Out-of-phase ventilation occurs when local regions of the lung reach their maximum or minimum volumes at breathing phases other than the global end inhalation or exhalation phases. This paper presents the N-phase local expansion ratio (LERN) as a surrogate for lung ventilation. A common approach to estimate lung ventilation is to use image registration to align the end exhalation and inhalation 3DCT images and then analyze the resulting correspondence map. This 2-phase local expansion ratio (LER2) is limited because it ignores out-of-phase ventilation and thus may underestimate local lung ventilation. To overcome this limitation, LERNmeasures the maximum ratio of local expansion and contraction over the entire breathing cycle. Comparing LER2to LERNprovides a means for detecting and characterizing locations of the lung that experience out-of-phase ventilation. We present a novel in-phase/out-of-phase ventilation (IOV) function plot to visualize and measure the amount of high-function IOV that occurs during a breathing cycle. Treatment planning 4DCT scans collected during coached breathing from 32 human subjects with lung cancer were analyzed in this study. Results show that out-of-phase breathing occurred in all subjects and that the spatial distribution of out-of-phase ventilation varied from subject to subject. For the 32 subjects analyzed, 50% of the out-of-phase regions on average were mislabeled as low-function by LER2(high-function threshold of 1.1, IOV threshold of 1.05). 4DCT and Xenon-enhanced CT of four sheep showed that LER8is more accurate than LER2 for measuring lung ventilation.

Pulmonary fissure detection in computed tomography (CT) is a critical component for automatic lobar segmentation. The majority of fissure detection methods use feature descriptors that are hand-crafted, low-level, and have local spatial extent. The design of such feature detectors is typically targeted toward normal fissure anatomy, yielding low sensitivity to weak, and abnormal fissures that are common in clinical data sets. Furthermore, local features commonly suffer from low specificity, as the complex textures in the lung can be indistinguishable from the fissure when the global context is not considered. We propose a supervised discriminative learning framework for simultaneous feature extraction and classification. The proposed framework, called FissureNet, is a coarse-to-fine cascade of two convolutional neural networks. The coarse-to-fine strategy alleviates the challenges associated with training a network to segment a thin structure that represents a small fraction of the image voxels. FissureNet was evaluated on a cohort of 3706 subjects with inspiration and expiration 3DCT scans from the COPDGene clinical trial and a cohort of 20 subjects with 4DCT scans from a lung cancer clinical trial. On both data sets, FissureNet showed superior performance compared with a deep learning approach using the U-Net architecture and a Hessian-based fissure detection method in terms of area under the precision-recall curve (PR-AUC). The overall PR-AUC for FissureNet, U-Net, and Hessian on the COPDGene (lung cancer) data set was 0.980 (0.966), 0.963 (0.937), and 0.158 (0.182), respectively. On a subset of 30 COPDGene scans, FissureNet was compared with a recently proposed advanced fissure detection method called derivative of sticks (DoS) and showed superior performance with a PR-AUC of 0.991 compared with 0.668 for DoS.

This paper presents an approach to predict the deformation of the lungs and surrounding organs during respiration. The framework incorporates a computational model of the respiratory system, which comprises an anatomical model extracted from computed tomography (CT) images at end-expiration (EE), and a biomechanical model of the respiratory physiology, including the material behavior and interactions between organs. A personalization step is performed to automatically estimate patient-specific thoracic pressure, which drives the biomechanical model. The zone-wise pressure values are obtained by using a trust-region optimizer, where the estimated motion is compared to CT images at end-inspiration (EI). A detailed convergence analysis in terms of mesh resolution, time stepping and number of pressure zones on the surface of the thoracic cavity is carried out. The method is then tested on five public datasets. Results show that the model is able to predict the respiratory motion with an average landmark error of 3.40 ±1.0 mm over the entire respiratory cycle. The estimated 3-D lung motion may constitute as an advanced 3-D surrogate for more accurate medical image reconstruction and patient respiratory analysis.

Positron emission tomography (PET)-computed tomography (CT) images have been widely used in clinical practice for radiotherapy treatment planning of the radiotherapy. Many existing segmentation approaches only work for a single imaging modality, which suffer from the low spatial resolution in PET or low contrast in CT. In this work, we propose a novel method for the co-segmentation of the tumor in both PET and CT images, which makes use of advantages from each modality: the functionality information from PET and the anatomical structure information from CT. The approach formulates the segmentation problem as a minimization problem of a Markov random field model, which encodes the information from both modalities. The optimization is solved using a graph-cut based method. Two sub-graphs are constructed for the segmentation of the PET and the CT images, respectively. To achieve consistent results in two modalities, an adaptive context cost is enforced by adding context arcs between the two sub-graphs. An optimal solution can be obtained by solving a single maximum flow problem, which leads to simultaneous segmentation of the tumor volumes in both modalities. The proposed algorithm was validated in robust delineation of lung tumors on 23 PET-CT datasets and two head-and-neck cancer subjects. Both qualitative and quantitative results show significant improvement compared to the graph cut methods solely using PET or CT.

In this paper, we propose a novel method to reduce the magnitude of 4D CT artifacts by stitching two images with a data-driven regularization constrain, which helps preserve the local anatomy structures. Our method first computes an interface seam for the stitching in the overlapping region of the first image, which passes through the "smoothest" region, to reduce the structure complexity along the stitching interface. Then, we compute the displacements of the seam by matching the corresponding interface seam in the second image. We use sparse 3D features as the structure cues to guide the seam matching, in which a regularization term is incorporated to keep the structure consistency. The energy function is minimized by solving a multiple-label problem in Markov Random Fields with an anatomical structure preserving regularization term. The displacements are propagated to the rest of second image and the two image are stitched along the interface seams based on the computed displacement field. The method was tested on both simulated data and clinical 4D CT images. The experiments on simulated data demonstrated that the proposed method was able to reduce the landmark distance error on average from 2.9 mm to 1.3 mm, outperforming the registration-based method by about 55%. For clinical 4D CT image data, the image quality was evaluated by three medical experts, and all identified much fewer artifacts from the resulting images by our method than from those by the compared method.

Precise localization of moving targets is essential to increase local control of the cancer via dose escalation while reducing the severity of normal tissue complication. Localization of targets in real time with radio-opaque marker is less favorable considering the excess radiation dose to the patient and potential complications of implantation. Various external surrogates could provide indications of the targets' positions during the breathing process. However, there is a great deal of uncertainty in the correlation between external surrogates and internal target positions/trajectory during respiratory cycles. In order to address this problem, we have developed an algorithm that automatically establishes correspondences between the fluoroscopic sequence frames taken from the patient on the day of treatment and the various phases of a 4DCT planning data set. Image based mapping/synchronization procedure is performed using an underlying Markov model established for the breathing process. The mapping procedure is formulated as an optimization process and is solved efficiently using a dynamic programming technique. Results on the phantom, synthetic, and real patient data demonstrate the effectiveness of the proposed method in coping with respiratory correlation variations. The approach could primarily be used for automatic gating interval adaptation in the gated radiotherapy.