Real-time virtual sonography in gynecology & obstetrics. literature's analysis and case series

Fusion Imaging is a latest generation diagnostic technique, designed to combine ultrasonography with a second-tier technique such as magnetic resonance imaging and computer tomography. It has been mainly used until now in urology and hepatology. Concerning gynecology and obstetrics, the studies mostly focus on the diagnosis of prenatal disease, benign pathology and cervical cancer. We provided a systematic review of the literature with the latest publications regarding the role of Fusion technology in gynecological and obstetrics fields and we also described a case series of six emblematic patients enrolled from Gynecology Department of Sant ‘Andrea Hospital, “la Sapienza”, Rome, evaluated with Esaote Virtual Navigator equipment. We consider that Fusion Imaging could add values at the diagnosis of various gynecological and obstetrics conditions, but further studies are needed to better define and improve the role of this fascinating diagnostic tool

Structural Adaptive Smoothing in Diffusion Tensor Imaging: The R Package dti

Diffusion weighted imaging has become and will certainly continue to be an important tool in medical research and diagnostics. Data obtained with diffusion weighted imaging are characterized by a high noise level. Thus, estimation of quantities like anisotropy indices or the main diffusion direction may be significantly compromised by noise in clinical or neuroscience applications. Here, we present a new package dti for R, which provides functions for the analysis of diffusion weighted data within the diffusion tensor model. This includes smoothing by a recently proposed structural adaptive smoothing procedure based on the propagation-separation approach in the context of the widely used diffusion tensor model. We extend the procedure and show, how a correction for Rician bias can be incorporated. We use a heteroscedastic nonlinear regression model to estimate the diffusion tensor. The smoothing procedure naturally adapts to different structures of different size and thus avoids oversmoothing edges and fine structures. We illustrate the usage and capabilities of the package through some examples.

Incremental low rank noise reduction for robust infrared tracking of body temperature during medical imaging

Thermal imagery for monitoring of body temperature provides a powerful tool to decrease health risks (e.g., burning) for patients during medical imaging (e.g., magnetic resonance imaging). The presented approach discusses an experiment to simulate radiology conditions with infrared imaging along with an automatic thermal monitoring/tracking system. The thermal tracking system uses an incremental low-rank noise reduction applying incremental singular value decomposition (SVD) and applies color based clustering for initialization of the region of interest (ROI) boundary. Then a particle filter tracks the ROI(s) from the entire thermal stream (video sequence). The thermal database contains 15 subjects in two positions (i.e., sitting, and lying) in front of thermal camera. This dataset is created to verify the robustness of our method with respect to motion-artifacts and in presence of additive noise (2–20%—salt and pepper noise). The proposed approach was tested for the infrared images in the dataset and was able to successfully measure and track the ROI continuously (100% detecting and tracking the temperature of participants), and provided considerable robustness against noise (unchanged accuracy even in 20% additive noise), which shows promising performanc

Intraoperative Navigation Systems for Image-Guided Surgery

Recent technological advancements in medical imaging equipment have resulted in a dramatic improvement of image accuracy, now capable of providing useful information previously not available to clinicians. In the surgical context, intraoperative imaging provides a crucial value for the success of the operation. Many nontrivial scientific and technical problems need to be addressed in order to efficiently exploit the different information sources nowadays available in advanced operating rooms. In particular, it is necessary to provide: (i) accurate tracking of surgical instruments, (ii) real-time matching of images from different modalities, and (iii) reliable guidance toward the surgical target. Satisfying all of these requisites is needed to realize effective intraoperative navigation systems for image-guided surgery. Various solutions have been proposed and successfully tested in the field of image navigation systems in the last ten years; nevertheless several problems still arise in most of the applications regarding precision, usability and capabilities of the existing systems. Identifying and solving these issues represents an urgent scientific challenge. This thesis investigates the current state of the art in the field of intraoperative navigation systems, focusing in particular on the challenges related to efficient and effective usage of ultrasound imaging during surgery. The main contribution of this thesis to the state of the art are related to: Techniques for automatic motion compensation and therapy monitoring applied to a novel ultrasound-guided surgical robotic platform in the context of abdominal tumor thermoablation. Novel image-fusion based navigation systems for ultrasound-guided neurosurgery in the context of brain tumor resection, highlighting their applicability as off-line surgical training instruments. The proposed systems, which were designed and developed in the framework of two international research projects, have been tested in real or simulated surgical scenarios, showing promising results toward their application in clinical practice

Respiratory organ motion in interventional MRI : tracking, guiding and modeling

Respiratory organ motion is one of the major challenges in interventional MRI, particularly in interventions with therapeutic ultrasound in the abdominal region. High-intensity focused ultrasound found an application in interventional MRI for noninvasive treatments of different abnormalities. In order to guide surgical and treatment interventions, organ motion imaging and modeling is commonly required before a treatment start. Accurate tracking of organ motion during various interventional MRI procedures is prerequisite for a successful outcome and safe therapy. In this thesis, an attempt has been made to develop approaches using focused ultrasound which could be used in future clinically for the treatment of abdominal organs, such as the liver and the kidney. Two distinct methods have been presented with its ex vivo and in vivo treatment results. In the first method, an MR-based pencil-beam navigator has been used to track organ motion and provide the motion information for acoustic focal point steering, while in the second approach a hybrid imaging using both ultrasound and magnetic resonance imaging was combined for advanced guiding capabilities. Organ motion modeling and four-dimensional imaging of organ motion is increasingly required before the surgical interventions. However, due to the current safety limitations and hardware restrictions, the MR acquisition of a time-resolved sequence of volumetric images is not possible with high temporal and spatial resolution. A novel multislice acquisition scheme that is based on a two-dimensional navigator, instead of a commonly used pencil-beam navigator, was devised to acquire the data slices and the corresponding navigator simultaneously using a CAIPIRINHA parallel imaging method. The acquisition duration for four-dimensional dataset sampling is reduced compared to the existing approaches, while the image contrast and quality are improved as well. Tracking respiratory organ motion is required in interventional procedures and during MR imaging of moving organs. An MR-based navigator is commonly used, however, it is usually associated with image artifacts, such as signal voids. Spectrally selective navigators can come in handy in cases where the imaging organ is surrounding with an adipose tissue, because it can provide an indirect measure of organ motion. A novel spectrally selective navigator based on a crossed-pair navigator has been developed. Experiments show the advantages of the application of this novel navigator for the volumetric imaging of the liver in vivo, where this navigator was used to gate the gradient-recalled echo sequence

Dynamic Thermal Imaging for Intraoperative Monitoring of Neuronal Activity and Cortical Perfusion

Neurosurgery is a demanding medical discipline that requires a complex interplay of several neuroimaging techniques. This allows structural as well as functional information to be recovered and then visualized to the surgeon. In the case of tumor resections this approach allows more fine-grained differentiation of healthy and pathological tissue which positively influences the postoperative outcome as well as the patient's quality of life. In this work, we will discuss several approaches to establish thermal imaging as a novel neuroimaging technique to primarily visualize neural activity and perfusion state in case of ischaemic stroke. Both applications require novel methods for data-preprocessing, visualization, pattern recognition as well as regression analysis of intraoperative thermal imaging. Online multimodal integration of preoperative and intraoperative data is accomplished by a 2D-3D image registration and image fusion framework with an average accuracy of 2.46 mm. In navigated surgeries, the proposed framework generally provides all necessary tools to project intraoperative 2D imaging data onto preoperative 3D volumetric datasets like 3D MR or CT imaging. Additionally, a fast machine learning framework for the recognition of cortical NaCl rinsings will be discussed throughout this thesis. Hereby, the standardized quantification of tissue perfusion by means of an approximated heating model can be achieved. Classifying the parameters of these models yields a map of connected areas, for which we have shown that these areas correlate with the demarcation caused by an ischaemic stroke segmented in postoperative CT datasets. Finally, a semiparametric regression model has been developed for intraoperative neural activity monitoring of the somatosensory cortex by somatosensory evoked potentials. These results were correlated with neural activity of optical imaging. We found that thermal imaging yields comparable results, yet doesn't share the limitations of optical imaging. In this thesis we would like to emphasize that thermal imaging depicts a novel and valid tool for both intraoperative functional and structural neuroimaging

Proposal of a health care network based on big data analytics for PDs

Health care networks for Parkinson's disease (PD) already exist and have been already proposed in the literature, but most of them are not able to analyse the vast volume of data generated from medical examinations and collected and organised in a pre-defined manner. In this work, the authors propose a novel health care network based on big data analytics for PD. The main goal of the proposed architecture is to support clinicians in the objective assessment of the typical PD motor issues and alterations. The proposed health care network has the ability to retrieve a vast volume of acquired heterogeneous data from a Data warehouse and train an ensemble SVM to classify and rate the motor severity of a PD patient. Once the network is trained, it will be able to analyse the data collected during motor examinations of a PD patient and generate a diagnostic report on the basis of the previously acquired knowledge. Such a diagnostic report represents a tool both to monitor the follow up of the disease for each patient and give robust advice about the severity of the disease to clinicians