A Deep Learning Framework for the Detection of Abnormality in Cerebral Blood Flow Velocity Using Transcranial Doppler Ultrasound

Transcranial doppler (TCD) ultrasound is a non-invasive imaging technique that can be used for continuous monitoring of blood flow in the brain through the major cerebral arteries by calculating the cerebral blood flow velocity (CBFV). Since the brain requires a consistent supply of blood to function properly and meet its metabolic demand, a change in CBVF can be an indication of neurological diseases. Depending on the severity of the disease, the symptoms may appear immediately or may appear weeks later. For the early detection of neurological diseases, a classification model is proposed in this study, with the ability to distinguish healthy subjects from critically ill subjects. The TCD ultrasound database used in this study contains signals from the middle cerebral artery (MCA) of 6 healthy subjects and 12 subjects with known neurocritical diseases. The classification model works based on the maximal blood flow velocity waveforms extracted from the TCD ultrasound. Since the signal quality of the recorded TCD ultrasound is highly dependent on the operator's skillset, a noisy and corrupted signal can exist and can add biases to the classifier. Therefore, a deep learning classifier, trained on a curated and clean biomedical signal can reliably detect neurological diseases. For signal classification, this study proposes a Self-organized Operational Neural Network (Self-ONN)-based deep learning model Self-ResAttentioNet18, which achieves classification accuracy of 96.05% with precision, recall, f1 score, and specificity of 96.06%, 96.05%, 96.06%, and 96.09%, respectively. With an area under the ROC curve of 0.99, the model proves its feasibility to confidently classify middle cerebral artery (MCA) waveforms in near real-time.This work was made possible by the High Impact grant of Qatar University # QUHI-CENG-22_23-548 and student grant: QUST-1-CENG-2023-796. The statements made herein are solely the responsibility of the authors.Scopu

Artificial Intelligence in Image-Based Screening, Diagnostics, and Clinical Care of Cardiopulmonary Diseases

Cardiothoracic and pulmonary diseases are a significant cause of mortality and morbidity worldwide. The COVID-19 pandemic has highlighted the lack of access to clinical care, the overburdened medical system, and the potential of artificial intelligence (AI) in improving medicine. There are a variety of diseases affecting the cardiopulmonary system including lung cancers, heart disease, tuberculosis (TB), etc., in addition to COVID-19-related diseases. Screening, diagnosis, and management of cardiopulmonary diseases has become difficult owing to the limited availability of diagnostic tools and experts, particularly in resource-limited regions. Early screening, accurate diagnosis and staging of these diseases could play a crucial role in treatment and care, and potentially aid in reducing mortality. Radiographic imaging methods such as computed tomography (CT), chest X-rays (CXRs), and echo ultrasound (US) are widely used in screening and diagnosis. Research on using image-based AI and machine learning (ML) methods can help in rapid assessment, serve as surrogates for expert assessment, and reduce variability in human performance. In this Special Issue, “Artificial Intelligence in Image-Based Screening, Diagnostics, and Clinical Care of Cardiopulmonary Diseases”, we have highlighted exemplary primary research studies and literature reviews focusing on novel AI/ML methods and their application in image-based screening, diagnosis, and clinical management of cardiopulmonary diseases. We hope that these articles will help establish the advancements in AI

Thickness estimation, automated classification and novelty detection in ultrasound images of the plantar fascia tissues

The plantar fascia (PF) tissue plays an important role in the movement and the stability of the foot during walking and running. Thus it is possible for the overuse and the associated medical problems to cause injuries and some severe common diseases. Ultrasound (US) imaging offers significant potential in diagnosis of PF injuries and monitoring treatments. Despite the advantages of US, the generated PF images are difficult to interpret during medical assessment. This is partly due to the size and position of the PF in relation to the adjacent tissues. This limits the use of US in clinical practice and therefore impacts on patient services for what is a common problem and a major cause of foot pain and discomfort. It is therefore a requirement to devise an automated system that allows better and easier interpretation of PF US images during diagnosis. This study is concerned with developing a computer-based system using a combination of medical image processing techniques whereby different PF US images can be visually improved, segmented, analysed and classified as normal or abnormal, so as to provide more information to the doctors and the clinical treatment department for early diagnosis and the detection of the PF associated medical problems. More specifically, this study is required to investigate the possibility of a proposed model for localizing and estimating the PF thickness a cross three different sections (rearfoot, midfoot and forefoot) using a supervised ANN segmentation technique. The segmentation method uses RBF artificial neural network module in order to classify small overlapping patches into PF and non-PF tissue. Feature selection technique was performed as a post-processing step for feature extraction to reduce the number of the extracted features. Then the trained RBF-ANN is used to segment the desired PF region. The PF thickness was calculated using two different methods: distance transformation and a proposed area-length calculation algorithm. Additionally, different machine learning approaches were investigated and applied to the segmented PF region in order to distinguish between symptomatic and asymptomatic PF subjects using the best normalized and selected feature set. This aims to facilitate the characterization and the classification of the PF area for the identification of patients with inferior heel pain at risk of plantar fasciitis. Finally, a novelty detection framework for detecting the symptomatic PF samples (with plantar fasciitis disorder) using only asymptomatic samples is proposed. This model implies the following: feature analysis, building a normality model by training the one-class SVDD classifier using only asymptomatic PF training datasets, and computing novelty scores using the trained SVDD classifier, training and testing asymptomatic datasets, and testing symptomatic datasets of the PF dataset. The performance evaluation results showed that the proposed approaches used in this study obtained favourable results compared to other methods reported in the literature

2D and 3D segmentation of medical images.

"Cardiovascular disease is one of the leading causes of the morbidity and mortality in the western world today. Many different imaging modalities are in place today to diagnose and investigate cardiovascular diseases. Each of these, however, has strengths and weaknesses. There are different forms of noise and artifacts in each image modality that combine to make the field of medical image analysis both important and challenging. The aim of this thesis is develop a reliable method for segmentation of vessel structures in medical imaging, combining the expert knowledge of the user in such a way as to maintain efficiency whilst overcoming the inherent noise and artifacts present in the images. We present results from 2D segmentation techniques using different methodologies, before developing 3D techniques for segmenting vessel shape from a series of images. The main drive of the work involves the investigation of medical images obtained using catheter based techniques, namely Intra Vascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT). We will present a robust segmentation paradigm, combining both edge and region information to segment the media-adventitia, and lumenal borders in those modalities respectively. By using a semi-interactive method that utilizes "soft" constraints, allowing imprecise user input which provides a balance between using the user's expert knowledge and efficiency. In the later part of the work, we develop automatic methods for segmenting the walls of lymph vessels. These methods are employed on sequential images in order to obtain data to reconstruct the vessel walls in the region of the lymph valves. We investigated methods to segment the vessel walls both individually and simultaneously, and compared the results both quantitatively and qualitatively in order obtain the most appropriate for the 3D reconstruction of the vessel wall. Lastly, we adapt the semi-interactive method used on vessels earlier into 3D to help segment out the lymph valve. This involved the user interactive method to provide guidance to help segment the boundary of the lymph vessel, then we apply a minimal surface segmentation methodology to provide segmentation of the valve.

A Fully Automatic Segmentation Method for Breast Ultrasound Images

Breast cancer is the second leading cause of death of women worldwide. Accurate lesion boundary detection is important for breast cancer diagnosis. Since many crucial features for discriminating benign and malignant lesions are based on the contour, shape, and texture of the lesion, an accurate segmentation method is essential for a successful diagnosis. Ultrasound is an effective screening tool and primarily useful for differentiating benign and malignant lesions. However, due to inherent speckle noise and low contrast of breast ultrasound imaging, automatic lesion segmentation is still a challenging task. This research focuses on developing a novel, effective, and fully automatic lesion segmentation method for breast ultrasound images. By incorporating empirical domain knowledge of breast structure, a region of interest is generated. Then, a novel enhancement algorithm (using a novel phase feature) and a newly developed neutrosophic clustering method are developed to detect the precise lesion boundary. Neutrosophy is a recently introduced branch of philosophy that deals with paradoxes, contradictions, antitheses, and antinomies. When neutrosophy is used to segment images with vague boundaries, its unique ability to deal with uncertainty is brought to bear. In this work, we apply neutrosophy to breast ultrasound image segmentation and propose a new clustering method named neutrosophic l-means. We compare the proposed method with traditional fuzzy c-means clustering and three other well-developed segmentation methods for breast ultrasound images, using the same database. Both accuracy and time complexity are analyzed. The proposed method achieves the best accuracy (TP rate is 94.36%, FP rate is 8.08%, and similarity rate is 87.39%) with a fairly rapid processing speed (about 20 seconds). Sensitivity analysis shows the robustness of the proposed method as well. Cases with multiple-lesions and severe shadowing effect (shadow areas having similar intensity values of the lesion and tightly connected with the lesion) are not included in this study

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

An Automated Modified Region Growing Technique for Prostate Segmentation in Trans-Rectal Ultrasound Images

Medical imaging plays a vital role in the medical field because it is widely used in diseases diagnosis and treatment of patients. There are different modalities of medical imaging such as ultrasounds, x-rays, Computed Tomography (CT), Magnetic Resonance (MR), and Positron Emission Tomography (PET). Most of these modalities usually suffer from noise and other sampling artifacts. The diagnosis process in these modalities depends mainly on the interpretation of the radiologists. Consequently, the diagnosis is subjective as it is based on the radiologist experience. Medical image segmentation is an important process in the field of image processing. It has a significant role in many applications such as diagnosis, therapy planning, and advanced surgeries. There are many segmentation techniques to be applied on medical images. However, most of these techniques are still depending on the experts, especially for initializing the segmentation process. The artifacts of images can affect the segmentation output. In this thesis, we propose a new approach for automatic prostate segmentation of Trans-Rectal UltraSound (TRUS) images by dealing with the speckle not as noise but as informative signals. The new approach is an automation of the conventional region growing technique. The proposed approach overcomes the requirement of manually selecting a seed point for initializing the segmentation process. In addition, the proposed approach depends on unique features such as the intensity and the spatial Euclidean distance to overcome the effect of the speckle noise of the images. The experimental results of the proposed approach show that it is fast and accurate. Moreover, it performs well on the ultrasound images, which has the common problem of the speckle noise

Automatic Spatiotemporal Analysis of Cardiac Image Series

RÉSUMÉ À ce jour, les maladies cardiovasculaires demeurent au premier rang des principales causes de décès en Amérique du Nord. Chez l’adulte et au sein de populations de plus en plus jeunes, la soi-disant épidémie d’obésité entraînée par certaines habitudes de vie tels que la mauvaise alimentation, le manque d’exercice et le tabagisme est lourde de conséquences pour les personnes affectées, mais aussi sur le système de santé. La principale cause de morbidité et de mortalité chez ces patients est l’athérosclérose, une accumulation de plaque à l’intérieur des vaisseaux sanguins à hautes pressions telles que les artères coronaires. Les lésions athérosclérotiques peuvent entraîner l’ischémie en bloquant la circulation sanguine et/ou en provoquant une thrombose. Cela mène souvent à de graves conséquences telles qu’un infarctus. Outre les problèmes liés à la sténose, les parois artérielles des régions criblées de plaque augmentent la rigidité des parois vasculaires, ce qui peut aggraver la condition du patient. Dans la population pédiatrique, la pathologie cardiovasculaire acquise la plus fréquente est la maladie de Kawasaki. Il s’agit d’une vasculite aigüe pouvant affecter l’intégrité structurale des parois des artères coronaires et mener à la formation d’anévrismes. Dans certains cas, ceux-ci entravent l’hémodynamie artérielle en engendrant une perfusion myocardique insuffisante et en activant la formation de thromboses. Le diagnostic de ces deux maladies coronariennes sont traditionnellement effectués à l’aide d’angiographies par fluoroscopie. Pendant ces examens paracliniques, plusieurs centaines de projections radiographiques sont acquises en séries suite à l’infusion artérielle d’un agent de contraste. Ces images révèlent la lumière des vaisseaux sanguins et la présence de lésions potentiellement pathologiques, s’il y a lieu. Parce que les séries acquises contiennent de l’information très dynamique en termes de mouvement du patient volontaire et involontaire (ex. battements cardiaques, respiration et déplacement d’organes), le clinicien base généralement son interprétation sur une seule image angiographique où des mesures géométriques sont effectuées manuellement ou semi-automatiquement par un technicien en radiologie. Bien que l’angiographie par fluoroscopie soit fréquemment utilisé partout dans le monde et souvent considéré comme l’outil de diagnostic “gold-standard” pour de nombreuses maladies vasculaires, la nature bidimensionnelle de cette modalité d’imagerie est malheureusement très limitante en termes de spécification géométrique des différentes régions pathologiques. En effet, la structure tridimensionnelle des sténoses et des anévrismes ne peut pas être pleinement appréciée en 2D car les caractéristiques observées varient selon la configuration angulaire de l’imageur. De plus, la présence de lésions affectant les artères coronaires peut ne pas refléter la véritable santé du myocarde, car des mécanismes compensatoires naturels (ex. vaisseaux----------ABSTRACT Cardiovascular disease continues to be the leading cause of death in North America. In adult and, alarmingly, ever younger populations, the so-called obesity epidemic largely driven by lifestyle factors that include poor diet, lack of exercise and smoking, incurs enormous stresses on the healthcare system. The primary cause of serious morbidity and mortality for these patients is atherosclerosis, the build up of plaque inside high pressure vessels like the coronary arteries. These lesions can lead to ischemic disease and may progress to precarious blood flow blockage or thrombosis, often with infarction or other severe consequences. Besides the stenosis-related outcomes, the arterial walls of plaque-ridden regions manifest increased stiffness, which may exacerbate negative patient prognosis. In pediatric populations, the most prevalent acquired cardiovascular pathology is Kawasaki disease. This acute vasculitis may affect the structural integrity of coronary artery walls and progress to aneurysmal lesions. These can hinder the blood flow’s hemodynamics, leading to inadequate downstream perfusion, and may activate thrombus formation which may lead to precarious prognosis. Diagnosing these two prominent coronary artery diseases is traditionally performed using fluoroscopic angiography. Several hundred serial x-ray projections are acquired during selective arterial infusion of a radiodense contrast agent, which reveals the vessels’ luminal area and possible pathological lesions. The acquired series contain highly dynamic information on voluntary and involuntary patient movement: respiration, organ displacement and heartbeat, for example. Current clinical analysis is largely limited to a single angiographic image where geometrical measures will be performed manually or semi-automatically by a radiological technician. Although widely used around the world and generally considered the gold-standard diagnosis tool for many vascular diseases, the two-dimensional nature of this imaging modality is limiting in terms of specifying the geometry of various pathological regions. Indeed, the 3D structures of stenotic or aneurysmal lesions may not be fully appreciated in 2D because their observable features are dependent on the angular configuration of the imaging gantry. Furthermore, the presence of lesions in the coronary arteries may not reflect the true health of the myocardium, as natural compensatory mechanisms may obviate the need for further intervention. In light of this, cardiac magnetic resonance perfusion imaging is increasingly gaining attention and clinical implementation, as it offers a direct assessment of myocardial tissue viability following infarction or suspected coronary artery disease. This type of modality is plagued, however, by motion similar to that present in fluoroscopic imaging. This issue predisposes clinicians to laborious manual intervention in order to align anatomical structures in sequential perfusion frames, thus hindering automation o