Multi-needle Localization for Pelvic Seed Implant Brachytherapy based on Tip-handle Detection and Matching

Accurate multi-needle localization in intraoperative CT images is crucial for optimizing seed placement in pelvic seed implant brachytherapy. However, this task is challenging due to poor image contrast and needle adhesion. This paper presents a novel approach that reframes needle localization as a tip-handle detection and matching problem to overcome these difficulties. An anchor-free network, based on HRNet, is proposed to extract multi-scale features and accurately detect needle tips and handles by predicting their centers and orientations using decoupled branches for heatmap regression and polar angle prediction. To associate detected tips and handles into individual needles, a greedy matching and merging (GMM) method designed to solve the unbalanced assignment problem with constraints (UAP-C) is presented. The GMM method iteratively selects the most probable tip-handle pairs and merges them based on a distance metric to reconstruct 3D needle paths. Evaluated on a dataset of 100 patients, the proposed method demonstrates superior performance, achieving higher precision and F1 score compared to segmentation-based baselines utilizing the nnUNet model, thereby offering a more robust and accurate solution for needle localization in complex clinical scenarios. The source code is available at: https://github.com/BUAAXZzz/CTNeedleLocalization.