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Accurate Model-based Segmentation of Gynecologic Brachytherapy Catheter Collections in MRI-images

Institution:
1Institute of Medical Informatics, University of Luebeck, Germany. Electronic address: mastmeyer@imi.uni-luebeck.de.
2Department of Bioengineering, Imperial College London, UK.
3Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
4Harvard Medical School, Boston, MA, USA.
Publisher:
Elsevier Science
Publication Date:
Dec-2017
Journal:
Med Image Anal
Volume Number:
42
Pages:
173-88
Citation:
Med Image Anal. 2017 Dec 18;42:173-88.
PubMed ID:
28803217
PMCID:
PMC5654713
Keywords:
Accuracy, Catheter, MRI, Outlier reduction;, Segmentation, Precision
Appears in Collections:
NCIGT, SLICER
Sponsors:
P41 EB015898/EB/NIBIB NIH HHS/United States
Generated Citation:
Mastmeyer A., Pernelle G., Ma R., Barber L., Kapur T. Accurate Model-based Segmentation of Gynecologic Brachytherapy Catheter Collections in MRI-images. Med Image Anal. 2017 Dec 18;42:173-88. PMID: 28803217. PMCID: PMC5654713.
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The gynecological cancer mortality rate, including cervical, ovarian, vaginal and vulvar cancers, is more than 20,000 annually in the US alone. In many countries, including the US, external-beam radiotherapy followed by high dose rate brachytherapy is the standard-of-care. The superior ability of MR to visualize soft tissue has led to an increase in its usage in planning and delivering brachytherapy treatment. A technical challenge associated with the use of MRI imaging for brachytherapy, in contrast to that of CT imaging, is the visualization of catheters that are used to place radiation sources into cancerous tissue. We describe here a precise, accurate method for achieving catheter segmentation and visualization. The algorithm, with the assistance of manually provided tip locations, performs segmentation using image-features, and is guided by a catheter-specific, estimated mechanical model. A final quality control step removes outliers or conflicting catheter trajectories. The mean Hausdorff error on a 54 patient, 760 catheter reference database was 1.49  mm; 51 of the outliers deviated more than two catheter widths (3.4  mm) from the gold standard, corresponding to catheter identification accuracy of 93% in a Syed-Neblett template. In a multi-user simulation experiment for evaluating RMS precision by simulating varying manually-provided superior tip positions, 3σ maximum errors were 2.44  mm. The average segmentation time for a single catheter was 3 s on a standard PC. The segmentation time, accuracy and precision, are promising indicators of the value of this method for clinical translation of MR-guidance in gynecologic brachytherapy and other catheter-based interventional procedures.

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