Reinforcing intra-operative tumour localisation with weak supervision from pre-operative appearances

Sidhart Sami, Ali Sharjeel, Sri Atluri, Miao Zhao, Caroline Roney +2

Limited tumour visibility on intra-operative images complicates surgical navigation, including liver hepatocellular carcinoma (HCC) targeting on computed tomography (CT) imaging. This makes labelled datasets difficult to curate for deep learning, and transferring pre-operative delineations through registration remains challenging due to intra-operative deformation and lack of paired pre- and intra-operative data. We propose to transfer tumour appearances learned from pre-operative magnetic resonance (MR) images to guide localisation on intra-operative CT through weak supervision. A classifier is trained to classify tumour presence on pre-operative images. This is applied to windows on intra-operative images, and despite the domain gap, it assigns higher tumour-presence probabilities on average to tumour-containing windows. These weak cross-domain signals guide a reinforcement learning agent to localise tumours on intra-operative images. We compare direct transfer, few-shot adaptation and synthetic transfer (trained using unpaired MR and CT), which translates CT into synthetic MR before localisation. On an external HCC cohort, synthetic transfer outperformed other tested methods…