Graduation Year

2004

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Electrical Engineering

Major Professor

Robert P. Velthuizen, Ph.D.

Co-Major Professor

Kenneth A. Buckle, Ph.D.

Committee Member

Laurence P. Clarke, Ph.D.

Committee Member

Stanley R. Deans, Ph.D.

Committee Member

John J. Heine, Ph.D.

Committee Member

Kent H. Larsen, Ph.D.

Keywords

automatic segmentation, glioma, magnetic resonance, knowledge guided, k-nearest neighbor

Abstract

Radiation therapy seeks to effectively irradiate the tumor cells while minimizing the dose to adjacent normal cells. Prior research found that the low success rates for treating brain tumors would be improved with higher radiation doses to the tumor area. This is feasible only if the target volume can be precisely identified. However, the definition of tumor volume is still based on time-intensive, highly subjective manual outlining by radiation oncologists. In this study the effectiveness of two automated Magnetic Resonance Imaging (MRI) segmentation methods, k-Nearest Neighbors (kNN) and Knowledge-Guided (KG), in determining the Gross Tumor Volume (GTV) of brain tumors for use in radiation therapy was assessed. Three criteria were applied: accuracy of the contours; quality of the resulting treatment plan in terms of dose to the tumor; and a novel treatment plan evaluation technique based on post-treatment images.

The kNN method was able to segment all cases while the KG method was limited to enhancing tumors and gliomas with clear enhancing edges. Various software applications were developed to create a closed smooth contour that encompassed the tumor pixels from the segmentations and to integrate these results into the treatment planning software. A novel, probabilistic measurement of accuracy was introduced to compare the agreement of the segmentation methods with the weighted average physician volume. Both computer methods under-segment the tumor volume when compared with the physicians but performed within the variability of manual contouring (28% plus/minus12% for inter-operator variability).

Computer segmentations were modified vertically to compensate for their under-segmentation. When comparing radiation treatment plans designed from physician-defined tumor volumes with treatment plans developed from the modified segmentation results, the reference target volume was irradiated within the same level of conformity. Analysis of the plans based on post- treatment MRI showed that the segmentation plans provided similar dose coverage to areas being treated by the original treatment plans.

This research demonstrates that computer segmentations provide a feasible route to automatic target volume definition. Because of the lower variability and greater efficiency of the automated techniques, their use could lead to more precise plans and better prognosis for brain tumor patients.

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