Image segmentation and reconstruction of 3D surfaces from carotid ultrasound images

Tese de doutoramento. Engenharia Electrotécnica e de Computadores. Faculdade de Engenharia. Universidade do Porto. 200

Ultrasound imaging system combined with multi-modality image analysis algorithms to monitor changes in anatomical structures

This dissertation concerns the development and validation of an ultrasound imaging system and novel image analysis algorithms applicable to multiple imaging modalities. The ultrasound imaging system will include a framework for 3D volume reconstruction of freehand ultrasound: a mechanism to register the 3D volumes across time and subjects, as well as with other imaging modalities, and a playback mechanism to view image slices concurrently from different acquisitions that correspond to the same anatomical region. The novel image analysis algorithms include a noise reduction method that clusters pixels into homogenous patches using a directed graph of edges between neighboring pixels, a segmentation method that creates a hierarchical graph structure using statistical analysis and a voting system to determine the similarity between homogeneous patches given their neighborhood, and finally, a hybrid atlas-based registration method that makes use of intensity corrections induced at anatomical landmarks to regulate deformable registration. The combination of the ultrasound imaging system and the image analysis algorithms will provide the ability to monitor nerve regeneration in patients undergoing regenerative, repair or transplant strategies in a sequential, non-invasive manner, including visualization of registered real-time and pre-acquired data, thus enabling preventive and therapeutic strategies for nerve regeneration in Composite Tissue Allotransplantation (CTA). The registration algorithm is also applied to MR images of the brain to obtain reliable and efficient segmentation of the hippocampus, which is a prominent structure in the study of diseases of the elderly such as vascular dementia, Alzheimer’s, and late life depression. Experimental results on 2D and 3D images, including simulated and real images, with illustrations visualizing the intermediate outcomes and the final results are presented.

Advancements and Breakthroughs in Ultrasound Imaging

Ultrasonic imaging is a powerful diagnostic tool available to medical practitioners, engineers and researchers today. Due to the relative safety, and the non-invasive nature, ultrasonic imaging has become one of the most rapidly advancing technologies. These rapid advances are directly related to the parallel advancements in electronics, computing, and transducer technology together with sophisticated signal processing techniques. This book focuses on state of the art developments in ultrasonic imaging applications and underlying technologies presented by leading practitioners and researchers from many parts of the world

Engineering a 3D ultrasound system for image-guided vascular modelling

Atherosclerosis is often diagnosed using an ultrasound (US) examination in the carotid and femoral arteries and the abdominal aorta. A decision to operate requires two measures of disease severity: the degree of stenosis measured using B-mode US; and the blood flow patterns in the artery measured using spectral Doppler US. However other biomechanical factors such as wall shear stress (WSS) and areas of flow recirculation are also important in disease development and rupture. These are estimated using an image-guided modelling approach, where a three-dimensional computational mesh of the artery is simulated. To generate a patient-specific arterial 3D computational mesh, a 3D ultrasound (3DUS) system was developed. This system uses a standard clinical US scanner with an optical position sensor to measure the position of the transducer; a video capture card to record video images from the scanner; and a PC running Stradwin software to reconstruct 3DUS data. The system was characterised using an industry-standard set of calibration phantoms, giving a reconstruction accuracy of ± 0.17 mm with a 12MHz linear array transducer. Artery movements from pulsatile flow were reduced using a retrospective gating technique. The effect of pressure applied to the transducer moving and deforming the artery was reduced using an image-based rigid registration technique. The artery lumen found on each 3DUS image was segmented using a semi-automatic segmentation technique known as ShIRT (the Sheffield Image Registration Toolkit). Arterial scans from healthy volunteers and patients with diagnosed arterial disease were segmented using the technique. The accuracy of the semi-automatic technique was assessed by comparing it to manual segmentation of each artery using a set of segmentation metrics. The mean accuracy of the semi-automatic technique ranged from 85% to 99% and depended on the quality of the images and the complexity of the shape of the lumen. Patient-specific 3D computational artery meshes were created using ShIRT. An idealised mesh was created using key features of the segmented 3DUS scan. This was registered and deformed to the rest of the segmented dataset, producing a mesh that represents the shape of the artery. Meshes created using ShIRT were compared to meshes created using the Rhino solid modelling package. ShIRT produced smoother meshes; Rhino reproduced the shape of arterial disease more accurately. The use of 3DUS with image-guided modelling has the potential to be an effective tool in the diagnosis of atherosclerosis. Simulations using these data reflect in vivo studies of wall shear stress and recirculation in diseased arteries and are comparable with results in the literature created using MRI and other 3DUS systems

Medical image analysis methods for anatomical surface reconstruction using tracked 3D ultrasound

The thesis focuses on a study of techniques for acquisition and reconstruction of surface data from anatomical objects by means of tracked 3D ultrasound. In the context of the work two experimental scanning systems are developed and tested on both artificial objects and biological tissues. The first system is based on the freehand ultrasound principle and utilizes a conventional 2D ultrasound transducer coupled with an electromechanical 3D position tracker. The main properties and the basic features of this system are discussed. A number of experiments show that its accuracy in the close to ideal conditions reaches 1.2 mm RMS. The second proposed system implements the sequential triggered scanning approach. The system consists of an ultrasound machine, a workstation and a scanning body (a moving tank filled with liquid and a transducer fixation block) that performs transducer positioning and tracking functions. The system is tested on artificial and real bones. The performed experiments illustrate that it provides significantly better accuracy than the freehand ultrasound (about 0.2 mm RMS) and allows acquiring regular data with a good precision. This makes such a system a promising tool for orthopaedic and trauma surgeons during contactless X-ray-free examinations of injured extremities. The second major subject of the thesis concerns development of medical image analysis methods for 3D surface reconstruction and 2D object detection. We introduce a method based on mesh-growing surface reconstruction that is designed for noisy and sparse data received from 3D tracked ultrasound scanners. A series of experiments on synthetic and ultrasound data show an appropriate reconstruction accuracy. The reconstruction error is measured as the averaged distance between the faces of the mesh and the points from the cloud. Dependently on the initial settings of the method the error varies in range 0.04 - 0.2% for artificial data and 0.3 - 0.7 mm for ultrasound bone data. The reconstructed surfaces correctly interpolate the original point clouds and demonstrate proper smoothness. The next significant problem considered in the work is 2D object detection. Although medical object detection is not integrated into the developed scanning systems, it can be used as a possible further extension of the systems for automatic detection of specific anatomical structures. We analyse the existent object detection methods and introduce a modification of the one based on the popular Generalized Hough Transform (GHT). Unlike the original GHT, the developed method is invariant to rotation and uniform scaling, and uses an intuitive two-point parametrization. We propose several implementations of the feature-to-vote conversion function with the corresponding vote analysis principles. Special attention is devoted to a study of the hierarchical vote analysis and its probabilistic properties. We introduce a parameter space subdivision strategy that reduces the probability of vote peak omission, and show that it can be efficiently implemented in practice using the Gumbel probability distribution

New Mechatronic Systems for the Diagnosis and Treatment of Cancer

Both two dimensional (2D) and three dimensional (3D) imaging modalities are useful tools for viewing the internal anatomy. Three dimensional imaging techniques are required for accurate targeting of needles. This improves the efficiency and control over the intervention as the high temporal resolution of medical images can be used to validate the location of needle and target in real time. Relying on imaging alone, however, means the intervention is still operator dependent because of the difficulty of controlling the location of the needle within the image. The objective of this thesis is to improve the accuracy and repeatability of needle-based interventions over conventional techniques: both manual and automated techniques. This includes increasing the accuracy and repeatability of these procedures in order to minimize the invasiveness of the procedure. In this thesis, I propose that by combining the remote center of motion concept using spherical linkage components into a passive or semi-automated device, the physician will have a useful tracking and guidance system at their disposal in a package, which is less threatening than a robot to both the patient and physician. This design concept offers both the manipulative transparency of a freehand system, and tremor reduction through scaling currently offered in automated systems. In addressing each objective of this thesis, a number of novel mechanical designs incorporating an remote center of motion architecture with varying degrees of freedom have been presented. Each of these designs can be deployed in a variety of imaging modalities and clinical applications, ranging from preclinical to human interventions, with an accuracy of control in the millimeter to sub-millimeter range

Augmented Image-Guidance for Transcatheter Aortic Valve Implantation

The introduction of transcatheter aortic valve implantation (TAVI), an innovative stent-based technique for delivery of a bioprosthetic valve, has resulted in a paradigm shift in treatment options for elderly patients with aortic stenosis. While there have been major advancements in valve design and access routes, TAVI still relies largely on single-plane fluoroscopy for intraoperative navigation and guidance, which provides only gross imaging of anatomical structures. Inadequate imaging leading to suboptimal valve positioning contributes to many of the early complications experienced by TAVI patients, including valve embolism, coronary ostia obstruction, paravalvular leak, heart block, and secondary nephrotoxicity from contrast use. A potential method of providing improved image-guidance for TAVI is to combine the information derived from intra-operative fluoroscopy and TEE with pre-operative CT data. This would allow the 3D anatomy of the aortic root to be visualized along with real-time information about valve and prosthesis motion. The combined information can be visualized as a `merged\u27 image where the different imaging modalities are overlaid upon each other, or as an `augmented\u27 image, where the location of key target features identified on one image are displayed on a different imaging modality. This research develops image registration techniques to bring fluoroscopy, TEE, and CT models into a common coordinate frame with an image processing workflow that is compatible with the TAVI procedure. The techniques are designed to be fast enough to allow for real-time image fusion and visualization during the procedure, with an intra-procedural set-up requiring only a few minutes. TEE to fluoroscopy registration was achieved using a single-perspective TEE probe pose estimation technique. The alignment of CT and TEE images was achieved using custom-designed algorithms to extract aortic root contours from XPlane TEE images, and matching the shape of these contours to a CT-derived surface model. Registration accuracy was assessed on porcine and human images by identifying targets (such as guidewires or coronary ostia) on the different imaging modalities and measuring the correspondence of these targets after registration. The merged images demonstrated good visual alignment of aortic root structures, and quantitative assessment measured an accuracy of less than 1.5mm error for TEE-fluoroscopy registration and less than 6mm error for CT-TEE registration. These results suggest that the image processing techniques presented have potential for development into a clinical tool to guide TAVI. Such a tool could potentially reduce TAVI complications, reducing morbidity and mortality and allowing for a safer procedure