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

Exploiting flow dynamics for super-resolution in contrast-enhanced ultrasound

Ultrasound localization microscopy offers new radiation-free diagnostic tools for vascular imaging deep within the tissue. Sequential localization of echoes returned from inert microbubbles with low-concentration within the bloodstream reveal the vasculature with capillary resolution. Despite its high spatial resolution, low microbubble concentrations dictate the acquisition of tens of thousands of images, over the course of several seconds to tens of seconds, to produce a single super-resolved image. %since each echo is required to be well separated from adjacent microbubbles. Such long acquisition times and stringent constraints on microbubble concentration are undesirable in many clinical scenarios. To address these restrictions, sparsity-based approaches have recently been developed. These methods reduce the total acquisition time dramatically, while maintaining good spatial resolution in settings with considerable microbubble overlap. %Yet, non of the reported methods exploit the fact that microbubbles actually flow within the bloodstream. % to improve recovery. Here, we further improve sparsity-based super-resolution ultrasound imaging by exploiting the inherent flow of microbubbles and utilize their motion kinematics. While doing so, we also provide quantitative measurements of microbubble velocities. Our method relies on simultaneous tracking and super-localization of individual microbubbles in a frame-by-frame manner, and as such, may be suitable for real-time implementation. We demonstrate the effectiveness of the proposed approach on both simulations and {\it in-vivo} contrast enhanced human prostate scans, acquired with a clinically approved scanner.Comment: 11 pages, 9 figure

Dynamic Image Processing for Guidance of Off-pump Beating Heart Mitral Valve Repair

Compared to conventional open heart procedures, minimally invasive off-pump beating heart mitral valve repair aims to deliver equivalent treatment for mitral regurgitation with reduced trauma and side effects. However, minimally invasive approaches are often limited by the lack of a direct view to surgical targets and/or tools, a challenge that is compounded by potential movement of the target during the cardiac cycle. For this reason, sophisticated image guidance systems are required in achieving procedural efficiency and therapeutic success. The development of such guidance systems is associated with many challenges. For example, the system should be able to provide high quality visualization of both cardiac anatomy and motion, as well as augmenting it with virtual models of tracked tools and targets. It should have the capability of integrating pre-operative images to the intra-operative scenario through registration techniques. The computation speed must be sufficiently fast to capture the rapid cardiac motion. Meanwhile, the system should be cost effective and easily integrated into standard clinical workflow. This thesis develops image processing techniques to address these challenges, aiming to achieve a safe and efficient guidance system for off-pump beating heart mitral valve repair. These techniques can be divided into two categories, using 3D and 2D image data respectively. When 3D images are accessible, a rapid multi-modal registration approach is proposed to link the pre-operative CT images to the intra-operative ultrasound images. The ultrasound images are used to display the real time cardiac motion, enhanced by CT data serving as high quality 3D context with annotated features. I also developed a method to generate synthetic dynamic CT images, aiming to replace real dynamic CT data in such a guidance system to reduce the radiation dose applied to the patients. When only 2D images are available, an approach is developed to track the feature of interest, i.e. the mitral annulus, based on bi-plane ultrasound images and a magnetic tracking system. The concept of modern GPU-based parallel computing is employed in most of these approaches to accelerate the computation in order to capture the rapid cardiac motion with desired accuracy. Validation experiments were performed on phantom, animal and human data. The overall accuracy of registration and feature tracking with respect to the mitral annulus was about 2-3mm with computation time of 60-400ms per frame, sufficient for one update per cardiac cycle. It was also demonstrated in the results that the synthetic CT images can provide very similar anatomical representations and registration accuracy compared to that of the real dynamic CT images. These results suggest that the approaches developed in the thesis have good potential for a safer and more effective guidance system for off-pump beating heart mitral valve repair

Emergency TeleOrthoPaedics m-health system for wireless communication links

For the first time, a complete wireless and mobile emergency TeleOrthoPaedics system with field trials and expert opinion is presented. The system enables doctors in a remote area to obtain a second opinion from doctors in the hospital using secured wireless telecommunication networks. Doctors can exchange securely medical images and video as well as other important data, and thus perform remote consultations, fast and accurately using a user friendly interface, via a reliable and secure telemedicine system of low cost. The quality of the transmitted compressed (JPEG2000) images was measured using different metrics and doctors opinions. The results have shown that all metrics were within acceptable limits. The performance of the system was evaluated successfully under different wireless communication links based on real data

Deep learning in medical image registration: introduction and survey

Image registration (IR) is a process that deforms images to align them with respect to a reference space, making it easier for medical practitioners to examine various medical images in a standardized reference frame, such as having the same rotation and scale. This document introduces image registration using a simple numeric example. It provides a definition of image registration along with a space-oriented symbolic representation. This review covers various aspects of image transformations, including affine, deformable, invertible, and bidirectional transformations, as well as medical image registration algorithms such as Voxelmorph, Demons, SyN, Iterative Closest Point, and SynthMorph. It also explores atlas-based registration and multistage image registration techniques, including coarse-fine and pyramid approaches. Furthermore, this survey paper discusses medical image registration taxonomies, datasets, evaluation measures, such as correlation-based metrics, segmentation-based metrics, processing time, and model size. It also explores applications in image-guided surgery, motion tracking, and tumor diagnosis. Finally, the document addresses future research directions, including the further development of transformers

Computational Methods for Segmentation of Multi-Modal Multi-Dimensional Cardiac Images

Segmentation of the heart structures helps compute the cardiac contractile function quantified via the systolic and diastolic volumes, ejection fraction, and myocardial mass, representing a reliable diagnostic value. Similarly, quantification of the myocardial mechanics throughout the cardiac cycle, analysis of the activation patterns in the heart via electrocardiography (ECG) signals, serve as good cardiac diagnosis indicators. Furthermore, high quality anatomical models of the heart can be used in planning and guidance of minimally invasive interventions under the assistance of image guidance. The most crucial step for the above mentioned applications is to segment the ventricles and myocardium from the acquired cardiac image data. Although the manual delineation of the heart structures is deemed as the gold-standard approach, it requires significant time and effort, and is highly susceptible to inter- and intra-observer variability. These limitations suggest a need for fast, robust, and accurate semi- or fully-automatic segmentation algorithms. However, the complex motion and anatomy of the heart, indistinct borders due to blood flow, the presence of trabeculations, intensity inhomogeneity, and various other imaging artifacts, makes the segmentation task challenging. In this work, we present and evaluate segmentation algorithms for multi-modal, multi-dimensional cardiac image datasets. Firstly, we segment the left ventricle (LV) blood-pool from a tri-plane 2D+time trans-esophageal (TEE) ultrasound acquisition using local phase based filtering and graph-cut technique, propagate the segmentation throughout the cardiac cycle using non-rigid registration-based motion extraction, and reconstruct the 3D LV geometry. Secondly, we segment the LV blood-pool and myocardium from an open-source 4D cardiac cine Magnetic Resonance Imaging (MRI) dataset by incorporating average atlas based shape constraint into the graph-cut framework and iterative segmentation refinement. The developed fast and robust framework is further extended to perform right ventricle (RV) blood-pool segmentation from a different open-source 4D cardiac cine MRI dataset. Next, we employ convolutional neural network based multi-task learning framework to segment the myocardium and regress its area, simultaneously, and show that segmentation based computation of the myocardial area is significantly better than that regressed directly from the network, while also being more interpretable. Finally, we impose a weak shape constraint via multi-task learning framework in a fully convolutional network and show improved segmentation performance for LV, RV and myocardium across healthy and pathological cases, as well as, in the challenging apical and basal slices in two open-source 4D cardiac cine MRI datasets. We demonstrate the accuracy and robustness of the proposed segmentation methods by comparing the obtained results against the provided gold-standard manual segmentations, as well as with other competing segmentation methods

Towards Closed-loop, Robot Assisted Percutaneous Interventions under MRI Guidance

Image guided therapy procedures under MRI guidance has been a focused research area over past decade. Also, over the last decade, various MRI guided robotic devices have been developed and used clinically for percutaneous interventions, such as prostate biopsy, brachytherapy, and tissue ablation. Though MRI provides better soft tissue contrast compared to Computed Tomography and Ultrasound, it poses various challenges like constrained space, less ergonomic patient access and limited material choices due to its high magnetic field. Even after, advancements in MRI compatible actuation methods and robotic devices using them, most MRI guided interventions are still open-loop in nature and relies on preoperative or intraoperative images. In this thesis, an intraoperative MRI guided robotic system for prostate biopsy comprising of an MRI compatible 4-DOF robotic manipulator, robot controller and control application with Clinical User Interface (CUI) and surgical planning applications (3DSlicer and RadVision) is presented. This system utilizes intraoperative images acquired after each full or partial needle insertion for needle tip localization. Presented system was approved by Institutional Review Board at Brigham and Women\u27s Hospital(BWH) and has been used in 30 patient trials. Successful translation of such a system utilizing intraoperative MR images motivated towards the development of a system architecture for close-loop, real-time MRI guided percutaneous interventions. Robot assisted, close-loop intervention could help in accurate positioning and localization of the therapy delivery instrument, improve physician and patient comfort and allow real-time therapy monitoring. Also, utilizing real-time MR images could allow correction of surgical instrument trajectory and controlled therapy delivery. Two of the applications validating the presented architecture; closed-loop needle steering and MRI guided brain tumor ablation are demonstrated under real-time MRI guidance

A Markov Random Field Based Approach to 3D Mosaicing and Registration Applied to Ultrasound Simulation

A novel Markov Random Field (MRF) based method for the mosaicing of 3D ultrasound volumes is presented in this dissertation. The motivation for this work is the production of training volumes for an affordable ultrasound simulator, which offers a low-cost/portable training solution for new users of diagnostic ultrasound, by providing the scanning experience essential for developing the necessary psycho-motor skills. It also has the potential for introducing ultrasound instruction into medical education curriculums. The interest in ultrasound training stems in part from the widespread adoption of point-of-care scanners, i.e. low cost portable ultrasound scanning systems in the medical community. This work develops a novel approach for producing 3D composite image volumes and validates the approach using clinically acquired fetal images from the obstetrics department at the University of Massachusetts Medical School (UMMS). Results using the Visible Human Female dataset as well as an abdominal trauma phantom are also presented. The process is broken down into five distinct steps, which include individual 3D volume acquisition, rigid registration, calculation of a mosaicing function, group-wise non-rigid registration, and finally blending. Each of these steps, common in medical image processing, has been investigated in the context of ultrasound mosaicing and has resulted in improved algorithms. Rigid and non-rigid registration methods are analyzed in a probabilistic framework and their sensitivity to ultrasound shadowing artifacts is studied. The group-wise non-rigid registration problem is initially formulated as a maximum likelihood estimation, where the joint probability density function is comprised of the partially overlapping ultrasound image volumes. This expression is simplified using a block-matching methodology and the resulting discrete registration energy is shown to be equivalent to a Markov Random Field. Graph based methods common in computer vision are then used for optimization, resulting in a set of transformations that bring the overlapping volumes into alignment. This optimization is parallelized using a fusion approach, where the registration problem is divided into 8 independent sub-problems whose solutions are fused together at the end of each iteration. This method provided a speedup factor of 3.91 over the single threaded approach with no noticeable reduction in accuracy during our simulations. Furthermore, the registration problem is simplified by introducing a mosaicing function, which partitions the composite volume into regions filled with data from unique partially overlapping source volumes. This mosaicing functions attempts to minimize intensity and gradient differences between adjacent sources in the composite volume. Experimental results to demonstrate the performance of the group-wise registration algorithm are also presented. This algorithm is initially tested on deformed abdominal image volumes generated using a finite element model of the Visible Human Female to show the accuracy of its calculated displacement fields. In addition, the algorithm is evaluated using real ultrasound data from an abdominal phantom. Finally, composite obstetrics image volumes are constructed using clinical scans of pregnant subjects, where fetal movement makes registration/mosaicing especially difficult. Our solution to blending, which is the final step of the mosaicing process, is also discussed. The trainee will have a better experience if the volume boundaries are visually seamless, and this usually requires some blending prior to stitching. Also, regions of the volume where no data was collected during scanning should have an ultrasound-like appearance before being displayed in the simulator. This ensures the trainee\u27s visual experience isn\u27t degraded by unrealistic images. A discrete Poisson approach has been adapted to accomplish these tasks. Following this, we will describe how a 4D fetal heart image volume can be constructed from swept 2D ultrasound. A 4D probe, such as the Philips X6-1 xMATRIX Array, would make this task simpler as it can acquire 3D ultrasound volumes of the fetal heart in real-time; However, probes such as these aren\u27t widespread yet. Once the theory has been introduced, we will describe the clinical component of this dissertation. For the purpose of acquiring actual clinical ultrasound data, from which training datasets were produced, 11 pregnant subjects were scanned by experienced sonographers at the UMMS following an approved IRB protocol. First, we will discuss the software/hardware configuration that was used to conduct these scans, which included some custom mechanical design. With the data collected using this arrangement we generated seamless 3D fetal mosaics, that is, the training datasets, loaded them into our ultrasound training simulator, and then subsequently had them evaluated by the sonographers at the UMMS for accuracy. These mosaics were constructed from the raw scan data using the techniques previously introduced. Specific training objectives were established based on the input from our collaborators in the obstetrics sonography group. Important fetal measurements are reviewed, which form the basis for training in obstetrics ultrasound. Finally clinical images demonstrating the sonographer making fetal measurements in practice, which were acquired directly by the Philips iU22 ultrasound machine from one of our 11 subjects, are compared with screenshots of corresponding images produced by our simulator

A Markov Random Field Based Approach to 3D Mosaicing and Registration Applied to Ultrasound Simulation

A novel Markov Random Field (MRF) based method for the mosaicing of 3D ultrasound volumes is presented in this dissertation. The motivation for this work is the production of training volumes for an affordable ultrasound simulator, which offers a low-cost/portable training solution for new users of diagnostic ultrasound, by providing the scanning experience essential for developing the necessary psycho-motor skills. It also has the potential for introducing ultrasound instruction into medical education curriculums. The interest in ultrasound training stems in part from the widespread adoption of point-of-care scanners, i.e. low cost portable ultrasound scanning systems in the medical community. This work develops a novel approach for producing 3D composite image volumes and validates the approach using clinically acquired fetal images from the obstetrics department at the University of Massachusetts Medical School (UMMS). Results using the Visible Human Female dataset as well as an abdominal trauma phantom are also presented. The process is broken down into five distinct steps, which include individual 3D volume acquisition, rigid registration, calculation of a mosaicing function, group-wise non-rigid registration, and finally blending. Each of these steps, common in medical image processing, has been investigated in the context of ultrasound mosaicing and has resulted in improved algorithms. Rigid and non-rigid registration methods are analyzed in a probabilistic framework and their sensitivity to ultrasound shadowing artifacts is studied. The group-wise non-rigid registration problem is initially formulated as a maximum likelihood estimation, where the joint probability density function is comprised of the partially overlapping ultrasound image volumes. This expression is simplified using a block-matching methodology and the resulting discrete registration energy is shown to be equivalent to a Markov Random Field. Graph based methods common in computer vision are then used for optimization, resulting in a set of transformations that bring the overlapping volumes into alignment. This optimization is parallelized using a fusion approach, where the registration problem is divided into 8 independent sub-problems whose solutions are fused together at the end of each iteration. This method provided a speedup factor of 3.91 over the single threaded approach with no noticeable reduction in accuracy during our simulations. Furthermore, the registration problem is simplified by introducing a mosaicing function, which partitions the composite volume into regions filled with data from unique partially overlapping source volumes. This mosaicing functions attempts to minimize intensity and gradient differences between adjacent sources in the composite volume. Experimental results to demonstrate the performance of the group-wise registration algorithm are also presented. This algorithm is initially tested on deformed abdominal image volumes generated using a finite element model of the Visible Human Female to show the accuracy of its calculated displacement fields. In addition, the algorithm is evaluated using real ultrasound data from an abdominal phantom. Finally, composite obstetrics image volumes are constructed using clinical scans of pregnant subjects, where fetal movement makes registration/mosaicing especially difficult. Our solution to blending, which is the final step of the mosaicing process, is also discussed. The trainee will have a better experience if the volume boundaries are visually seamless, and this usually requires some blending prior to stitching. Also, regions of the volume where no data was collected during scanning should have an ultrasound-like appearance before being displayed in the simulator. This ensures the trainee\u27s visual experience isn\u27t degraded by unrealistic images. A discrete Poisson approach has been adapted to accomplish these tasks. Following this, we will describe how a 4D fetal heart image volume can be constructed from swept 2D ultrasound. A 4D probe, such as the Philips X6-1 xMATRIX Array, would make this task simpler as it can acquire 3D ultrasound volumes of the fetal heart in real-time; However, probes such as these aren\u27t widespread yet. Once the theory has been introduced, we will describe the clinical component of this dissertation. For the purpose of acquiring actual clinical ultrasound data, from which training datasets were produced, 11 pregnant subjects were scanned by experienced sonographers at the UMMS following an approved IRB protocol. First, we will discuss the software/hardware configuration that was used to conduct these scans, which included some custom mechanical design. With the data collected using this arrangement we generated seamless 3D fetal mosaics, that is, the training datasets, loaded them into our ultrasound training simulator, and then subsequently had them evaluated by the sonographers at the UMMS for accuracy. These mosaics were constructed from the raw scan data using the techniques previously introduced. Specific training objectives were established based on the input from our collaborators in the obstetrics sonography group. Important fetal measurements are reviewed, which form the basis for training in obstetrics ultrasound. Finally clinical images demonstrating the sonographer making fetal measurements in practice, which were acquired directly by the Philips iU22 ultrasound machine from one of our 11 subjects, are compared with screenshots of corresponding images produced by our simulator

PVR: Patch-to-Volume Reconstruction for Large Area Motion Correction of Fetal MRI

In this paper we present a novel method for the correction of motion artifacts that are present in fetal Magnetic Resonance Imaging (MRI) scans of the whole uterus. Contrary to current slice-to-volume registration (SVR) methods, requiring an inflexible anatomical enclosure of a single investigated organ, the proposed patch-to-volume reconstruction (PVR) approach is able to reconstruct a large field of view of non-rigidly deforming structures. It relaxes rigid motion assumptions by introducing a specific amount of redundant information that is exploited with parallelized patch-wise optimization, super-resolution, and automatic outlier rejection. We further describe and provide an efficient parallel implementation of PVR allowing its execution within reasonable time on commercially available graphics processing units (GPU), enabling its use in the clinical practice. We evaluate PVR's computational overhead compared to standard methods and observe improved reconstruction accuracy in presence of affine motion artifacts of approximately 30% compared to conventional SVR in synthetic experiments. Furthermore, we have evaluated our method qualitatively and quantitatively on real fetal MRI data subject to maternal breathing and sudden fetal movements. We evaluate peak-signal-to-noise ratio (PSNR), structural similarity index (SSIM), and cross correlation (CC) with respect to the originally acquired data and provide a method for visual inspection of reconstruction uncertainty. With these experiments we demonstrate successful application of PVR motion compensation to the whole uterus, the human fetus, and the human placenta.Comment: 10 pages, 13 figures, submitted to IEEE Transactions on Medical Imaging. v2: wadded funders acknowledgements to preprin