After seminal papers over the period 2009 – 2011, the use of texture analysis of PET/CT images for quantification of intratumour uptake heterogeneity has received increasing attention in the last ...4 years. Results are difficult to compare due to the heterogeneity of studies and lack of standardization. There are also numerous challenges to address. In this review we provide critical insights into the recent development of texture analysis for quantifying the heterogeneity in PET/CT images, identify issues and challenges, and offer recommendations for the use of texture analysis in clinical research. Numerous potentially confounding issues have been identified, related to the complex workflow for the calculation of textural features, and the dependency of features on various factors such as acquisition, image reconstruction, preprocessing, functional volume segmentation, and methods of establishing and quantifying correspondences with genomic and clinical metrics of interest. A lack of understanding of what the features may represent in terms of the underlying pathophysiological processes and the variability of technical implementation practices makes comparing results in the literature challenging, if not impossible. Since progress as a field requires pooling results, there is an urgent need for standardization and recommendations/guidelines to enable the field to move forward. We provide a list of correct formulae for usual features and recommendations regarding implementation. Studies on larger cohorts with robust statistical analysis and machine learning approaches are promising directions to evaluate the potential of this approach.
In tomographic medical imaging (PET, SPECT, CT), differences in data acquisition and organization are a major hurdle for the development of tomographic reconstruction software. The implementation of ...a given reconstruction algorithm is usually limited to a specific set of conditions, depending on the modality, the purpose of the study, the input data, or on the characteristics of the reconstruction algorithm itself. It causes restricted or limited use of algorithms, differences in implementation, code duplication, impractical code development, and difficulties for comparing different methods. This work attempts to address these issues by proposing a unified and generic code framework for formatting, processing and reconstructing acquired multi-modal and multi-dimensional data. The proposed iterative framework processes in the same way elements from list-mode (i.e. events) and histogrammed (i.e. sinogram or other bins) data sets. Each element is processed separately, which opens the way for highly parallel execution. A unique iterative algorithm engine makes use of generic core components corresponding to the main parts of the reconstruction process. Features that are specific to different modalities and algorithms are embedded into specific components inheriting from the generic abstract components. Temporal dimensions are taken into account in the core architecture. The framework is implemented in an open-source C++ parallel platform, called CASToR (customizable and advanced software for tomographic reconstruction). Performance assessments show that the time loss due to genericity remains acceptable, being one order of magnitude slower compared to a manufacturer's software optimized for computational efficiency for a given system geometry. Specific optimizations were made possible by the underlying data set organization and processing and allowed for an average speed-up factor ranging from 1.54 to 3.07 when compared to more conventional implementations. Using parallel programming, an almost linear speed-up increase (factor of 0.85 times number of cores) was obtained in a realistic clinical PET setting. In conclusion, the proposed framework offers a substantial flexibility for the integration of new reconstruction algorithms while maintaining computation efficiency.
Since the seventies, positron emission tomography (PET) has become an invaluable medical molecular imaging modality with an unprecedented sensitivity at the picomolar level, especially for cancer ...diagnosis and the monitoring of its response to therapy. More recently, its combination with x-ray computed tomography (CT) or magnetic resonance (MR) has added high precision anatomic information in fused PET/CT and PET/MR images, thus compensating for the modest intrinsic spatial resolution of PET. Nevertheless, a number of medical challenges call for further improvements in PET sensitivity. These concern in particular new treatment opportunities in the context personalized (also called precision) medicine, such as the need to dynamically track a small number of cells in cancer immunotherapy or stem cells for tissue repair procedures. A better signal-to-noise ratio (SNR) in the image would allow detecting smaller size tumours together with a better staging of the patients, thus increasing the chances of putting cancer in complete remission. Moreover, there is an increasing demand for reducing the radioactive doses injected to the patients without impairing image quality. There are three ways to improve PET scanner sensitivity: improving detector efficiency, increasing geometrical acceptance of the imaging device and pushing the timing performance of the detectors. Currently, some pre-localization of the electron-positron annihilation along a line-of-response (LOR) given by the detection of a pair of annihilation photons is provided by the detection of the time difference between the two photons, also known as the time-of-flight (TOF) difference of the photons, whose accuracy is given by the coincidence time resolution (CTR). A CTR of about 10 picoseconds FWHM will ultimately allow to obtain a direct 3D volume representation of the activity distribution of a positron emitting radiopharmaceutical, at the millimetre level, thus introducing a quantum leap in PET imaging and quantification and fostering more frequent use of 11C radiopharmaceuticals. The present roadmap article toward the advent of 10 ps TOF-PET addresses the status and current/future challenges along the development of TOF-PET with the objective to reach this mythic 10 ps frontier that will open the door to real-time volume imaging virtually without tomographic inversion. The medical impact and prospects to achieve this technological revolution from the detection and image reconstruction point-of-views, together with a few perspectives beyond the TOF-PET application are discussed.
Simultaneous PET and MR imaging is a promising new technique allowing the fusion of functional (PET) and anatomic/functional (MR) information. In the thoracic-abdominal regions, respiratory motion is ...a major challenge leading to reduced quantitative and qualitative image accuracy. Correction methodologies include the use of gated frames that lead to low signal-to-noise ratio considering the associated low statistics. More advanced correction approaches, previously developed for PET/CT imaging, consist of either registering all the reconstructed gated frames to the reference frame or incorporating motion parameters into the iterative reconstruction process to produce a single motion-compensated PET image. The goal of this work was to compare these two—previously implemented in PET/CT—correction approaches within the context of PET/MR motion correction for oncology applications using clinical 4-dimensional PET/MR acquisitions. Two different correction approaches were evaluated comparing the incorporation of elastic transformations extracted from 4-dimensional MR imaging datasets during PET list-mode image reconstruction to a postreconstruction image-based approach.
Eleven patient datasets acquired on a PET/MR system were used. T1-weighted 4D MR images were registered to the end-expiration image using a nonrigid B-spline registration algorithm to derive deformation matrices accounting for respiratory motion. The derived matrices were subsequently incorporated within a PET image reconstruction of the original emission list-mode data (reconstruction space RS method). The corrected images were compared with those produced by applying the deformation matrices in the image space (IS method) followed by summing the realigned gated frames, as well as with uncorrected motion-averaged images.
Both correction techniques led to significant improvement in accounting for respiratory motion artifacts when compared with uncorrected motion-averaged images. These improvements included signal-to-noise ratio (mean increase of 28.0% and 24.2% for the RS and IS methods, respectively), lesion size (reduction of 60.4% and 47.9%, respectively), lesion contrast (increase of 70.1% and 57.2%, respectively), and lesion position (changes of 60.9% and 46.7%, respectively).
Our results demonstrate significant respiratory motion compensation using both methods, with superior results from a 4D PET RS approach.
Objectives
To assess the value of contrast-enhanced (CE) diagnostic CT scans characterized through radiomics as predictors of recurrence for patients with stage II and III colorectal cancer in a ...two-center context.
Materials and methods
This study included 193 patients diagnosed with stage II and III colorectal adenocarcinoma from 1 July 2008 to 15 March 2017 in two different French University Hospitals. To compensate for the variability in two-center data, a statistical harmonization method Bootstrapped ComBat (B-ComBat) was used. Models predicting disease-free survival (DFS) were built using 3 different machine learning (ML): (1) multivariate regression (MR) with 10-fold cross-validation after feature selection based on least absolute shrinkage and selection operator (LASSO), (2) random forest (RF), and (3) support vector machine (SVM), both with embedded feature selection.
Results
The performance for both balanced and 95% sensitivity models was systematically higher after our proposed B-ComBat harmonization compared to the use of the original untransformed data. The most clinically relevant performance was achieved by the multivariate regression model combining a clinical variable (postoperative chemotherapy) with two radiomics shape descriptors (compactness and least axis length) with a BAcc of 0.78 and an MCC of 0.6 associated with a required sensitivity of 95%. The resulting stratification in terms of DFS was significant (
p
= 0.00021), especially compared to the use of unharmonized original data (
p
= 0.17).
Conclusions
Radiomics models derived from contrast-enhanced CT could be trained and validated in a two-center cohort with a good predictive performance of recurrence in stage II et III colorectal cancer patients.
Key Points
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Adjuvant therapy decision in colorectal cancer can be a challenge in medical oncology.
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Radiomics models, derived from diagnostic CT, trained and validated in a two-center cohort, could predict recurrence in stage II and III colorectal cancer patients
.
• Identifying patients with a low risk of recurrence, these models could facilitate treatment optimization and avoid unnecessary treatment.
•Extensive evolution and applicability of Artificial Intelligence in medicine.•Personalization and high diagnostic and therapeutic precision.•Crucial requirements of multicenter recruitment of large ...datasets.•Increasing biomarkers variability, to establish the potential clinical value of radiomics.•Development of robust explainable AI models.
Over the last decade there has been an extensive evolution in the Artificial Intelligence (AI) field. Modern radiation oncology is based on the exploitation of advanced computational methods aiming to personalization and high diagnostic and therapeutic precision. The quantity of the available imaging data and the increased developments of Machine Learning (ML), particularly Deep Learning (DL), triggered the research on uncovering “hidden” biomarkers and quantitative features from anatomical and functional medical images. Deep Neural Networks (DNN) have achieved outstanding performance and broad implementation in image processing tasks. Lately, DNNs have been considered for radiomics and their potentials for explainable AI (XAI) may help classification and prediction in clinical practice. However, most of them are using limited datasets and lack generalized applicability. In this study we review the basics of radiomics feature extraction, DNNs in image analysis, and major interpretability methods that help enable explainable AI. Furthermore, we discuss the crucial requirement of multicenter recruitment of large datasets, increasing the biomarkers variability, so as to establish the potential clinical value of radiomics and the development of robust explainable AI models.
In this paper, the authors' review the applicability of the open-source GATE Monte Carlo simulation platform based on the GEANT4 toolkit for radiation therapy and dosimetry applications. The many ...applications of GATE for state-of-the-art radiotherapy simulations are described including external beam radiotherapy, brachytherapy, intraoperative radiotherapy, hadrontherapy, molecular radiotherapy, and in vivo dose monitoring. Investigations that have been performed using GEANT4 only are also mentioned to illustrate the potential of GATE. The very practical feature of GATE making it easy to model both a treatment and an imaging acquisition within the same frameworkis emphasized. The computational times associated with several applications are provided to illustrate the practical feasibility of the simulations using current computing facilities.
Personalized medicine aims at offering optimized treatment options and improved survival for cancer patients based on individual variability. The success of precision medicine depends on robust ...biomarkers. Recently, the requirement for improved non-biologic biomarkers that reflect tumor biology has emerged and there has been a growing interest in the automatic extraction of quantitative features from medical images, denoted as radiomics. Radiomics as a methodological approach can be applied to any image and most studies have focused on PET, CT, ultrasound, and MRI. Here, we aim to present an overview of the radiomics workflow as well as the major challenges with special emphasis on the use of multiparametric MRI datasets. We then reviewed recent studies on radiomics in the field of pelvic oncology including prostate, cervical, and colorectal cancer.
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