Shape analysis for assessment of progression in spinal deformities

Adolescent idiopathic scoliosis (AIS) is a three-dimensional structural spinal deformation. It is the most common type of scoliosis. It can be visually detected as a lateral curvature in the postero-anterior plane. This condition starts in early puberty, affecting between 1-4% of the adolescent population between 10-18 years old, affecting in majority female. In severe cases (0.1% of population with AIS) the patient will require a surgical treatment. To date, the diagnosis of AIS relies on the quantification of the major curvature observed on posteroanterior and sagittal radiographs. Radiographs in standing position are the common imaging modality used in clinical settings to diagnose AIS. The assessment of the deformation is carried out using the Cobb angle method. This angle is calculated in the postero-anterior plane, and it is formed between a line drawn parallel to the superior endplate of the upper vertebra included in the scoliotic curve and a line drawn parallel to the inferior endplate of the lower vertebra of the same curve. Patients that present a Cobb angle of more than 10°, are diagnosed with AIS. The gold standard to classify curve deformations is the Lenke classification method. This paradigm is widely accepted in the clinical community. It divides spines with scoliosis into six types and provides treatment recommendations depending on the type. This method is limited to the analysis of the spine in the 2D space, since it relies on the observation of radiographs and Cobb angle measurements. On the one hand, when clinicians are treating patients with AIS, one of the main concerns is to determine whether the deformation will progress through time. Knowing beforehand of how the shape of the spine is going to evolve would aid to guide treatments strategies. On the other hand, however, patients at higher risks of progression require to be monitored more frequently, which results in constant exposure to radiation. Therefore, there is a need for an alternative radiation-free technology to reduce the use of radiographs and alleviate the perils of other health issues derived from current imaging modalities. This thesis presents a framework designed to characterize and model the variation of the shape of the spine throughout AIS. This framework includes three contributions: 1) two measurement techniques for computing 3D descriptors of the spine, and a classification method to categorize spine deformations, 2) a method to simulate the variation of the shape of the spine through time, and 3) a protocol to generate a 3D model of the spine from a volume reconstruction produced from ultrasound images. In our first contribution, we introduced two measurement techniques to characterize the shape of the spine in the 3D space, leave-n-out, and fan leave-n-out angles. In addition, a dynamic ensemble method was presented as an automated alternative to classify spinal deformations. Our measurement techniques were designed for computing the 3D descriptors and to be easy to use in a clinical setting. Also, the classification method contributes by assisting clinicians to identify patient-specific descriptors, which could help improving the classification in borderline curve deformations and, hence, suggests the proper management strategies. In order to observe how the shape of the spine progresses through time, in our second contribution, we designed a method to visualize the shape’s variation from the first visit up to 18 months, for every three months. Our method is trained with modes of variation, computed using independent component analysis from 3D model reconstructions of the spine of patients with AIS. Each of the modes of variation can be visualized for interpretation. This contribution could aid clinicians to identify which spine progression pattern might be prone to progression. Finally, our third contribution addresses the necessity of a radiation-free image modality for assessing and monitoring patients with AIS. We proposed a protocol to model a spine by identifying the spinous processes on a volume reconstruction. This reconstruction was computed from ultrasound images acquired from the external geometry of the subject. Our acquisition protocol documents a setup for image acquisition, as well as some recommendations to take into account depending on the body composition of the subjects to be scanned. We believe that this protocol could contribute to reduce the use of radiographs during the assessment and monitoring of patients with AIS

Accuracy of 3D printed spine models for pre-surgical planning of complex adolescent idiopathic scoliosis (AIS) in spinal surgeries: a case series

Adolescent idiopathic scoliosis (AIS) is a noticeable spinal deformity in both adult and adolescent population. In majority of the cases, the gold standard of treatment is surgical intervention. Technological advancements in medical imaging and 3D printing have revolutionised the surgical planning and intraoperative decision making for surgeons in spinal surgery. However, its applicability for planning complex spinal surgeries is poorly documented with human subjects. The objective of this study is to evaluate the accuracy of 3D printed models for complex spinal deformities based on Cobb angles between 40° to 95°.This is a retrospective cohort study where, five CT scans of the patients with AIS were segmented and 3D printed for evaluating the accuracy. Consideration was given to the Inter-patient and acquisition apparatus variability of the CT-scan dataset to understand the effect on trueness and accuracy of the developed CAD models. The developed anatomical models were re-scanned for analysing quantitative surface deviation to assess the accuracy of 3D printed spinal models. Results show that the average of the root mean square error (RMSE) between the 3DP models and virtual models developed using CT scan of mean surface deviations for the five 3d printed models was found to be 0.5§0.07 mm. Based on the RMSE, it can be concluded that 3D printing based workflow is accurate enough to be used for presurgical planning for complex adolescent spinal deformities. Image acquisition and post processing parameters, type of 3D printing technology plays key role in acquiring required accuracy for surgical applications

An automated classification system to determine malignant grades of brain tumour (glioma) in magnetic resonance images based on meta-trainable multiple classifier schemes

The accurate classification of malignant grades of brain tumours is crucial for therapeutic planning as it impacts on the tumour’s prognosis, where the higher the malignancy levels of the brain tumour are, the higher the mortality rate is. It is also essential to provide patients with appropriate clinical management that may prolong survival and improve their quality of life. Determining the malignant grade of a brain tumour is a critical challenge because different malignant grades of brain tumours, in some cases, have inconsistent and mixed morphological characteristics. Consequently, the visual diagnosis using only the naked eye is a very complex and challenging task. The most common type of brain tumour is glioma. According to the World Health Organisation, low-grade glioma, which includes grade I and grade II are the least malignant, slow growing, and respond well to treatment. While, high-grade gliomas, which include grade III and grade IV are extremely malignant, have a poor prognosis and may lead to a high mortality rate. Hence, the motivation to develop an automated classification system to predict the malignant grade of glioma is the aim of this research. To achieve this aim, several novel methods were developed and this includes new methods for the extraction of statistical measures, selection of the dominant predictors, and the fusion of multi-classification models. The integration of these stages generates an accurate and automated decision system to determine the malignant grade of glioma. The feature extraction starts from the viewpoint that the objective measure of the brain tumour descriptors in MR images lead to an accurate classification of malignant brain tumours. This work starts from the standpoint that meta-trainable fusion of multiple classifier models can offer a better classification accuracy to recognise the malignant grade of glioma in MR images. This study developed a novel strategy based on two stages of multiple classifier systems for glioma grades. In the first stage, different machine learning algorithms were used. In the second stage, a systematic trainable combiner was designed based on deep neural networks. This research was validated using four benchmark datasets of MR images, which are publicly available and confirmed with the histopathological diagnosis. The proposed system was also evaluated and compared against different traditional algorithms; the experimental results showed that the proposed system has successfully achieved better and optimal discrimination in glioma grades on all dataset

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe