VR-Caps: A Virtual Environment for Capsule Endoscopy

Current capsule endoscopes and next-generation robotic capsules for diagnosis and treatment of gastrointestinal diseases are complex cyber-physical platforms that must orchestrate complex software and hardware functions. The desired tasks for these systems include visual localization, depth estimation, 3D mapping, disease detection and segmentation, automated navigation, active control, path realization and optional therapeutic modules such as targeted drug delivery and biopsy sampling. Data-driven algorithms promise to enable many advanced functionalities for capsule endoscopes, but real-world data is challenging to obtain. Physically-realistic simulations providing synthetic data have emerged as a solution to the development of data-driven algorithms. In this work, we present a comprehensive simulation platform for capsule endoscopy operations and introduce VR-Caps, a virtual active capsule environment that simulates a range of normal and abnormal tissue conditions (e.g., inflated, dry, wet etc.) and varied organ types, capsule endoscope designs (e.g., mono, stereo, dual and 360{\deg}camera), and the type, number, strength, and placement of internal and external magnetic sources that enable active locomotion. VR-Caps makes it possible to both independently or jointly develop, optimize, and test medical imaging and analysis software for the current and next-generation endoscopic capsule systems. To validate this approach, we train state-of-the-art deep neural networks to accomplish various medical image analysis tasks using simulated data from VR-Caps and evaluate the performance of these models on real medical data. Results demonstrate the usefulness and effectiveness of the proposed virtual platform in developing algorithms that quantify fractional coverage, camera trajectory, 3D map reconstruction, and disease classification.Comment: 18 pages, 14 figure

Automatic colonic polyp detection using curvature analysis for standard and low dose CT data

Colon cancer is the second leading cause of cancer related deaths in the developed nations. Early detection and removal of colorectal polyps via screening is the most effective way to reduce colorectal cancer (CRC) mortality. Computed Tomography Colonography (CTC) or Virtual Colonoscopy (VC) is a rapidly evolving non-invasive technique and the medical community view this medical procedure as an alternative to the standard colonoscopy for the detection of colonic polyps. In CTC the first step for automatic polyp detection for 3D visualization of the colon structure and automatic polyp detection addresses the segmentation of the colon lumen. The segmentation of colon lumen is far from a trivial task as in practice many datasets are collapsed due to incorrect patient preparation or blockages caused by residual water/materials left in the colon. In this thesis a robust multi-stage technique for automatic segmentation of the colon is proposed tha t maximally uses the anatomical model of a generic colon. In this regard, the colon is reconstructed using volume by length analysis, orientation, length, end points, geometrical position in the volumetric data, and gradient of the centreline of each candidate air region detected in the CT data. The proposed method was validated using a total of 151 standard dose (lOOmAs) and 13 low-dose (13mAs-40mAs) datasets and the collapsed colon surface detection was always higher than 95% with an average of 1.58% extra colonic surface inclusion. The second major step of automated CTC attempts the identification of colorectal polyps. In this thesis a robust method for polyp detection based on surface curvature analysis has been developed and evaluated. The convexity of the segmented colon surface is sampled using the surface normal intersection, Hough transform, 3D histogram, Gaussian distribution, convexity constraint and 3D region growing. For each polyp candidate surface the morphological and statistical features are extracted and the candidate surface is classified as a polyp/fold structure using a Feature Normalized Nearest Neighbourhood classifier. The devised polyp detection scheme entails a low computational overhead (typically takes 3.60 minute per dataset) and shows 100% sensitivity for polyps larger than 10mm, 92% sensitivity for polyps in the range 5 to 10mm and 64.28% sensitivity for polyp smaller than 5mm. The developed technique returns in average 4.01 false positives per dataset. The patient exposure to ionising radiation is the major concern in using CTC as a mass screening technique for colonic polyp detection. A reduction of the radiation dose will increase the level of noise during the acquisition process and as a result the quality of the CT d a ta is degraded. To fully investigate the effect of the low-dose radiation on the performance of automated polyp detection, a phantom has been developed and scanned using different radiation doses. The phantom polyps have realistic shapes (sessile, pedunculated, and flat) and sizes (3 to 20mm) and were designed to closely approximate the real polyps encountered in clinical CT data. Automatic polyp detection shows 100% sensitivity for polyps larger than 10mm and shows 95% sensitivity for polyps in the range 5 to 10mm. The developed method was applied to CT data acquired at radiation doses between 13 to 40mAs and the experimental results indicate th a t robust polyp detection can be obtained even at radiation doses as low as 13mAs

Registration of prone and supine CT colonography images and its clinical application

Computed tomographic (CT) colonography is a technique for detecting bowel cancer and potentially precancerous polyps. CT imaging is performed on the cleansed and insufflated bowel in order to produce a virtual endoluminal representation similar to optical colonoscopy. Because fluids and stool can mimic pathology, images are acquired with the patient in both prone and supine positions. Radiologists then match endoluminal locations visually between the two acquisitions in order to determine whether pathology is real or not. This process is hindered by the fact that the colon can undergo considerable deformation between acquisitions. Robust and accurate automated registration between prone and supine data acquisitions is therefore pivotal for medical interpretation, but a challenging problem. The method proposed in this thesis reduces the complexity of the registration task of aligning the prone and supine CT colonography acquisitions. This is done by utilising cylindrical representations of the colonic surface which reflect the colon's specific anatomy. Automated alignment in the cylindrical domain is achieved by non-rigid image registration using surface curvatures, applicable even when cases exhibit local luminal collapses. It is furthermore shown that landmark matches for initialisation improve the registration's accuracy and robustness. Additional performance improvements are achieved by symmetric and inverse-consistent registration and iteratively deforming the surface in order to compensate for differences in distension and bowel preparation. Manually identified reference points in human data and fiducial markers in a porcine phantom are used to validate the registration accuracy. The potential clinical impact of the method has been evaluated using data that reflects clinical practise. Furthermore, correspondence between follow-up CT colonography acquisitions is established in order to facilitate the clinical need to investigate polyp growth over time. Accurate registration has the potential to both improve the diagnostic process and decrease the radiologist's interpretation time. Furthermore, its result could be integrated into algorithms for improved computer-aided detection of colonic polyps

Feature extraction to aid disease detection and assessment of disease progression in CT and MR colonography

Computed tomographic colonography (CTC) is a technique employed to examine the whole colon for cancers and premalignant adenomas (polyps). Oral preparation is taken to fully cleanse the colon, and gas insufflation maximises the attenuation contrast between the enoluminal colon surface and the lumen. The procedure is performed routinely with the patient both prone and supine to redistribute gas and residue. This helps to differentiate fixed colonic pathology from mobile faecal residue and also helps discover pathology occluded by retained fluid or luminal collapse. Matching corresponding endoluminal surface locations with the patient in the prone and supine positions is therefore an essential aspect of interpretation by radiologists; however, interpretation can be difficult and time consuming due to the considerable colonic deformations that occur during repositioning. Hence, a method for automated registration has the potential to improve efficiency and diagnostic accuracy. I propose a novel method to establish correspondence between prone and supine CT colonography acquisitions automatically. The problem is first simplified by detecting haustral folds which are elongated ridgelike endoluminal structures and can be identified by curvature based measurements. These are subsequently matched using appearance based features, and their relative geometric relationships. It is shown that these matches can be used to find correspondence along the full length of the colon, but may also be used in conjunction with other registration methods to achieve a more robust and accurate result, explicitly addressing the problem of colonic collapse. The potential clinical value of this method has been assessed in an external clinical validation, and the application to follow-up CTC surveillance has been investigated. MRI has recently been applied as a tool to quantitatively evaluate the therapeutic response to therapy in patients with Crohn's disease, and is the preferred choice for repeated imaging. A primary biomarker for this evaluation is the measurement of variations of bowel wall thickness on changing from the active phase of the disease to remission; however, a poor level of interobserver agreement of measured thickness is reported and therefore a system for accurate, robust and reproducible measurements is desirable. I propose a novel method which will automatically track sections of colon, by estimating the positions of elliptical cross sections. Subsequently, estimation of the positions of the inner and outer bowel walls are made based on image gradient information and therefore a thickness measurement value can be extracted

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

Frontiers of robotic endoscopic capsules: a review

Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd., is an example of disruptive technology and represents an attractive alternative to traditional diagnostic techniques. WCE overcomes conventional endoscopy enabling inspection of the digestive system without discomfort or the need for sedation. Thus, it has the advantage of encouraging patients to undergo gastrointestinal (GI) tract examinations and of facilitating mass screening programmes. With the integration of further capabilities based on microrobotics, e.g. active locomotion and embedded therapeutic modules, WCE could become the key-technology for GI diagnosis and treatment. This review presents a research update on WCE and describes the state-of-the-art of current endoscopic devices with a focus on research-oriented robotic capsule endoscopes enabled by microsystem technologies. The article also presents a visionary perspective on WCE potential for screening, diagnostic and therapeutic endoscopic procedures

Facilitating Colorectal Cancer Diagnosis with Computed Tomographic Colonography

Computed tomographic colonography (CTC) is a diagnostic technique involving helical volume acquisition of the cleansed, distended colorectum to detect colorectal cancer or potentially premalignant polyps. This Thesis summarises the evidence base, identifies areas in need of further research, quantifies sources of bias and presents novel techniques to facilitate colorectal cancer diagnosis using CTC. CTC literature is reviewed to justify the rationale for current implementation and to identify fruitful areas for research. This confirms excellent diagnostic performance can be attained providing CTC is interpreted by trained, experienced observers employing state-of-the-art implementation. The technique is superior to barium enema and consequently, it has been embraced by radiologists, clinicians and health policy-makers. Factors influencing generalisability of CTC research are investigated, firstly with a survey of European educational workshop participants which revealed limited CTC experience and training, followed by a systematic review exploring bias in research studies of diagnostic test accuracy which established that studies focussing on these aspects were lacking. Experiments to address these sources of bias are presented, using novel methodology: Conjoint analysis is used to ascertain patients‘ and clinicians’ attitudes to false-positive screening diagnoses, showing that both groups overwhelmingly value sensitivity over specificity. The results inform a weighted statistical analysis for CAD which is applied to the results of two previous studies showing the incremental benefit is significantly higher for novices than experienced readers. We have employed eye-tracking technology to establish the visual search patterns of observers reading CTC, demonstrated feasibility and developed metrics for analysis. We also describe development and validation of computer software to register prone and supine endoluminal surface locations demonstrating accurate matching of corresponding points when applied to a phantom and a generalisable, publically available, CTC database. Finally, areas in need of future development are suggested