Radiation therapy plays a crucial role in cancer treatment, necessitating precise delivery of radiation to tumors while sparing healthy tissues over multiple days. Computed tomography (CT) is integral for treatment planning, offering electron density data crucial for accurate dose calculations. However, accurately representing patient anatomy is challenging, especially in adaptive radiotherapy, where CT is not acquired daily. Magnetic resonance imaging (MRI) provides superior soft-tissue contrast. Still, it lacks electron density information, while cone beam CT (CBCT) lacks direct electron density calibration and is mainly used for patient positioning. Adopting MRI-only or CBCT-based adaptive radiotherapy eliminates the need for CT planning but presents challenges. Synthetic CT (sCT) generation techniques aim to address these challenges by using image synthesis to bridge the gap between MRI, CBCT, and CT. The SynthRAD2023 challenge was organized to compare synthetic CT generation methods using multi-center ground truth data from 1080 patients, divided into two tasks: (1) MRI-to-CT and (2) CBCT-to-CT. The evaluation included image similarity and dose-based metrics from proton and photon plans. The challenge attracted significant participation, with 617 registrations and 22/17 valid submissions for tasks 1/2. Top-performing teams achieved high structural similarity indices (≥0.87/0.90) and gamma pass rates for photon (≥98.1%/99.0%) and proton (≥97.3%/97.0%) plans. However, no significant correlation was found between image similarity metrics and dose accuracy, emphasizing the need for dose evaluation when assessing the clinical applicability of sCT. SynthRAD2023 facilitated the investigation and benchmarking of sCT generation techniques, providing insights for developing MRI-only and CBCT-based adaptive radiotherapy. It showcased the growing capacity of deep learning to produce high-quality sCT, reducing reliance on conventional CT for treatment planning.

• This paper investigates the capacity of AI models for airway modelling on national datasets with paired clinical metadata. • We evaluated AI models against unharmonised, noisy, and out-of-distribution data, as well as the prognostication for FLD. • We found a new biomarker for mortality prediction, outperforming existing clinical measurements (FVC% and fibrosis scores). • In-depth analysis of AI models on airway modelling and prognosis, highlighting challenges and future research directions. Airway-related quantitative imaging biomarkers are crucial for examination, diagnosis, and prognosis in pulmonary diseases. However, the manual delineation of airway structures remains prohibitively time-consuming. While significant efforts have been made towards enhancing automatic airway modelling, current public-available datasets predominantly concentrate on lung diseases with moderate morphological variations. The intricate honeycombing patterns present in the lung tissues of fibrotic lung disease patients exacerbate the challenges, often leading to various prediction errors. To address this issue, the 'Airway-Informed Quantitative CT Imaging Biomarker for Fibrotic Lung Disease 2023′ (AIIB23) competition was organized in conjunction with the official 2023 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI). The airway structures were meticulously annotated by three experienced radiologists. Competitors were encouraged to develop automatic airway segmentation models with high robustness and generalization abilities, followed by exploring the most correlated QIB of mortality prediction. A training set of 120 high-resolution computerised tomography (HRCT) scans were publicly released with expert annotations and mortality status. The online validation set incorporated 52 HRCT scans from patients with fibrotic lung disease and the offline test set included 140 cases from fibrosis and COVID-19 patients. The results have shown that the capacity of extracting airway trees from patients with fibrotic lung disease could be enhanced by introducing voxel-wise weighted general union loss and continuity loss. In addition to the competitive image biomarkers for mortality prediction, a strong airway-derived biomarker (Hazard ratio>1.5, p < 0.0001) was revealed for survival prognostication compared with existing clinical measurements, clinician assessment and AI-based biomarkers.

Chest multi-bone segmentation plays an important role in clinical applications such as metastasis analysis and surgical planning. The global context between bones is critical for accurately identifying bone sub-classes; meanwhile, the influence of local details on bone segmentation accuracy cannot be ignored. However, the global context and local details are challenging to trade off under hardware and computation cost limitations. In this study, we propose Bone-Net that simultaneously leverages global context and local details by employing a two-stage cascaded framework for multi-bone segmentation in chest CT. In the first stage, we feed low-resolution large-scale images to bidirectional feature pyramid network to extract global context and perform multi-bone category prediction. In the second stage, we propose a global-guided gating module to link global context and local details to refine bone segmentation. During inference, we obtained the multi-bone segmentation results by rendering the category information into the segmentation results. Furthermore, we design a novel loss function to alleviate the category confusion problem for adjacent bones. The proposed method is trained and evaluated on a challenging dataset of 250 chest CT scans from various centers and scanners. Experimental results show that the proposed Bone-Net achieves high performance (84.1% of dice similarity coefficient, 87.7% of recall, and 80.7% of precision) and outperforms five benchmarks for multi-bone segmentation.