Cube-Cut: Vertebral Body Segmentation in MRI-Data through Cubic-Shaped Divergences

In this article, we present a graph-based method using a cubic template for volumetric segmentation of vertebrae in magnetic resonance imaging (MRI) acquisitions. The user can define the degree of deviation from a regular cube via a smoothness value Delta. The Cube-Cut algorithm generates a directed graph with two terminal nodes (s-t-network), where the nodes of the graph correspond to a cubic-shaped subset of the image's voxels. The weightings of the graph's terminal edges, which connect every node with a virtual source s or a virtual sink t, represent the affinity of a voxel to the vertebra (source) and to the background (sink). Furthermore, a set of infinite weighted and non-terminal edges implements the smoothness term. After graph construction, a minimal s-t-cut is calculated within polynomial computation time, which splits the nodes into two disjoint units. Subsequently, the segmentation result is determined out of the source-set. A quantitative evaluation of a C++ implementation of the algorithm resulted in an average Dice Similarity Coefficient (DSC) of 81.33% and a running time of less than a minute.Comment: 23 figures, 2 tables, 43 references, PLoS ONE 9(4): e9338

Probabilistic and geometric shape based segmentation methods.

Image segmentation is one of the most important problems in image processing, object recognition, computer vision, medical imaging, etc. In general, the objective of the segmentation is to partition the image into the meaningful areas using the existing (low level) information in the image and prior (high level) information which can be obtained using a number of features of an object. As stated in [1,2], the human vision system aims to extract and use as much information as possible in the image including but not limited to the intensity, possible motion of the object (in sequential images), spatial relations (interaction) as the existing information, and the shape of the object which is learnt from the experience as the prior information. The main objective of this dissertation is to couple the prior information with the existing information since the machine vision system cannot predict the prior information unless it is given. To label the image into meaningful areas, the chosen information is modelled to fit progressively in each of the regions by an optimization process. The intensity and spatial interaction (as the existing information) and shape (as the prior information) are modeled to obtain the optimum segmentation in this study. The intensity information is modelled using the Gaussian distribution. Spatial interaction that describes the relation between neighboring pixels/voxels is modelled by assuming that the pixel intensity depends on the intensities of the neighboring pixels. The shape model is obtained using occurrences of histogram of training shape pixels or voxels. The main objective is to capture the shape variation of the object of interest. Each pixel in the image will have three probabilities to be an object and a background class based on the intensity, spatial interaction, and shape models. These probabilistic values will guide the energy (cost) functionals in the optimization process. This dissertation proposes segmentation frameworks which has the following properties: i) original to solve some of the existing problems, ii) robust under various segmentation challenges, and iii) fast enough to be used in the real applications. In this dissertation, the models are integrated into different methods to obtain the optimum segmentation: 1) variational (can be considered as the spatially continuous), and 2) statistical (can be considered as the spatially discrete) methods. The proposed segmentation frameworks start with obtaining the initial segmentation using the intensity / spatial interaction models. The shape model, which is obtained using the training shapes, is registered to the image domain. Finally, the optimal segmentation is obtained using the optimization of the energy functionals. Experiments show that the use of the shape prior improves considerably the accuracy of the alternative methods which use only existing or both information in the image. The proposed methods are tested on the synthetic and clinical images/shapes and they are shown to be robust under various noise levels, occlusions, and missing object information. Vertebral bodies (VBs) in clinical computed tomography (CT) are segmented using the proposed methods to help the bone mineral density measurements and fracture analysis in bones. Experimental results show that the proposed solutions eliminate some of the existing problems in the VB segmentation. One of the most important contributions of this study is to offer a segmentation framework which can be suitable to the clinical works

Shape/image registration for medical imaging : novel algorithms and applications.

This dissertation looks at two different categories of the registration approaches: Shape registration, and Image registration. It also considers the applications of these approaches into the medical imaging field. Shape registration is an important problem in computer vision, computer graphics and medical imaging. It has been handled in different manners in many applications like shapebased segmentation, shape recognition, and tracking. Image registration is the process of overlaying two or more images of the same scene taken at different times, from different viewpoints, and/or by different sensors. Many image processing applications like remote sensing, fusion of medical images, and computer-aided surgery need image registration. This study deals with two different applications in the field of medical image analysis. The first one is related to shape-based segmentation of the human vertebral bodies (VBs). The vertebra consists of the VB, spinous, and other anatomical regions. Spinous pedicles, and ribs should not be included in the bone mineral density (BMD) measurements. The VB segmentation is not an easy task since the ribs have similar gray level information. This dissertation investigates two different segmentation approaches. Both of them are obeying the variational shape-based segmentation frameworks. The first approach deals with two dimensional (2D) case. This segmentation approach starts with obtaining the initial segmentation using the intensity/spatial interaction models. Then, shape model is registered to the image domain. Finally, the optimal segmentation is obtained using the optimization of an energy functional which integrating the shape model with the intensity information. The second one is a 3D simultaneous segmentation and registration approach. The information of the intensity is handled by embedding a Willmore flow into the level set segmentation framework. Then the shape variations are estimated using a new distance probabilistic model. The experimental results show that the segmentation accuracy of the framework are much higher than other alternatives. Applications on BMD measurements of vertebral body are given to illustrate the accuracy of the proposed segmentation approach. The second application is related to the field of computer-aided surgery, specifically on ankle fusion surgery. The long-term goal of this work is to apply this technique to ankle fusion surgery to determine the proper size and orientation of the screws that are used for fusing the bones together. In addition, we try to localize the best bone region to fix these screws. To achieve these goals, the 2D-3D registration is introduced. The role of 2D-3D registration is to enhance the quality of the surgical procedure in terms of time and accuracy, and would greatly reduce the need for repeated surgeries; thus, saving the patients time, expense, and trauma

Multi-Surface Simplex Spine Segmentation for Spine Surgery Simulation and Planning

This research proposes to develop a knowledge-based multi-surface simplex deformable model for segmentation of healthy as well as pathological lumbar spine data. It aims to provide a more accurate and robust segmentation scheme for identification of intervertebral disc pathologies to assist with spine surgery planning. A robust technique that combines multi-surface and shape statistics-aware variants of the deformable simplex model is presented. Statistical shape variation within the dataset has been captured by application of principal component analysis and incorporated during the segmentation process to refine results. In the case where shape statistics hinder detection of the pathological region, user-assistance is allowed to disable the prior shape influence during deformation. Results have been validated against user-assisted expert segmentation

Image Fusion and Axial Labeling of the Spine

In order to improve radiological diagnosis of back pain and spine disease, two new algorithms have been developed to aid the 75% of Canadians who will suffer from back pain in a given year. With the associated medical imaging required for many of these patients, there is a potential for improvement in both patient care and healthcare economics by increasing the accuracy and efficiency of spine diagnosis. A real-time spine image fusion system and an automatic vertebra/disc labeling system have been developed to address this. Both magnetic resonance (MR) images and computed tomography (CT) images are often acquired for patients. The MR image highlights soft tissue detail while the CT image highlights bone detail. It is desirable to present both modalities on a single fused image containing the clinically relevant detail. The fusion problem was encoded in an energy functional balancing three competing goals for the fused image: 1) similarity to the MR image, 2) similarity to the CT image and 3) smoothness (containing natural transitions). Graph-Cut and convex solutions have been developed. They have similar performance to each other and outperform other fusion methods from recent literature. The convex solution has real-time performance on modern graphics processing units, allowing for interactive control of the fused image. Clinical validation has been conducted on the convex solution based on 15 patient images. The fused images have been shown to increase confidence of diagnosis compared to unregistered MR and CT images, with no change in time for diagnosis based on readings from 5 radiologists. Spinal vertebrae serve as a reference for the location of surrounding tissues, but vertebrae have a very similar appearance to each other, making it time consume for radiologist to keep track of their locations. To automate this, an axial MR labeling algorithm was developed that runs in near real-time. Probability product kernels and fast integral images combined with simple geometric rules were used to classify pixels, slices and vertebrae. Evaluation was conducted on 32 lumbar spine images and 24 cervical spine images. The algorithm demonstrated 99% and 79% accuracy on the lumbar and cervical spine respectively

An Analysis by Synthesis Approach for Automatic Vertebral Shape Identification in Clinical QCT

Quantitative computed tomography (QCT) is a widely used tool for osteoporosis diagnosis and monitoring. The assessment of cortical markers like cortical bone mineral density (BMD) and thickness is a demanding task, mainly because of the limited spatial resolution of QCT. We propose a direct model based method to automatically identify the surface through the center of the cortex of human vertebra. We develop a statistical bone model and analyze its probability distribution after the imaging process. Using an as-rigid-as-possible deformation we find the cortical surface that maximizes the likelihood of our model given the input volume. Using the European Spine Phantom (ESP) and a high resolution \mu CT scan of a cadaveric vertebra, we show that the proposed method is able to accurately identify the real center of cortex ex-vivo. To demonstrate the in-vivo applicability of our method we use manually obtained surfaces for comparison.Comment: Presented on German Conference on Pattern Recognition (GCPR) 2018 in Stuttgar

Automatic Segmentation of the Lumbar Spine from Medical Images

Segmentation of the lumbar spine in 3D is a necessary step in numerous medical applications, but remains a challenging problem for computational methods due to the complex and varied shape of the anatomy and the noise and other artefacts often present in the images. While manual annotation of anatomical objects such as vertebrae is often carried out with the aid of specialised software, obtaining even a single example can be extremely time-consuming. Automating the segmentation process is the only feasible way to obtain accurate and reliable segmentations on any large scale. This thesis describes an approach for automatic segmentation of the lumbar spine from medical images; specifically those acquired using magnetic resonance imaging (MRI) and computed tomography (CT). The segmentation problem is formulated as one of assigning class labels to local clustered regions of an image (called superpixels in 2D or supervoxels in 3D). Features are introduced in 2D and 3D which can be used to train a classifier for estimating the class labels of the superpixels or supervoxels. Spatial context is introduced by incorporating the class estimates into a conditional random field along with a learned pairwise metric. Inference over the resulting model can be carried out very efficiently, enabling an accurate pixel- or voxel-level segmentation to be recovered from the labelled regions. In contrast to most previous work in the literature, the approach does not rely on explicit prior shape information. It therefore avoids many of the problems associated with these methods, such as the need to construct a representative prior model of anatomical shape from training data and the approximate nature of the optimisation. The general-purpose nature of the proposed method means that it can be used to accurately segment both vertebrae and intervertebral discs from medical images without fundamental change to the model. Evaluation of the approach shows it to obtain accurate and robust performance in the presence of significant anatomical variation. The median average symmetric surface distances for 2D vertebra segmentation were 0.27mm on MRI data and 0.02mm on CT data. For 3D vertebra segmentation the median surface distances were 0.90mm on MRI data and 0.20mm on CT data. For 3D intervertebral disc segmentation a median surface distance of 0.54mm was obtained on MRI data

Segmentierung medizinischer Bilddaten und bildgestützte intraoperative Navigation

Die Entwicklung von Algorithmen zur automatischen oder semi-automatischen Verarbeitung von medizinischen Bilddaten hat in den letzten Jahren mehr und mehr an Bedeutung gewonnen. Das liegt zum einen an den immer besser werdenden medizinischen Aufnahmemodalitäten, die den menschlichen Körper immer feiner virtuell abbilden können. Zum anderen liegt dies an der verbesserten Computerhardware, die eine algorithmische Verarbeitung der teilweise im Gigabyte-Bereich liegenden Datenmengen in einer vernünftigen Zeit erlaubt. Das Ziel dieser Habilitationsschrift ist die Entwicklung und Evaluation von Algorithmen für die medizinische Bildverarbeitung. Insgesamt besteht die Habilitationsschrift aus einer Reihe von Publikationen, die in drei übergreifende Themenbereiche gegliedert sind: -Segmentierung medizinischer Bilddaten anhand von vorlagenbasierten Algorithmen -Experimentelle Evaluation quelloffener Segmentierungsmethoden unter medizinischen Einsatzbedingungen -Navigation zur Unterstützung intraoperativer Therapien Im Bereich Segmentierung medizinischer Bilddaten anhand von vorlagenbasierten Algorithmen wurden verschiedene graphbasierte Algorithmen in 2D und 3D entwickelt, die einen gerichteten Graphen mittels einer Vorlage aufbauen. Dazu gehört die Bildung eines Algorithmus zur Segmentierung von Wirbeln in 2D und 3D. In 2D wird eine rechteckige und in 3D eine würfelförmige Vorlage genutzt, um den Graphen aufzubauen und das Segmentierungsergebnis zu berechnen. Außerdem wird eine graphbasierte Segmentierung von Prostatadrüsen durch eine Kugelvorlage zur automatischen Bestimmung der Grenzen zwischen Prostatadrüsen und umliegenden Organen vorgestellt. Auf den vorlagenbasierten Algorithmen aufbauend, wurde ein interaktiver Segmentierungsalgorithmus, der einem Benutzer in Echtzeit das Segmentierungsergebnis anzeigt, konzipiert und implementiert. Der Algorithmus nutzt zur Segmentierung die verschiedenen Vorlagen, benötigt allerdings nur einen Saatpunkt des Benutzers. In einem weiteren Ansatz kann der Benutzer die Segmentierung interaktiv durch zusätzliche Saatpunkte verfeinern. Dadurch wird es möglich, eine semi-automatische Segmentierung auch in schwierigen Fällen zu einem zufriedenstellenden Ergebnis zu führen. Im Bereich Evaluation quelloffener Segmentierungsmethoden unter medizinischen Einsatzbedingungen wurden verschiedene frei verfügbare Segmentierungsalgorithmen anhand von Patientendaten aus der klinischen Routine getestet. Dazu gehörte die Evaluierung der semi-automatischen Segmentierung von Hirntumoren, zum Beispiel Hypophysenadenomen und Glioblastomen, mit der frei verfügbaren Open Source-Plattform 3D Slicer. Dadurch konnte gezeigt werden, wie eine rein manuelle Schicht-für-Schicht-Vermessung des Tumorvolumens in der Praxis unterstützt und beschleunigt werden kann. Weiterhin wurde die Segmentierung von Sprachbahnen in medizinischen Aufnahmen von Hirntumorpatienten auf verschiedenen Plattformen evaluiert. Im Bereich Navigation zur Unterstützung intraoperativer Therapien wurden Softwaremodule zum Begleiten von intra-operativen Eingriffen in verschiedenen Phasen einer Behandlung (Therapieplanung, Durchführung, Kontrolle) entwickelt. Dazu gehört die erstmalige Integration des OpenIGTLink-Netzwerkprotokolls in die medizinische Prototyping-Plattform MeVisLab, die anhand eines NDI-Navigationssystems evaluiert wurde. Außerdem wurde hier ebenfalls zum ersten Mal die Konzeption und Implementierung eines medizinischen Software-Prototypen zur Unterstützung der intraoperativen gynäkologischen Brachytherapie vorgestellt. Der Software-Prototyp enthielt auch ein Modul zur erweiterten Visualisierung bei der MR-gestützten interstitiellen gynäkologischen Brachytherapie, welches unter anderem die Registrierung eines gynäkologischen Brachytherapie-Instruments in einen intraoperativen Datensatz einer Patientin ermöglichte. Die einzelnen Module führten zur Vorstellung eines umfassenden bildgestützten Systems für die gynäkologische Brachytherapie in einem multimodalen Operationssaal. Dieses System deckt die prä-, intra- und postoperative Behandlungsphase bei einer interstitiellen gynäkologischen Brachytherapie ab