Cadaver validation of intensity-based ultrasound to CT registration

A method is presented for the rigid registration of tracked B-mode ultrasound images to a CT volume of a femur and pelvis. This registration can allow tracked surgical instruments to be aligned with the CT image or an associated preoperative plan. Our method is fully automatic and requires no manual segmentation of either the ultrasound images or the CT volume. The parameter which is directly related to the speed of sound through tissue has also been included in the registration optimisation process. Experiments have been carried out on six cadaveric femurs and three cadaveric pelves. Registration results were compared with a "gold standard" registration acquired using bone implanted fiducial markers. Results show the registration method to be accurate, on average, to 1.6 mm root-mean-square target registration error.     

Linear intensity-based image registration by Markov random fields and discrete optimization

We propose a framework for intensity-based registration of images by linear transformations, based on a discrete Markov random field (MRF) formulation. Here, the challenge arises from the fact that optimizing the energy associated with this problem requires a high-order MRF model. Currently, methods for optimizing such high-order models are less general, easy to use, and efficient, than methods for the popular second-order models.Therefore, we propose an approximation to the original energy by an MRF with tractable second-order terms. The approximation at a certain point p in the parameter space is the normalized sum of evaluations of the original energy at projections of p to two-dimensional subspaces. We demonstrate the quality of the proposed approximation by computing the correlation with the original energy, and show that registration can be performed by discrete optimization of the approximated energy in an iteration loop. A search space refinement strategy is employed over iterations to achieve sub-pixel accuracy, while keeping the number of labels small for efficiency. The proposed framework can encode any similarity measure is robust to the settings of the internal parameters, and allows an intuitive control of the parameter ranges. We demonstrate the applicability of the framework by intensity-based registration, and 2D–3D registration of medical images. The evaluation is performed by random studies and real registration tasks. The tests indicate increased robustness and precision compared to corresponding standard optimization of the original energy, and demonstrate robustness to noise. Finally, the proposed framework allows the transfer of advances in MRF optimization to linear registration problems.     

基于灰度的二维/三维图像配准方法及其在骨科导航手术中的实现

目的随着基于医学图像导航的手术对三维信息需求的加强,建立二维/三维的医学图像配准算法,在二维规划的基础上引入三维信息。方法首先,将获取的骨盆图像体数据集通过投影得到DRR图像,将获取的X线图像进行校正;然后,利用灰度相似性测度配准DRR图像和无失真X线图像。结果在初始位置相对坐标位移<20mm,角度<5°时配准精度小于1.47%,取得良好的配准结果。结论本文提出的基于灰度计算的配准技术能够实现术中二维医学图像与术前三维医学图像的配准,实现术中二维/三维手术规划相结合。     

Tracking of a bronchoscope using epipolar geometry analysis and intensity-based image registration of real and virtual endoscopic images

This paper describes a method for tracking the camera motion of a flexible endoscope, in particular a bronchoscope, using epipolar geometry analysis and intensity-based image registration. The method proposed here does not use a positional sensor attached to the endoscope. Instead, it tracks camera motion using real endoscopic (RE) video images obtained at the time of the procedure and X-ray CT images acquired before the endoscopic examination. A virtual endoscope system (VES) is used for generating virtual endoscopic (VE) images. The basic idea of this tracking method is to find the viewpoint and view direction of the VES that maximizes a similarity measure between the VE and RE images. To assist the parameter search process, camera motion is also computed directly from epipolar geometry analysis of the RE video images. The complete method consists of two steps: (a) rough estimation using epipolar geometry analysis and (b) precise estimation using intensity-based image registration. In the rough registration process, the method computes camera motion from optical flow patterns between two consecutive RE video image frames using epipolar geometry analysis. In the image registration stage, we search for the VES viewing parameters that generate the VE image that is most similar to the current RE image. The correlation coefficient and the mean square intensity difference are used for measuring image similarity. The result obtained in the rough estimation process is used for restricting the parameter search area. We applied the method to bronchoscopic video image data from three patients who had chest CT images. The method successfully tracked camera motion for about 600 consecutive frames in the best case. Visual inspection suggests that the tracking is sufficiently accurate for clinical use. Tracking results obtained by performing the method without the epipolar geometry analysis step were substantially worse. Although the method required about 20 s to process one frame, the results demonstrate the potential of image-based tracking for use in an endoscope navigation system.     

Automatic multimodal 2D/3D breast image registration using biomechanical FEM models and intensity-based optimization

Due to their different physical origin, X-ray mammography and Magnetic Resonance Imaging (MRI) provide complementary diagnostic information. However, the correlation of their images is challenging due to differences in dimensionality, patient positioning and compression state of the breast. Our automated registration takes over part of the correlation task. The registration method is based on a biomechanical finite element model, which is used to simulate mammographic compression. The deformed MRI volume can be compared directly with the corresponding mammogram. The registration accuracy is determined by a number of patient-specific parameters. We optimize these parameters – e.g. breast rotation – using image similarity measures. The method was evaluated on 79 datasets from clinical routine. The mean target registration error was 13.2 mm in a fully automated setting. On basis of our results, we conclude that a completely automated registration of volume images with 2D mammograms is feasible. The registration accuracy is within the clinically relevant range and thus beneficial for multimodal diagnosis.     

Functional MRI of global and local processing in children

Functional magnetic resonance imaging was used to examine developmental change in hemispheric biases for globally and locally directed analysis of hierarchical forms. In a previous reaction time (RT) study, which presented hierarchical stimuli to the visual hemifields, children 7 to 14 years of age demonstrated an emerging pattern of hemispheric differences. Initially children analyzed local elements more slowly, without a strongly lateralized advantage for local or global level processing. With age, children's development was marked by a left hemisphere advantage for local level processing that resembled an adult's and a trend toward a right hemisphere advantage for global. In the current study, 20 children 12 to 14 years old were imaged during attend-global and attend-local conditions to determine whether the developmental change in cognitive measures corresponded to a change in distribution of functional activation. Children formed two groups based on their RT performance, immature-bilateral (IB) or mature-lateralized (ML). The volume of task-related activation within lateral temporo-occipital regions of interest was compared for global and local conditions between the two groups. The IB children showed greater activation overall for local level processing, comparable activation across the two hemispheres for the global condition, and a trend of right greater than left hemisphere activation for local. In contrast, the ML children displayed right greater than left hemisphere activation during global analysis and the opposite during local processing. Importantly these patterns of functional activation mirror the profiles of RT performance. Together they demonstrate a shift from undifferentiated, bilateral processing toward hemispheric lateralization.     

A versatile intensity-based 3D/2D rigid registration compatible with mobile C-arm for endovascular treatment of abdominal aortic aneurysm

Purpose

Augmented reality-assisted surgery requires prior registration between preoperative and intraoperative data. In the context of the endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm, no satisfactory solution exists at present for clinical use, in particular in the case of use with a mobile C-arm. The difficulties stem in particular from the diversity of intraoperative images, table movements and changes of C-arm pose.

Methods

We propose a fast and versatile 3D/2D registration method compatible with mobile C-arm that can be easily repeated during an EVAR procedure. Applicable to both vascular and bone structures, our approach is based on an optimization by reduced exhaustive search involving a multi-resolution scheme and a decomposition of the transformation to reduce calculation time.

Results

Registration was performed between the preoperative CT-scan and fluoroscopic images for a group of 26 patients in order to confront our method in real conditions of use. The evaluation was completed by also performing registration between an intraoperative CBCT volume and fluoroscopic images for a group of 6 patients to compare registration results with reference transformations. The experimental results show that our approach allows obtaining accuracy of the order of 0.5 mm, a computation time of \({<}17\,\hbox {s}\) and a higher rate of success in comparison with a classical optimization method. When integrated in an augmented reality navigation system, our approach shows that it is compatible with clinical workflow.

Conclusion

We presented a versatile 3D/2D rigid registration applicable to all intraoperative scenes and usable to guide an EVAR procedure by augmented reality.

     

Prostate multimodality image registration based on B-splines and quadrature local energy

Purpose  

Needle biopsy of the prostate is guided by Transrectal Ultrasound (TRUS) imaging. The TRUS images do not provide proper spatial localization of malignant tissues due to the poor sensitivity of TRUS to visualize early malignancy. Magnetic Resonance Imaging (MRI) has been shown to be sensitive for the detection of early stage malignancy, and therefore, a novel 2D deformable registration method that overlays pre-biopsy MRI onto TRUS images has been proposed.     

A global optimisation method for robust affine registration of brain images

Registration is an important component of medical image analysis and for analysing large amounts of data it is desirable to have fully automatic registration methods. Many different automatic registration methods have been proposed to date, and almost all share a common mathematical framework - one of optimising a cost function. To date little attention has been focused on the optimisation method itself, even though the success of most registration methods hinges on the quality of this optimisation. This paper examines the assumptions underlying the problem of registration for brain images using inter-modal voxel similarity measures. It is demonstrated that the use of local optimisation methods together with the standard multi-resolution approach is not sufficient to reliably find the global minimum. To address this problem, a global optimisation method is proposed that is specifically tailored to this form of registration. A full discussion of all the necessary implementation details is included as this is an important part of any practical method. Furthermore, results are presented for inter-modal, inter-subject registration experiments that show that the proposed method is more reliable at finding the global minimum than several of the currently available registration packages in common usage.     

Removal of confounding effects of global signal in functional MRI analyses

Local signals obtained from BOLD fMRI are generally confounded by global effects. In this paper, we make an essential distinction between global effects and the global signal. Global effects have a similar influence on local signals from a large proportion of cerebral voxels. They may reflect diffuse physiological processes or variations in scanner sensitivity and are difficult to measure directly. Global effects are often estimated from the global signal, which is the spatial average of local signals from all cerebral voxels. If the global signal is strongly correlated with experimental manipulations, meaningfully different results may be obtained whether or not global effects are modeled (G. K. Aguirre et al., 1998, NeuroImage, 8, 302-306). In particular, if local BOLD signals make a significant contribution to the global signal, analyses using ANCOVAor proportional scaling models may yield artifactual deactivations. In this paper, we present a modification to the proportional scaling model that accounts for the contribution of local BOLD signals to the global signal. An event-related oddball stimulus paradigm and a block design working memory task were used to illustrate the efficacy of our model.     

Hierarchical adaptive local affine registration for fast and robust respiratory motion estimation

Non-rigid image registration techniques are commonly used to estimate complex tissue deformations in medical imaging. A range of non-rigid registration algorithms have been proposed, but they typically have high computational complexity. To reduce this complexity, combinations of multiple less complex deformations have been proposed such as hierarchical techniques which successively split the non-rigid registration problem into multiple locally rigid or affine components. However, to date the splitting has been regular and the underlying image content has not been considered in the splitting process. This can lead to errors and artefacts in the resulting motion fields. In this paper, we propose three novel adaptive splitting techniques, an image-based, a similarity-based, and a motion-based technique within a hierarchical framework which attempt to process regions of similar motion and/or image structure in single registration components. We evaluate our technique on free-breathing whole-chest 3D MRI data from 10 volunteers and two publicly available CT datasets. We demonstrate a reduction in registration error of up to 49.1% over a non-adaptive technique and compare our results with a commonly used free-form registration algorithm.     

Accurate assessment of patellar tracking using fiducial and intensity-based fluoroscopic techniques

Accuracies of a point-based and an intensity-based fluoroscopic methods of assessing patella tracking were determined by comparing the pattern of patellar motion with respect to orientation (flexion, internal rotation, and lateral tilt) and translation (lateral, proximal, and anterior) with the pattern of patellar motion measured using Roentgen stereophotogrammetric analysis in three cadaver knee specimens. Each pose in the patellar motion could be obtained from single as well as multiple calibrated fluoroscopic images. The errors using the intensity-based method were slightly higher than those of the point-based method, but they appear to be sufficiently low to detect clinically significant differences in patellar kinematics.     

Meeting tomorrow's health care needs through local and global involvement

Strengthened efforts to achieve the United Nations Millennium Development Goals by 2015 are urgently needed. A fundamental step toward achieving these goals is strengthening global partnerships for development. This article describes critical challenges and opportunities in global health and the social responsibility of the nursing profession in this area. Examples and suggestions for nursing action are provided for consideration by those interested in influencing global health. Engaging in global health activities such as study abroad programs, interprofessional exchanges, continuing education workshops, and seminars with a global health focus can have significant implications for nursing education, research, policy, and practice. Equipping nurses with the leadership skills, knowledge, and attitudes needed to advance global health is integral in the delivery of effective, culturally relevant health care.     

Automated quantification of caudate atrophy by local registration of serial MRI: Evaluation and application in Huntington's disease

Objective: Caudate atrophy rate measured from serial MRI is proposed as a biomarker of HD progression that may be of use in assessing putative disease-modifying agents. Manual measurement techniques are the most widely applied but are time-consuming. We describe and evaluate an automated technique based on a local registration and boundary shift integral (BSI) approach at the caudate–CSF and caudate–white matter boundaries; caudate boundary shift integral (CBSI). Methods: Two-year caudate volume change was measured in controls, premanifest HD and early HD using the CBSI and compared with a detailed manual measure in terms of 1) raw caudate volume change, 2) group differentiation, 3) associations with clinical variables and 4) rater requirements. CBSI additivity was assessed by comparing measurements over a single scan pair (baseline → 2 years), with the sum of measurements from two scan pairs (baseline → 1 year → 2 years). Results: Techniques produced comparable caudate volume change measurements, although CBSI under-reported by 0.04 ml relative to manual. Both techniques distinguished controls, premanifest and early HD with a stepwise increase in rates across groups. Higher rates (CBSI and manual) were associated with increased proximity to estimated disease onset but not clinical change scores. CBSI reduced rater requirements by 2/3 (2 h per subject) relative to manual for this three time-point investigation. CBSI measurements over one scan pair showed good agreement with the sum of measurements from two scan pairs. Conclusions: CBSI results were comparable to a manual measure but with reduced rater requirements. CBSI may be of use in large-scale studies of HD.     

Hemispheric asymmetry in global/local processing: effects of stimulus position and spatial frequency

We examined the neural mechanisms of functional asymmetry between hemispheres in the processing of global and local information of hierarchical stimuli by measuring hemodynamic responses with functional magnetic resonance imaging (fMRI). In a selective attention task, subjects responded to targets at the global or local level of compound letters that were (1) broadband in spatial-frequency spectrum and presented at fixation; (2) broadband and presented randomly to the left or the right of fixation; or (3) contrast balanced (CB) to remove low spatial frequencies (SFs) and presented at fixation. Central broadband stimuli induced stronger activation in the right middle occipital cortex under global relative to local attention conditions but in the left inferior occipital cortex, stronger activation was induced under local relative to global attention conditions. The asymmetry over the occipital cortex was weakened by unilateral presentation and by contrast balancing. The results indicate that the lateralization of global and local processing is modulated by the position and SF spectrum of the compound stimuli. The global attention also produced stronger activation over the medial occipital cortex relative to the local attention under all the stimulus conditions. The nature of these effects is discussed.     

Early albumin infusion improves global and local hemodynamics and reduces inflammatory response in hemorrhagic shock

OBJECTIVE: To evaluate the effects of an early, short-term albumin infusion on mesenteric microcirculation and global hemodynamics in hemorrhagic shock. DESIGN: A prospective, randomized study. SETTING: Animal laboratory at a university medical clinic. SUBJECTS: Seventeen Sprague-Dawley rats weighing 250-400 g. INTERVENTIONS: The rats underwent median laparotomy and exteriorization of an ileal loop for intravital microscopy of the mesenteric microcirculation. Volume-controlled hemorrhagic shock was provoked by arterial blood withdrawal (2.5 mL/100 g body weight for 60 mins), followed by a 4-hr reperfusion period. Albumin (20%) or 0.9% NaCl was administered intravenously as a continuous infusion for 30 mins at the beginning of reperfusion. Reperfusion time mimicked a "prehospital" phase of 30 mins followed by a quasi "in-hospital" phase of 3.5 hrs. The "in-hospital" phase in both groups was initiated by substitution of blood followed by reperfusion with normal saline. MEASUREMENTS AND MAIN RESULTS: Central hemodynamics, mesenteric microcirculation, and arterial blood gas parameters were monitored before, during, and 60 mins after hemorrhagic shock, and for a 240-min follow-up period after initiation of reperfusion. Application of albumin markedly reduced rolling and adherent leukocytes, maximum velocity, and shear rate in the mesenteric microcirculation. Later, after improvement of mesenteric microcirculation, an intermittent increase of central venous pressure and abdominal blood flow and decrease of hematocrit was observed. CONCLUSIONS: Albumin treatment of hemorrhagic shock improves microcirculation and global hemodynamics and attenuates the inflammatory response to reperfusion. It may provide clinical benefit when applied at an early stage of reperfusion during hemorrhagic shock.