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12 May 2004 Ventriculogram segmentation using boosted decision trees
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Left ventricular status, reflected in ejection fraction or end systolic volume, is a powerful prognostic indicator in heart disease. Quantitative analysis of these and other parameters from ventriculograms (cine xrays of the left ventricle) is infrequently performed due to the labor required for manual segmentation. None of the many methods developed for automated segmentation has achieved clinical acceptance. We present a method for semi-automatic segmentation of ventriculograms based on a very accurate two-stage boosted decision-tree pixel classifier. The classifier determines which pixels are inside the ventricle at key ED (end-diastole) and ES (end-systole) frames. The test misclassification rate is about 1%. The classifier is semi-automatic, requiring a user to select 3 points in each frame: the endpoints of the aortic valve and the apex. The first classifier stage is 2 boosted decision-trees, trained using features such as gray-level statistics (e.g. median brightness) and image geometry (e.g. coordinates relative to user supplied 3 points). Second stage classifiers are trained using the same features as the first, plus the output of the first stage. Border pixels are determined from the segmented images using dilation and erosion. A curve is then fit to the border pixels, minimizing a penalty function that trades off fidelity to the border pixels with smoothness. ED and ES volumes, and ejection fraction are estimated from border curves using standard area-length formulas. On independent test data, the differences between automatic and manual volumes (and ejection fractions) are similar in size to the differences between two human observers.
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John Alan McDonald and Florence H. Sheehan M.D. "Ventriculogram segmentation using boosted decision trees", Proc. SPIE 5370, Medical Imaging 2004: Image Processing, (12 May 2004);

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