Foetal echocardiographic segmentation

Congenital heart disease affects just under one percentage of all live births [1]. Those defects that manifest themselves as changes to the cardiac chamber volumes are the motivation for the research presented in this thesis. Blood volume measurements in vivo require delineation of the cardiac chambers and manual tracing of foetal cardiac chambers is very time consuming and operator dependent. This thesis presents a multi region based level set snake deformable model applied in both 2D and 3D which can automatically adapt to some extent towards ultrasound noise such as attenuation, speckle and partial occlusion artefacts. The algorithm presented is named Mumford Shah Sarti Collision Detection (MSSCD). The level set methods presented in this thesis have an optional shape prior term for constraining the segmentation by a template registered to the image in the presence of shadowing and heavy noise. When applied to real data in the absence of the template the MSSCD algorithm is initialised from seed primitives placed at the centre of each cardiac chamber. The voxel statistics inside the chamber is determined before evolution. The MSSCD stops at open boundaries between two chambers as the two approaching level set fronts meet. This has significance when determining volumes for all cardiac compartments since cardiac indices assume that each chamber is treated in isolation. Comparison of the segmentation results from the implemented snakes including a previous level set method in the foetal cardiac literature show that in both 2D and 3D on both real and synthetic data, the MSSCD formulation is better suited to these types of data. All the algorithms tested in this thesis are within 2mm error to manually traced segmentation of the foetal cardiac datasets. This corresponds to less than 10% of the length of a foetal heart. In addition to comparison with manual tracings all the amorphous deformable model segmentations in this thesis are validated using a physical phantom. The volume estimation of the phantom by the MSSCD segmentation is to within 13% of the physically determined volume

Deep learning for fast and robust medical image reconstruction and analysis

Medical imaging is an indispensable component of modern medical research as well as clinical practice. Nevertheless, imaging techniques such as magnetic resonance imaging (MRI) and computational tomography (CT) are costly and are less accessible to the majority of the world. To make medical devices more accessible, affordable and efficient, it is crucial to re-calibrate our current imaging paradigm for smarter imaging. In particular, as medical imaging techniques have highly structured forms in the way they acquire data, they provide us with an opportunity to optimise the imaging techniques holistically by leveraging data. The central theme of this thesis is to explore different opportunities where we can exploit data and deep learning to improve the way we extract information for better, faster and smarter imaging. This thesis explores three distinct problems. The first problem is the time-consuming nature of dynamic MR data acquisition and reconstruction. We propose deep learning methods for accelerated dynamic MR image reconstruction, resulting in up to 10-fold reduction in imaging time. The second problem is the redundancy in our current imaging pipeline. Traditionally, imaging pipeline treated acquisition, reconstruction and analysis as separate steps. However, we argue that one can approach them holistically and optimise the entire pipeline jointly for a specific target goal. To this end, we propose deep learning approaches for obtaining high fidelity cardiac MR segmentation directly from significantly undersampled data, greatly exceeding the undersampling limit for image reconstruction. The final part of this thesis tackles the problem of interpretability of the deep learning algorithms. We propose attention-models that can implicitly focus on salient regions in an image to improve accuracy for ultrasound scan plane detection and CT segmentation. More crucially, these models can provide explainability, which is a crucial stepping stone for the harmonisation of smart imaging and current clinical practice.Open Acces

Recent Advances in Artificial Intelligence-Assisted Ultrasound Scanning

Funded by the Spanish Ministry of Economic Affairs and Digital Transformation (Project MIA.2021.M02.0005 TARTAGLIA, from the Recovery, Resilience, and Transformation Plan financed by the European Union through Next Generation EU funds). TARTAGLIA takes place under the R&D Missions in Artificial Intelligence program, which is part of the Spain Digital 2025 Agenda and the Spanish National Artificial Intelligence Strategy.Ultrasound (US) is a flexible imaging modality used globally as a first-line medical exam procedure in many different clinical cases. It benefits from the continued evolution of ultrasonic technologies and a well-established US-based digital health system. Nevertheless, its diagnostic performance still presents challenges due to the inherent characteristics of US imaging, such as manual operation and significant operator dependence. Artificial intelligence (AI) has proven to recognize complicated scan patterns and provide quantitative assessments for imaging data. Therefore, AI technology has the potential to help physicians get more accurate and repeatable outcomes in the US. In this article, we review the recent advances in AI-assisted US scanning. We have identified the main areas where AI is being used to facilitate US scanning, such as standard plane recognition and organ identification, the extraction of standard clinical planes from 3D US volumes, and the scanning guidance of US acquisitions performed by humans or robots. In general, the lack of standardization and reference datasets in this field makes it difficult to perform comparative studies among the different proposed methods. More open-access repositories of large US datasets with detailed information about the acquisition are needed to facilitate the development of this very active research field, which is expected to have a very positive impact on US imaging.Depto. de Estructura de la Materia, Física Térmica y ElectrónicaFac. de Ciencias FísicasTRUEMinistry of Economic Affairs and Digital Transformation from the Recovery, Resilience, and Transformation PlanNext Generation EU fundspu

Deep Learning in Cardiology

The medical field is creating large amount of data that physicians are unable to decipher and use efficiently. Moreover, rule-based expert systems are inefficient in solving complicated medical tasks or for creating insights using big data. Deep learning has emerged as a more accurate and effective technology in a wide range of medical problems such as diagnosis, prediction and intervention. Deep learning is a representation learning method that consists of layers that transform the data non-linearly, thus, revealing hierarchical relationships and structures. In this review we survey deep learning application papers that use structured data, signal and imaging modalities from cardiology. We discuss the advantages and limitations of applying deep learning in cardiology that also apply in medicine in general, while proposing certain directions as the most viable for clinical use.Comment: 27 pages, 2 figures, 10 table

Towards Whole Placenta Segmentation At Late Gestation Using Multi-View Ultrasound Images

We propose a method to extract the human placenta at late gestation using multi-view 3D US images. This is the first step towards automatic quantification of placental volume and morphology from US images along the whole pregnancy beyond early stages (where the entire placenta can be captured with a single 3D US image). Our method uses 3D US images from different views acquired with a multi-probe system. A whole placenta segmentation is obtained from these images by using a novel technique based on 3D convolutional neural networks. We demonstrate the performance of our method on 3D US images of the placenta in the last trimester. We achieve a high Dice overlap of up to 0.8 with respect to manual annotations, and the derived placental volumes are comparable to corresponding volumes extracted from MR.Wellcome Trust IEH Award; EPSRC Centre for Medical Engineering; National Institute for Health Research (NIHR); King’s College London; NHS Foundation Trus

Recalage déformable à base de graphes : mise en correspondance coupe-vers-volume et méthodes contextuelles

Image registration methods, which aim at aligning two or more images into one coordinate system, are among the oldest and most widely used algorithms in computer vision. Registration methods serve to establish correspondence relationships among images (captured at different times, from different sensors or from different viewpoints) which are not obvious for the human eye. A particular type of registration algorithm, known as graph-based deformable registration methods, has become popular during the last decade given its robustness, scalability, efficiency and theoretical simplicity. The range of problems to which it can be adapted is particularly broad. In this thesis, we propose several extensions to the graph-based deformable registration theory, by exploring new application scenarios and developing novel methodological contributions.Our first contribution is an extension of the graph-based deformable registration framework, dealing with the challenging slice-to-volume registration problem. Slice-to-volume registration aims at registering a 2D image within a 3D volume, i.e. we seek a mapping function which optimally maps a tomographic slice to the 3D coordinate space of a given volume. We introduce a scalable, modular and flexible formulation accommodating low-rank and high order terms, which simultaneously selects the plane and estimates the in-plane deformation through a single shot optimization approach. The proposed framework is instantiated into different variants based on different graph topology, label space definition and energy construction. Simulated and real-data in the context of ultrasound and magnetic resonance registration (where both framework instantiations as well as different optimization strategies are considered) demonstrate the potentials of our method.The other two contributions included in this thesis are related to how semantic information can be encompassed within the registration process (independently of the dimensionality of the images). Currently, most of the methods rely on a single metric function explaining the similarity between the source and target images. We argue that incorporating semantic information to guide the registration process will further improve the accuracy of the results, particularly in the presence of semantic labels making the registration a domain specific problem.We consider a first scenario where we are given a classifier inferring probability maps for different anatomical structures in the input images. Our method seeks to simultaneously register and segment a set of input images, incorporating this information within the energy formulation. The main idea is to use these estimated maps of semantic labels (provided by an arbitrary classifier) as a surrogate for unlabeled data, and combine them with population deformable registration to improve both alignment and segmentation.Our last contribution also aims at incorporating semantic information to the registration process, but in a different scenario. In this case, instead of supposing that we have pre-trained arbitrary classifiers at our disposal, we are given a set of accurate ground truth annotations for a variety of anatomical structures. We present a methodological contribution that aims at learning context specific matching criteria as an aggregation of standard similarity measures from the aforementioned annotated data, using an adapted version of the latent structured support vector machine (LSSVM) framework.Les méthodes de recalage d’images, qui ont pour but l’alignement de deux ou plusieurs images dans un même système de coordonnées, sont parmi les algorithmes les plus anciens et les plus utilisés en vision par ordinateur. Les méthodes de recalage servent à établir des correspondances entre des images (prises à des moments différents, par différents senseurs ou avec différentes perspectives), lesquelles ne sont pas évidentes pour l’œil humain. Un type particulier d’algorithme de recalage, connu comme « les méthodes de recalage déformables à l’aide de modèles graphiques » est devenu de plus en plus populaire ces dernières années, grâce à sa robustesse, sa scalabilité, son efficacité et sa simplicité théorique. La gamme des problèmes auxquels ce type d’algorithme peut être adapté est particulièrement vaste. Dans ce travail de thèse, nous proposons plusieurs extensions à la théorie de recalage déformable à l’aide de modèles graphiques, en explorant de nouvelles applications et en développant des contributions méthodologiques originales.Notre première contribution est une extension du cadre du recalage à l’aide de graphes, en abordant le problème très complexe du recalage d’une tranche avec un volume. Le recalage d’une tranche avec un volume est le recalage 2D dans un volume 3D, comme par exemple le mapping d’une tranche tomographique dans un système de coordonnées 3D d’un volume en particulier. Nos avons proposé une formulation scalable, modulaire et flexible pour accommoder des termes d'ordre élevé et de rang bas, qui peut sélectionner le plan et estimer la déformation dans le plan de manière simultanée par une seule approche d'optimisation. Le cadre proposé est instancié en différentes variantes, basés sur différentes topologies du graph, définitions de l'espace des étiquettes et constructions de l'énergie. Le potentiel de notre méthode a été démontré sur des données réelles ainsi que des données simulées dans le cadre d’une résonance magnétique d’ultrason (où le cadre d’installation et les stratégies d’optimisation ont été considérés).Les deux autres contributions inclues dans ce travail de thèse, sont liées au problème de l’intégration de l’information sémantique dans la procédure de recalage (indépendamment de la dimensionnalité des images). Actuellement, la plupart des méthodes comprennent une seule fonction métrique pour expliquer la similarité entre l’image source et l’image cible. Nous soutenons que l'intégration des informations sémantiques pour guider la procédure de recalage pourra encore améliorer la précision des résultats, en particulier en présence d'étiquettes sémantiques faisant du recalage un problème spécifique adapté à chaque domaine.Nous considérons un premier scénario en proposant un classificateur pour inférer des cartes de probabilité pour les différentes structures anatomiques dans les images d'entrée. Notre méthode vise à recaler et segmenter un ensemble d'images d'entrée simultanément, en intégrant cette information dans la formulation de l'énergie. L'idée principale est d'utiliser ces cartes estimées des étiquettes sémantiques (fournie par un classificateur arbitraire) comme un substitut pour les données non-étiquettées, et les combiner avec le recalage déformable pour améliorer l'alignement ainsi que la segmentation.Notre dernière contribution vise également à intégrer l'information sémantique pour la procédure de recalage, mais dans un scénario différent. Dans ce cas, au lieu de supposer que nous avons des classificateurs arbitraires pré-entraînés à notre disposition, nous considérons un ensemble d’annotations précis (vérité terrain) pour une variété de structures anatomiques. Nous présentons une contribution méthodologique qui vise à l'apprentissage des critères correspondants au contexte spécifique comme une agrégation des mesures de similarité standard à partir des données annotées, en utilisant une adaptation de l’algorithme « Latent Structured Support Vector Machine »