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Semiautomated segmentation of head and neck cancers in 18F-FDG PET scans: A just-enough-interaction approach
Journal article   Open access   Peer reviewed

Semiautomated segmentation of head and neck cancers in 18F-FDG PET scans: A just-enough-interaction approach

Reinhard R Beichel, Markus Van Tol, Ethan J Ulrich, Christian Bauer, Tangel Chang, Kristin A Plichta, Brian J Smith, John J Sunderland, Michael M Graham, Milan Sonka, …
Medical physics (Lancaster), Vol.43(6), pp.2948-2964
06/2016
DOI: 10.1118/1.4948679
PMCID: PMC4874930
PMID: 27277044
url
https://doi.org/10.1118/1.4948679View
Published (Version of record) Open Access

Abstract

Purpose:\nThe purpose of this work was to develop, validate, and compare a highly computer-aided method for the segmentation of hot lesions in head and neck 18F-FDG PET scans.\nMethods:\nA semiautomated segmentation method was developed, which transforms the segmentation problem into a graph-based optimization problem. For this purpose, a graph structure around a user-provided approximate lesion centerpoint is constructed and a suitable cost function is derived based on local image statistics. To handle frequently occurring situations that are ambiguous (e.g., lesions adjacent to each other versus lesion with inhomogeneous uptake), several segmentation modes are introduced that adapt the behavior of the base algorithm accordingly. In addition, the authors present approaches for the efficient interactive local and global refinement of initial segmentations that are based on the “just-enough-interaction” principle. For method validation, 60 PET/CT scans from 59 different subjects with 230 head and neck lesions were utilized. All patients had squamous cell carcinoma of the head and neck. A detailed comparison with the current clinically relevant standard manual segmentation approach was performed based on 2760 segmentations produced by three experts.\nResults:\nSegmentation accuracy measured by the Dice coefficient of the proposed semiautomated and standard manual segmentation approach was 0.766 and 0.764, respectively. This difference was not statistically significant (p = 0.2145). However, the intra- and interoperator standard deviations were significantly lower for the semiautomated method. In addition, the proposed method was found to be significantly faster and resulted in significantly higher intra- and interoperator segmentation agreement when compared to the manual segmentation approach.\nConclusions:\nLack of consistency in tumor definition is a critical barrier for radiation treatment targeting as well as for response assessment in clinical trials and in clinical oncology decision-making. The properties of the authors approach make it well suited for applications in image-guided radiation oncology, response assessment, or treatment outcome prediction.
just-enough-interaction principle graph-based segmentation cancer segmentation optimal surface finding FDG PET imaging

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