Personalized pulmonary trunk modeling for intervention planning and valve assessment estimated from CT data

Pulmonary valve disease affects a significant portion of the global population and often occurs in conjunction with other heart dysfunctions. Emerging interventional methods enable percutaneous pulmonary valve implantation, which constitute an alternative to open heart surgery. As minimal invasive procedures become common practice, imaging and non-invasive assessment techniques turn into key clinical tools. In this paper, we propose a novel approach for intervention planning as well as morphological and functional quantification of the pulmonary trunk and valve. An abstraction of the anatomic structures is represented through a four-dimensional, physiological model able to capture large pathological variation. A hierarchical estimation, based on robust learning methods, is applied to identify the patient-specific model parameters from volumetric CT scans. The algorithm involves detection of piecewise affine parameters, fast centre-line computation and local surface delineation. The estimated personalized model enables for efficient and precise quantification of function and morphology. This ability may have impact on the assessment and surgical interventions of the pulmonary valve and trunk. Experiments performed on 50 cardiac computer tomography sequences demonstrated the average speed of 202 seconds and accuracy of 2.2mm for the proposed approach. An initial clinical validation yielded a significant correlation between model-based and expert measurements. To the best of our knowledge this is the first dynamic model of the pulmonary trunk and right ventricle outflow track estimated from CT data.

Dynamic layer separation for coronary DSA and enhancement in fluoroscopic sequences

This paper presents a new technique of coronary digital subtraction angiography which separates layers of moving background structures from dynamic fluoroscopic sequences of the heart and obtains moving layers of coronary arteries. A Bayeisan framework combines dense motion estimation, uncertainty propagation and statistical fusion to achieve reliable background layer estimation and motion compensation for coronary sequences. Encouraging results have been achieved on clinically acquired coronary sequences, where the proposed method considerably improves the visibility and perceptibility of coronary arteries undergoing breathing and cardiac movements. Perceptibility improvement is significant especially for very thin vessels. Clinical benefit is expected in the context of obese patients and deep angulation, as well as in the reduction of contrast dose in normal size patients.

Four-chamber heart modeling and automatic segmentation for 3-D cardiac CT volumes using marginal space learning and steerable features

We propose an automatic four-chamber heart segmentation system for the quantitative functional analysis of the heart from cardiac computed tomography (CT) volumes. Two topics are discussed: heart modeling and automatic model fitting to an unseen volume. Heart modeling is a nontrivial task since the heart is a complex nonrigid organ. The model must be anatomically accurate, allow manual editing, and provide sufficient information to guide automatic detection and segmentation. Unlike previous work, we explicitly represent important landmarks (such as the valves and the ventricular septum cusps) among the control points of the model. The control points can be detected reliably to guide the automatic model fitting process. Using this model, we develop an efficient and robust approach for automatic heart chamber segmentation in 3-D CT volumes. We formulate the segmentation as a two-step learning problem: anatomical structure localization and boundary delineation. In both steps, we exploit the recent advances in learning discriminative models. A novel algorithm, marginal space learning (MSL), is introduced to solve the 9-D similarity transformation search problem for localizing the heart chambers. After determining the pose of the heart chambers, we estimate the 3-D shape through learning-based boundary delineation. The proposed method has been extensively tested on the largest dataset (with 323 volumes from 137 patients) ever reported in the literature. To the best of our knowledge, our system is the fastest with a speed of 4.0 s per volume (on a dual-core 3.2-GHz processor) for the automatic segmentation of all four chambers.

Detection and measurement of fetal anatomies from ultrasound images using a constrained probabilistic boosting tree

We propose a novel method for the automatic detection and measurement of fetal anatomical structures in ultrasound images. This problem offers a myriad of challenges, including: difficulty of modeling the appearance variations of the visual object of interest, robustness to speckle noise and signal dropout, and large search space of the detection procedure. Previous solutions typically rely on the explicit encoding of prior knowledge and formulation of the problem as a perceptual grouping task solved through clustering or variational approaches. These methods are constrained by the validity of the underlying assumptions and usually are not enough to capture the complex appearances of fetal anatomies. We propose a novel system for fast automatic detection and measurement of fetal anatomies that directly exploits a large database of expert annotated fetal anatomical structures in ultrasound images. Our method learns automatically to distinguish between the appearance of the object of interest and background by training a constrained probabilistic boosting tree classifier. This system is able to produce the automatic segmentation of several fetal anatomies using the same basic detection algorithm. We show results on fully automatic measurement of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), humerus length (HL), and crown rump length (CRL). Notice that our approach is the first in the literature to deal with the HL and CRL measurements. Extensive experiments (with clinical validation) show that our system is, on average, close to the accuracy of experts in terms of segmentation and obstetric measurements. Finally, this system runs under half second on a standard dual-core PC computer.

Sequential kernel density approximation and its application to real-time visual tracking

Visual features are commonly modeled with probability density functions in computer vision problems, but current methods such as a mixture of Gaussians and kernel density estimation suffer from either the lack of flexibility, by fixing or limiting the number of Gaussian components in the mixture, or large memory requirement, by maintaining a non-parametric representation of the density. These problems are aggravated in real-time computer vision applications since density functions are required to be updated as new data becomes available. We present a novel kernel density approximation technique based on the mean-shift mode finding algorithm, and describe an efficient method to sequentially propagate the density modes over time. While the proposed density representation is memory efficient, which is typical for mixture densities, it inherits the flexibility of non-parametric methods by allowing the number of components to be variable. The accuracy and compactness of the sequential kernel density approximation technique is illustrated by both simulations and experiments. Sequential kernel density approximation is applied to on-line target appearance modeling for visual tracking, and its performance is demonstrated on a variety of videos.

A FAST AND ACCURATE TRACKING ALGORITHM OF LEFT VENTRICLES IN 3D ECHOCARDIOGRAPHY

Tracking of left ventricles in 3D echocardiography is a challenging topic because of the poor quality of ultrasound images and the speed consideration. In this paper, a fast and accurate learning based 3D tracking algorithm is presented. A novel one-step forward prediction is proposed to generate the motion prior using motion manifold learning. Collaborative trackers are introduced to achieve both temporal consistence and tracking robustness. The algorithm is completely automatic and computationally efficient. The mean point-to-mesh error of our algorithm is 1.28 mm. It requires less than 1.5 seconds to process a 3D volume (160 × 148 × 208 voxels).

Automatic mitral valve inflow measurements from Doppler echocardiography

Doppler echocardiography is widely used for functional assessment of heart valves such as mitral valve. In current clinical work flow, to extract Doppler measurements, the envelopes of acquired Doppler spectra are manually traced. We propose a robust algorithm for automatically tracing the envelopes of mitral valve inflow Doppler spectra, which exhibit a large amount of variations in envelope shape and image appearance due to various disease conditions, patient/sonographer/instrument differences, etc. The algorithm is learning-based and capable of fully automatic detection and segmentation of the mitral inflow structures. Experiments show that the algorithm, running within one second, yields comparable performance to experts.

A discriminative model-constrained graph cuts approach to fully automated pediatric brain tumor segmentation in 3-D MRI

In this paper we present a fully automated approach to the segmentation of pediatric brain tumors in multi-spectral 3-D magnetic resonance images. It is a top-down segmentation approach based on a Markov random field (MRF) model that combines probabilistic boosting trees (PBT) and lower-level segmentation via graph cuts. The PBT algorithm provides a strong discriminative observation model that classifies tumor appearance while a spatial prior takes into account the pair-wise homogeneity in terms of classification labels and multi-spectral voxel intensities. The discriminative model relies not only on observed local intensities but also on surrounding context for detecting candidate regions for pathology. A mathematically sound formulation for integrating the two approaches into a unified statistical framework is given. The proposed method is applied to the challenging task of detection and delineation of pediatric brain tumors. This segmentation task is characterized by a high non-uniformity of both the pathology and the surrounding non-pathologic brain tissue. A quantitative evaluation illustrates the robustness of the proposed method. Despite dealing with more complicated cases of pediatric brain tumors the results obtained are mostly better than those reported for current state-of-the-art approaches to 3-D MR brain tumor segmentation in adult patients. The entire processing of one multi-spectral data set does not require any user interaction, and takes less time than previously proposed methods.

Hierarchical part-based detection of 3D flexible tubes: application to CT colonoscopy

In this paper, we present a learning-based method for the detection and segmentation of 3D free-form tubular structures, such as the rectal tubes in CT colonoscopy. This method can be used to reduce the false alarms introduced by rectal tubes in current polyp detection algorithms. The method is hierarchical, detecting parts of the tube in increasing order of complexity, from tube cross sections and tube segments to the whole flexible tube. To increase the speed of the algorithm, candidate parts are generated using a voting strategy. The detected tube segments are combined into a flexible tube using a dynamic programming algorithm. Testing the algorithm on 210 unseen datasets resulted in a tube detection rate of 94.7% and 0.12 false alarms per volume. The method can be easily retrained to detect and segment other tubular 3D structures.

Exploiting interactions among polymorphisms contributing to complex disease traits with boosted generative modeling

Although there has been great success in identifying disease genes for simple, monogenic Mendelian traits, deciphering the genetic mechanisms involved in complex diseases remains challenging. One major approach is to identify configurations of interacting factors such as single nucleotide polymorphisms (SNPs) that confer susceptibility to disease. Traditional methods, such as the multiple dimensional reduction method and the combinatorial partitioning method, provide good tools to decipher such interactions amid a disease population with a single genetic cause. However, these traditional methods have not managed to resolve the issue of genetic heterogeneity, which is believed to be a very common phenomenon in complex diseases. There is rarely prior knowledge of the genetic heterogeneity of a disease, and traditional methods based on estimation over the entire population are unlikely to succeed in the presence of heterogeneity. We present a novel Boosted Generative Modeling (BGM) approach for structure-model the interactions leading to diseases in the context of genetic heterogeneity. Our BGM method bridges the ensemble and generative modeling approaches to genetic association studies under a case-control design. Generative modeling is employed to model the interaction network configuration and the causal relationships, while boosting is used to address the genetic heterogeneity problem. We perform our method on simulation data of complex diseases. The results indicate that our method is capable of modeling the structure of interaction networks among disease-susceptible loci and of addressing genetic heterogeneity issues where the traditional methods, such as multiple dimensional reduction method, fail to apply. Our BGM method provides an exploratory tool that identifies the variables (e.g., disease-susceptible loci) that are likely to correlate and contribute to the disease.

Fractal Clustering and Knowledge-driven Validation Assessment for Gene Expression Profiling

DNA microarray experiments generate a substantial amount of information about the global gene expression. Gene expression profiles can be represented as points in multi-dimensional space. It is essential to identify relevant groups of genes in biomedical research. Clustering is helpful in pattern recognition in gene expression profiles. A number of clustering techniques have been introduced. However, these traditional methods mainly utilize shape-based assumption or some distance metric to cluster the points in multi-dimension linear Euclidean space. Their results shows poor consistence with the functional annotation of genes in previous validation study. From a novel different perspective, we propose fractal clustering method to cluster genes using intrinsic (fractal) dimension from modern geometry. This method clusters points in such a way that points in the same clusters are more self-affine among themselves than to the points in other clusters. We assess this method using annotation-based validation assessment for gene clusters. It shows that this method is superior in identifying functional related gene groups than other traditional methods.

Shape regression machine

We present a machine learning approach called shape regression machine (SRM) to segmenting in real time an anatomic structure that manifests a deformable shape in a medical image. Traditional shape segmentation methods rely on various assumptions. For instance, the deformable model assumes that edge defines the shape; the Mumford-Shah variational method assumes that the regions inside/outside the (closed) contour are homogenous in intensity; and the active appearance model assumes that shape/appearance variations are linear. In addition, they all need a good initialization. In contrast, SRM poses no such restrictions. It is a two-stage approach that leverages (a) the underlying medical context that defines the anatomic structure and (b) an annotated database that exemplifies the shape and appearance variations of the anatomy. In the first stage, it solves the initialization problem as object detection and derives a regression solution that needs just one scan in principle. In the second stage, it learns a nonlinear regressor that predicts the nonrigid shape from image appearance. We also propose a boosting regression approach that supports real time segmentation. We demonstrate the effectiveness of SRM using experiments on segmenting the left ventricle endocardium from an echocardiogram of an apical four chamber view.

Automatic fetal measurements in ultrasound using constrained probabilistic boosting tree

Automatic delineation and robust measurement of fetal anat-omical structures in 2D ultrasound images is a challenging task due to the complexity of the object appearance, noise, shadows, and quantity of information to be processed. Previous solutions rely on explicit encoding of prior knowledge and formulate the problem as a perceptual grouping task solved through clustering or variational approaches. These methods are known to be limited by the validity of the underlying assumptions and cannot capture complex structure appearances. We propose a novel system for fast automatic obstetric measurements by directly exploiting a large database of expert annotated fetal anatomical structures in ultrasound images. Our method learns to distinguish between the appearance of the object of interest and background by training a discriminative constrained probabilistic boosting tree classifier. This system is able to handle previously unsolved problems in this domain, such as the effective segmentation of fetal abdomens. We show results on fully automatic measurement of head circumference, biparietal diameter, abdominal circumference and femur length. Unparalleled extensive experiments show that our system is, on average, close to the accuracy of experts in terms of segmentation and obstetric measurements. Finally, this system runs under half second on a standard dual-core PC computer.

Total variation models for variable lighting face recognition

In this paper, we present the logarithmic total variation (LTV) model for face recognition under varying illumination, including natural lighting conditions, where we rarely know the strength, direction, or number of light sources. The proposed LTV model has the ability to factorize a single face image and obtain the illumination invariant facial structure, which is then used for face recognition. Our model is inspired by the SQI model but has better edge-preserving ability and simpler parameter selection. The merit of this model is that neither does it require any lighting assumption nor does it need any training. The LTV model reaches very high recognition rates in the tests using both Yale and CMU PIE face databases as well as a face database containing 765 subjects under outdoor lighting conditions.

Pairwise active appearance model and its application to echocardiography tracking

We propose a pairwise active appearance model (PAAM) to characterize statistical regularities in shape, appearance, and motion presented by a target that undergoes a series of motion phases, such as the left ventricle in echocardiography. The PAAM depicts the transition in motion phase through a Markov chain and the transition in both shape and appearance through a conditional Gaussian distribution. We learn from a database the joint Gaussian distribution of the shapes and appearances belonging to two consecutive motion phases (i.e., a pair of motion phases), from which we analytically compute the conditional Gaussian distribution. We utilize the PAAM in tracking the left ventricle contour in echocardiography and obtain improved tracking results in terms of localization accuracy when compared with expert-specified contours.

Health-e-child: an integrated biomedical platform for grid-based paediatric applications

There is a compelling demand for the integration and exploitation of heterogeneous biomedical information for improved clinical practice, medical research, and personalised healthcare across the EU. The Health-e-Child project aims at developing an integrated healthcare platform for European Paediatrics, providing seamless integration of traditional and emerging sources of biomedical information. The long-term goal of the project is to provide uninhibited access to universal biomedical knowledge repositories for personalised and preventive healthcare, large-scale information-based biomedical research and training, and informed policy making. The project focus will be on individualized disease prevention, screening, early diagnosis, therapy and follow-up of paediatric heart diseases, inflammatory diseases, and brain tumours. The project will build a Grid-enabled European network of leading clinical centres that will share and annotate biomedical data, validate systems clinically, and diffuse clinical excellence across Europe by setting up new technologies, clinical workflows, and standards. This paper outlines the design approach being adopted in Health-e-Child to enable the delivery of an integrated biomedical information platform.

Robust anisotropic Gaussian fitting for volumetric characterization of pulmonary nodules in multislice CT

This paper proposes a robust statistical estimation and verification framework for characterizing the ellipsoidal (anisotropic) geometrical structure of pulmonary nodules in the Multislice X-ray computed tomography (CT) images. Given a marker indicating a rough location of a target, the proposed solution estimates the target's center location, ellipsoidal boundary approximation, volume, maximum/average diameters, and isotropy by robustly and efficiently fitting an anisotropic Gaussian intensity model. We propose a novel multiscale joint segmentation and model fitting solution which extends the robust mean shift-based analysis to the linear scale-space theory. The design is motivated for enhancing the robustness against margin-truncation induced by neighboring structures, data with large deviations from the chosen model, and marker location variability. A chi-square-based statistical verification and analytical volumetric measurement solutions are also proposed to complement this estimation framework. Experiments with synthetic one-dimensional and two-dimensional data clearly demonstrate the advantage of our solution in comparison with the gamma-normalized Laplacian approach (Linderberg, 1998) and the standard sample estimation approach (Matei, 2001). A quasi-real-time three-dimensional nodule characterization system is developed using this framework and validated with two clinical data sets of thin-section chest CT images. Our experiments with 1310 nodules resulted in (1) robustness against intraoperator and interoperator variability due to varying marker locations, (2) 81% correct estimation rate, (3) 3% false acceptance and 5% false rejection rates, and (4) correct characterization of clinically significant nonsolid ground-glass opacity nodules. This system processes each 33-voxel volume-of-interest by an average of 2 s with a 2.4-GHz Intel CPU. Our solution is generic and can be applied for the analysis of blob-like structures in various other applications.

An information fusion framework for robust shape tracking

Abstract-Existing methods for incorporating subspace model constraints in shape tracking use only partial information from the measurements and model distribution. We propose a unified framework for robust shape tracking, optimally fusing heteroscedastic uncertainties or noise from measurement, system dynamics, and a subspace model. The resulting nonorthogonal subspace projection and fusion are natural extensions of the traditional model constraint using orthogonal projection. We present two motion measurement algorithms and introduce alternative solutions for measurement uncertainty estimation. We build shape models offline from training data and exploit information from the ground truth initialization online through a strong model adaptation. Our framework is applied for tracking in echocardiograms where the motion estimation errors are heteroscedastic in nature, each heart has a distinct shape, and the relative motions of epicardial and endocardial borders reveal crucial diagnostic features. The proposed method significantly outperforms the existing shape-space-constrained tracking algorithm. Due to the complete treatment of heteroscedastic uncertainties, the strong model adaptation, and the coupled tracking of double-contours, robust performance is observed even on the most challenging cases.

Robust real-time myocardial border tracking for echocardiography: an information fusion approach

Ultrasound is a main noninvasive modality for the assessment of the heart function. Wall tracking from ultrasound data is, however, inherently difficult due to weak echoes, clutter, poor signal-to-noise ratio, and signal dropouts. To cope with these artifacts, pretrained shape models can be applied to constrain the tracking. However, existing methods for incorporating subspace shape constraints in myocardial border tracking use only partial information from the model distribution, and do not exploit spatially varying uncertainties from feature tracking. In this paper, we propose a complete fusion formulation in the information space for robust shape tracking, optimally resolving uncertainties from the system dynamics, heteroscedastic measurement noise, and subspace shape model. We also exploit information from the ground truth initialization where this is available. The new framework is applied for tracking of myocardial borders in very noisy echocardiography sequences. Numerous myocardium tracking experiments validate the theory and show the potential of very accurate wall motion measurements. The proposed framework outperforms the traditional shape-space-constrained tracking algorithm by a significant margin. Due to the optimal fusion of different sources of uncertainties, robust performance is observed even for the most challenging cases.

Computer-assisted discrimination among malignant lymphomas and leukemia using immunophenotyping, intelligent image repositories, and telemicroscopy

The process of discriminating among pathologies involving peripheral blood, bone marrow, and lymph node has traditionally begun with subjective morphological assessment of cellular materials viewed using light microscopy. The subtle visible differences exhibited by some malignant lymphomas and leukemia, however, give rise to a significant number of false negatives during microscopic evaluation by medical technologists. We have developed a distributed, clinical decision support prototype for distinguishing among hematologic malignancies. The system consists of two major components, a distributed telemicroscopy system and an intelligent image repository. The hybrid system enables individuals located at disparate clinical and research sites to engage in interactive consultation and to obtain computer-assisted decision support. Software, written in JAVA, allows primary users to control the specimen stage, objective lens, light levels, and focus of a robotic microscope remotely while a digital representation of the specimen is continuously broadcast to all session participants. Primary user status can be passed as a token. The system features shared graphical pointers, text messaging capability, and automated database management. Search engines for the database allow one to automatically identify and retrieve images, diagnoses, and correlated clinical data of cases from a "gold standard" database which exhibit spectral and spatial profiles which are most similar to a given query image. The system suggests the most likely diagnosis based on majority logic of the retrieved cases. The system was used to discriminate among three lymphoproliferative disorders and healthy cells. The system provided the correct classification in more than 83% of the cases studied. System performance was evaluated using rigorous statistical assessment and by comparison with human observers.