Segmentation of pelvic structures from preoperative images for surgical planning and guidance

Prostate cancer is one of the most frequently diagnosed malignancies globally and the second leading cause of cancer-related mortality in males in the developed world. In recent decades, many techniques have been proposed for prostate cancer diagnosis and treatment. With the development of imaging technologies such as CT and MRI, image-guided procedures have become increasingly important as a means to improve clinical outcomes. Analysis of the preoperative images and construction of 3D models prior to treatment would help doctors to better localize and visualize the structures of interest, plan the procedure, diagnose disease and guide the surgery or therapy. This requires efficient and robust medical image analysis and segmentation technologies to be developed. The thesis mainly focuses on the development of segmentation techniques in pelvic MRI for image-guided robotic-assisted laparoscopic radical prostatectomy and external-beam radiation therapy. A fully automated multi-atlas framework is proposed for bony pelvis segmentation in MRI, using the guidance of MRI AE-SDM. With the guidance of the AE-SDM, a multi-atlas segmentation algorithm is used to delineate the bony pelvis in a new \ac{MRI} where there is no CT available. The proposed technique outperforms state-of-the-art algorithms for MRI bony pelvis segmentation. With the SDM of pelvis and its segmented surface, an accurate 3D pelvimetry system is designed and implemented to measure a comprehensive set of pelvic geometric parameters for the examination of the relationship between these parameters and the difficulty of robotic-assisted laparoscopic radical prostatectomy. This system can be used in both manual and automated manner with a user-friendly interface. A fully automated and robust multi-atlas based segmentation has also been developed to delineate the prostate in diagnostic MR scans, which have large variation in both intensity and shape of prostate. Two image analysis techniques are proposed, including patch-based label fusion with local appearance-specific atlases and multi-atlas propagation via a manifold graph on a database of both labeled and unlabeled images when limited labeled atlases are available. The proposed techniques can achieve more robust and accurate segmentation results than other multi-atlas based methods. The seminal vesicles are also an interesting structure for therapy planning, particularly for external-beam radiation therapy. As existing methods fail for the very onerous task of segmenting the seminal vesicles, a multi-atlas learning framework via random decision forests with graph cuts refinement has further been proposed to solve this difficult problem. Motivated by the performance of this technique, I further extend the multi-atlas learning to segment the prostate fully automatically using multispectral (T1 and T2-weighted) MR images via hybrid \ac{RF} classifiers and a multi-image graph cuts technique. The proposed method compares favorably to the previously proposed multi-atlas based prostate segmentation. The work in this thesis covers different techniques for pelvic image segmentation in MRI. These techniques have been continually developed and refined, and their application to different specific problems shows ever more promising results.Open Acces

Landmark Localization, Feature Matching and Biomarker Discovery from Magnetic Resonance Images

The work presented in this thesis proposes several methods that can be roughly divided into three different categories: I) landmark localization in medical images, II) feature matching for image registration, and III) biomarker discovery in neuroimaging. The first part deals with the identification of anatomical landmarks. The motivation stems from the fact that the manual identification and labeling of these landmarks is very time consuming and prone to observer errors, especially when large datasets must be analyzed. In this thesis we present three methods to tackle this challenge: A landmark descriptor based on local self-similarities (SS), a subspace building framework based on manifold learning and a sparse coding landmark descriptor based on data-specific learned dictionary basis. The second part of this thesis deals with finding matching features between a pair of images. These matches can be used to perform a registration between them. Registration is a powerful tool that allows mapping images in a common space in order to aid in their analysis. Accurate registration can be challenging to achieve using intensity based registration algorithms. Here, a framework is proposed for learning correspondences in pairs of images by matching SS features and random sample and consensus (RANSAC) is employed as a robust model estimator to learn a deformation model based on feature matches. Finally, the third part of the thesis deals with biomarker discovery using machine learning. In this section a framework for feature extraction from learned low-dimensional subspaces that represent inter-subject variability is proposed. The manifold subspace is built using data-driven regions of interest (ROI). These regions are learned via sparse regression, with stability selection. Also, probabilistic distribution models for different stages in the disease trajectory are estimated for different class populations in the low-dimensional manifold and used to construct a probabilistic scoring function.Open Acces

Detection of anatomical structures in medical datasets

Detection and localisation of anatomical structures is extremely helpful for many image analysis algorithms. This thesis is concerned with the automatic identification of landmark points, anatomical regions and vessel centre lines in three-dimensional medical datasets. We examine how machine learning and atlas-based ideas may be combined to produce efficient, context-aware algorithms. For the problem of anatomical landmark detection, we develop an analog to the idea of autocontext, termed atlas location autocontext, whereby spatial context is iteratively learnt by the machine learning algorithm as part of a feedback loop. We then extend our anatomical landmark detection algorithm from Computed Tomography to Magnetic Resonance images, using image features based on histograms of oriented gradients. A cross-modality landmark detector is demonstrated using unsigned gradient orientations. The problem of brain parcellation is approached by independently training a random forest and a multi-atlas segmentation algorithm, then combining them by a simple Bayesian product operation. It is shown that, given classifiers providing complementary information, the hybrid classifier provides a superior result. The Bayesian product method of combination outperforms simple averaging where the classifiers are sufficiently independent. Finally, we present a system for identifying and tracking major arteries in Magnetic Resonance Angiography datasets, using automatically detected vascular landmarks to seed the tracking. Knowledge of individual vessel characteristics is employed to guide the tracking algorithm by two means. Firstly, the data is pre-processed using a top-hat transform of size corresponding to the vessel diameter. Secondly, a vascular atlas is generated to inform the cost function employed in the minimum path algorithm. Fully automatic tracking of the major arteries of the body is satisfactorily demonstrated

Machine Learning for Biomedical Application

Biomedicine is a multidisciplinary branch of medical science that consists of many scientific disciplines, e.g., biology, biotechnology, bioinformatics, and genetics; moreover, it covers various medical specialties. In recent years, this field of science has developed rapidly. This means that a large amount of data has been generated, due to (among other reasons) the processing, analysis, and recognition of a wide range of biomedical signals and images obtained through increasingly advanced medical imaging devices. The analysis of these data requires the use of advanced IT methods, which include those related to the use of artificial intelligence, and in particular machine learning. It is a summary of the Special Issue “Machine Learning for Biomedical Application”, briefly outlining selected applications of machine learning in the processing, analysis, and recognition of biomedical data, mostly regarding biosignals and medical images

Methods for three-dimensional Registration of Multimodal Abdominal Image Data

Multimodal image registration benefits the diagnosis, treatment planning and the performance of image-guided procedures in the liver, since it enables the fusion of complementary information provided by pre- and intrainterventional data about tumor localization and access. Although there exist various registration methods, approaches which are specifically optimized for the registration of multimodal abdominal scans are only scarcely available. The work presented in this thesis aims to tackle this problem by focusing on the development, optimization and evaluation of registration methods specifically for the registration of multimodal liver scans. The contributions to the research field of medical image registration include the development of a registration evaluation methodology that enables the comparison and optimization of linear and non-linear registration algorithms using a point-based accuracy measure. This methodology has been used to benchmark standard registration methods as well as novel approaches that were developed within the frame of this thesis. The results of the methodology showed that the employed similarity measure used during the registration has a major impact on the registration accuracy of the method. Due to this influence, two alternative similarity metrics bearing the potential to be used on multimodal image data are proposed and evaluated. The first metric relies on the use of gradient information in form of Histograms of Oriented Gradients (HOG) whereas the second metric employs a siamese neural network to learn a similarity measure directly on the image data. The evaluation showed, that both metrics could compete with state of the art similarity measures in terms of registration accuracy. The HOG-metric offers the advantage that it does not require ground truth data to learn a similarity estimation, but instead it is applicable to various data sets with the sole requirement of distinct gradients. However, the Siamese metric is characterized by a higher robustness for large rotations than the HOG-metric. To train such a network, registered ground truth data is required which may be critical for multimodal image data. Yet, the results show that it is possible to apply models trained on registered synthetic data on real patient data. The last part of this thesis focuses on methods to learn an entire registration process using neural networks, thereby offering the advantage to replace the traditional, time-consuming iterative registration procedure. Within the frame of this thesis, the so-called VoxelMorph network which was originally proposed for monomodal, non-linear registration learning is extended for affine and multimodal registration learning tasks. This extension includes the consideration of an image mask during metric evaluation as well as loss functions for multimodal data, such as the pretrained Siamese metric and a loss relying on the comparison of deformation fields. Based on the developed registration evaluation methodology, the performance of the original network as well as the extended variants are evaluated for monomodal and multimodal registration tasks using multiple data sets. With the extended network variants, it is possible to learn an entire multimodal registration process for the correction of large image displacements. As for the Siamese metric, the results imply a general transferability of models trained with synthetic data to registration tasks including real patient data. Due to the lack of multimodal ground truth data, this transfer represents an important step towards making Deep Learning based registration procedures clinically usable

Rapid Segmentation Techniques for Cardiac and Neuroimage Analysis

Recent technological advances in medical imaging have allowed for the quick acquisition of highly resolved data to aid in diagnosis and characterization of diseases or to guide interventions. In order to to be integrated into a clinical work flow, accurate and robust methods of analysis must be developed which manage this increase in data. Recent improvements in in- expensive commercially available graphics hardware and General-Purpose Programming on Graphics Processing Units (GPGPU) have allowed for many large scale data analysis problems to be addressed in meaningful time and will continue to as parallel computing technology improves. In this thesis we propose methods to tackle two clinically relevant image segmentation problems: a user-guided segmentation of myocardial scar from Late-Enhancement Magnetic Resonance Images (LE-MRI) and a multi-atlas segmentation pipeline to automatically segment and partition brain tissue from multi-channel MRI. Both methods are based on recent advances in computer vision, in particular max-flow optimization that aims at solving the segmentation problem in continuous space. This allows for (approximately) globally optimal solvers to be employed in multi-region segmentation problems, without the particular drawbacks of their discrete counterparts, graph cuts, which typically present with metrication artefacts. Max-flow solvers are generally able to produce robust results, but are known for being computationally expensive, especially with large datasets, such as volume images. Additionally, we propose two new deformable registration methods based on Gauss-Newton optimization and smooth the resulting deformation fields via total-variation regularization to guarantee the problem is mathematically well-posed. We compare the performance of these two methods against four highly ranked and well-known deformable registration methods on four publicly available databases and are able to demonstrate a highly accurate performance with low run times. The best performing variant is subsequently used in a multi-atlas segmentation pipeline for the segmentation of brain tissue and facilitates fast run times for this computationally expensive approach. All proposed methods are implemented using GPGPU for a substantial increase in computational performance and so facilitate deployment into clinical work flows. We evaluate all proposed algorithms in terms of run times, accuracy, repeatability and errors arising from user interactions and we demonstrate that these methods are able to outperform established methods. The presented approaches demonstrate high performance in comparison with established methods in terms of accuracy and repeatability while largely reducing run times due to the employment of GPU hardware

Automated brain lesion segmentation in magnetic resonance images

In this thesis, we investigate the potential of automation in brain lesion segmentation in magnetic resonance images. We first develop a novel supervised method, which segments regions in magnetic resonance images using gated recurrent units, provided training data with pixel-wise annotations on what to segment is available. We improve on this method using the latest technical advances in the field of machine learning and insights on possible weaknesses of our method, and adapt it specifically for the task of lesion segmentation in the brain. We show the feasibility of our approach on multiple public benchmarks, consistently reaching positions at the top of the list of competing methods. Adapting our problem successfully to the problem of landmark localization, we show the generalizability of the approach. Moving away from large training cohorts with manual segmentations to data where it is only known that a certain pathology is present, we propose a weakly-supervised segmentation approach. Given a set of images with known pathology of a certain kind and a healthy reference set, our formulation can segment the difference of the two data distributions. Lastly, we show how information from already existing lesion maps can be extracted in a meaningful way by connecting lesions across time in longitudinal studies. We hence present a full tool set for the automated processing of lesions in magnetic resonance images