Doctor of Philosophy

dissertationCongenital heart defects are classes of birth defects that affect the structure and function of the heart. These defects are attributed to the abnormal or incomplete development of a fetal heart during the first few weeks following conception. The overall detection rate of congenital heart defects during routine prenatal examination is low. This is attributed to the insufficient number of trained personnel in many local health centers where many cases of congenital heart defects go undetected. This dissertation presents a system to identify congenital heart defects to improve pregnancy outcomes and increase their detection rates. The system was developed and its performance assessed in identifying the presence of ventricular defects (congenital heart defects that affect the size of the ventricles) using four-dimensional fetal chocardiographic images. The designed system consists of three components: 1) a fetal heart location estimation component, 2) a fetal heart chamber segmentation component, and 3) a detection component that detects congenital heart defects from the segmented chambers. The location estimation component is used to isolate a fetal heart in any four-dimensional fetal echocardiographic image. It uses a hybrid region of interest extraction method that is robust to speckle noise degradation inherent in all ultrasound images. The location estimation method's performance was analyzed on 130 four-dimensional fetal echocardiographic images by comparison with manually identified fetal heart region of interest. The location estimation method showed good agreement with the manually identified standard using four quantitative indexes: Jaccard index, Sørenson-Dice index, Sensitivity index and Specificity index. The average values of these indexes were measured at 80.70%, 89.19%, 91.04%, and 99.17%, respectively. The fetal heart chamber segmentation component uses velocity vector field estimates computed on frames contained in a four-dimensional image to identify the fetal heart chambers. The velocity vector fields are computed using a histogram-based optical flow technique which is formulated on local image characteristics to reduces the effect of speckle noise and nonuniform echogenicity on the velocity vector field estimates. Features based on the velocity vector field estimates, voxel brightness/intensity values, and voxel Cartesian coordinate positions were extracted and used with kernel k-means algorithm to identify the individual chambers. The segmentation method's performance was evaluated on 130 images from 31 patients by comparing the segmentation results with manually identified fetal heart chambers. Evaluation was based on the Sørenson-Dice index, the absolute volume difference and the Hausdorff distance, with each resulting in per patient average values of 69.92%, 22.08%, and 2.82 mm, respectively. The detection component uses the volumes of the identified fetal heart chambers to flag the possible occurrence of hypoplastic left heart syndrome, a type of congenital heart defect. An empirical volume threshold defined on the relative ratio of adjacent fetal heart chamber volumes obtained manually is used in the detection process. The performance of the detection procedure was assessed by comparison with a set of images with confirmed diagnosis of hypoplastic left heart syndrome and a control group of normal fetal hearts. Of the 130 images considered 18 of 20 (90%) fetal hearts were correctly detected as having hypoplastic left heart syndrome and 84 of 110 (76.36%) fetal hearts were correctly detected as normal in the control group. The results show that the detection system performs better than the overall detection rate for congenital heart defect which is reported to be between 30% and 60%

Foetal echocardiographic segmentation

Congenital heart disease affects just under one percentage of all live births [1]. Those defects that manifest themselves as changes to the cardiac chamber volumes are the motivation for the research presented in this thesis. Blood volume measurements in vivo require delineation of the cardiac chambers and manual tracing of foetal cardiac chambers is very time consuming and operator dependent. This thesis presents a multi region based level set snake deformable model applied in both 2D and 3D which can automatically adapt to some extent towards ultrasound noise such as attenuation, speckle and partial occlusion artefacts. The algorithm presented is named Mumford Shah Sarti Collision Detection (MSSCD). The level set methods presented in this thesis have an optional shape prior term for constraining the segmentation by a template registered to the image in the presence of shadowing and heavy noise. When applied to real data in the absence of the template the MSSCD algorithm is initialised from seed primitives placed at the centre of each cardiac chamber. The voxel statistics inside the chamber is determined before evolution. The MSSCD stops at open boundaries between two chambers as the two approaching level set fronts meet. This has significance when determining volumes for all cardiac compartments since cardiac indices assume that each chamber is treated in isolation. Comparison of the segmentation results from the implemented snakes including a previous level set method in the foetal cardiac literature show that in both 2D and 3D on both real and synthetic data, the MSSCD formulation is better suited to these types of data. All the algorithms tested in this thesis are within 2mm error to manually traced segmentation of the foetal cardiac datasets. This corresponds to less than 10% of the length of a foetal heart. In addition to comparison with manual tracings all the amorphous deformable model segmentations in this thesis are validated using a physical phantom. The volume estimation of the phantom by the MSSCD segmentation is to within 13% of the physically determined volume

Tissue mimicking materials for imaging and therapy phantoms: a review

Tissue mimicking materials (TMMs), typically contained within phantoms, have been used for many decades in both imaging and therapeutic applications. This review investigates the specifications that are typically being used in development of the latest TMMs. The imaging modalities that have been investigated focus around CT, mammography, SPECT, PET, MRI and ultrasound. Therapeutic applications discussed within the review include radiotherapy, thermal therapy and surgical applications. A number of modalities were not reviewed including optical spectroscopy, optical imaging and planar x-rays. The emergence of image guided interventions and multimodality imaging have placed an increasing demand on the number of specifications on the latest TMMs. Material specification standards are available in some imaging areas such as ultrasound. It is recommended that this should be replicated for other imaging and therapeutic modalities. Materials used within phantoms have been reviewed for a series of imaging and therapeutic applications with the potential to become a testbed for cross-fertilization of materials across modalities. Deformation, texture, multimodality imaging and perfusion are common themes that are currently under development

Vascular Complexity Evaluation Using a Skeletonization Approach and 3D LED-Based Photoacoustic Images

Vasculature analysis is a fundamental aspect in the diagnosis, treatment, outcome evaluation and follow-up of several diseases. The quantitative characterization of the vascular network can be a powerful means for earlier pathologies revealing and for their monitoring. For this reason, non-invasive and quantitative methods for the evaluation of blood vessels complexity is a very important issue. Many imaging techniques can be used for visualizing blood vessels, but many modalities are limited by high costs, the need of exogenous contrast agents, the use of ionizing radiation, a very limited acquisition depth, and/or long acquisition times. Photoacoustic imaging has recently been the focus of much research and is now emerging in clinical applications. This imaging modality combines the qualities of good contrast and the spectral specificity of optical imaging and the high penetration depth and the spatial resolution of acoustic imaging. The optical absorption properties of blood also make it an endogenous contrast agent, allowing a completely non-invasive visualization of blood vessels. Moreover, more recent LED-based photoacoustic imaging systems are more affordable, safe and portable when compared to a laser-based systems. In this chapter we will confront the issue of vessel extraction techniques and how quantitative vascular parameters can be computed on 3D LED-based photoacoustic images using an in vitro vessel phantom model

A non-invasive diagnostic system for early assessment of acute renal transplant rejection.

Early diagnosis of acute renal transplant rejection (ARTR) is of immense importance for appropriate therapeutic treatment administration. Although the current diagnostic technique is based on renal biopsy, it is not preferred due to its invasiveness, recovery time (1-2 weeks), and potential for complications, e.g., bleeding and/or infection. In this thesis, a computer-aided diagnostic (CAD) system for early detection of ARTR from 4D (3D + b-value) diffusion-weighted (DW) MRI data is developed. The CAD process starts from a 3D B-spline-based data alignment (to handle local deviations due to breathing and heart beat) and kidney tissue segmentation with an evolving geometric (level-set-based) deformable model. The latter is guided by a voxel-wise stochastic speed function, which follows from a joint kidney-background Markov-Gibbs random field model accounting for an adaptive kidney shape prior and for on-going visual kidney-background appearances. A cumulative empirical distribution of apparent diffusion coefficient (ADC) at different b-values of the segmented DW-MRI is considered a discriminatory transplant status feature. Finally, a classifier based on deep learning of a non-negative constrained stacked auto-encoder is employed to distinguish between rejected and non-rejected renal transplants. In the “leave-one-subject-out” experiments on 53 subjects, 98% of the subjects were correctly classified (namely, 36 out of 37 rejected transplants and 16 out of 16 nonrejected ones). Additionally, a four-fold cross-validation experiment was performed, and an average accuracy of 96% was obtained. These experimental results hold promise of the proposed CAD system as a reliable non-invasive diagnostic tool

Patient-specific CFD simulation of intraventricular haemodynamics based on 3D ultrasound imaging

Background: The goal of this paper is to present a computational fluid dynamic (CFD) model with moving boundaries to study the intraventricular flows in a patient-specific framework. Starting from the segmentation of real-time transesophageal echocardiographic images, a CFD model including the complete left ventricle and the moving 3D mitral valve was realized. Their motion, known as a function of time from the segmented ultrasound images, was imposed as a boundary condition in an Arbitrary Lagrangian-Eulerian framework. Results: The model allowed for a realistic description of the displacement of the structures of interest and for an effective analysis of the intraventricular flows throughout the cardiac cycle. The model provides detailed intraventricular flow features, and highlights the importance of the 3D valve apparatus for the vortex dynamics and apical flow. Conclusions: The proposed method could describe the haemodynamics of the left ventricle during the cardiac cycle. The methodology might therefore be of particular importance in patient treatment planning to assess the impact of mitral valve treatment on intraventricular flow dynamics

Semi-Automatic Segmentation of Normal Female Pelvic Floor Structures from Magnetic Resonance Images

Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are important health issues affecting millions of American women. Investigation of the cause of SUI and POP requires a better understand of the anatomy of female pelvic floor. In addition, pre-surgical planning and individualized treatment plans require development of patient-specific three-dimensional or virtual reality models. The biggest challenge in building those models is to segment pelvic floor structures from magnetic resonance images because of their complex shapes, which make manual segmentation labor-intensive and inaccurate. In this dissertation, a quick and reliable semi-automatic segmentation method based on a shape model is proposed. The model is built on statistical analysis of the shapes of structures in a training set. A local feature map of the target image is obtained by applying a filtering pipeline, including contrast enhancement, noise reduction, smoothing, and edge extraction. With the shape model and feature map, automatic segmentation is performed by matching the model to the border of the structure using an optimization technique called evolution strategy. Segmentation performance is evaluated by calculating a similarity coefficient between semi-automatic and manual segmentation results. Taguchi analysis is performed to investigate the significance of segmentation parameters and provide tuning trends for better performance. The proposed method was successfully tested on both two-dimensional and three-dimensional image segmentation using the levator ani and obturator muscles as examples. Although the method is designed for segmentation of female pelvic floor structures, it can also be applied to other structures or organs without large shape variatio

Semi-Automatic Segmentation of Normal Female Pelvic Floor Structures from Magnetic Resonance Images

Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are important health issues affecting millions of American women. Investigation of the cause of SUI and POP requires a better understand of the anatomy of female pelvic floor. In addition, pre-surgical planning and individualized treatment plans require development of patient-specific three-dimensional or virtual reality models. The biggest challenge in building those models is to segment pelvic floor structures from magnetic resonance images because of their complex shapes, which make manual segmentation labor-intensive and inaccurate. In this dissertation, a quick and reliable semi-automatic segmentation method based on a shape model is proposed. The model is built on statistical analysis of the shapes of structures in a training set. A local feature map of the target image is obtained by applying a filtering pipeline, including contrast enhancement, noise reduction, smoothing, and edge extraction. With the shape model and feature map, automatic segmentation is performed by matching the model to the border of the structure using an optimization technique called evolution strategy. Segmentation performance is evaluated by calculating a similarity coefficient between semi-automatic and manual segmentation results. Taguchi analysis is performed to investigate the significance of segmentation parameters and provide tuning trends for better performance. The proposed method was successfully tested on both two-dimensional and three-dimensional image segmentation using the levator ani and obturator muscles as examples. Although the method is designed for segmentation of female pelvic floor structures, it can also be applied to other structures or organs without large shape variatio