Image registration based automated lesion correspondence pipeline for longitudinal CT data

Patients diagnosed with metastatic breast cancer (mBC) typically undergo several radiographic assessments during their treatment. mBC often involves multiple metastatic lesions in different organs, it is imperative to accurately track and assess these lesions to gain a comprehensive understanding of the disease's response to treatment. Computerized analysis methods that rely on lesion-level tracking have often used manual matching of corresponding lesions, a time-consuming process that is prone to errors. This paper introduces an automated lesion correspondence algorithm designed to precisely track both targets' lesions and non-targets' lesions in longitudinal data. Here we demonstrate the applicability of our algorithm on the anonymized data from two Phase III trials. The dataset contains imaging data of patients for different follow-up timepoints and the radiologist annotations for the patients enrolled in the trials. Target and non-target lesions are annotated by either one or two groups of radiologists. To facilitate accurate tracking, we have developed a registration-assisted lesion correspondence algorithm. The algorithm employs a sequential two-step pipeline: (a) Firstly, an adaptive Hungarian algorithm is used to establish correspondence among lesions within a single volumetric image series which have been annotated by multiple radiologists at a specific timepoint. (b) Secondly, after establishing correspondence and assigning unique names to the lesions, three-dimensional rigid registration is applied to various image series at the same timepoint. Registration is followed by ongoing lesion correspondence based on the adaptive Hungarian algorithm and updating lesion names for accurate tracking. Validation of our automated lesion correspondence algorithm is performed through triaxial plots based on axial, sagittal, and coronal views, confirming its efficacy in matching lesions.

Informing selection of performance metrics for medical image segmentation evaluation using configurable synthetic errors

Machine learning-based segmentation in medical imaging is widely used in clinical applications from diagnostics to radiotherapy treatment planning. Segmented medical images with ground truth are useful for investigating the properties of different segmentation performance metrics to inform metric selection. Regular geometrical shapes are often used to synthesize segmentation errors and illustrate properties of performance metrics, but they lack the complexity of anatomical variations in real images. In this study, we present a tool to emulate segmentations by adjusting the reference (truth) masks of anatomical objects extracted from real medical images. Our tool is designed to modify the defined truth contours and emulate different types of segmentation errors with a set of user-configurable parameters. We defined the ground truth objects from 230 patient images in the Glioma Image Segmentation for Radiotherapy (GLIS-RT) database. For each object, we used our segmentation synthesis tool to synthesize 10 versions of segmentation (i.e., 10 simulated segmentors or algorithms), where each version has a pre-defined combination of segmentation errors. We then applied 20 performance metrics to evaluate all synthetic segmentations. We demonstrated the properties of these metrics, including their ability to capture specific types of segmentation errors. By analyzing the intrinsic properties of these metrics and categorizing the segmentation errors, we are working toward the goal of developing a decision-tree tool for assisting in the selection of segmentation performance metrics.