Multi-Catheter Digitization in Brachytherapy via Few-Shot Synthetic-to-Real Learning and Structure-Aware Tracking

Accurate catheter digitization in CT-guided interstitial brachytherapy is a critical but time-consuming task, especially for complex implant configurations. We developed a data-efficient, physics-guided framework for automated multi-catheter digitization with minimal clinical annotation. The pipeline consists of two stages. First, an implant region-aware network was pretrained on synthetic CT volumes with simulated metallic signatures and then fine-tuned using only 10 clinical cases. Second, a structure-aware reconstruction module combined a direction-constrained 3D Hough transform with synchronous physics-constrained inward tracking to separate adherent catheter trajectories. The method was evaluated by patient-level five-fold cross-validation on 203 treatment fractions from 38 patients. The fine-tuned network achieved an HD95 of 0.853 +/- 0.362 mm. End-to-end evaluation yielded an F1 score of 0.891 +/- 0.178, with shaft and tip errors of 0.334 +/- 0.367 mm and 0.896 +/- 0.680 mm, respectively. In cases with severe catheter adhesion, the tracking F1 score remained 0.843 +/- 0.190. The complete workflow required approximately 11.6 s per case. These results indicate that combining few-shot synthetic-to-real learning with physics-guided structural tracking can provide robust and efficient multi-catheter digitization for time-sensitive clinical workflows.