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Curcio N, Rosato A, Mazzaccaro D, Nano G, Conti M, Matrone G. 3D patient-specific modeling and structural finite element analysis of atherosclerotic carotid artery based on computed tomography angiography. Sci Rep 2023; 13:19911. [PMID: 37964071 PMCID: PMC10645924 DOI: 10.1038/s41598-023-46949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023] Open
Abstract
The assessment of carotid plaque vulnerability is a relevant clinical information that can help prevent adverse cerebrovascular events. To this aim, in this study, we propose a patient-specific computational workflow to quantify the stress distribution in an atherosclerotic carotid artery, by means of geometric modeling and structural simulation of the plaque and vessel wall. Ten patients were involved in our study. Starting with segmentation of the lumen, calcific and lipid plaque components from computed tomography angiography images, the fibrous component and the vessel wall were semi-automatically reconstructed with an ad-hoc procedure. Finite element analyses were performed using local pressure values derived from ultrasound imaging. Simulation outputs were analyzed to assess how mechanical factors influence the stresses within the atherosclerotic wall. The developed reconstruction method was first evaluated by comparing the results obtained using the automatically generated fibrous component model and the one derived from image segmentation. The high-stress regions in the carotid artery wall around plaques suggest areas of possible rupture. In mostly lipidic and heterogeneous plaques, the highest stresses are localized at the interface between the lipidic components and the lumen, in the fibrous cap.
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Affiliation(s)
- Nicoletta Curcio
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Antonio Rosato
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Nano
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Giulia Matrone
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy.
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2
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Maas EJ, Nievergeld AHM, Fonken JHC, Thirugnanasambandam M, van Sambeek MRHM, Lopata RGP. 3D-Ultrasound Based Mechanical and Geometrical Analysis of Abdominal Aortic Aneurysms and Relationship to Growth. Ann Biomed Eng 2023; 51:2554-2565. [PMID: 37410199 PMCID: PMC10598132 DOI: 10.1007/s10439-023-03301-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
The heterogeneity of progression of abdominal aortic aneurysms (AAAs) is not well understood. This study investigates which geometrical and mechanical factors, determined using time-resolved 3D ultrasound (3D + t US), correlate with increased growth of the aneurysm. The AAA diameter, volume, wall curvature, distensibility, and compliance in the maximal diameter region were determined automatically from 3D + t echograms of 167 patients. Due to limitations in the field-of-view and visibility of aortic pulsation, measurements of the volume, compliance of a 60 mm long region and the distensibility were possible for 78, 67, and 122 patients, respectively. Validation of the geometrical parameters with CT showed high similarity, with a median similarity index of 0.92 and root-mean-square error (RMSE) of diameters of 3.5 mm. Investigation of Spearman correlation between parameters showed that the elasticity of the aneurysms decreases slightly with diameter (p = 0.034) and decreases significantly with mean arterial pressure (p < 0.0001). The growth of a AAA is significantly related to its diameter, volume, compliance, and surface curvature (p < 0.002). Investigation of a linear growth model showed that compliance is the best predictor for upcoming AAA growth (RMSE 1.70 mm/year). To conclude, mechanical and geometrical parameters of the maximally dilated region of AAAs can automatically and accurately be determined from 3D + t echograms. With this, a prediction can be made about the upcoming AAA growth. This is a step towards more patient-specific characterization of AAAs, leading to better predictability of the progression of the disease and, eventually, improved clinical decision making about the treatment of AAAs.
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Affiliation(s)
- Esther Jorien Maas
- PULS/e Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Arjet Helena Margaretha Nievergeld
- PULS/e Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Judith Helena Cornelia Fonken
- PULS/e Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Mirunalini Thirugnanasambandam
- PULS/e Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Marc Rodolph Henricus Maria van Sambeek
- PULS/e Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Schwab HM, Lopata RGP. Automatic Probe Localization in Multiaperture Ultrasound by Radon Domain Signal Matching. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1329-1338. [PMID: 37590104 DOI: 10.1109/tuffc.2023.3306033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
In multiaperture ultrasound, several ultrasound probes with different insonification angles are combined to increase the field of view and angular coverage of image structures. A full reconstruction incorporating all possible combinations of transmitting and receiving probes has been shown to improve resolution, contrast, and angular coverage beyond what can be achieved by the registration of single images from different probes. A major challenge in multiaperture imaging is the correct determination of relative probe locations. A registration based on the content of images from different probes is challenging due to the decorrelation of image structures and speckle with increasing angle between the probes. We propose a probe localization method for plane-wave ultrasound that uses solely the receive dataset of a nontransmitting probe. The localization is performed by signal tracking in the Radon domain. To demonstrate that the method does not rely on common structures in the individual images, we show that a satisfying localization can be performed in pure speckle for angles, where the speckle patterns have completely decorrelated. The method shows potential for real-time probe localization in free-hand multiprobe ultrasound imaging or for flexible and wearable multiarray combination of multiple capacitive micromachined (CMUT)-based systems in the future.
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Makouei F, Agander TK, Ewertsen C, Søndergaard Svendsen MB, Norling R, Kaltoft M, Hansen AE, Rasmussen JH, Wessel I, Todsen T. 3D Ultrasound and MRI in Assessing Resection Margins during Tongue Cancer Surgery: A Research Protocol for a Clinical Diagnostic Accuracy Study. J Imaging 2023; 9:174. [PMID: 37754938 PMCID: PMC10532641 DOI: 10.3390/jimaging9090174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 09/28/2023] Open
Abstract
Surgery is the primary treatment for tongue cancer. The goal is a complete resection of the tumor with an adequate margin of healthy tissue around the tumor.Inadequate margins lead to a high risk of local cancer recurrence and the need for adjuvant therapies. Ex vivo imaging of the resected surgical specimen has been suggested for margin assessment and improved surgical results. Therefore, we have developed a novel three-dimensional (3D) ultrasound imaging technique to improve the assessment of resection margins during surgery. In this research protocol, we describe a study comparing the accuracy of 3D ultrasound, magnetic resonance imaging (MRI), and clinical examination of the surgical specimen to assess the resection margins during cancer surgery. Tumor segmentation and margin measurement will be performed using 3D ultrasound and MRI of the ex vivo specimen. We will determine the accuracy of each method by comparing the margin measurements and the proportion of correctly classified margins (positive, close, and free) obtained by each technique with respect to the gold standard histopathology.
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Affiliation(s)
- Fatemeh Makouei
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
| | - Tina Klitmøller Agander
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Caroline Ewertsen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, DK-2100 Copenhagen, Denmark
- Department of Computer Science, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Rikke Norling
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Mikkel Kaltoft
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Adam Espe Hansen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Jacob Høygaard Rasmussen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
| | - Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, DK-2100 Copenhagen, Denmark
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Ren L, Yan L, Fei X, Luo Y. Intraobserver and Interobserver Consistency Evaluation of Carotid Plaque Volume Measured by Different 3-Dimensional Ultrasound Methods. Ultrasound Q 2023; 39:17-22. [PMID: 36716417 DOI: 10.1097/ruq.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT This study aims to evaluate the accuracy of the semiautomatic planimetric measurement (SAPM) method and the necessity of manually adjusted boundary measurement in 3-dimensional ultrasound measurement of plaque volume. A total of 50 patients with 82 plaques in the common carotid arteries between December 2020 and March 2021 were included in this study. Two observers measured the 3-dimensional volume of plaque for each patient in 3 different methods (contour tracing method [CTM], SAPM method without manually adjusted boundary [SAPM1], and SAPM method with manually adjusted boundary [SAPM2]). The difference in measurement time between the 3 methods was evaluated by Kruskal-Wallis H test. Intraclass correlation coefficient and 95% confidence interval were used to evaluate the intraobserver and interobserver reliability of the 3 measurement modes. The Bland-Altman analysis was used to assess the agreement, which was expressed as the mean difference with the 95% limits of agreement (LOA). The difference in measurement time between the 3 methods was statistically significant ( P < 0.001). Both observers' intraobserver and interobserver reliability showed well in the 3 methods (all of the intraclass correlation coefficients were >0.75). The mean differences of the plaque volume measurement were 38.17, 26.42, and 11.75 mm 3 , respectively. The agreement between CTM and SAPM2 was the best, and LOA was -57.00 to 80.51. The agreement between SAPM1 and SAPM2 and the agreement between SAPM1 and CTM were similar, and the LOAs were -126.10 to 202.40 and -158.00 to 210.80, respectively. The SAPM method may be recommended to measure plaque volume in clinical practice.
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Affiliation(s)
| | - Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing
| | - Xiang Fei
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing
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De Hoop H, Vermeulen M, Schwab HM, Lopata RGP. Coherent Bistatic 3-D Ultrasound Imaging Using Two Sparse Matrix Arrays. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:182-196. [PMID: 37027570 DOI: 10.1109/tuffc.2022.3233158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
In the last decade, many advances have been made in high frame rate 3-D ultrasound imaging, including more flexible acquisition systems, transmit (TX) sequences, and transducer arrays. Compounding multiangle transmits of diverging waves has shown to be fast and effective for 2-D matrix arrays, where heterogeneity between transmits is key in optimizing the image quality. However, the anisotropy in contrast and resolution remains a drawback that cannot be overcome with a single transducer. In this study, a bistatic imaging aperture is demonstrated that consists of two synchronized matrix ( 32×32 ) arrays, allowing for fast interleaved transmits with a simultaneous receive (RX). First, for a single array, the aperture efficiency for high volume rate imaging was evaluated between sparse random arrays and fully multiplexed arrays. Second, the performance of the bistatic acquisition scheme was analyzed for various positions on a wire phantom and was showcased in a dynamic setup mimicking the human abdomen and aorta. Sparse array volume images were equal in resolution and lower in contrast compared to fully multiplexed arrays but can efficiently minimize decorrelation during motion for multiaperture imaging. The dual-array imaging aperture improved the spatial resolution in the direction of the second transducer, reducing the average volumetric speckle size with 72% and the axial-lateral eccentricity with 8%. In the aorta phantom, the angular coverage increased by a factor of 3 in the axial-lateral plane, raising the wall-lumen contrast with 16% compared to single-array images, despite accumulation of thermal noise in the lumen.
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Liu C, Tang L, Zhou Y, Tang X, Zhang G, Zhu Q, Zhou Y. Immune-associated biomarkers identification for diagnosing carotid plaque progression with uremia through systematical bioinformatics and machine learning analysis. Eur J Med Res 2023; 28:92. [PMID: 36823662 PMCID: PMC9948329 DOI: 10.1186/s40001-023-01043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/04/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Uremia is one of the most challenging problems in medicine and an increasing public health issue worldwide. Patients with uremia suffer from accelerated atherosclerosis, and atherosclerosis progression may trigger plaque instability and clinical events. As a result, cardiovascular and cerebrovascular complications are more likely to occur. This study aimed to identify diagnostic biomarkers in uremic patients with unstable carotid plaques (USCPs). METHODS Four microarray datasets (GSE37171, GSE41571, GSE163154, and GSE28829) were downloaded from the NCBI Gene Expression Omnibus database. The Limma package was used to identify differentially expressed genes (DEGs) in uremia and USCP. Weighted gene co-expression network analysis (WGCNA) was used to determine the respective significant module genes associated with uremia and USCP. Moreover, a protein-protein interaction (PPI) network and three machine learning algorithms were applied to detect potential diagnostic genes. Subsequently, a nomogram and a receiver operating characteristic curve (ROC) were plotted to diagnose USCP with uremia. Finally, immune cell infiltrations were further analyzed. RESULTS Using the Limma package and WGCNA, the intersection of 2795 uremia-related DEGs and 1127 USCP-related DEGs yielded 99 uremia-related DEGs in USCP. 20 genes were selected as candidate hub genes via PPI network construction. Based on the intersection of genes from the three machine learning algorithms, three hub genes (FGR, LCP1, and C5AR1) were identified and used to establish a nomogram that displayed a high diagnostic performance (AUC: 0.989, 95% CI 0.971-1.000). Dysregulated immune cell infiltrations were observed in USCP, showing positive correlations with the three hub genes. CONCLUSION The current study systematically identified three candidate hub genes (FGR, LCP1, and C5AR1) and established a nomogram to assist in diagnosing USCP with uremia using various bioinformatic analyses and machine learning algorithms. Herein, the findings provide a foothold for future studies on potential diagnostic candidate genes for USCP in uremic patients. Additionally, immune cell infiltration analysis revealed that the dysregulated immune cell proportions were identified, and macrophages could have a critical role in USCP pathogenesis.
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Affiliation(s)
- Chunjiang Liu
- grid.415644.60000 0004 1798 6662Department of General Surgery, Division of Vascular Surgery, Shaoxing People’s Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000 China
| | - Liming Tang
- grid.415644.60000 0004 1798 6662Department of General Surgery, Division of Vascular Surgery, Shaoxing People’s Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000 China
| | - Yue Zhou
- grid.415644.60000 0004 1798 6662Department of General Surgery, Division of Vascular Surgery, Shaoxing People’s Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000 China
| | - Xiaoqi Tang
- grid.415644.60000 0004 1798 6662Department of General Surgery, Division of Vascular Surgery, Shaoxing People’s Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000 China
| | - Gang Zhang
- grid.412679.f0000 0004 1771 3402Department of Rehabilitation, The First Affiliated Hospital of Anhui Medical University, Anhui Public Health Clinical Center, Hefei, 230000 Anhui China
| | - Qin Zhu
- Hepatobiliary CenterKey Laboratory of Liver TransplantationNHC Key Laboratory of Living Donor Liver Transplantation, The First Affiliated Hospital of Nanjing Medical UniversityChinese Academy of Medical SciencesNanjing Medical University), Nanjing, 210000, Jiangsu, China.
| | - Yufei Zhou
- Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Jansen LC, Schwab HM, van de Vosse FN, van Sambeek MRHM, Lopata RGP. Local and global distensibility assessment of abdominal aortic aneurysms in vivo from probe tracked 2D ultrasound images. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 4:1052213. [PMID: 36699662 PMCID: PMC9869420 DOI: 10.3389/fmedt.2022.1052213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/28/2022] [Indexed: 01/11/2023] Open
Abstract
Rupture risk estimation of abdominal aortic aneurysm (AAA) patients is currently based on the maximum diameter of the AAA. Mechanical properties that characterize the mechanical state of the vessel may serve as a better rupture risk predictor. Non-electrocardiogram-gated (non-ECG-gated) freehand 2D ultrasound imaging is a fast approach from which a reconstructed volumetric image of the aorta can be obtained. From this 3D image, the geometry, volume, and maximum diameter can be obtained. The distortion caused by the pulsatility of the vessel during the acquisition is usually neglected, while it could provide additional quantitative parameters of the vessel wall. In this study, a framework was established to semi-automatically segment probe tracked images of healthy aortas (N = 10) and AAAs (N = 16), after which patient-specific geometries of the vessel at end diastole (ED), end systole (ES), and at the mean arterial pressure (MAP) state were automatically assessed using heart frequency detection and envelope detection. After registration AAA geometries were compared to the gold standard computed tomography (CT). Local mechanical properties, i.e., compliance, distensibility and circumferential strain, were computed from the assessed ED and ES geometries for healthy aortas and AAAs, and by using measured brachial pulse pressure values. Globally, volume, compliance, and distensibility were computed. Geometries were in good agreement with CT geometries, with a median similarity index and interquartile range of 0.91 [0.90-0.92] and mean Hausdorff distance and interquartile range of 4.7 [3.9-5.6] mm. As expected, distensibility (Healthy aortas: 80 ± 15·10-3 kPa-1; AAAs: 29 ± 9.6·10-3 kPa-1) and circumferential strain (Healthy aortas: 0.25 ± 0.03; AAAs: 0.15 ± 0.03) were larger in healthy vessels compared to AAAs. Circumferential strain values were in accordance with literature. Global healthy aorta distensibility was significantly different from AAAs, as was demonstrated with a Wilcoxon test (p-value = 2·10-5). Improved image contrast and lateral resolution could help to further improve segmentation to improve mechanical characterization. The presented work has demonstrated how besides accurate geometrical assessment freehand 2D ultrasound imaging is a promising tool for additional mechanical property characterization of AAAs.
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Affiliation(s)
- Larissa C. Jansen
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands,Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands,Correspondence: Larissa C. Jansen
| | - Hans-Martin Schwab
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Frans N. van de Vosse
- Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Marc R. H. M. van Sambeek
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands,Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Richard G. P. Lopata
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Sjoerdsma M, Verstraeten SCFPM, Maas EJ, van de Vosse FN, van Sambeek MRHM, Lopata RGP. Spatiotemporal Registration of 3-D Multi-perspective Ultrasound Images of Abdominal Aortic Aneurysms. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:318-332. [PMID: 36441033 DOI: 10.1016/j.ultrasmedbio.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/02/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Methods for patient-specific abdominal aortic aneurysm (AAA) progression monitoring and rupture risk assessment are widely investigated. Three-dimensional ultrasound can visualize the AAA's complex geometry and displacement fields. However, ultrasound has a limited field of view and low frame rate (i.e., 3-8 Hz). This article describes an approach to enhance the temporal resolution and the field of view. First, the frame rate was increased for each data set by sequencing multiple blood pulse cycles into one cycle. The sequencing method uses the original frame rate and the estimated pulse wave rate obtained from AAA distension curves. Second, the temporal registration was applied to multi-perspective acquisitions of the same AAA. Third, the field of view was increased through spatial registration and fusion using an image feature-based phase-only correlation method and a wavelet transform, respectively. Temporal sequencing was fully correct in aortic phantoms and was successful in 51 of 62 AAA patients, yielding a factor 5 frame rate increase. Spatial registration of proximal and distal ultrasound acquisitions was successful in 32 of 37 different AAA patients, based on the comparison between the fused ultrasound and computed tomography segmentation (95th percentile Haussdorf distances and similarity indices of 4.2 ± 1.7 mm and 0.92 ± 0.02 mm, respectively). Furthermore, the field of view was enlarged by 9%-49%.
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Affiliation(s)
- Marloes Sjoerdsma
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Sabine C F P M Verstraeten
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Esther J Maas
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Frans N van de Vosse
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marc R H M van Sambeek
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Richard G P Lopata
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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van Knippenberg L, van Sloun RJG, Mischi M, de Ruijter J, Lopata R, Bouwman RA. Unsupervised domain adaptation method for segmenting cross-sectional CCA images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107037. [PMID: 35907375 DOI: 10.1016/j.cmpb.2022.107037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Automatic vessel segmentation in ultrasound is challenging due to the quality of the ultrasound images, which is affected by attenuation, high level of speckle noise and acoustic shadowing. Recently, deep convolutional neural networks are increasing in popularity due to their great performance on image segmentation problems, including vessel segmentation. Traditionally, large labeled datasets are required to train a network that achieves high performance, and is able to generalize well to different orientations, transducers and ultrasound scanners. However, these large datasets are rare, given that it is challenging and time-consuming to acquire and manually annotate in-vivo data. METHODS In this work, we present a model-based, unsupervised domain adaptation method that consists of two stages. In the first stage, the network is trained on simulated ultrasound images, which have an accurate ground truth. In the second stage, the network continues training on in-vivo data in an unsupervised way, therefore not requiring the data to be labelled. Rather than using an adversarial neural network, prior knowledge on the elliptical shape of the segmentation mask is used to detect unexpected outputs. RESULTS The segmentation performance was quantified using manually segmented images as ground truth. Due to the proposed domain adaptation method, the median Dice similarity coefficient increased from 0 to 0.951, outperforming a domain adversarial neural network (median Dice 0.922) and a state-of-the-art Star-Kalman algorithm that was specifically designed for this dataset (median Dice 0.942). CONCLUSIONS The results show that it is feasible to first train a neural network on simulated data, and then apply model-based domain adaptation to further improve segmentation performance by training on unlabeled in-vivo data. This overcomes the limitation of conventional deep learning approaches to require large amounts of manually labeled in-vivo data. Since the proposed domain adaptation method only requires prior knowledge on the shape of the segmentation mask, performance can be explored in various domains and applications in future research.
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Affiliation(s)
- Luuk van Knippenberg
- Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands.
| | - Ruud J G van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands; Department of Anesthesiology, Catharina Hospital Eindhoven, the Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands; Department of Anesthesiology, Catharina Hospital Eindhoven, the Netherlands
| | - Joerik de Ruijter
- Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - Richard Lopata
- Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands; Department of Anesthesiology, Catharina Hospital Eindhoven, the Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital Eindhoven, the Netherlands
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Atherogenic potential of microgravity hemodynamics in the carotid bifurcation: a numerical investigation. NPJ Microgravity 2022; 8:39. [PMID: 36085153 PMCID: PMC9463447 DOI: 10.1038/s41526-022-00223-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 08/22/2022] [Indexed: 11/08/2022] Open
Abstract
Long-duration spaceflight poses multiple hazards to human health, including physiological changes associated with microgravity. The hemodynamic adaptations occurring upon entry into weightlessness have been associated with retrograde stagnant flow conditions and thromboembolic events in the venous vasculature but the impact of microgravity on cerebral arterial hemodynamics and function remains poorly understood. The objective of this study was to quantify the effects of microgravity on hemodynamics and wall shear stress (WSS) characteristics in 16 carotid bifurcation geometries reconstructed from ultrasonography images using computational fluid dynamics modeling. Microgravity resulted in a significant 21% increase in flow stasis index, a 22-23% decrease in WSS magnitude and a 16-26% increase in relative residence time in all bifurcation branches, while preserving WSS unidirectionality. In two anatomies, however, microgravity not only promoted flow stasis but also subjected the convex region of the external carotid arterial wall to a moderate increase in WSS bidirectionality, which contrasted with the population average trend. This study suggests that long-term exposure to microgravity has the potential to subject the vasculature to atheroprone hemodynamics and this effect is modulated by subject-specific anatomical features. The exploration of the biological impact of those microgravity-induced WSS aberrations is needed to better define the risk posed by long spaceflights on cardiovascular health.
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12
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van Hal VHJ, De Hoop H, Muller JW, van Sambeek MRHM, Schwab HM, Lopata RGP. Multiperspective Bistatic Ultrasound Imaging and Elastography of the Ex Vivo Abdominal Aorta. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:604-616. [PMID: 34780324 DOI: 10.1109/tuffc.2021.3128227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Knowledge of aneurysm geometry and local mechanical wall parameters using ultrasound (US) can contribute to a better prediction of rupture risk in abdominal aortic aneurysms (AAAs). However, aortic strain imaging using conventional US is limited by the lateral lumen-wall contrast and resolution. In this study, ultrafast multiperspective bistatic (MP BS) imaging is used to improve aortic US, in which two curved array transducers receive simultaneously on each transmit event. The advantage of such bistatic US imaging on both image quality and strain estimations was investigated by comparing it to single-perspective monostatic (SP MS) and MP monostatic (MP MS) imaging, i.e., alternately transmitting and receiving with either transducer. Experimental strain imaging was performed in US simulations and in an experimental study on porcine aortas. Different compounding strategies were tested to retrieve the most useful information from each received US signal. Finally, apart from the conventional sector grid in curved array US imaging, a polar grid with respect to the vessel's local coordinate system is introduced. This new reconstruction method demonstrated improved displacement estimations in aortic US. The US simulations showed increased strain estimation accuracy using MP BS imaging bistatic imaging compared to MP MS imaging, with a decrease in the average relative error between 41% and 84% in vessel wall regions between transducers. In the experimental results, the mean image contrast-to-noise ratio was improved by up to 8 dB in the vessel wall regions between transducers. This resulted in an increased mean elastographic signal-to-noise ratio by about 15 dB in radial strain and 6 dB in circumferential strain.
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13
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Mesin L, Albani S, Policastro P, Pasquero P, Porta M, Melchiorri C, Leonardi G, Albera C, Scacciatella P, Pellicori P, Stolfo D, Grillo A, Fabris B, Bini R, Giannoni A, Pepe A, Ermini L, Seddone S, Sinagra G, Antonini-Canterin F, Roatta S. Assessment of Phasic Changes of Vascular Size by Automated Edge Tracking-State of the Art and Clinical Perspectives. Front Cardiovasc Med 2022; 8:775635. [PMID: 35127855 PMCID: PMC8814097 DOI: 10.3389/fcvm.2021.775635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/14/2021] [Indexed: 12/25/2022] Open
Abstract
Assessment of vascular size and of its phasic changes by ultrasound is important for the management of many clinical conditions. For example, a dilated and stiff inferior vena cava reflects increased intravascular volume and identifies patients with heart failure at greater risk of an early death. However, lack of standardization and sub-optimal intra- and inter- operator reproducibility limit the use of these techniques. To overcome these limitations, we developed two image-processing algorithms that quantify phasic vascular deformation by tracking wall movements, either in long or in short axis. Prospective studies will verify the clinical applicability and utility of these methods in different settings, vessels and medical conditions.
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Affiliation(s)
- Luca Mesin
- Mathematical Biology and Physiology, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
- *Correspondence: Luca Mesin
| | - Stefano Albani
- SC Cardiologia Ospedale Regionale U. Parini, Aosta, Italy
- Department of Medical, Surgical and Health Sciences, Universitá di Trieste, Trieste, Italy
| | - Piero Policastro
- Mathematical Biology and Physiology, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Paolo Pasquero
- Department of Medical Sciences, Universitá di Torino, Turin, Italy
| | - Massimo Porta
- Department of Medical Sciences, Universitá di Torino, Turin, Italy
| | | | | | - Carlo Albera
- Department of Medical Sciences, Universitá di Torino, Turin, Italy
| | | | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics, Research Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Davide Stolfo
- Department of Medical, Surgical and Health Sciences, Universitá di Trieste, Trieste, Italy
| | - Andrea Grillo
- Department of Medical, Surgical and Health Sciences, Universitá di Trieste, Trieste, Italy
| | - Bruno Fabris
- Department of Medical, Surgical and Health Sciences, Universitá di Trieste, Trieste, Italy
| | - Roberto Bini
- Chirurgia Generale e Trauma Team GOM Niguarda, Milan, Italy
| | - Alberto Giannoni
- Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Antonio Pepe
- Highly Specialized in Rehabilitation Hospital-ORAS S.p.A., Motta di Livenza, Italy
- Ospedale Unico di Santorso, AULSS7 Pedemontana, Italy
| | - Leonardo Ermini
- Integrative Physiology Lab, Department of Neuroscience, Universitá di Torino, Turin, Italy
| | - Stefano Seddone
- Integrative Physiology Lab, Department of Neuroscience, Universitá di Torino, Turin, Italy
| | - Gianfranco Sinagra
- Robertson Centre for Biostatistics, Research Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Silvestro Roatta
- Integrative Physiology Lab, Department of Neuroscience, Universitá di Torino, Turin, Italy
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de Ruijter J, Muijsers JJM, van de Vosse FN, van Sambeek MRHM, Lopata RGP. A Generalized Approach for Automatic 3-D Geometry Assessment of Blood Vessels in Transverse Ultrasound Images Using Convolutional Neural Networks. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:3326-3335. [PMID: 34143734 DOI: 10.1109/tuffc.2021.3090461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Accurate 3-D geometries of arteries and veins are important clinical data for diagnosis of arterial disease and intervention planning. Automatic segmentation of vessels in the transverse view suffers from the low lateral resolution and contrast. Convolutional neural networks are a promising tool for automatic segmentation of medical images, outperforming the traditional segmentation methods with high robustness. In this study, we aim to create a general, robust, and accurate method to segment the lumen-wall boundary of healthy central and peripheral vessels in large field-of-view freehand ultrasound (US) datasets. Data were acquired using the freehand US, in combination with a probe tracker. A total of ±36 000 cross-sectional images, acquired in the common, internal, and external carotid artery ( N = 37 ), in the radial, ulnar artery, and cephalic vein ( N = 12 ), and in the femoral artery ( N = 5 ) were included. To create masks (of the lumen) for training data, a conventional automatic segmentation method was used. The neural networks were trained on: 1) data of all vessels and 2) the carotid artery only. The performance was compared and tested using an open-access dataset. The recall, precision, DICE, and intersection over union (IoU) were calculated. Overall, segmentation was successful in the carotid and peripheral arteries. The Multires U-net architecture performs best overall with DICE = 0.93 when trained on the total dataset. Future studies will focus on the inclusion of vascular pathologies.
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15
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Fonken JHC, Maas EJ, Nievergeld AHM, van Sambeek MRHM, van de Vosse FN, Lopata RGP. Ultrasound-Based Fluid-Structure Interaction Modeling of Abdominal Aortic Aneurysms Incorporating Pre-stress. Front Physiol 2021; 12:717593. [PMID: 34483971 PMCID: PMC8414835 DOI: 10.3389/fphys.2021.717593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 12/05/2022] Open
Abstract
Currently, the prediction of rupture risk in abdominal aortic aneurysms (AAAs) solely relies on maximum diameter. However, wall mechanics and hemodynamics have shown to provide better risk indicators. Patient-specific fluid-structure interaction (FSI) simulations based on a non-invasive image modality are required to establish a patient-specific risk indicator. In this study, a robust framework to execute FSI simulations based on time-resolved three-dimensional ultrasound (3D+t US) data was obtained and employed on a data set of 30 AAA patients. Furthermore, the effect of including a pre-stress estimation (PSE) to obtain the stresses present in the measured geometry was evaluated. The established workflow uses the patient-specific 3D+t US-based segmentation and brachial blood pressure as input to generate meshes and boundary conditions for the FSI simulations. The 3D+t US-based FSI framework was successfully employed on an extensive set of AAA patient data. Omitting the pre-stress results in increased displacements, decreased wall stresses, and deviating time-averaged wall shear stress and oscillatory shear index patterns. These results underline the importance of incorporating pre-stress in FSI simulations. After validation, the presented framework provides an important tool for personalized modeling and longitudinal studies on AAA growth and rupture risk.
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Affiliation(s)
- Judith H. C. Fonken
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Esther J. Maas
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Arjet H. M. Nievergeld
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Marc R. H. M. van Sambeek
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Frans N. van de Vosse
- Cardiovascular Biomechanics, Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Richard G. P. Lopata
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Vrtovec T, Močnik D, Strojan P, Pernuš F, Ibragimov B. Auto-segmentation of organs at risk for head and neck radiotherapy planning: From atlas-based to deep learning methods. Med Phys 2020; 47:e929-e950. [PMID: 32510603 DOI: 10.1002/mp.14320] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy (RT) is one of the basic treatment modalities for cancer of the head and neck (H&N), which requires a precise spatial description of the target volumes and organs at risk (OARs) to deliver a highly conformal radiation dose to the tumor cells while sparing the healthy tissues. For this purpose, target volumes and OARs have to be delineated and segmented from medical images. As manual delineation is a tedious and time-consuming task subjected to intra/interobserver variability, computerized auto-segmentation has been developed as an alternative. The field of medical imaging and RT planning has experienced an increased interest in the past decade, with new emerging trends that shifted the field of H&N OAR auto-segmentation from atlas-based to deep learning-based approaches. In this review, we systematically analyzed 78 relevant publications on auto-segmentation of OARs in the H&N region from 2008 to date, and provided critical discussions and recommendations from various perspectives: image modality - both computed tomography and magnetic resonance image modalities are being exploited, but the potential of the latter should be explored more in the future; OAR - the spinal cord, brainstem, and major salivary glands are the most studied OARs, but additional experiments should be conducted for several less studied soft tissue structures; image database - several image databases with the corresponding ground truth are currently available for methodology evaluation, but should be augmented with data from multiple observers and multiple institutions; methodology - current methods have shifted from atlas-based to deep learning auto-segmentation, which is expected to become even more sophisticated; ground truth - delineation guidelines should be followed and participation of multiple experts from multiple institutions is recommended; performance metrics - the Dice coefficient as the standard volumetric overlap metrics should be accompanied with at least one distance metrics, and combined with clinical acceptability scores and risk assessments; segmentation performance - the best performing methods achieve clinically acceptable auto-segmentation for several OARs, however, the dosimetric impact should be also studied to provide clinically relevant endpoints for RT planning.
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Affiliation(s)
- Tomaž Vrtovec
- Faculty Electrical Engineering, University of Ljubljana, Tržaška cesta 25, Ljubljana, SI-1000, Slovenia
| | - Domen Močnik
- Faculty Electrical Engineering, University of Ljubljana, Tržaška cesta 25, Ljubljana, SI-1000, Slovenia
| | - Primož Strojan
- Institute of Oncology Ljubljana, Zaloška cesta 2, Ljubljana, SI-1000, Slovenia
| | - Franjo Pernuš
- Faculty Electrical Engineering, University of Ljubljana, Tržaška cesta 25, Ljubljana, SI-1000, Slovenia
| | - Bulat Ibragimov
- Faculty Electrical Engineering, University of Ljubljana, Tržaška cesta 25, Ljubljana, SI-1000, Slovenia.,Department of Computer Science, University of Copenhagen, Universitetsparken 1, Copenhagen, D-2100, Denmark
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