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

Segmentation of 3D Carotid Ultrasound Images Using Weak Geometric Priors

Vascular diseases are among the leading causes of death in Canada and around the globe. A major underlying cause of most such medical conditions is atherosclerosis, a gradual accumulation of plaque on the walls of blood vessels. Particularly vulnerable to atherosclerosis is the carotid artery, which carries blood to the brain. Dangerous narrowing of the carotid artery can lead to embolism, a dislodgement of plaque fragments which travel to the brain and are the cause of most strokes. If this pathology can be detected early, such a deadly scenario can be potentially prevented through treatment or surgery. This not only improves the patient's prognosis, but also dramatically lowers the overall cost of their treatment. Medical imaging is an indispensable tool for early detection of atherosclerosis, in particular since the exact location and shape of the plaque need to be known for accurate diagnosis. This can be achieved by locating the plaque inside the artery and measuring its volume or texture, a process which is greatly aided by image segmentation. In particular, the use of ultrasound imaging is desirable because it is a cost-effective and safe modality. However, ultrasonic images depict sound-reflecting properties of tissue, and thus suffer from a number of unique artifacts not present in other medical images, such as acoustic shadowing, speckle noise and discontinuous tissue boundaries. A robust ultrasound image segmentation technique must take these properties into account. Prior to segmentation, an important pre-processing step is the extraction of a series of features from the image via application of various transforms and non-linear filters. A number of such features are explored and evaluated, many of them resulting in piecewise smooth images. It is also proposed to decompose the ultrasound image into several statistically distinct components. These components can be then used as features directly, or other features can be obtained from them instead of the original image. The decomposition scheme is derived using Maximum-a-Posteriori estimation framework and is efficiently computable. Furthermore, this work presents and evaluates an algorithm for segmenting the carotid artery in 3D ultrasound images from other tissues. The algorithm incorporates information from different sources using an energy minimization framework. Using the ultrasound image itself, statistical differences between the region of interest and its background are exploited, and maximal overlap with strong image edges encouraged. In order to aid the convergence to anatomically accurate shapes, as well as to deal with the above-mentioned artifacts, prior knowledge is incorporated into the algorithm by using weak geometric priors. The performance of the algorithm is tested on a number of available 3D images, and encouraging results are obtained and discussed

Doctor of Philosophy

dissertationCongenital heart defects are classes of birth defects that affect the structure and function of the heart. These defects are attributed to the abnormal or incomplete development of a fetal heart during the first few weeks following conception. The overall detection rate of congenital heart defects during routine prenatal examination is low. This is attributed to the insufficient number of trained personnel in many local health centers where many cases of congenital heart defects go undetected. This dissertation presents a system to identify congenital heart defects to improve pregnancy outcomes and increase their detection rates. The system was developed and its performance assessed in identifying the presence of ventricular defects (congenital heart defects that affect the size of the ventricles) using four-dimensional fetal chocardiographic images. The designed system consists of three components: 1) a fetal heart location estimation component, 2) a fetal heart chamber segmentation component, and 3) a detection component that detects congenital heart defects from the segmented chambers. The location estimation component is used to isolate a fetal heart in any four-dimensional fetal echocardiographic image. It uses a hybrid region of interest extraction method that is robust to speckle noise degradation inherent in all ultrasound images. The location estimation method's performance was analyzed on 130 four-dimensional fetal echocardiographic images by comparison with manually identified fetal heart region of interest. The location estimation method showed good agreement with the manually identified standard using four quantitative indexes: Jaccard index, Sørenson-Dice index, Sensitivity index and Specificity index. The average values of these indexes were measured at 80.70%, 89.19%, 91.04%, and 99.17%, respectively. The fetal heart chamber segmentation component uses velocity vector field estimates computed on frames contained in a four-dimensional image to identify the fetal heart chambers. The velocity vector fields are computed using a histogram-based optical flow technique which is formulated on local image characteristics to reduces the effect of speckle noise and nonuniform echogenicity on the velocity vector field estimates. Features based on the velocity vector field estimates, voxel brightness/intensity values, and voxel Cartesian coordinate positions were extracted and used with kernel k-means algorithm to identify the individual chambers. The segmentation method's performance was evaluated on 130 images from 31 patients by comparing the segmentation results with manually identified fetal heart chambers. Evaluation was based on the Sørenson-Dice index, the absolute volume difference and the Hausdorff distance, with each resulting in per patient average values of 69.92%, 22.08%, and 2.82 mm, respectively. The detection component uses the volumes of the identified fetal heart chambers to flag the possible occurrence of hypoplastic left heart syndrome, a type of congenital heart defect. An empirical volume threshold defined on the relative ratio of adjacent fetal heart chamber volumes obtained manually is used in the detection process. The performance of the detection procedure was assessed by comparison with a set of images with confirmed diagnosis of hypoplastic left heart syndrome and a control group of normal fetal hearts. Of the 130 images considered 18 of 20 (90%) fetal hearts were correctly detected as having hypoplastic left heart syndrome and 84 of 110 (76.36%) fetal hearts were correctly detected as normal in the control group. The results show that the detection system performs better than the overall detection rate for congenital heart defect which is reported to be between 30% and 60%

Basic Science to Clinical Research: Segmentation of Ultrasound and Modelling in Clinical Informatics

The world of basic science is a world of minutia; it boils down to improving even a fraction of a percent over the baseline standard. It is a domain of peer reviewed fractions of seconds and the world of squeezing every last ounce of efficiency from a processor, a storage medium, or an algorithm. The field of health data is based on extracting knowledge from segments of data that may improve some clinical process or practice guideline to improve the time and quality of care. Clinical informatics and knowledge translation provide this information in order to reveal insights to the world of improving patient treatments, regimens, and overall outcomes. In my world of minutia, or basic science, the movement of blood served an integral role. The novel detection of sound reverberations map out the landscape for my research. I have applied my algorithms to the various anatomical structures of the heart and artery system. This serves as a basis for segmentation, active contouring, and shape priors. The algorithms presented, leverage novel applications in segmentation by using anatomical features of the heart for shape priors and the integration of optical flow models to improve tracking. The presented techniques show improvements over traditional methods in the estimation of left ventricular size and function, along with plaque estimation in the carotid artery. In my clinical world of data understanding, I have endeavoured to decipher trends in Alzheimer’s disease, Sepsis of hospital patients, and the burden of Melanoma using mathematical modelling methods. The use of decision trees, Markov models, and various clustering techniques provide insights into data sets that are otherwise hidden. Finally, I demonstrate how efficient data capture from providers can achieve rapid results and actionable information on patient medical records. This culminated in generating studies on the burden of illness and their associated costs. A selection of published works from my research in the world of basic sciences to clinical informatics has been included in this thesis to detail my transition. This is my journey from one contented realm to a turbulent one

An Information Tracking Approach to the Segmentation of Prostates in Ultrasound Imaging

Outlining of the prostate boundary in ultrasound images is a very useful procedure performed and subsequently used by clinicians. The contribution of the resulting segmentation is twofold. First of all, the segmentation of the prostate glands can be used to analyze the size, geometry, and volume of the gland. Such analysis is useful as it is known that the former quantities used in conjunction with a PSA blood test can be used as an indicator of malignancy in the gland itself. The second purpose of accurate segmentation is for treatment planning purposes. In brachetherapy, commonly used to treat localized prostate cancer, the accurate location of the prostate must be found so that the radioactive seeds can be placed precisely in the malignant regions. Unfortunately, the current method of segmentation of ultrasound images is performed manually by expert radiologists. Due to the abundance of ultrasound data, the process of manual segmentation can be extremely time consuming and inefficient. A much more desirable way to perform the segmentation process is through automatic procedures, which should be able to accurately and efficiently extract the boundary of the prostate gland with minimal user intervention. This is the ultimate goal of the proposed approach. The proposed segmentation algorithm uses a probability distribution tracking framework to accurately and efficiently perform the task at hand. The basis for this methodology is to extract image and shape features from available manually segmented ultrasound images for which the actual prostate region is known. Then, the segmentation algorithm seeks a region in new ultrasound images whose features closely mirror the learned features of known prostate regions. Promising results were achieved using this method in a series of in silico and in vivo experiments

The application of b-mode ultrasonography for analysis of human skeletal muscle

Skeletal muscles control the joints of the skeletal system and they allow human movement and interaction with the environment. They are vital for stability in balance, walking and running, and many other skilled motor tasks. To understand how muscles operate in general and specific situations there are a variety of tools at the disposal of research scientists and clinicians for analysing muscle function. Strain gauges for example allow the quantification of forces exerted during joint rotation. However, skeletal muscles are multilayer systems and often different muscles are responsible for the overall force generated during joint rotation. Therefore, strain gauges do not reveal the extent of the contribution of individual muscles during muscle function. The most widely-used and accepted muscle analysis tool is electromyography (EMG), which can measure the activation level of individual muscles by measuring the electrical potential propagating through muscle resulting from local activations of motor units. However, EMG does not linearly relate to any real physical forces, meaning that without prior knowledge of the force exertion on the level of the muscle, force cannot be estimated. EMG can measure superficial layers of muscle non-invasively by attaching surface electrodes (surface EMG) to the skin over the belly of the muscle. To measure the activity of individual muscle beneath the superficial muscle, a needle or thin-wire electrode must be inserted through the skin and into the muscle volume (intramuscular EMG), which is invasive and not practical in many situations. Furthermore, intramuscular EMG can only provide measurement of a very small volume (<1mm3) which can have varying amounts of active motor units. Ultrasonography is a powerful cost-effective non-invasive imaging technology which allows real-time observation of cross-sections of multiple layers of dynamic skeletal muscle. Recent advances in automated skeletal muscle ultrasound analysis techniques, and advances in image processing techniques make ultrasound a valuable line of investigation for analysis of dynamic skeletal muscle. This aim of this thesis is to study and develop advanced image analysis techniques applicable to the analysis of dynamic skeletal muscle. The broader aim is to understand the capacity/limits of ultrasound as a skeletal muscle analysis tool. The ideas presented within offer new approaches to modelling complex muscle architecture and function via ultrasound. Tools have also been developed here that will contribute to, and promote ultrasound skeletal muscle analysis as a new and emerging technology which may be used by clinicians and research scientists to develop our understanding of skeletal muscle function. The main findings of this thesis are that automated segmentation of architecturally simple and complex skeletal muscle groups is possible and accurate, and that information about joint angles and muscle activity/force can be automatically extracted directly from ultrasound images without the explicit knowledge of how to extract it. The techniques used offer new possibilities for non-invasive information extraction from complex muscle groups such as the muscles in the human posterior neck

Echocardiography

The book "Echocardiography - New Techniques" brings worldwide contributions from highly acclaimed clinical and imaging science investigators, and representatives from academic medical centers. Each chapter is designed and written to be accessible to those with a basic knowledge of echocardiography. Additionally, the chapters are meant to be stimulating and educational to the experts and investigators in the field of echocardiography. This book is aimed primarily at cardiology fellows on their basic echocardiography rotation, fellows in general internal medicine, radiology and emergency medicine, and experts in the arena of echocardiography. Over the last few decades, the rate of technological advancements has developed dramatically, resulting in new techniques and improved echocardiographic imaging. The authors of this book focused on presenting the most advanced techniques useful in today's research and in daily clinical practice. These advanced techniques are utilized in the detection of different cardiac pathologies in patients, in contributing to their clinical decision, as well as follow-up and outcome predictions. In addition to the advanced techniques covered, this book expounds upon several special pathologies with respect to the functions of echocardiography

Automated retinal layer segmentation and pre-apoptotic monitoring for three-dimensional optical coherence tomography

The aim of this PhD thesis was to develop segmentation algorithm adapted and optimized to retinal OCT data that will provide objective 3D layer thickness which might be used to improve diagnosis and monitoring of retinal pathologies. Additionally, a 3D stack registration method was produced by modifying an existing algorithm. A related project was to develop a pre-apoptotic retinal monitoring based on the changes in texture parameters of the OCT scans in order to enable treatment before the changes become irreversible; apoptosis refers to the programmed cell death that can occur in retinal tissue and lead to blindness. These issues can be critical for the examination of tissues within the central nervous system. A novel statistical model for segmentation has been created and successfully applied to a large data set. A broad range of future research possibilities into advanced pathologies has been created by the results obtained. A separate model has been created for choroid segmentation located deep in retina, as the appearance of choroid is very different from the top retinal layers. Choroid thickness and structure is an important index of various pathologies (diabetes etc.). As part of the pre-apoptotic monitoring project it was shown that an increase in proportion of apoptotic cells in vitro can be accurately quantified. Moreover, the data obtained indicates a similar increase in neuronal scatter in retinal explants following axotomy (removal of retinas from the eye), suggesting that UHR-OCT can be a novel non-invasive technique for the in vivo assessment of neuronal health. Additionally, an independent project within the computer science department in collaboration with the school of psychology has been successfully carried out, improving analysis of facial dynamics and behaviour transfer between individuals. Also, important improvements to a general signal processing algorithm, dynamic time warping (DTW), have been made, allowing potential application in a broad signal processing field.EThOS - Electronic Theses Online ServiceGBUnited Kingdo