Computer-aided detection of polyps in CT colonography

Master'sMASTER OF ENGINEERIN

Enhanced computer assisted detection of polyps in CT colonography

This thesis presents a novel technique for automatically detecting colorectal polyps in computed tomography colonography (CTC). The objective of the documented computer assisted diagnosis (CAD) technique is to deal with the issue of false positive detections without adversely affecting polyp detection sensitivity. The thesis begins with an overview of CTC and a review of the associated research areas, with particular attention given to CAD-CTC. This review identifies excessive false positive detections as a common problem associated with current CAD-CTC techniques. Addressing this problem constitutes the major contribution of this thesis. The documented CAD-CTC technique is trained with, and evaluated using, a series of clinical CTC data sets These data sets contain polyps with a range of different sizes and morphologies. The results presented m this thesis indicate the validity of the developed CAD-CTC technique and demonstrate its effectiveness m accurately detecting colorectal polyps while significantly reducing the number of false positive detections

Segmentation and Fracture Detection in CT Images for Traumatic Pelvic Injuries

In recent decades, more types and quantities of medical data have been collected due to advanced technology. A large number of significant and critical information is contained in these medical data. High efficient and automated computational methods are urgently needed to process and analyze all available medical data in order to provide the physicians with recommendations and predictions on diagnostic decisions and treatment planning. Traumatic pelvic injury is a severe yet common injury in the United States, often caused by motor vehicle accidents or fall. Information contained in the pelvic Computed Tomography (CT) images is very important for assessing the severity and prognosis of traumatic pelvic injuries. Each pelvic CT scan includes a large number of slices. Meanwhile, each slice contains a large quantity of data that may not be thoroughly and accurately analyzed via simple visual inspection with the desired accuracy and speed. Hence, a computer-assisted pelvic trauma decision-making system is needed to assist physicians in making accurate diagnostic decisions and determining treatment planning in a short period of time. Pelvic bone segmentation is a vital step in analyzing pelvic CT images and assisting physicians with diagnostic decisions in traumatic pelvic injuries. In this study, a new hierarchical segmentation algorithm is proposed to automatically extract multiplelevel bone structures using a combination of anatomical knowledge and computational techniques. First, morphological operations, image enhancement, and edge detection are performed for preliminary bone segmentation. The proposed algorithm then uses a template-based best shape matching method that provides an entirely automated segmentation process. This is followed by the proposed Registered Active Shape Model (RASM) algorithm that extracts pelvic bone tissues using more robust training models than the Standard ASM algorithm. In addition, a novel hierarchical initialization process for RASM is proposed in order to address the shortcoming of the Standard ASM, i.e. high sensitivity to initialization. Two suitable measures are defined to evaluate the segmentation results: Mean Distance and Mis-segmented Area to quantify the segmentation accuracy. Successful segmentation results indicate effectiveness and robustness of the proposed algorithm. Comparison of segmentation performance is also conducted using both the proposed method and the Snake method. A cross-validation process is designed to demonstrate the effectiveness of the training models. 3D pelvic bone models are built after pelvic bone structures are segmented from consecutive 2D CT slices. Automatic and accurate detection of the fractures from segmented bones in traumatic pelvic injuries can help physicians detect the severity of injuries in patients. The extraction of fracture features (such as presence and location of fractures) as well as fracture displacement measurement, are vital for assisting physicians in making faster and more accurate decisions. In this project, after bone segmentation, fracture detection is performed using a hierarchical algorithm based on wavelet transformation, adaptive windowing, boundary tracing and masking. Also, a quantitative measure of fracture severity based on pelvic CT scans is defined and explored. The results are promising, demonstrating that the proposed method not only capable of automatically detecting both major and minor fractures, but also has potentials to be used for clinical applications

New Techniques in Gastrointestinal Endoscopy

As result of progress, endoscopy has became more complex, using more sophisticated devices and has claimed a special form. In this moment, the gastroenterologist performing endoscopy has to be an expert in macroscopic view of the lesions in the gut, with good skills for using standard endoscopes, with good experience in ultrasound (for performing endoscopic ultrasound), with pathology experience for confocal examination. It is compulsory to get experience and to have patience and attention for the follow-up of thousands of images transmitted during capsule endoscopy or to have knowledge in physics necessary for autofluorescence imaging endoscopy. Therefore, the idea of an endoscopist has changed. Examinations mentioned need a special formation, a superior level of instruction, accessible to those who have already gained enough experience in basic diagnostic endoscopy. This is the reason for what these new issues of endoscopy are presented in this book of New techniques in Gastrointestinal Endoscopy

Visualisation of curved tubular structures in medical databases: An application to virtual colonoscopy

Medical conditions affecting the colon are problematic to diagnose due to the difficulty in examining this particular internal organ. To date, the most widely used approach is to perform a colonoscopy; a procedure in which a small camera is inserted into the colon to examine its surface. This procedure is unpleasant and potentially dangerous for the patient, and is expensive and time consuming for the hospital. As a result, patients at risk of developing the conditions are not always screened as often as would be desirable. Over the last few years a new approach known as virtual colonoscopy has been gaining popularity. The method uses information from a CT scan to reconstruct a 3D model of the colon which can then be examined without the patient needing to undergo a colonoscopy. This approach is now commonly used when screening for polyps (an indication of colon cancer) but can not be so easily used on conditions such as Inflammatory Bowel Disease (IBD) where information beyond the shape of the surface is required. This thesis forms part of a larger project which aims to diagnose conditions such as IBD by using image processing algorithms on CT data and presenting the results to the user in an easy to interpret way. Specifically we are concerned with this visualisation stage of the system and so have developed a new visualisation approach which we call Volumetric CPR. This can be used to supplement the more traditional virtual flythrough visualisation and is applicable to IBD detection as well as screening for polyps. Our technique builds on the concept of Curved Planar Reformation (CPR), which has proved to be a practical and widely used tool for the visualisation of curved tubular structures within the human body. It has been useful in medical procedures involving the examination of blood vessels and the spine. However, it is more difficult to use it for structures such as the colon because abnormalities are smaller relative to the size of the structure and may not have such distinct density and shape characteristics. Our new approach improves on this situation by using volume rendering for hollow regions of the structure and standard CPR, for the surrounding tissue. This effectively combines grey scale contextual information with detailed colour information from the area of interest. The approach is successfully used with each of the standard CPR types and the resulting images are promising as an alternative for virtual colonoscopy. We also demonstrate how systems can effectively utilize this new visualisation in order to convey maximum information to the user. We show how overlays can be used to present surface coverage data and how sophisticated lighting models can improve the users understanding of the 3D structure. We also present details of how to integrate our visualisation into existing systems and work flows

Surgical Subtask Automation for Intraluminal Procedures using Deep Reinforcement Learning

Intraluminal procedures have opened up a new sub-field of minimally invasive surgery that use flexible instruments to navigate through complex luminal structures of the body, resulting in reduced invasiveness and improved patient benefits. One of the major challenges in this field is the accurate and precise control of the instrument inside the human body. Robotics has emerged as a promising solution to this problem. However, to achieve successful robotic intraluminal interventions, the control of the instrument needs to be automated to a large extent. The thesis first examines the state-of-the-art in intraluminal surgical robotics and identifies the key challenges in this field, which include the need for safe and effective tool manipulation, and the ability to adapt to unexpected changes in the luminal environment. To address these challenges, the thesis proposes several levels of autonomy that enable the robotic system to perform individual subtasks autonomously, while still allowing the surgeon to retain overall control of the procedure. The approach facilitates the development of specialized algorithms such as Deep Reinforcement Learning (DRL) for subtasks like navigation and tissue manipulation to produce robust surgical gestures. Additionally, the thesis proposes a safety framework that provides formal guarantees to prevent risky actions. The presented approaches are evaluated through a series of experiments using simulation and robotic platforms. The experiments demonstrate that subtask automation can improve the accuracy and efficiency of tool positioning and tissue manipulation, while also reducing the cognitive load on the surgeon. The results of this research have the potential to improve the reliability and safety of intraluminal surgical interventions, ultimately leading to better outcomes for patients and surgeons

Colonoscopy and Colorectal Cancer Screening

Colorectal cancer (CRC) represents a major public health problem worldwide. Fortunately most CRCs originate from a precursor lesion, the adenoma, which is accessible and removable. This is the rationale for CRC screening programs, which are aimed to diagnose CRC at an early stage or even better to detect and resect the advanced adenoma before CRC has developed. In this background colonoscopy emerges as the main tool to achieve these goals with recent evidence supporting its role in CRC prevention. This book deals with several topics to be faced when implementing a CRC screening program. The interested reader will learn about the rationale and challenges of implementing such a program, the management of the detected lesions, the prevention of complications of colonoscopy, and finally the use of other screening modalities that are emerging as valuable alternatives. The relevance of the topics covered in it and the updated evidence included by the authors turn this book into a very useful tool to introduce the reader in this amazing and evolving field