A deep learning method for real-time intraoperative US image segmentation in prostate brachytherapy.

PURPOSE: This paper addresses the detection of the clinical target volume (CTV) in transrectal ultrasound (TRUS) image-guided intraoperative for permanent prostate brachytherapy. Developing a robust and automatic method to detect the CTV on intraoperative TRUS images is clinically important to have faster and reproducible interventions that can benefit both the clinical workflow and patient health. METHODS: We present a multi-task deep learning method for an automatic prostate CTV boundary detection in intraoperative TRUS images by leveraging both the low-level and high-level (prior shape) information. Our method includes a channel-wise feature calibration strategy for low-level feature extraction and learning-based prior knowledge modeling for prostate CTV shape reconstruction. It employs CTV shape reconstruction from automatically sampled boundary surface coordinates (pseudo-landmarks) to detect the low-contrast and noisy regions across the prostate boundary, while being less biased from shadowing, inherent speckles, and artifact signals from the needle and implanted radioactive seeds. RESULTS: The proposed method was evaluated on a clinical database of 145 patients who underwent permanent prostate brachytherapy under TRUS guidance. Our method achieved a mean accuracy of [Formula: see text] and a mean surface distance error of [Formula: see text]. Extensive ablation and comparison studies show that our method outperformed previous deep learning-based methods by more than 7% for the Dice similarity coefficient and 6.9 mm reduced 3D Hausdorff distance error. CONCLUSION: Our study demonstrates the potential of shape model-based deep learning methods for an efficient and accurate CTV segmentation in an ultrasound-guided intervention. Moreover, learning both low-level features and prior shape knowledge with channel-wise feature calibration can significantly improve the performance of deep learning methods in medical image segmentation.

Fast interactive medical image segmentation with weakly supervised deep learning method.

PURPOSE: To achieve accurate image segmentation, which is the first critical step in medical image analysis and interventions, using deep neural networks seems a promising approach provided sufficiently large and diverse annotated data from experts. However, annotated datasets are often limited because it is prone to variations in acquisition parameters and require high-level expert's knowledge, and manually labeling targets by tracing their contour is often laborious. Developing fast, interactive, and weakly supervised deep learning methods is thus highly desirable. METHODS: We propose a new efficient deep learning method to accurately segment targets from images while generating an annotated dataset for deep learning methods. It involves a generative neural network-based prior-knowledge prediction from pseudo-contour landmarks. The predicted prior knowledge (i.e., contour proposal) is then refined using a convolutional neural network that leverages the information from the predicted prior knowledge and the raw input image. Our method was evaluated on a clinical database of 145 intraoperative ultrasound and 78 postoperative CT images of image-guided prostate brachytherapy. It was also evaluated on a cardiac multi-structure segmentation from 450 2D echocardiographic images. RESULTS: Experimental results show that our model can segment the prostate clinical target volume in 0.499 s (i.e., 7.79 milliseconds per image) with an average Dice coefficient of 96.9 ± 0.9% and 95.4 ± 0.9%, 3D Hausdorff distance of 4.25 ± 4.58 and 5.17 ± 1.41 mm, and volumetric overlap ratio of 93.9 ± 1.80% and 91.3 ± 1.70 from TRUS and CT images, respectively. It also yielded an average Dice coefficient of 96.3 ± 1.3% on echocardiographic images. CONCLUSIONS: We proposed and evaluated a fast, interactive deep learning method for accurate medical image segmentation. Moreover, our approach has the potential to solve the bottleneck of deep learning methods in adapting to inter-clinical variations and speed up the annotation processes.

Inferring postimplant dose distribution of salvage permanent prostate implant (PPI) after primary PPI on CT images.

PURPOSE: To evaluate the dose distribution of additional radioactive seeds implanted during salvage permanent prostate implant (sPPI) after a primary permanent prostate implant (pPPI). METHODS AND MATERIALS: Patients with localized prostate cancer were primarily implanted with iodine-125 seeds and had a dosimetric assessment based on day 30 postimplant CT (CT1). After an average of 6 years, these patients underwent sPPI followed by the same CT-based evaluation of dosimetry (CT2). Radioactive seeds on each CT were detected. The detected primary seeds on CT1 and CT2 were registered and then removed from CT2 referred as a modified CT2 (mCT2). Dosimetry evaluations (D90 and V100) of sPPI were performed with dedicated planning software on CT2 and mCT2. Indeed, prostate volume, D90, and V100 differences between CT2 and either CT1 or mCT2 were calculated, and values were expressed as mean (standard deviation). RESULTS: The mean prostate volume difference between sPPI and pPPI over the 6 patients was 9.85 (7.32) cm3. The average D90 and V100 assessed on CT2 were 486.5 Gy (58.9) and 100.0% (0.0), respectively, whereas it was 161.3 Gy (47.5) and 77.3% (25.2) on mCT2 (p = 0.031 each time). The average D90 the day of sPPI [145.4 Gy (11.2)] was not significantly different from that observed on mCT2 (p = 0.56). CONCLUSION: Postimplant D90 and V100 of sPPI after pPPI can be estimated on CT images after removing the primary seeds.