Manual or automatic delineation of the esophageal tumor in CT images is known to be very challenging. This is due to the low contrast between the tumor and adjacent tissues, the anatomical variation of the esophagus, as well as the occasional presence of foreign bodies (e.g. feeding tubes). Physicians therefore usually exploit additional knowledge such as endoscopic findings, clinical history, additional imaging modalities like PET scans. Achieving his additional information is time-consuming, while the results are error-prone and might lead to non-deterministic results. In this paper we aim to investigate if and to what extent a simplified clinical workflow based on CT alone, allows one to automatically segment the esophageal tumor with sufficient quality. For this purpose, we present a fully automatic end-to-end esophageal tumor segmentation method based on convolutional neural networks (CNNs). The proposed network, called Dilated Dense Attention Unet (DDAUnet), leverages spatial and channel attention gates in each dense block to selectively concentrate on determinant feature maps and regions. Dilated convolutional layers are used to manage GPU memory and increase the network receptive field. We collected a dataset of 792 scans from 288 distinct patients including varying anatomies with air pockets, feeding tubes and proximal tumors. Repeatability and reproducibility studies were conducted for three distinct splits of training and validation sets. The proposed network achieved a DSC value of 0.79 ± 0.20, a mean surface distance of 5.4 ± 20.2mm and 95% Hausdorff distance of 14.7 ± 25.0mm for 287 test scans, demonstrating promising results with a simplified clinical workflow based on CT alone. Our code is publicly available via https://github.com/yousefis/DenseUnet_Esophagus_Segmentation.

In this paper we propose a supervised method to predict registration misalignment using convolutional neural networks (CNNs). This task is casted to a classification problem with multiple classes of misalignment: 'correct' 0-3 mm, 'poor' 3-6 mm and 'wrong' over 6 mm. Rather than a direct prediction, we propose a hierarchical approach, where the prediction is gradually refined from coarse to fine. Our solution is based on a convolutional Long Short-Term Memory (LSTM), using hierarchical misalignment predictions on three resolutions of the image pair, leveraging the intrinsic strengths of an LSTM for this problem. The convolutional LSTM is trained on a set of artificially generated image pairs obtained from artificial displacement vector fields (DVFs). Results on chest CT scans show that incorporating multi-resolution information, and the hierarchical use via an LSTM for this, leads to overall better F1 scores, with fewer misclassifications in a well-tuned registration setup. The final system yields an accuracy of 87.1%, and an average F1 score of 66.4% aggregated in two independent chest CT scan studies.

Adaptive intelligence aims at empowering machine learning techniques with the additional use of domain knowledge. In this work, we present the application of adaptive intelligence to accelerate MR acquisition. Starting from undersampled k-space data, an iterative learning-based reconstruction scheme inspired by compressed sensing theory is used to reconstruct the images. We developed a novel deep neural network to refine and correct prior reconstruction assumptions given the training data. The network was trained and tested on a knee MRI dataset from the 2019 fastMRI challenge organized by Facebook AI Research and NYU Langone Health. All submissions to the challenge were initially ranked based on similarity with a known groundtruth, after which the top 4 submissions were evaluated radiologically. Our method was evaluated by the fastMRI organizers on an independent challenge dataset. It ranked #1, shared #1, and #3 on respectively the 8× accelerated multi-coil, the 4× multi-coil, and the 4× single-coil tracks. This demonstrates the superior performance and wide applicability of the method.

Hadamard time-encoded pseudo-continuous arterial spin labeling (te-pCASL) is a signal-to-noise ratio (SNR)-efficient MRI technique for acquiring dynamic pCASL signals that encodes the temporal information into the labeling according to a Hadamard matrix. In the decoding step, the contribution of each sub-bolus can be isolated resulting in dynamic perfusion scans. When acquiring te-ASL both with and without flow-crushing, the ASL-signal in the arteries can be isolated resulting in 4D-angiographic information. However, obtaining multi-timepoint perfusion and angiographic data requires two acquisitions. In this study, we propose a 3D Dense-Unet convolutional neural network with a multi-level loss function for reconstructing multi-timepoint perfusion and angiographic information from an interleaved 50 % -sampled crushed and 50 % -sampled non-crushed data, thereby negating the additional scan time. We present a framework to generate dynamic pCASL training and validation data, based on models of the intravascular and extravascular te-pCASL signals. The proposed network achieved SSIM values of 97.3 ± 1.1 and 96.2 ± 11.1 respectively for 4D perfusion and angiographic data reconstruction for 313 test data-sets.

Purpose: To develop and validate a robust and accurate registration pipeline for automatic contour propagation for online adaptive Intensity-Modulated Proton Therapy (IMPT) of prostate cancer using elastix software and deep learning. Methods: A three-dimensional (3D) Convolutional Neural Network was trained for automatic bladder segmentation of the computed tomography (CT) scans. The automatic bladder segmentation alongside the computed tomography (CT) scan is jointly optimized to add explicit knowledge about the underlying anatomy to the registration algorithm. We included three datasets from different institutes and CT manufacturers. The first was used for training and testing the ConvNet, where the second and the third were used for evaluation of the proposed pipeline. The system performance was quantified geometrically using the dice similarity coefficient (DSC), the mean surface distance (MSD), and the 95% Hausdorff distance (HD). The propagated contours were validated clinically through generating the associated IMPT plans and compare it with the IMPT plans based on the manual delineations. Propagated contours were considered clinically acceptable if their treatment plans met the dosimetric coverage constraints on the manual contours. Results: The bladder segmentation network achieved a DSC of 88% and 82% on the test datasets. The proposed registration pipeline achieved a MSD of 1.29 ± 0.39, 1.48 ± 1.16, and 1.49 ± 0.44 mm for the prostate, seminal vesicles, and lymph nodes, respectively, on the second dataset and a MSD of 2.31 ± 1.92 and 1.76 ± 1.39 mm for the prostate and seminal vesicles on the third dataset. The automatically propagated contours met the dose coverage constraints in 86%, 91%, and 99% of the cases for the prostate, seminal vesicles, and lymph nodes, respectively. A Conservative Success Rate (CSR) of 80% was obtained, compared to 65% when only using intensity-based registration. Conclusion: The proposed registration pipeline obtained highly promising results for generating treatment plans adapted to the daily anatomy. With 80% of the automatically generated treatment plans directly usable without manual correction, a substantial improvement in system robustness was reached compared to a previous approach. The proposed method therefore facilitates more precise proton therapy of prostate cancer, potentially leading to fewer treatment-related adverse side effects.