Deformable Multisurface Segmentation of the Spine for Orthopedic Surgery Planning and Simulation

Purpose: We describe a shape-aware multisurface simplex deformable model for the segmentation of healthy as well as pathological lumbar spine in medical image data. Approach: This model provides an accurate and robust segmentation scheme for the identification of intervertebral disc pathologies to enable the minimally supervised planning and patient-specific simulation of spine surgery, in a manner that combines multisurface and shape statistics-based variants of the deformable simplex model. Statistical shape variation within the dataset has been captured by application of principal component analysis and incorporated during the segmentation process to refine results. In the case where shape statistics hinder detection of the pathological region, user assistance is allowed to disable the prior shape influence during deformation. Results: Results demonstrate validation against user-assisted expert segmentation, showing excellent boundary agreement and prevention of spatial overlap between neighboring surfaces. This section also plots the characteristics of the statistical shape model, such as compactness, generalizability and specificity, as a function of the number of modes used to represent the family of shapes. Final results demonstrate a proof-of-concept deformation application based on the open-source surgery simulation Simulation Open Framework Architecture toolkit. Conclusions: To summarize, we present a deformable multisurface model that embeds a shape statistics force, with applications to surgery planning and simulation

Multi-Surface Simplex Spine Segmentation for Spine Surgery Simulation and Planning

This research proposes to develop a knowledge-based multi-surface simplex deformable model for segmentation of healthy as well as pathological lumbar spine data. It aims to provide a more accurate and robust segmentation scheme for identification of intervertebral disc pathologies to assist with spine surgery planning. A robust technique that combines multi-surface and shape statistics-aware variants of the deformable simplex model is presented. Statistical shape variation within the dataset has been captured by application of principal component analysis and incorporated during the segmentation process to refine results. In the case where shape statistics hinder detection of the pathological region, user-assistance is allowed to disable the prior shape influence during deformation. Results have been validated against user-assisted expert segmentation

Analysis of uncertainty and variability in finite element computational models for biomedical engineering: characterization and propagation

Computational modeling has become a powerful tool in biomedical engineering thanks to its potential to simulate coupled systems. However, real parameters are usually not accurately known, and variability is inherent in living organisms. To cope with this, probabilistic tools, statistical analysis and stochastic approaches have been used. This article aims to review the analysis of uncertainty and variability in the context of finite element modeling in biomedical engineering. Characterization techniques and propagation methods are presented, as well as examples of their applications in biomedical finite element simulations. Uncertainty propagation methods, both non-intrusive and intrusive, are described. Finally, pros and cons of the different approaches and their use in the scientific community are presented. This leads us to identify future directions for research and methodological development of uncertainty modeling in biomedical engineering

CAD-Based Porous Scaffold Design of Intervertebral Discs in Tissue Engineering

With the development and maturity of three-dimensional (3D) printing technology over the past decade, 3D printing has been widely investigated and applied in the field of tissue engineering to repair damaged tissues or organs, such as muscles, skin, and bones, Although a number of automated fabrication methods have been developed to create superior bio-scaffolds with specific surface properties and porosity, the major challenges still focus on how to fabricate 3D natural biodegradable scaffolds that have tailor properties such as intricate architecture, porosity, and interconnectivity in order to provide the needed structural integrity, strength, transport, and ideal microenvironment for cell- and tissue-growth. In this dissertation, a robust pipeline of fabricating bio-functional porous scaffolds of intervertebral discs based on different innovative porous design methodologies is illustrated. Firstly, a triply periodic minimal surface (TPMS) based parameterization method, which has overcome the integrity problem of traditional TPMS method, is presented in Chapter 3. Then, an implicit surface modeling (ISM) approach using tetrahedral implicit surface (TIS) is demonstrated and compared with the TPMS method in Chapter 4. In Chapter 5, we present an advanced porous design method with higher flexibility using anisotropic radial basis function (ARBF) and volumetric meshes. Based on all these advanced porous design methods, the 3D model of a bio-functional porous intervertebral disc scaffold can be easily designed and its physical model can also be manufactured through 3D printing. However, due to the unique shape of each intervertebral disc and the intricate topological relationship between the intervertebral discs and the spine, the accurate localization and segmentation of dysfunctional discs are regarded as another obstacle to fabricating porous 3D disc models. To that end, we discuss in Chapter 6 a segmentation technique of intervertebral discs from CT-scanned medical images by using deep convolutional neural networks. Additionally, some examples of applying different porous designs on the segmented intervertebral disc models are demonstrated in Chapter 6

Cube-Cut: Vertebral Body Segmentation in MRI-Data through Cubic-Shaped Divergences

In this article, we present a graph-based method using a cubic template for volumetric segmentation of vertebrae in magnetic resonance imaging (MRI) acquisitions. The user can define the degree of deviation from a regular cube via a smoothness value Delta. The Cube-Cut algorithm generates a directed graph with two terminal nodes (s-t-network), where the nodes of the graph correspond to a cubic-shaped subset of the image's voxels. The weightings of the graph's terminal edges, which connect every node with a virtual source s or a virtual sink t, represent the affinity of a voxel to the vertebra (source) and to the background (sink). Furthermore, a set of infinite weighted and non-terminal edges implements the smoothness term. After graph construction, a minimal s-t-cut is calculated within polynomial computation time, which splits the nodes into two disjoint units. Subsequently, the segmentation result is determined out of the source-set. A quantitative evaluation of a C++ implementation of the algorithm resulted in an average Dice Similarity Coefficient (DSC) of 81.33% and a running time of less than a minute.Comment: 23 figures, 2 tables, 43 references, PLoS ONE 9(4): e9338

Spinal cord grey matter segmentation challenge

An important image processing step in spinal cord magnetic resonance imaging is the ability to reliably and accurately segment grey and white matter for tissue specific analysis. There are several semi- or fully-automated segmentation methods for cervical cord cross-sectional area measurement with an excellent performance close or equal to the manual segmentation. However, grey matter segmentation is still challenging due to small cross-sectional size and shape, and active research is being conducted by several groups around the world in this field. Therefore a grey matter spinal cord segmentation challenge was organised to test different capabilities of various methods using the same multi-centre and multi-vendor dataset acquired with distinct 3D gradient-echo sequences. This challenge aimed to characterize the state-of-the-art in the field as well as identifying new opportunities for future improvements. Six different spinal cord grey matter segmentation methods developed independently by various research groups across the world and their performance were compared to manual segmentation outcomes, the present gold-standard. All algorithms provided good overall results for detecting the grey matter butterfly, albeit with variable performance in certain quality-of-segmentation metrics. The data have been made publicly available and the challenge web site remains open to new submissions. No modifications were introduced to any of the presented methods as a result of this challenge for the purposes of this publication

Automatic Labeling of Vertebral Levels Using a Robust Template-Based Approach

Context. MRI of the spinal cord provides a variety of biomarkers sensitive to white matter integrity and neuronal function. Current processing methods are based on manual labeling of vertebral levels, which is time consuming and prone to user bias. Although several methods for automatic labeling have been published; they are not robust towards image contrast or towards susceptibility-related artifacts. Methods. Intervertebral disks are detected from the 3D analysis of the intensity profile along the spine. The robustness of the disk detection is improved by using a template of vertebral distance, which was generated from a training dataset. The developed method has been validated using T1- and T2-weighted contrasts in ten healthy subjects and one patient with spinal cord injury. Results. Accuracy of vertebral labeling was 100%. Mean absolute error was 2.1 ± 1.7 mm for T2-weighted images and 2.3 ± 1.6 mm for T1-weighted images. The vertebrae of the spinal cord injured patient were correctly labeled, despite the presence of artifacts caused by metallic implants. Discussion. We proposed a template-based method for robust labeling of vertebral levels along the whole spinal cord for T1- and T2-weighted contrasts. The method is freely available as part of the spinal cord toolbox

Statistical anatomical modelling for efficient and personalised spine biomechanical models

Personalised medicine is redefining the present and future of healthcare by increasing treatment efficacy and predicting diseases before they actually manifest. This innovative approach takes into consideration patient’s unique genes, environment, and lifestyle. An essential component is physics-based simulations, which allows the outcome of a treatment or a disease to be replicated and visualised using a computer. The main requirement to perform this type of simulation is to build patient-specific models. These models require the extraction of realistic object geometries from images, as well as the detection of diseases or deformities to improve the estimation of the material properties of the studied object. The aim of this thesis was the design of a general framework for creating patient- specific models for biomechanical simulations using a framework based on statistical shape models. The proposed methodology was tested on the construction of spine models, including vertebrae and intervertebral discs (IVD). The proposed framework is divided into three well-defined components: The paramount and first step is the extraction of the organ or anatomical structure from medical images. In the case of the spine, IVDs and vertebrae were extracted from Magnetic Resonance images (MRI) and Computed Tomography (CT), respectively. The second step is the classification of objects according to different factors, for instance, bones by its type and grade of fracture or IVDs by its degree of degeneration. This process is essential to properly model material properties, which depends on the possible pathologies of the tissue. The last component of the framework is the creation of the patient-specific model itself by combining the information from previous steps. The behaviour of the developed algorithms was tested using different datasets of spine images from both computed tomography (CT) and Magnetic resonance (MR) images from different institutions, type of population and image resolution

Development of ultrasound to measure deformation of functional spinal units in cervical spine

Neck pain is a pervasive problem in the general population, especially in those working in vibrating environments, e.g. military troops and truck drivers. Previous studies showed neck pain was strongly associated with the degeneration of intervertebral disc, which is commonly caused by repetitive loading in the work place. Currently, there is no existing method to measure the in-vivo displacement and loading condition of cervical spine on the site. Therefore, there is little knowledge about the alternation of cervical spine functionality and biomechanics in dynamic environments. In this thesis, a portable ultrasound system was explored as a tool to measure the vertebral motion and functional spinal unit deformation. It is hypothesized that the time sequences of ultrasound imaging signals can be used to characterize the deformation of cervical spine functional spinal units in response to applied displacements and loading. Specifically, a multi-frame tracking algorithm is developed to measure the dynamic movement of vertebrae, which is validated in ex-vivo models. The planar kinematics of the functional spinal units is derived from a dual ultrasound system, which applies two ultrasound systems to image C-spine anteriorly and posteriorly. The kinematics is reconstructed from the results of the multi-frame movement tracking algorithm and a method to co-register ultrasound vertebrae images to MRI scan. Using the dual ultrasound, it is shown that the dynamic deformation of functional spinal unit is affected by the biomechanics properties of intervertebral disc ex-vivo and different applied loading in activities in-vivo. It is concluded that ultrasound is capable of measuring functional spinal units motion, which allows rapid in-vivo evaluation of C-spine in dynamic environments where X-Ray, CT or MRI cannot be used.2020-02-20T00:00:00

Unveiling healthcare data archiving: Exploring the role of artificial intelligence in medical image analysis

Gli archivi sanitari digitali possono essere considerati dei moderni database progettati per immagazzinare e gestire ingenti quantità di informazioni mediche, dalle cartelle cliniche dei pazienti, a studi clinici fino alle immagini mediche e a dati genomici. I dati strutturati e non strutturati che compongono gli archivi sanitari sono oggetto di scrupolose e rigorose procedure di validazione per garantire accuratezza, affidabilità e standardizzazione a fini clinici e di ricerca. Nel contesto di un settore sanitario in continua e rapida evoluzione, l’intelligenza artificiale (IA) si propone come una forza trasformativa, capace di riformare gli archivi sanitari digitali migliorando la gestione, l’analisi e il recupero di vasti set di dati clinici, al fine di ottenere decisioni cliniche più informate e ripetibili, interventi tempestivi e risultati migliorati per i pazienti. Tra i diversi dati archiviati, la gestione e l’analisi delle immagini mediche in archivi digitali presentano numerose sfide dovute all’eterogeneità dei dati, alla variabilità della qualità delle immagini, nonché alla mancanza di annotazioni. L’impiego di soluzioni basate sull’IA può aiutare a risolvere efficacemente queste problematiche, migliorando l’accuratezza dell’analisi delle immagini, standardizzando la qualità dei dati e facilitando la generazione di annotazioni dettagliate. Questa tesi ha lo scopo di utilizzare algoritmi di IA per l’analisi di immagini mediche depositate in archivi sanitari digitali. Il presente lavoro propone di indagare varie tecniche di imaging medico, ognuna delle quali è caratterizzata da uno specifico dominio di applicazione e presenta quindi un insieme unico di sfide, requisiti e potenziali esiti. In particolare, in questo lavoro di tesi sarà oggetto di approfondimento l’assistenza diagnostica degli algoritmi di IA per tre diverse tecniche di imaging, in specifici scenari clinici: i) Immagini endoscopiche ottenute durante esami di laringoscopia; ciò include un’esplorazione approfondita di tecniche come la detection di keypoints per la stima della motilità delle corde vocali e la segmentazione di tumori del tratto aerodigestivo superiore; ii) Immagini di risonanza magnetica per la segmentazione dei dischi intervertebrali, per la diagnosi e il trattamento di malattie spinali, così come per lo svolgimento di interventi chirurgici guidati da immagini; iii) Immagini ecografiche in ambito reumatologico, per la valutazione della sindrome del tunnel carpale attraverso la segmentazione del nervo mediano. Le metodologie esposte in questo lavoro evidenziano l’efficacia degli algoritmi di IA nell’analizzare immagini mediche archiviate. I progressi metodologici ottenuti sottolineano il notevole potenziale dell’IA nel rivelare informazioni implicitamente presenti negli archivi sanitari digitali