Automatic Thoracic CT Image Segmentation using Deep Convolutional Neural Networks. Xiao Han, Ph.D.

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Automatic Thoracic CT Image Segmentation using Deep Convolutional Neural Networks Xiao Han, Ph.D.

Outline Background Brief Introduction to DCNN Method Results 2 Focus where it matters

Structure Segmentation For RTP A prerequisite for radiotherapy treatment planning Manual Segmentation - Tedious and time-consuming - Suffers from large inter- and intra- rater variability Automatic Segmentation Methods - Atlas-based methods have been popular - Deep learning (DL) methods very likely be the method of choice for future 3 Focus where it matters

Deep Convolutional Neural Networks (DCNN) well suited for image related problems [LeCun 1998, Hinton 2006] Take advantage of spatial structures of image data - Local receptive fields - Shared weights - Multi-scale, hierarchical feature learning input image convolution feature maps feature maps prediction dog(0.05) cat(0.92) boat(0.01) bird(0.02) Convolutions 4 Focus where it matters Pooling Convolutions Pooling Fully connected

Encoder-Decoder DCNNs for semantic image segmentation (pixel-by-pixel labeling) [Badrinarayanan 2015] FCN (2015, Long et al, Univ. of California, Berkeley) DeconvNet (2015, Noh et al, POSTECH, Korea) U-Net (2015, Ronneberger et al, Univ. of Freiburg) SegNet (2015, Badrinarayanan et al, Univ. of Cambridge) 5 Focus where it matters

DCNN Architecture For Thoracic Image Segmentation A modified U-Net, added with residue connections from ResNet 6 Focus where it matters 27 Convolutional Layers 34.9 Million Parameters Residue-UNet [He 2015]

A Two-Model Scheme for better computation efficiency A 2.5D model for large structures the lungs - Input is 5 adjacent axial slices of size 360x360, output is 2D segmentation map corresponding to the center slice - Fast, but accuracy limited for thin, elongated structures e.g. esophagus A 3D model for small structures heart, esophagus, spinal cord - Input is a 128x128x32 sub-volume, output is 3D segmentation map of same size - Very slow if applied to process a whole 3D volume The 2.5D model is first applied, the result is used to automatically define a smaller ROI, within which the 3D model is applied 7 Focus where it matters

DCNN Workflow Two stages Training data Image Data Expected Results Training Model Prediction Results Model New Image Data 8 Focus where it matters cross-entropy loss ߠ = ଵ, ଵ, ଶ, ଶ,

Some Implementation Details Models implemented using Caffe package, trained using stochastic gradient descent with momentum algorithm Data augmentation very important during training when training data are limited - Apply random deformations to each training sample (image and label map) on the fly Hardware: PC with a NVIDIA Titan X GPU with 12GB memory Training a model from scratch takes about 3 days Applying the two trained models to process a new 3D image takes ~30 seconds each 9 Focus where it matters

Cross Validation Using AAPM Challenge Data 36 patients, 12 from each of three institutions - Randomly select 3 subjects from each institution as test data - Using the remaining 27 (9x3) as training data for DCNN model training - DCNN results on 9 test subjects are compared with ground truth (manual) segmentation Comparison is also made with respect to an ABAS method we previously developed 10 Focus where it matters

Comparing Method Atlas-based Auto-segmentation [Han MLMI2013] Multi-atlas atlas-based auto-segmentation using online RF (Random Forest) enhanced label fusion Using the 9 training subjects as atlases for the 3 test subjects from the same institution 11 Focus where it matters

Auto-segmentation using the DCNN method A sample result Color: DCNN result White: manual segmentation 12 Focus where it matters

Comparison DCNN vs ABAS DCNN more accurate for most structures DCNN only takes ~1m, atlas-based takes ~6 minutes 13 Focus where it matters

Discussion Advantages of Deep Learning DCNN method produces fast and accurate autosegmentation results even with limited training data Accuracy should improve further with more training data DL greatly benefits from big data due to high model capacity DCNN can easily accommodate large amount of training data Only training time may increase, applying the model takes the same time Computation time for ABAS increases with number of atlases 14 Focus where it matters

Thank you Email: xiao.han@elekta.com

A 3D U-Net based thoracic segmentation framework using cropped images Xue Feng 1, Kun Qing 2, Craig H. Meyer 1,2 1 Biomedical Engineering, University of Virginia, Charlottesville, VA 2 Radiology, University of Virginia, Charlottesville, VA

Introduction: Deep Learning Deep learning models have shown their superiority in classification, object detection and (medical) image segmentation Models: Patch-based CNN model: predicts the class label of the center pixel U-Net: fully convolutional networks trained end-to-end Data: The more, the better [1, 2] Key: how well can the training data represent the task distribution? [1] Ronneberger et al., arxiv:1505.04597 (2015) [2] Cicek et al., arxiv:1606.06650 (2016) 2

Methods: General Model U-Net is a better suited model Efficiency Captures information of intensity, position, shape, etc. 3D vs. 2D (?) Pros: Cons: Additional input information (slice) Consistent output Less training data Memory (hard to fit 200 * 512 * 512 into GPU) We choose 3D U-Net and deal with the challenges 3

Methods: Image Pre-processing Why? If more data is difficult, it s better to limit the variability in the dataset Steps: Intensity normalization (crop to -1000~600 in Hounsfield scale) Unify the pixel spacing and slice thickness (resizing) Crop the images to the same in-plane dimension (#slice * 512 * 512) Generate masks with ROI labels (0-Background, 1-SpinalCord, 2- Lung_R, 3-Lung_L, 4-Heart, 5-Esophagus 4

Methods: U-Net with Cropped Images Challenges: GPU Memory (Titan X: 12 GB) limits the size of input images Due to small data set, U-Net model does not perform good when trained end-to-end (full image -> all ROI labels) Solution: crop the input images to separate regions containing one ROI each (organs don t overlap!) Step 1: train a U-Net model on scaled images for end-to-end segmentation and extract the bounding boxes for each ROI Step 2: train one U-Net model for each ROI with cropped images and combine the results (including resolve of conflicts) 5

Methods: Step 1 Objective: extract bounding boxes for each ROI Network structure: Input: scale to 72x256x256, then crop to 72x208x208 (uniform slice thickness is broken) Encoding path: 72x208x208x24 -> 36x104x104x48 -> 18x52x52x96 Decoding path: 18x52x52x96 -> 36x104x104x48 -> 72x208x208x24 Loss: weighted cross entropy (background: 1.0, SpinalCord: 2.0, Lung_R: 1.0, Lung_L: 1.0, Espophagus: 3.0) Data augmentation Random 3D translation, rotation, scaling is applied on the fly 6

Methods: Step 1 - Continued Training 200 epochs (8 hours on Titan X) Post-processing (bounding boxes extraction): Clean the contour by removing isolated regions (keep only one connected region for each ROI) Transform to original shape via padding and scaling Calculate the range for each ROI and extraction cropped images with slightly enlarged bounding boxes 7

Methods: Step 2 Objective: get the label maps for each ROI Network structure: Input: fixed size for each ROI estimated from the mean sizes (uniform slice thickness and pixel spacing are broken) Wider than step 1 model (48 filters in the first layer) Output: foreground (ROI) and background Loss: weighted cross-entropy for SpinalCord and Esophagus Data augmentation: Random 3D rotation and shear, variations of bounding boxes 8

Methods: Step 2 - Continued Training 200 epochs (7-10 hours on Titan X depending on the input size) Post-processing: Clean the contour by removing isolated regions (keep only one connected region for each ROI) Transform to original shape via padding and scaling If conflicts exist (e.g. multiple models predict foreground for the same voxel), choose the result with the highest probability from softmax output 9

Results: Training Step 1: Mean Step 2: SpinalCord Step 2: Lung_R Step 2: Lung_L Step 2: Heart Step 2: Esophagus 10

Results: Validation (Splitted Training) Step 1 Mean Dice: 0.84 Step 2 Mean Dice: 0.88 Step 1: Mean Step 2: SpinalCord Step 2: Lung_R Step 2: Lung_L Step 2: Heart Step 2: Esophagus 11

Results: Validation SpinalCord Lung_R Lung_L Heart Esophagus Dice 0.91 0.97 0.97 0.89 0.75 Hausdorff Distance Average Distance 1.73 4.83 3.29 13.40 11.45 0.59 1.05 0.82 4.11 3.58 12

Discussion and Conclusion U-Net structure fits this task well Intensity normalization is important The easier the task, the better the performance (label all ROIs from all images vs. separate foreground and background from cropped images) More work needs to be done for Esophagus (e.g. post processing using shape constraint) 13

Devil is in the Detail Source code: https://github.com/xf4j/aapm_thoracic_challenge Thanks 14

Automatic Multi-organ Segmentation in 3D Computed Tomography Surgical Sciences Bruno Miguel Gomes Oliveira Master in Biomedical Engineering E-mail: brunooliveira@med.uminho.pt July - 2017 1

Methodology 1º 2º Atlas alignment Label fusion Non-deformable registration Dense deformation field reconstruction Deformable registration Statistic selection Local weight voting Global Local Vote Selection 2

Methodology - Atlas alignment Coarse-to-fine strategy Atlas alignment Non-deformable registration Dense deformation field reconstruction Deformable registration Global Affine Local Afine 3

Methodology - Atlas alignment Example, coronal slice from one atlas 2º Local affine registration + Dense deformation field reconstruction 1º Global affine registration 3º Deformable registration 4

Methodology - Label Fusion Label fusion Statistical selection Local weight voting Vote Selection 5

Results AD DICE HD Esophagus 0.64 7.6 2.4 Lung_L 0.96 1.7 0.90 Lung_R 0.97 5.9 1.3 Heart 0.90 10.8 3.3 Spinal Cord 0.91 1.8 0.60 Challenge score: 46.4 Questions: brunooliveira@med.uminho.p

Circumscriptio ex machina A step-change for auto-contouring Paul Aljabar, Devis Peressutti, Mark Gooding Mirada Medical Ltd. Copyright Mirada Medical 2017

Deus ex machina - an unexpected power or event saving a seemingly hopeless situation Copyright Mirada Medical 2017

A story about auto-contouring Basic segmentation methods Prior-knowledge segmentation ASM Atlas Sharp, Gregory, et al. "Vision 20/20: Perspectives on automated image segmentation for radiotherapy." Medical physics 41.5 (2014). Copyright Mirada Medical 2017

Atlas based auto-contouring Copyright Mirada Medical 2017

What s achievable with atlas-based auto-contouring Single atlas Multi atlas DSC HD* AD DSC HD* AD Esophagus 0.81 7.0 1.19 0.87 4.9 0.8 Heart 0.94 10.8 1.72 0.96 7.8 1.3 Lung_L 0.99 10.8 0.45 1.0 10.3 0.4 Lung_R 0.99 11.2 0.47 1.0 8.4 0.3 SpinalCord 0.93 3.6 0.50 0.95 3.0 0.4 * Calculated differently to the Extreme challenge Value Theory H&N results presented at ICCR 2016 Copyright Mirada Medical 2017

The problem Estimates the potential performance for a very large atlas database assuming perfect atlas selection by an oracle with fore-knowledge of the output performance Copyright Mirada Medical 2017

Atlas selection doesn t work so well in practice H&N results presented at AAPM 2016 Copyright Mirada Medical 2017

Circumscriptio ex machina Deep Learning Copyright Mirada Medical 2017

Deep learning Architecture Initialisation Epochs and Iterations Momentum Jittering DATA Lots of data! Pre-trained on 450 cases Refined on training set Copyright Mirada Medical 2017

Comparing results DSC HD AD DSC HD AD Esophagus 0.56 10.2 3.0 0.76 5.9 1.8 Heart 0.89 11.6 3.9 0.90 10.8 3.6 Lung_L 0.94 6.9 1.7 0.97 2.8 0.71 Lung_R 0.96 6.3 1.3 0.97 4.2 0.91 SpinalCord 0.88 2.2 0.75 0.91 1.6 0.58 Challenge score 39.5 54.2 Copyright Mirada Medical 2017

An example from the test data Copyright Mirada Medical 2017

Difficulties with the challenge Limited data Institutional variation Quantitative scoring Copyright Mirada Medical 2017

Can you tell the difference from a clinician? www.auto-contouring.com 2014 Mirada Medical Mirada Medical USA, Inc. 999 18th Street Suite 2025N Denver, CO 80202 enquiries@mirada-medical.com 877.872.2617 Copyright Mirada Medical 2017