A Framework on A Computer Assisted and Systematic Methodology for Detection of Chronic Lower Back Pain using Artificial Intelligence and Computer Graphics Technologies

Back pain is one of the major musculoskeletal pain problems that can affect many people and is considered as one of the main causes of disability all over the world. Lower back pain, which is the most common type of back pain, is estimated to affect at least 60% to 80% of the adult population in the United Kingdom at some time in their lives. Some of those patients develop a more serious condition namely Chronic Lower Back Pain in which physicians must carry out a more involved diagnostic procedure to determine its cause. In most cases, this procedure involves a long and laborious task by the physicians to visually identify abnormalities from the patient’s Magnetic Resonance Images. Limited technological advances have been made in the past decades to support this process. This paper presents a comprehensive literature review on these technological advances and presents a framework of a methodology for diagnosing and predicting Chronic Lower Back Pain. This framework will combine current state-of-the-art computing technologies including those in the area of artificial intelligence, physics modelling, and computer graphics, and is argued to be able to improve the diagnosis process

Lumbar Spine Discs Labeling using Axial View MRI Based on the Pixels Coordinate and Gray Level Features

Disc herniation is a major reason for lower back pain (LBP), it cost the United Kingdom (UK) government over £1.3 million per day. In fact a very high proportion of the UK population will complain from their back pain. Fur-thermore, Magnetic Resonance Imaging (MRI) is one of the main diagnosing procedure for LBP. Automatic disc labeling in the MRI to detect the herniation area will reduce the required time to issue the report from the radiologist. We present a method for automatic labeling for the lumbar spine disc area using the axial view MRI based on the pixels coordinate and gray level features. We use a clinical MRI for the training and testing. Moreover, the accuracy and the recon-structed images was the main indicator for our result. The highest achieved ac-curacy was 98.9 and 91.1 for Weighted KNN and Fine Gaussian SVM respec-tively

A Machine Learning and Computer Assisted Methodology for Diagnosing Chronic Lower Back Pain on Lumbar Spine Magnetic Resonance Images

Chronic Lower Back Pain (CLBP) is one of the major types of pain that affects many people around the world. It is estimated that 28.1% of US adults suffer from this illness and 2.5 million of the UK population experience this type of pain every day. Most CLBP cases do not happen overnight and it is usually developed from a less serious but acute variant of lower back pain. An acute type of lower back pain can develop into a chronic one if the underlying cause is serious and left untreated. The longer a person is disabled by back pain, the less chance he or she returns to work and the more health care cost he or she will require. It is therefore important to identify the cause of back pains as early as possible in order to improve the chance of patient rehabilitation. The speediness of early diagnosis can depend on many factors including referral time from a general practitioner to the hospital, waiting time for a specialist appointment, time for a Magnetic Resonance Imaging (MRI) scan and time for the analysis result to come out. Currently diagnosing the lower back pain is done by visual observation and analysis of the lumbar spine MRI images by radiologists and clinicians and this process could take up much of their time and effort. This, therefore, rationalizes the need for a new method to increase the efficiency and effectiveness of the imaging diagnostic process. This thesis details a novel methodology to automatically aid clinicians in performing diagnosis of CLBP on lumbar spine MRI images. The methodology is based on the current accepted medical practice of manual inspection of the MRI scans of the patient’s lumbar spine as advised by several practitioners in this field. The main methodology is divided into three sub-methods the first sub-method is disc herniation detection using disc segmentation and centroid distance function. While the second sub-method is lumbar spinal stenosis detection via segmentation of area between anterior and posterior (AAP) Elements. Whereas, the last sub-method is the use of deep learning to perform semantic segmentation to identify regions in the MRI images that are relevant to the diagnosis process. The method then performs boundary delineation between these regions, identifies key points along the boundaries and measures distances between these points that can be used as an indication to the health of the lumbar spine. Due to a limitation in the size and suitability of the currently existing open-access lumbar spine dataset necessary to train and test any good classification algorithms, a dataset consisting of 48,345 MRI slices from a complete clinical lumbar MRI study of 515 symptomatic back pain patients from several specialty hospitals around the world has been created. Each MRI study is annotated by expert radiologists with notes regarding the observed characteristics, condition of the lumbar spine, or presence of diseases. The ground-truth dataset containing manually labelled segmented images has also been developed. To complement this ground-truth dataset, a novel method of constructing and evaluating the suitability of ground truth data for lumbar spine MRI image segmentation has been developed. A subset of the dataset, which includes the data for 101 patients, is used in a set of experiments that have been conducted using a variety of algorithms to conclude with using SegNet as the image segmentation algorithm. The network consists of VGG16 layers pre-trained using a subset of non-medical images from the ImageNet database and fine-tuned using the training portion of the ground-truth dataset. The results of these experiments show the accurate delineation of important boundaries of regions in lumbar spine MRI. The experiments also show very close agreement between the expert radiologists’ notes on the condition of a lumbar spine and the conclusion of the system about the lumbar spine in the majority of cases

Statistical shape model reconstruction with sparse anomalous deformations: application to intervertebral disc herniation

Many medical image processing techniques rely on accurate shape modeling of anatomical features. The presence of shape abnormalities challenges traditional processing algorithms based on strong morphological priors. In this work, a sparse shape reconstruction from a statistical shape model is presented. It combines the advantages of traditional statistical shape models (defining a ‘normal’ shape space) and previously presented sparse shape composition (providing localized descriptors of anomalies). The algorithm was incorporated into our image segmentation and classification software. Evaluation was performed on simulated and clinical MRI data from 22 sciatica patients with intervertebral disc herniation, containing 35 herniated and 97 normal discs. Moderate to high correlation (R = 0.73) was achieved between simulated and detected herniations. The sparse reconstruction provided novel quantitative features describing the herniation morphology and MRI signal appearance in three dimensions (3D). The proposed descriptors of local disc morphology resulted to the 3D segmentation accuracy of 1.07 ± 1.00 mm (mean absolute vertex-to-vertex mesh distance over the posterior disc region), and improved the intervertebral disc classification from 0.888 to 0.931 (area under receiver operating curve). The results show that the sparse shape reconstruction may improve computer-aided diagnosis of pathological conditions presenting local morphological alterations, as seen in intervertebral disc herniation

Segmentation of Lumbar Spine MRI Images for Stenosis Detection using Patch-based Pixel Classification Neural Network

This paper addresses the central problem of automatic segmentation of lumbar spine Magnetic Resonance Imaging (MRI) images to delineate boundaries between the anterior arch and posterior arch of the lumbar spine. This is necessary to efficiently detect the occurrence of lumbar spinal stenosis as a leading cause of Chronic Lower Back Pain. A patch-based classification neural network consisting of convolutional and fully connected layers is used to classify and label pixels in MRI images. The classifier is trained using overlapping patches of size 25x25 pixels taken from a set of cropped axial-view T2-weighted MRI images of the bottom three intervertebral discs. A set of experiment is conducted to measure the performance of the classification network in segmenting the images when either all or each of the discs separately is used. Using pixel accuracy, mean accuracy, mean Intersection over Union (IoU), and frequency weighted IoU as the performance metrics we have shown that our approach produces better segmentation results than eleven other pixel classifiers. Furthermore, our experiment result also indicates that our approach produces more accurate delineation of all important boundaries and making it best suited for the subsequent stage of lumbar spinal stenosis detection

Development of Ground Truth Data for Automatic Lumbar Spine MRI Image Segmentation

Artificial Intelligence through supervised machine learning remains an attractive and popular research area in medical image processing. The objective of such research is often tied to the development of an intelligent computer aided diagnostic system whose aim is to assist physicians in their task of diagnosing diseases. The quality of the resulting system depends largely on the availability of good data for the machine learning algorithm to train on. Training data of a supervised learning process needs to include ground truth, i.e., data that have been correctly annotated by experts. Due to the complex nature of most medical images, human error, experience, and perception play a strong role in the quality of the ground truth. In this paper, we present the results of annotating lumbar spine Magnetic Resonance Imaging images for automatic image segmentation and propose confidence and consistency metrics to measure the quality and variability of the resulting ground truth data, respectively

Machine learning in orthopedics: a literature review

In this paper we present the findings of a systematic literature review covering the articles published in the last two decades in which the authors described the application of a machine learning technique and method to an orthopedic problem or purpose. By searching both in the Scopus and Medline databases, we retrieved, screened and analyzed the content of 70 journal articles, and coded these resources following an iterative method within a Grounded Theory approach. We report the survey findings by outlining the articles\u2019 content in terms of the main machine learning techniques mentioned therein, the orthopedic application domains, the source data and the quality of their predictive performance

Generative models : an upcoming innovation in musculoskeletal radiology? A preliminary test in spine imaging

Background Deep learning is a ground-breaking technology that is revolutionising many research and industrial fields. Generative models are recently gaining interest. Here, we investigate their potential, namely conditional generative adversarial networks, in the field of magnetic resonance imaging (MRI) of the spine, by performing clinically relevant benchmark cases. Methods First, the enhancement of the resolution of T2-weighted (T2W) images (super-resolution) was tested. Then, automated image-to-image translation was tested in the following tasks: (1) from T1-weighted to T2W images of the lumbar spine and (2) vice versa; (3) from T2W to short time inversion-recovery (STIR) images; (4) from T2W to turbo inversion recovery magnitude (TIRM) images; (5) from sagittal standing x-ray projections to T2W images. Clinical and quantitative assessments of the outputs by means of image quality metrics were performed. The training of the models was performed on MRI and x-ray images from 989 patients. Results The performance of the models was generally positive and promising, but with several limitations. The number of disc protrusions or herniations showed good concordance (\u3ba = 0.691) between native and super-resolution images. Moderate-to-excellent concordance was found when translating T2W to STIR and TIRM images (\u3ba 65\u20090.842 regarding disc degeneration), while the agreement was poor when translating x-ray to T2W images. Conclusions Conditional generative adversarial networks are able to generate perceptually convincing synthetic images of the spine in super-resolution and image-to-image translation tasks. Taking into account the limitations of the study, deep learning-based generative methods showed the potential to be an upcoming innovation in musculoskeletal radiology

CT Scanning

Since its introduction in 1972, X-ray computed tomography (CT) has evolved into an essential diagnostic imaging tool for a continually increasing variety of clinical applications. The goal of this book was not simply to summarize currently available CT imaging techniques but also to provide clinical perspectives, advances in hybrid technologies, new applications other than medicine and an outlook on future developments. Major experts in this growing field contributed to this book, which is geared to radiologists, orthopedic surgeons, engineers, and clinical and basic researchers. We believe that CT scanning is an effective and essential tools in treatment planning, basic understanding of physiology, and and tackling the ever-increasing challenge of diagnosis in our society