Statistical study of parameters for deep brain stimulation automatic preoperative planning of electrodes trajectories

Evaluating the impact of reinforcement learning on automatic deep brain stimulation planning

PURPOSE

Traditional techniques for automating the planning of brain electrode placement based on multi-objective optimization involving many parameters are subject to limitations, especially in terms of sensitivity to local optima, and tend to be replaced by machine learning approaches. This paper explores the feasibility of using deep reinforcement learning (DRL) in this context, starting with the single-electrode use-case of deep brain stimulation (DBS).

METHODS

We propose a DRL approach based on deep Q-learning where the states represent the electrode trajectory and associated information, and actions are the possible motions. Deep neural networks allow to navigate the complex state space derived from MRI data. The chosen reward function emphasizes safety and accuracy in reaching the target structure. The results were compared with a reference (segmented electrode) and a conventional technique.

RESULTS

The DRL approach excelled in navigating the complex anatomy, consistently providing safer and more precise electrode placements than the reference. Compared to conventional techniques, it showed an improvement in accuracy of 2.3% in average proximity to obstacles and 19.4% in average orientation angle. Expectedly, computation times rose significantly, from 2 to 18 min.

CONCLUSION

Our investigation into DRL for DBS electrode trajectory planning has showcased its promising potential. Despite only delivering modest accuracy gains compared to traditional methods in the single-electrode case, its relevance for problems with high-dimensional state and action spaces and its resilience against local optima highlight its promising role for complex scenarios. This preliminary study constitutes a first step toward the more challenging problem of multiple-electrodes planning.

Robust Deep 3D Blood Vessel Segmentation Using Structural Priors

Deep learning has enabled significant improvements in the accuracy of 3D blood vessel segmentation. Open challenges remain in scenarios where labeled 3D segmentation maps for training are severely limited, as is often the case in practice, and in ensuring robustness to noise. Inspired by the observation that 3D vessel structures project onto 2D image slices with informative and unique edge profiles, we propose a novel deep 3D vessel segmentation network guided by edge profiles. Our network architecture comprises a shared encoder and two decoders that learn segmentation maps and edge profiles jointly. 3D context is mined in both the segmentation and edge prediction branches by employing bidirectional convolutional long-short term memory (BCLSTM) modules. 3D features from the two branches are concatenated to facilitate learning of the segmentation map. As a key contribution, we introduce new regularization terms that: a) capture the local homogeneity of 3D blood vessel volumes in the presence of biomarkers; and b) ensure performance robustness to domain-specific noise by suppressing false positive responses. Experiments on benchmark datasets with ground truth labels reveal that the proposed approach outperforms state-of-the-art techniques on standard measures such as DICE overlap and mean Intersection-over-Union. The performance gains of our method are even more pronounced when training is limited. Furthermore, the computational cost of our network inference is among the lowest compared with state-of-the-art.

Surgical planning assistance in keyhole and percutaneous surgery: A systematic review

Surgical planning of percutaneous interventions has a crucial role to guarantee the success of minimally invasive surgeries. In the last decades, many methods have been proposed to reduce clinician work load related to the planning phase and to augment the information used in the definition of the optimal trajectory. In this survey, we include 113 articles related to computer assisted planning (CAP) methods and validations obtained from a systematic search on three databases. First, a general formulation of the problem is presented, independently from the surgical field involved, and the key steps involved in the development of a CAP solution are detailed. Secondly, we categorized the articles based on the main surgical applications, which have been object of study and we categorize them based on the type of assistance provided to the end-user.

Knowledge-based automated planning system for StereoElectroEncephaloGraphy: A center-based scenario

Surgical planning for StereoElectroEncephaloGraphy (SEEG) is a complex and patient specific task, where the experience and medical workflow of each institution may influence the final planning choices. To account for this variability, we developed a data-based Computer Assisted Planning (CAP) solution able to exploit the knowledge extracted by past cases. By the analysis of retrospective patients' data sets, our system proposes a pool of trajectories commonly used by the institution, which can be selected to initialize a new patient plan. An optimization framework adapts those to the patient's anatomy by optimizing clinical requirements (e.g. distance from vessel, gray matter recording and insertion angle), and adapting its strategy based on the trajectory type selected.The system has been customized based on the data of a single institution. Two neurosurgeons, working in a high-volume hospital, have validated it by using 15 retrospective patient data sets, with more than 200 trajectories reviewed. Both surgeons considered ~81% of the optimized trajectories as clinically feasible (75% inter-rater reliability). Quantitative comparison of distance from vessels, insertion angle and gray matter recording index showed that the optimized trajectories reached superior or comparable values with respect to the original manual plans. The results suggest that a tailored center-based solution could increase the acceptance rate of the automated trajectories proposed.

Automated neurosurgical stereotactic planning for intraoperative use: a comprehensive review of the literature and perspectives

The creation of intracranial stereotactic trajectories, from entry point to target point, is still mostly done manually by the neurosurgeon. The development of automated stereotactic planning tools has been described in the literature. This systematic review aims to assess the effectiveness of stereotactic planning procedure automation and develop tools for patients undergoing neurosurgical stereotactic procedures. PubMed/MEDLINE, EMBASE, Google Scholar, CINAHL, PsycINFO, and Cochrane Register of Controlled Trials databases were searched from inception to September 1, 2019, at the exception of Google Scholar (from 1 January 2010 to September 1, 2019) in French and English. Eligible studies included all studies proposing automated stereotactic planning. A total of 1543 studies were screened. Forty-two studies were included in the systematic review, including 18 (42.9%) conference papers. The surgical procedures planned automatically were mainly deep brain stimulation (n = 14, 33.3%), stereoelectroencephalography (n = 12, 28.6%), and not specified (n = 10, 23.8%). The most frequently used surgical constraints to plan the trajectory were blood vessels (n = 32, 76.2%), cerebral sulci (n = 27, 64.3%), and cerebral ventricles (n = 23, 54.8%). The distance from blood vessels ranged from 1.96 to 4.78 mm for manual trajectories and from 2.47 to 7.0 mm for automated trajectories. At least one neurosurgeon was involved in 36 studies (85.7%). The automated stereotactic trajectory was preferred in 75.4% of the studied cases (range 30-92.9). Only 3 (7.1%) studies were multicentric. No study reported prospective use of the planning software. Stereotactic planning automation is a promising tool to provide valuable stereotactic trajectories for clinical applications.

Automated Steerable Path Planning for Deep Brain Stimulation Safeguarding Fiber Tracts and Deep Gray Matter Nuclei

Deep Brain Stimulation (DBS) is a neurosurgical procedure consisting in the stereotactic implantation of stimulation electrodes to specific brain targets, such as deep gray matter nuclei. Current solutions to place the electrodes rely on rectilinear stereotactic trajectories (RTs) manually defined by surgeons, based on pre-operative images. An automatic path planner that accurately targets subthalamic nuclei (STN) and safeguards critical surrounding structures is still lacking. Also, robotically-driven curvilinear trajectories (CTs) computed on the basis of state-of-the-art neuroimaging would decrease DBS invasiveness, circumventing patient-specific obstacles. This work presents a new algorithm able to estimate a pool of DBS curvilinear trajectories for reaching a given deep target in the brain, in the context of the EU's Horizon EDEN2020 project. The prospect of automatically computing trajectory plans relying on sophisticated newly engineered steerable devices represents a breakthrough in the field of microsurgical robotics. By tailoring the paths according to single-patient anatomical constraints, as defined by advanced preoperative neuroimaging including diffusion MR tractography, this planner ensures a higher level of safety than the standard rectilinear approach. Ten healthy controls underwent Magnetic Resonance Imaging (MRI) on 3T scanner, including 3DT1-weighted sequences, 3Dhigh-resolution time-of-flight MR angiography (TOF-MRA) and high angular resolution diffusion MR sequences. A probabilistic q-ball residual-bootstrap MR tractography algorithm was used to reconstruct motor fibers, while the other deep gray matter nuclei surrounding STN and vessels were segmented on T1 and TOF-MRA images, respectively. These structures were labeled as obstacles. The reliability of the automated planner was evaluated; CTs were compared to RTs in terms of efficacy and safety. Targeting the anterior STN, CTs performed significantly better in maximizing the minimal distance from critical structures, by finding a tuned balance between all obstacles. Moreover, CTs resulted superior in reaching the center of mass (COM) of STN, as well as in optimizing the entry angle in STN and in the skull surface.

Blood vessel segmentation algorithms - Review of methods, datasets and evaluation metrics

BACKGROUND

Blood vessel segmentation is a topic of high interest in medical image analysis since the analysis of vessels is crucial for diagnosis, treatment planning and execution, and evaluation of clinical outcomes in different fields, including laryngology, neurosurgery and ophthalmology. Automatic or semi-automatic vessel segmentation can support clinicians in performing these tasks. Different medical imaging techniques are currently used in clinical practice and an appropriate choice of the segmentation algorithm is mandatory to deal with the adopted imaging technique characteristics (e.g. resolution, noise and vessel contrast).

OBJECTIVE

This paper aims at reviewing the most recent and innovative blood vessel segmentation algorithms. Among the algorithms and approaches considered, we deeply investigated the most novel blood vessel segmentation including machine learning, deformable model, and tracking-based approaches.

METHODS

This paper analyzes more than 100 articles focused on blood vessel segmentation methods. For each analyzed approach, summary tables are presented reporting imaging technique used, anatomical region and performance measures employed. Benefits and disadvantages of each method are highlighted.

DISCUSSION

Despite the constant progress and efforts addressed in the field, several issues still need to be overcome. A relevant limitation consists in the segmentation of pathological vessels. Unfortunately, not consistent research effort has been addressed to this issue yet. Research is needed since some of the main assumptions made for healthy vessels (such as linearity and circular cross-section) do not hold in pathological tissues, which on the other hand require new vessel model formulations. Moreover, image intensity drops, noise and low contrast still represent an important obstacle for the achievement of a high-quality enhancement. This is particularly true for optical imaging, where the image quality is usually lower in terms of noise and contrast with respect to magnetic resonance and computer tomography angiography.

CONCLUSION

No single segmentation approach is suitable for all the different anatomical region or imaging modalities, thus the primary goal of this review was to provide an up to date source of information about the state of the art of the vessel segmentation algorithms so that the most suitable methods can be chosen according to the specific task.

Automatic preoperative planning of DBS electrode placement using anatomo-clinical atlases and volume of tissue activated

PURPOSE

Deep brain stimulation (DBS) is a procedure requiring accurate targeting and electrode placement. The two key elements for successful planning are preserving patient safety by ensuring a safe trajectory and creating treatment efficacy through optimal selection of the stimulation point. In this work, we present the first approach of computer-assisted preoperative DBS planning to automatically optimize both the safety of the electrode's trajectory and location of the stimulation point so as to provide the best clinical outcome.

METHODS

Building upon the findings of previous works focused on electrode trajectory, we added a set of constraints guiding the choice of stimulation point. These took into account retrospective data represented by anatomo-clinical atlases and intersections between the stimulation region and sensitive anatomical structures causing side effects. We implemented our method into automatic preoperative planning software to assess if the algorithm was able to simultaneously optimize electrode trajectory and the stimulation point.

RESULTS

Leave-one-out cross-validation on a dataset of 18 cases demonstrated an improvement in the expected outcome when using the new constraints. The distance to critical structures was not reduced. The intersection between the stimulation region and structures sensitive to stimulation was minimized.

CONCLUSIONS

Introducing these new constraints guided the planning to select locations showing a trend toward symptom improvement, while minimizing the risks of side effects, and there was no cost in terms of trajectory safety.

Vascular segmentation of head phase-contrast magnetic resonance angiograms using grayscale and shape features

BACKGROUND AND OBJECTIVE

In neurosurgery planning, vascular structures must be predetermined, which can guarantee the security of the operation carried out in the case of avoiding blood vessels. In this paper, an automatic algorithm of vascular segmentation, which combined the grayscale and shape features of the blood vessels, is proposed to extract 3D vascular structures from head phase-contrast magnetic resonance angiography dataset.

METHODS

First, a cost function of mis-segmentation is introduced on the basis of traditional Bayesian statistical classification, and the blood vessel of weak grayscale that tended to be misclassified into background will be preserved. Second, enhanced vesselness image is obtained according to the shape-based multiscale vascular enhancement filter. Third, a new reconstructed vascular image is established according to the fusion of vascular grayscale and shape features using Dempster-Shafer evidence theory; subsequently, the corresponding segmentation structures are obtained. Finally, according to the noise distribution characteristic of the data, segmentation ratio coefficient, which increased linearly from top to bottom, is proposed to control the segmentation result, thereby preventing over-segmentation.

RESULTS

Experiment results show that, through the proposed method, vascular structures can be detected not only when both grayscale and shape features are strong, but also when either of them is strong. Compared with traditional grayscale feature- and shape feature-based methods, it is better in the evaluation of testing in segmentation accuracy, and over-segmentation and under-segmentation ratios.

CONCLUSIONS

The proposed grayscale and shape features combined vascular segmentation is not only effective but also accurate. It may be used for diagnosis of vascular diseases and planning of neurosurgery.