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

Constrained snake vs. conventional snake for carotid ultrasound automated IMT measurements on multi-center data sets

Accurate intima-media thickness (IMT) measurement of the carotid artery from minimal plaque ultrasound images is a relevant clinical need, since IMT increase is related to the progression of atherosclerosis. In this paper, we describe a novel dual snake-based model for the high-performance carotid IMT measurement, called Carotid Measurement Using Dual Snakes (CMUDS). Snakes (which are deformable contours) adapt to the lumen-intima (LI) and media-adventitia (MA) interfaces, thus enabling the IMT computation as distance between the LI and MA snakes. However, traditional snakes might be unable to maintain a correct distance and in some spatial location along the artery, it might even collapse between them or diverge. The technical improvement of this work is the definition of a dual snake-based constrained system, which prevents the LI and MA snakes from collapsing or bleeding, thus optimizing the IMT estimation. The CMUDS system consists of two parametric models automatically initialized using the far adventitia border which we automatically traced by using a previously developed multi-resolution approach. The dual snakes evolve simultaneously and are constrained by the distances between them, ensuring the regularization of LI/MA topology. We benchmarked our automated CMUDS with the previous conventional semi-automated snake system called Carotid Measurement Using Single Snake (CMUSS). Two independent readers manually traced the LIMA boundaries of a multi-institutional, multi-ethnic, and multi-scanner database of 665 CCA longitudinal 2D images. We evaluated our system performance by comparing it with the gold standard as traced by clinical readers. CMUDS and CMUSS correctly processed 100% of the 665 images. Comparing the performance with respect to the two readers, our automatically measured IMT was on average very close to that of the two readers (IMT measurement biases for CMUSS was equal to −0.011 ± 0.329 mm and −0.045 ± 0.317 mm, respectively, while for CMUDS, it was 0.030 ± 0.284 mm and −0.004 ± 0.273 mm, respectively). The Figure-of-Merit of the system was 98.5% and 94.4% for CMUSS, while 96.0% and 99.6% for CMUDS, respectively. Results showed that the dual-snake system CMUDS reduced the IMT measurement error accuracy (Wilcoxon, p < 0.02) and the IMT error variability (Fisher, p < 3 × 10−2). We propose the CMUDS technique for use in large multi-centric studies, where the need for a standard, accurate, and automated IMT measurement technique is require

Comparison of ultrasound image filtering methods by means of multivariable kurtosis

Comparison of the quality of despeckled US medical images is complicated because there is no image of a human body that would be free of speckles and could serve as a reference. A number of various image metrics are currently used for comparison of filtering methods; however, they do not satisfactorily represent the visual quality of images and medical expert’s satisfaction with images. This paper proposes an innovative use of relative multivariate kurtosis for the evaluation of the most important edges in an image. Multivariate kurtosis allows one to introduce an order among the filtered images and can be used as one of the metrics for image quality evaluation. At present there is no method which would jointly consider individual metrics. Furthermore, these metrics are typically defined by comparing the noisy original and filtered images, which is incorrect since the noisy original cannot serve as a golden standard. In contrast to this, the proposed kurtosis is the absolute measure, which is calculated independently of any reference image and it agrees with the medical expert’s satisfaction to a large extent. The paper presents a numerical procedure for calculating kurtosis and describes results of such calculations for a computer-generated noisy image, images of a general purpose phantom and a cyst phantom, as well as real-life images of thyroid and carotid artery obtained with SonixTouch ultrasound machine. 16 different methods of image despeckling are compared via kurtosis. The paper shows that visually more satisfactory despeckling results are associated with higher kurtosis, and to a certain degree kurtosis can be used as a single metric for evaluation of image quality

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

Advancements and Breakthroughs in Ultrasound Imaging

Ultrasonic imaging is a powerful diagnostic tool available to medical practitioners, engineers and researchers today. Due to the relative safety, and the non-invasive nature, ultrasonic imaging has become one of the most rapidly advancing technologies. These rapid advances are directly related to the parallel advancements in electronics, computing, and transducer technology together with sophisticated signal processing techniques. This book focuses on state of the art developments in ultrasonic imaging applications and underlying technologies presented by leading practitioners and researchers from many parts of the world

Phase Aberration Correction: A Deep Learning-Based Aberration to Aberration Approach

One of the primary sources of suboptimal image quality in ultrasound imaging is phase aberration. It is caused by spatial changes in sound speed over a heterogeneous medium, which disturbs the transmitted waves and prevents coherent summation of echo signals. Obtaining non-aberrated ground truths in real-world scenarios can be extremely challenging, if not impossible. This challenge hinders training of deep learning-based techniques' performance due to the presence of domain shift between simulated and experimental data. Here, for the first time, we propose a deep learning-based method that does not require ground truth to correct the phase aberration problem, and as such, can be directly trained on real data. We train a network wherein both the input and target output are randomly aberrated radio frequency (RF) data. Moreover, we demonstrate that a conventional loss function such as mean square error is inadequate for training such a network to achieve optimal performance. Instead, we propose an adaptive mixed loss function that employs both B-mode and RF data, resulting in more efficient convergence and enhanced performance. Finally, we publicly release our dataset, including 161,701 single plane-wave images (RF data). This dataset serves to mitigate the data scarcity problem in the development of deep learning-based techniques for phase aberration correction.Comment: arXiv admin note: text overlap with arXiv:2303.0574

Low Cost 3D Flow Estimation in Medical Ultrasound

abstract: Medical ultrasound imaging is widely used today because of it being non-invasive and cost-effective. Flow estimation helps in accurate diagnosis of vascular diseases and adds an important dimension to medical ultrasound imaging. Traditionally flow estimation is done using Doppler-based methods which only estimate velocity in the beam direction. Thus when blood vessels are close to being orthogonal to the beam direction, there are large errors in the estimation results. In this dissertation, a low cost blood flow estimation method that does not have the angle dependency of Doppler-based methods, is presented. First, a velocity estimator based on speckle tracking and synthetic lateral phase is proposed for clutter-free blood flow. Speckle tracking is based on kernel matching and does not have any angle dependency. While velocity estimation in axial dimension is accurate, lateral velocity estimation is challenging due to reduced resolution and lack of phase information. This work presents a two tiered method which estimates the pixel level movement using sum-of-absolute difference, and then estimates the sub-pixel level using synthetic phase information in the lateral dimension. Such a method achieves highly accurate velocity estimation with reduced complexity compared to a cross correlation based method. The average bias of the proposed estimation method is less than 2% for plug flow and less than 7% for parabolic flow. Blood is always accompanied by clutter which originates from vessel wall and surrounding tissues. As magnitude of the blood signal is usually 40-60 dB lower than magnitude of the clutter signal, clutter filtering is necessary before blood flow estimation. Clutter filters utilize the high magnitude and low frequency features of clutter signal to effectively remove them from the compound (blood + clutter) signal. Instead of low complexity FIR filter or high complexity SVD-based filters, here a power/subspace iteration based method is proposed for clutter filtering. Excellent clutter filtering performance is achieved for both slow and fast moving clutters with lower complexity compared to SVD-based filters. For instance, use of the proposed method results in the bias being less than 8% and standard deviation being less than 12% for fast moving clutter when the beam-to-flow-angle is $90^o$. Third, a flow rate estimation method based on kernel power weighting is proposed. As the velocity estimator is a kernel-based method, the estimation accuracy degrades near the vessel boundary. In order to account for kernels that are not fully inside the vessel, fractional weights are given to these kernels based on their signal power. The proposed method achieves excellent flow rate estimation results with less than 8% bias for both slow and fast moving clutters. The performance of the velocity estimator is also evaluated for challenging models. A 2D version of our two-tiered method is able to accurately estimate velocity vectors in a spinning disk as well as in a carotid bifurcation model, both of which are part of the synthetic aperture vector flow imaging (SA-VFI) challenge of 2018. In fact, the proposed method ranked 3rd in the challenge for testing dataset with carotid bifurcation. The flow estimation method is also evaluated for blood flow in vessels with stenosis. Simulation results show that the proposed method is able to estimate the flow rate with less than 9% bias.Dissertation/ThesisDoctoral Dissertation Electrical Engineering 201

Three-dimensional segmentation of three-dimensional ultrasound carotid atherosclerosis using sparse field level sets.

PURPOSE: Three-dimensional ultrasound (3DUS) vessel wall volume (VWV) provides a 3D measurement of carotid artery wall remodeling and atherosclerotic plaque and is sensitive to temporal changes of carotid plaque burden. Unfortunately, although 3DUS VWV provides many advantages compared to measurements of arterial wall thickening or plaque alone, it is still not widely used in research or clinical practice because of the inordinate amount of time required to train observers and to generate 3DUS VWV measurements. In this regard, semiautomated methods for segmentation of the carotid media-adventitia boundary (MAB) and the lumen-intima boundary (LIB) would greatly improve the time to train observers and for them to generate 3DUS VWV measurements with high reproducibility. METHODS: The authors describe a 3D algorithm based on a modified sparse field level set method for segmenting the MAB and LIB of the common carotid artery (CCA) from 3DUS images. To the authors\u27 knowledge, the proposed algorithm is the first direct 3D segmentation method, which has been validated for segmenting both the carotid MAB and the LIB from 3DUS images for the purpose of computing VWV. Initialization of the algorithm requires the observer to choose anchor points on each boundary on a set of transverse slices with a user-specified interslice distance (ISD), in which larger ISD requires fewer user interactions than smaller ISD. To address the challenges of the MAB and LIB segmentations from 3DUS images, the authors integrated regional- and boundary-based image statistics, expert initializations, and anatomically motivated boundary separation into the segmentation. The MAB is segmented by incorporating local region-based image information, image gradients, and the anchor points provided by the observer. Moreover, a local smoothness term is utilized to maintain the smooth surface of the MAB. The LIB is segmented by constraining its evolution using the already segmented surface of the MAB, in addition to the global region-based information and the anchor points. The algorithm-generated surfaces were sliced and evaluated with respect to manual segmentations on a slice-by-slice basis using 21 3DUS images. RESULTS: The authors used ISD of 1, 2, 3, 4, and 10 mm for algorithm initialization to generate segmentation results. The algorithm-generated accuracy and intraobserver variability results are comparable to the previous methods, but with fewer user interactions. For example, for the ISD of 3 mm, the algorithm yielded an average Dice coefficient of 94.4% ± 2.2% and 90.6% ± 5.0% for the MAB and LIB and the coefficient of variation of 6.8% for computing the VWV of the CCA, while requiring only 1.72 min (vs 8.3 min for manual segmentation) for a 3DUS image. CONCLUSIONS: The proposed 3D semiautomated segmentation algorithm yielded high-accuracy and high-repeatability, while reducing the expert interaction required for initializing the algorithm than the previous 2D methods