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Registration free automatic identification of gold fiducial markers in MRI target delineation images for prostate radiotherapy

Gustafsson, Christian LU ; Korhonen, Juha; Persson, Emilia LU ; Gunnlaugsson, Adalsteinn LU ; Nyholm, Tufve and Olsson, Lars E. LU (2017) In Medical Physics 44(11). p.5563-5574
Abstract

Purpose: The superior soft tissue contrast of magnetic resonance imaging (MRI) compared to computed tomography (CT) has urged the integration of MRI and elimination of CT in radiotherapy treatment (RT) for prostate. An intraprostatic gold fiducial marker (GFM) appears hyperintense on CT. On T2-weighted (T2w) MRI target delineation images, the GFM appear as a small signal void similar to calcifications and post biopsy fibrosis. It can therefore be difficult to identify the markers without CT. Detectability of GFMs can be improved using additional MR images, which are manually registered to target delineation images. This task requires manual labor, and is associated with interoperator differences and image registration errors. The aim of... (More)

Purpose: The superior soft tissue contrast of magnetic resonance imaging (MRI) compared to computed tomography (CT) has urged the integration of MRI and elimination of CT in radiotherapy treatment (RT) for prostate. An intraprostatic gold fiducial marker (GFM) appears hyperintense on CT. On T2-weighted (T2w) MRI target delineation images, the GFM appear as a small signal void similar to calcifications and post biopsy fibrosis. It can therefore be difficult to identify the markers without CT. Detectability of GFMs can be improved using additional MR images, which are manually registered to target delineation images. This task requires manual labor, and is associated with interoperator differences and image registration errors. The aim of this work was to develop and evaluate an automatic method for identification of GFMs directly in the target delineation images without the need for image registration. Methods: T2w images, intended for target delineation, and multiecho gradient echo (MEGRE) images intended for GFM identification, were acquired for prostate cancer patients. Signal voids in the target delineation images were identified as GFM candidates. The GFM appeared as round, symmetric, signal void with increasing area for increasing echo time in the MEGRE images. These image features were exploited for automatic identification of GFMs in a MATLAB model using a patient training dataset (n = 20). The model was validated on an independent patient dataset (n = 40). The distances between the identified GFM in the target delineation images and the GFM in CT images were measured. A human observatory study was conducted to validate the use of MEGRE images. Results: The sensitivity, specificity, and accuracy of the automatic method and the observatory study was 84%, 74%, 81% and 98%, 94%, 97%, respectively. The mean absolute difference in the GFM distances for the automatic method and observatory study was 1.28 ± 1.25 mm and 1.14 ± 1.06 mm, respectively. Conclusions: Multiecho gradient echo images were shown to be a feasible and reliable way to perform GFM identification. For clinical practice, visual inspection of the results from the automatic method is needed at the current stage.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Fiducial marker, MRI only, Prostate cancer, Radiation therapy, Synthetic CT
in
Medical Physics
volume
44
issue
11
pages
5563 - 5574
publisher
American Association of Physicists in Medicine
external identifiers
  • scopus:85029228799
  • wos:000414970800004
ISSN
0094-2405
DOI
10.1002/mp.12516
language
English
LU publication?
yes
id
84540a65-bccf-4bcb-9c1d-cd1b7a89d882
date added to LUP
2017-10-09 11:25:31
date last changed
2018-04-10 03:00:13
@article{84540a65-bccf-4bcb-9c1d-cd1b7a89d882,
  abstract     = {<p>Purpose: The superior soft tissue contrast of magnetic resonance imaging (MRI) compared to computed tomography (CT) has urged the integration of MRI and elimination of CT in radiotherapy treatment (RT) for prostate. An intraprostatic gold fiducial marker (GFM) appears hyperintense on CT. On T2-weighted (T2w) MRI target delineation images, the GFM appear as a small signal void similar to calcifications and post biopsy fibrosis. It can therefore be difficult to identify the markers without CT. Detectability of GFMs can be improved using additional MR images, which are manually registered to target delineation images. This task requires manual labor, and is associated with interoperator differences and image registration errors. The aim of this work was to develop and evaluate an automatic method for identification of GFMs directly in the target delineation images without the need for image registration. Methods: T2w images, intended for target delineation, and multiecho gradient echo (MEGRE) images intended for GFM identification, were acquired for prostate cancer patients. Signal voids in the target delineation images were identified as GFM candidates. The GFM appeared as round, symmetric, signal void with increasing area for increasing echo time in the MEGRE images. These image features were exploited for automatic identification of GFMs in a MATLAB model using a patient training dataset (n = 20). The model was validated on an independent patient dataset (n = 40). The distances between the identified GFM in the target delineation images and the GFM in CT images were measured. A human observatory study was conducted to validate the use of MEGRE images. Results: The sensitivity, specificity, and accuracy of the automatic method and the observatory study was 84%, 74%, 81% and 98%, 94%, 97%, respectively. The mean absolute difference in the GFM distances for the automatic method and observatory study was 1.28 ± 1.25 mm and 1.14 ± 1.06 mm, respectively. Conclusions: Multiecho gradient echo images were shown to be a feasible and reliable way to perform GFM identification. For clinical practice, visual inspection of the results from the automatic method is needed at the current stage.</p>},
  author       = {Gustafsson, Christian and Korhonen, Juha and Persson, Emilia and Gunnlaugsson, Adalsteinn and Nyholm, Tufve and Olsson, Lars E.},
  issn         = {0094-2405},
  keyword      = {Fiducial marker,MRI only,Prostate cancer,Radiation therapy,Synthetic CT},
  language     = {eng},
  number       = {11},
  pages        = {5563--5574},
  publisher    = {American Association of Physicists in Medicine},
  series       = {Medical Physics},
  title        = {Registration free automatic identification of gold fiducial markers in MRI target delineation images for prostate radiotherapy},
  url          = {http://dx.doi.org/10.1002/mp.12516},
  volume       = {44},
  year         = {2017},
}