The Stacked-Ellipse Algorithm: An Ultrasound-Based 3-D Uterine Segmentation Tool for Enabling Adaptive Radiotherapy for Uterine Cervix Cancer

The stacked-ellipse (SE) algorithm was developed to rapidly segment the uterus on 3-D ultrasound (US) for the purpose of enabling US-guided adaptive radiotherapy (RT) for uterine cervix cancer patients. The algorithm was initialised manually on a single sagittal slice to provide a series of elliptical initialisation contours in semi-axial planes along the uterus. The elliptical initialisation contours were deformed according to US features such that they conformed to the uterine boundary. The uterus of 15 patients was scanned with 3-D US using the Clarity System (Elekta Ltd.) at multiple days during RT and manually contoured (n = 49 images and corresponding contours). The median (interquartile range) Dice similarity coefficient and mean surface-to-surface-distance between the SE algorithm and manual contours were 0.80 (0.03) and 3.3 (0.2) mm, respectively, which are within the ranges of reported inter-observer contouring variabilities. The SE algorithm could be implemented in adaptive RT to precisely segment the uterus on 3-D US.

[1]  J. Bamber,et al.  Towards ultrasound‐guided adaptive radiotherapy for cervical cancer: Evaluation of Elekta's semiautomated uterine segmentation method on 3D ultrasound images , 2017, Medical physics.

[2]  S. Dwivedi,et al.  Obesity May Be Bad: Compressed Convolutional Networks for Biomedical Image Segmentation , 2020 .

[3]  Nassir Navab,et al.  Integrating Diagnostic B-Mode Ultrasonography Into CT-Based Radiation Treatment Planning , 2007, IEEE Transactions on Medical Imaging.

[4]  Aaron Fenster,et al.  Automatic 3D segmentation of ultrasound images using atlas registration and statistical texture prior , 2011, Medical Imaging.

[5]  M. Lachaine,et al.  INTRAFRACTIONAL PROSTATE MOTION MANAGEMENT WITH THE CLARITY AUTOSCAN SYSTEM , 2013 .

[6]  Sheng Xu,et al.  Discrete Deformable Model Guided by Partial Active Shape Model for TRUS Image Segmentation , 2010, IEEE Transactions on Biomedical Engineering.

[7]  M S Hoogeman,et al.  Individualized nonadaptive and online-adaptive intensity-modulated radiotherapy treatment strategies for cervical cancer patients based on pretreatment acquired variable bladder filling computed tomography scans. , 2012, International journal of radiation oncology, biology, physics.

[8]  D. Verellen,et al.  Volumetric imaging by megavoltage computed tomography for assessment of internal organ motion during radiotherapy for cervical cancer. , 2010, International journal of radiation oncology, biology, physics.

[9]  Davide Fontanarosa,et al.  Review of ultrasound image guidance in external beam radiotherapy: I. Treatment planning and inter-fraction motion management , 2015, Physics in medicine and biology.

[10]  Martijn Ketelaars,et al.  Conventional, conformal, and intensity-modulated radiation therapy treatment planning of external beam radiotherapy for cervical cancer: The impact of tumor regression. , 2006, International journal of radiation oncology, biology, physics.

[11]  L. R. Dice.  Measures of the Amount of Ecologic Association Between Species , 1945 .

[12]  J. Alison Noble,et al.  Ultrasound image segmentation: a survey , 2006, IEEE Transactions on Medical Imaging.

[14]  Michael Egmont-Petersen,et al.  Image processing with neural networks - a review , 2002, Pattern Recognit..

[15]  Thomas Brox,et al.  U-Net: Convolutional Networks for Biomedical Image Segmentation , 2015, MICCAI.

[16]  S. Bai,et al.  An assessment of interfractional bladder, rectum and vagina motion in postoperative cervical cancer based on daily cone-beam computed tomography. , 2016, Molecular and clinical oncology.

[17]  Gustavo Carneiro,et al.  The Segmentation of the Left Ventricle of the Heart From Ultrasound Data Using Deep Learning Architectures and Derivative-Based Search Methods , 2012, IEEE Transactions on Image Processing.

[18]  C. Burckhardt.  Speckle in ultrasound B-mode scans , 1978, IEEE Transactions on Sonics and Ultrasonics.

[19]  Issam El Naqa,et al.  Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. , 2011, International journal of radiation oncology, biology, physics.

[20]  Yongmin Kim,et al.  Parametric shape modeling using deformable superellipses for prostate segmentation , 2004, IEEE Transactions on Medical Imaging.

[21]  Bernard Chazelle,et al.  An optimal convex hull algorithm in any fixed dimension , 1993, Discret. Comput. Geom..

[22]  J. Staffurth,et al.  A systematic review of organ motion and image-guided strategies in external beam radiotherapy for cervical cancer. , 2014, Clinical oncology (Royal College of Radiologists (Great Britain)).

[23]  Luiza Bondar,et al.  Clinical implementation of an online adaptive plan-of-the-day protocol for nonrigid motion management in locally advanced cervical cancer IMRT. , 2014, International journal of radiation oncology, biology, physics.

[24]  J. Flusser,et al.  Numerically Stable Direct Least Squares Fitting of Ellipses , 1998 .

[25]  Jason Dowling,et al.  A review of segmentation and deformable registration methods applied to adaptive cervical cancer radiation therapy treatment planning , 2015, Artif. Intell. Medicine.

[26]  Mischa S. Hoogeman,et al.  Towards Automatic Plan Selection for Radiotherapy of Cervical Cancer by Fast Automatic Segmentation of Cone Beam CT Scans , 2014, MICCAI.

[27]  R. Halír.  Numerically Stable Direct Least Squares Fitting of Ellipses , 1998 .

[28]  Young-Bin Cho,et al.  Inter- and intrafractional tumor and organ movement in patients with cervical cancer undergoing radiotherapy: a cinematic-MRI point-of-interest study. , 2008, International journal of radiation oncology, biology, physics.

[29]  Yi Le,et al.  Tumor boundary detection in ultrasound imagery using multi-scale generalized gradient vector flow , 2014, Journal of Medical Ultrasonics.

[30]  T. Yamashiro,et al.  Predictive factors of uterine movement during definitive radiotherapy for cervical cancer , 2016, Journal of radiation research.