A Survey on Deep Learning in Medical Image Registration: New Technologies, Uncertainty, Evaluation Metrics, and Beyond

Over the past decade, deep learning technologies have greatly advanced the field of medical image registration. The initial developments, such as ResNet-based and U-Net-based networks, laid the groundwork for deep learning-driven image registration. Subsequent progress has been made in various aspects of deep learning-based registration, including similarity measures, deformation regularizations, and uncertainty estimation. These advancements have not only enriched the field of deformable image registration but have also facilitated its application in a wide range of tasks, including atlas construction, multi-atlas segmentation, motion estimation, and 2D-3D registration. In this paper, we present a comprehensive overview of the most recent advancements in deep learning-based image registration. We begin with a concise introduction to the core concepts of deep learning-based image registration. Then, we delve into innovative network architectures, loss functions specific to registration, and methods for estimating registration uncertainty. Additionally, this paper explores appropriate evaluation metrics for assessing the performance of deep learning models in registration tasks. Finally, we highlight the practical applications of these novel techniques in medical imaging and discuss the future prospects of deep learning-based image registration

Med-DANet V2: A Flexible Dynamic Architecture for Efficient Medical Volumetric Segmentation

Recent works have shown that the computational efficiency of 3D medical image (e.g. CT and MRI) segmentation can be impressively improved by dynamic inference based on slice-wise complexity. As a pioneering work, a dynamic architecture network for medical volumetric segmentation (i.e. Med-DANet) has achieved a favorable accuracy and efficiency trade-off by dynamically selecting a suitable 2D candidate model from the pre-defined model bank for different slices. However, the issues of incomplete data analysis, high training costs, and the two-stage pipeline in Med-DANet require further improvement. To this end, this paper further explores a unified formulation of the dynamic inference framework from the perspective of both the data itself and the model structure. For each slice of the input volume, our proposed method dynamically selects an important foreground region for segmentation based on the policy generated by our Decision Network and Crop Position Network. Besides, we propose to insert a stage-wise quantization selector to the employed segmentation model (e.g. U-Net) for dynamic architecture adapting. Extensive experiments on BraTS 2019 and 2020 show that our method achieves comparable or better performance than previous state-of-the-art methods with much less model complexity. Compared with previous methods Med-DANet and TransBTS with dynamic and static architecture respectively, our framework improves the model efficiency by up to nearly 4.1 and 17.3 times with comparable segmentation results on BraTS 2019.Comment: Accepted by WACV 202

A Multi-scale Learning of Data-driven and Anatomically Constrained Image Registration for Adult and Fetal Echo Images

Temporal echo image registration is a basis for clinical quantifications such as cardiac motion estimation, myocardial strain assessments, and stroke volume quantifications. Deep learning image registration (DLIR) is consistently accurate, requires less computing effort, and has shown encouraging results in earlier applications. However, we propose that a greater focus on the warped moving image's anatomic plausibility and image quality can support robust DLIR performance. Further, past implementations have focused on adult echo, and there is an absence of DLIR implementations for fetal echo. We propose a framework combining three strategies for DLIR for both fetal and adult echo: (1) an anatomic shape-encoded loss to preserve physiological myocardial and left ventricular anatomical topologies in warped images; (2) a data-driven loss that is trained adversarially to preserve good image texture features in warped images; and (3) a multi-scale training scheme of a data-driven and anatomically constrained algorithm to improve accuracy. Our experiments show that the shape-encoded loss and the data-driven adversarial loss are strongly correlated to good anatomical topology and image textures, respectively. They improve different aspects of registration performance in a non-overlapping way, justifying their combination. We show that these strategies can provide excellent registration results in both adult and fetal echo using the publicly available CAMUS adult echo dataset and our private multi-demographic fetal echo dataset, despite fundamental distinctions between adult and fetal echo images. Our approach also outperforms traditional non-DL gold standard registration approaches, including Optical Flow and Elastix. Registration improvements could also be translated to more accurate and precise clinical quantification of cardiac ejection fraction, demonstrating a potential for translation

Automatic Plane Pose Estimation for Cardiac Left Ventricle Coverage Estimation via Deep Adversarial Regression Network

Accurate segmentation of the ventricles plays a crucial role in determining cardiac functional parameters such as ventricular volume, ventricular mass, or ejection fraction. However, poor image quality, such as inadequate coverage of the left ventricle (LV) and right ventricle (RV) in cardiac magnetic resonance (CMR) image sequences, can significantly affect the assessment of cardiac function. This study investigates issues related to missing or corrupted imaging planes, which often lead to incomplete ventricle coverage. To address the challenge of estimating ventricle coverage in CMR images regardless of variations in imaging parameters such as device type, magnetic field strength, and protocol execution, we introduce a novel convolutional neural network (CNN) based on adversarial learning. Additionally, we integrate supplementary information (e.g., cross-view image data) as privileged information to enhance the interpretability of our model’s predictions and identify potential biases or inaccuracies. This research represents the first attempt to automatically estimate ventricular coverage by identifying missing slices and plane orientations in CMR images using a dataset-agnostic approach. The effectiveness of the proposed model is demonstrated through the evaluation of datasets from three diverse and sizable image acquisition cohorts, demonstrating superior performance compared to existing methods

Deep Learning for Vascular Segmentation and Applications in Phase Contrast Tomography Imaging

Automated blood vessel segmentation is vital for biomedical imaging, as vessel changes indicate many pathologies. Still, precise segmentation is difficult due to the complexity of vascular structures, anatomical variations across patients, the scarcity of annotated public datasets, and the quality of images. We present a thorough literature review, highlighting the state of machine learning techniques across diverse organs. Our goal is to provide a foundation on the topic and identify a robust baseline model for application to vascular segmentation in a new imaging modality, Hierarchical Phase Contrast Tomography (HiP CT). Introduced in 2020 at the European Synchrotron Radiation Facility, HiP CT enables 3D imaging of complete organs at an unprecedented resolution of ca. 20mm per voxel, with the capability for localized zooms in selected regions down to 1mm per voxel without sectioning. We have created a training dataset with double annotator validated vascular data from three kidneys imaged with HiP CT in the context of the Human Organ Atlas Project. Finally, utilising the nnU Net model, we conduct experiments to assess the models performance on both familiar and unseen samples, employing vessel specific metrics. Our results show that while segmentations yielded reasonably high scores such as clDice values ranging from 0.82 to 0.88, certain errors persisted. Large vessels that collapsed due to the lack of hydrostatic pressure (HiP CT is an ex vivo technique) were segmented poorly. Moreover, decreased connectivity in finer vessels and higher segmentation errors at vessel boundaries were observed. Such errors obstruct the understanding of the structures by interrupting vascular tree connectivity. Through our review and outputs, we aim to set a benchmark for subsequent model evaluations using various modalities, especially with the HiP CT imaging database

Fluorescence microscopy image analysis of retinal neurons using deep learning

An essential goal of neuroscience is to understand the brain by simultaneously identifying, measuring, and analyzing activity from individual cells within a neural population in live brain tissue. Analyzing fluorescence microscopy (FM) images in real-time with computational algorithms is essential for achieving this goal. Deep learning techniques have shown promise in this area, but face domain-specific challenges due to limited training data, significant amounts of voxel noise in FM images, and thin structures present in large 3D images. In this thesis, I address these issues by introducing a novel deep learning pipeline to analyze static FM images of neurons with minimal data requirements and demonstrate the pipeline’s ability to segment neurons from low signal-to-noise ratio FM images with few training samples. The first step of this pipeline employs a Generative Adversarial Network (GAN) equipped to learn imaging properties from a small set of static FM images acquired for a given neuroscientific experiment. Operating like an actual microscope, our fully-trained GAN can then generate realistic static FM images from volumetric reconstructions of neurons with added control over the intensity and noise of the generated images. For the second step in our pipeline, a novel segmentation network is trained on GAN-generated images with reconstructed neurons serving as “gold standard” ground truths. While training on a large dataset of FM images is optimal, a 15\% improvement in neuron segmentation accuracy from noisy FM images is shown when architectures are fine-tuned only on a small subsample of real image data. To evaluate the overall feasibility of our pipeline and the utility of generated images, 2 novel synthetic and 3 newly acquired FM image datasets are introduced along with a new evaluation protocol for FM image ”realness” that incorporates content, texture, and expert opinion metrics. While this pipeline's primary application is to segment neurons from highly noisy FM images, its utility can be extended to automate other FM tasks such as synapse identification, neuron classification, or super-resolution

Unsupervised learning for vascular heterogeneity assessment of glioblastoma based on magnetic resonance imaging: The Hemodynamic Tissue Signature

[ES] El futuro de la imagen médica está ligado a la inteligencia artificial. El análisis manual de imágenes médicas es hoy en día una tarea ardua, propensa a errores y a menudo inasequible para los humanos, que ha llamado la atención de la comunidad de Aprendizaje Automático (AA). La Imagen por Resonancia Magnética (IRM) nos proporciona una rica variedad de representaciones de la morfología y el comportamiento de lesiones inaccesibles sin una intervención invasiva arriesgada. Sin embargo, explotar la potente pero a menudo latente información contenida en la IRM es una tarea muy complicada, que requiere técnicas de análisis computacional inteligente. Los tumores del sistema nervioso central son una de las enfermedades más críticas estudiadas a través de IRM. Específicamente, el glioblastoma representa un gran desafío, ya que, hasta la fecha, continua siendo un cáncer letal que carece de una terapia satisfactoria. Del conjunto de características que hacen del glioblastoma un tumor tan agresivo, un aspecto particular que ha sido ampliamente estudiado es su heterogeneidad vascular. La fuerte proliferación vascular del glioblastoma, así como su robusta angiogénesis han sido consideradas responsables de la alta letalidad de esta neoplasia. Esta tesis se centra en la investigación y desarrollo del método Hemodynamic Tissue Signature (HTS): un método de AA no supervisado para describir la heterogeneidad vascular de los glioblastomas mediante el análisis de perfusión por IRM. El método HTS se basa en el concepto de hábitat, que se define como una subregión de la lesión con un perfil de IRM que describe un comportamiento fisiológico concreto. El método HTS delinea cuatro hábitats en el glioblastoma: el hábitat HAT, como la región más perfundida del tumor con captación de contraste; el hábitat LAT, como la región del tumor con un perfil angiogénico más bajo; el hábitat IPE, como la región adyacente al tumor con índices de perfusión elevados; y el hábitat VPE, como el edema restante de la lesión con el perfil de perfusión más bajo. La investigación y desarrollo de este método ha originado una serie de contribuciones enmarcadas en esta tesis. Primero, para verificar la fiabilidad de los métodos de AA no supervisados en la extracción de patrones de IRM, se realizó una comparativa para la tarea de segmentación de gliomas de grado alto. Segundo, se propuso un algoritmo de AA no supervisado dentro de la familia de los Spatially Varying Finite Mixture Models. El algoritmo propone una densidad a priori basada en un Markov Random Field combinado con la función probabilística Non-Local Means, para codificar la idea de que píxeles vecinos tienden a pertenecer al mismo objeto. Tercero, se presenta el método HTS para describir la heterogeneidad vascular del glioblastoma. El método se ha aplicado a casos reales en una cohorte local de un solo centro y en una cohorte internacional de más de 180 pacientes de 7 centros europeos. Se llevó a cabo una evaluación exhaustiva del método para medir el potencial pronóstico de los hábitats HTS. Finalmente, la tecnología desarrollada en la tesis se ha integrado en la plataforma online ONCOhabitats (https://www.oncohabitats.upv.es). La plataforma ofrece dos servicios: 1) segmentación de tejidos de glioblastoma, y 2) evaluación de la heterogeneidad vascular del tumor mediante el método HTS. Los resultados de esta tesis han sido publicados en diez contribuciones científicas, incluyendo revistas y conferencias de alto impacto en las áreas de Informática Médica, Estadística y Probabilidad, Radiología y Medicina Nuclear y Aprendizaje Automático. También se emitió una patente industrial registrada en España, Europa y EEUU. Finalmente, las ideas originales concebidas en esta tesis dieron lugar a la creación de ONCOANALYTICS CDX, una empresa enmarcada en el modelo de negocio de los companion diagnostics de compuestos farmacéuticos.[EN] The future of medical imaging is linked to Artificial Intelligence (AI). The manual analysis of medical images is nowadays an arduous, error-prone and often unaffordable task for humans, which has caught the attention of the Machine Learning (ML) community. Magnetic Resonance Imaging (MRI) provides us with a wide variety of rich representations of the morphology and behavior of lesions completely inaccessible without a risky invasive intervention. Nevertheless, harnessing the powerful but often latent information contained in MRI acquisitions is a very complicated task, which requires computational intelligent analysis techniques. Central nervous system tumors are one of the most critical diseases studied through MRI. Specifically, glioblastoma represents a major challenge, as it remains a lethal cancer that, to date, lacks a satisfactory therapy. Of the entire set of characteristics that make glioblastoma so aggressive, a particular aspect that has been widely studied is its vascular heterogeneity. The strong vascular proliferation of glioblastomas, as well as their robust angiogenesis and extensive microvasculature heterogeneity have been claimed responsible for the high lethality of the neoplasm. This thesis focuses on the research and development of the Hemodynamic Tissue Signature (HTS) method: an unsupervised ML approach to describe the vascular heterogeneity of glioblastomas by means of perfusion MRI analysis. The HTS builds on the concept of habitats. A habitat is defined as a sub-region of the lesion with a particular MRI profile describing a specific physiological behavior. The HTS method delineates four habitats within the glioblastoma: the HAT habitat, as the most perfused region of the enhancing tumor; the LAT habitat, as the region of the enhancing tumor with a lower angiogenic profile; the potentially IPE habitat, as the non-enhancing region adjacent to the tumor with elevated perfusion indexes; and the VPE habitat, as the remaining edema of the lesion with the lowest perfusion profile. The research and development of the HTS method has generated a number of contributions to this thesis. First, in order to verify that unsupervised learning methods are reliable to extract MRI patterns to describe the heterogeneity of a lesion, a comparison among several unsupervised learning methods was conducted for the task of high grade glioma segmentation. Second, a Bayesian unsupervised learning algorithm from the family of Spatially Varying Finite Mixture Models is proposed. The algorithm integrates a Markov Random Field prior density weighted by the probabilistic Non-Local Means function, to codify the idea that neighboring pixels tend to belong to the same semantic object. Third, the HTS method to describe the vascular heterogeneity of glioblastomas is presented. The HTS method has been applied to real cases, both in a local single-center cohort of patients, and in an international retrospective cohort of more than 180 patients from 7 European centers. A comprehensive evaluation of the method was conducted to measure the prognostic potential of the HTS habitats. Finally, the technology developed in this thesis has been integrated into an online open-access platform for its academic use. The ONCOhabitats platform is hosted at https://www.oncohabitats.upv.es, and provides two main services: 1) glioblastoma tissue segmentation, and 2) vascular heterogeneity assessment of glioblastomas by means of the HTS method. The results of this thesis have been published in ten scientific contributions, including top-ranked journals and conferences in the areas of Medical Informatics, Statistics and Probability, Radiology & Nuclear Medicine and Machine Learning. An industrial patent registered in Spain, Europe and EEUU was also issued. Finally, the original ideas conceived in this thesis led to the foundation of ONCOANALYTICS CDX, a company framed into the business model of companion diagnostics for pharmaceutical compounds.[CA] El futur de la imatge mèdica està lligat a la intel·ligència artificial. L'anàlisi manual d'imatges mèdiques és hui dia una tasca àrdua, propensa a errors i sovint inassequible per als humans, que ha cridat l'atenció de la comunitat d'Aprenentatge Automàtic (AA). La Imatge per Ressonància Magnètica (IRM) ens proporciona una àmplia varietat de representacions de la morfologia i el comportament de lesions inaccessibles sense una intervenció invasiva arriscada. Tanmateix, explotar la potent però sovint latent informació continguda a les adquisicions de IRM esdevé una tasca molt complicada, que requereix tècniques d'anàlisi computacional intel·ligent. Els tumors del sistema nerviós central són una de les malalties més crítiques estudiades a través de IRM. Específicament, el glioblastoma representa un gran repte, ja que, fins hui, continua siguent un càncer letal que manca d'una teràpia satisfactòria. Del conjunt de característiques que fan del glioblastoma un tumor tan agressiu, un aspecte particular que ha sigut àmpliament estudiat és la seua heterogeneïtat vascular. La forta proliferació vascular dels glioblastomes, així com la seua robusta angiogènesi han sigut considerades responsables de l'alta letalitat d'aquesta neoplàsia. Aquesta tesi es centra en la recerca i desenvolupament del mètode Hemodynamic Tissue Signature (HTS): un mètode d'AA no supervisat per descriure l'heterogeneïtat vascular dels glioblastomas mitjançant l'anàlisi de perfusió per IRM. El mètode HTS es basa en el concepte d'hàbitat, que es defineix com una subregió de la lesió amb un perfil particular d'IRM, que descriu un comportament fisiològic concret. El mètode HTS delinea quatre hàbitats dins del glioblastoma: l'hàbitat HAT, com la regió més perfosa del tumor amb captació de contrast; l'hàbitat LAT, com la regió del tumor amb un perfil angiogènic més baix; l'hàbitat IPE, com la regió adjacent al tumor amb índexs de perfusió elevats, i l'hàbitat VPE, com l'edema restant de la lesió amb el perfil de perfusió més baix. La recerca i desenvolupament del mètode HTS ha originat una sèrie de contribucions emmarcades a aquesta tesi. Primer, per verificar la fiabilitat dels mètodes d'AA no supervisats en l'extracció de patrons d'IRM, es va realitzar una comparativa en la tasca de segmentació de gliomes de grau alt. Segon, s'ha proposat un algorisme d'AA no supervisat dintre de la família dels Spatially Varying Finite Mixture Models. L'algorisme proposa un densitat a priori basada en un Markov Random Field combinat amb la funció probabilística Non-Local Means, per a codificar la idea que els píxels veïns tendeixen a pertànyer al mateix objecte semàntic. Tercer, es presenta el mètode HTS per descriure l'heterogeneïtat vascular dels glioblastomas. El mètode HTS s'ha aplicat a casos reals en una cohort local d'un sol centre i en una cohort internacional de més de 180 pacients de 7 centres europeus. Es va dur a terme una avaluació exhaustiva del mètode per mesurar el potencial pronòstic dels hàbitats HTS. Finalment, la tecnologia desenvolupada en aquesta tesi s'ha integrat en una plataforma online ONCOhabitats (https://www.oncohabitats.upv.es). La plataforma ofereix dos serveis: 1) segmentació dels teixits del glioblastoma, i 2) avaluació de l'heterogeneïtat vascular dels glioblastomes mitjançant el mètode HTS. Els resultats d'aquesta tesi han sigut publicats en deu contribucions científiques, incloent revistes i conferències de primer nivell a les àrees d'Informàtica Mèdica, Estadística i Probabilitat, Radiologia i Medicina Nuclear i Aprenentatge Automàtic. També es va emetre una patent industrial registrada a Espanya, Europa i els EEUU. Finalment, les idees originals concebudes en aquesta tesi van donar lloc a la creació d'ONCOANALYTICS CDX, una empresa emmarcada en el model de negoci dels companion diagnostics de compostos farmacèutics.En este sentido quiero agradecer a las diferentes instituciones y estructuras de financiación de investigación que han contribuido al desarrollo de esta tesis. En especial quiero agradecer a la Universitat Politècnica de València, donde he desarrollado toda mi carrera acadèmica y científica, así como al Ministerio de Ciencia e Innovación, al Ministerio de Economía y Competitividad, a la Comisión Europea, al EIT Health Programme y a la fundación Caixa ImpulseJuan Albarracín, J. (2020). Unsupervised learning for vascular heterogeneity assessment of glioblastoma based on magnetic resonance imaging: The Hemodynamic Tissue Signature [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/149560TESI

Deep Learning in Medical Image Analysis

The accelerating power of deep learning in diagnosing diseases will empower physicians and speed up decision making in clinical environments. Applications of modern medical instruments and digitalization of medical care have generated enormous amounts of medical images in recent years. In this big data arena, new deep learning methods and computational models for efficient data processing, analysis, and modeling of the generated data are crucially important for clinical applications and understanding the underlying biological process. This book presents and highlights novel algorithms, architectures, techniques, and applications of deep learning for medical image analysis

Deep learning for medical image processing

Medical image segmentation represents a fundamental aspect of medical image computing. It facilitates measurements of anatomical structures, like organ volume and tissue thickness, critical for many classification algorithms which can be instrumental for clinical diagnosis. Consequently, enhancing the efficiency and accuracy of segmentation algorithms could lead to considerable improvements in patient care and diagnostic precision. In recent years, deep learning has become the state-of-the-art approach in various domains of medical image computing, including medical image segmentation. The key advantages of deep learning methods are their speed and efficiency, which have the potential to transform clinical practice significantly. Traditional algorithms might require hours to perform complex computations, but with deep learning, such computational tasks can be executed much faster, often within seconds. This thesis focuses on two distinct segmentation strategies: voxel-based and surface-based. Voxel-based segmentation assigns a class label to each individual voxel of an image. On the other hand, surface-based segmentation techniques involve reconstructing a 3D surface from the input images, then segmenting that surface into different regions. This thesis presents multiple methods for voxel-based image segmentation. Here, the focus is segmenting brain structures, white matter hyperintensities, and abdominal organs. Our approaches confront challenges such as domain adaptation, learning with limited data, and optimizing network architectures to handle 3D images. Additionally, the thesis discusses ways to handle the failure cases of standard deep learning approaches, such as dealing with rare cases like patients who have undergone organ resection surgery. Finally, the thesis turns its attention to cortical surface reconstruction and parcellation. Here, deep learning is used to extract cortical surfaces from MRI scans as triangular meshes and parcellate these surfaces on a vertex level. The challenges posed by this approach include handling irregular and topologically complex structures. This thesis presents novel deep learning strategies for voxel-based and surface-based medical image segmentation. By addressing specific challenges in each approach, it aims to contribute to the ongoing advancement of medical image computing.Die Segmentierung medizinischer Bilder stellt einen fundamentalen Aspekt der medizinischen Bildverarbeitung dar. Sie erleichtert Messungen anatomischer Strukturen, wie Organvolumen und Gewebedicke, die für viele Klassifikationsalgorithmen entscheidend sein können und somit für klinische Diagnosen von Bedeutung sind. Daher könnten Verbesserungen in der Effizienz und Genauigkeit von Segmentierungsalgorithmen zu erheblichen Fortschritten in der Patientenversorgung und diagnostischen Genauigkeit führen. Deep Learning hat sich in den letzten Jahren als führender Ansatz in verschiedenen Be-reichen der medizinischen Bildverarbeitung etabliert. Die Hauptvorteile dieser Methoden sind Geschwindigkeit und Effizienz, die die klinische Praxis erheblich verändern können. Traditionelle Algorithmen benötigen möglicherweise Stunden, um komplexe Berechnungen durchzuführen, mit Deep Learning können solche rechenintensiven Aufgaben wesentlich schneller, oft innerhalb von Sekunden, ausgeführt werden. Diese Dissertation konzentriert sich auf zwei Segmentierungsstrategien, die voxel- und oberflächenbasierte Segmentierung. Die voxelbasierte Segmentierung weist jedem Voxel eines Bildes ein Klassenlabel zu, während oberflächenbasierte Techniken eine 3D-Oberfläche aus den Eingabebildern rekonstruieren und segmentieren. In dieser Arbeit werden mehrere Methoden für die voxelbasierte Bildsegmentierung vorgestellt. Der Fokus liegt hier auf der Segmentierung von Gehirnstrukturen, Hyperintensitäten der weißen Substanz und abdominellen Organen. Unsere Ansätze begegnen Herausforderungen wie der Anpassung an verschiedene Domänen, dem Lernen mit begrenzten Daten und der Optimierung von Netzwerkarchitekturen, um 3D-Bilder zu verarbeiten. Darüber hinaus werden in dieser Dissertation Möglichkeiten erörtert, mit den Fehlschlägen standardmäßiger Deep-Learning-Ansätze umzugehen, beispielsweise mit seltenen Fällen nach einer Organresektion. Schließlich legen wir den Fokus auf die Rekonstruktion und Parzellierung von kortikalen Oberflächen. Hier wird Deep Learning verwendet, um kortikale Oberflächen aus MRT-Scans als Dreiecksnetz zu extrahieren und diese Oberflächen auf Knoten-Ebene zu parzellieren. Zu den Herausforderungen dieses Ansatzes gehört der Umgang mit unregelmäßigen und topologisch komplexen Strukturen. Diese Arbeit stellt neuartige Deep-Learning-Strategien für die voxel- und oberflächenbasierte medizinische Segmentierung vor. Durch die Bewältigung spezifischer Herausforderungen in jedem Ansatz trägt sie so zur Weiterentwicklung der medizinischen Bildverarbeitung bei