Novel Autosegmentation Spatial Similarity Metrics Capture the Time Required to Correct Segmentations Better Than Traditional Metrics in a Thoracic Cavity Segmentation Workflow.

Automated segmentation templates can save clinicians time compared to de novo segmentation but may still take substantial time to review and correct. It has not been thoroughly investigated which automated segmentation-corrected segmentation similarity metrics best predict clinician correction time. Bilateral thoracic cavity volumes in 329 CT scans were segmented by a UNet-inspired deep learning segmentation tool and subsequently corrected by a fourth-year medical student. Eight spatial similarity metrics were calculated between the automated and corrected segmentations and associated with correction times using Spearman's rank correlation coefficients. Nine clinical variables were also associated with metrics and correction times using Spearman's rank correlation coefficients or Mann-Whitney U tests. The added path length, false negative path length, and surface Dice similarity coefficient correlated better with correction time than traditional metrics, including the popular volumetric Dice similarity coefficient (respectively ρ = 0.69, ρ = 0.65, ρ = - 0.48 versus ρ = - 0.25; correlation p values < 0.001). Clinical variables poorly represented in the autosegmentation tool's training data were often associated with decreased accuracy but not necessarily with prolonged correction time. Metrics used to develop and evaluate autosegmentation tools should correlate with clinical time saved. To our knowledge, this is only the second investigation of which metrics correlate with time saved. Validation of our findings is indicated in other anatomic sites and clinical workflows. Novel spatial similarity metrics may be preferable to traditional metrics for developing and evaluating autosegmentation tools that are intended to save clinicians time.

Segmenting Thoracic Cavities with Neoplastic Lesions: A Head-to-head Benchmark with Fully Convolutional Neural Networks.

Automatic segmentation of thoracic cavity structures in computer tomography (CT) is a key step for applications ranging from radiotherapy planning to imaging biomarker discovery with radiomics approaches. State-of-the-art segmentation can be provided by fully convolutional neural networks such as the U-Net or V-Net. However, there is a very limited body of work on a comparative analysis of the performance of these architectures for chest CTs with significant neoplastic disease. In this work, we compared four different types of fully convolutional architectures using the same pre-processing and post-processing pipelines. These methods were evaluated using a dataset of CT images and thoracic cavity segmentations from 402 cancer patients. We found that these methods achieved very high segmentation performance by benchmarks of three evaluation criteria, i.e. Dice coefficient, average symmetric surface distance and 95% Hausdorff distance. Overall, the two-stage 3D U-Net model performed slightly better than other models, with Dice coefficients for left and right lung reaching 0.947 and 0.952, respectively. However, 3D U-Net model achieved the best performance under the evaluation of HD95 for right lung and ASSD for both left and right lung. These results demonstrate that the current state-of-art deep learning models can work very well for segmenting not only healthy lungs but also the lung containing different stages of cancerous lesions. The comprehensive types of lung masks from these evaluated methods enabled the creation of imaging-based biomarkers representing both healthy lung parenchyma and neoplastic lesions, allowing us to utilize these segmented areas for the downstream analysis, e.g. treatment planning, prognosis and survival prediction.

PleThora: Pleural effusion and thoracic cavity segmentations in diseased lungs for benchmarking chest CT processing pipelines.

This manuscript describes a dataset of thoracic cavity segmentations and discrete pleural effusion segmentations we have annotated on 402 computed tomography (CT) scans acquired from patients with non-small cell lung cancer. The segmentation of these anatomic regions precedes fundamental tasks in image analysis pipelines such as lung structure segmentation, lesion detection, and radiomics feature extraction. Bilateral thoracic cavity volumes and pleural effusion volumes were manually segmented on CT scans acquired from The Cancer Imaging Archive "NSCLC Radiomics" data collection. Four hundred and two thoracic segmentations were first generated automatically by a U-Net based algorithm trained on chest CTs without cancer, manually corrected by a medical student to include the complete thoracic cavity (normal, pathologic, and atelectatic lung parenchyma, lung hilum, pleural effusion, fibrosis, nodules, tumor, and other anatomic anomalies), and revised by a radiation oncologist or a radiologist. Seventy-eight pleural effusions were manually segmented by a medical student and revised by a radiologist or radiation oncologist. Interobserver agreement between the radiation oncologist and radiologist corrections was acceptable. All expert-vetted segmentations are publicly available in NIfTI format through The Cancer Imaging Archive at https://doi.org/10.7937/tcia.2020.6c7y-gq39. Tabular data detailing clinical and technical metadata linked to segmentation cases are also available. Thoracic cavity segmentations will be valuable for developing image analysis pipelines on pathologic lungs - where current automated algorithms struggle most. In conjunction with gross tumor volume segmentations already available from "NSCLC Radiomics," pleural effusion segmentations may be valuable for investigating radiomics profile differences between effusion and primary tumor or training algorithms to discriminate between them.

"Après Mois, Le Déluge": Preparing for the Coming Data Flood in the MRI-Guided Radiotherapy Era.

Magnetic resonance imaging provides a sea of quantitative and semi-quantitative data. While radiation oncologists already navigate a pool of clinical (semantic) and imaging data, the tide will swell with the advent of hybrid MRI/linear accelerator devices and increasing interest in MRI-guided radiotherapy (MRIgRT), including adaptive MRIgRT. The variety of MR sequences (of greater complexity than the single parameter Hounsfield unit of CT scanning routinely used in radiotherapy), the workflow of adaptive fractionation, and the sheer quantity of daily images acquired are challenges for scaling this technology. Biomedical informatics, which is the science of information in biomedicine, can provide helpful insights for this looming transition. Funneling MRIgRT data into clinically meaningful information streams requires committing to the flow of inter-institutional data accessibility and interoperability initiatives, standardizing MRIgRT dosimetry methods, streamlining MR linear accelerator workflow, and standardizing MRI acquisition and post-processing. This review will attempt to conceptually ford these topics using clinical informatics approaches as a theoretical bridge.