects of OR resources are just a few of the applications that could benefit. Unfortunately, obtaining the annotations needed to train machine learning models to identify and localize surgical tools is a difficult task. Annotating bounding boxes frame-by-frame is tedious and time-consuming, yet large amounts of data with a wide variety of surgical tools and surgeries must be captured for robust training. Moreover, ongoing annotator training is needed to stay up to date with surgical instrument innovation. In robotic-assisted surgery, however, potentially informative data like timestamps of instrument installation and removal can be programmatically harvested. The ability to rely on tool installation data alone would significantly reduce the workload to train robust tool-tracking models. With this motivation in mind we invited the surgical data science community to participate in the challenge, SurgToolLoc 2022. The goal was to leverage tool presence data as weak labels for machine learning models trained to detect tools and localize them in video frames with bounding boxes. We present the results of this challenge along with many of the team's efforts. We conclude by discussing these results in the broader context of machine learning and surgical data science. The training data used for this challenge consisting of 24,695 video clips with tool presence labels is also being released publicly and can be accessed at https://console.cloud.google.com/storage/browser/isi-surgtoolloc-2022.

The performance of the Deep Learning (DL) models depends on the quality of labels. In some areas, the involvement of human annotators may lead to noise in the data. When these corrupted labels are blindly regarded as the ground truth (GT), DL models suffer from performance deficiency. This paper presents a method that aims to learn a confident model in the presence of noisy labels. This is done in conjunction with estimating the uncertainty of multiple annotators. We robustly estimate the predictions given only the noisy labels by adding entropy or information-based regularizer to the classifier network. We conduct our experiments on a noisy version of MNIST, CIFAR-10, and FMNIST datasets. Our empirical results demonstrate the robustness of our method as it outperforms or performs comparably to other state-of-the-art (SOTA) methods. In addition, we evaluated the proposed method on the curated dataset, where the noise type and level of various annotators depend on the input image style. We show that our approach performs well and is adept at learning annotators' confusion. Moreover, we demonstrate how our model is more confident in predicting GT than other baselines. Finally, we assess our approach for segmentation problem and showcase its effectiveness with experiments.

When oncologists estimate cancer patient survival, they rely on multimodal data. Even though some multimodal deep learning methods have been proposed in the literature, the majority rely on having two or more independent networks that share knowledge at a later stage in the overall model. On the other hand, oncologists do not do this in their analysis but rather fuse the information in their brain from multiple sources such as medical images and patient history. This work proposes a deep learning method that mimics oncologists' analytical behavior when quantifying cancer and estimating patient survival. We propose TMSS, an end-to-end Transformer based Multimodal network for Segmentation and Survival prediction that leverages the superiority of transformers that lies in their abilities to handle different modalities. The model was trained and validated for segmentation and prognosis tasks on the training dataset from the HEad & NeCK TumOR segmentation and the outcome prediction in PET/CT images challenge (HECKTOR). We show that the proposed prognostic model significantly outperforms state-of-the-art methods with a concordance index of 0.763+/-0.14 while achieving a comparable dice score of 0.772+/-0.030 to a standalone segmentation model. The code is publicly available.

Vision Transformers (ViT) are competing to replace Convolutional Neural Networks (CNN) for various computer vision tasks in medical imaging such as classification and segmentation. While the vulnerability of CNNs to adversarial attacks is a well-known problem, recent works have shown that ViTs are also susceptible to such attacks and suffer significant performance degradation under attack. The vulnerability of ViTs to carefully engineered adversarial samples raises serious concerns about their safety in clinical settings. In this paper, we propose a novel self-ensembling method to enhance the robustness of ViT in the presence of adversarial attacks. The proposed Self-Ensembling Vision Transformer (SEViT) leverages the fact that feature representations learned by initial blocks of a ViT are relatively unaffected by adversarial perturbations. Learning multiple classifiers based on these intermediate feature representations and combining these predictions with that of the final ViT classifier can provide robustness against adversarial attacks. Measuring the consistency between the various predictions can also help detect adversarial samples. Experiments on two modalities (chest X-ray and fundoscopy) demonstrate the efficacy of SEViT architecture to defend against various adversarial attacks in the gray-box (attacker has full knowledge of the target model, but not the defense mechanism) setting. Code: https://github.com/faresmalik/SEViT

Glaucoma is one of the most severe eye diseases, characterized by rapid progression and leading to irreversible blindness. It is often the case that diagnostics is carried out when one's sight has already significantly degraded due to the lack of noticeable symptoms at early stage of the disease. Regular glaucoma screenings of the population shall improve early-stage detection, however the desirable frequency of etymological checkups is often not feasible due to the excessive load imposed by manual diagnostics on limited number of specialists. Considering the basic methodology to detect glaucoma is to analyze fundus images for the optic-disc-to-optic-cup ratio, Machine Learning algorithms can offer sophisticated methods for image processing and classification. In our work, we propose an advanced image pre-processing technique combined with a multi-view network of deep classification models to categorize glaucoma. Our Glaucoma Automated Retinal Detection Network (GARDNet) has been successfully tested on Rotterdam EyePACS AIROGS dataset with an AUC of 0.92, and then additionally fine-tuned and tested on RIM-ONE DL dataset with an AUC of 0.9308 outperforming the state-of-the-art of 0.9272. Our code is available on https://github.com/ahmed1996said/gardnet, Keywords: Glaucoma Classification, Color Fundus Images. Computer Aided Diagnosis. Deep Learning

In medical imaging analysis, deep learning has shown promising results. We frequently rely on volumetric data to segment medical images, necessitating the use of 3D architectures, which are commended for their capacity to capture interslice context. However, because of the 3D convolutions, max pooling, up-convolutions, and other operations utilized in these networks, these architectures are often more inefficient in terms of time and computation than their 2D equivalents. Furthermore, there are few 3D pretrained model weights, and pretraining is often difficult. We present a simple yet effective 2D method to handle 3D data while efficiently embedding the 3D knowledge during training. We propose transforming volumetric data into 2D super images and segmenting with 2D networks to solve these challenges. Our method generates a super-resolution image by stitching slices side by side in the 3D image. We expect deep neural networks to capture and learn these properties spatially despite losing depth information. This work aims to present a novel perspective when dealing with volumetric data, and we test the hypothesis using CNN and ViT networks as well as self-supervised pretraining. While attaining equal, if not superior, results to 3D networks utilizing only 2D counterparts, the model complexity is reduced by around threefold. Because volumetric data is relatively scarce, we anticipate that our approach will entice more studies, particularly in medical imaging analysis., 13 pages, 4 figures, 4 tables

In oncology, Positron Emission Tomography (PET) is frequently performed for cancer staging and treatment monitoring. Metabolic active tumor volume (MATV) as well as total MATV (TMATV - including primary tumor, lymph nodes and metastasis) derived from PET images have been identified as prognostic factor or for evaluating treatment efficacy in cancer patients. To this end a segmentation approach with high precision and repeatability is important. Moreover, to derive TMATV, a reliable segmentation of the primary tumor as well as all metastasis is essential. However, the implementation of a repeatable and accurate segmentation algorithm remains a challenge. In this work, we propose an artificial intelligence based segmentation method based on textural features (TF) extracted from the PET image. From a large number of textural features, the most important features for the segmentation task were selected. The selected features are used for training a random forest classifier to identify voxels as tumor or background. The algorithm is trained, validated and tested using a lung cancer PET/CT dataset and, additionally, applied on a fully independent test-retest dataset. The approach is especially designed for accurate and repeatable segmentation of primary tumors and metastasis in order to derive TMATV. The segmentation results are compared with conventional segmentation approaches in terms of accuracy and repeatability. In summary, the TF segmentation proposed in this study provided better repeatability and accuracy than conventional segmentation approaches. Moreover, segmentations were accurate for both primary tumors and metastasis and the proposed algorithm is therefore a good candidate for PET tumor segmentation.

Contrastive learning has proven useful in many applications where access to labelled data is limited. The lack of annotated data is particularly problematic in medical image segmentation as it is difficult to have clinical experts manually annotate large volumes of data such as cardiac structures in ultrasound images of the heart. In this paper, We propose a self supervised contrastive learning method to segment the left ventricle from echocardiography when limited annotated images exist. Furthermore, we study the effect of contrastive pretraining on two well-known segmentation networks, UNet and DeepLabV3. Our results show that contrastive pretraining helps improve the performance on left ventricle segmentation, particularly when annotated data is scarce. We show how to achieve comparable results to state-of-the-art fully supervised algorithms when we train our models in a self-supervised fashion followed by fine-tuning on just 5\% of the data. We show that our solution outperforms what is currently published on a large public dataset (EchoNet-Dynamic) achieving a Dice score of 0.9252. We also compare the performance of our solution on another smaller dataset (CAMUS) to demonstrate the generalizability of our proposed solution. The code is available at (https://github.com/BioMedIA-MBZUAI/contrastive-echo).

Accurate prognosis of a tumor can help doctors provide a proper course of treatment and, therefore, save the lives of many. Traditional machine learning algorithms have been eminently useful in crafting prognostic models in the last few decades. Recently, deep learning algorithms have shown significant improvement when developing diagnosis and prognosis solutions to different healthcare problems. However, most of these solutions rely solely on either imaging or clinical data. Utilizing patient tabular data such as demographics and patient medical history alongside imaging data in a multimodal approach to solve a prognosis task has started to gain more interest recently and has the potential to create more accurate solutions. The main issue when using clinical and imaging data to train a deep learning model is to decide on how to combine the information from these sources. We propose a multimodal network that ensembles deep multi-task logistic regression (MTLR), Cox proportional hazard (CoxPH) and CNN models to predict prognostic outcomes for patients with head and neck tumors using patients' clinical and imaging (CT and PET) data. Features from CT and PET scans are fused and then combined with patients' electronic health records for the prediction. The proposed model is trained and tested on 224 and 101 patient records respectively. Experimental results show that our proposed ensemble solution achieves a C-index of 0.72 on The HECKTOR test set that saved us the first place in prognosis task of the HECKTOR challenge. The full implementation based on PyTorch is available on \url{https://github.com/numanai/BioMedIA-Hecktor2021}., Comment: 9 pages, 5 figures

Lung cancer is a leading cause of death worldwide. Early-stage detection of lung cancer is essential for a more favorable prognosis. Radiogenomics is an emerging discipline that combines medical imaging and genomics features for modeling patient outcomes non-invasively. This study presents a radiogenomics pipeline that has: 1) a novel mixed architecture (RA-Seg) to segment lung cancer through attention and recurrent blocks; and 2) deep feature classifiers to distinguish Epidermal Growth Factor Receptor (EGFR) mutation status. We evaluate the proposed algorithm on multiple public datasets to assess its generalizability and robustness. We demonstrate how the proposed segmentation and classification methods outperform existing baseline and SOTA approaches (73.54 Dice and 93 F1 scores)., Comment: 4 pages, 3 figures, 3 tables. Preprint to International Symposium on Biomedical Imaging (ISBI) 2023

Despite the introduction of vaccines, Coronavirus disease (COVID-19) remains a worldwide dilemma, continuously developing new variants such as Delta and the recent Omicron. The current standard for testing is through polymerase chain reaction (PCR). However, PCRs can be expensive, slow, and/or inaccessible to many people. X-rays on the other hand have been readily used since the early 20th century and are relatively cheaper, quicker to obtain, and typically covered by health insurance. With a careful selection of model, hyperparameters, and augmentations, we show that it is possible to develop models with 83% accuracy in binary classification and 64% in multi-class for detecting COVID-19 infections from chest x-rays., Comment: 15 pages, 13 figures

To assess fetal health during pregnancy, doctors use the gestational age (GA) calculation based on the Crown Rump Length (CRL) measurement in order to check for fetal size and growth trajectory. However, GA estimation based on CRL, requires proper positioning of calipers on the fetal crown and rump view, which is not always an easy plane to find, especially for an inexperienced sonographer. Finding a slightly oblique view from the true CRL view could lead to a different CRL value and therefore incorrect estimation of GA. This study presents an AI-based method for a quality assessment of the CRL view by verifying 7 clinical scoring criteria that are used to verify the correctness of the acquired plane. We show how our proposed solution achieves high accuracy on the majority of the scoring criteria when compared to an expert. We also show that if such scoring system is used, it helps identify poorly acquired images accurately and hence may help sonographers acquire better images which could potentially lead to a better assessment of conditions such as Intrauterine Growth Restriction (IUGR)., Comment: 13 pages, 2 figures, 3 tables. Proceedings of Machine Learning Research, Under Review. Full Paper MIDL 2022 submission

Vision Transformer (ViT), a radically different architecture than convolutional neural networks offers multiple advantages including design simplicity, robustness and state-of-the-art performance on many vision tasks. However, in contrast to convolutional neural networks, Vision Transformer lacks inherent inductive biases. Therefore, successful training of such models is mainly attributed to pre-training on large-scale datasets such as ImageNet with 1.2M or JFT with 300M images. This hinders the direct adaption of Vision Transformer for small-scale datasets. In this work, we show that self-supervised inductive biases can be learned directly from small-scale datasets and serve as an effective weight initialization scheme for fine-tuning. This allows to train these models without large-scale pre-training, changes to model architecture or loss functions. We present thorough experiments to successfully train monolithic and non-monolithic Vision Transformers on five small datasets including CIFAR10/100, CINIC10, SVHN, Tiny-ImageNet and two fine-grained datasets: Aircraft and Cars. Our approach consistently improves the performance of Vision Transformers while retaining their properties such as attention to salient regions and higher robustness. Our codes and pre-trained models are available at: https://github.com/hananshafi/vits-for-small-scale-datasets., Comment: Accepted at BMVC 2022

Quick and accurate diagnosis is of paramount importance to mitigate the effects of COVID-19 infection, particularly for severe cases. Enormous effort has been put towards developing deep learning methods to classify and detect COVID-19 infections from chest radiography images. However, recently some questions have been raised surrounding the clinical viability and effectiveness of such methods. In this work, we investigate the impact of multi-task learning (classification and segmentation) on the ability of CNNs to differentiate between various appearances of COVID-19 infections in the lung. We also employ self-supervised pre-training approaches, namely MoCo and inpainting-CXR, to eliminate the dependence on expensive ground truth annotations for COVID-19 classification. Finally, we conduct a critical evaluation of the models to assess their deploy-readiness and provide insights into the difficulties of fine-grained COVID-19 multi-class classification from chest X-rays., Comment: Accepted to Conference on Medical Image Understanding and Analysis (MIUA) 2022

Cancer is one of the leading causes of death worldwide, and head and neck (H&N) cancer is amongst the most prevalent types. Positron emission tomography and computed tomography are used to detect, segment and quantify the tumor region. Clinically, tumor segmentation is extensively time-consuming and prone to error. Machine learning, and deep learning in particular, can assist to automate this process, yielding results as accurate as the results of a clinician. In this paper, we investigate a vision transformer-based method to automatically delineate H&N tumor, and compare its results to leading convolutional neural network (CNN)-based models. We use multi-modal data from CT and PET scans to perform the segmentation task. We show that a solution with a transformer-based model has the potential to achieve comparable results to CNN-based ones. With cross validation, the model achieves a mean dice similarity coefficient (DSC) of 0.736, mean precision of 0.766 and mean recall of 0.766. This is only 0.021 less than the 2020 competition winning model (cross validated in-house) in terms of the DSC score. On the testing set, the model performs similarly, with DSC of 0.736, precision of 0.773, and recall of 0.760, which is only 0.023 lower in DSC than the 2020 competition winning model. This work shows that cancer segmentation via transformer-based models is a promising research area to further explore., 8 pages, 2 figures (3 more figures in Appendix), 2 tables; accepted to MIDL conference

Chest X-ray is one of the most popular medical imaging modalities due to its accessibility and effectiveness. However, there is a chronic shortage of well-trained radiologists who can interpret these images and diagnose the patient's condition. Therefore, automated radiology report generation can be a very helpful tool in clinical practice. A typical report generation workflow consists of two main steps: (i) encoding the image into a latent space and (ii) generating the text of the report based on the latent image embedding. Many existing report generation techniques use a standard convolutional neural network (CNN) architecture for image encoding followed by a Transformer-based decoder for medical text generation. In most cases, CNN and the decoder are trained jointly in an end-to-end fashion. In this work, we primarily focus on understanding the relative importance of encoder and decoder components. Towards this end, we analyze four different image encoding approaches: direct, fine-grained, CLIP-based, and Cluster-CLIP-based encodings in conjunction with three different decoders on the large-scale MIMIC-CXR dataset. Among these encoders, the cluster CLIP visual encoder is a novel approach that aims to generate more discriminative and explainable representations. CLIP-based encoders produce comparable results to traditional CNN-based encoders in terms of NLP metrics, while fine-grained encoding outperforms all other encoders both in terms of NLP and clinical accuracy metrics, thereby validating the importance of image encoder to effectively extract semantic information. GitHub repository: https://github.com/mudabek/encoding-cxr-report-gen

We would like to thank EPSRC impact acceleration fund (EP/K503940/1) for helping support this project. RR was supported as part of the James-Watt Scholarship during her PhD research at the Heriot-Watt University. Co-locating the gross tumour volume (GTV) on cone-beam computed tomography (CBCT) of non small cell lung cancer (NSCLC) patients receiving radiotherapy (RT) is difficult because of the lack of image contrast between the tumour and surrounding tissue. This paper presents a new image analysis approach, based on second-order statistics obtained from gray level co-occurrence matrices (GLCM) combined with level sets, for assisting clinicians in identifying the GTV on CBCT images. To demonstrate the potential of the approach planning CT images from 50 NSCLC patients were rigidly registered with CBCT images from fractions 1 and 10. Image texture analysis was combined with two level set methodologies and used to automatically identify the GTV on the registered CBCT images. The Dice correlation coefficients (μ± σ) calculated between the clinician-defined and image analysis defined GTV on the planning CT and the CBCT for three different parameterisations of the model were: 0.69 ± 0.19, 0.63 ± 0.17, 0.86 ± 0.13 on fraction 1 CBCT images and 0.70 ± 0.17, 0.62 ± 0.15, 0.86 ± 0.12 on fraction 10 CBCT images. This preliminary data suggests that the image analysis approach presented may have potential for clinicians in identifying the GTV in low contrast CBCT images of NSCLC patients. Additional validation and further work, particularly in overcoming the lack of gold standard reference images, are required to progress this approach. Postprint

In oncology, Positron Emission Tomography (PET) is frequently performed for cancer staging and treatment monitoring. Metabolic active tumor volume (MATV) as well as total MATV (TMATV - including primary tumor, lymph nodes and metastasis) derived from PET images have been identified as prognostic factor or for evaluating treatment efficacy in cancer patients. To this end a segmentation approach with high precision and repeatability is important. Moreover, to derive TMATV, a reliable segmentation of the primary tumor as well as all metastasis is essential. However, the implementation of a repeatable and accurate segmentation algorithm remains a challenge. In this work, we propose an artificial intelligence based segmentation method based on textural features (TF) extracted from the PET image. From a large number of textural features, the most important features for the segmentation task were selected. The selected features are used for training a random forest classifier to identify voxels as tumor or background. The algorithm is trained, validated and tested using a lung cancer PET/CT dataset and, additionally, applied on a fully independent test-retest dataset. The approach is especially designed for accurate and repeatable segmentation of primary tumors and metastasis in order to derive TMATV. The segmentation results are compared with conventional segmentation approaches in terms of accuracy and repeatability. In summary, the TF segmentation proposed in this study provided better repeatability and accuracy than conventional segmentation approaches. Moreover, segmentations were accurate for both primary tumors and metastasis and the proposed algorithm is therefore a good candidate for PET tumor segmentation.