Improving foveal avascular zone segmentation in fluorescein angiograms by leveraging manual vessel labels from public color fundus pictures

In clinical routine, ophthalmologists frequently analyze the shape and size of the foveal avascular zone (FAZ) to detect and monitor retinal diseases. In order to extract those parameters, the contours of the FAZ need to be segmented, which is normally achieved by analyzing the retinal vasculature (RV) around the macula in fluorescein angiograms (FA). Computer-aided segmentation methods based on deep learning (DL) can automate this task. However, current approaches for segmenting the FAZ are often tailored to a specific dataset or require manual initialization. Furthermore, they do not take the variability and challenges of clinical FA into account, which are often of low quality and difficult to analyze. In this paper we propose a DL-based framework to automatically segment the FAZ in challenging FA scans from clinical routine. Our approach mimics the workflow of retinal experts by using additional RV labels as a guidance during training. Hence, our model is able to produce RV segmentations simultaneously. We minimize the annotation work by using a multi-modal approach that leverages already available public datasets of color fundus pictures (CFPs) and their respective manual RV labels. Our experimental evaluation on two datasets with FA from 1) clinical routine and 2) large multicenter clinical trials shows that the addition of weak RV labels as a guidance during training improves the FAZ segmentation significantly with respect to using only manual FAZ annotations.Fil: Hofer, Dominik. Medizinische Universität Wien; AustriaFil: Schmidt Erfurth, Ursula. Medizinische Universität Wien; AustriaFil: Orlando, José Ignacio. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; Argentina. Medizinische Universität Wien; AustriaFil: Goldbach, Felix. Medizinische Universität Wien; AustriaFil: Gerendas, Bianca S.. Medizinische Universität Wien; AustriaFil: Seeböck, Philipp. Medizinische Universität Wien; Austri

Automatic segmentation and classification methods using optical coherence tomography angiography (Octa): A review and handbook

Optical coherence tomography angiography (OCTA) is a promising technology for the non-invasive imaging of vasculature. Many studies in literature present automated algorithms to quantify OCTA images, but there is a lack of a review on the most common methods and their comparison considering multiple clinical applications (e.g., ophthalmology and dermatology). Here, we aim to provide readers with a useful review and handbook for automatic segmentation and classification methods using OCTA images, presenting a comparison of techniques found in the literature based on the adopted segmentation or classification method and on the clinical application. Another goal of this study is to provide insight into the direction of research in automated OCTA image analysis, especially in the current era of deep learning

Deep Neural Ensemble for Retinal Vessel Segmentation in Fundus Images towards Achieving Label-free Angiography

Automated segmentation of retinal blood vessels in label-free fundus images entails a pivotal role in computed aided diagnosis of ophthalmic pathologies, viz., diabetic retinopathy, hypertensive disorders and cardiovascular diseases. The challenge remains active in medical image analysis research due to varied distribution of blood vessels, which manifest variations in their dimensions of physical appearance against a noisy background. In this paper we formulate the segmentation challenge as a classification task. Specifically, we employ unsupervised hierarchical feature learning using ensemble of two level of sparsely trained denoised stacked autoencoder. First level training with bootstrap samples ensures decoupling and second level ensemble formed by different network architectures ensures architectural revision. We show that ensemble training of auto-encoders fosters diversity in learning dictionary of visual kernels for vessel segmentation. SoftMax classifier is used for fine tuning each member auto-encoder and multiple strategies are explored for 2-level fusion of ensemble members. On DRIVE dataset, we achieve maximum average accuracy of 95.33\% with an impressively low standard deviation of 0.003 and Kappa agreement coefficient of 0.708 . Comparison with other major algorithms substantiates the high efficacy of our model.Comment: Accepted as a conference paper at IEEE EMBC, 201

Segmentation of Foveal Avascular Zone in Colour Fundus Images Based on Retinal Capillary Endpoints Detection

Diabetic retinopathy (DR) is one of the diabetes complications affecting the retina. It can be detected by investigating foveal avascular zone (FAZ) since there is a correlation between enlargement of FAZ and DR progression. In this research work, a method of FAZ detection is developed. Firstly, pre-processing is conducted to enhance and improve image quality. Afterwards, segmentation of FAZ is conducted using matched filter and local entropy thresholding to extract retinal vessels. FAZ area segmentation is done based on retinal capillary endpoints detection. This work is validated using retinal fundus images from Messidor and DRIVE databases. The result of FAZ segmentation has been verified by measuring the correlation coefficient of determined FAZ areas between the capillary endpoints of the proposed method and that of detected by ophthalmologists. The correlation values achieved are 0.912 and 0.802 for two aforementioned databases, respectively. These results indicate that the proposed method has successfully detected and segmented FAZ area, due to the highly significant correlation coefficient obtained between the proposed FAZ and that of the ophthalmologists

NON-INVASIVE IMAGE ENHANCEMENT OF COLOUR RETINAL FUNDUS IMAGES FOR A COMPUTERISED DIABETIC RETINOPATHY MONITORING AND GRADING SYSTEM

Diabetic Retinopathy (DR) is a sight threatening complication due to diabetes mellitus affecting the retina. The pathologies of DR can be monitored by analysing colour fundus images. However, the low and varied contrast between retinal vessels and the background in colour fundus images remains an impediment to visual analysis in particular in analysing tiny retinal vessels and capillary networks. To circumvent this problem, fundus fluorescein angiography (FF A) that improves the image contrast is used. Unfortunately, it is an invasive procedure (injection of contrast dyes) that leads to other physiological problems and in the worst case may cause death. The objective of this research is to develop a non-invasive digital Image enhancement scheme that can overcome the problem of the varied and low contrast colour fundus images in order that the contrast produced is comparable to the invasive fluorescein method, and without introducing noise or artefacts. The developed image enhancement algorithm (called RETICA) is incorporated into a newly developed computerised DR system (called RETINO) that is capable to monitor and grade DR severity using colour fundus images. RETINO grades DR severity into five stages, namely No DR, Mild Non Proliferative DR (NPDR), Moderate NPDR, Severe NPDR and Proliferative DR (PDR) by enhancing the quality of digital colour fundus image using RETICA in the macular region and analysing the enlargement of the foveal avascular zone (F AZ), a region devoid of retinal vessels in the macular region. The importance of this research is to improve image quality in order to increase the accuracy, sensitivity and specificity of DR diagnosis, and to enable DR grading through either direct observation or computer assisted diagnosis system

The Role of Medical Image Modalities and AI in the Early Detection, Diagnosis and Grading of Retinal Diseases: A Survey.

Traditional dilated ophthalmoscopy can reveal diseases, such as age-related macular degeneration (AMD), diabetic retinopathy (DR), diabetic macular edema (DME), retinal tear, epiretinal membrane, macular hole, retinal detachment, retinitis pigmentosa, retinal vein occlusion (RVO), and retinal artery occlusion (RAO). Among these diseases, AMD and DR are the major causes of progressive vision loss, while the latter is recognized as a world-wide epidemic. Advances in retinal imaging have improved the diagnosis and management of DR and AMD. In this review article, we focus on the variable imaging modalities for accurate diagnosis, early detection, and staging of both AMD and DR. In addition, the role of artificial intelligence (AI) in providing automated detection, diagnosis, and staging of these diseases will be surveyed. Furthermore, current works are summarized and discussed. Finally, projected future trends are outlined. The work done on this survey indicates the effective role of AI in the early detection, diagnosis, and staging of DR and/or AMD. In the future, more AI solutions will be presented that hold promise for clinical applications

NON-INVASIVE IMAGE ENHANCEMENT OF COLOUR RETINAL FUNDUS IMAGES FOR A COMPUTERISED DIABETIC RETINOPATHY MONITORING AND GRADING SYSTEM

Diabetic Retinopathy (DR) is a sight threatening complication due to diabetes mellitus affecting the retina. The pathologies of DR can be monitored by analysing colour fundus images. However, the low and varied contrast between retinal vessels and the background in colour fundus images remains an impediment to visual analysis in particular in analysing tiny retinal vessels and capillary networks. To circumvent this problem, fundus fluorescein angiography (FF A) that improves the image contrast is used. Unfortunately, it is an invasive procedure (injection of contrast dyes) that leads to other physiological problems and in the worst case may cause death. The objective of this research is to develop a non-invasive digital Image enhancement scheme that can overcome the problem of the varied and low contrast colour fundus images in order that the contrast produced is comparable to the invasive fluorescein method, and without introducing noise or artefacts. The developed image enhancement algorithm (called RETICA) is incorporated into a newly developed computerised DR system (called RETINO) that is capable to monitor and grade DR severity using colour fundus images. RETINO grades DR severity into five stages, namely No DR, Mild Non Proliferative DR (NPDR), Moderate NPDR, Severe NPDR and Proliferative DR (PDR) by enhancing the quality of digital colour fundus image using RETICA in the macular region and analysing the enlargement of the foveal avascular zone (F AZ), a region devoid of retinal vessels in the macular region. The importance of this research is to improve image quality in order to increase the accuracy, sensitivity and specificity of DR diagnosis, and to enable DR grading through either direct observation or computer assisted diagnosis system

CAD system for early diagnosis of diabetic retinopathy based on 3D extracted imaging markers.

This dissertation makes significant contributions to the field of ophthalmology, addressing the segmentation of retinal layers and the diagnosis of diabetic retinopathy (DR). The first contribution is a novel 3D segmentation approach that leverages the patientspecific anatomy of retinal layers. This approach demonstrates superior accuracy in segmenting all retinal layers from a 3D retinal image compared to current state-of-the-art methods. It also offers enhanced speed, enabling potential clinical applications. The proposed segmentation approach holds great potential for supporting surgical planning and guidance in retinal procedures such as retinal detachment repair or macular hole closure. Surgeons can benefit from the accurate delineation of retinal layers, enabling better understanding of the anatomical structure and more effective surgical interventions. Moreover, real-time guidance systems can be developed to assist surgeons during procedures, improving overall patient outcomes. The second contribution of this dissertation is the introduction of a novel computeraided diagnosis (CAD) system for precise identification of diabetic retinopathy. The CAD system utilizes 3D-OCT imaging and employs an innovative approach that extracts two distinct features: first-order reflectivity and 3D thickness. These features are then fused and used to train and test a neural network classifier. The proposed CAD system exhibits promising results, surpassing other machine learning and deep learning algorithms commonly employed in DR detection. This demonstrates the effectiveness of the comprehensive analysis approach employed by the CAD system, which considers both low-level and high-level data from the 3D retinal layers. The CAD system presents a groundbreaking contribution to the field, as it goes beyond conventional methods, optimizing backpropagated neural networks to integrate multiple levels of information effectively. By achieving superior performance, the proposed CAD system showcases its potential in accurately diagnosing DR and aiding in the prevention of vision loss. In conclusion, this dissertation presents novel approaches for the segmentation of retinal layers and the diagnosis of diabetic retinopathy. The proposed methods exhibit significant improvements in accuracy, speed, and performance compared to existing techniques, opening new avenues for clinical applications and advancements in the field of ophthalmology. By addressing future research directions, such as testing on larger datasets, exploring alternative algorithms, and incorporating user feedback, the proposed methods can be further refined and developed into robust, accurate, and clinically valuable tools for diagnosing and monitoring retinal diseases

An Exploration of an Innovative Curriculum and an Effectiveness of Pedagogy of ESP Courses with Special Reference to Engineering World

The present study is an effort to explore a cutting-edge engineering-English curriculum and a time-tested pedagogy based on longitudinal needs-analysis to best suit the students and professionals of engineering world. The needs analysis in this study drew on both English for Academic Purposes (EAP) and English for Occupational Purposes (EOP) that the students and professionals of engineering disciplines need to master in order to perform well in their respective domains. The quantitative and qualitative surveys were conducted on one thousand respondents including the engineering students, professionals, professors and ELT/ESP practitioners of Saudi universities to collect valid and reliable data with the purpose of confirming what kinds of innovative English curricula and effective pedagogies will be the best panaceas for Saudi engineering students’ academic and occupational needs. With regard to the English curriculum, the findings reveal that it needs to be contents-based embedded in integrated language activities, vocabulary and communicative grammar teaching. For pedagogy to be effective and productive, as the findings reveal, the ESP educators have to be highly learner-centered, multidimensional, communicative, collaborative and interdisciplinary