Medical image computing and computer-aided medical interventions applied to soft tissues. Work in progress in urology

Until recently, Computer-Aided Medical Interventions (CAMI) and Medical Robotics have focused on rigid and non deformable anatomical structures. Nowadays, special attention is paid to soft tissues, raising complex issues due to their mobility and deformation. Mini-invasive digestive surgery was probably one of the first fields where soft tissues were handled through the development of simulators, tracking of anatomical structures and specific assistance robots. However, other clinical domains, for instance urology, are concerned. Indeed, laparoscopic surgery, new tumour destruction techniques (e.g. HIFU, radiofrequency, or cryoablation), increasingly early detection of cancer, and use of interventional and diagnostic imaging modalities, recently opened new challenges to the urologist and scientists involved in CAMI. This resulted in the last five years in a very significant increase of research and developments of computer-aided urology systems. In this paper, we propose a description of the main problems related to computer-aided diagnostic and therapy of soft tissues and give a survey of the different types of assistance offered to the urologist: robotization, image fusion, surgical navigation. Both research projects and operational industrial systems are discussed

A novel NMF-based DWI CAD framework for prostate cancer.

In this thesis, a computer aided diagnostic (CAD) framework for detecting prostate cancer in DWI data is proposed. The proposed CAD method consists of two frameworks that use nonnegative matrix factorization (NMF) to learn meaningful features from sets of high-dimensional data. The first technique, is a three dimensional (3D) level-set DWI prostate segmentation algorithm guided by a novel probabilistic speed function. This speed function is driven by the features learned by NMF from 3D appearance, shape, and spatial data. The second technique, is a probabilistic classifier that seeks to label a prostate segmented from DWI data as either alignat, contain cancer, or benign, containing no cancer. This approach uses a NMF-based feature fusion to create a feature space where data classes are clustered. In addition, using DWI data acquired at a wide range of b-values (i.e. magnetic field strengths) is investigated. Experimental analysis indicates that for both of these frameworks, using NMF producing more accurate segmentation and classification results, respectively, and that combining the information from DWI data at several b-values can assist in detecting prostate cancer

Shape Deformation Statistics and Regional Texture-Based Appearance Models for Segmentation

Transferring identified regions of interest (ROIs) from planning-time MRI images to the trans-rectal ultrasound (TRUS) images used to guide prostate biopsy is difficult because of the large difference in appearance between the two modalities as well as the deformation of the prostate's shape caused by the TRUS transducer. This dissertation describes methods for addressing these difficulties by both estimating a patient's prostate shape after the transducer is applied and then locating it in the TRUS image using skeletal models (s-reps) of prostate shapes. First, I introduce a geometrically-based method for interpolating discretely sampled s-reps into continuous objects. This interpolation is important for many tasks involving s-reps, including fitting them to new objects as well as the later applications described in this dissertation. This method is shown to be accurate for ellipsoids where an analytical solution is known. Next, I create a method for estimating a probability distribution on the difference between two shapes. Because s-reps live in a high-dimensional curved space, I use Principal Nested Spheres (PNS) to transform these representations to instead live in a flat space where standard techniques can be applied. This method is shown effective both on synthetic data as well as for modeling the deformation caused by the TRUS transducer to the prostate. In cases where appearance is described via a large number of parameters, such as intensity combined with multiple texture features, it is computationally beneficial to be able to turn these large tuples of descriptors into a scalar value. Using the inherent localization properties of s-reps, I develop a method for using regionally-trained classifiers to turn appearance tuples into the probability that the appearance tuple in question came from inside the prostate boundary. This method is shown to be able to accurately discern inside appearances from outside appearances over a large majority of the prostate boundary. Finally, I combine these techniques into a deformable model-based segmentation framework to segment the prostate in TRUS. By applying the learned mean deformation to a patient's prostate and then deforming it so that voxels with high probability of coming from the prostate's interior are also in the model's interior, I am able to generate prostate segmentations which are comparable to state of the art methods.Doctor of Philosoph

An Information Tracking Approach to the Segmentation of Prostates in Ultrasound Imaging

Outlining of the prostate boundary in ultrasound images is a very useful procedure performed and subsequently used by clinicians. The contribution of the resulting segmentation is twofold. First of all, the segmentation of the prostate glands can be used to analyze the size, geometry, and volume of the gland. Such analysis is useful as it is known that the former quantities used in conjunction with a PSA blood test can be used as an indicator of malignancy in the gland itself. The second purpose of accurate segmentation is for treatment planning purposes. In brachetherapy, commonly used to treat localized prostate cancer, the accurate location of the prostate must be found so that the radioactive seeds can be placed precisely in the malignant regions. Unfortunately, the current method of segmentation of ultrasound images is performed manually by expert radiologists. Due to the abundance of ultrasound data, the process of manual segmentation can be extremely time consuming and inefficient. A much more desirable way to perform the segmentation process is through automatic procedures, which should be able to accurately and efficiently extract the boundary of the prostate gland with minimal user intervention. This is the ultimate goal of the proposed approach. The proposed segmentation algorithm uses a probability distribution tracking framework to accurately and efficiently perform the task at hand. The basis for this methodology is to extract image and shape features from available manually segmented ultrasound images for which the actual prostate region is known. Then, the segmentation algorithm seeks a region in new ultrasound images whose features closely mirror the learned features of known prostate regions. Promising results were achieved using this method in a series of in silico and in vivo experiments

A non-invasive image based system for early diagnosis of prostate cancer.

Prostate cancer is the second most fatal cancer experienced by American males. The average American male has a 16.15% chance of developing prostate cancer, which is 8.38% higher than lung cancer, the second most likely cancer. The current in-vitro techniques that are based on analyzing a patients blood and urine have several limitations concerning their accuracy. In addition, the prostate Specific Antigen (PSA) blood-based test, has a high chance of false positive diagnosis, ranging from 28%-58%. Yet, biopsy remains the gold standard for the assessment of prostate cancer, but only as the last resort because of its invasive nature, high cost, and potential morbidity rates. The major limitation of the relatively small needle biopsy samples is the higher possibility of producing false positive diagnosis. Moreover, the visual inspection system (e.g., Gleason grading system) is not quantitative technique and different observers may classify a sample differently, leading to discrepancies in the diagnosis. As reported in the literature that the early detection of prostate cancer is a crucial step for decreasing prostate cancer related deaths. Thus, there is an urgent need for developing objective, non-invasive image based technology for early detection of prostate cancer. The objective of this dissertation is to develop a computer vision methodology, later translated into a clinically usable software tool, which can improve sensitivity and specificity of early prostate cancer diagnosis based on the well-known hypothesis that malignant tumors are will connected with the blood vessels than the benign tumors. Therefore, using either Diffusion Weighted Magnetic Resonance imaging (DW-MRI) or Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI), we will be able to interrelate the amount of blood in the detected prostate tumors by estimating either the Apparent Diffusion Coefficient (ADC) in the prostate with the malignancy of the prostate tumor or perfusion parameters. We intend to validate this hypothesis by demonstrating that automatic segmentation of the prostate from either DW-MRI or DCE-MRI after handling its local motion, provides discriminatory features for early prostate cancer diagnosis. The proposed CAD system consists of three majors components, the first two of which constitute new research contributions to a challenging computer vision problem. The three main components are: (1) A novel Shape-based segmentation approach to segment the prostate from either low contrast DW-MRI or DCE-MRI data; (2) A novel iso-contours-based non-rigid registration approach to ensure that we have voxel-on-voxel matches of all data which may be more difficult due to gross patient motion, transmitted respiratory effects, and intrinsic and transmitted pulsatile effects; and (3) Probabilistic models for the estimated diffusion and perfusion features for both malignant and benign tumors. Our results showed a 98% classification accuracy using Leave-One-Subject-Out (LOSO) approach based on the estimated ADC for 30 patients (12 patients diagnosed as malignant; 18 diagnosed as benign). These results show the promise of the proposed image-based diagnostic technique as a supplement to current technologies for diagnosing prostate cancer

Biomechanical Modeling and Inverse Problem Based Elasticity Imaging for Prostate Cancer Diagnosis

Early detection of prostate cancer plays an important role in successful prostate cancer treatment. This requires screening the prostate periodically after the age of 50. If screening tests lead to prostate cancer suspicion, prostate needle biopsy is administered which is still considered as the clinical gold standard for prostate cancer diagnosis. Given that needle biopsy is invasive and is associated with issues including discomfort and infection, it is desirable to develop a prostate cancer diagnosis system that has high sensitivity and specificity for early detection with a potential to improve needle biopsy outcome. Given the complexity and variability of prostate cancer pathologies, many research groups have been pursuing multi-parametric imaging approach as no single modality imaging technique has proven to be adequate. While imaging additional tissue properties increases the chance of reliable prostate cancer detection and diagnosis, selecting an additional property needs to be done carefully by considering clinical acceptability and cost. Clinical acceptability entails ease with respect to both operating by the radiologist and patient comfort. In this work, effective tissue biomechanics based diagnostic techniques are proposed for prostate cancer assessment with the aim of early detection and minimizing the numbers of prostate biopsies. The techniques take advantage of the low cost, widely available and well established TRUS imaging method. The proposed techniques include novel elastography methods which were formulated based on an inverse finite element frame work. Conventional finite element analysis is known to have high computational complexity, hence computation time demanding. This renders the proposed elastography methods not suitable for real-time applications. To address this issue, an accelerated finite element method was proposed which proved to be suitable for prostate elasticity reconstruction. In this method, accurate finite element analysis of a large number of prostates undergoing TRUS probe loadings was performed. Geometry input and displacement and stress fields output obtained from the analysis were used to train a neural network mapping function to be used for elastopgraphy imaging of prostate cancer patients. The last part of the research presented in this thesis tackles an issue with the current 3D TRUS prostate needle biopsy. Current 3D TRUS prostate needle biopsy systems require registering preoperative 3D TRUS to intra-operative 2D TRUS images. Such image registration is time-consuming while its real-time implementation is yet to be developed. To bypass this registration step, concept of a robotic system was proposed which can reliably determine the preoperative TRUS probe position relative to the prostate to place at the same position relative to the prostate intra-operatively. For this purpose, a contact pressure feedback system is proposed to ensure similar prostate deformation during 3D and 2D image acquisition in order to bypass the registration step

Automatic analysis of medical images for change detection in prostate cancer

Prostate cancer is the most common cancer and second most common cause of cancer death in men in the UK. However, the patient risk from the cancer can vary considerably, and the widespread use of prostate-specific antigen (PSA) screening has led to over-diagnosis and over-treatment of low-grade tumours. It is therefore important to be able to differentiate high-grade prostate cancer from the slowly- growing, low-grade cancer. Many of these men with low-grade cancer are placed on active surveillance (AS), which involves constant monitoring and intervention for risk reclassification, relying increasingly on magnetic resonance imaging (MRI) to detect disease progression, in addition to TRUS-guided biopsies which are the routine clinical standard method to use. This results in a need for new tools to process these images. For this purpose, it is important to have a good TRUS-MR registration so corresponding anatomy can be located accurately between the two. Automatic segmentation of the prostate gland on both modalities reduces some of the challenges of the registration, such as patient motion, tissue deformation, and the time of the procedure. This thesis focuses on the use of deep learning methods, specifically convolutional neural networks (CNNs), for prostate cancer management. Chapters 4 and 5 investigated the use of CNNs for both TRUS and MRI prostate gland segmentation, and reported high segmentation accuracies for both, Dice Score Coefficients (DSC) of 0.89 for TRUS segmentations and DSCs between 0.84-0.89 for MRI prostate gland segmentation using a range of networks. Chapter 5 also investigated the impact of these segmentation scores on more clinically relevant measures, such as MRI-TRUS registration errors and volume measures, showing that a statistically significant difference in DSCs did not lead to a statistically significant difference in the clinical measures using these segmentations. The potential of these algorithms in commercial and clinical systems are summarised and the use of the MRI prostate gland segmentation in the application of radiological prostate cancer progression prediction for AS patients are investigated and discussed in Chapter 8, which shows statistically significant improvements in accuracy when using spatial priors in the form of prostate segmentations (0.63 ± 0.16 vs. 0.82 ± 0.18 when comparing whole prostate MRI vs. only prostate gland region, respectively)

Automatic Prostate Segmentation in Ultrasound Images using Gradient Vector Flow Active Contour

ABSTRACT: Prostate cancer is one of the leading causes of death by cancer among men in the world. Ultrasonography is said to be the safest technique in medical imaging so it is used extensively in prostate cancer detection. On the other hand, determining of prostate's boundary in TRUS (Transrectal Ultrasound) images is very necessary in lots of treatment methods prostate cancer. So the first and essential step for computer aided diagnosis (CAD) is the automatic prostate segmentation that is an open problem yet. But the low SNR, presence of strong speckle noise, Weak edges and shadow artifacts in these kinds of images limit the effectiveness of classical segmentation schemes. The classical segmentation methods fail completely or require post processing step to remove invalid object boundaries in the segmentation results. This paper has proposed a fully automatic algorithm for prostate segmentation in TRUS images that overcomes the explained problems completely. The presented algorithm contains three main stages. First, morphological smoothing and stick's filter are used for noise removing. A neural network is employed in the second step to find a point in prostate region. Finally in the last step, the prostate boundaries are extracted by GVF active contour. Some experiments for the performance validity of the presented method, compared with the extracted prostate by the proposed algorithm with manually-delineated boundaries by radiologist. The results show that our method extracts prostate boundaries with mean square area error lower than 4.4%