Body-wide hierarchical fuzzy modeling, recognition, and delineation of anatomy in medical images

Auto-segmentation of thoraco-abdominal organs in pediatric dynamic MRI

Purpose

Analysis of the abnormal motion of thoraco-abdominal organs in respiratory disorders such as the Thoracic Insufficiency Syndrome (TIS) and scoliosis such as adolescent idiopathic scoliosis (AIS) or early onset scoliosis (EOS) can lead to better surgical plans. We can use healthy subjects to find out the normal architecture and motion of a rib cage and associated organs and attempt to modify the patient's deformed anatomy to match to it. Dynamic magnetic resonance imaging (dMRI) is a practical and preferred imaging modality for capturing dynamic images of healthy pediatric subjects. In this paper, we propose an auto-segmentation set-up for the lungs, kidneys, liver, spleen, and thoraco-abdominal skin in these dMRI images which have their own challenges such as poor contrast, image non-standardness, and similarity in texture amongst gas, bone, and connective tissue at several inter-object interfaces.

Methods

The segmentation set-up has been implemented in two steps: recognition and delineation using two deep neural network (DL) architectures (say DL-R and DL-D) for the recognition step and delineation step, respectively. The encoder-decoder framework in DL-D utilizes features at four different resolution levels to counter the challenges involved in the segmentation. We have evaluated on dMRI sagittal acquisitions of 189 (near-)normal subjects. The spatial resolution in all dMRI acquisitions is 1.46 mm in a sagittal slice and 6.00 mm between sagittal slices. We utilized images of 89 (10) subjects at end inspiration for training (validation). For testing we experimented with three scenarios: utilizing (1) the images of 90 (=189-89-10) different (remaining) subjects at end inspiration for testing, (2) the images of the aforementioned 90 subjects at end expiration for testing, and (3) the images of the aforesaid 99 (=89+10) subjects but at end expiration for testing. In some situations, we can take advantage of already available ground truth (GT) of a subject at a particular respiratory phase to automatically segment the object in the image of the same subject at a different respiratory phase and then refining the segmentation to create the final GT. We anticipate that this process of creating GT would require minimal post hoc correction. In this spirit, we conducted separate experiments where we assume to have the ground truth of the test subjects at end expiration for scenario (1), end inspiration for (2), and end inspiration for (3).

Results

Amongst these three scenarios of testing, for the DL-R, we achieve a best average location error (LE) of about 1 voxel for the lungs, kidneys, and spleen and 1.5 voxels for the liver and the thoraco- abdominal skin. The standard deviation (SD) of LE is about 1 or 2 voxels. For the delineation approach, we achieve an average Dice coefficient (DC) of about 0.92 to 0.94 for the lungs, 0.82 for the kidneys, 0.90 for the liver, 0.81 for the spleen, and 0.93 for the thoraco-abdominal skin. The SD of DC is lower for the lungs, liver, and the thoraco-abdominal skin, and slightly higher for the spleen and kidneys.

Conclusions

Motivated by applications in surgical planning for disorders such as TIS, AIS, and EOS, we have shown an auto-segmentation system for thoraco-abdominal organs in dMRI acquisitions. This proposed setup copes with the challenges posed by low resolution, motion blur, inadequate contrast, and image intensity non-standardness quite well. We are in the process of testing its effectiveness on TIS patient dMRI data.

Reviewing 3D convolutional neural network approaches for medical image segmentation

Background

Convolutional neural networks (CNNs) assume pivotal roles in aiding clinicians in diagnosis and treatment decisions. The rapid evolution of imaging technology has established three-dimensional (3D) CNNs as a formidable framework for delineating organs and anomalies in medical images. The prominence of 3D CNN frameworks is steadily growing within medical image segmentation and classification. Thus, our proposition entails a comprehensive review, encapsulating diverse 3D CNN algorithms for the segmentation of medical image anomalies and organs.

Methods

This study systematically presents an exhaustive review of recent 3D CNN methodologies. Rigorous screening of abstracts and titles were carried out to establish their relevance. Research papers disseminated across academic repositories were meticulously chosen, analyzed, and appraised against specific criteria. Insights into the realm of anomalies and organ segmentation were derived, encompassing details such as network architecture and achieved accuracies.

Results

This paper offers an all-encompassing analysis, unveiling the prevailing trends in 3D CNN segmentation. In-depth elucidations encompass essential insights, constraints, observations, and avenues for future exploration. A discerning examination indicates the preponderance of the encoder-decoder network in segmentation tasks. The encoder-decoder framework affords a coherent methodology for the segmentation of medical images.

Conclusion

The findings of this study are poised to find application in clinical diagnosis and therapeutic interventions. Despite inherent limitations, CNN algorithms showcase commendable accuracy levels, solidifying their potential in medical image segmentation and classification endeavors.

GA-Net: A geographical attention neural network for the segmentation of body torso tissue composition

PURPOSE

Body composition analysis (BCA) of the body torso plays a vital role in the study of physical health and pathology and provides biomarkers that facilitate the diagnosis and treatment of many diseases, such as type 2 diabetes mellitus, cardiovascular disease, obstructive sleep apnea, and osteoarthritis. In this work, we propose a body composition tissue segmentation method that can automatically delineate those key tissues, including subcutaneous adipose tissue, skeleton, skeletal muscle tissue, and visceral adipose tissue, on positron emission tomography/computed tomography scans of the body torso.

METHODS

To provide appropriate and precise semantic and spatial information that is strongly related to body composition tissues for the deep neural network, first we introduce a new concept of the body area and integrate it into our proposed segmentation network called Geographical Attention Network (GA-Net). The body areas are defined following anatomical principles such that the whole body torso region is partitioned into three non-overlapping body areas. Each body composition tissue of interest is fully contained in exactly one specific minimal body area. Secondly, the proposed GA-Net has a novel dual-decoder schema that is composed of a tissue decoder and an area decoder. The tissue decoder segments the body composition tissues, while the area decoder segments the body areas as an auxiliary task. The features of body areas and body composition tissues are fused through a soft attention mechanism to gain geographical attention relevant to the body tissues. Thirdly, we propose a body composition tissue annotation approach that takes the body area labels as the region of interest, which significantly improves the reproducibility, precision, and efficiency of delineating body composition tissues.

RESULTS

Our evaluations on 50 low-dose unenhanced CT images indicate that GA-Net outperforms other architectures statistically significantly based on the Dice metric. GA-Net also shows improvements for the 95% Hausdorff Distance metric in most comparisons. Notably, GA-Net exhibits more sensitivity to subtle boundary information and produces more reliable and robust predictions for such structures, which are the most challenging parts to manually mend in practice, with potentially significant time-savings in the post hoc correction of these subtle boundary placement errors. Due to the prior knowledge provided from body areas, GA-Net achieves competitive performance with less training data. Our extension of the dual-decoder schema to TransUNet and 3D U-Net demonstrates that the new schema significantly improves the performance of these classical neural networks as well. Heatmaps obtained from attention gate layers further illustrate the geographical guidance function of body areas for identifying body tissues.

CONCLUSIONS

(i) Prior anatomic knowledge supplied in the form of appropriately designed anatomic container objects significantly improves the segmentation of bodily tissues. (ii) Of particular note are the improvements achieved in the delineation of subtle boundary features which otherwise would take much effort for manual correction. (iii) The method can be easily extended to existing networks to improve their accuracy for this application.

Auto-segmentation of thoracic brachial plexuses for radiation therapy planning

Recently, deep learning networks have achieved considerable success in segmenting organs in medical images. Several methods have used volumetric information with deep networks to achieve segmentation accuracy. However, these networks suffer from interference, risk of overfitting, and low accuracy as a result of artifacts, in the case of very challenging objects like the brachial plexuses. In this paper, to address these issues, we synergize the strengths of high-level human knowledge (i.e., natural intelligence (NI)) with deep learning (i.e., artificial intelligence (AI)) for recognition and delineation of the thoracic brachial plexuses (BPs) in computed tomography (CT) images. We formulate an anatomy-guided deep learning hybrid intelligence approach for segmenting thoracic right and left brachial plexuses consisting of 2 key stages. In the first stage (AAR-R), objects are recognized based on a previously created fuzzy anatomy model of the body region with its key organs relevant for the task at hand wherein high-level human anatomic knowledge is precisely codified. The second stage (DL-D) uses information from AAR-R to limit the search region to just where each object is most likely to reside and performs encoder-decoder delineation in slices. The proposed method is tested on a dataset that consists of 125 images of the thorax acquired for radiation therapy planning of tumors in the thorax and achieves a Dice coefficient of 0.659.

Combining natural and artificial intelligence for robust automatic anatomy segmentation: Application in neck and thorax auto-contouring

BACKGROUND

Automatic segmentation of 3D objects in computed tomography (CT) is challenging. Current methods, based mainly on artificial intelligence (AI) and end-to-end deep learning (DL) networks, are weak in garnering high-level anatomic information, which leads to compromised efficiency and robustness. This can be overcome by incorporating natural intelligence (NI) into AI methods via computational models of human anatomic knowledge.

PURPOSE

We formulate a hybrid intelligence (HI) approach that integrates the complementary strengths of NI and AI for organ segmentation in CT images and illustrate performance in the application of radiation therapy (RT) planning via multisite clinical evaluation.

METHODS

The system employs five modules: (i) body region recognition, which automatically trims a given image to a precisely defined target body region; (ii) NI-based automatic anatomy recognition object recognition (AAR-R), which performs object recognition in the trimmed image without DL and outputs a localized fuzzy model for each object; (iii) DL-based recognition (DL-R), which refines the coarse recognition results of AAR-R and outputs a stack of 2D bounding boxes (BBs) for each object; (iv) model morphing (MM), which deforms the AAR-R fuzzy model of each object guided by the BBs output by DL-R; and (v) DL-based delineation (DL-D), which employs the object containment information provided by MM to delineate each object. NI from (ii), AI from (i), (iii), and (v), and their combination from (iv) facilitate the HI system.

RESULTS

The HI system was tested on 26 organs in neck and thorax body regions on CT images obtained prospectively from 464 patients in a study involving four RT centers. Data sets from one separate independent institution involving 125 patients were employed in training/model building for each of the two body regions, whereas 104 and 110 data sets from the 4 RT centers were utilized for testing on neck and thorax, respectively. In the testing data sets, 83% of the images had limitations such as streak artifacts, poor contrast, shape distortion, pathology, or implants. The contours output by the HI system were compared to contours drawn in clinical practice at the four RT centers by utilizing an independently established ground-truth set of contours as reference. Three sets of measures were employed: accuracy via Dice coefficient (DC) and Hausdorff boundary distance (HD), subjective clinical acceptability via a blinded reader study, and efficiency by measuring human time saved in contouring by the HI system. Overall, the HI system achieved a mean DC of 0.78 and 0.87 and a mean HD of 2.22 and 4.53 mm for neck and thorax, respectively. It significantly outperformed clinical contouring in accuracy and saved overall 70% of human time over clinical contouring time, whereas acceptability scores varied significantly from site to site for both auto-contours and clinically drawn contours.

CONCLUSIONS

The HI system is observed to behave like an expert human in robustness in the contouring task but vastly more efficiently. It seems to use NI help where image information alone will not suffice to decide, first for the correct localization of the object and then for the precise delineation of the boundary.

Establishing correlations between normal pancreatic and submandibular gland ducts

Background

The objectives of this study were to evaluate the relationship between ductal morphometry and ramification patterns in the submandibular gland and pancreas in order to validate their common fractal dimension.

Methods

X-ray ductography with software-aided morphometry were obtained by injecting barium sulphate in the ducts of post-mortem submandibular gland and pancreas specimens harvested from 42 adult individuals.

Results

Three cases were excluded from the study because of underlying pathology. There was a significant correlation between the length of the main pancreatic duct (MPD) and the intraglandular portion of the right submandibular duct (SMD) (r = 0.3616; p = 0.028), and left SMD (r = 0.595; p < 0.01), respectively, but their maximal diameters did not correlate (r = 0.139—0.311; p > 0.05). Both dimensions of the SMD showed a significant right-left correlation (p < 0.05). The number of MPD side branches (mean = 37) correlated with the number of side branches of left SMD, but not with the right one (mean = 9). Tortuosity was observed in 54% of the MPD, 32% of the right SMD, and 24% of the left SMD, with mutual association only between the two salivary glands.

Conclusions

Although the length of intraglandular SMD and MPD correlate, other morphometric ductal features do not, thus suggesting a more complex relationship between the two digestive glands.

An Anatomy-based Iteratively Searching Convolutional Neural Network for Organ Localization in CT images

Organ localization is a common and essential preprocessing operation for many medical image analysis tasks. We propose a novel multi-organ localization method based on an end-to-end 3D convolutional neural network. The proposed algorithm employs a regression network to learn the position relationship between any patch and target organs in a medical computed tomography (CT) image. With this framework, it can iteratively localize the target organs in a coarse-to-fine manner. The main idea behind this method is to embed the anatomy of structures in a deep learning-based approach. For implementation, the proposed network outputs an 8-dimensional vector that contains information about the position, scale, and presence of each target organ. A piecewise loss function and a multi-density sampling strategy help to optimize this network to learn anatomy layout characteristics over the entire CT image. Starting from a random position, this network can accurately locate the target organ with a few iterations. Moreover, a dual-resolution strategy is employed to improve the accuracy affected by varying organ scales, further enhancing the localizing performance for all organs. We evaluate our method on a public data set (LiTS) to locate 11 organs in the thoraco-abdomino-pelvic region. The proposed method outperforms state-of-the-art methods with a mean intersection over union (IOU) of 80.84%, mean wall distance of 3.63 mm, and mean centroid distance of 4.93 mm, constituting excellent accuracy. The improvements on relatively small-size and medium-size organs are noteworthy.

SOMA: Subject-, object-, and modality-adapted precision atlas approach for automatic anatomy recognition and delineation in medical images

PURPOSE

In the multi-atlas segmentation (MAS) method, a large enough atlas set, which can cover the complete spectrum of the whole population pattern of the target object will benefit the segmentation quality. However, the difficulty in obtaining and generating such a large set of atlases and the computational burden required in the segmentation procedure make this approach impractical. In this paper, we propose a method called SOMA to select subject-, object-, and modality-adapted precision atlases for automatic anatomy recognition in medical images with pathology, following the idea that different regions of the target object in a novel image can be recognized by different atlases with regionally best similarity, so that effective atlases have no need to be globally similar to the target subject and also have no need to be overall similar to the target object.

METHODS

The SOMA method consists of three main components: atlas building, object recognition, and object delineation. Considering the computational complexity, we utilize an all-to-template strategy to align all images to the same image space belonging to the root image determined by the minimum spanning tree (MST) strategy among a subset of radiologically near-normal images. The object recognition process is composed of two stages: rough recognition and refined recognition. In rough recognition, subimage matching is conducted between the test image and each image of the whole atlas set, and only the atlas corresponding to the best-matched subimage contributes to the recognition map regionally. The frequency of best match for each atlas is recorded by a counter, and the atlases with the highest frequencies are selected as the precision atlases. In refined recognition, only the precision atlases are examined, and the subimage matching is conducted in a nonlocal manner of searching to further increase the accuracy of boundary matching. Delineation is based on a U-net-based deep learning network, where the original gray scale image together with the fuzzy map from refined recognition compose a two-channel input to the network, and the output is a segmentation map of the target object.

RESULTS

Experiments are conducted on computed tomography (CT) images with different qualities in two body regions - head and neck (H&N) and thorax, from 298 subjects with nine objects and 241 subjects with six objects, respectively. Most objects achieve a localization error within two voxels after refined recognition, with marked improvement in localization accuracy from rough to refined recognition of 0.6-3 mm in H&N and 0.8-4.9 mm in thorax, and also in delineation accuracy (Dice coefficient) from refined recognition to delineation of 0.01-0.11 in H&N and 0.01-0.18 in thorax.

CONCLUSIONS

The SOMA method shows high accuracy and robustness in anatomy recognition and delineation. The improvements from rough to refined recognition and further to delineation, as well as immunity of recognition accuracy to varying image and object qualities, demonstrate the core principles of SOMA where segmentation accuracy increases with precision atlases and gradually refined object matching.

Automatic upper airway segmentation in static and dynamic MRI via anatomy-guided convolutional neural networks

PURPOSE

Upper airway segmentation on MR images is a prerequisite step for quantitatively studying the anatomical structure and function of the upper airway and surrounding tissues. However, the complex variability of intensity and shape of anatomical structures and different modes of image acquisition commonly used in this application makes automatic upper airway segmentation challenging. In this paper, we develop and test a comprehensive deep learning-based segmentation system for use on MR images to address this problem.

MATERIALS AND METHODS

In our study, both static and dynamic MRI data sets are utilized, including 58 axial static 3D MRI studies, 22 mid-retropalatal dynamic 2D MRI studies, 21 mid-retroglossal dynamic 2D MRI studies, 36 mid-sagittal dynamic 2D MRI studies, and 23 isotropic dynamic 3D MRI studies, involving a total of 160 subjects and over 20 000 MRI slices. Samples of static and 2D dynamic MRI data sets were randomly divided into training, validation, and test sets by an approximate ratio of 5:2:3. Considering that the variability of annotation data among 3D dynamic MRIs was greater than for other MRI data sets, we increased the ratio of training data for these data to improve the robustness of the model. We designed a unified framework consisting of the following procedures. For static MRI, a generalized region-of-interest (GROI) strategy is applied to localize the partitions of nasal cavity and other portions of upper airway in axial data sets as two separate subobjects. Subsequently, the two subobjects are segmented by two separate 2D U-Nets. The two segmentation results are combined as the whole upper airway structure. The GROI strategy is also applied to other MRI modes. To minimize false-positive and false-negative rates in the segmentation results, we employed a novel loss function based explicitly on these rates to train the segmentation networks. An inter-reader study is conducted to test the performance of our system in comparison to human variability in ground truth (GT) segmentation of these challenging structures.

RESULTS

The proposed approach yielded mean Dice coefficients of 0.84±0.03, 0.89±0.13, 0.84±0.07, and 0.86±0.05 for static 3D MRI, mid-retropalatal/mid-retroglossal 2D dynamic MRI, mid-sagittal 2D dynamic MRI, and isotropic dynamic 3D MRI, respectively. The quantitative results show excellent agreement with manual delineation results. The inter-reader study results demonstrate that the segmentation performance of our approach is statistically indistinguishable from manual segmentations considering the inter-reader variability in GT.

CONCLUSIONS

The proposed method can be utilized for routine upper airway segmentation from static and dynamic MR images with high accuracy and efficiency. The proposed approach has the potential to be employed in other dynamic MRI-related applications, such as lung or heart segmentation.

Automatic Segmentation of Mandible from Conventional Methods to Deep Learning-A Review

Medical imaging techniques, such as (cone beam) computed tomography and magnetic resonance imaging, have proven to be a valuable component for oral and maxillofacial surgery (OMFS). Accurate segmentation of the mandible from head and neck (H&N) scans is an important step in order to build a personalized 3D digital mandible model for 3D printing and treatment planning of OMFS. Segmented mandible structures are used to effectively visualize the mandible volumes and to evaluate particular mandible properties quantitatively. However, mandible segmentation is always challenging for both clinicians and researchers, due to complex structures and higher attenuation materials, such as teeth (filling) or metal implants that easily lead to high noise and strong artifacts during scanning. Moreover, the size and shape of the mandible vary to a large extent between individuals. Therefore, mandible segmentation is a tedious and time-consuming task and requires adequate training to be performed properly. With the advancement of computer vision approaches, researchers have developed several algorithms to automatically segment the mandible during the last two decades. The objective of this review was to present the available fully (semi)automatic segmentation methods of the mandible published in different scientific articles. This review provides a vivid description of the scientific advancements to clinicians and researchers in this field to help develop novel automatic methods for clinical applications.

Segmentation evaluation with sparse ground truth data: Simulating true segmentations as perfect/imperfect as those generated by humans

Fully annotated data sets play important roles in medical image segmentation and evaluation. Expense and imprecision are the two main issues in generating ground truth (GT) segmentations. In this paper, in an attempt to overcome these two issues jointly, we propose a method, named SparseGT, which exploit variability among human segmenters to maximally save manual workload in GT generation for evaluating actual segmentations by algorithms. Pseudo ground truth (p-GT) segmentations are created by only a small fraction of workload and with human-level perfection/imperfection, and they can be used in practice as a substitute for fully manual GT in evaluating segmentation algorithms at the same precision. p-GT segmentations are generated by first selecting slices sparsely, where manual contouring is conducted only on these sparse slices, and subsequently filling segmentations on other slices automatically. By creating p-GT with different levels of sparseness, we determine the largest workload reduction achievable for each considered object, where the variability of the generated p-GT is statistically indistinguishable from inter-segmenter differences in full manual GT segmentations for that object. Furthermore, we investigate the segmentation evaluation errors introduced by variability in manual GT by applying p-GT in evaluation of actual segmentations by an algorithm. Experiments are conducted on ∼500 computed tomography (CT) studies involving six objects in two body regions, Head & Neck and Thorax, where optimal sparseness and corresponding evaluation errors are determined for each object and each strategy. Our results indicate that creating p-GT by the concatenated strategy of uniformly selecting sparse slices and filling segmentations via deep-learning (DL) network show highest manual workload reduction by ∼80-96% without sacrificing evaluation accuracy compared to fully manual GT. Nevertheless, other strategies also have obvious contributions in different situations. A non-uniform strategy for slice selection shows its advantage for objects with irregular shape change from slice to slice. An interpolation strategy for filling segmentations can achieve ∼60-90% of workload reduction in simulating human-level GT without the need of an actual training stage and shows potential in enlarging data sets for training p-GT generation networks. We conclude that not only over 90% reduction in workload is feasible without sacrificing evaluation accuracy but also the suitable strategy and the optimal sparseness level achievable for creating p-GT are object- and application-specific.

Anatomy Recognition in CT Images of Head & Neck Region via Precision Atlases

Multi-atlas segmentation methods will benefit from atlases covering the complete spectrum of population patterns, while the difficulties in generating such large enough datasets and the computation burden required in the segmentation procedure reduce its practicality in clinical application. In this work, we start from a viewpoint that different parts of the target object can be recognized by different atlases and propose a precision atlas selection strategy. By comparing regional similarity between target image and atlases, precision atlases are ranked and selected by the frequency of regional best match, which have no need to be globally similar to the target subject at either image-level or object-level, largely increasing the implicit patterns contained in the atlas set. In the proposed anatomy recognition method, atlas building is first achieved by all-to-template registration, where the minimum spanning tree (MST) strategy is used to select a registration template from a subset of radiologically near-normal images. Then, a two-stage recognition process is conducted: in rough recognition, sub-image level similarity is calculated between the test image and each image of the whole atlas set, and only the atlas with the highest similarity contributes to the recognition map regionally; in refined recognition, the atlases with the highest frequencies of best match are selected as the precision atlases and are utilized to further increase the accuracy of boundary matching. The proposed method is demonstrated on 298 computed tomography (CT) images and 9 organs in the Head & Neck (H&N) body region. Experimental results illustrate that our method is effective for organs with different segmentation challenge and samples with different image quality, where remarkable improvement in boundary interpretation is made by refined recognition and most objects achieve a localization error within 2 voxels.

Hierarchical Image Segmentation Based on Nonsymmetry and Anti-Packing Pattern Representation Model

Image segmentation is the foundation of high-level image analysis and image understanding. How to effectively segment an image into regions that are "meaningful" to the human visual perception and ensure that the segmented regions are consistent at different resolutions is still a very challenging issue. Inspired by the idea of the Nonsymmetry and Anti-packing pattern representation Model in the Lab color space (NAMLab) and the "global-first" invariant perceptual theory, in this paper, we propose a novel framework for hierarchical image segmentation. Firstly, by defining the dissimilarity between two pixels in the Lab color space, we propose an NAMLab-based color image representation approach that is more in line with the human visual perception characteristics and can make the image pixels fast and effectively merge into the NAMLab blocks. Then, by defining the dissimilarity between two NAMLab-based regions and iteratively executing NAMLab-based merging algorithm of adjacent regions into larger ones to progressively generate a segmentation dendrogram, we propose a fast NAMLab-based algorithm for hierarchical image segmentation. Finally, the complexities of our proposed NAMLab-based algorithm for hierarchical image segmentation are analyzed in details. The experimental results presented in this paper show that our proposed algorithm when compared with the state-of-the-art algorithms not only can preserve more details of the object boundaries, but also it can better identify the foreground objects with similar color distributions. Also, our proposed algorithm can be executed much faster and takes up less memory and therefore it is a better algorithm for hierarchical image segmentation.

DiSegNet: A deep dilated convolutional encoder-decoder architecture for lymph node segmentation on PET/CT images

PURPOSE

Automated lymph node (LN) recognition and segmentation from cross-sectional medical images is an important step for the automated diagnostic assessment of patients with cancer. Yet, it is still a difficult task owing to the low contrast of LNs and surrounding soft tissues as well as due to the variation in nodal size and shape. In this paper, we present a novel LN segmentation method based on a newly designed neural network for positron emission tomography/computed tomography (PET/CT) images.

METHODS

This work communicates two problems involved in LN segmentation task. Firstly, an efficient loss function named cosine-sine (CS) is proposed for the voxel class imbalance problem in the convolution network training process. Second, a multi-stage and multi-scale Atrous (Dilated) spatial pyramid pooling sub-module, named MS-ASPP, is introduced to the encoder-decoder architecture (SegNet), which aims to make use of multi-scale information to improve the performance of LN segmentation. The new architecture is named DiSegNet (Dilated SegNet).

RESULTS

Four-fold cross-validation is performed on 63 PET/CT data sets. In each experiment, 10 data sets are selected randomly for testing and the other 53 for training. The results show that we reach an average 77 % Dice similarity coefficient score with CS loss function by trained DiSegNet, compared to a baseline method SegNet by cross-entropy (CE) with 71 % Dice similarity coefficient.

CONCLUSIONS

The performance of the proposed DiSegNet with CS loss function suggests its potential clinical value for disease quantification.

A slice classification model-facilitated 3D encoder-decoder network for segmenting organs at risk in head and neck cancer

For deep learning networks used to segment organs at risk (OARs) in head and neck (H&N) cancers, the class-imbalance problem between small volume OARs and whole computed tomography (CT) images results in delineation with serious false-positives on irrelevant slices and unnecessary time-consuming calculations. To alleviate this problem, a slice classification model-facilitated 3D encoder-decoder network was developed and validated. In the developed two-step segmentation model, a slice classification model was firstly utilized to classify CT slices into six categories in the craniocaudal direction. Then the target categories for different OARs were pushed to the different 3D encoder-decoder segmentation networks, respectively. All the patients were divided into training (n = 120), validation (n = 30) and testing (n = 20) datasets. The average accuracy of the slice classification model was 95.99%. The Dice similarity coefficient and 95% Hausdorff distance, respectively, for each OAR were as follows: right eye (0.88 ± 0.03 and 1.57 ± 0.92 mm), left eye (0.89 ± 0.03 and 1.35 ± 0.43 mm), right optic nerve (0.72 ± 0.09 and 1.79 ± 1.01 mm), left optic nerve (0.73 ± 0.09 and 1.60 ± 0.71 mm), brainstem (0.87 ± 0.04 and 2.28 ± 0.99 mm), right temporal lobe (0.81 ± 0.12 and 3.28 ± 2.27 mm), left temporal lobe (0.82 ± 0.09 and 3.73 ± 2.08 mm), right temporomandibular joint (0.70 ± 0.13 and 1.79 ± 0.79 mm), left temporomandibular joint (0.70 ± 0.16 and 1.98 ± 1.48 mm), mandible (0.89 ± 0.02 and 1.66 ± 0.51 mm), right parotid (0.77 ± 0.07 and 7.30 ± 4.19 mm) and left parotid (0.71 ± 0.12 and 8.41 ± 4.84 mm). The total segmentation time was 40.13 s. The 3D encoder-decoder network facilitated by the slice classification model demonstrated superior performance in accuracy and efficiency in segmenting OARs in H&N CT images. This may significantly reduce the workload for radiation oncologists.

BRR-Net: A tandem architectural CNN-RNN for automatic body region localization in CT images

PURPOSE

Automatic identification of consistently defined body regions in medical images is vital in many applications. In this paper, we describe a method to automatically demarcate the superior and inferior boundaries for neck, thorax, abdomen, and pelvis body regions in computed tomography (CT) images.

METHODS

For any three-dimensional (3D) CT image I, following precise anatomic definitions, we denote the superior and inferior axial boundary slices of the neck, thorax, abdomen, and pelvis body regions by NS(I), NI(I), TS(I), TI(I), AS(I), AI(I), PS(I), and PI(I), respectively. Of these, by definition, AI(I) = PS(I), and so the problem reduces to demarcating seven body region boundaries. Our method consists of a two-step approach. In the first step, a convolutional neural network (CNN) is trained to classify each axial slice in I into one of nine categories: the seven body region boundaries, plus legs (defined as all axial slices inferior to PI(I)), and the none-of-the-above category. This CNN uses a multichannel approach to exploit the interslice contrast, providing the neural network with additional visual context at the body region boundaries. In the second step, to improve the predictions for body region boundaries that are very subtle and that exhibit low contrast, a recurrent neural network (RNN) is trained on features extracted by CNN, limited to a flexible window about the predictions from the CNN.

RESULTS

The method is evaluated on low-dose CT images from 442 patient scans, divided into training and testing sets with a ratio of 70:30. Using only the CNN, overall absolute localization error for NS(I), NI(I), TS(I), TI(I), AS(I), AI(I), and PI(I) expressed in terms of number of slices (nS) is (mean ± SD): 0.61 ± 0.58, 1.05 ± 1.13, 0.31 ± 0.46, 1.85 ± 1.96, 0.57 ± 2.44, 3.42 ± 3.16, and 0.50 ± 0.50, respectively. Using the RNN to refine the CNN's predictions for select classes improved the accuracy of TI(I) and AI(I) to: 1.35 ± 1.71 and 2.83 ± 2.75, respectively. This model outperforms the results achieved in our previous work by 2.4, 1.7, 3.1, 1.1, and 2 slices, respectively for TS(I), TI(I), AS(I), AI(I) = PS(I), and PI(I) classes with statistical significance. The model trained on low-dose CT images was also tested on diagnostic CT images for NS(I), NI(I), and TS(I) classes; the resulting errors were: 1.48 ± 1.33, 2.56 ± 2.05, and 0.58 ± 0.71, respectively.

CONCLUSIONS

Standardized body region definitions are a prerequisite for effective implementation of quantitative radiology, but the literature is severely lacking in the precise identification of body regions. The method presented in this paper significantly outperforms earlier works by a large margin, and the deviations of our results from ground truth are comparable to variations observed in manual labeling by experts. The solution presented in this work is critical to the adoption and employment of the idea of standardized body regions, and clears the path for development of applications requiring accurate demarcations of body regions. The work is indispensable for automatic anatomy recognition, delineation, and contouring for radiation therapy planning, as it not only automates an essential part of the process, but also removes the dependency on experts for accurately demarcating body regions in a study.

AAR-LN-DQ: Automatic anatomy recognition based disease quantification in thoracic lymph node zones via FDG PET/CT images without Nodal Delineation

PURPOSE

The derivation of quantitative information from medical images in a practical manner is essential for quantitative radiology (QR) to become a clinical reality, but still faces a major hurdle because of image segmentation challenges. With the goal of performing disease quantification in lymph node (LN) stations without explicit nodal delineation, this paper presents a novel approach for disease quantification (DQ) by automatic recognition of LN zones and detection of malignant lymph nodes within thoracic LN zones via positron emission tomography/computed tomography (PET/CT) images. Named AAR-LN-DQ, this approach decouples DQ methods from explicit nodal segmentation via an LN recognition strategy involving a novel globular filter and a deep neural network called SegNet.

METHOD

The methodology consists of four main steps: (a) Building lymph node zone models by automatic anatomy recognition (AAR) method. It incorporates novel aspects of model building that relate to finding an optimal hierarchy for organs and lymph node zones in the thorax. (b) Recognizing lymph node zones by the built lymph node models. (c) Detecting pathologic LNs in the recognized zones by using a novel globular filter (g-filter) and a multi-level support vector machine (SVM) classifier. Here, we make use of the general globular shape of LNs to first localize them and then use a multi-level SVM classifier to identify pathologic LNs from among the LNs localized by the g-filter. Alternatively, we designed a deep neural network called SegNet which is trained to directly recognize pathologic nodes within AAR localized LN zones. (d) Disease quantification based on identified pathologic LNs within localized zones. A fuzzy disease map is devised to express the degree of disease burden at each voxel within the identified LNs to simultaneously handle several uncertain phenomena such as PET partial volume effects, uncertainty in localization of LNs, and gradation of disease content at the voxel level. We focused on the task of disease quantification in patients with lymphoma based on PET/CT acquisitions and devised a method of evaluation. Model building was carried out using 42 near-normal patient datasets via contrast-enhanced CT examinations of their thorax. PET/CT datasets from an additional 63 lymphoma patients were utilized for evaluating the AAR-LN-DQ methodology. We assess the accuracy of the three main processes involved in AAR-LN-DQ via fivefold cross validation: lymph node zone recognition, abnormal lymph node localization, and disease quantification.

RESULTS

The recognition and scale error for LN zones were 12.28 mm ± 1.99 and 0.94 ± 0.02, respectively, on normal CT datasets. On abnormal PET/CT datasets, the sensitivity and specificity of pathologic LN recognition were 84.1% ± 0.115 and 98.5% ± 0.003, respectively, for the g-filter-SVM strategy, and 91.3% ± 0.110 and 96.1% ± 0.016, respectively, for the SegNet method. Finally, the mean absolute percent errors for disease quantification of the recognized abnormal LNs were 8% ± 0.09 and 14% ± 0.10 for the g-filter-SVM method and the best SegNet strategy, respectively.

CONCLUSIONS

Accurate disease quantification on PET/CT images without performing explicit delineation of lymph nodes is feasible following lymph node zone and pathologic LN localization. It is very useful to perform LN zone recognition by AAR as this step can cover most (95.8%) of the abnormal LNs and drastically reduce the regions to search for abnormal LNs. This also improves the specificity of deep networks such as SegNet significantly. It is possible to utilize general shape information about LNs such as their globular nature via g-filter and to arrive at high recognition rates for abnormal LNs in conjunction with a traditional classifier such as SVM. Finally, the disease map concept is effective for estimating disease burden, irrespective of how the LNs are identified, to handle various uncertainties without having to address them explicitly one by one.

Obtaining the potential number of object models/atlases needed in medical image analysis

Medical image processing and analysis operations, particularly segmentation, can benefit a great deal from prior information encoded to capture variations over a population in form, shape, anatomic layout, and image appearance of objects. Model/atlas-based methods are extant in medical image segmentation. Although multi-atlas/ multi-model methods have shown improved accuracy for image segmentation, if the atlases/models do not cover representatively the distinct groups, then the methods may not be generalizable to new populations. In a previous study, we have given an answer to address the following problem at image level: How many models/ atlases are needed for optimally encoding prior information to address the differing body habitus factor in a population? However, the number of models for different objects may be different, and at the image level, it may not be possible to infer the number of models needed for each object. So, the modified question to which we are now seeking an answer to in this paper is: How many models/ atlases are needed for optimally encoding prior information to address the differing body habitus factor for each object in a body region? To answer this question, we modified our method in the previous study for seeking the optimum grouping for a given population of images but focusing on the individual objects. We present our results on head and neck computed tomography (CT) scans of 298 patients.

LinSEM: Linearizing segmentation evaluation metrics for medical images

Numerous algorithms are available for segmenting medical images. Empirical discrepancy metrics are commonly used in measuring the similarity or difference between segmentations by algorithms and "true" segmentations. However, one issue with the commonly used metrics is that the same metric value often represents different levels of "clinical acceptability" for different objects depending on their size, shape, and complexity of form. An ideal segmentation evaluation metric should be able to reflect degrees of acceptability directly from metric values and be able to show the same acceptability meaning by the same metric value for objects of different shape, size, and form. Intuitively, metrics which have a linear relationship with degree of acceptability will satisfy these conditions of the ideal metric. This issue has not been addressed in the medical image segmentation literature. In this paper, we propose a method called LinSEM for linearizing commonly used segmentation evaluation metrics based on corresponding degrees of acceptability evaluated by an expert in a reader study. LinSEM consists of two main parts: (a) estimating the relationship between metric values and degrees of acceptability separately for each considered metric and object, and (b) linearizing any given metric value corresponding to a given segmentation of an object based on the estimated relationship. Since algorithmic segmentations do not usually cover the full range of variability of acceptability, we create a set (SS) of simulated segmentations for each object that guarantee such coverage by using image transformations applied to a set (ST) of true segmentations of the object. We then conduct a reader study wherein the reader assigns an acceptability score (AS) for each sample in SS, expressing the acceptability of the sample on a 1 to 5 scale. Then the metric-AS relationship is constructed for the object by using an estimation method. With the idea that the ideal metric should be linear with respect to acceptability, we can then linearize the metric value of any segmentation sample of the object from a set (SA) of actual segmentations to its linearized value by using the constructed metric-acceptability relationship curve. Experiments are conducted involving three metrics - Dice coefficient (DC), Jaccard index (JI), and Hausdorff Distance (HD) - on five objects: skin outer boundary of the head and neck (cervico-thoracic) body region superior to the shoulders, right parotid gland, mandible, cervical esophagus, and heart. Actual segmentations (SA) of these objects are generated via our Automatic Anatomy Recognition (AAR) method. Our results indicate that, generally, JI has a more linear relationship with acceptability before linearization than other metrics. LinSEM achieves significantly improved uniformity of meaning post-linearization across all tested objects and metrics, except in a few cases where the departure from linearity was insignificant. This improvement is generally the largest for DC and HD reaching 8-25% for many tested cases. Although some objects (such as right parotid gland and esophagus for DC and JI) are close in their meaning between themselves before linearization, they are distant in this meaning from other objects but are brought close to other objects after linearization. This suggests the importance of performing linearization considering all objects in a body region and body-wide.

How many models/atlases are needed as priors for capturing anatomic population variations?

Many medical image processing and analysis operations can benefit a great deal from prior information encoded in the form of models/atlases to capture variations over a population in form, shape, anatomic layout, and image appearance of objects. However, two fundamental questions have not been addressed in the literature: "How many models/atlases are needed for optimally encoding prior information to address the differing body habitus factor in that population?" and "Images of how many subjects in the given population are needed to optimally harness prior information?" We propose a method to seek answers to these questions. We assume that there is a well-defined body region of interest and a subject population under consideration, and that we are given a set of representative images of the body region for the population. After images are trimmed to the exact body region, a hierarchical agglomerative clustering algorithm partitions the set of images into a specified number of groups by using pairwise image (dis)similarity as a cost function. Optionally the images may be pre-registered among themselves prior to this partitioning operation. We define a measure called Residual Dissimilarity (RD) to determine the goodness of each partition. We then ascertain how RD varies as a function of the number of elements in the partition for finding the optimum number(s) of groups. Breakpoints in this function are taken as the recommended number of groups/models/atlases. Our results from analysis of sizeable CT data sets of adult patients from two body regions - thorax (346) and head and neck (298) - can be summarized as follows. (1) A minimum of 5 to 8 groups (or models/atlases) seems essential to properly capture information about differing anatomic forms and body habitus. (2) A minimum of 150 images from different subjects in a population seems essential to cover the anatomical variations for a given body region. (3) In grouping, body habitus variations seem to override differences due to other factors such as gender, with/without contrast enhancement in image acquisition, and presence of moderate pathology. This method may be helpful for constructing high quality models/atlases from a sufficiently large population of images and in optimally selecting the training image sets needed in deep learning strategies.

AAR-RT - A system for auto-contouring organs at risk on CT images for radiation therapy planning: Principles, design, and large-scale evaluation on head-and-neck and thoracic cancer cases

Contouring (segmentation) of Organs at Risk (OARs) in medical images is required for accurate radiation therapy (RT) planning. In current clinical practice, OAR contouring is performed with low levels of automation. Although several approaches have been proposed in the literature for improving automation, it is difficult to gain an understanding of how well these methods would perform in a realistic clinical setting. This is chiefly due to three key factors - small number of patient studies used for evaluation, lack of performance evaluation as a function of input image quality, and lack of precise anatomic definitions of OARs. In this paper, extending our previous body-wide Automatic Anatomy Recognition (AAR) framework to RT planning of OARs in the head and neck (H&N) and thoracic body regions, we present a methodology called AAR-RT to overcome some of these hurdles. AAR-RT follows AAR's 3-stage paradigm of model-building, object-recognition, and object-delineation. Model-building: Three key advances were made over AAR. (i) AAR-RT (like AAR) starts off with a computationally precise definition of the two body regions and all of their OARs. Ground truth delineations of OARs are then generated following these definitions strictly. We retrospectively gathered patient data sets and the associated contour data sets that have been created previously in routine clinical RT planning from our Radiation Oncology department and mended the contours to conform to these definitions. We then derived an Object Quality Score (OQS) for each OAR sample and an Image Quality Score (IQS) for each study, both on a 1-to-10 scale, based on quality grades assigned to each OAR sample following 9 key quality criteria. Only studies with high IQS and high OQS for all of their OARs were selected for model building. IQS and OQS were employed for evaluating AAR-RT's performance as a function of image/object quality. (ii) In place of the previous hand-crafted hierarchy for organizing OARs in AAR, we devised a method to find an optimal hierarchy for each body region. Optimality was based on minimizing object recognition error. (iii) In addition to the parent-to-child relationship encoded in the hierarchy in previous AAR, we developed a directed probability graph technique to further improve recognition accuracy by learning and encoding in the model "steady" relationships that may exist among OAR boundaries in the three orthogonal planes. Object-recognition: The two key improvements over the previous approach are (i) use of the optimal hierarchy for actual recognition of OARs in a given image, and (ii) refined recognition by making use of the trained probability graph. Object-delineation: We use a kNN classifier confined to the fuzzy object mask localized by the recognition step and then fit optimally the fuzzy mask to the kNN-derived voxel cluster to bring back shape constraint on the object. We evaluated AAR-RT on 205 thoracic and 298 H&N (total 503) studies, involving both planning and re-planning scans and a total of 21 organs (9 - thorax, 12 - H&N). The studies were gathered from two patient age groups for each gender - 40-59 years and 60-79 years. The number of 3D OAR samples analyzed from the two body regions was 4301. IQS and OQS tended to cluster at the two ends of the score scale. Accordingly, we considered two quality groups for each gender - good and poor. Good quality data sets typically had OQS ≥ 6 and had distortions, artifacts, pathology etc. in not more than 3 slices through the object. The number of model-worthy data sets used for training were 38 for thorax and 36 for H&N, and the remaining 479 studies were used for testing AAR-RT. Accordingly, we created 4 anatomy models, one each for: Thorax male (20 model-worthy data sets), Thorax female (18 model-worthy data sets), H&N male (20 model-worthy data sets), and H&N female (16 model-worthy data sets). On "good" cases, AAR-RT's recognition accuracy was within 2 voxels and delineation boundary distance was within ∼1 voxel. This was similar to the variability observed between two dosimetrists in manually contouring 5-6 OARs in each of 169 studies. On "poor" cases, AAR-RT's errors hovered around 5 voxels for recognition and 2 voxels for boundary distance. The performance was similar on planning and replanning cases, and there was no gender difference in performance. AAR-RT's recognition operation is much more robust than delineation. Understanding object and image quality and how they influence performance is crucial for devising effective object recognition and delineation algorithms. OQS seems to be more important than IQS in determining accuracy. Streak artifacts arising from dental implants and fillings and beam hardening from bone pose the greatest challenge to auto-contouring methods.

Quantification of body-torso-wide tissue composition on low-dose CT images via automatic anatomy recognition

PURPOSE

Quantification of body composition plays an important role in many clinical and research applications. Radiologic imaging techniques such as Dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging (MRI), and computed tomography (CT) imaging make accurate quantification of the body composition possible. However, most current imaging-based methods need human interaction to quantify multiple tissues. When dealing with whole-body images of many subjects, interactive methods become impractical. This paper presents an automated, efficient, accurate, and practical body composition quantification method for low-dose CT images.

METHOD

Our method, named automatic anatomy recognition body composition analysis (AAR-BCA), aims to quantify four tissue components in body torso (BT) - subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), bone tissue, and muscle tissue - from CT images of given whole-body positron emission tomography/computed tomography (PET/CT) acquisitions. AAR-BCA consists of three key steps - modeling BT with its ensemble of key objects from a population of patient images, recognition or localization of these objects in a given patient image I, and delineation and quantification of the four tissue components in I guided by the recognized objects. In the first step, from a given set of patient images and the associated delineated objects, a fuzzy anatomy model of the key object ensemble, including anatomic organs, tissue regions, and tissue interfaces, is built where the objects are organized in a hierarchical order. The second step involves recognizing, or finding roughly the location of, each object in any given whole-body image I of a patient following the object hierarchy and guided by the built model. The third step makes use of this fuzzy localization information of the objects and the intensity distributions of the four tissue components, already learned and encoded in the model, to optimally delineate in a fuzzy manner and quantify these components. All parameters in our method are determined from training datasets.

RESULTS

Thirty-eight low-dose CT images from different subjects are tested in a fivefold cross-validation strategy for evaluating AAR-BCA with a 23-15 train-test dataset division. For BT, over all objects, AAR-BCA achieves a false-positive volume fraction (FPVF) of 3.7% and false-negative volume fraction (FNVF) of 3.8%. Notably, SAT achieves both a FPVF and FNVF under 3%. For bone tissue, it achieves a FPVF and a FNVF both under 3.5%. For VAT tissue, the FNVF of 4.8% is higher than for other objects and so also for muscle (4.7%). The level of accuracy for the four tissue components in individual body subregions mostly remains at the same level as for BT. The processing time required per patient image is under a minute.

CONCLUSIONS

Motivated by applications in cancer and systemic diseases, our goal in this paper was to seek a practical method for body composition quantification which is automated, accurate, and efficient, and works on BT in low-dose CT. The proposed AAR-BCA method toward this goal can quantify four tissue components including SAT, VAT, bone tissue, and muscle tissue in the body torso with under 5% overall error. All needed parameters can be automatically estimated from the training datasets.

Body region localization in whole-body low-dose CT images of PET/CT scans using virtual landmarks

PURPOSE

Radiological imaging and image interpretation for clinical decision making are mostly specific to each body region such as head and neck, thorax, abdomen, pelvis, and extremities. In this study, we present a new solution to trim automatically the given axial image stack into image volumes satisfying the given body region definition.

METHODS

The proposed approach consists of the following steps. First, a set of reference objects is selected and roughly segmented. Virtual landmarks (VLs) for the objects are then identified by using principal component analysis and recursive subdivision of the object via the principal axes system. The VLs can be defined based on just the binary objects or objects with gray values also considered. The VLs may lie anywhere with respect to the object, inside or outside, and rarely on the object surface, and are tethered to the object. Second, a classic neural network regressor is configured to learn the geometric mapping relationship between the VLs and the boundary locations of each body region. The trained network is then used to predict the locations of the body region boundaries. In this study, we focus on three body regions - thorax, abdomen, and pelvis, and predict their superior and inferior axial locations denoted by TS(I), TI(I), AS(I), AI(I), PS(I), and PI(I), respectively, for any given volume image I. Two kinds of reference objects - the skeleton and the lungs and airways, are employed to test the localization performance of the proposed approach.

RESULTS

Our method is tested by using low-dose unenhanced computed tomography (CT) images of 180 near whole-body ¹⁸ F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scans (including 34 whole-body scans) which are randomly divided into training and testing sets with a ratio of 85%:15%. The procedure is repeated six times and three times for the case of lungs and skeleton, respectively, with different divisions of the entire data set at this proportion. For the case of using skeleton as a reference object, the overall mean localization error for the six locations expressed as number of slices (nS) and distance (dS) in mm, is found to be nS: 3.4, 4.7, 4.1, 5.2, 5.2, and 3.9; dS: 13.4, 18.9, 16.5, 20.8, 20.8, and 15.5 mm for binary objects; nS: 4.1, 5.7, 4.3, 5.9, 5.9, and 4.0; dS: 16.2, 22.7, 17.2, 23.7, 23.7, and 16.1 mm for gray objects, respectively. For the case of using lungs and airways as a reference object, the corresponding results are, nS: 4.0, 5.3, 4.1, 6.9, 6.9, and 7.4; dS: 15.0, 19.7, 15.3, 26.2, 26.2, and 27.9 mm for binary objects; nS: 3.9, 5.4, 3.6, 7.2, 7.2, and 7.6; dS: 14.6, 20.1, 13.7, 27.3, 27.3, and 28.6 mm for gray objects, respectively.

CONCLUSIONS

Precise body region identification automatically in whole-body or body region tomographic images is vital for numerous medical image analysis and analytics applications. Despite its importance, this issue has received very little attention in the literature. We present a solution to this problem in this study using the concept of virtual landmarks. The method achieves localization accuracy within 2-3 slices, which is roughly comparable to the variation found in localization by experts. As long as the reference objects can be roughly segmented, the method with its learned VLs-to-boundary location relationship and predictive ability is transferable from one image modality to another.

Disease quantification on PET/CT images without explicit object delineation

PURPOSE

The derivation of quantitative information from images in a clinically practical way continues to face a major hurdle because of image segmentation challenges. This paper presents a novel approach, called automatic anatomy recognition-disease quantification (AAR-DQ), for disease quantification (DQ) on positron emission tomography/computed tomography (PET/CT) images. This approach explores how to decouple DQ methods from explicit dependence on object (e.g., organ) delineation through the use of only object recognition results from our recently developed automatic anatomy recognition (AAR) method to quantify disease burden.

METHOD

The AAR-DQ process starts off with the AAR approach for modeling anatomy and automatically recognizing objects on low-dose CT images of PET/CT acquisitions. It incorporates novel aspects of model building that relate to finding an optimal disease map for each organ. The parameters of the disease map are estimated from a set of training image data sets including normal subjects and patients with metastatic cancer. The result of recognition for an object on a patient image is the location of a fuzzy model for the object which is optimally adjusted for the image. The model is used as a fuzzy mask on the PET image for estimating a fuzzy disease map for the specific patient and subsequently for quantifying disease based on this map. This process handles blur arising in PET images from partial volume effect entirely through accurate fuzzy mapping to account for heterogeneity and gradation of disease content at the voxel level without explicitly performing correction for the partial volume effect. Disease quantification is performed from the fuzzy disease map in terms of total lesion glycolysis (TLG) and standardized uptake value (SUV) statistics. We also demonstrate that the method of disease quantification is applicable even when the "object" of interest is recognized manually with a simple and quick action such as interactively specifying a 3D box ROI. Depending on the degree of automaticity for object and lesion recognition on PET/CT, DQ can be performed at the object level either semi-automatically (DQ-MO) or automatically (DQ-AO), or at the lesion level either semi-automatically (DQ-ML) or automatically.

RESULTS

We utilized 67 data sets in total: 16 normal data sets used for model building, and 20 phantom data sets plus 31 patient data sets (with various types of metastatic cancer) used for testing the three methods DQ-AO, DQ-MO, and DQ-ML. The parameters of the disease map were estimated using the leave-one-out strategy. The organs of focus were left and right lungs and liver, and the disease quantities measured were TLG, SUV_Mean, and SUV_Max. On phantom data sets, overall error for the three parameters were approximately 6%, 3%, and 0%, respectively, with TLG error varying from 2% for large "lesions" (37 mm diameter) to 37% for small "lesions" (10 mm diameter). On patient data sets, for non-conspicuous lesions, those overall errors were approximately 19%, 14% and 0%; for conspicuous lesions, these overall errors were approximately 9%, 7%, 0%, respectively, with errors in estimation being generally smaller for liver than for lungs, although without statistical significance.

CONCLUSIONS

Accurate disease quantification on PET/CT images without performing explicit delineation of lesions is feasible following object recognition. Method DQ-MO generally yields more accurate results than DQ-AO although the difference is statistically not significant. Compared to current methods from the literature, almost all of which focus only on lesion-level DQ and not organ-level DQ, our results were comparable for large lesions and were superior for smaller lesions, with less demand on training data and computational resources. DQ-AO and even DQ-MO seem to have the potential for quantifying disease burden body-wide routinely via the AAR-DQ approach.

Dual-modality multi-atlas segmentation of torso organs from [18F]FDG-PET/CT images

PURPOSE

Automated segmentation of torso organs from positron emission tomography/computed tomography (PET/CT) images is a prerequisite step for nuclear medicine image analysis. However, accurate organ segmentation from clinical PET/CT is challenging due to the poor soft tissue contrast in the low-dose CT image and the low spatial resolution of the PET image. To overcome these challenges, we developed a multi-atlas segmentation (MAS) framework for torso organ segmentation from 2-deoxy-2-[¹⁸F]fluoro-D-glucose PET/CT images.

METHOD

Our key idea is to use PET information to compensate for the imperfect CT contrast and use surface-based atlas fusion to overcome the low PET resolution. First, all the organs are segmented from CT using a conventional MAS method, and then the abdomen region of the PET image is automatically cropped. Focusing on the cropped PET image, a refined MAS segmentation of the abdominal organs is performed, using a surface-based atlas fusion approach to reach subvoxel accuracy.

RESULTS

This method was validated based on 69 PET/CT images. The Dice coefficients of the target organs were between 0.80 and 0.96, and the average surface distances were between 1.58 and 2.44 mm. Compared to the CT-based segmentation, the PET-based segmentation gained a Dice increase of 0.06 and an ASD decrease of 0.38 mm. The surface-based atlas fusion leads to significant accuracy improvement for the liver and kidneys and saved ~ 10 min computation time compared to volumetric atlas fusion.

CONCLUSIONS

The presented method achieves better segmentation accuracy than conventional MAS method within acceptable computation time for clinical applications.

Automatic Anatomy Recognition using Neural Network Learning of Object Relationships via Virtual Landmarks

The recently developed body-wide Automatic Anatomy Recognition (AAR) methodology depends on fuzzy modeling of individual objects, hierarchically arranging objects, constructing an anatomy ensemble of these models, and a dichotomous object recognition-delineation process. The parent-to-offspring spatial relationship in the object hierarchy is crucial in the AAR method. We have found this relationship to be quite complex, and as such any improvement in capturing this relationship information in the anatomy model will improve the process of recognition itself. Currently, the method encodes this relationship based on the layout of the geometric centers of the objects. Motivated by the concept of virtual landmarks (VLs), this paper presents a new one-shot AAR recognition method that utilizes the VLs to learn object relationships by training a neural network to predict the pose and the VLs of an offspring object given the VLs of the parent object in the hierarchy. We set up two neural networks for each parent-offspring object pair in a body region, one for predicting the VLs and another for predicting the pose parameters. The VL-based learning/prediction method is evaluated on two object hierarchies involving 14 objects. We utilize 54 computed tomography (CT) image data sets of head and neck cancer patients and the associated object contours drawn by dosimetrists for routine radiation therapy treatment planning. The VL neural network method is found to yield more accurate object localization than the currently used simple AAR method.

The optimal anatomic site for a single slice to estimate the total volume of visceral adipose tissue by using the quantitative computed tomography (QCT) in Chinese population

BACKGROUND/OBJECTIVES

To investigate the relationship between the cross-sectional visceral adipose tissue (VAT) areas at different anatomic sites and the total VAT volume in a healthy Chinese population using quantitative computed tomography (QCT), and to identify the optimal anatomic site for a single slice to estimate the total VAT volume.

SUBJECTS/METHODS

A total of 389 healthy Chinese subjects aged 19-63 years underwent lumbar spine QCT scans. The cross-sectional area of total adipose tissue and VAT were measured using the tissue composition module of the software (QCT Pro, Mindways) at each intervertebral disc level from T₁₂/L₁ to L₅/S₁, as well as at the umbilical level. The total VAT volume was defined as the fat areas multiplied by the height of vertebral body for all six slices. Statistical analysis was performed to determine the correlation between single-slice VAT areas and the total VAT volume. Moreover, the optimal anatomic site for a single slice to estimate the total VAT volume was identified by multiple regression analysis.

RESULTS

The cross-sectional area of VAT and subcutaneous adipose tissue (SAT) measured at each anatomic site was all highly correlated with the total VAT volume and the total SAT volume (r = 0.89-0.98). Additionally, the VAT area measured at the L₂/L₃ level showed the strongest correlation with the total VAT volume (r = 0.98, P < 0.001). Covariates including age, gender, BMI, waist, and hypertension make a slight effect on the prediction of the total VAT volume.

CONCLUSION

It is feasible to perform measurements of VAT area on a single slice at L₂/L₃ level for estimating the total VAT volume.

Image Quality and Segmentation

Algorithms for image segmentation (including object recognition and delineation) are influenced by the quality of object appearance in the image and overall image quality. However, the issue of how to perform segmentation evaluation as a function of these quality factors has not been addressed in the literature. In this paper, we present a solution to this problem. We devised a set of key quality criteria that influence segmentation (global and regional): posture deviations, image noise, beam hardening artifacts (streak artifacts), shape distortion, presence of pathology, object intensity deviation, and object contrast. A trained reader assigned a grade to each object for each criterion in each study. We developed algorithms based on logical predicates for determining a 1 to 10 numeric quality score for each object and each image from reader-assigned quality grades. We analyzed these object and image quality scores (OQS and IQS, respectively) in our data cohort by gender and age. We performed recognition and delineation of all objects using recent adaptations [8, 9] of our Automatic Anatomy Recognition (AAR) framework [6] and analyzed the accuracy of recognition and delineation of each object. We illustrate our method on 216 head & neck and 211 thoracic cancer computed tomography (CT) studies.

Thoracic lymph node station recognition on CT images based on automatic anatomy recognition with an optimal parent strategy

Currently, there are many papers that have been published on the detection and segmentation of lymph nodes from medical images. However, it is still a challenging problem owing to low contrast with surrounding soft tissues and the variations of lymph node size and shape on computed tomography (CT) images. This is particularly very difficult on low-dose CT of PET/CT acquisitions. In this study, we utilize our previous automatic anatomy recognition (AAR) framework to recognize the thoracic-lymph node stations defined by the International Association for the Study of Lung Cancer (IASLC) lymph node map. The lymph node stations themselves are viewed as anatomic objects and are localized by using a one-shot method in the AAR framework. Two strategies have been taken in this paper for integration into AAR framework. The first is to combine some lymph node stations into composite lymph node stations according to their geometrical nearness. The other is to find the optimal parent (organ or union of organs) as an anchor for each lymph node station based on the recognition error and thereby find an overall optimal hierarchy to arrange anchor organs and lymph node stations. Based on 28 contrast-enhanced thoracic CT image data sets for model building, 12 independent data sets for testing, our results show that thoracic lymph node stations can be localized within 2-3 voxels compared to the ground truth.

Hierarchical model-based object localization for auto-contouring in head and neck radiation therapy planning

Segmentation of organs at risk (OARs) is a key step during the radiation therapy (RT) treatment planning process. Automatic anatomy recognition (AAR) is a recently developed body-wide multiple object segmentation approach, where segmentation is designed as two dichotomous steps: object recognition (or localization) and object delineation. Recognition is the high-level process of determining the whereabouts of an object, and delineation is the meticulous low-level process of precisely indicating the space occupied by an object. This study focuses on recognition. The purpose of this paper is to introduce new features of the AAR-recognition approach (abbreviated as AAR-R from now on) of combining texture and intensity information into the recognition procedure, using the optimal spanning tree to achieve the optimal hierarchy for recognition to minimize recognition errors, and to illustrate recognition performance by using large-scale testing computed tomography (CT) data sets. The data sets pertain to 216 non-serial (planning) and 82 serial (re-planning) studies of head and neck (H&N) cancer patients undergoing radiation therapy, involving a total of ~2600 object samples. Texture property "maximum probability of occurrence" derived from the co-occurrence matrix was determined to be the best property and is utilized in conjunction with intensity properties in AAR-R. An optimal spanning tree is found in the complete graph whose nodes are individual objects, and then the tree is used as the hierarchy in recognition. Texture information combined with intensity can significantly reduce location error for gland-related objects (parotid and submandibular glands). We also report recognition results by considering image quality, which is a novel concept. AAR-R with new features achieves a location error of less than 4 mm (~1.5 voxels in our studies) for good quality images for both serial and non-serial studies.

Auto-contouring via Automatic Anatomy Recognition of Organs at Risk in Head and Neck Cancer on CT images

Contouring of the organs at risk is a vital part of routine radiation therapy planning. For the head and neck (H&N) region, this is more challenging due to the complexity of anatomy, the presence of streak artifacts, and the variations of object appearance. In this paper, we describe the latest advances in our Automatic Anatomy Recognition (AAR) approach, which aims to automatically contour multiple objects in the head and neck region on planning CT images. Our method has three major steps: model building, object recognition, and object delineation. First, the better-quality images from our cohort of H&N CT studies are used to build fuzzy models and find the optimal hierarchy for arranging objects based on the relationship between objects. Then, the object recognition step exploits the rich prior anatomic information encoded in the hierarchy to derive the location and pose for each object, which leads to generalizable and robust methods and mitigation of object localization challenges. Finally, the delineation algorithms employ local features to contour the boundary based on object recognition results. We make several improvements within the AAR framework, including finding recognition-error-driven optimal hierarchy, modeling boundary relationships, combining texture and intensity, and evaluating object quality. Experiments were conducted on the largest ensemble of clinical data sets reported to date, including 216 planning CT studies and over 2,600 object samples. The preliminary results show that on data sets with minimal (<4 slices) streak artifacts and other deviations, overall recognition accuracy reaches 2 voxels, with overall delineation Dice coefficient close to 0.8 and Hausdorff Distance within 1 voxel.

A Study of the Feasibility of FDG-PET/CT to Systematically Detect and Quantify Differential Metabolic Effects of Chronic Tobacco Use in Organs of the Whole Body-A Prospective Pilot Study

RATIONALE AND OBJECTIVES

The aim of this study was to assess the feasibility of ¹⁸F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) to systematically detect and quantify differential effects of chronic tobacco use in organs of the whole body.

MATERIALS AND METHODS

Twenty healthy male subjects (10 nonsmokers and 10 chronic heavy smokers) were enrolled. Subjects underwent whole-body FDG-PET/CT, diagnostic unenhanced chest CT, mini-mental state examination, urine testing for oxidative stress, and serum testing. The organs of interest (thyroid, skin, skeletal muscle, aorta, heart, lung, adipose tissue, liver, spleen, brain, lumbar spinal bone marrow, and testis) were analyzed on FDG-PET/CT images to determine their metabolic activities using standardized uptake value (SUV) or metabolic volumetric product (MVP). Measurements were compared between subject groups using two-sample t tests or Wilcoxon rank-sum tests as determined by tests for normality. Correlational analyses were also performed.

RESULTS

FDG-PET/CT revealed significantly decreased metabolic activity of lumbar spinal bone marrow (MVPmean: 29.8 ± 9.7 cc vs 40.8 ± 11.6 cc, P = 0.03) and liver (SUVmean: 1.8 ± 0.2 vs 2.0 ± 0.2, P = 0.049) and increased metabolic activity of visceral adipose tissue (SUVmean: 0.35 ± 0.10 vs 0.26 ± 0.06, P = 0.02) in chronic smokers compared to nonsmokers. Normalized visceral adipose tissue volume was also significantly decreased (P = 0.04) in chronic smokers. There were no statistically significant differences in the metabolic activity of other assessed organs.

CONCLUSIONS

Subclinical organ effects of chronic tobacco use are detectable and quantifiable on FDG-PET/CT. FDG-PET/CT may, therefore, play a major role in the study of systemic toxic effects of tobacco use in organs of the whole body for clinical or research purposes.

Segmentation of Pathological Structures by Landmark-Assisted Deformable Models

Computerized segmentation of pathological structures in medical images is challenging, as, in addition to unclear image boundaries, image artifacts, and traces of surgical activities, the shape of pathological structures may be very different from the shape of normal structures. Even if a sufficient number of pathological training samples are collected, statistical shape modeling cannot always capture shape features of pathological samples as they may be suppressed by shape features of a considerably larger number of healthy samples. At the same time, landmarking can be efficient in analyzing pathological structures but often lacks robustness. In this paper, we combine the advantages of landmark detection and deformable models into a novel supervised multi-energy segmentation framework that can efficiently segment structures with pathological shape. The framework adopts the theory of Laplacian shape editing, that was introduced in the field of computer graphics, so that the limitations of statistical shape modeling are avoided. The performance of the proposed framework was validated by segmenting fractured lumbar vertebrae from 3-D computed tomography images, atrophic corpora callosa from 2-D magnetic resonance (MR) cross-sections and cancerous prostates from 3D MR images, resulting respectively in a Dice coefficient of 84.7 ± 5.0%, 85.3 ± 4.8% and 78.3 ± 5.1%, and boundary distance of 1.14 ± 0.49mm, 1.42 ± 0.45mm and 2.27 ± 0.52mm. The obtained results were shown to be superior in comparison to existing deformable model-based segmentation algorithms.

Automatic thoracic body region localization

Radiological imaging and image interpretation for clinical decision making are mostly specific to each body region such as head & neck, thorax, abdomen, pelvis, and extremities. For automating image analysis and consistency of results, standardizing definitions of body regions and the various anatomic objects, tissue regions, and zones in them becomes essential. Assuming that a standardized definition of body regions is available, a fundamental early step needed in automated image and object analytics is to automatically trim the given image stack into image volumes exactly satisfying the body region definition. This paper presents a solution to this problem based on the concept of virtual landmarks and evaluates it on whole-body positron emission tomography/computed tomography (PET/CT) scans. The method first selects a (set of) reference object(s), segments it (them) roughly, and identifies virtual landmarks for the object(s). The geometric relationship between these landmarks and the boundary locations of body regions in the cranio-caudal direction is then learned through a neural network regressor, and the locations are predicted. Based on low-dose unenhanced CT images of 180 near whole-body PET/CT scans (which includes 34 whole-body PET/CT scans), the mean localization error for the boundaries of superior of thorax (TS) and inferior of thorax (TI), expressed as number of slices (slice spacing ≈ 4mm)), and using either the skeleton or the pleural spaces as reference objects, is found to be 3,2 (using skeleton) and 3, 5 (using pleural spaces) respectively, or in mm 13, 10 mm (using skeleton) and 10.5, 20 mm (using pleural spaces), respectively. Improvements of this performance via optimal selection of objects and virtual landmarks and other object analytics applications are currently being pursued. and the skeleton and pleural spaces used as a reference objects.

Automatic Segmentation and Quantification of White and Brown Adipose Tissues from PET/CT Scans

In this paper, we investigate the automatic detection of white and brown adipose tissues using Positron Emission Tomography/Computed Tomography (PET/CT) scans, and develop methods for the quantification of these tissues at the whole-body and body-region levels. We propose a patient-specific automatic adiposity analysis system with two modules. In the first module, we detect white adipose tissue (WAT) and its two sub-types from CT scans: Visceral Adipose Tissue (VAT) and Subcutaneous Adipose Tissue (SAT). This process relies conventionally on manual or semi-automated segmentation, leading to inefficient solutions. Our novel framework addresses this challenge by proposing an unsupervised learning method to separate VAT from SAT in the abdominal region for the clinical quantification of central obesity. This step is followed by a context driven label fusion algorithm through sparse 3D Conditional Random Fields (CRF) for volumetric adiposity analysis. In the second module, we automatically detect, segment, and quantify brown adipose tissue (BAT) using PET scans because unlike WAT, BAT is metabolically active. After identifying BAT regions using PET, we perform a co-segmentation procedure utilizing asymmetric complementary information from PET and CT. Finally, we present a new probabilistic distance metric for differentiating BAT from non-BAT regions. Both modules are integrated via an automatic body-region detection unit based on one-shot learning. Experimental evaluations conducted on 151 PET/CT scans achieve state-of-the-art performances in both central obesity as well as brown adiposity quantification.

Planimetric correlation between the submandibular glands and the pancreas: a postmortem ductographic study

The salivary glands and pancreas have comparable anatomic and antigenic properties and can share common pathogenetic mechanisms involving toxic or autoimmune processes. The aim of this study is to assess the correlation in size between the normal submandibular glands and the pancreas. The study was based on human autopsy specimens of the pancreas, neck and oral base from 22 adults, both sexes (mean age, 57.9 years). The pancreatic and submandibular ducts were injected with a contrast medium, and the area of the salivary and pancreatic glandular ductograms was measured with the aid of software for quantification of visual information. Samples of tissue from the salivary glands and the pancreas were studied by means of light microscopy. A high correlation was found between the planimetric size of the pancreas and the submandibular glands (correlation coefficient 0.497 and 0.699 for the right and the left gland, respectively). This ratio was close to 5:1. There were no significant differences in size for the left vs. right submandibular gland (p = 0.39). The ductograms were significantly larger in size in males than in females (p < 0.001). This study has proven a positive correlation in planimetric size between the normal submandibular glands and pancreas, a result that is expected to have possible clinical implications in the long-term follow-up of patients with chronic pancreatitis.

Automatic anatomy recognition in whole-body PET/CT images

PURPOSE

Whole-body positron emission tomography/computed tomography (PET/CT) has become a standard method of imaging patients with various disease conditions, especially cancer. Body-wide accurate quantification of disease burden in PET/CT images is important for characterizing lesions, staging disease, prognosticating patient outcome, planning treatment, and evaluating disease response to therapeutic interventions. However, body-wide anatomy recognition in PET/CT is a critical first step for accurately and automatically quantifying disease body-wide, body-region-wise, and organwise. This latter process, however, has remained a challenge due to the lower quality of the anatomic information portrayed in the CT component of this imaging modality and the paucity of anatomic details in the PET component. In this paper, the authors demonstrate the adaptation of a recently developed automatic anatomy recognition (AAR) methodology [Udupa et al., "Body-wide hierarchical fuzzy modeling, recognition, and delineation of anatomy in medical images," Med. Image Anal. 18, 752-771 (2014)] to PET/CT images. Their goal was to test what level of object localization accuracy can be achieved on PET/CT compared to that achieved on diagnostic CT images.

METHODS

The authors advance the AAR approach in this work in three fronts: (i) from body-region-wise treatment in the work of Udupa et al. to whole body; (ii) from the use of image intensity in optimal object recognition in the work of Udupa et al. to intensity plus object-specific texture properties, and (iii) from the intramodality model-building-recognition strategy to the intermodality approach. The whole-body approach allows consideration of relationships among objects in different body regions, which was previously not possible. Consideration of object texture allows generalizing the previous optimal threshold-based fuzzy model recognition method from intensity images to any derived fuzzy membership image, and in the process, to bring performance to the level achieved on diagnostic CT and MR images in body-region-wise approaches. The intermodality approach fosters the use of already existing fuzzy models, previously created from diagnostic CT images, on PET/CT and other derived images, thus truly separating the modality-independent object assembly anatomy from modality-specific tissue property portrayal in the image.

RESULTS

Key ways of combining the above three basic ideas lead them to 15 different strategies for recognizing objects in PET/CT images. Utilizing 50 diagnostic CT image data sets from the thoracic and abdominal body regions and 16 whole-body PET/CT image data sets, the authors compare the recognition performance among these 15 strategies on 18 objects from the thorax, abdomen, and pelvis in object localization error and size estimation error. Particularly on texture membership images, object localization is within three voxels on whole-body low-dose CT images and 2 voxels on body-region-wise low-dose images of known true locations. Surprisingly, even on direct body-region-wise PET images, localization error within 3 voxels seems possible.

CONCLUSIONS

The previous body-region-wise approach can be extended to whole-body torso with similar object localization performance. Combined use of image texture and intensity property yields the best object localization accuracy. In both body-region-wise and whole-body approaches, recognition performance on low-dose CT images reaches levels previously achieved on diagnostic CT images. The best object recognition strategy varies among objects; the proposed framework however allows employing a strategy that is optimal for each object.

Retrospective 4D MR image construction from free-breathing slice Acquisitions: A novel graph-based approach

PURPOSE

Dynamic or 4D imaging of the thorax has many applications. Both prospective and retrospective respiratory gating and tracking techniques have been developed for 4D imaging via CT and MRI. For pediatric imaging, due to radiation concerns, MRI becomes the de facto modality of choice. In thoracic insufficiency syndrome (TIS), patients often suffer from extreme malformations of the chest wall, diaphragm, and/or spine with inability of the thorax to support normal respiration or lung growth (Campbell et al., 2003, Campbell and Smith, 2007), as such patient cooperation needed by some of the gating and tracking techniques are difficult to realize without causing patient discomfort and interference with the breathing mechanism itself. Therefore (ventilator-supported) free-breathing MRI acquisition is currently the best choice for imaging these patients. This, however, raises a question of how to create a consistent 4D image from such acquisitions. This paper presents a novel graph-based technique for compiling the best 4D image volume representing the thorax over one respiratory cycle from slice images acquired during unencumbered natural tidal-breathing of pediatric TIS patients.

METHODS

In our approach, for each coronal (or sagittal) slice position, images are acquired at a rate of about 200-300ms/slice over several natural breathing cycles which yields over 2000 slices. A weighted graph is formed where each acquired slice constitutes a node and the weight of the arc between two nodes defines the degree of contiguity in space and time of the two slices. For each respiratory phase, an optimal 3D spatial image is constructed by finding the best path in the graph in the spatial direction. The set of all such 3D images for a given respiratory cycle constitutes a 4D image. Subsequently, the best 4D image among all such constructed images is found over all imaged respiratory cycles. Two types of evaluation studies are carried out to understand the behavior of this algorithm and in comparison to a method called Random Stacking - a 4D phantom study and 10 4D MRI acquisitions from TIS patients and normal subjects. The 4D phantom was constructed by 3D printing the pleural spaces of an adult thorax, which were segmented in a breath-held MRI acquisition.

RESULTS

Qualitative visual inspection via cine display of the slices in space and time and in 3D rendered form showed smooth variation for all data sets constructed by the proposed method. Quantitative evaluation was carried out to measure spatial and temporal contiguity of the slices via segmented pleural spaces. The optimal method showed smooth variation of the pleural space as compared to Random Stacking whose behavior was erratic. The volumes of the pleural spaces at the respiratory phase corresponding to end inspiration and end expiration were compared to volumes obtained from breath-hold acquisitions at roughly the same phase. The mean difference was found to be roughly 3%.

CONCLUSIONS

The proposed method is purely image-based and post-hoc and does not need breath holding or external surrogates or instruments to record respiratory motion or tidal volume. This is important and practically warranted for pediatric patients. The constructed 4D images portray spatial and temporal smoothness that should be expected in a consistent 4D volume. We believe that the method can be routinely used for thoracic 4D imaging.

Minimally interactive segmentation of 4D dynamic upper airway MR images via fuzzy connectedness

PURPOSE

There are several disease conditions that lead to upper airway restrictive disorders. In the study of these conditions, it is important to take into account the dynamic nature of the upper airway. Currently, dynamic magnetic resonance imaging is the modality of choice for studying these diseases. Unfortunately, the contrast resolution obtainable in the images poses many challenges for an effective segmentation of the upper airway structures. No viable methods have been developed to date to solve this problem. In this paper, the authors demonstrate a practical solution by employing an iterative relative fuzzy connectedness delineation algorithm as a tool.

METHODS

3D dynamic images were collected at ten equally spaced instances over the respiratory cycle (i.e., 4D) in 20 female subjects with obstructive sleep apnea syndrome. The proposed segmentation approach consists of the following steps. First, image background nonuniformities are corrected which is then followed by a process to correct for the nonstandardness of MR image intensities. Next, standardized image intensity statistics are gathered for the nasopharynx and oropharynx portions of the upper airway as well as the surrounding soft tissue structures including air outside the body region, hard palate, soft palate, tongue, and other soft structures around the airway including tonsils (left and right) and adenoid. The affinity functions needed for fuzzy connectedness computation are derived based on these tissue intensity statistics. In the next step, seeds for fuzzy connectedness computation are specified for the airway and the background tissue components. Seed specification is needed in only the 3D image corresponding to the first time instance of the 4D volume; from this information, the 3D volume corresponding to the first time point is segmented. Seeds are automatically generated for the next time point from the segmentation of the 3D volume corresponding to the previous time point, and the process continues and runs without human interaction and completes in 10 s for segmenting the airway structure in the whole 4D volume.

RESULTS

Qualitative evaluations performed to examine smoothness and continuity of motions of the entire upper airway as well as its transverse sections at critical anatomic locations indicate that the segmentations are consistent. Quantitative evaluations of the separate 200 3D volumes and the 20 4D volumes yielded true positive and false positive volume fractions around 95% and 0.1%, respectively, and mean boundary placement errors under 0.5 mm. The method is robust to variations in the subjective action of seed specification. Compared with a segmentation approach based on a registration technique to propagate segmentations, the proposed method is more efficient, accurate, and less prone to error propagation from one respiratory time point to the next.

CONCLUSIONS

The proposed method is the first demonstration of a viable and practical approach for segmenting the upper airway structures in dynamic MR images. Compared to registration-based methods, it effectively reduces error propagation and consequently achieves not only more accurate segmentations but also more consistent motion representation in the segmentations. The method is practical, requiring minimal user interaction and computational time.

Progress in Fully Automated Abdominal CT Interpretation

OBJECTIVE

Automated analysis of abdominal CT has advanced markedly over just the last few years. Fully automated assessment of organs, lymph nodes, adipose tissue, muscle, bowel, spine, and tumors are some examples where tremendous progress has been made. Computer-aided detection of lesions has also improved dramatically.

CONCLUSION

This article reviews the progress and provides insights into what is in store in the near future for automated analysis for abdominal CT, ultimately leading to fully automated interpretation.

Quantitative normal thoracic anatomy at CT

Automatic anatomy recognition (AAR) methodologies for a body region require detailed understanding of the morphology, architecture, and geographical layout of the organs within the body region. The aim of this paper was to quantitatively characterize the normal anatomy of the thoracic region for AAR. Contrast-enhanced chest CT images from 41 normal male subjects, each with 11 segmented objects, were considered in this study. The individual objects were quantitatively characterized in terms of their linear size, surface area, volume, shape, CT attenuation properties, inter-object distances, size and shape correlations, size-to-distance correlations, and distance-to-distance correlations. A heat map visualization approach was used for intuitively portraying the associations between parameters. Numerous new observations about object geography and relationships were made. Some objects, such as the pericardial region, vary far less than others in size across subjects. Distance relationships are more consistent when involving an object such as trachea and bronchi than other objects. Considering the inter-object distance, some objects have a more prominent correlation, such as trachea and bronchi, right and left lungs, arterial system, and esophagus. The proposed method provides new, objective, and usable knowledge about anatomy whose utility in building body-wide models toward AAR has been demonstrated in other studies.

Defect detection in slab surface: a novel dual Charge-coupled Device imaging-based fuzzy connectedness strategy

To provide an accurate surface defects inspection system and make the automation of robust image segmentation method a reality in routine production line, a general approach is presented for continuous casting slab (CC-slab) surface defects extraction and delineation. The applicability of the system is not tied to CC-slab exclusively. We combined the line array CCD (Charge-coupled Device) traditional scanning imaging (LS-imaging) and area array CCD laser three-dimensional (3D) scanning imaging (AL-imaging) strategies in designing the system. Its aim is to suppress the respective imaging system's limitations. In the system, the images acquired from the two CCD sensors are carefully aligned in space and in time by maximum mutual information-based full-fledged registration schema. Subsequently, the image information is fused from these two subsystems such as the unbroken 2D information in LS-imaging and 3D depressed information in AL-imaging. Finally, on the basis of the established dual scanning imaging system the region of interest (ROI) localization by seed specification was designed, and the delineation for ROI by iterative relative fuzzy connectedness (IRFC) algorithm was utilized to get a precise inspection result. Our method takes into account the complementary advantages in the two common machine vision (MV) systems and it performs competitively with the state-of-the-art as seen from the comparison of experimental results. For the first time, a joint imaging scanning strategy is proposed for CC-slab surface defect inspection that allows a feasible way of powerful ROI delineation strategies to be applied to the MV inspection field. Multi-ROI delineation by using IRFC in this research field may further improve the results.