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Title: A super-voxel-based method for generating surrogate lung ventilation images from CT
Authors: Chen, Z 
Huang, YH 
Kong, FM
Ho, WY
Ren, G 
Cai, J 
Issue Date: 2023
Source: Frontiers in physiology, 2023, v. 14, 1085158
Abstract: Purpose: This study aimed to develop and evaluate (Formula presented.), a super-voxel-based method for surrogate computed tomography ventilation imaging (CTVI).
Methods and Materials: The study used four-dimensional CT (4DCT) and single-photon emission computed tomography (SPECT) images and corresponding lung masks from 21 patients with lung cancer obtained from the Ventilation And Medical Pulmonary Image Registration Evaluation dataset. The lung volume of the exhale CT for each patient was segmented into hundreds of super-voxels using the Simple Linear Iterative Clustering (SLIC) method. These super-voxel segments were applied to the CT and SPECT images to calculate the mean density values (Dmean) and mean ventilation values (Ventmean), respectively. The final CT-derived ventilation images were generated by interpolation from the Dmean values to yield (Formula presented.). For the performance evaluation, the voxel- and region-wise differences between (Formula presented.) and SPECT were compared using Spearman’s correlation and the Dice similarity coefficient index. Additionally, images were generated using two deformable image registration (DIR)-based methods, (Formula presented.) and (Formula presented.), and compared with the SPECT images.
Results: The correlation between the Dmean and Ventmean of the super-voxel was 0.59 ± 0.09, representing a moderate-to-high correlation at the super-voxel level. In the voxel-wise evaluation, the (Formula presented.) method achieved a stronger average correlation (0.62 ± 0.10) with SPECT, which was significantly better than the correlations achieved with the (Formula presented.) (0.33 ± 0.14, p < 0.05) and (Formula presented.) (0.23 ± 0.11, p < 0.05) methods. For the region-wise evaluation, the Dice similarity coefficient of the high functional region for (Formula presented.) (0.63 ± 0.07) was significantly higher than the corresponding values for the (Formula presented.) (0.43 ± 0.08, p < 0.05) and (Formula presented.) (0.42 ± 0.05, p < 0.05) methods.
Conclusion: The strong correlation between (Formula presented.) and SPECT demonstrates the potential usefulness of this novel method of ventilation estimation for surrogate ventilation imaging.
Keywords: 4DCT
Lung cancer
Radiotherapy
Super-voxel
Ventilation
Publisher: Frontiers Research Foundation
Journal: Frontiers in physiology 
EISSN: 1664-042X
DOI: 10.3389/fphys.2023.1085158
Rights: Copyright © 2023 Chen, Huang, Kong, Ho, Ren and Cai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
The following publication Chen Z, Huang Y-H, Kong F-M, Ho WY, Ren G and Cai J (2023) A super-voxel-based method for generating surrogate lung ventilation images from CT. Front. Physiol. 14:1085158 is available at https://doi.org/10.3389/fphys.2023.1085158.
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