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Fan Y, Wang J, Zhao Y, Li R, Liu H, Labadie RF, Noble JH, Dawant BM. A Unified Deep-Learning-Based Framework for Cochlear Implant Electrode Array Localization. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2023; 14228:376-385. [PMID: 38559808 PMCID: PMC10976972 DOI: 10.1007/978-3-031-43996-4_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Cochlear implants (CIs) are neuroprosthetics that can provide a sense of sound to people with severe-to-profound hearing loss. A CI contains an electrode array (EA) that is threaded into the cochlea during surgery. Recent studies have shown that hearing outcomes are correlated with EA placement. An image-guided cochlear implant programming technique is based on this correlation and utilizes the EA location with respect to the intracochlear anatomy to help audiologists adjust the CI settings to improve hearing. Automated methods to localize EA in postoperative CT images are of great interest for large-scale studies and for translation into the clinical workflow. In this work, we propose a unified deep-learning-based framework for automated EA localization. It consists of a multi-task network and a series of postprocessing algorithms to localize various types of EAs. The evaluation on a dataset with 27 cadaveric samples shows that its localization error is slightly smaller than the state-of-the-art method. Another evaluation on a large-scale clinical dataset containing 561 cases across two institutions demonstrates a significant improvement in robustness compared to the state-of-the-art method. This suggests that this technique could be integrated into the clinical workflow and provide audiologists with information that facilitates the programming of the implant leading to improved patient care.
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Affiliation(s)
- Yubo Fan
- Department of Computer Science, Vanderbilt University, Nashville, TN 37235, USA
| | - Jianing Wang
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ 08540, USA
| | - Yiyuan Zhao
- Digital and Automation, Siemens Healthineers, Malvern, PA 19355, USA
| | - Rui Li
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Han Liu
- Department of Computer Science, Vanderbilt University, Nashville, TN 37235, USA
| | - Robert F Labadie
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Jack H Noble
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Benoit M Dawant
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
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Mewes A, Bennett C, Dambon J, Brademann G, Hey M. Evaluation of CI electrode position from imaging: comparison of an automated technique with the established manual method. BMC Med Imaging 2023; 23:143. [PMID: 37773060 PMCID: PMC10543862 DOI: 10.1186/s12880-023-01102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND A manual evaluation of the CI electrode position from CT and DVT scans may be affected by diagnostic errors due to cognitive biases. The aim of this study was to compare the CI electrode localization using an automated method (image-guided cochlear implant programming, IGCIP) with the clinically established manual method. METHODS This prospective experimental study was conducted on a dataset comprising N=50 subjects undergoing cochlear implantation with a Nucleus® CI532 or CI632 Slim Modiolar electrode. Scalar localization, electrode-to-modiolar axis distances (EMD) and angular insertion depth (aDOI) were compared between the automated IGCIP tool and the manual method. Two raters made the manual measurements, and the interrater reliability (±1.96·SD) was determined as the reference for the method comparison. The method comparison was performed using a correlation analysis and a Bland-Altman analysis. RESULTS Concerning the scalar localization, all electrodes were localized both manually and automatically in the scala tympani. The interrater differences ranged between ±0.2 mm (EMD) and ±10° (aDOI). There was a bias between the automatic and manual method in measuring both localization parameters, which on the one hand was smaller than the interrater variations. On the other hand, this bias depended on the magnitude of the EMD respectively aDOI. A post-hoc analysis revealed that the deviations between the methods were likely due to a different selection of mid-modiolar axis. CONCLUSIONS The IGCIP is a promising tool for automated processing of CT and DVT scans and has useful functionality such as being able to segment the cochlear using post-operative scans. When measuring EMD, the IGCIP tool is superior to the manual method because the smallest possible distance to the axis is determined depending on the cochlear turn, whereas the manual method selects the helicotrema as the reference point rigidly. Functionality to deal with motion artifacts and measurements of aDOI according to the consensus approach are necessary, otherwise the IGCIP is not unrestrictedly ready for clinical use.
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Affiliation(s)
- Alexander Mewes
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | | | - Jan Dambon
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Goetz Brademann
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Matthias Hey
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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Smetak MR, Fernando SJ, O'Malley MR, Bennett ML, Haynes DS, Wootten CT, Virgin FW, Dwyer RT, Dawant BM, Noble JH, Labadie RF. Electrode array positioning after cochlear reimplantation from single manufacturer. Cochlear Implants Int 2023. [PMID: 37489512 PMCID: PMC10372339 DOI: 10.1080/14670100.2023.2179756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To investigate whether revision surgery with the same device results in a change in three key indicators of electrode positioning: scalar location, mean modiolar distance (M¯), and angular insertion depth (AID). METHODS Retrospective analysis of a cochlear implant database at a university-based tertiary medical center. Intra-operative CT scans were obtained after initial and revision implantation. Electrode array (EA) position was calculated using auto-segmentation techniques. Initial and revision scalar location, M¯, and AID were compared. RESULTS Mean change in M¯ for all ears was -0.07 mm (SD 0.24 mm; P = 0.16). The mean change in AID for all ears was -5° (SD 67°; P = 0.72). Three initial implantations with pre-curved EAs resulted in a translocation from Scala Tympani (ST) to Scala Vestibuli (SV). Two remained translocated after revision, while one was corrected when revised with a straight EA. An additional five translocations occurred after revision. CONCLUSIONS In this study examining revision cochlear implantation from a single manufacturer, we demonstrated no significant change in key indicators of EA positioning, even when revising with a different style of electrode. However, the revision EA is not necessarily confined by the initial trajectory and there may be an increased risk of translocation.
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Affiliation(s)
- Miriam R. Smetak
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Shanik J. Fernando
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Matthew R. O'Malley
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Marc L. Bennett
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - David S. Haynes
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Christopher T. Wootten
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Frank W. Virgin
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Robert T. Dwyer
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Benoit M. Dawant
- Department of Electrical Engineering & Computer Science, Vanderbilt University, 2201 West End Avenue, Nashville, TN 37235, USA
| | - Jack H. Noble
- Department of Electrical Engineering & Computer Science, Vanderbilt University, 2201 West End Avenue, Nashville, TN 37235, USA
| | - Robert F. Labadie
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
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Gifford RH, Sunderhaus LW, Dawant BM, Labadie RF, Noble JH. Cochlear implant spectral bandwidth for optimizing electric and acoustic stimulation (EAS). Hear Res 2022; 426:108584. [PMID: 35985964 PMCID: PMC10036878 DOI: 10.1016/j.heares.2022.108584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 06/26/2022] [Accepted: 07/21/2022] [Indexed: 01/09/2023]
Abstract
Cochlear implantation with acoustic hearing preservation is becoming increasingly prevalent allowing cochlear implant (CI) users to combine electric and acoustic stimulation (EAS) in the implanted ears. Despite a growing EAS population, our field does not have definitive guidance regarding EAS technology optimization and the majority of previous studies investigating hearing aid (HA) and cochlear implant (CI) programming for EAS listeners have been mixed. Thus, the purpose of this exploratory study was to explore the effects of various EAS crossover frequencies-defined as the low-frequency (LF) CI cutoff-relative to the underlying spiral ganglion (SG) characteristic frequency associated with the most distal or apical electrode in the array. Speech recognition in semi-diffuse noise and subjective estimates of listening difficulty were measured for 15 adult CI recipients with acoustic hearing preservation in three listening conditions: 1) CI-alone, 2) bimodal (CI+HA), and best-aided EAS (CIHA+HA). The results showed no effect of LF CI cutoff for any of the three listening conditions such that there was no trend for increased performance or less subjective listening difficulty across LF CI cutoffs, referenced to underlying SG-place frequency. Consistent with past studies, the current results were also consistent with significant speech recognition and subject listening difficulty benefits for both bimodal (CI+HA) and best-aided EAS (CIHA+HA) as compared to CI-alone listening as well as significant additional benefits for best-aided EAS (CIHA+HA) compared to bimodal hearing (CI+HA). Future studies are necessary to investigate the efficacy of SG-place-based fittings for i) large samples of experienced EAS listeners for whom perceptual adaptation has occurred to the frequency mismatch provided by standard CI frequency allocations, and ii) EAS users at or close to CI activation as place-based approaches may ultimately yield greater outcomes, particularly for newly activated CI users for whom SG-place-based approaches may afford a steeper trajectory to performance asymptote.
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Affiliation(s)
- René H Gifford
- Vanderbilt University Medical Center, Department of Hearing and Speech Sciences, Nashville, TN.
| | - Linsey W Sunderhaus
- Vanderbilt University Medical Center, Department of Hearing and Speech Sciences, Nashville, TN
| | - Benoit M Dawant
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, TN
| | - Robert F Labadie
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, TN; Vanderbilt University Medical Center, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN
| | - Jack H Noble
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, TN
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Mewes A, Burg S, Brademann G, Dambon JA, Hey M. Quality-assured training in the evaluation of cochlear implant electrode position: a prospective experimental study. BMC MEDICAL EDUCATION 2022; 22:386. [PMID: 35596162 PMCID: PMC9121556 DOI: 10.1186/s12909-022-03464-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The objective of this study was to demonstrate the utility of an approach in training predoctoral medical students, to enable them to measure electrode-to-modiolus distances (EMDs) and insertion-depth angles (aDOIs) in cochlear implant (CI) imaging at the performance level of a single senior rater. METHODS This prospective experimental study was conducted on a clinical training dataset comprising patients undergoing cochlear implantation with a Nucleus® CI532 Slim Modiolar electrode (N = 20) or a CI512 Contour Advance electrode (N = 10). To assess the learning curves of a single medical student in measuring EMD and aDOI, interrater differences (senior-student) were compared with the intrarater differences of a single senior rater (test-retest). The interrater and intrarater range were both calculated as the distance between the 0.1th and 99.9th percentiles. A "deliberate practice" training approach was used to teach knowledge and skills, while correctives were applied to minimize faulty data-gathering and data synthesis. RESULTS Intrarater differences of the senior rater ranged from - 0.5 to 0.5 mm for EMD and - 14° to 16° for aDOI (respective medians: 0 mm and 0°). Use of the training approach led to interrater differences that matched this after the 4th (EMD) and 3rd (aDOI) feedback/measurement series had been provided to the student. CONCLUSIONS The training approach enabled the student to evaluate the CI electrode position at the performance level of a senior rater. This finding may offer a basis for ongoing clinical quality assurance for the assessment of CI electrode position.
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Affiliation(s)
- Alexander Mewes
- Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Department of Otorhinolaryngology, Head and Neck Surgery, Kiel, Germany.
| | - Sebastian Burg
- Christian-Albrechts-Universität (CAU) zu Kiel, Faculty of Medicine, Kiel, Germany
| | - Goetz Brademann
- Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Department of Otorhinolaryngology, Head and Neck Surgery, Kiel, Germany
| | - Jan Andreas Dambon
- Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Department of Otorhinolaryngology, Head and Neck Surgery, Kiel, Germany
| | - Matthias Hey
- Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Department of Otorhinolaryngology, Head and Neck Surgery, Kiel, Germany
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Morrel WG, Manzoor NF, Dawant BM, Noble JH, Labadie RF. Intraoperative Correction of Cochlear Implant Electrode Translocation. Audiol Neurootol 2021; 27:104-108. [PMID: 33915536 PMCID: PMC10119869 DOI: 10.1159/000515684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 03/05/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Translocation of precurved cochlear implant (CI) electrodes reduces hearing outcomes, but it is not known whether it is possible to correct scalar translocation such that all electrodes reside fully in the scala tympani (ST). METHODS Six cadaveric temporal bones were scanned with CT and segmented to delineate intracochlear anatomy. Mastoidectomy with facial recess was performed. Precurved CI electrodes (CI532; Cochlear Limited) were implanted until scalar translocation was confirmed with postoperative CT. Then, electrodes were removed and replaced. CT scan was repeated to assess for translocation correction. Scalar position of electrode contacts, angular insertion depth (AID) of the electrode array, and M- (average distance between each electrode contact and the modiolus) were measured. An in vivo case is reported in which intraoperative translocation detection led to removal and replacement of the electrode. RESULTS Five of 6 cadaveric translocations (83%) were corrected with 1 attempt, resulting in full ST insertions. AID averaged 285 ± 77° for translocated electrodes compared to 344 ± 28° for nontranslocated electrodes (p = 0.109). M- averaged 0.75 ± 0.18 mm for translocated electrodes and 0.45 ± 0.11 mm for nontranslocated electrodes (p = 0.016). Reduction in M- with translocation correction averaged 38%. In the in vivo case, translocation was successfully corrected in a single attempt. CONCLUSION Scalar translocation of precurved CI electrodes can be corrected by removal and reinsertion. This significantly improves the perimodiolar positioning of these electrodes. There was a high rate of success (83%) in this cadaveric model as well as a successful in vivo attempt.
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Affiliation(s)
- William G Morrel
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benoit M Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Jack H Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Robert F Labadie
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
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Zhao Y, Chakravorti S, Labadie RF, Dawant BM, Noble JH. Automatic graph-based method for localization of cochlear implant electrode arrays in clinical CT with sub-voxel accuracy. Med Image Anal 2019; 52:1-12. [PMID: 30468968 PMCID: PMC6543817 DOI: 10.1016/j.media.2018.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/18/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
Cochlear implants (CIs) are neural prosthetics that provide a sense of sound to people who experience severe to profound hearing loss. Recent studies have demonstrated a correlation between hearing outcomes and intra-cochlear locations of CI electrodes. Our group has been conducting investigations on this correlation and has been developing an image-guided cochlear implant programming (IGCIP) system to program CI devices to improve hearing outcomes. One crucial step that has not been automated in IGCIP is the localization of CI electrodes in clinical CTs. Existing methods for CI electrode localization do not generalize well on large-scale datasets of clinical CTs implanted with different brands of CI arrays. In this paper, we propose a novel method for localizing different brands of CI electrodes in clinical CTs. We firstly generate the candidate electrode positions at sub-voxel resolution in a whole head CT by thresholding an up-sampled feature image and voxel-thinning the result. Then, we use a graph-based path-finding algorithm to find a fixed-length path that consists of a subset of the candidates as the localization result. Validation on a large-scale dataset of clinical CTs shows that our proposed method outperforms the state-of-art CI electrode localization methods and achieves a mean error of 0.12 mm when compared to expert manual localization results. This represents a crucial step in translating IGCIP from the laboratory to large-scale clinical use.
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Affiliation(s)
- Yiyuan Zhao
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA.
| | - Srijata Chakravorti
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA
| | - Robert F Labadie
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Benoit M Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA
| | - Jack H Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA.
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