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The registration of preoperative and follow-up brain MRI, which is crucial in illustrating patients' responses to treatments and providing guidance for postoperative therapy, presents significant challenges. These challenges stem from the considerable deformation of brain tissue and the areas of non-correspondence due to surgical intervention and postoperative changes. We propose a stepwise corrected attention registration network grounded in convolutional neural networks (CNNs). This methodology leverages preoperative and follow-up MRI scans as fixed images and moving images, respectively, and employs a multi-level registration strategy that establishes a precise and holistic correspondence between images, from coarse to fine. Furthermore, our model introduces a corrected attention module into the multi-level registration network that can generate an attention map at the local level through the deformation fields of the upper-level registration network and pathological areas of preoperative images segmented by a mature algorithm in BraTS, serving to strengthen the registration accuracy of non-correspondence areas. A comparison between our scheme and the leading approach identified in the MICCAI's BraTS-Reg challenge indicates a 7.5% enhancement in the target registration error (TRE) metric and improved visualization of non-correspondence areas. These results illustrate the better performance of our stepwise corrected attention registration network in not only enhancing the registration accuracy but also achieving a more logical representation of non-correspondence areas. Thus, this work contributes significantly to the optimization of the registration of brain MRI between preoperative and follow-up scans. [ABSTRACT FROM AUTHOR]

Producing spatial transformations that are diffeomorphic is a key goal in deformable image registration. As a diffeomorphic transformation should have positive Jacobian determinant | J | everywhere, the number of pixels (2D) or voxels (3D) with | J | < 0 has been used to test for diffeomorphism and also to measure the irregularity of the transformation. For digital transformations, | J | is commonly approximated using a central difference, but this strategy can yield positive | J | 's for transformations that are clearly not diffeomorphic—even at the pixel or voxel resolution level. To show this, we first investigate the geometric meaning of different finite difference approximations of | J | . We show that to determine if a deformation is diffeomorphic for digital images, the use of any individual finite difference approximation of | J | is insufficient. We further demonstrate that for a 2D transformation, four unique finite difference approximations of | J | 's must be positive to ensure that the entire domain is invertible and free of folding at the pixel level. For a 3D transformation, ten unique finite differences approximations of | J | 's are required to be positive. Our proposed digital diffeomorphism criteria solves several errors inherent in the central difference approximation of | J | and accurately detects non-diffeomorphic digital transformations. The source code of this work is available at https://github.com/yihao6/digital_diffeomorphism. [ABSTRACT FROM AUTHOR]

The registration of preoperative and follow-up brain MRI, which is crucial in illustrating patients’ responses to treatments and providing guidance for postoperative therapy, presents significant challenges. These challenges stem from the considerable deformation of brain tissue and the areas of non-correspondence due to surgical intervention and postoperative changes. We propose a stepwise corrected attention registration network grounded in convolutional neural networks (CNNs). This methodology leverages preoperative and follow-up MRI scans as fixed images and moving images, respectively, and employs a multi-level registration strategy that establishes a precise and holistic correspondence between images, from coarse to fine. Furthermore, our model introduces a corrected attention module into the multi-level registration network that can generate an attention map at the local level through the deformation fields of the upper-level registration network and pathological areas of preoperative images segmented by a mature algorithm in BraTS, serving to strengthen the registration accuracy of non-correspondence areas. A comparison between our scheme and the leading approach identified in the MICCAI’s BraTS-Reg challenge indicates a 7.5% enhancement in the target registration error (TRE) metric and improved visualization of non-correspondence areas. These results illustrate the better performance of our stepwise corrected attention registration network in not only enhancing the registration accuracy but also achieving a more logical representation of non-correspondence areas. Thus, this work contributes significantly to the optimization of the registration of brain MRI between preoperative and follow-up scans.

Abstract Background To evaluate a novel CBCT conversion algorithm for dose calculation implemented in a research version of a treatment planning system (TPS). Methods The algorithm was implemented in a research version of RayStation (v. 11B-DTK, RaySearch, Stockholm, Sweden). CBCTs acquired for each ten head and neck (HN), gynecology (GYN) and lung cancer (LNG) patients were collected and converted using the new algorithm (CBCTc). A bulk density overriding technique implemented in the same version of the TPS was used for comparison (CBCTb). A deformed CT (dCT) was created by using deformable image registration of the planning CT (pCT) to the CBCT to reduce anatomical changes. All treatment plans were recalculated on the pCT, dCT, CBCTc and the CBCTb. The resulting dose distributions were analyzed using the MICE toolkit (NONPIMedical AB Sweden, Umeå) with local gamma analysis, with 1% dose difference and 1 mm distance to agreement criteria. A Wilcoxon paired rank sum test was applied to test the differences in gamma pass rates (GPRs). A p value smaller than 0.05 considered statistically significant. Results The GPRs for the CBCTb method were systematically lower compared to the CBCTc method. Using the 10% dose threshold and the dCT as reference the median GPRs were for the CBCTc method were 100% and 99.8% for the HN and GYN cases, respectively. Compared to that the GPRs of the CBCTb method were lower with values of 99.8% and 98.0%, for the HN and GYN cases, respectively. The GPRs of the LNG cases were 99.9% and 97.5% for the CBCTc and CBCTb method, respectively. These differences were statistically significant. The main differences between the dose calculated on the CBCTs and the pCTs were found in regions near air/tissue interfaces, which are also subject to anatomical variations. Conclusion The dose distribution calculated using the new CBCTc method showed excellent agreement with the dose calculated using dCT and pCT and was superior to the CBCTb method. The main reasons for deviations of the calculated dose distribution were caused by anatomical variations between the pCT and the corrected CBCT.

Abstract Deformable multimodal image registration plays a key role in medical image analysis. It remains a challenge to find accurate dense correspondences between multimodal images due to the significant intensity distortion and the large deformation. macJNet is proposed to align the multimodal medical images, which is a weakly-supervised multimodal image deformable registration method using a joint learning framework and multi-sampling cascaded modality independent neighborhood descriptor (macMIND). The joint learning framework consists of a multimodal image registration network and two segmentation networks. The proposed macMIND is a modality-independent image structure descriptor to provide dense correspondence for registration, which incorporates multi-orientation and multi-scale sampling patterns to build self-similarity context. It greatly enhances the representation ability of cross-modal features in the registration network. The semi-supervised segmentation networks generate anatomical labels to provide semantics correspondence for registration, and the registration network helps to improve the performance of multimodal image segmentation by providing the consistency of anatomical labels. 3D CT-MR liver image dataset with 118 samples is built for evaluation, and comprehensive experiments have been conducted to demonstrate that macJNet achieves superior performance over state-of-the-art multi-modality medical image registration methods.

PurposeTo develop a convolutional neural network (CNN)-based deformable lung registration algorithm to reduce computation time and assess its potential for lobar air trapping quantification.Materials and methodsIn this retrospective study, a CNN algorithm was developed to perform deformable registration of lung CT (LungReg) using data on 9118 patients from the COPDGene Study (data collected between 2007 and 2012). Loss function constraints included cross-correlation, displacement field regularization, lobar segmentation overlap, and the Jacobian determinant. LungReg was compared with a standard diffeomorphic registration (SyN) for lobar Dice overlap, percentage voxels with nonpositive Jacobian determinants, and inference runtime using paired t tests. Landmark colocalization error (LCE) across 10 patients was compared using a random effects model. Agreement between LungReg and SyN air trapping measurements was assessed using intraclass correlation coefficient. The ability of LungReg versus SyN emphysema and air trapping measurements to predict Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages was compared using area under the receiver operating characteristic curves.ResultsAverage performance of LungReg versus SyN showed lobar Dice overlap score of 0.91-0.97 versus 0.89-0.95, respectively (P < .001); percentage voxels with nonpositive Jacobian determinant of 0.04 versus 0.10, respectively (P < .001); inference run time of 0.99 second (graphics processing unit) and 2.27 seconds (central processing unit) versus 418.46 seconds (central processing unit) (P < .001); and LCE of 7.21 mm versus 6.93 mm (P < .001). LungReg and SyN whole-lung and lobar air trapping measurements achieved excellent agreement (intraclass correlation coefficients > 0.98). LungReg versus SyN area under the receiver operating characteristic curves for predicting GOLD stage were not statistically different (range, 0.88-0.95 vs 0.88-0.95, respectively; P = .31-.95).ConclusionCNN-based deformable lung registration is accurate and fully automated, with runtime feasible for clinical lobar air trapping quantification, and has potential to improve diagnosis of small airway diseases.Keywords: Air Trapping, Convolutional Neural Network, Deformable Registration, Small Airway Disease, CT, Lung, Semisupervised Learning, Unsupervised Learning Supplemental material is available for this article. © RSNA, 2021 An earlier incorrect version of this article appeared online. This article was corrected on December 22, 2021.

Background: To evaluate a novel CBCT conversion algorithm for dose calculation implemented in a research version of a treatment planning system (TPS). Methods: The algorithm was implemented in a research version of RayStation (v. 11B-DTK, RaySearch, Stockholm, Sweden). CBCTs acquired for each ten head and neck (HN), gynecology (GYN) and lung cancer (LNG) patients were collected and converted using the new algorithm (CBCTc). A bulk density overriding technique implemented in the same version of the TPS was used for comparison (CBCTb). A deformed CT (dCT) was created by using deformable image registration of the planning CT (pCT) to the CBCT to reduce anatomical changes. All treatment plans were recalculated on the pCT, dCT, CBCTc and the CBCTb. The resulting dose distributions were analyzed using the MICE toolkit (NONPIMedical AB Sweden, Umeå) with local gamma analysis, with 1% dose difference and 1 mm distance to agreement criteria. A Wilcoxon paired rank sum test was applied to test the differences in gamma pass rates (GPRs). A p value smaller than 0.05 considered statistically significant. Results: The GPRs for the CBCTb method were systematically lower compared to the CBCTc method. Using the 10% dose threshold and the dCT as reference the median GPRs were for the CBCTc method were 100% and 99.8% for the HN and GYN cases, respectively. Compared to that the GPRs of the CBCTb method were lower with values of 99.8% and 98.0%, for the HN and GYN cases, respectively. The GPRs of the LNG cases were 99.9% and 97.5% for the CBCTc and CBCTb method, respectively. These differences were statistically significant. The main differences between the dose calculated on the CBCTs and the pCTs were found in regions near air/tissue interfaces, which are also subject to anatomical variations. Conclusion: The dose distribution calculated using the new CBCTc method showed excellent agreement with the dose calculated using dCT and pCT and was superior to the CBCTb method. The main reasons for deviations of the calculated dose distribution were caused by anatomical variations between the pCT and the corrected CBCT. [ABSTRACT FROM AUTHOR]

Deformable multimodal image registration plays a key role in medical image analysis. It remains a challenge to find accurate dense correspondences between multimodal images due to the significant intensity distortion and the large deformation. macJNet is proposed to align the multimodal medical images, which is a weakly-supervised multimodal image deformable registration method using a joint learning framework and multi-sampling cascaded modality independent neighborhood descriptor (macMIND). The joint learning framework consists of a multimodal image registration network and two segmentation networks. The proposed macMIND is a modality-independent image structure descriptor to provide dense correspondence for registration, which incorporates multi-orientation and multi-scale sampling patterns to build self-similarity context. It greatly enhances the representation ability of cross-modal features in the registration network. The semi-supervised segmentation networks generate anatomical labels to provide semantics correspondence for registration, and the registration network helps to improve the performance of multimodal image segmentation by providing the consistency of anatomical labels. 3D CT-MR liver image dataset with 118 samples is built for evaluation, and comprehensive experiments have been conducted to demonstrate that macJNet achieves superior performance over state-of-the-art multi-modality medical image registration methods. [ABSTRACT FROM AUTHOR]

PurposeMissing or discrepant imaging volume is a common challenge in deformable image registration (DIR). To minimize the adverse impact, we train a neural network to synthesize cropped portions of head and neck CT's and then test its use in DIR.MethodsUsing a training dataset of 409 head and neck CT's, we trained a generative adversarial network to take in a cropped 3D image and output an image with synthesized anatomy in the cropped region. The network used a 3D U-Net generator along with Visual Geometry Group (VGG) deep feature losses. To test our technique, for each of the 53 test volumes, we used Elastix to deformably register combinations of a randomly cropped, full, and synthetically full volume to a single cropped, full, and synthetically full target volume. We additionally tested our method's robustness to crop extent by progressively increasing the amount of cropping, synthesizing the missing anatomy using our network, and then performing the same registration combinations. Registration performance was measured using 95% Hausdorff distance across 16 contours.ResultsWe successfully trained a network to synthesize missing anatomy in superiorly and inferiorly cropped images. The network can estimate large regions in an incomplete image, far from the cropping boundary. Registration using our estimated full images was not significantly different from registration using the original full images. The average contour matching error for full image registration was 9.9 mm, whereas our method was 11.6, 12.1, and 13.6 mm for synthesized-to-full, full-to-synthesized, and synthesized-to-synthesized registrations, respectively. In comparison, registration using the cropped images had errors of 31.7 mm and higher. Plotting the registered image contour error as a function of initial preregistered error shows that our method is robust to registration difficulty. Synthesized-to-full registration was statistically independent of cropping extent up to 18.7 cm superiorly cropped. Synthesized-to-synthesized registration was nearly independent, with a -0.04 mm of change in average contour error for every additional millimeter of cropping.ConclusionsDifferent or inadequate in scan extent is a major cause of DIR inaccuracies. We address this challenge by training a neural network to complete cropped 3D images. We show that with image completion, the source of DIR inaccuracy is eliminated, and the method is robust to varying crop extent.

Purpose: To evaluate deep learning (DL)‐based deformable image registration (DIR) for dose accumulation during radiotherapy of prostate cancer patients. Methods and Materials: Data including 341 CBCTs (209 daily, 132 weekly) and 23 planning CTs from 23 patients was retrospectively analyzed. Anatomical deformation during treatment was estimated using free‐form deformation (FFD) method from Elastix and DL‐based VoxelMorph approaches. The VoxelMorph method was investigated using anatomical scans (VMorph_Sc) or label images (VMorph_Msk), or the combination of both (VMorph_Sc_Msk). Accumulated doses were compared with the planning dose. Results: The DSC ranges, averaged for prostate, rectum and bladder, were 0.60–0.71, 0.67–0.79, 0.93–0.98, and 0.89–0.96 for the FFD, VMorph_Sc, VMorph_Msk, and VMorph_Sc_Msk methods, respectively. When including both anatomical and label images, VoxelMorph estimated more complex deformations resulting in heterogeneous determinant of Jacobian and higher percentage of deformation vector field (DVF) folding (up to a mean value of 1.90% in the prostate). Large differences were observed between DL‐based methods regarding estimation of the accumulated dose, showing systematic overdosage and underdosage of the bladder and rectum, respectively. The difference between planned mean dose and accumulated mean dose with VMorph_Sc_Msk reached a median value of +6.3 Gy for the bladder and −5.1 Gy for the rectum. Conclusion: The estimation of the deformations using DL‐based approach is feasible for male pelvic anatomy but requires the inclusion of anatomical contours to improve organ correspondence. High variability in the estimation of the accumulated dose depending on the deformable strategy suggests further investigation of DL‐based techniques before clinical deployment. [ABSTRACT FROM AUTHOR]

Accurate registration of lung X-rays is an important task in medical image analysis. However, the conventional methods usually cost a lot in running time, and the existing deep learning methods are hard to deal with the large deformation caused by respiratory and cardiac motion. In this paper, we attempt to use deep learning methods to deal with large deformation and enable it to achieve the accuracy of conventional methods. We proposed the cascading affine and B-spline network (CABN), which consists of convolutional cross-stitch affine block (CCAB) and B-splines U-net-like block (BUB) for large lung motion. CCAB makes use of the convolutional cross-stitch model to learn global features among images. And BUB adopts the idea of cubic B-splines which is suitable for large deformation. We separately demonstrated CCAB, BUB, and CABN on two chest X-ray datasets. The experimental results indicate that our methods are highly competitive both in accuracy and runtime when compared to both other deep learning methods and iterative conventional approaches. Moreover, CCAB also can be used for the preprocessing of non-rigid registration methods, replacing affine in conventional methods. [ABSTRACT FROM AUTHOR]

Deformable image registration plays a crucial role in estimating cardiac deformation from a sequence of images. However, existing registration methods primarily process images as pairs instead of processing all images in a sequence together. This study proposes a novel end-to-end learning-free generative multi-resolution convolutional neural network (GMCNet) with the primary focus of registering images in a sequence. Even though learning-based methods have yielded high performance for image registration, their performance depends on their ability to learn information from a large number of samples which are difficult to obtain and might bias the framework to the specific domain of data. The proposed learning-free method eliminates the need for a dedicated training set while exploiting the capabilities of neural networks to achieve accurate deformation fields. Due to its capability of parameter sharing through the architecture, the GMCNet can be used as a groupwise registration as well as pairwise registration. The proposed method was evaluated on three different clinical cardiac magnetic resonance imaging datasets and compared quantitatively against nine other state-of-the-art learning and optimization-based algorithms. The proposed method outperformed other methods in all comparisons and yielded average Dice metric values ranging from 0.85 to 0.88 for the datasets. Different aspects of the GMCNet are also explored by assessing 1) the robustness; 2) performance on pairwise registration; 3) the influence of spatial transformation in a controlled environment; and 4) the impact of different multi-resolution structures. The results demonstrate that using temporal information to estimate the deformation fields leads to more accurate registration results and improved robustness under different noise levels. Moreover, the proposed method does not need images for training, and therefore, its prediction is not domain-specific and can be applied to any sequence of images.

To address the low precision of pairwise registration method based on the deep learning and the time-consuming nature of traditional registration algorithm, this paper presents a method of unsupervised end-to-end groupwise registration based on variational inference, as well as a registration framework based on normalized cross correlation (NCC) and prior knowledge. The framework can warp all images in the group into a common space and effectively control the deformation field of the regularization, and it doesn't need a real deformation field or a reference image. The estimation of deformation field by this method can be modeled as a probability generation model and solved by variational inference. Then unsupervised training is implemented with the help of spatial transformer network and loss function. The registration results of 3D brain magnetic resonance image from the public data set LPBA40 show that: compared with the baseline method, the proposed method has better Dice score, less running time, better diffeomorphisms domain, and is robust to noise.

3d reconstruction of deformable objects in dynamic scenes forms the fundamental basis of many robotic applications. Existing mesh-based approaches compromise registration accuracy, and lose important details due to interpolation and smoothing. Additionally, existing non-rigid registration techniques struggle with unindexed points and disconnected manifolds. We propose a novel non-rigid registration framework for raw, unstructured, deformable point clouds purely based on geometric features. The global non-rigid deformation of an object is formulated as an aggregation of locally rigid transformations. The concept of locality is embodied in soft patches described by geometrical properties based on SHOT descriptor and its neighborhood. By considering the confidence score of pairwise association between soft patches of two scans (not necessarily consecutive), a computed similarity matrix serves as the seed to grow a correspondence graph which leverages rigidity terms defined in As-Rigid-As-Possible for pruning and optimization. Experiments on simulated and publicly available datasets demonstrate the capability of the proposed approach to cope with large deformations blended with numerous missing parts in the scan process.

Introduction: This study aimed to assess and compare the capabilities of two commercially available deformable image registration algorithms implemented in Raystation 9A (A1) and Velocity AI (A2) for possible usage in adaptive prostate radiotherapy based on the propagation of anatomical contours from computed tomography (CT) images to cone-beam CT (CBCT) images. Material and methods: Ten patients were retrospectively selected from a group treated for localized prostate cancer. The propagation of rectum contours was analyzed in a set of CT-CBCT pairs. Two independent observers carried out qualitative analysis using the two-level descriptive scale (meet/fail). Quantitative analysis was done using landmark points distances based on implanted markers as navigation points and differently obtained contours (manually and automatically using DIR algorithms). Quantitative analysis was taken on sets preselected by qualitative analysis. Results: Qualitative analysis shows that 83.7% of the rectum contours were scored identically (meet or fail) for both algorithms, from which 53.5% and 55.8% are failed results for A1 and A2, respectively. For the rectum size (RWD parameter), differences between referenced and deformation-based values were 5.5 and 5.8 mm, and for the rectum wall, the prostate marker distance (WMD parameter) was 4.5 and 5.5 mm for A1 and A2, respectively. The differences between the WMD parameters were statistically significant (p = 0.007). Conclusions: In both tested algorithms, neither effectiveness nor measured uncertainties in the propagation of rectum contour process in prostate patient cases were satisfactory. Careful selection of input images followed by case/set-based verification of every deformable registration is a substantial step to avoid inappropriate results.

Organ shape reconstruction based on a single-projection image during treatment has wide clinical scope, e.g., in image-guided radiotherapy and surgical guidance. We propose an image-to-graph convolutional network that achieves deformable registration of a three-dimensional (3D) organ mesh for a low-contrast two-dimensional (2D) projection image. This framework enables simultaneous training of two types of transformation: from the 2D projection image to a displacement map, and from the sampled per-vertex feature to a 3D displacement that satisfies the geometrical constraint of the mesh structure. Assuming application to radiation therapy, the 2D/3D deformable registration performance is verified for multiple abdominal organs that have not been targeted to date, i.e., the liver, stomach, duodenum, and kidney, and for pancreatic cancer. The experimental results show shape prediction considering relationships among multiple organs can be used to predict respiratory motion and deformation from digitally reconstructed radiographs with clinically acceptable accuracy. [ABSTRACT FROM AUTHOR]

The performance and speed of medical image registration have been greatly boosted by advanced deep-learning based methods. However, most current methods are challenged by large deformations between input images, which necessitate a compromise in computational cost to enhance the model's receptive field and its ability to model long-range spatial relationships for improving registration performance. In order to enhance the performance of registration for images with large deformations at a lower computational cost, in this paper, we propose a light-weight registration model with the ability to model large receptive fields and long-range spatial relationships, named LL-Net. The core components of LL-Net consist of a Rectangular Decomposition Large Kernel Attention (RD-LKA) layer and a Spatial and Channel Fusion Attention (SC-Fusion) layer. The RD-LKA layer utilizes anisotropic depth-wise large kernel convolutions to capture large receptive fields with an extremely low parameter count while modeling long-range spatial relationships. Moreover, the SC-Fusion layer enhances the model's feature fusion capability and strengthens feature representations at critical locations. Our LL-Net exhibits state-of-the-art performance across multiple datasets. Specifically, it achieves a Dice score of 76.7% and an HD95 of 2.983 mm on the IXI dataset, and a Dice score of 87.8% and an HD95 of 1.042 mm on the OASIS dataset. Experimental results substantiate the efficacy of LL-Net in capturing large receptive fields and modeling long-range spatial relationships. The code for LL-Net is available at https://github.com/BoyOfChu/LL_Net. • A light-weight registration network that models large receptive fields. • RD-LKA block extracts global semantic information and detailed local information. • SC-Fusion block decouples the interaction of spatial and channel dimensions. • Experimental results on two datasets validate the effectiveness of our network. [ABSTRACT FROM AUTHOR]

Purpose: This investigation compares three commercial methods of cone-beam computed tomography (CBCT)-based dosimetric analysis to a method based on repeat computed tomography (CT). Materials and Methods: Seventeen head-and-neck patients treated in 2020, and with a repeat CT, were included in the analyses. The planning CT was deformed to anatomy in repeat CT to generate a reference plan. Two of the CBCT-based methods generated test plans by deforming the planning CT to CBCT of fraction N using VelocityAI™ and SmartAdapt®. The third method compared directly calculated doses on the CBCT for fraction 1 and fraction N, using PerFraction™. Maximum dose to spinal cord (Cord_dmax) and dose to 95% volume (D95) of planning target volumes (PTVs) were used to assess “need to replan” criteria. Results: The VelocityAI™ method provided results that most accurately matched the reference plan in “need to replan” criteria using either Cord_dmax or PTV D95. SmartAdapt® method overestimated the change in Cord_dmax (6.77% vs. 3.85%, P < 0.01) and change in cord volume (9.56% vs. 0.67%, P < 0.01) resulting in increased false positives in “need to replan” criteria, and performed similarly to VelocityAI™ for D95, but yielded more false negatives. PerFraction™ method underestimated Cord_dmax, did not perform any volume deformation, and missed all “need to replan” cases based on cord dose. It also yielded high false negatives using the D95 PTV criteria. Conclusions: The VelocityAI™-based method using fraction N CBCT is most similar to the reference plan using repeat CT; the other two methods had significant differences.

PURPOSE:The deformable registration of pulmonary computed tomography images before and after radiation therapy is challenging due to anatomic changes from radiation fibrosis. We hypothesize that a line-enhanced registration algorithm can reduce landmark error over the entire lung, including the irradiated regions, when compared to an intensity-based deformable registration algorithm. MATERIALS:Two intensity-based B-spline deformable registration algorithms of pre-radiation therapy and post-radiation therapy images were compared. The first was a control intensity-based algorithm that utilized computed tomography images without modification. The second was a line enhancement algorithm that incorporated a Hessian-based line enhancement filter prior to deformable image registration. Registrations were evaluated based on the landmark error between user-identified landmark pairs and the overlap ratio. RESULTS:Twenty-one patients with pre-radiation therapy and post-radiation therapy scans were included. The median time interval between scans was 1.2 years (range: 0.3-3.3 years). Median landmark errors for the line enhancement algorithm were significantly lower than those for the control algorithm over the entire lung (1.67 vs 1.83 mm; P < .01), as well as within the 0 to 5 Gy (1.40 vs 1.57; P < .01) and >5 Gy (2.25 vs 3.31; P < .01) dose intervals. The median lung mask overlap ratio for the line enhancement algorithm (96.2%) was greater than that for the control algorithm (95.8%; P < .01). Landmark error within the >5 Gy dose interval demonstrated a significant inverse relationship with post-radiation therapy fibrosis enhancement after line enhancement filtration (Pearson correlation coefficient = -0.48; P = .03). CONCLUSION:The line enhancement registration algorithm is a promising method for registering images before and after radiation therapy.

Purpose: This investigation compares three commercial methods of cone‑beam computed tomography (CBCT)‑based dosimetric analysis to a method based on repeat computed tomography (CT). Materials and Methods: Seventeen head‑and‑neck patients treated in 2020, and with a repeat CT, were included in the analyses. The planning CT was deformed to anatomy in repeat CT to generate a reference plan. Two of the CBCT‑based methods generated test plans by deforming the planning CT to CBCT of fraction N using VelocityAI™ and SmartAdapt®. The third method compared directly calculated doses on the CBCT for fraction 1 and fraction N, using PerFraction™. Maximum dose to spinal cord (Cord_dmax) and dose to 95% volume (D95) of planning target volumes (PTVs) were used to assess “need to replan” criteria. Results: The VelocityAI™ method provided results that most accurately matched the reference plan in “need to replan” criteria using either Cord_dmax or PTV D95. SmartAdapt® method overestimated the change in Cord_dmax (6.77% vs. 3.85%, P < 0.01) and change in cord volume (9.56% vs. 0.67%, P < 0.01) resulting in increased false positives in “need to replan” criteria, and performed similarly to VelocityAI™ for D95, but yielded more false negatives. PerFraction™ method underestimated Cord_dmax, did not perform any volume deformation, and missed all “need to replan” cases based on cord dose. It also yielded high false negatives using the D95 PTV criteria. Conclusions: The VelocityAI™‑based method using fraction N CBCT is most similar to the reference plan using repeat CT; the other two methods had significant differences. [ABSTRACT FROM AUTHOR]

Abstract Background Image-guided adaptive brachytherapy shows the ability to deliver high doses to tumors while sparing normal tissues. However, interfraction dose delivery introduces uncertainties to high dose estimation, which relates to normal tissue toxicity. The purpose of this study was to investigate the high-dose regions of two applicator approaches in brachytherapy. Method For 32 cervical cancer patients, the CT images from each fraction were wrapped to a reference image, and the displacement vector field (DVF) was calculated with a hybrid intensity-based deformable registration algorithm. The fractional dose was then accumulated to calculate the position and the overlap of high dose (D2cc) during multiple fractions. Result The overall Dice similarity coefficient (DSC) of the deformation algorithm for the bladder and the rectum was (0.97 and 0.91). No significant difference was observed between the two applicators. However, the location of the intracavitary brachytherapy (ICBT) high-dose region was relatively concentrated. The overlap volume of bladder and rectum D2cc was 0.42 and 0.71, respectively, which was higher than that of interstitial brachytherapy (ISBT) (0.26 and 0.31). The cumulative dose was overestimated in ISBT cases when using the GEC-recommended method. The ratio of bladder and rectum D2cc to the GEC method was 0.99 and 1, respectively, which was higher than that of the ISBT method (0.96 and 0.94). Conclusion High-dose regions for brachytherapy based on different applicator types were different. The 3D-printed ICBT has better high-dose region consistency than freehand ISBT and hence is more predictable.

This study aimed to assess and compare the capabilities of two commercially available deformable image registration algorithms implemented in Raystation 9A (A 1) and Velocity AI (A 2) for possible usage in adaptive prostate radiotherapy based on the propagation of anatomical contours from computed tomography (CT) images to cone-beam CT (CBCT) images. Ten patients were retrospectively selected from a group treated for localized prostate cancer. The propagation of rectum contours was analyzed in a set of CT-CBCT pairs. Two independent observers carried out qualitative analysis using the two-level descriptive scale (meet/fail). Quantitative analysis was done using landmark points distances based on implanted markers as navigation points and differently obtained contours (manually and automatically using DIR algorithms). Quantitative analysis was taken on sets preselected by qualitative analysis. Qualitative analysis shows that 83.7% of the rectum contours were scored identically (meet or fail) for both algorithms, from which 53.5% and 55.8% are failed results for A 1 and A 2 , respectively. For the rectum size (RWD parameter), differences between referenced and deformation-based values were 5.5 and 5.8 mm, and for the rectum wall, the prostate marker distance (WMD parameter) was 4.5 and 5.5 mm for A 1 and A 2 , respectively. The differences between the WMD parameters were statistically significant (p = 0.007). In both tested algorithms, neither effectiveness nor measured uncertainties in the propagation of rectum contour process in prostate patient cases were satisfactory. Careful selection of input images followed by case/set-based verification of every deformable registration is a substantial step to avoid inappropriate results. [ABSTRACT FROM AUTHOR]

Deformable registration is a crucial step in many medical procedures such as image-guided surgery and radiation therapy. Most recent learning-based methods focus on improving the accuracy by optimizing the non-linear spatial correspondence between the input images. Therefore, these methods are computationally expensive and require modern graphic cards for real-time deployment. In this paper, we introduce a new Light-weight Deformable Registration network that significantly reduces the computational cost while achieving competitive accuracy. In particular, we propose a new adversarial learning with distilling knowledge algorithm that successfully leverages meaningful information from the effective but expensive teacher network to the student network. We design the student network such as it is light-weight and well suitable for deployment on a typical CPU. The extensively experimental results on different public datasets show that our proposed method achieves state-of-the-art accuracy while significantly faster than recent methods. We further show that the use of our adversarial learning algorithm is essential for a time-efficiency deformable registration method. Finally, our source code and trained models are available at https://github.com/aioz-ai/LDR_ALDK. [ABSTRACT FROM AUTHOR]

We address the problem of lung CT image registration, which underpins various diagnoses and treatments for lung diseases. The main crux of the problem is the large deformation that the lungs undergo during respiration. This physiological process imposes several challenges from a learning point of view. In this paper, we propose a novel training scheme, called stochastic decomposition, which enables deep networks to effectively learn such a difficult deformation field during lung CT image registration. The key idea is to stochastically decompose the deformation field, and supervise the registration by synthetic data that have the corresponding appearance discrepancy. The stochastic decomposition allows for revealing all possible decompositions of the deformation field. At the learning level, these decompositions can be seen as a prior to reduce the ill-posedness of the registration yielding to boost the performance. We demonstrate the effectiveness of our framework on Lung CT data. We show, through extensive numerical and visual results, that our technique outperforms existing methods. • A novel and effective training algorithm for deformable lung CT registration. • Stochastic decomposition of large deformation and supervision with surrogate images. • The surrogate image has corresponding intensity discrepancy at decomposition phase. [ABSTRACT FROM AUTHOR]

Deformable registration is fundamental to longitudinal and population-based image analyses. However, it is challenging to precisely align longitudinal infant brain MR images of the same subject, as well as cross-sectional infant brain MR images of different subjects, due to fast brain development during infancy. In this paper, we propose a recurrently usable deep neural network for the registration of infant brain MR images. There are three main highlights of our proposed method. (i) We use brain tissue segmentation maps for registration, instead of intensity images, to tackle the issue of rapid contrast changes of brain tissues during the first year of life. (ii) A single registration network is trained in a one-shot manner, and then recurrently applied in inference for multiple times, such that the complex deformation field can be recovered incrementally. (iii) We also propose both the adaptive smoothing layer and the tissue-aware anti-folding constraint into the registration network to ensure the physiological plausibility of estimated deformations without degrading the registration accuracy. Experimental results, in comparison to the state-of-the-art registration methods, indicate that our proposed method achieves the highest registration accuracy while still preserving the smoothness of the deformation field. The implementation of our proposed registration network is available online https://github.com/Barnonewdm/ACTA-Reg-Net. [ABSTRACT FROM AUTHOR]

Purpose: Quality assurance computed tomography (QACT) is the current clinical practice in proton therapy to evaluate the needs for replan. QACT could falsely indicate replan because of setup issues that would be solved on the treatment machine. Deforming the treatment planning CT (TPCT) to the pretreatment CBCT may eliminate this issue. We investigated the performance of replan evaluation based on deformed TPCT (TPCTdir) for proton head and neck (H&N) therapy. Methods and materials: Twenty‐eight H&N datasets along with pretreatment CBCT and QACT were used to validate the method. The changes in body volume were analyzed between the no‐replan and replan groups. The dose on the TPCTdir, the deformed QACT (QACTdir), and the QACT were calculated by applying the clinical plans to these image sets. Dosimetric parameters' changes, including ΔD95, ΔDmean, and ΔD1 for the clinical target volumes (CTVs) were calculated. Receiver operating characteristic curves for replan evaluation based on ΔD95 on QACT and TPCTdir were calculated, using ΔD95 on QACTdir as the reference. A threshold for replan based on ΔD95 on TPCTdir is proposed. The specificities for the proposed method were calculated. Results: The changes in the body contour were 95.8 ± 83.8 cc versus 305.0 ± 235.0 cc (p < 0.01) for the no‐replan and replan groups, respectively. The ΔD95, ΔDmean, and ΔD1 are all comparable for all the evaluations. The differences between TPCTdir and QACTdir evaluations were 0.30% ± 0.86%, 0.00 ± 0.22 Gy, and −0.17 ± 0.61 Gy for CTV ΔD95, ΔDmean, and ΔD1, respectively. The corresponding differences between the QACT and QACTdir were 0.12% ± 1.1%, 0.02 ± 0.32 Gy, and −0.01 ± 0.71 Gy. CTV ΔD95 > 2.6% in TPCTdir was chosen as the threshold to trigger QACT/replan. The corresponding specificity was 94% and 98% for the clinical practice and the proposed method, respectively. Conclusions: The replan evaluation based on TPCTdir provides better specificity than that based on the QACT. [ABSTRACT FROM AUTHOR]

The Varian Ethos system allows for online adaptive treatments through the utilization of artificial intelligence (AI) and deformable image registration which automates large parts of the anatomical contouring and plan optimization process. In this study, treatments of intact prostate and prostate bed, with and without nodes, were simulated for 182 online adaptive fractions, and then a further 184 clinical fractions were delivered on the Ethos system. Frequency and magnitude of contour edits were recorded, as well as a range of plan quality metrics. From the fractions analyzed, 11% of AI generated contours, known as influencer contours, required no change, and 81% required minor edits in any given fraction. The frequency of target and noninfluencer organs at risk (OAR) contour editing varied substantially between different targets and noninfluencer OARs, although across all targets 72% of cases required no edits. The adaptive plan was the preference in 95% of fractions. The adaptive plan met more goals than the scheduled plan in 78% of fractions, while in 15% of fractions the number of goals met was the same. The online adaptive recontouring and replanning process was carried out in 19 min on average. Significant improvements in dosimetry are possible with the Ethos online adaptive system in prostate radiotherapy. [ABSTRACT FROM AUTHOR]

Accurate medical image registration is highly important for the quantitative analysis of infant brain dynamic development in the first year of life. However, the deformable registration of infant brain magnetic resonance (MR) images is highly challenging for the following two reasons: First, there are very large anatomical and appearance variations in these longitudinal images; Second, there is a one-to-many correspondence in appearance between global anatomical tissues and the small local tissues therein. In this paper, we use a CNN (convolution neural network)-based global-and-local-label-driven deformable registration scheme. Two to-be-registered image patches are input into the UNet-style regression network. Then, a dense displacement field (DDF) between them is obtained by optimizing the total loss function between two corresponding label patches. Global and local label patches are used only during training. During inference, two new MR images are divided into many patch pairs and fed into the trained network. By averaging the deformation of the patches at the same location, the final 3D DDF between the two whole images is obtained. The highlight is that the global (white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF)) and local tissues can be registered simultaneously without any prior ground-truth deformation. Especially for the local hippocampal tissues, the Dice ratios are substantially improved after registration via our method. Experimental results are presented on the intrasubject and intersubject registration of infant brain MR images between different time points, and the intersubject registration of brain T1-weighted MR images on the OASIS-1 dataset, according to which the proposed method realizes higher accuracy on both global and local tissues compared with state-of-the-art registration methods.

Image-guided ablation therapy has been widely used as a minimally invasive treatment for hepatic malignant tumors. Image registration is very useful during such operations, especially for multimode tumor ablation therapy. This research proposes a novel idea for performing MR-CT registration in multimode tumor ablation therapy based on liver segmentation. First, the liver is segmented from the preoperative 3D MR image and the intraoperative 3D CT image using a deep learning method based on a modified UNet++ architecture. Then, the preoperative MR image and the intraoperative CT image are coregistered using rigid and nonrigid registration methods with the segmented liver as the region of interest. The segmented binary images, rather than gray-level images, are aligned in the rigid registration step, which proves to be faster and more accurate than the registration method based on gray information. For the nonrigid registration, a multilevel free-form deformation method is applied to correct tiny misalignments. Finally, our method was validated using clinical data from 15 patients. The proposed method achieved an average Dice coefficient and target registration error of 93.36±1.21% and 4.42±2.35 mm, respectively, and it can help interventional radiologists adjust the probe position in clinical work.

Deep learning techniques have been applied to certain rigid or non-rigid medical image registration due to its potential advantages in meeting the clinical requirements of real-time and accuracy. Based on the deep learning model, this study aims to explore specific network models suitable for lung CT images. The proposed model took unlabeled 3D image pairs as input, and the convolutional neural network (CNN) was utilized and identified as a function with ability of sharing parameters to obtain displacement field. The image pair could be aligned by applying the acquired displacement field to the target image through spatial transformation. The similarity between the aligned image pair combined with the constraints on the displacement field was taken as the objective function to obtain the optimal parameters. Two models with different depths were designed and the consequent registration effects with different optimization methods and convolution kernel sizes were explored. The results proved that the designs with deeper level using Adam optimizer and smaller convolution kernels in obtaining displacement fields had higher accuracy and stronger robustness. The accuracy of the unsupervised model was comparable to state-of-the-art methods, while operating orders of magnitude faster. This study proposed a feasible registration method for lung 3D-CT, and its usefulness in aligning CT images has been demonstrated.

Neck pain is one of the most common symptoms of cervical spine disease, and segmenting neck muscles to create volumetric measurements may assist clinical diagnosis. While image registration is used to segment medical images, registration is highly challenging for neck muscles due to their tight proximity, shape and size variations among subjects, and similar appearance. These challenges cause conventional multi resolution-based registration methods to be trapped in local minima due to their low degree of freedom geometrical transforms. This article presents a novel object-constrained hierarchical registration framework for aligning inter-subject neck muscles. First, to handle large scale local minima, the proposed framework uses a coarse registration technique, which optimizes the new edge position difference (EPD) similarity measure, to align large mismatches. Also, a new transformation based on the discrete periodic spline wavelet (DPSW), affine and free-form-deformation (FFD) transformations are exploited. Second, to avoid monotonous nature of using transformations in multiple stages, a fine registration technique is designed for aligning small mismatches. This technique uses a double-pushing system by changing edges in the EPD and switching transformation resolutions. The EPD helps in both coarse and fine techniques to implement object-constrained registration via controlling edges, which is not possible when using traditional similarity measures. Experiments are performed on clinical 3D magnetic resonance imaging (MRI) scans of the neck, with the results showing that the EPD is more effective than the mutual information (MI) and sum of squared difference (SSD) measure in terms of volumetric dice similarity coefficient (DSC). Additionally, the proposed method is compared with the diffeomorphic Demons and SyN state-of-the-art approaches with ablation studies in inter-subject deformable registration. The proposed method achieves better accuracy, robustness and consistency than the reference methods, with an average volumetric DSC of 0.7029 compared to 0.6654 and 0.6606 for the Demons and SyN methods, respectively.

Background: The evaluation of brain tumor recurrence after surgery is based on the comparison between tumor regions on pre-operative and follow-up magnetic resonance imaging (MRI) scans in clinical practice. Accurate alignment of MRI scans is important in this evaluation process. However, existing methods often fail to yield accurate alignment due to substantial appearance and shape changes of tumor regions. The study aimed to improve this misalignment situation through multimodal information and compensation for shape changes., Methods: In this work, a deep learning-based deformation registration method using bilateral pyramid to create multi-scale image features was developed. Moreover, morphology operations were employed to build correspondence between the surgical resection on the follow-up and pre-operative MRI scans., Results: Compared with baseline methods, the proposed method achieved the lowest mean absolute error of 1.82 mm on the public BraTS-Reg 2022 dataset., Conclusions: The results suggest that the proposed method is potentially useful for evaluating tumor recurrence after surgery. We effectively verified its ability to extract and integrate the information of the second modality, and also revealed the micro representation of tumor recurrence. This study can assist doctors in registering multiple sequence images of patients, observing lesions and surrounding areas, analyzing and processing them, and guiding doctors in their treatment plans., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-1821/coif). The authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Affine image registration is a cornerstone of medical-image analysis. While classical algorithms can achieve excellent accuracy, they solve a time-consuming optimization for every image pair. Deep-learning (DL) methods learn a function that maps an image pair to an output transform. Evaluating the function is fast, but capturing large transforms can be challenging, and networks tend to struggle if a test-image characteristic shifts from the training domain, such as the resolution. Most affine methods are agnostic to the anatomy the user wishes to align, meaning the registration will be inaccurate if algorithms consider all structures in the image. We address these shortcomings with SynthMorph, a fast, symmetric, diffeomorphic, and easy-to-use DL tool for joint affine-deformable registration of any brain image without preprocessing. First, we leverage a strategy that trains networks with widely varying images synthesized from label maps, yielding robust performance across acquisition specifics unseen at training. Second, we optimize the spatial overlap of select anatomical labels. This enables networks to distinguish anatomy of interest from irrelevant structures, removing the need for preprocessing that excludes content which would impinge on anatomy-specific registration. Third, we combine the affine model with a deformable hypernetwork that lets users choose the optimal deformation-field regularity for their specific data, at registration time, in a fraction of the time required by classical methods. This framework is applicable to learning anatomy-aware, acquisition-agnostic registration of any anatomy with any architecture, as long as label maps are available for training. We analyze how competing architectures learn affine transforms and compare state-of-the-art registration tools across an extremely diverse set of neuroimaging data, aiming to truly capture the behavior of methods in the real world. SynthMorph demonstrates high accuracy and is available at https://w3id.org/synthmorph, as a single complete end-to-end solution for registration of brain magnetic resonance imaging (MRI) data., Competing Interests: Bruce Fischl has financial interests in CorticoMetrics, a company whose medical pursuits focus on brain imaging and measurement technologies. Malte Hoffmann and Bruce Fischl received salary support from GE HealthCare. Massachusetts General Hospital and Mass General Brigham manage this interest in accordance with their conflict of interest policies. The authors have no other interests that could have inappropriately influenced the work reported in this paper., (© 2024 The Authors. Published under a Creative Commons Attribution 4.0 International (CC BY 4.0) license.)

Background: Image-guided adaptive brachytherapy shows the ability to deliver high doses to tumors while sparing normal tissues. However, interfraction dose delivery introduces uncertainties to high dose estimation, which relates to normal tissue toxicity. The purpose of this study was to investigate the high-dose regions of two applicator approaches in brachytherapy.Method: For 32 cervical cancer patients, the CT images from each fraction were wrapped to a reference image, and the displacement vector field (DVF) was calculated with a hybrid intensity-based deformable registration algorithm. The fractional dose was then accumulated to calculate the position and the overlap of high dose (D2cc) during multiple fractions.Result: The overall Dice similarity coefficient (DSC) of the deformation algorithm for the bladder and the rectum was (0.97 and 0.91). No significant difference was observed between the two applicators. However, the location of the intracavitary brachytherapy (ICBT) high-dose region was relatively concentrated. The overlap volume of bladder and rectum D2cc was 0.42 and 0.71, respectively, which was higher than that of interstitial brachytherapy (ISBT) (0.26 and 0.31). The cumulative dose was overestimated in ISBT cases when using the GEC-recommended method. The ratio of bladder and rectum D2cc to the GEC method was 0.99 and 1, respectively, which was higher than that of the ISBT method (0.96 and 0.94).Conclusion: High-dose regions for brachytherapy based on different applicator types were different. The 3D-printed ICBT has better high-dose region consistency than freehand ISBT and hence is more predictable. [ABSTRACT FROM AUTHOR]

Purpose: The deformable registration of 3D chest computed tomography (CT) images is one of the most important tasks in the field of medical image registration. However, the nonlinear deformation and large‐scale displacement of lung tissues caused by respiratory motion cause great challenges in the deformable registration of 3D lung CT images. Materials and methods: We proposed an end‐to‐end fast registration method based on unsupervised learning, optimized the classic U‐Net, and added inception modules between skip connections. The inception module attempts to capture and merge information at different spatial scales to generate a high‐precision dense displacement vector field. To solve the problem of voxel folding in flexible registration, we put the Jacobian regularization term into the loss function to directly penalize the singularity of the displacement field during training to ensure a smooth displacement vector field. In the stage of data preprocessing, we segmented the lung fields to eliminate the interference of irrelevant information in the network during training. The existing publicly available datasets cannot implement model training. To alleviate the problem of overfitting caused by limited data resources being available, we proposed a data augmentation method based on the 3D‐TPS (3D thin plate spline) transform to expand the training data. Results: Compared with the experimental results obtained by using the VoxelMorph deep learning method and registration packages, such as ANTs and Elastix, we achieved a competitive target registration error of 2.09 mm, an optimal Dice score of 0.987, and almost no folding voxels. Additionally, the proposed method was much faster than the traditional methods. Conclusions: In this study, we have shown that the proposed method was efficient in 3D chest image registration. The promising results demonstrated that our method showed strong robustness in the deformable registration of 3D chest CT images. [ABSTRACT FROM AUTHOR]

In the last two years learning-based methods have started to show encouraging results in different supervised and unsupervised medical image registration tasks. Deep neural networks enable (near) real time applications through fast inference times and have tremendous potential for increased registration accuracies by task-specific learning. However, estimation of large 3D deformations, for example present in inhale to exhale lung CT or interpatient abdominal MRI registration, is still a major challenge for the widely adopted U-Net-like network architectures. Even when using multi-level strategies, current state-of-the-art DL registration results do not yet reach the high accuracy of conventional frameworks. To overcome the problem of large deformations for deep learning approaches, in this work, we present GraphRegNet, a sparse keypoint-based geometric network for dense deformable medical image registration. Similar to the successful 2D optical flow estimation of FlowNet or PWC-Net we leverage discrete dense displacement maps to facilitate the registration process. In order to cope with enormously increasing memory requirements when working with displacement maps in 3D medical volumes and to obtain a well-regularised and accurate deformation field we 1) formulate the registration task as the prediction of displacement vectors on a sparse irregular grid of distinctive keypoints and 2) introduce our efficient GraphRegNet for displacement regularisation, a combination of convolutional and graph neural network layers in a unified architecture. In our experiments on exhale to inhale lung CT registration we demonstrate substantial improvements (TRE below 1.4 mm) over other deep learning methods. Our code is publicly available at https://github.com/multimodallearning/graphregnet. [ABSTRACT FROM AUTHOR]

Deformable image registration (DIR) of fractional high-dose-rate (HDR) CT images is challenging due to the presence of applicators in the brachytherapy image. Point-to-point correspondence fails because of the undesired deformation vector fields (DVF) propagated from the applicator region (AR) to the surrounding tissues, which can potentially introduce significant DIR errors in dose mapping. This paper proposes a novel segmentation and point-matching enhanced efficient DIR (named SPEED) scheme to facilitate dose accumulation among HDR treatment fractions. In SPEED, a semi-automatic seed point generation approach is developed to obtain the incremented fore/background point sets to feed the random walks algorithm, which is used to segment and remove the AR, leaving empty AR cavities in the HDR CT images. A feature-based 'thin-plate-spline robust point matching' algorithm is then employed for AR cavity surface points matching. With the resulting mapping, a DVF defining on each voxel is estimated by B-spline approximation, which serves as the initial DVF for the subsequent Demons-based DIR between the AR-free HDR CT images. The calculated DVF via Demons combined with the initial one serve as the final DVF to map doses between HDR fractions. The segmentation and registration accuracy are quantitatively assessed by nine clinical HDR cases from three gynecological cancer patients. The quantitative analysis and visual inspection of the DIR results indicate that SPEED can suppress the impact of applicator on DIR, and accurately register HDR CT images as well as deform and add interfractional HDR doses.

Landmark correspondences are a widely used type of gold standard in image registration. However, the manual placement of corresponding points is subject to high inter-user variability in the chosen annotated locations and in the interpretation of visual ambiguities. In this paper, we introduce a principled strategy for the construction of a gold standard in deformable registration. Our framework: (i) iteratively suggests the most informative location to annotate next, taking into account its redundancy with previous annotations; (ii) extends traditional pointwise annotations by accounting for the spatial uncertainty of each annotation, which can either be directly specified by the user, or aggregated from pointwise annotations from multiple experts; and (iii) naturally provides a new strategy for the evaluation of deformable registration algorithms. Our approach is validated on four different registration tasks. The experimental results show the efficacy of suggesting annotations according to their informativeness, and an improved capacity to assess the quality of the outputs of registration algorithms. In addition, our approach yields, from sparse annotations only, a dense visualization of the errors made by a registration method. The source code of our approach supporting both 2D and 3D data is publicly available at https://github.com/LoicPeter/evaluation-deformable-registration. [ABSTRACT FROM AUTHOR]

Automatic and accurate segmentation of the prostate is still a challenging task due to intensity inhomogeneity and complicated deformation of MR images. To tackle these problems with multi-atlas segmentation, in this paper, we propose a new metric for image registration and new descriptor for label fusion. First, to reduce the amount of edges in entropic graph, a modified α-mutual information (α-MI) based on fast minimal spanning tree (MST) is implemented for deformable registration. Second, localized α-MI allowing for the spatial information is proposed with the stochastic gradient optimization, and the feature space is encoded by a sparse auto-encoder. Finally, a multi-scale descriptor utilizing local self-similarity is integrated into the patch-based label fusion to obtain final segmentation. Experiments were performed on two subsets of totally 46 T2-weighted prostate MR images from 46 patients. Compared to α-MI based on k-nearest neighbor graph, the registration time of α-MI based on fast MST can be reduced by almost half. The median Dice overlap of registration using localized α-MI on one subset is shown to improve significantly from 0.725 to 0.764 (p = 1.14 × 10-5), compared to using α-MI without the spatial information. The median Dice overlap of prostate segmentation using the proposed method on 20 testing images of another subset is 0.871, and the median Hausdorff distance is 8.013 mm, which demonstrate a comparable accuracy to state-of-the-art methods.

Background: Recently, magnetic resonance imaging (MRI)-based radiotherapy has become a favorite science field for treatment planning purposes. In this study, a simple algorithm was introduced to create synthetic computed tomography (sCT) of the head from MRI. Methods: A simple atlas-based method was proposed to create sCT images based on the paired T1/T2-weighted MRI and bone/brain window CT. Dataset included 10 patients with glioblastoma multiforme and 10 patients with other brain tumors. To generate a sCT image, first each MR from dataset was registered to the target-MR, the resulting transformation was applied to the corresponding CT to create the set of deformed CTs. Then, deformed-CTs were fused to generate a single sCT image. The sCT images were compared with the real CT images using geometric measures (mean absolute error [MAE] and dice similarity coefficient of bone [DSCbone]) and Hounsfield unit gamma-index (ГHU) with criteria 100 HU/2 mm. Results: The evaluations carried out by MAE, DSCbone, and ГHUshowed a good agreement between the synthetic and real CT images. The results represented the range of 78–93 HU and 0.80–0.89 for MAE and DSCbone, respectively. The ГHUalso showed that approximately 91%–93% of pixels fulfilled the criteria 100 HU/2 mm for brain tumors. Conclusion: This method showed that MR sequence (T1w or T2w) should be selected depending on the type of tumor. In addition, the brain window synthetic CTs are in better agreement with real CT relative to bone window sCT images.

We propose to learn a probabilistic motion model from a sequence of images for spatio-temporal registration. Our model encodes motion in a low-dimensional probabilistic space – the motion matrix – which enables various motion analysis tasks such as simulation and interpolation of realistic motion patterns allowing for faster data acquisition and data augmentation. More precisely, the motion matrix allows to transport the recovered motion from one subject to another simulating for example a pathological motion in a healthy subject without the need for inter-subject registration. The method is based on a conditional latent variable model that is trained using amortized variational inference. This unsupervised generative model follows a novel multivariate Gaussian process prior and is applied within a temporal convolutional network which leads to a diffeomorphic motion model. Temporal consistency and generalizability is further improved by applying a temporal dropout training scheme. Applied to cardiac cine-MRI sequences, we show improved registration accuracy and spatio-temporally smoother deformations compared to three state-of-the-art registration algorithms. Besides, we demonstrate the model’s applicability for motion analysis, simulation and super-resolution by an improved motion reconstruction from sequences with missing frames compared to linear and cubic interpolation. [ABSTRACT FROM AUTHOR]

Virtual anatomic phantoms offer precise voxel mapping of the variation of anatomy with ground truth deformation vector fields (DVFs). Dice similarity coefficient (DSC) and mean distance to agreement (MDA) are the standard metrics for evaluating geometric contour congruence when testing deformable registration (DIR) algorithms. A HN virtual patient phantom data set was used for a kVCT‐kVCT automatic propagation contour validation study employing the Accuray DIR algorithm. Furthermore, since TomoTherapy uses MVCT images of the relevant anatomy for adaptive monitoring, the kVCT image data set quality was transformed to an MVCT image data set quality to study intermodal kVCT‐MVCT DIR accuracy. The results of the study indicate that the Accuray DIR algorithm can be expected to autopropagate HN contours adequately, on average, within tolerances recommended by TG‐132 (DSC 0.8‐0.9, MDA within voxel width). However, contours critical to dosimetric planning should always be visually proofed for accuracy. Using standard reconstruction MVCT image quality causes slightly less, but acceptable, agreement with ground truth contours. [ABSTRACT FROM AUTHOR]

Objective: In image-guided neurosurgery, co-registered preoperative anatomical, functional, and diffusion tensor imaging can be used to facilitate a safe resection of brain tumors in eloquent areas of the brain. However, the brain deforms during surgery, particularly in the presence of tumor resection. Non-Rigid Registration (NRR) of the preoperative image data can be used to create a registered image that captures the deformation in the intraoperative image while maintaining the quality of the preoperative image. Using clinical data, this paper reports the results of a comparison of the accuracy and performance among several non-rigid registration methods for handling brain deformation. A new adaptive method that automatically removes mesh elements in the area of the resected tumor, thereby handling deformation in the presence of resection is presented. To improve the user experience, we also present a new way of using mixed reality with ultrasound, MRI, and CT.Materials and methods: This study focuses on 30 glioma surgeries performed at two different hospitals, many of which involved the resection of significant tumor volumes. An Adaptive Physics-Based Non-Rigid Registration method (A-PBNRR) registers preoperative and intraoperative MRI for each patient. The results are compared with three other readily available registration methods: a rigid registration implemented in 3D Slicer v4.4.0; a B-Spline non-rigid registration implemented in 3D Slicer v4.4.0; and PBNRR implemented in ITKv4.7.0, upon which A-PBNRR was based. Three measures were employed to facilitate a comprehensive evaluation of the registration accuracy: (i) visual assessment, (ii) a Hausdorff Distance-based metric, and (iii) a landmark-based approach using anatomical points identified by a neurosurgeon.Results: The A-PBNRR using multi-tissue mesh adaptation improved the accuracy of deformable registration by more than five times compared to rigid and traditional physics based non-rigid registration, and four times compared to B-Spline interpolation methods which are part of ITK and 3D Slicer. Performance analysis showed that A-PBNRR could be applied, on average, in

Purpose: To investigate the effect of breathing motion on dose distribution for hepatocellular carcinoma (HCC) patients using four‐dimensional (4D) CT and deformable registration. Methods: Fifty HCC patients who were going to receive radiotherapy were enrolled in this study. All patients had been treated with transarterial chemoembolization beforehand. Three‐dimensional (3D) and 4D CT scans in free breathing were acquired sequentially. Volumetric modulated arc therapy (VMAT) was planned on the 3D CT images and maximum intensity projection (MIP) images. Thus, the 3D dose (Dose‐3D) and MIP dose (Dose‐MIP) were obtained, respectively. Then, the Dose‐3D and Dose‐MIP were recalculated on 10 phases of 4D CT images, respectively, in which the end‐inhale and end‐exhale phase doses were defined as Dose‐3D‐EI, Dose‐3D‐EE, Dose‐MIP‐EI, and Dose‐MIP‐EE. The 4D dose (Dose‐4D‐3D and Dose‐4D‐MIP) were obtained by deforming 10 phase doses to the end‐exhale CT to accumulate. The dosimetric difference in Dose‐3D, Dose‐EI3D, Dose‐EE3D, Dose‐4D‐3D, Dose‐MIP, Dose‐EIMIP, Dose‐EEMIP, and Dose‐4D‐MIP were compared to evaluate the motion effect on dose delivery to the planning target volume (PTV) and normal liver. Results: Compared with Dose‐3D, PTV D99 in Dose‐EI3D, Dose‐EE3D and Dose‐4D‐3D decreased by an average of 6.02%, 1.32%, 2.43%, respectively (P < 0.05); while PTV D95 decreased by an average of 3.34%, 1.51%, 1.93%, respectively (P < 0.05). However, CI and HI of the PTV in Dose‐3D was superior to the other three distributions (P < 0.05). There was no significant differences for the PTV between Dose‐EI and Dose‐EE, and between the two extreme phase doses and Dose‐4D (P> 0.05). Negligible difference was observed for normal liver in all dose distributions (P> 0.05). Conclusions: Four‐dimensional dose calculations potentially ensure target volume coverage when breathing motion may affect the dose distribution. Dose escalation can be considered to improve the local control of HCC on the basis of accurately predicting the probability of radiation‐induced liver disease. [ABSTRACT FROM AUTHOR]

Image registration and segmentation are the two most studied problems in medical image analysis. Deep learning algorithms have recently gained a lot of attention due to their success and state-of-the-art results in variety of problems and communities. In this paper, we propose a novel, efficient, and multi-task algorithm that addresses the problems of image registration and brain tumor segmentation jointly. Our method exploits the dependencies between these tasks through a natural coupling of their interdependencies during inference. In particular, the similarity constraints are relaxed within the tumor regions using an efficient and relatively simple formulation. We evaluated the performance of our formulation both quantitatively and qualitatively for registration and segmentation problems on two publicly available datasets (BraTS 2018 and OASIS 3), reporting competitive results with other recent state-of-the-art methods. Moreover, our proposed framework reports significant amelioration (p < 0.005) for the registration performance inside the tumor locations, providing a generic method that does not need any predefined conditions (e.g., absence of abnormalities) about the volumes to be registered. Our implementation is publicly available online at https://github.com/TheoEst/joint_registration_tumor_segmentation.

Objective: To analyze the difference between planned dose and delivered dose by accumulating the dose based on CT and CBCT image deformable registration.Methods: The clinical data of 24 NSCLC (non-small cell lung cancer) patients receiving conformal radiotherapy or intensity-modulated radiotherapy (IMRT) were retrospectively analyzed. With the CBCT image of each week as the target image, we performed the deformation registration for CBCT images and planning CT images in RayStation. The delivered dose of CBCT images compared to the planning CT images was accumulated with the use of mapping relationships in registration. The differences in planned dose and accumulative dose of target and at-risk organs were compared.Results: The average planned and accumulative doses of GTV in 24 patients were 5832.45 ± 645.42 and 5750.65 ± 630.27 cGy, respectively (P < 0.05). The average planning target volume (PTV) in CT plans and accumulation plans reaching the prescription dose was 95.59 and 81.47% of the PTV (P > 0.05). At the stage of treatment, the volumes of the at-risk organs in CBCT images were not significantly different. There were no statistically significant differences in the probability of complications in the right lung, left lung, heart, total lung, or spinal cord (P > 0.05).Conclusion: With the dose deformable registration method, the dose caused by changes in the target anatomical structure of NSCLC patients was found. The dose to organs did not change much. However, in some patients, the received radiation in the target organ was less than the prescribed dose.

Abstract Background The aim of this work is to assess the impact of using different deformable registration (DR) algorithms on the quality of cone-beam CT (CBCT) correction with histogram matching (HM). Methods and materials Data sets containing planning CT (pCT) and CBCT images for ten patients with prostate cancer were used. Each pCT image was registered to its corresponding CBCT image using one rigid registration algorithm with mutual information similarity metric (RR-MI) and three DR algorithms with normalized correlation coefficient, mutual information and normalized mutual information (DR-NCC, DR-MI and DR-NMI, respectively). Then, the HM was performed between deformed pCT and CBCT in order to correct the distribution of the Hounsfield Units (HU) in CBCT images. Results The visual assessment showed that the absolute difference between corrected CBCT and deformed pCT was reduced after correction with HM except for soft tissue-air and soft-tissue-bone interfaces due to the improper registration. Furthermore, volumes comparison in terms of average HU error showed that using DR-NCC algorithm with HM yielded the lowest error values of about 55.95 ± 10.43 HU compared to DR-MI and DR-NMI for which the errors were 58.60 ± 10.35 and 56.58 ± 10.51 HU, respectively. Tissue class’s comparison by the mean absolute error (MAE) plots confirmed the performance of DR-NCC algorithm to produce corrected CBCT images with lowest values of MAE even in regions where the misalignment is more pronounced. It was also found that the used method had successfully improved the spatial uniformity in the CBCT images by reducing the root mean squared difference (RMSD) between the pCT and CBCT in fat and muscle from 57 and 25 HU to 8HU, respectively. Conclusion The choice of an accurate DR algorithm before performing the HM leads to an accurate correction of CBCT images. The results suggest that applying DR process based on NCC similarity metric reduces significantly the uncertainties in CBCT images and generates images in good agreement with pCT.