Clinical Evaluation of Real-Time Optical-Tracking Navigation and Live Time-Intensity Curves to Provide Feedback During Blinded 4D Contrast-Enhanced Ultrasound Imaging
Ahmed El Kaffas, Renhui Gong, Samvardhini Sridharan, Rosa Maria Silveira Sigrist, Isabelle Durot, Jürgen K. Willmann, Dimitre Hristov
Current commercial matrix transducers for 3D DCE-US do not display side-by-side B-mode and contrast-mode images when capturing volumetric data, thus leaving the operator with no position feedback during lengthy acquisitions. The purpose of this study was to investigate the use of transducer tracking to provide positioning feedback and to re-align images to improve quantification. An interventional tracking system was developed in house using an infrared camera and a 3D-printed tracking target attached to a X6-1 matrix transducer. The system displays a virtual probe on a separate screen and allows to capture a reference position to provide operator feedback when no B-mode image is available. To test this set-up, five experienced operators were asked to locate an image landmark within a volunteer liver in B-mode images using the X6-1 connected to an EPIQ7 system. Operators were then asked to maintain the transducer position for 4 minutes under three feedback methods: i) B-mode, ii) display of real-time virtual transducer, iii) blind. The magnitude of displacement over the cine was computed as an estimate of the imaging position error. We also investigated whether transducer coordinates can be used to re-align images due to motion and improve contrast ultrasound perfusion repeatability. A total of 8 patient data were obtained under an IRB for this. Results suggest that tracking can assist operators maintain a steady position during a lengthy acquisition. With blinded acquisition, an average displacement of 4.58 mm (S.D. 2.65 mm) was noted. In contrast, the average displacement for tracking-feedback was comparable to B-mode at 3.48 mm (S.D. 0.8 mm). We also observed that perfusion parameters had better repeatability after re-alignment.
Volume visualization is a method that displays three-dimensional (3D) data in two-dimensional (2D) space. Using 3D datasets instead of 2D traditional images improves the visualization of anatomical structures, and volume visualization helps radiologists and surgeons to review large datasets comprehensively so that diagnosis and treatment can be enhanced. In liver surgery, blood vessel detection is important. Liver vessels have various shapes and due to the presence of noise in the ultrasound images, they can be confused with noise. Suboptimal images can sometimes lead to surgical errors where …
Applications of ultrasound images have expanded from fetal imaging to abdominal and cardiac diagnosis. Liver-being the largest gland in the body and responsible for metabolic activities requires to be to be diagnosed and therefore subject to utmost injury. Although, ultrasound imaging has developed into three and four dimensions providing higher amount of information; it requires highly trained medical staff due to the image complexity and dimensions it contain. Since 2D ultrasound images are still considered to be the basis of clinical treatments,computer aided automated liver diagnosis is ve…
Image-guided radiation therapy can benefit from accurate motion tracking by ultrasound imaging, in order to minimize treatment margins and radiate moving anatomical targets, e.g., due to breathing. One way to formulate this tracking problem is the automatic localization of given tracked anatomical landmarks throughout a temporal ultrasound sequence. For this, we herein propose a fully-convolutional Siamese network that learns the similarity between pairs of image regions containing the same landmark. Accordingly, it learns to localize and thus track arbitrary image features, not only predefine…
PAII Inc.（PAII 公司）；Chang Gung Memorial Hospital, Linkou Medical Center（长庚纪念医院林口医学中心）；Institute of Molecular and Genomic Medicine, National Health Research Institutes（国家卫生研究院分子与基因组医学研究所）；Ping An Insurance Group（平安保险集团）
Background & Aims: Hepatic steatosis is a major cause of chronic liver disease. 2D ultrasound is the most widely used non-invasive tool for screening and monitoring, but associated diagnoses are highly subjective. We developed a scalable deep learning (DL) algorithm for quantitative scoring of liver steatosis from 2D ultrasound images. Approach & Results: Using retrospectively collected multi-view ultrasound data from 3,310 patients, 19,513 studies, and 228,075 images, we trained a DL algorithm to diagnose steatosis stages (healthy, mild, moderate, or severe) from ultrasound diagnoses. Perform…
Rutgers University（罗格斯大学）；Rutgers Cancer Institute of New Jersey（罗格斯大学新泽西癌症研究所）；Rutgers Robert Wood Johnson Medical School（罗格斯大学罗伯特·伍德·约翰逊医学院）；Johns Hopkins University（约翰斯·霍普金斯大学）
With the success of deep learning-based methods applied in medical image analysis, convolutional neural networks (CNNs) have been investigated for classifying liver disease from ultrasound (US) data. However, the scarcity of available large-scale labeled US data has hindered the success of CNNs for classifying liver disease from US data. In this work, we propose a novel generative adversarial network (GAN) architecture for realistic diseased and healthy liver US image synthesis. We adopt the concept of stacking to synthesize realistic liver US data. Quantitative and qualitative evaluation is p…
Chinese University of Hong Kong, Shenzhen（香港中文大学（深圳））；Shenzhen Research Institute of Big Data（深圳市大数据研究院）
Accurate analysis of the fibrosis stage plays very important roles in follow-up of patients with chronic hepatitis B infection. In this paper, a deep learning framework is presented for automatically liver fibrosis prediction. On contrary of previous works, our approach can take use of the information provided by multiple ultrasound images. An indicator-guided learning mechanism is further proposed to ease the training of the proposed model. This follows the workflow of clinical diagnosis and make the prediction procedure interpretable. To support the training, a dataset is well-collected whic…
Shenzhen Research Institute of Big Data, the Chinese University of Hong Kong（香港中文大学深圳大数据研究院）；Huazhong University of Science and Technology（华中科技大学）；Shenzhen Third People’s Hospital（深圳市第三人民医院）
With the development of radiomics, noninvasive diagnosis like ultrasound (US) imaging plays a very important role in automatic liver fibrosis diagnosis (ALFD). Due to the noisy data, expensive annotations of US images, the application of Artificial Intelligence (AI) assisting approaches encounters a bottleneck. Besides, the use of mono-modal US data limits the further improve of the classification results. In this work, we innovatively propose a multi-modal fusion network with active learning (MMFN-AL) for ALFD to exploit the information of multiple modalities, eliminate the noisy data and red…
PAII Inc.（PAII公司）；Chang Gung Memorial Hospital（长庚纪念医院）；Vanderbilt University（范德堡大学）；PingAn Technology（平安科技）
Ultrasound (US) is a critical modality for diagnosing liver fibrosis. Unfortunately, assessment is very subjective, motivating automated approaches. We introduce a principled deep convolutional neural network (CNN) workflow that incorporates several innovations. First, to avoid overfitting on non-relevant image features, we force the network to focus on a clinical region of interest (ROI), encompassing the liver parenchyma and upper border. Second, we introduce global heteroimage fusion (GHIF), which allows the CNN to fuse features from any arbitrary number of images in a study, increasing its…
Institute of Fundamental Technological Research, Polish Academy of Sciences（波兰科学院基础技术研究所）；Medical University of Warsaw（华沙医科大学）
Convolutional neural networks (CNNs) have achieved remarkable success in medical image analysis tasks. In ultrasound (US) imaging, CNNs have been applied to object classification, image reconstruction and tissue characterization. However, CNNs can be vulnerable to adversarial attacks, even small perturbations applied to input data may significantly affect model performance and result in wrong output. In this work, we devise a novel adversarial attack, specific to ultrasound (US) imaging. US images are reconstructed based on radio-frequency signals. Since the appearance of US images depends on …
Deep Regression 2D-3D Ultrasound Registration for Liver Motion Correction in Focal Tumor Thermal Ablation
Robarts Research Institute（罗伯茨研究所）；Western University（西安大略大学）；School of Biomedical Engineering, Western University（西安大略大学生物医学工程学院）；Lawson Health Research Institute（劳森健康研究所）
A Novel Framework for Integrating 3D Ultrasound into Percutaneous Liver Tumour Ablation
Robarts Research Institute, Western University, London, Canada（罗巴茨研究所在西蒙大学伦敦分校）；School of Biomedical Engineering, Western University, London, Canada（生物医学工程学院，西蒙大学伦敦分校）；Department of Medical Biophysics, Western University, London, Canada（医学生物物理学系，西蒙大学伦敦分校）；Department of Electrical and Computer Engineering, Western University, London, Canada（电气与计算机工程系，西蒙大学伦敦分校）；Department of Medical Imaging, Western University, London, Canada（医学影像系，西蒙大学伦敦分校）
University of Jordan（约旦大学）；King Abdullah II School for IT（阿卜杜拉二世信息技术学院）
Effective ultrasound tissue characterization is usually hindered by complex tissue structures. The interlacing of speckle patterns complicates the correct estimation of backscatter distribution parameters. Nakagami parametric imaging based on localized shape parameter mapping can model different backscattering conditions. However, performance of the constructed Nakagami image depends on the sensitivity of the estimation method to the backscattered statistics and scale of analysis. Using a fixed focal region of interest in estimating the Nakagami parametric image would increase estimation varia…
Ultrasound images are one of the most widely used techniques in clinical settings to analyze and detect different organs for study or diagnoses of diseases. The dependence on subjective opinions of experts such as radiologists calls for an automatic recognition and detection system that can provide an objective analysis. Previous work done on this topic is limited and can be classified by the organ of interest. Hybrid neural networks, linear and logistic regression models, 3D reconstructed models, and various machine learning techniques have been used to solve complex problems such as detectio…
Institute for Robotics and Cognitive Systems, Universität zu Lübeck（吕贝克大学机器人与认知系统研究所）
3D ultrasound (3DUS) becomes more interesting for target tracking in radiation therapy due to its capability to provide volumetric images in real-time without using ionizing radiation. It is potentially usable for tracking without using fiducials. For this, a method for learning meaningful representations would be useful to recognize anatomical structures in different time frames in representation space (r-space). In this study, 3DUS patches are reduced into a 128-dimensional r-space using conventional autoencoder, variational autoencoder and sliced-wasserstein autoencoder. In the r-space, the…
Non-invasive detection of microvascular alterations in deep tissues in vivo provides critical information for clinical diagnosis and evaluation of a broad-spectrum of pathologies. Recently, the emergence of super-resolution ultrasound localization microscopy (ULM) offers new possibilities for clinical imaging of microvasculature at capillary level. Currently, the clinical utility of ULM on clinical ultrasound scanners is hindered by the technical limitations, such as long data acquisition time, and compromised tracking performance associated with low imaging frame-rate. Here we present an in-h…
Energy-based ultrasound elastography techniques minimize a regularized cost function consisting of data and continuity terms to obtain local displacement estimates based on the local time-delay estimation (TDE) between radio-frequency (RF) frames. The data term associated with the existing techniques takes only the amplitude similarity into account and hence is not sufficiently robust to the outlier samples present in the RF frames under consideration. This drawback creates noticeable artifacts in the strain image. To resolve this issue, we propose to formulate the data function as a linear co…
Università degli Studi di Genova（热那亚大学）；IRCCS San Martino Hospital（IRCCS圣马蒂诺医院）
Due to the need for quick and effective treatments for liver diseases, which are among the most common health problems in the world, staging fibrosis through non-invasive and economic methods has become of great importance. Taking inspiration from diagnostic laparoscopy, used in the past for hepatic diseases, in this paper ultrasound images of the liver are studied, focusing on a specific region of the organ where the Glisson's capsule is visible. In ultrasound images, the Glisson's capsule appears in the shape of a line which can be extracted via classical methods in literature. By making use…
Ultrasound strain imaging, which delineates mechanical properties to detect tissue abnormalities, involves estimating the time-delay between two radio-frequency (RF) frames collected before and after tissue deformation. The existing regularized optimization-based time-delay estimation (TDE) techniques suffer from at least one of the following drawbacks: 1) The regularizer is not aligned with tissue deformation physics due to taking only the first-order displacement derivative into account. 2) The L2-norm of the displacement derivatives, which oversmooths the estimated time-delay, is utilized a…
Imperial College London（帝国理工学院）；King’s College London（伦敦国王学院）；Guy’s and St Thomas’ NHS Foundation Trust（盖伊和圣托马斯国民保健服务基金会信托）；City, University of London（伦敦城市大学）；Technical University of Munich（慕尼黑工业大学）
Fetal ultrasound screening during pregnancy plays a vital role in the early detection of fetal malformations which have potential long-term health impacts. The level of skill required to diagnose such malformations from live ultrasound during examination is high and resources for screening are often limited. We present an interpretable, atlas-learning segmentation method for automatic diagnosis of Hypo-plastic Left Heart Syndrome (HLHS) from a single `4 Chamber Heart' view image. We propose to extend the recently introduced Image-and-Spatial Transformer Networks (Atlas-ISTN) into a framework t…
Pakistan Institute of Engineering and Applied Sciences（巴基斯坦工程与应用科学学院）；Multan Institute of Nuclear Medicine and Radiotherapy（木尔坦核医学与放射治疗研究所）
This paper presents a novel approach for detection of liver abnormalities in an automated manner using ultrasound images. For this purpose, we have implemented a machine learning model that can not only generate labels (normal and abnormal) for a given ultrasound image but it can also detect when its prediction is likely to be incorrect. The proposed model abstains from generating the label of a test example if it is not confident about its prediction. Such behavior is commonly practiced by medical doctors who, when given insufficient information or a difficult case, can chose to carry out fur…
In conventional 2D DCE-US, motion correction algorithms take advantage of accompanying side-by-side anatomical Bmode images that contain time-stable features. However, current commercial models of 3D DCE-US do not provide side-by-side Bmode images, which makes motion correction challenging. This work introduces a novel motion correction (MC) algorithm for 3D DCE-US and assesses its efficacy when handling clinical data sets. In brief, the algorithm uses a pyramidal approach whereby short temporal windows consisting of 3-6 consecutive frames are created to perform local registrations, which are …
Objective: Strain elastography and shear wave elastography are two commonly used methods to quantify cervical elasticity; however, they have limitations. Strain elastography is effective in showing tissue elasticity distribution in a single image, but the absence of stress information causes difficulty in comparing the results acquired from different imaging sessions. Shear wave elastography is effective in measuring shear wave speed (an intrinsic tissue property correlated with elasticity) in relatively homogeneous tissue, such as in the liver. However, for inhomogeneous tissue in the cervix,…
