Enabling machine learning in X-ray-based procedures via realistic simulation of image formation

Purpose Machine learning-based approaches now outperform competing methods in most disciplines relevant to diagnostic radiology. Image-guided procedures, however, have not yet benefited substantially from the advent of deep learning, in particular because images for procedural guidance are not archived and thus unavailable for learning, and even if they were available, annotations would be a severe challenge due to the vast amounts of data. In silico simulation of X-ray images from 3D CT is an interesting alternative to using true clinical radiographs since labeling is comparably easy and potentially readily available. Methods We extend our framework for fast and realistic simulation of fluoroscopy from high-resolution CT, called DeepDRR , with tool modeling capabilities. The framework is publicly available, open source, and tightly integrated with the software platforms native to deep learning, i.e., Python, PyTorch, and PyCuda. DeepDRR relies on machine learning for material decomposition and scatter estimation in 3D and 2D, respectively, but uses analytic forward projection and noise injection to ensure acceptable computation times. On two X-ray image analysis tasks, namely (1) anatomical landmark detection and (2) segmentation and localization of robot end-effectors, we demonstrate that convolutional neural networks (ConvNets) trained on DeepDRR s generalize well to real data without re-training or domain adaptation. To this end, we use the exact same training protocol to train ConvNets on naïve and DeepDRR s and compare their performance on data of cadaveric specimens acquired using a clinical C-arm X-ray system. Results Our findings are consistent across both considered tasks. All ConvNets performed similarly well when evaluated on the respective synthetic testing set. However, when applied to real radiographs of cadaveric anatomy, ConvNets trained on DeepDRR s significantly outperformed ConvNets trained on naïve DRRs ( p < 0.01 ). Conclusion Our findings for both tasks are positive and promising. Combined with complementary approaches, such as image style transfer, the proposed framework for fast and realistic simulation of fluoroscopy from CT contributes to promoting the implementation of machine learning in X-ray-guided procedures. This paradigm shift has the potential to revolutionize intra-operative image analysis to simplify surgical workflows.