Computed tomography image analysis for the detection of obstructive lung diseases

Damage to the small airways resulting from direct lung injury or associated with many systemic disorders is not easy to identify. Non-invasive techniques such as chest radiography or conventional tests of lung function often cannot reveal the pathology. On Computed Tomography (CT) images, the signs suggesting the presence of obstructive airways disease are subtle, and inter- and intra-observer variability can be considerable. The goal of this research was to implement a system for the automated analysis of CT data of the lungs. Its function is to help clinicians establish a confident assessment of specific obstructive airways diseases and increase the precision of investigation of structure/function relationships. To help resolve the ambiguities of the CT scans, the main objectives of our system were to provide a functional description of the raster images, extract semi-quantitative measurements of the extent of obstructive airways disease and propose a clinical diagnosis aid using a priori knowledge of CT image features of the diseased lungs. The diagnostic process presented in this thesis involves the extraction and analysis of multiple findings. Several novel low-level computer vision feature extractors and image processing algorithms were developed for extracting the extent of the hypo-attenuated areas, textural characterisation of the lung parenchyma, and morphological description of the bronchi. The fusion of the results of these extractors was achieved with a probabilistic network combining a priori knowledge of lung pathology. Creating a CT lung phantom allowed for the initial validation of the proposed methods. Performance of the techniques was then assessed with clinical trials involving other diagnostic tests and expert chest radiologists. The results of the proposed system for diagnostic decision-support demonstrated the feasibility and importance of information fusion in medical image interpretation.Open acces

Computer-Aided Assessment of Tuberculosis with Radiological Imaging: From rule-based methods to Deep Learning

Mención Internacional en el título de doctorTuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (Mtb.) that produces pulmonary damage due to its airborne nature. This fact facilitates the disease fast-spreading, which, according to the World Health Organization (WHO), in 2021 caused 1.2 million deaths and 9.9 million new cases. Traditionally, TB has been considered a binary disease (latent/active) due to the limited specificity of the traditional diagnostic tests. Such a simple model causes difficulties in the longitudinal assessment of pulmonary affectation needed for the development of novel drugs and to control the spread of the disease. Fortunately, X-Ray Computed Tomography (CT) images enable capturing specific manifestations of TB that are undetectable using regular diagnostic tests, which suffer from limited specificity. In conventional workflows, expert radiologists inspect the CT images. However, this procedure is unfeasible to process the thousands of volume images belonging to the different TB animal models and humans required for a suitable (pre-)clinical trial. To achieve suitable results, automatization of different image analysis processes is a must to quantify TB. It is also advisable to measure the uncertainty associated with this process and model causal relationships between the specific mechanisms that characterize each animal model and its level of damage. Thus, in this thesis, we introduce a set of novel methods based on the state of the art Artificial Intelligence (AI) and Computer Vision (CV). Initially, we present an algorithm to assess Pathological Lung Segmentation (PLS) employing an unsupervised rule-based model which was traditionally considered a needed step before biomarker extraction. This procedure allows robust segmentation in a Mtb. infection model (Dice Similarity Coefficient, DSC, 94%±4%, Hausdorff Distance, HD, 8.64mm±7.36mm) of damaged lungs with lesions attached to the parenchyma and affected by respiratory movement artefacts. Next, a Gaussian Mixture Model ruled by an Expectation-Maximization (EM) algorithm is employed to automatically quantify the burden of Mtb.using biomarkers extracted from the segmented CT images. This approach achieves a strong correlation (R2 ≈ 0.8) between our automatic method and manual extraction. Consequently, Chapter 3 introduces a model to automate the identification of TB lesions and the characterization of disease progression. To this aim, the method employs the Statistical Region Merging algorithm to detect lesions subsequently characterized by texture features that feed a Random Forest (RF) estimator. The proposed procedure enables a selection of a simple but powerful model able to classify abnormal tissue. The latest works base their methodology on Deep Learning (DL). Chapter 4 extends the classification of TB lesions. Namely, we introduce a computational model to infer TB manifestations present in each lung lobe of CT scans by employing the associated radiologist reports as ground truth. We do so instead of using the classical manually delimited segmentation masks. The model adjusts the three-dimensional architecture, V-Net, to a multitask classification context in which loss function is weighted by homoscedastic uncertainty. Besides, the method employs Self-Normalizing Neural Networks (SNNs) for regularization. Our results are promising with a Root Mean Square Error of 1.14 in the number of nodules and F1-scores above 0.85 for the most prevalent TB lesions (i.e., conglomerations, cavitations, consolidations, trees in bud) when considering the whole lung. In Chapter 5, we present a DL model capable of extracting disentangled information from images of different animal models, as well as information of the mechanisms that generate the CT volumes. The method provides the segmentation mask of axial slices from three animal models of different species employing a single trained architecture. It also infers the level of TB damage and generates counterfactual images. So, with this methodology, we offer an alternative to promote generalization and explainable AI models. To sum up, the thesis presents a collection of valuable tools to automate the quantification of pathological lungs and moreover extend the methodology to provide more explainable results which are vital for drug development purposes. Chapter 6 elaborates on these conclusions.Programa de Doctorado en Multimedia y Comunicaciones por la Universidad Carlos III de Madrid y la Universidad Rey Juan CarlosPresidenta: María Jesús Ledesma Carbayo.- Secretario: David Expósito Singh.- Vocal: Clarisa Sánchez Gutiérre

Image Area Reduction for Efficient Medical Image Retrieval

Content-based image retrieval (CBIR) has been one of the most active areas in medical image analysis in the last two decades because of the steadily increase in the number of digital images used. Efficient diagnosis and treatment planning can be supported by developing retrieval systems to provide high-quality healthcare. Extensive research has attempted to improve the image retrieval efficiency. The critical factors when searching in large databases are time and storage requirements. In general, although many methods have been suggested to increase accuracy, fast retrieval has been rather sporadically investigated. In this thesis, two different approaches are proposed to reduce both time and space requirements for medical image retrieval. The IRMA data set is used to validate the proposed methods. Both methods utilized Local Binary Pattern (LBP) histogram features which are extracted from 14,410 X-ray images of IRMA dataset. The first method is image folding that operates based on salient regions in an image. Saliency is determined by a context-aware saliency algorithm which includes folding the image. After the folding process, the reduced image area is used to extract multi-block and multi-scale LBP features and to classify these features by multi-class Support vector machine (SVM). The other method consists of classification and distance-based feature similarity. Images are firstly classified into general classes by utilizing LBP features. Subsequently, the retrieval is performed within the class to locate the most similar images. Between the retrieval and classification processes, LBP features are eliminated by employing the error histogram of a shallow (n/p/n) autoencoder to quantify the retrieval relevance of image blocks. If the region is relevant, the autoencoder gives large error for its decoding. Hence, via examining the autoencoder error of image blocks, irrelevant regions can be detected and eliminated. In order to calculate similarity within general classes, the distance between the LBP features of relevant regions is calculated. The results show that the retrieval time can be reduced, and the storage requirements can be lowered without significant decrease in accuracy

Hierarchical clustering-based segmentation (HCS) aided diagstic image interpretation monitoring.

Machines are good at operations which require precision and computing objective measures. In contrast, humans are good at generalisation and making decisions based on their past experience and heuristics. Hence, to solve any problem with a solution involving human-machine interaction, it is imperative that the tasks are shared appropriately. However, the boundary which divides these two different set of tasks is not well defined in domains such as medical image interpretation. Therefore, one needs a versatile tool which is flexible enough to accommodate the varied requirements of the user. The aim of this study is to design and implement such a software tool to aid the radiologists in the interpretation of diagnostic images.Tissue abnormality in a medical image is usually related to a dissimilar part of an otherwise homogeneous image. The dissimilarity may be subtle or strong depending on the medical modality and the type of abnormal tissue. Hierarchical Clustering-based Segmentation (HCS) process is a dissimilarity highlighting process that yields a hierarchy of segmentation results. In this study, the HCS process was investigated for offering the user a versatile and flexible environment to perceive the varied dissimilarities that might be present in diagnostic images. Consequently, the user derives the maximum benefit from the computational capability (perception) of the machine and at the same time incorporate their own decision process (interpretation) at the appropriate places.As a result of the above investigation, this study demonstrates how HCS process can be used to aid radiologists in their interpretive tasks. Specifically this study has designed the following HCS process aided diagnostic image interpretation applications: interpretation of computed tomography (CT) images of the lungs to quantitatively measure the dimensions of the airways and the accompanying blood vessels; Interpretation of X-ray mammograms to quantitatively differentiate benign from malignant abnormalities. One of the major contribution of this study is to demonstrate how the above HCS process aided interpretation of diagnostic images can be used to monitor disease conditions. This thesis details the development and evaluation of the novel computer aided monitoring (CAM) system. The designed CAM system is used to objectively measure the properties of suspected abnormal areas in the CT images of the lungs and in X-ray mammogram. Thus, the CAM system can be used to assist the clinician to objectively monitor the abnormality. For instance, its response to treatment and consequently its prognosis. The implemented CAM system to monitor abnormalities in X-ray mammograms is briefly described below. Using the approximate location and size of the abnormality, obtained from the user, the HCS process automatically identifies the more appropriate boundaries of the different regions within a region of interest (ROI), centred at the approximate location. From the set of, HCS process segmented, regions the user identifies the regions which most likely represent the abnormality and the healthy areas. Subsequently, the CAM system compares the characteristics of the user identified abnormal region with that of the healthy region; to differentiate malignant from benign abnormality. In processing sixteen mammograms, the designed CAM system demonstrated the possibility of successfully differentiating malignant from benign abnormalities

Tumour grading and discrimination based on class assignment and quantitative texture analysis techniques

Medical imaging represents the utilisation of technology in biology for the purpose of noninvasively revealing the internal structure of the organs of the human body. It is a way to improve the quality of the patient's life through a more precise and rapid diagnosis, and with limited side-effects, leading to an effective overall treatment procedure. The main objective of this thesis is to propose novel tumour discrimination techniques that cover both micro and macro-scale textures encountered in computed tomography (CI') and digital microscopy (DM) modalities, respectively. Image texture can provide significant information on the (ab)normality of tissue, and this thesis expands this idea to tumour texture grading and classification. The fractal dimension (FO) as a texture measure was applied to contrast enhanced CT lung tumour images in an aim to improve tumour grading accuracy from conventional CI' modality, and quantitative performance analysis showed an accuracy of 83.30% in distinguishing between advanced (aggressive) and early stage (non-aggressive) malignant tumours. A different approach was adopted for subtype discrimination of brain tumour OM images via a set of statistical and model-based texture analysis algorithms. The combined Gaussian Markov random field and run-length matrix texture measures outperformed all other combinations, achieving an overall class assignment classification accuracy of 92.50%. Also two new histopathological multi resolution approaches based on applying the FO as the best bases selection for discrete wavelet packet transform, and when fused with the Gabor filters' energy output improved the accuracy to 91.25% and 95.00%, respectively. While noise is quite common in all medical imaging modalities, the impact of noise on the applied texture measures was assessed as well. The developed lung and brain texture analysis techniques can improve the physician's ability to detect and analyse pathologies leading for a more reliable diagnosis and treatment of disease

Detection and description of pulmonary nodules through 2D and 3D clustering

Precise 3D automated detection, description and classification of pulmonary nodules offer the potential for early diagnosis of cancer and greater efficiency in the reading of computerised tomography (CT) images. CT scan centres are currently experiencing high loads and experts shortage, especially in developing countries such as Iraq where the results of the current research will be used. This motivates the researchers to address these problems and challenges by developing automated processes for the early detection and efficient description of cancer cases. This research attempts to reduce workloads, enhance the patient throughput and improve the diagnosis performance. To achieve this goal, the study selects techniques for segmentation, classification, detection and implements the best candidates alongside a novel automated approach. Techniques for each stage in the process are quantitatively evaluated to select the best performance against standard data for lung cancer. In addition, the ideal approach is identified by comparing them against other works in detecting and describing pulmonary nodules. This work detects and describes the nodules and their characteristics in several stages: automated lung segmentation from the background, automated 2D and 3D clustering of vessels and nodules, applying shape and textures features, classification and automatic measurement of nodule characteristics. This work is tested on standard CT lung image data and shows promising results, matching or close to experts’ diagnosis in the nodules number and their features (size/volume, location) and in terms the accuracy and automation. It also achieved a classification accuracy of 98% and efficient results in measuring the nodules’ volume automatically

Image similarity in medical images

Recent experiments have indicated a strong influence of the substrate grain orientation on the self-ordering in anodic porous alumina. Anodic porous alumina with straight pore channels grown in a stable, self-ordered manner is formed on (001) oriented Al grain, while disordered porous pattern is formed on (101) oriented Al grain with tilted pore channels growing in an unstable manner. In this work, numerical simulation of the pore growth process is carried out to understand this phenomenon. The rate-determining step of the oxide growth is assumed to be the Cabrera-Mott barrier at the oxide/electrolyte (o/e) interface, while the substrate is assumed to determine the ratio β between the ionization and oxidation reactions at the metal/oxide (m/o) interface. By numerically solving the electric field inside a growing porous alumina during anodization, the migration rates of the ions and hence the evolution of the o/e and m/o interfaces are computed. The simulated results show that pore growth is more stable when β is higher. A higher β corresponds to more Al ionized and migrating away from the m/o interface rather than being oxidized, and hence a higher retained O:Al ratio in the oxide. Experimentally measured oxygen content in the self-ordered porous alumina on (001) Al is indeed found to be about 3% higher than that in the disordered alumina on (101) Al, in agreement with the theoretical prediction. The results, therefore, suggest that ionization on (001) Al substrate is relatively easier than on (101) Al, and this leads to the more stable growth of the pore channels on (001) Al