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Fechter T, Sachpazidis I, Baltas D. The use of deep learning in interventional radiotherapy (brachytherapy): A review with a focus on open source and open data. Z Med Phys 2024; 34:180-196. [PMID: 36376203 PMCID: PMC11156786 DOI: 10.1016/j.zemedi.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022]
Abstract
Deep learning advanced to one of the most important technologies in almost all medical fields. Especially in areas, related to medical imaging it plays a big role. However, in interventional radiotherapy (brachytherapy) deep learning is still in an early phase. In this review, first, we investigated and scrutinised the role of deep learning in all processes of interventional radiotherapy and directly related fields. Additionally, we summarised the most recent developments. For better understanding, we provide explanations of key terms and approaches to solving common deep learning problems. To reproduce results of deep learning algorithms both source code and training data must be available. Therefore, a second focus of this work is on the analysis of the availability of open source, open data and open models. In our analysis, we were able to show that deep learning plays already a major role in some areas of interventional radiotherapy, but is still hardly present in others. Nevertheless, its impact is increasing with the years, partly self-propelled but also influenced by closely related fields. Open source, data and models are growing in number but are still scarce and unevenly distributed among different research groups. The reluctance in publishing code, data and models limits reproducibility and restricts evaluation to mono-institutional datasets. The conclusion of our analysis is that deep learning can positively change the workflow of interventional radiotherapy but there is still room for improvements when it comes to reproducible results and standardised evaluation methods.
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Affiliation(s)
- Tobias Fechter
- Division of Medical Physics, Department of Radiation Oncology, Medical Center University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany.
| | - Ilias Sachpazidis
- Division of Medical Physics, Department of Radiation Oncology, Medical Center University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany
| | - Dimos Baltas
- Division of Medical Physics, Department of Radiation Oncology, Medical Center University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany
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Karagoz A, Alis D, Seker ME, Zeybel G, Yergin M, Oksuz I, Karaarslan E. Anatomically guided self-adapting deep neural network for clinically significant prostate cancer detection on bi-parametric MRI: a multi-center study. Insights Imaging 2023; 14:110. [PMID: 37337101 DOI: 10.1186/s13244-023-01439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a self-adapting deep network, trained on large-scale bi-parametric MRI data, in detecting clinically significant prostate cancer (csPCa) in external multi-center data from men of diverse demographics; to investigate the advantages of transfer learning. METHODS We used two samples: (i) Publicly available multi-center and multi-vendor Prostate Imaging: Cancer AI (PI-CAI) training data, consisting of 1500 bi-parametric MRI scans, along with its unseen validation and testing samples; (ii) In-house multi-center testing and transfer learning data, comprising 1036 and 200 bi-parametric MRI scans. We trained a self-adapting 3D nnU-Net model using probabilistic prostate masks on the PI-CAI data and evaluated its performance on the hidden validation and testing samples and the in-house data with and without transfer learning. We used the area under the receiver operating characteristic (AUROC) curve to evaluate patient-level performance in detecting csPCa. RESULTS The PI-CAI training data had 425 scans with csPCa, while the in-house testing and fine-tuning data had 288 and 50 scans with csPCa, respectively. The nnU-Net model achieved an AUROC of 0.888 and 0.889 on the hidden validation and testing data. The model performed with an AUROC of 0.886 on the in-house testing data, with a slight decrease in performance to 0.870 using transfer learning. CONCLUSIONS The state-of-the-art deep learning method using prostate masks trained on large-scale bi-parametric MRI data provides high performance in detecting csPCa in internal and external testing data with different characteristics, demonstrating the robustness and generalizability of deep learning within and across datasets. CLINICAL RELEVANCE STATEMENT A self-adapting deep network, utilizing prostate masks and trained on large-scale bi-parametric MRI data, is effective in accurately detecting clinically significant prostate cancer across diverse datasets, highlighting the potential of deep learning methods for improving prostate cancer detection in clinical practice.
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Affiliation(s)
- Ahmet Karagoz
- Department of Computer Engineering, Istanbul Technical University, Istanbul, Turkey
- Artificial Intelligence and Information Technologies, Hevi AI Health, Istanbul, Turkey
| | - Deniz Alis
- Artificial Intelligence and Information Technologies, Hevi AI Health, Istanbul, Turkey.
- Department of Radiology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - Mustafa Ege Seker
- School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Gokberk Zeybel
- School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Mert Yergin
- Artificial Intelligence and Information Technologies, Hevi AI Health, Istanbul, Turkey
| | - Ilkay Oksuz
- Department of Computer Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Ercan Karaarslan
- Department of Radiology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Xu L, Zhang G, Zhang D, Zhang J, Zhang X, Bai X, Chen L, Peng Q, Jin R, Mao L, Li X, Jin Z, Sun H. Development and clinical utility analysis of a prostate zonal segmentation model on T2-weighted imaging: a multicenter study. Insights Imaging 2023; 14:44. [PMID: 36928683 PMCID: PMC10020392 DOI: 10.1186/s13244-023-01394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/19/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES To automatically segment prostate central gland (CG) and peripheral zone (PZ) on T2-weighted imaging using deep learning and assess the model's clinical utility by comparing it with a radiologist annotation and analyzing relevant influencing factors, especially the prostate zonal volume. METHODS A 3D U-Net-based model was trained with 223 patients from one institution and tested using one internal testing group (n = 93) and two external testing datasets, including one public dataset (ETDpub, n = 141) and one private dataset from two centers (ETDpri, n = 59). The Dice similarity coefficients (DSCs), 95th Hausdorff distance (95HD), and average boundary distance (ABD) were calculated to evaluate the model's performance and further compared with a junior radiologist's performance in ETDpub. To investigate factors influencing the model performance, patients' clinical characteristics, prostate morphology, and image parameters in ETDpri were collected and analyzed using beta regression. RESULTS The DSCs in the internal testing group, ETDpub, and ETDpri were 0.909, 0.889, and 0.869 for CG, and 0.844, 0.755, and 0.764 for PZ, respectively. The mean 95HD and ABD were less than 7.0 and 1.3 for both zones. The U-Net model outperformed the junior radiologist, having a higher DSC (0.769 vs. 0.706) and higher intraclass correlation coefficient for volume estimation in PZ (0.836 vs. 0.668). CG volume and Magnetic Resonance (MR) vendor were significant influencing factors for CG and PZ segmentation. CONCLUSIONS The 3D U-Net model showed good performance for CG and PZ auto-segmentation in all the testing groups and outperformed the junior radiologist for PZ segmentation. The model performance was susceptible to prostate morphology and MR scanner parameters.
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Affiliation(s)
- Lili Xu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.,National Center for Quality Control of Radiology, Beijing, China
| | - Gumuyang Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Daming Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Jiahui Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xiaoxiao Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xin Bai
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Li Chen
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Qianyu Peng
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Ru Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Li Mao
- AI Lab, Deepwise Healthcare, Beijing, China
| | - Xiuli Li
- AI Lab, Deepwise Healthcare, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China. .,National Center for Quality Control of Radiology, Beijing, China.
| | - Hao Sun
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China. .,National Center for Quality Control of Radiology, Beijing, China.
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Ayyad SM, Badawy MA, Shehata M, Alksas A, Mahmoud A, Abou El-Ghar M, Ghazal M, El-Melegy M, Abdel-Hamid NB, Labib LM, Ali HA, El-Baz A. A New Framework for Precise Identification of Prostatic Adenocarcinoma. SENSORS 2022; 22:s22051848. [PMID: 35270995 PMCID: PMC8915102 DOI: 10.3390/s22051848] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
Prostate cancer, which is also known as prostatic adenocarcinoma, is an unconstrained growth of epithelial cells in the prostate and has become one of the leading causes of cancer-related death worldwide. The survival of patients with prostate cancer relies on detection at an early, treatable stage. In this paper, we introduce a new comprehensive framework to precisely differentiate between malignant and benign prostate cancer. This framework proposes a noninvasive computer-aided diagnosis system that integrates two imaging modalities of MR (diffusion-weighted (DW) and T2-weighted (T2W)). For the first time, it utilizes the combination of functional features represented by apparent diffusion coefficient (ADC) maps estimated from DW-MRI for the whole prostate in combination with texture features with its first- and second-order representations, extracted from T2W-MRIs of the whole prostate, and shape features represented by spherical harmonics constructed for the lesion inside the prostate and integrated with PSA screening results. The dataset presented in the paper includes 80 biopsy confirmed patients, with a mean age of 65.7 years (43 benign prostatic hyperplasia, 37 prostatic carcinomas). Experiments were conducted using different well-known machine learning approaches including support vector machines (SVM), random forests (RF), decision trees (DT), and linear discriminant analysis (LDA) classification models to study the impact of different feature sets that lead to better identification of prostatic adenocarcinoma. Using a leave-one-out cross-validation approach, the diagnostic results obtained using the SVM classification model along with the combined feature set after applying feature selection (88.75% accuracy, 81.08% sensitivity, 95.35% specificity, and 0.8821 AUC) indicated that the system’s performance, after integrating and reducing different types of feature sets, obtained an enhanced diagnostic performance compared with each individual feature set and other machine learning classifiers. In addition, the developed diagnostic system provided consistent diagnostic performance using 10-fold and 5-fold cross-validation approaches, which confirms the reliability, generalization ability, and robustness of the developed system.
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Affiliation(s)
- Sarah M. Ayyad
- Computers and Systems Department, Faculty of Engineering, Mansoura University, Mansoura 35511, Egypt; (S.M.A.); (N.B.A.-H.); (L.M.L.); (H.A.A.)
| | - Mohamed A. Badawy
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt; (M.A.B.); (M.A.E.-G.)
| | - Mohamed Shehata
- BioImaging Laboratory, Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.S.); (A.A.); (A.M.)
| | - Ahmed Alksas
- BioImaging Laboratory, Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.S.); (A.A.); (A.M.)
| | - Ali Mahmoud
- BioImaging Laboratory, Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.S.); (A.A.); (A.M.)
| | - Mohamed Abou El-Ghar
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt; (M.A.B.); (M.A.E.-G.)
| | - Mohammed Ghazal
- Department of Electrical and Computer Engineering, College of Engineering, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates;
| | - Moumen El-Melegy
- Department of Electrical Engineering, Assiut University, Assiut 71511, Egypt;
| | - Nahla B. Abdel-Hamid
- Computers and Systems Department, Faculty of Engineering, Mansoura University, Mansoura 35511, Egypt; (S.M.A.); (N.B.A.-H.); (L.M.L.); (H.A.A.)
| | - Labib M. Labib
- Computers and Systems Department, Faculty of Engineering, Mansoura University, Mansoura 35511, Egypt; (S.M.A.); (N.B.A.-H.); (L.M.L.); (H.A.A.)
| | - H. Arafat Ali
- Computers and Systems Department, Faculty of Engineering, Mansoura University, Mansoura 35511, Egypt; (S.M.A.); (N.B.A.-H.); (L.M.L.); (H.A.A.)
- Faulty of Artificial Intelligence, Delta University for Science and Technology, Mansoura 35516, Egypt
| | - Ayman El-Baz
- BioImaging Laboratory, Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.S.); (A.A.); (A.M.)
- Correspondence:
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