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Automatic multi-anatomical skull structure segmentation of cone-beam computed tomography scans using 3D UNETR

Key Investigators
  - Maxime Gillot (UoM)
 
  - Baptiste Baquero (UoM)
 
  - Celia Le (UoM)
 
  - Romain Deleat-Besson (UoM)
 
  - Jonas Bianchi (UoM, UoP)
 
  - Antonio Ruellas (UoM)
 
  - Marcela Gurge (UoM)
 
  - Marilia Yatabe (UoM)
 
  - Najla Al Turkestani (UoM)
 
  - Kayvan Najarian (UoM)
 
  - Reza Soroushmehr (UoM)
 
  - Steve Pieper (ISOMICS)
 
  - Ron Kikinis (Harvard Medical School)
 
  - Beatriz Paniagua (Kitware)
 
  - Jonathan Gryak (UoM)
 
  - Marcos Ioshida (UoM)
 
  - Camila Massaro (UoM)
 
  - Liliane Gomes (UoM)
 
  - Heesoo Oh (UoP)
 
  - Karine Evangelista (UoM)
 
  - Cauby Chaves Jr
 
  - Daniela Garib
 
  - F ́abio Costa (UoM)
 
  - Erika Benavides (UoM)
 
  - Fabiana Soki (UoM)
 
  - Jean-Christophe Fillion-Robin (Kitware)
 
  - Hina Joshi (UoNC)
 
  - Lucia Cevidanes (UoM)
 
  - Juan Prieto (UoNC)
 
Project Description
The segmentation of medical and dental images is a fundamental step in automated clinical decision support systems.
It supports the entire clinical workflow from diagnosis, therapy planning, intervention, and follow-up. 
In this paper, we propose a novel tool to accurately process a full-face segmentation in about 5 minutes 
that would otherwise require an average of 7h of manual work by experienced clinicians. 
This work focuses on the integration of the state-of-the-art UNEt TRansformers (UNETR)
of the Medical Open Network for Artificial Intelligence (MONAI) framework. 
We trained and tested our models using 618 de-identified Cone-Beam Computed Tomography (CBCT) volumetric images of the head 
acquired with several parameters from different centers for a generalized clinical application. Our results on a 5-fold cross-validation 
showed high accuracy and robustness with an Dice up to 0.962 pm 0.02.
Objective
  - Create only one model for multiple structures.
 
  - Create a slicer module for the algorithm
 
  - Add new structure to segment
 
  - Deploy the AMASSS tool with the updated trained models
 
Approach and Plan
  - Get the data merged by the clinicians for the skull.
 
  - Use the begening of a slicer module to create a new one for AMASSS.
 
  - Use new dataset to train new HD models.
 
Progress and Next Steps
  - An algorithm has already been made to run segmentation out of slicer as a docker to implement in the DSCI
 
  - We collected data to generate segmentation model using the MONAI librairie
 
  - For large field of view :
    
      - A model has been trained to generate a segmentation of 5 skull structures (mandible, maxilla, cranial base, cervical vertebra and upper airway)
 
      - An other to segment the skin.
 
    
   
  - For small field of view :
    
      - A model for upper and lower root canal has been trained as well as HD mandible and maxilla
 
      - We still need data to train networks for crown and mandible canal segmentation
 
    
   
  - To be more user friendly, the development of an AMASSS module for Slicer has been started in march.
 
  - The UI of a slicer module was already started befor project week and has now been updated.
 
  - We linked the UI with a CLI module to run the prediction/segmentation directly on the user computer through Slicer 5’s  python 3.9
 
  - 
    
The module has been tested locally with clinicians and is ready to be deployed as a Slicer module as a part of the slicer CMF extention
( The code is available at https://github.com/Maxlo24/Slicer_Automatic_Tools )
   
  - We colaborated with Slicer Batch Annonymize (Hina Shah, Juan Carolos Prieto) to use AMASSS as a first step to perform defacing of patients scans during the batch anonymisation process. ( Figure 3 Mask for defacing )
 
Illustrations
  - Contrast correction and rescaling to the trained model spacing
 
  - Use the UNETR classifier network through the scan to perform a first raw segmentation
 
  - Post process steps to clean and smooth the segmentation
 
  - Upscale to the original images size
 

2. Screen of the slicer module during a segmentation

  - The scan intensity in the pink region ( mainely nose, lips and eyes ) will be set to 0 to make it impossible to identify the patient
 
  - The bones segmentations are used to make sure we dont remove important informations during the process
 

Background and References