Department of Radiology-Annual Report-July 1, 1997 to June 30, 1998

Department of Radiology Annual Executive Summary Report, July 1, 1997 to June 30, 1998. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States. 103 pages

Sixth Annual Users' Conference

Conference papers and presentation outlines which address the use of the Transportable Applications Executive (TAE) and its various applications programs are compiled. Emphasis is given to the design of the user interface and image processing workstation in general. Alternate ports of TAE and TAE subsystems are also covered

Application of Advanced MRI to Fetal Medicine and Surgery

Robust imaging is essential for comprehensive preoperative evaluation, prognostication, and surgical planning in the field of fetal medicine and surgery. This is a challenging task given the small fetal size and increased fetal and maternal motion which affect MRI spatial resolution. This thesis explores the clinical applicability of post-acquisition processing using MRI advances such as super-resolution reconstruction (SRR) to generate optimal 3D isotropic volumes of anatomical structures by mitigating unpredictable fetal and maternal motion artefact. It paves the way for automated robust and accurate rapid segmentation of the fetal brain. This enables a hierarchical analysis of volume, followed by a local surface-based shape analysis (joint spectral matching) using mathematical markers (curvedness, shape index) that infer gyrification. This allows for more precise, quantitative measurements, and calculation of longitudinal correspondences of cortical brain development. I explore the potential of these MRI advances in three clinical settings: fetal brain development in the context of fetal surgery for spina bifida, airway assessment in fetal tracheolaryngeal obstruction, and the placental-myometrial-bladder interface in placenta accreta spectrum (PAS). For the fetal brain, MRI advances demonstrated an understanding of the impact of intervention on cortical development which may improve fetal candidate selection, neurocognitive prognostication, and parental counselling. This is of critical importance given that spina bifida fetal surgery is now a clinical reality and is routinely being performed globally. For the fetal trachea, SRR can provide improved anatomical information to better select those pregnancies where an EXIT procedure is required to enable the fetal airway to be secured in a timely manner. This would improve maternal and fetal morbidity outcomes associated with haemorrhage and hypoxic brain injury. Similarly, in PAS, SRR may assist surgical planning by providing enhanced anatomical assessment and prediction for adverse peri-operative maternal outcome such as bladder injury, catastrophic obstetric haemorrhage and maternal death

Computer-aided detection and diagnosis of breast cancer in 2D and 3D medical imaging through multifractal analysis

This Thesis describes the research work performed in the scope of a doctoral research program and presents its conclusions and contributions. The research activities were carried on in the industry with Siemens S.A. Healthcare Sector, in integration with a research team. Siemens S.A. Healthcare Sector is one of the world biggest suppliers of products, services and complete solutions in the medical sector. The company offers a wide selection of diagnostic and therapeutic equipment and information systems. Siemens products for medical imaging and in vivo diagnostics include: ultrasound, computer tomography, mammography, digital breast tomosynthesis, magnetic resonance, equipment to angiography and coronary angiography, nuclear imaging, and many others. Siemens has a vast experience in Healthcare and at the beginning of this project it was strategically interested in solutions to improve the detection of Breast Cancer, to increase its competitiveness in the sector. The company owns several patents related with self-similarity analysis, which formed the background of this Thesis. Furthermore, Siemens intended to explore commercially the computer- aided automatic detection and diagnosis eld for portfolio integration. Therefore, with the high knowledge acquired by University of Beira Interior in this area together with this Thesis, will allow Siemens to apply the most recent scienti c progress in the detection of the breast cancer, and it is foreseeable that together we can develop a new technology with high potential. The project resulted in the submission of two invention disclosures for evaluation in Siemens A.G., two articles published in peer-reviewed journals indexed in ISI Science Citation Index, two other articles submitted in peer-reviewed journals, and several international conference papers. This work on computer-aided-diagnosis in breast led to innovative software and novel processes of research and development, for which the project received the Siemens Innovation Award in 2012. It was very rewarding to carry on such technological and innovative project in a socially sensitive area as Breast Cancer.No cancro da mama a deteção precoce e o diagnóstico correto são de extrema importância na prescrição terapêutica e caz e e ciente, que potencie o aumento da taxa de sobrevivência à doença. A teoria multifractal foi inicialmente introduzida no contexto da análise de sinal e a sua utilidade foi demonstrada na descrição de comportamentos siológicos de bio-sinais e até na deteção e predição de patologias. Nesta Tese, três métodos multifractais foram estendidos para imagens bi-dimensionais (2D) e comparados na deteção de microcalci cações em mamogramas. Um destes métodos foi também adaptado para a classi cação de massas da mama, em cortes transversais 2D obtidos por ressonância magnética (RM) de mama, em grupos de massas provavelmente benignas e com suspeição de malignidade. Um novo método de análise multifractal usando a lacunaridade tri-dimensional (3D) foi proposto para classi cação de massas da mama em imagens volumétricas 3D de RM de mama. A análise multifractal revelou diferenças na complexidade subjacente às localizações das microcalci cações em relação aos tecidos normais, permitindo uma boa exatidão da sua deteção em mamogramas. Adicionalmente, foram extraídas por análise multifractal características dos tecidos que permitiram identi car os casos tipicamente recomendados para biópsia em imagens 2D de RM de mama. A análise multifractal 3D foi e caz na classi cação de lesões mamárias benignas e malignas em imagens 3D de RM de mama. Este método foi mais exato para esta classi cação do que o método 2D ou o método padrão de análise de contraste cinético tumoral. Em conclusão, a análise multifractal fornece informação útil para deteção auxiliada por computador em mamogra a e diagnóstico auxiliado por computador em imagens 2D e 3D de RM de mama, tendo o potencial de complementar a interpretação dos radiologistas

DEVELOPMENT OF MULTI-DIMENSIONAL X-RAY COMPUTED TOMOGRAPHY MEASUREMENTS OF LUNG TUMOURS

Metastatic disease is the most common cause of cancer-related deaths. Two established image analysis tools, the World Health Organization Handbook for Reporting Results for Cancer Treatment (2D measurement), and Response Evaluation Criteria in Solid Tumours (ID measurement), have been used to quantify metastatic tumour burden in vivo. Limitations of the ID and 2D measurements may be addressed using a 3D technique. The overall objective of this thesis was to determine the accuracy and reproducibility of a 3D measurement technique to be used as a potential imaging biomarker to quantify pulmonary metastases in vivo, using x-ray CT. We compared the accuracy and reproducibility of our 3D technique to the ID and 2D measurements using lung tumour phantoms of known dimensions and seven subjects with pulmonary metastases. Three­ dimensional measurements accurately quantified spherical and irregularly-shaped tumour phantoms (p\u3c0.05), and most observers measurement patient metastases with high intra- and inter-observer reproducibility ICC\u3e0.900

Multi Parametric Magnetic Resonance Imaging in the early detection and risk stratification of prostate cancer: The PROMIS trial

Although prostate cancer is the most common cancer in men, it remains a difficult and controversial disease in terms of its diagnostic, risk stratification and treatment pathway. This is mainly due to the shortcomings of the standard diagnostic test, trans rectal ultrasound guided biopsy (TRUSBx), that is triggered following an elevated serum prostate specific antigen (PSA) test and the lack of agreement on disease thresholds that correlate to patient risk, if left untreated (and thus undetected). These factors often complicate the selection of the appropriate management that best fits the individual patient. In this doctoral thesis I propose, examine and validate a different approach that aims to shift the current diagnostic paradigm to that of incorporating an imaging test, multi-parametric magnetic resonance imaging (MP-MRI), prior to TRUS biopsy. First, I will discuss the nature of prostate cancer and highlight the shortcomings of the current diagnostic pathway and their implications. Second, I will analyze the shortcomings in early MP-MRI research that might have hindered its acceptance and adoption into the pathway and review the advances in research that occurred since I started my research. Third, I will discuss the rationale and methodological design considerations behind the PROstate Mri Imaging Study (PROMIS). PROMIS was a multicentre diagnostic paired validating confirmatory cohort study conducted to provide level 1b evidence on diagnostic accuracy of MP-MRI. It was designed to avoid the pitfalls identified in the current literature. I will discuss and analyze the design, conduct and results of the trial and its implications. Finally, I will discuss the wider implications of my work on the clinical practice of prostate cancer management and the future research opportunities made possible by the PROMIS data and its findings