FedSynthCT-Brain: A Federated Learning Framework for Multi-Institutional Brain MRI-to-CT Synthesis

The generation of Synthetic Computed Tomography (sCT) images has become a pivotal methodology in modern clinical practice, particularly in the context of Radiotherapy (RT) treatment planning. The use of sCT enables the calculation of doses, pushing towards Magnetic Resonance Imaging (MRI) guided radiotherapy treatments. Moreover, with the introduction of MRI-Positron Emission Tomography (PET) hybrid scanners, the derivation of sCT from MRI can improve the attenuation correction of PET images. Deep learning methods for MRI-to-sCT have shown promising results, but their reliance on single-centre training dataset limits generalisation capabilities to diverse clinical settings. Moreover, creating centralised multicentre datasets may pose privacy concerns. To solve the issues, this study introduces FedSynthCT-Brain, a framework based on the Federated Learning (FL) paradigm for MRI-to-sCT in brain imaging. We reproduced a federation across four European and American centres using a U-Net-based model. The approach was implemented using data from centres belonging the federation and it was tested on an unseen dataset from a centre outside the federation. In the case of the unseen centre, the federated model achieved a median Mean Absolute Error (MAE) of 102.0 HU across 23 patients, with an interquartile range of 96.7-110.5 HU. The median (interquartile range) for the Structural Similarity Index (SSIM) and the Peak Signal to Noise Ratio (PNSR) were 0.89 (0.86-0.89) and 26.58 (25.52-27.42), respectively. The analysis of the results showed acceptable performances of the federated approach, thus highlighting the potential of FL to enhance MRI-to-sCT to improve generalisability and advancing safe and equitable clinical applications while fostering collaboration and preserving data privacy.

LIMIS: Towards Language-based Interactive Medical Image Segmentation

Within this work, we introduce LIMIS: The first purely language-based interactive medical image segmentation model. We achieve this by adapting Grounded SAM to the medical domain and designing a language-based model interaction strategy that allows radiologists to incorporate their knowledge into the segmentation process. LIMIS produces high-quality initial segmentation masks by leveraging medical foundation models and allows users to adapt segmentation masks using only language, opening up interactive segmentation to scenarios where physicians require using their hands for other tasks. We evaluate LIMIS on three publicly available medical datasets in terms of performance and usability with experts from the medical domain confirming its high-quality segmentation masks and its interactive usability.

Deep learning-based synthetic-CT generation in radiotherapy and PET: a review

Recently, deep learning (DL)-based methods for the generation of synthetic computed tomography (sCT) have received significant research attention as an alternative to classical ones. We present here a systematic review of these methods by grouping them into three categories, according to their clinical applications: I) to replace CT in magnetic resonance (MR)-based treatment planning, II) facilitate cone-beam computed tomography (CBCT)-based image-guided adaptive radiotherapy, and III) derive attenuation maps for the correction of Positron Emission Tomography (PET). Appropriate database searching was performed on journal articles published between January 2014 and December 2020. The DL methods' key characteristics were extracted from each eligible study, and a comprehensive comparison among network architectures and metrics was reported. A detailed review of each category was given, highlighting essential contributions, identifying specific challenges, and summarising the achievements. Lastly, the statistics of all the cited works from various aspects were analysed, revealing the popularity and future trends, and the potential of DL-based sCT generation. The current status of DL-based sCT generation was evaluated, assessing the clinical readiness of the presented methods.