Csaba Pinter

PLUS: open-source toolkit for ultrasound-guided intervention systems.

A variety of advanced image analysis methods have been under the development for ultrasound-guided interventions. Unfortunately, the transition from an image analysis algorithm to clinical feasibility trials as part of an intervention system requires integration of many components, such as imaging and tracking devices, data processing algorithms, and visualization software. The objective of our paper is to provide a freely available open-source software platform-PLUS: Public software Library for Ultrasound-to facilitate rapid prototyping of ultrasound-guided intervention systems for translational clinical research. PLUS provides a variety of methods for interventional tool pose and ultrasound image acquisition from a wide range of tracking and imaging devices, spatial and temporal calibration, volume reconstruction, simulated image generation, and recording and live streaming of the acquired data. This paper introduces PLUS, explains its functionality and architecture, and presents typical uses and performance in ultrasound-guided intervention systems. PLUS fulfills the essential requirements for the development of ultrasound-guided intervention systems and it aspires to become a widely used translational research prototyping platform.

SlicerRT: Radiation therapy research toolkit for 3D Slicer

PURPOSE Interest in adaptive radiation therapy research is constantly growing, but software tools available for researchers are mostly either expensive, closed proprietary applications, or free open-source packages with limited scope, extensibility, reliability, or user support. To address these limitations, we propose SlicerRT, a customizable, free, and open-source radiation therapy research toolkit. SlicerRT aspires to be an open-source toolkit for RT research, providing fast computations, convenient workflows for researchers, and a general image-guided therapy infrastructure to assist clinical translation of experimental therapeutic approaches. It is a medium into which RT researchers can integrate their methods and algorithms, and conduct comparative testing. METHODS SlicerRT was implemented as an extension for the widely used 3D Slicer medical image visualization and analysis application platform. SlicerRT provides functionality specifically designed for radiation therapy research, in addition to the powerful tools that 3D Slicer offers for visualization, registration, segmentation, and data management. The feature set of SlicerRT was defined through consensus discussions with a large pool of RT researchers, including both radiation oncologists and medical physicists. The development processes used were similar to those of 3D Slicer to ensure software quality. Standardized mechanisms of 3D Slicer were applied for documentation, distribution, and user support. The testing and validation environment was configured to automatically launch a regression test upon each software change and to perform comparison with ground truth results provided by other RT applications. RESULTS Modules have been created for importing and loading DICOM-RT data, computing and displaying dose volume histograms, creating accumulated dose volumes, comparing dose volumes, and visualizing isodose lines and surfaces. The effectiveness of using 3D Slicer with the proposed SlicerRT extension for radiation therapy research was demonstrated on multiple use cases. CONCLUSIONS A new open-source software toolkit has been developed for radiation therapy research. SlicerRT can import treatment plans from various sources into 3D Slicer for visualization, analysis, comparison, and processing. The provided algorithms are extensively tested and they are accessible through a convenient graphical user interface as well as a flexible application programming interface.

Perk Tutor: An Open-Source Training Platform for Ultrasound-Guided Needle Insertions

Image-guided needle placement, including ultrasound (US)-guided techniques, have become commonplace in modern medical diagnosis and therapy. To ensure that the next generations of physicians are competent using this technology, efficient and effective educational programs need to be developed. This paper presents the Perk Tutor: a configurable, open-source training platform for US-guided needle insertions. The Perk Tutor was successfully tested in three different configurations to demonstrate its adaptability to different procedures and learning objectives. 1) The Targeting Tutor, designed to develop US-guided needle targeting skills, 2) the Lumbar Tutor, designed for practicing US-guided lumbar spinal procedures, and (3) the Prostate Biopsy Tutor, configured for US-guided prostate biopsies. The Perk Tutor provides the trainee with quantitative feedback on progress toward the specific learning objectives of each configuration. Configurations were implemented through simple rearrangement of hardware and software components, attesting to the modularity and ease of configuration. The Perk Tutor is provided as a free resource to enable research and development of educational programs for US-guided intervention.

Implementation of an efficient workflow process for gel dosimetry using 3D Slicer

One challenge in gel dosimetry is the manipulation and analysis of complex data sets from different systems. In this paper, we describe a simple and fast gel dosimetry analysis tool for radiation therapy dose deliveries. Using the open source medical imaging software 3D Slicer, an extension was designed and implemented for the purpose of importing treatment planning system dose, CT imaging from simulation and at treatment, and optical CT gel dosimeter data. The extension also allows for calibration of gel dosimeter data, registration, and comparison of 3D dose distributions. The development of an open source gel dosimetry processing environment may help adoption of gels in the clinic.

Performing radiation therapy research using the open-source SlicerRT toolkit

Radiation therapy (RT) is a common treatment option for a wide variety of cancer types. Despite significant improvements in this technique over the past years, software tools for research in RT are limited to either expensive, closed, proprietary applications or heterogeneous sets of open-source software packages with limited scope, reliability, and user support. Our SlicerRT toolkit aspires to overcome these limitations by providing an extensive set of RT research tools leveraging the advanced visualization and image analysis features of its base platform 3D Slicer.

Reconstruction of surfaces from planar contours through contour interpolation

Segmented structures such as targets or organs at risk are typically stored as 2D contours contained on evenly spaced cross sectional images (slices). Contour interpolation algorithms are implemented in radiation oncology treatment planning software to turn 2D contours into a 3D surface, however the results differ between algorithms, causing discrepancies in analysis. Our goal was to create an accurate and consistent contour interpolation algorithm that can handle issues such as keyhole contours, rapid changes, and branching. This was primarily motivated by radiation therapy research using the open source SlicerRT extension for the 3D Slicer platform. The implemented algorithm triangulates the mesh by minimizing the length of edges spanning the contours with dynamic programming. The first step in the algorithm is removing keyholes from contours. Correspondence is then found between contour layers and branching patterns are determined. The final step is triangulating the contours and sealing the external contours. The algorithm was tested on contours segmented on computed tomography (CT) images. Some cases such as inner contours, rapid changes in contour size, and branching were handled well by the algorithm when encountered individually. There were some special cases in which the simultaneous occurrence of several of these problems in the same location could cause the algorithm to produce suboptimal mesh. An open source contour interpolation algorithm was implemented in SlicerRT for reconstructing surfaces from planar contours. The implemented algorithm was able to generate qualitatively good 3D mesh from the set of 2D contours for most tested structures.

dcmqi: An Open Source Library for Standardized Communication of Quantitative Image Analysis Results Using DICOM

Quantitative analysis of clinical image data is an active area of research that holds promise for precision medicine, early assessment of treatment response, and objective characterization of the disease. Interoperability, data sharing, and the ability to mine the resulting data are of increasing importance, given the explosive growth in the number of quantitative analysis methods being proposed. The Digital Imaging and Communications in Medicine (DICOM) standard is widely adopted for image and metadata in radiology. dcmqi (DICOM for Quantitative Imaging) is a free, open source library that implements conversion of the data stored in commonly used research formats into the standard DICOM representation. dcmqi source code is distributed under BSD-style license. It is freely available as a precompiled binary package for every major operating system, as a Docker image, and as an extension to 3D Slicer. Installation and usage instructions are provided in the GitHub repository at https://github.com/qiicr/dcmqi Cancer Res; 77(21); e87-90. ©2017 AACR.

Measuring radiation treatment plan similarity in the cloud

Radiation therapy is a form of cancer treatment in which carefully designed plans are used to direct treatment over multiple occasions (fractions). Creating radiation plans is quite laborious, so it is not feasible to manually create a plan for each fraction to maintain treatment quality. We propose to use a database of plans to find the most similar anatomy, based on which a suitable daily plan might be automatically created, thus reducing staff time. However, the computation for finding the most similar plan is long and computationally intensive. We present a method for finding the most similar plan using cloud resources to reduce computation time. The preliminary, unoptimized implementation finds the most similar plan in less than 7 minutes when choosing from five plans, and it is anticipated that increasing the number of plans will result in only a small relative increase in computation time.

SU-E-T-231: Cross-Validation of 3D Gamma Comparison Tools

Purpose: Moving the computational analysis for 3D gel dosimetry into the 3D Slicer (www.slicer.org) environment has made gel dosimetry more clinically accessible. To ensure accuracy, we cross-validate the 3D gamma comparison module in 3D Slicer with an independently developed algorithm using simulated and measured dose distributions. Methods: Two reference dose distributions were generated using the Varian Eclipse treatment planning system. The first distribution consisted of a four-field box irradiation delivered to a plastic water phantom and the second, a VMAT plan delivered to a gel dosimeter phantom. The first reference distribution was modified within Eclipse to create an evaluated dose distribution by spatially shifting one field by 3mm, increasing the monitor units of the second field, applying a dynamic wedge for the third field, and leaving the fourth field unchanged. The VMAT plan was delivered to a gel dosimeter and the evaluated dose in the gel was calculated from optical CT measurements. Results from the gamma comparison tool built into the SlicerRT toolbox were compared to results from our in-house gamma algorithm implemented in Matlab (via MatlabBridge in 3D Slicer). The effects of noise, resolution and the exchange of reference and evaluated designations on the gamma comparison were also examined. Results: Perfect agreement was found between the gamma results obtained using the SlicerRT tool and our Matlab implementation for both the four-field box and gel datasets. The behaviour of the SlicerRT comparison with respect to changes in noise, resolution and the role of the reference and evaluated dose distributions was consistent with previous findings. Conclusion: Two independently developed gamma comparison tools have been cross-validated and found to be identical. As we transition our gel dosimetry analysis from Matlab to 3D Slicer, this validation serves as an important test towards ensuring the consistency of dose comparisons using the 3D Slicer environment.

A tool for intraoperative visualization of registration results

PURPOSE: Validation of image registration algorithms is frequently accomplished by the visual inspection of the resulting linear or deformable transformation due to the lack of ground truth information. Visualization of transformations produced by image registration algorithms during image-guided interventions allows for a clinician to evaluate the accuracy of the result transformation. Software packages that perform the visualization of transformations exist, but are not part of a clinically usable software application. We present a tool that visualizes both linear and deformable transformations and is integrated in an open-source software application framework suited for intraoperative use and general evaluation of registration algorithms. METHODS: A choice of six different modes are available for visualization of a transform. Glyph visualization mode uses oriented and scaled glyphs, such as arrows, to represent the displacement field in 3D whereas glyph slice visualization mode creates arrows that can be seen as a 2D vector field. Grid visualization mode creates deformed grids shown in 3D whereas grid slice visualization mode creates a series of 2D grids. Block visualization mode creates a deformed bounding box of the warped volume. Finally, contour visualization mode creates isosurfaces and isolines that visualize the magnitude of displacement across a volume. The application 3D Slicer was chosen as the platform for the transform visualizer tool. 3D Slicer is a comprehensive open-source application framework developed for medical image computing and used for intra-operative registration. RESULTS: The transform visualizer tool fulfilled the requirements for quick evaluation of intraoperative image registrations. Visualizations were generated in 3D Slicer with little computation time on realistic datasets. It is freely available as an extension for 3D Slicer. CONCLUSION: A tool for the visualization of displacement fields was created and integrated into 3D Slicer, facilitating the validation of image registration algorithms within a comprehensive application framework suited for intraoperative use.