Estimating and understanding motion : from diagnostic to robotic surgery

Estimating and understanding motion from an image sequence is a central topic in computer vision. The high interest in this topic is because we are living in a world where many events that occur in the environment are dynamic. This makes motion estimation and understanding a natural component and a key factor in a widespread of applications including object recognition , 3D shape reconstruction, autonomous navigation and medica! diagnosis. Particularly, we focus on the medical domain in which understanding the human body for clinical purposes requires retrieving the organs' complex motion patterns, which is in general a hard problem when using only image data. In this thesis, we cope with this problem by posing the question - How to achieve a realistic motion estimation to offer a better clinical understanding? We focus this thesis on answering this question by using a variational formulation as a basis to understand one of the most complex motions in the human's body, the heart motion, through three different applications: (i) cardiac motion estimation for diagnostic, (ii) force estimation and (iii) motion prediction, both for robotic surgery. Firstly, we focus on a central topic in cardiac imaging that is the estimation of the cardiac motion. The main aim is to offer objective and understandable measures to physicians for helping them in the diagnostic of cardiovascular diseases. We employ ultrafast ultrasound data and tools for imaging motion drawn from diverse areas such as low-rank analysis and variational deformation to perform a realistic cardiac motion estimation. The significance is that by taking low-rank data with carefully chosen penalization, synergies in this complex variational problem can be created. We demonstrate how our proposed solution deals with complex deformations through careful numerical experiments using realistic and simulated data. We then move from diagnostic to robotic surgeries where surgeons perform delicate procedures remotely through robotic manipulators without directly interacting with the patients. As a result, they lack force feedback, which is an important primary sense for increasing surgeon-patient transparency and avoiding injuries and high mental workload. To solve this problem, we follow the conservation principies of continuum mechanics in which it is clear that the change in shape of an elastic object is directly proportional to the force applied. Thus, we create a variational framework to acquire the deformation that the tissues undergo due to an applied force. Then, this information is used in a learning system to find the nonlinear relationship between the given data and the applied force. We carried out experiments with in-vivo and ex-vivo data and combined statistical, graphical and perceptual analyses to demonstrate the strength of our solution. Finally, we explore robotic cardiac surgery, which allows carrying out complex procedures including Off-Pump Coronary Artery Bypass Grafting (OPCABG). This procedure avoids the associated complications of using Cardiopulmonary Bypass (CPB) since the heart is not arrested while performing the surgery on a beating heart. Thus, surgeons have to deal with a dynamic target that compromisetheir dexterity and the surgery's precision. To compensate the heart motion, we propase a solution composed of three elements: an energy function to estimate the 3D heart motion, a specular highlight detection strategy and a prediction approach for increasing the robustness of the solution. We conduct evaluation of our solution using phantom and realistic datasets. We conclude the thesis by reporting our findings on these three applications and highlight the dependency between motion estimation and motion understanding at any dynamic event, particularly in clinical scenarios.L’estimació i comprensió del moviment dins d’una seqüència d’imatges és un tema central en la visió per ordinador, el que genera un gran interès perquè vivim en un entorn ple d’esdeveniments dinàmics. Per aquest motiu és considerat com un component natural i factor clau dins d’un ampli ventall d’aplicacions, el qual inclou el reconeixement d’objectes, la reconstrucció de formes tridimensionals, la navegació autònoma i el diagnòstic de malalties. En particular, ens situem en l’àmbit mèdic en el qual la comprensió del cos humà, amb finalitats clíniques, requereix l’obtenció de patrons complexos de moviment dels òrgans. Aquesta és, en general, una tasca difícil quan s’utilitzen només dades de tipus visual. En aquesta tesi afrontem el problema plantejant-nos la pregunta - Com es pot aconseguir una estimació realista del moviment amb l’objectiu d’oferir una millor comprensió clínica? La tesi se centra en la resposta mitjançant l’ús d’una formulació variacional com a base per entendre un dels moviments més complexos del cos humà, el del cor, a través de tres aplicacions: (i) estimació del moviment cardíac per al diagnòstic, (ii) estimació de forces i (iii) predicció del moviment, orientant-se les dues últimes en cirurgia robòtica. En primer lloc, ens centrem en un tema principal en la imatge cardíaca, que és l’estimació del moviment cardíac. L’objectiu principal és oferir als metges mesures objectives i comprensibles per ajudar-los en el diagnòstic de les malalties cardiovasculars. Fem servir dades d’ultrasons ultraràpids i eines per al moviment d’imatges procedents de diverses àrees, com ara l’anàlisi de baix rang i la deformació variacional, per fer una estimació realista del moviment cardíac. La importància rau en que, en prendre les dades de baix rang amb una penalització acurada, es poden crear sinergies en aquest problema variacional complex. Mitjançant acurats experiments numèrics, amb dades realístiques i simulades, hem demostrat com les nostres propostes solucionen deformacions complexes. Després passem del diagnòstic a la cirurgia robòtica, on els cirurgians realitzen procediments delicats remotament, a través de manipuladors robòtics, sense interactuar directament amb els pacients. Com a conseqüència, no tenen la percepció de la força com a resposta, que és un sentit primari important per augmentar la transparència entre el cirurgià i el pacient, per evitar lesions i per reduir la càrrega de treball mental. Resolem aquest problema seguint els principis de conservació de la mecànica del medi continu, en els quals està clar que el canvi en la forma d’un objecte elàstic és directament proporcional a la força aplicada. Per això hem creat un marc variacional que adquireix la deformació que pateixen els teixits per l’aplicació d’una força. Aquesta informació s’utilitza en un sistema d’aprenentatge, per trobar la relació no lineal entre les dades donades i la força aplicada. Hem dut a terme experiments amb dades in-vivo i ex-vivo i hem combinat l’anàlisi estadístic, gràfic i de percepció que demostren la robustesa de la nostra solució. Finalment, explorem la cirurgia cardíaca robòtica, la qual cosa permet realitzar procediments complexos, incloent la cirurgia coronària sense bomba (off-pump coronary artery bypass grafting o OPCAB). Aquest procediment evita les complicacions associades a l’ús de circulació extracorpòria (Cardiopulmonary Bypass o CPB), ja que el cor no s’atura mentre es realitza la cirurgia. Això comporta que els cirurgians han de tractar amb un objectiu dinàmic que compromet la seva destresa i la precisió de la cirurgia. Per compensar el moviment del cor, proposem una solució composta de tres elements: un funcional d’energia per estimar el moviment tridimensional del cor, una estratègia de detecció de les reflexions especulars i una aproximació basada en mètodes de predicció, per tal d’augmentar la robustesa de la solució. L’avaluació de la nostra solució s’ha dut a terme mitjançant conjunts de dades sintètiques i realistes. La tesi conclou informant dels nostres resultats en aquestes tres aplicacions i posant de relleu la dependència entre l’estimació i la comprensió del moviment en qualsevol esdeveniment dinàmic, especialment en escenaris clínics.Postprint (published version

AI in Medical Imaging Informatics: Current Challenges and Future Directions

This paper reviews state-of-the-art research solutions across the spectrum of medical imaging informatics, discusses clinical translation, and provides future directions for advancing clinical practice. More specifically, it summarizes advances in medical imaging acquisition technologies for different modalities, highlighting the necessity for efficient medical data management strategies in the context of AI in big healthcare data analytics. It then provides a synopsis of contemporary and emerging algorithmic methods for disease classification and organ/ tissue segmentation, focusing on AI and deep learning architectures that have already become the de facto approach. The clinical benefits of in-silico modelling advances linked with evolving 3D reconstruction and visualization applications are further documented. Concluding, integrative analytics approaches driven by associate research branches highlighted in this study promise to revolutionize imaging informatics as known today across the healthcare continuum for both radiology and digital pathology applications. The latter, is projected to enable informed, more accurate diagnosis, timely prognosis, and effective treatment planning, underpinning precision medicine

Visualization of the Cardiac Excitation and PVC Arrhythmia on a 3D Heart Model

Visualization of the cardiac potential movement is important in understanding the physiology of the human heart. A 3D visualization tool will help the cardiology students and others interested in human physiology to understand the functioning of the heart. In this thesis, such a tool is proposed which helps in the visualization of the cardiac potential movement and Premature Ventricular Contraction (PVC) event on a 3D heart model. The cardiac excitation obtained from a limb lead and a precordial lead of a 12 lead electrocardiograph (ECG) is mapped on a 3D heart model with fixed conduction pathways. The 3D heart model is obtained by modifying an existing anatomically accurate heart model. Fixed conduction pathways are defined on this derived 3D heart model. Each component of the ECG corresponds to the potential movement along each segment of these conduction pathways. The timing information from the limb lead signal is used to map the position of the cardiac potential on these conduction pathways. Amplitude and the timing information obtained from the precordial lead is mapped on a vector which points towards the corresponding precordial electrode on a separate window. This helps in understanding the instantaneous position of the cardiac potential on the transverse plane. Mapping of the cardiac excitation on the conduction pathways will stop and the color map of the heart will change during the occurrence of a PVC event. MIT-BIH arrhythmia database signals with at least one PVC wave were considered as input signal. It is observed that the system was able to detect PVC approximately 95% of the time (for the selected sample signals) and was able to map each ECG component accurately on the conduction pathways with minimum mapping delay

The HoloLens in Medicine: A systematic Review and Taxonomy

The HoloLens (Microsoft Corp., Redmond, WA), a head-worn, optically see-through augmented reality display, is the main player in the recent boost in medical augmented reality research. In medical settings, the HoloLens enables the physician to obtain immediate insight into patient information, directly overlaid with their view of the clinical scenario, the medical student to gain a better understanding of complex anatomies or procedures, and even the patient to execute therapeutic tasks with improved, immersive guidance. In this systematic review, we provide a comprehensive overview of the usage of the first-generation HoloLens within the medical domain, from its release in March 2016, until the year of 2021, were attention is shifting towards it's successor, the HoloLens 2. We identified 171 relevant publications through a systematic search of the PubMed and Scopus databases. We analyze these publications in regard to their intended use case, technical methodology for registration and tracking, data sources, visualization as well as validation and evaluation. We find that, although the feasibility of using the HoloLens in various medical scenarios has been shown, increased efforts in the areas of precision, reliability, usability, workflow and perception are necessary to establish AR in clinical practice.Comment: 35 pages, 11 figure

Adaptive Layout for Interactive Documents

This thesis presents a novel approach to create automated layouts for rich illustrative material that could adapt according to the screen size and contextual requirements. The adaption not only considers global layout but also deals with the content and layout adaptation of individual illustrations in the layout. An unique solution has been developed that integrates constraint-based and force-directed techniques to create adaptive grid-based and non-grid layouts. A set of annotation layouts are developed which adapt the annotated illustrations to match the contextual requirements over time