Vertebral Compression Fracture Detection With Novel 3D Localisation

Vertebral compression fractures (VCF) often go undetected in radiology images, potentially leading to secondary fractures and permanent disability or even death. The objective of this thesis is to develop a fully automated method for detecting VCF in incidental CT images acquired for other purposes, thereby facilitating better follow up and treatment. The proposed approach is based on 3D localisation in CT images, followed by VCF detection in the localised regions. The 3D localisation algorithm combines deep reinforcement learning (DRL) with imitation learning (IL) to extract thoracic / lumbar spine regions from chest / abdomen CT scans. The algorithm generates six bounding boxes as Regions of Interest (ROI) using three different CNN models, with an average Jaccard Index (JI)/Dice Coefficient (DC) of 74.21%/84.71%. The extracted ROI were then divided into slices and the slices into patches to train four convolutional neural network (CNN) models for VCF detection at the patch level. The predictions from the patches were aggregated at bounding box level, and majority voting performed to decide on the presence / absence of VCF for a patient. The best performing model was a six layered CNN, which together with majority voting achieved threefold cross validation accuracy / F1 Score of 85.95% / 85.94% from 308 chest scans. The same model also achieved a fivefold cross validation accuracy / F1 score of 86.67% / 87.04% from 168 abdomen scans. Because of the success of the 3D localisation algorithm, it was also trained on other abdominal organs, namely the spleen and left and right kidneys, with promising results. The 3D localisation algorithm was enhanced to work with fused bounding boxes and also in semi-supervised mode to address the problem of annotation time by radiologists. Experiments using three different proportions of labelled and unlabelled data achieved fairly good performance, although not as good as the fully supervised equivalents. Finally, VCF detection in a weakly supervised multiple instance learning (MIL) setting was performed to reduce radiologists’ time for annotations, together with majority voting on the six bounding boxes. The best performing model was the six layered CNN which achieved threefold cross validation accuracy / F1 score of 81.05% / 80.74 % on 308 thoracic scans, and fivefold cross validation accuracy / F1 Score of 85.45% / 86.61% on 168 abdomen scans. Overall, the results are comparable to the state-of the art that used an order of magnitude more scans

Non-communicable Diseases, Big Data and Artificial Intelligence

This reprint includes 15 articles in the field of non-communicable Diseases, big data, and artificial intelligence, overviewing the most recent advances in the field of AI and their application potential in 3P medicine

ADVANCED MOTION MODELS FOR RIGID AND DEFORMABLE REGISTRATION IN IMAGE-GUIDED INTERVENTIONS

Image-guided surgery (IGS) has been a major area of interest in recent decades that continues to transform surgical interventions and enable safer, less invasive procedures. In the preoperative contexts, diagnostic imaging, including computed tomography (CT) and magnetic resonance (MR) imaging, offers a basis for surgical planning (e.g., definition of target, adjacent anatomy, and the surgical path or trajectory to the target). At the intraoperative stage, such preoperative images and the associated planning information are registered to intraoperative coordinates via a navigation system to enable visualization of (tracked) instrumentation relative to preoperative images. A major limitation to such an approach is that motions during surgery, either rigid motions of bones manipulated during orthopaedic surgery or brain soft-tissue deformation in neurosurgery, are not captured, diminishing the accuracy of navigation systems. This dissertation seeks to use intraoperative images (e.g., x-ray fluoroscopy and cone-beam CT) to provide more up-to-date anatomical context that properly reflects the state of the patient during interventions to improve the performance of IGS. Advanced motion models for inter-modality image registration are developed to improve the accuracy of both preoperative planning and intraoperative guidance for applications in orthopaedic pelvic trauma surgery and minimally invasive intracranial neurosurgery. Image registration algorithms are developed with increasing complexity of motion that can be accommodated (single-body rigid, multi-body rigid, and deformable) and increasing complexity of registration models (statistical models, physics-based models, and deep learning-based models). For orthopaedic pelvic trauma surgery, the dissertation includes work encompassing: (i) a series of statistical models to model shape and pose variations of one or more pelvic bones and an atlas of trajectory annotations; (ii) frameworks for automatic segmentation via registration of the statistical models to preoperative CT and planning of fixation trajectories and dislocation / fracture reduction; and (iii) 3D-2D guidance using intraoperative fluoroscopy. For intracranial neurosurgery, the dissertation includes three inter-modality deformable registrations using physic-based Demons and deep learning models for CT-guided and CBCT-guided procedures

Epidemiology of Injury in English Women's Super league Football: A Cohort Study

INTRODUCTION: The epidemiology of injury in male professional football has been well documented (Ekstrand, Hägglund, & Waldén, 2011) and used as a basis to understand injury trends for a number of years. The prevalence and incidence of injuries occurring in womens super league football is unknown. The aim of this study is to estimate the prevalence and incidence of injury in an English Super League Women’s Football squad. METHODS: Following ethical approval from Leeds Beckett University, players (n = 25) signed to a Women’s Super League Football club provided written informed consent to complete a self-administered injury survey. Measures of exposure, injury and performance over a 12-month period was gathered. Participants were classified as injured if they reported a football injury that required medical attention or withdrawal from participation for one day or more. Injuries were categorised as either traumatic or overuse and whether the injury was a new injury and/or re-injury of the same anatomical site RESULTS: 43 injuries, including re-injury were reported by the 25 participants providing a clinical incidence of 1.72 injuries per player. Total incidence of injury was 10.8/1000 h (95% CI: 7.5 to 14.03). Participants were at higher risk of injury during a match compared with training (32.4 (95% CI: 15.6 to 48.4) vs 8.0 (95% CI: 5.0 to 10.85)/1000 hours, p 28 days) of which there were three non-contact anterior cruciate ligament (ACL) injuries. The epidemiological incidence proportion was 0.80 (95% CI: 0.64 to 0.95) and the average probability that any player on this team will sustain at least one injury was 80.0% (95% CI: 64.3% to 95.6%) CONCLUSION: This is the first report capturing exposure and injury incidence by anatomical site from a cohort of English players and is comparable to that found in Europe (6.3/1000 h (95% CI 5.4 to 7.36) Larruskain et al 2017). The number of ACL injuries highlights a potential injury burden for a squad of this size. Multi-site prospective investigations into the incidence and prevalence of injury in women’s football are require