Intraoperative Liver Surface Completion with Graph Convolutional VAE

In this work we propose a method based on geometric deep learning to predict the complete surface of the liver, given a partial point cloud of the organ obtained during the surgical laparoscopic procedure. We introduce a new data augmentation technique that randomly perturbs shapes in their frequency domain to compensate the limited size of our dataset. The core of our method is a variational autoencoder (VAE) that is trained to learn a latent space for complete shapes of the liver. At inference time, the generative part of the model is embedded in an optimisation procedure where the latent representation is iteratively updated to generate a model that matches the intraoperative partial point cloud. The effect of this optimisation is a progressive non-rigid deformation of the initially generated shape. Our method is qualitatively evaluated on real data and quantitatively evaluated on synthetic data. We compared with a state-of-the-art rigid registration algorithm, that our method outperformed in visible areas

Latent Disentanglement for the Analysis and Generation of Digital Human Shapes

Analysing and generating digital human shapes is crucial for a wide variety of applications ranging from movie production to healthcare. The most common approaches for the analysis and generation of digital human shapes involve the creation of statistical shape models. At the heart of these techniques is the definition of a mapping between shapes and a low-dimensional representation. However, making these representations interpretable is still an open challenge. This thesis explores latent disentanglement as a powerful technique to make the latent space of geometric deep learning based statistical shape models more structured and interpretable. In particular, it introduces two novel techniques to disentangle the latent representation of variational autoencoders and generative adversarial networks with respect to the local shape attributes characterising the identity of the generated body and head meshes. This work was inspired by a shape completion framework that was proposed as a viable alternative to intraoperative registration in minimally invasive surgery of the liver. In addition, one of these methods for latent disentanglement was also applied to plastic surgery, where it was shown to improve the diagnosis of craniofacial syndromes and aid surgical planning

Physical and statistical shape modelling in craniomaxillofacial surgery: a personalised approach for outcome prediction

Orthognathic surgery involves repositioning of the jaw bones to restore face function and shape for patients who require an operation as a result of a syndrome, due to growth disturbances in childhood or after trauma. As part of the preoperative assessment, three-dimensional medical imaging and computer-assisted surgical planning help to improve outcomes, and save time and cost. Computer-assisted surgical planning involves visualisation and manipulation of the patient anatomy and can be used to aid objective diagnosis, patient communication, outcome evaluation, and surgical simulation. Despite the benefits, the adoption of three-dimensional tools has remained limited beyond specialised hospitals and traditional two-dimensional cephalometric analysis is still the gold standard. This thesis presents a multidisciplinary approach to innovative surgical simulation involving clinical patient data, medical image analysis, engineering principles, and state-of-the-art machine learning and computer vision algorithms. Two novel three-dimensional computational models were developed to overcome the limitations of current computer-assisted surgical planning tools. First, a physical modelling approach – based on a probabilistic finite element model – provided patient-specific simulations and, through training and validation, population-specific parameters. The probabilistic model was equally accurate compared to two commercial programs whilst giving additional information regarding uncertainties relating to the material properties and the mismatch in bone position between planning and surgery. Second, a statistical modelling approach was developed that presents a paradigm shift in its modelling formulation and use. Specifically, a 3D morphable model was constructed from 5,000 non-patient and orthognathic patient faces for fully-automated diagnosis and surgical planning. Contrary to traditional physical models that are limited to a finite number of tests, the statistical model employs machine learning algorithms to provide the surgeon with a goal-driven patient-specific surgical plan. The findings in this thesis provide markers for future translational research and may accelerate the adoption of the next generation surgical planning tools to further supplement the clinical decision-making process and ultimately to improve patients’ quality of life

Latent Disentanglement in Mesh Variational Autoencoders Improves the Diagnosis of Craniofacial Syndromes and Aids Surgical Planning

The use of deep learning to undertake shape analysis of the complexities of the human head holds great promise. However, there have traditionally been a number of barriers to accurate modelling, especially when operating on both a global and local level. In this work, we will discuss the application of the Swap Disentangled Variational Autoencoder (SD-VAE) with relevance to Crouzon, Apert and Muenke syndromes. Although syndrome classification is performed on the entire mesh, it is also possible, for the first time, to analyse the influence of each region of the head on the syndromic phenotype. By manipulating specific parameters of the generative model, and producing procedure-specific new shapes, it is also possible to simulate the outcome of a range of craniofacial surgical procedures. This opens new avenues to advance diagnosis, aids surgical planning and allows for the objective evaluation of surgical outcomes

3D statistical shape analysis of the face in Apert syndrome

Timely diagnosis of craniofacial syndromes as well as adequate timing and choice of surgical technique are essential for proper care management. Statistical shape models and machine learning approaches are playing an increasing role in Medicine and have proven its usefulness. Frameworks that automate processes have become more popular. The use of 2D photographs for automated syndromic identification has shown its potential with the Face2Gene application. Yet, using 3D shape information without texture has not been studied in such depth. Moreover, the use of these models to understand shape change during growth and its applicability for surgical outcome measurements have not been analysed at length. This thesis presents a framework using state-of-the-art machine learning and computer vision algorithms to explore possibilities for automated syndrome identification based on shape information only. The purpose of this was to enhance understanding of the natural development of the Apert syndromic face and its abnormality as compared to a normative group. An additional method was used to objectify changes as result of facial bipartition distraction, a common surgical correction technique, providing information on the successfulness and on inadequacies in terms of facial normalisation. Growth curves were constructed to further quantify facial abnormalities in Apert syndrome over time along with 3D shape models for intuitive visualisation of the shape variations. Post-operative models were built and compared with age-matched normative data to understand where normalisation is coming short. The findings in this thesis provide markers for future translational research and may accelerate the adoption of the next generation diagnostics and surgical planning tools to further supplement the clinical decision-making process and ultimately to improve patients’ quality of life

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Characterization of normal facial features and their association with genes

ABSTRACT Background: Craniofacial morphology has been reported to be highly heritable, but little is known about which genetic variants influence normal facial variation in the general population. Aim: To identify facial variation and explore phenotype-genotype associations in a 15-year-old population (2514 females and 2233 males). Subjects and Methods: The subjects involved in this study were recruited from the Avon Longitudinal Study of Parents and Children (ALSPAC). Three-dimensional (3D) facial images were obtained for each subject using two high-resolution Konica Minolta laser scanners. Twenty-one reproducible facial soft tissue landmarks and one constructed mid-endocanthion point (men) were identified and their coordinates were recorded. The 3D facial images were registered using Procrustes analysis (with and without scaling). Principal Component Analysis (PCA) was then employed to identify independent groups ‘principal components, PCs’ of correlated landmark coordinates that represent key facial features contributing to normal facial variation. A novel surface-based method of facial averaging was employed to visualize facial variation. Facial parameters (distances, angles, and ratios) were also generated using facial landmarks. Sex prediction based on facial parameters was explored using discriminant function analysis. A discovery-phase genome-wide association analysis (GWAS) was carried out for 2,185 ALSPAC subjects and replication was undertaken in a further 1,622 ALSPAC individuals. Results: 14 (unscaled) and 17 (scaled) PCs were identified explaining 82% of the total variance in facial form and shape. 250 facial parameters were derived (90 distances, 118 angles, 42 ratios). 24 facial parameters were found to provide sex prediction efficiency of over 70%, 23 of these parameters are distances that describe variation in face height, nose width, and prominence of various facial structures. 54 distances associated with previous reported high heritability and the 14 (unscaled) PCs were included in the discovery-phase GWAS. Four genetic associations with the distances were identified in the discovery analysis, and one of these, the association between the common ‘intronic’ SNP (rs7559271) in PAX3 gene on chromosome (2) and the nasion to mid-endocanthion 3D distance (n-men) was replicated strongly (p = 4 x 10-7). PAX3 gene encodes a transcription factor that plays crucial role in fetal development including craniofacial bones. PAX3 contains two DNA-binding domains, a paired-box domain and a homeodomain. The protein made from PAX3 gene directs the activity of other genes that signal neural crest cells to form specialized tissues such as craniofacial bones. PAX3 different mutations may lead to non-functional PAX3 polypeptides and destroy the ability of the PAX3 proteins to bind to DNA and regulate the activity of other genes to form bones and other specific tissues. Conclusions: The variation in facial form and shape can be accurately quantified and visualized as a multidimensional statistical continuum with respect to the principal components. The derived PCs may be useful to identify and classify faces according to a scale of normality. A strong genetic association was identified between the common SNP (rs7559271) in PAX3 gene on chromosome (2) and the nasion to mid-endocanthion 3D distance (n-men). Variation in this distance leads to nasal bridge prominence

Highly automated method for facial expression synthesis

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The synthesis of realistic facial expressions has been an unexplored area for computer graphics scientists. Over the last three decades, several different construction methods have been formulated in order to obtain natural graphic results. Despite these advancements, though, current techniques still require costly resources, heavy user intervention and specific training and outcomes are still not completely realistic. This thesis, therefore, aims to achieve an automated synthesis that will produce realistic facial expressions at a low cost. This thesis, proposes a highly automated approach for achieving a realistic facial expression synthesis, which allows for enhanced performance in speed (3 minutes processing time maximum) and quality with a minimum of user intervention. It will also demonstrate a highly technical and automated method of facial feature detection, by allowing users to obtain their desired facial expression synthesis with minimal physical input. Moreover, it will describe a novel approach to the normalization of the illumination settings values between source and target images, thereby allowing the algorithm to work accurately, even in different lighting conditions. Finally, we will present the results obtained from the proposed techniques, together with our conclusions, at the end of the paper