Traditional CT image acquisition uses bowtie filters to reduce dose, x-ray scatter, and detector dynamic range requirements. However, accurate patient centering within the bore of the CT scanner takes time and is often difficult to achieve precisely. Patient miscentering combined with a static bowtie filter can result in significant increases in dose, reconstruction noise, and CT number variations, and consequently raise overall exposure requirements. Approaches to estimate the patient position from scout scans and perform dynamic spatial beam filtration during acquisition are developed and applied in physical experiments on a CT test bench using different beam filtration strategies. While various dynamic beam modulation strategies have been developed, we focus on two approaches: (1) a simple approach using attenuation-based beam modulation using a translating bowtie filter and (2) dynamic beam modulation using multiple aperture devices (MADs)—an emerging beam filtration strategy based on binary filtration of the x-ray beam using variable width slits in a high-density beam blocker. Improved dose utilization and more consistent image performance with respect to an unmodulated baseline (static filter) are demonstrated for miscentered objects and dynamic beam filtration in physical experiments. For a homogeneous object miscentered by 4 cm, the dynamic filter reduced the maximum regional noise and dose penalties (compared with a centered object) from 173% to 16% and 42% to 14%, respectively, for a traditional bowtie, 29% to 8% and 24% to 15%, respectively, for a single MAD, and 275% to 11% and 56% to 18%, respectively, for a dual-MAD filter. The proposed methodology has the potential to relax patient centering requirements within the scanner, reduce setup time, and facilitate additional CT dose reduction.

Photon counting detectors (PCD) have the potential to improve x-ray imaging; however, they are still hindered by high costs and performance limitations. By using amorphous selenium (a-Se), the cost of PCDs can be significantly reduced compared with modern crystalline semiconductors, and enable large-area deposition. We are developing a direct conversion field-shaping multiwell avalanche detector (SWAD) to overcome the limitation of low carrier mobility and low charge conversion gain in a-Se. SWAD’s dual-grid design creates separate nonavalanche interaction (bulk) and avalanche sensing (well) regions, achieving depth-independent avalanche gain. Unipolar time differential (UTD) charge sensing, combined with tunable avalanche gain in the well region allows for fast response and high charge gain. We developed a probability-based numerical simulation to investigate the impact of UTD charge sensing and avalanche gain on the photon counting performance of different a-Se detector configurations. Pulse height spectra (PHS) for 59.5 and 30 keV photons were simulated. We observed excellent agreement between our model and previously published PHS measurements for a planar detector. The energy resolution significantly improved from 33 keV for the planar detector to ∼7  keV for SWAD. SWAD was found to have a linear response approaching 200  kcps  /  pixel.

The purpose of this study is to understand the phenotypes of thyroid eye disease (TED) through data derived from a multiatlas segmentation of computed tomography (CT) imaging. Images of 170 orbits of 85 retrospectively selected TED patients were analyzed with the developed automated segmentation tool. Twenty-five bilateral orbital structural metrics were used to perform principal component analysis (PCA). PCA of the 25 structural metrics identified the two most dominant structural phenotypes or characteristics, the “big volume phenotype” and the “stretched optic nerve phenotype,” that accounted for 60% of the variance. Most of the subjects in the study have either of these characteristics or a combination of both. A Kendall rank correlation between the principal components (phenotypes) and clinical data showed that the big volume phenotype was very strongly correlated (p-value <0.05) with motility defects, and loss of visual acuity. Whereas, the stretched optic nerve phenotype was strongly correlated (p-value <0.05) with an increased Hertel measurement, relatively better visual acuity, and smoking. Two clinical subtypes of TED, type 1 with enlarged muscles and type 2 with proptosis, are recognizable in CT imaging. Our automated algorithm identifies the phenotypes and finds associations with clinical markers.

Understanding the behavior of cells is an important problem for biologists. Significant research has been done to facilitate this by automating the segmentation of microscopic cellular images. Bright-field images of cells prove to be particularly difficult to segment, due to features such as low contrast, missing boundaries, and broken halos. We present two algorithms for automated segmentation of cellular images. These algorithms are based on a graph-partitioning approach, where each pixel is modeled as a node of a weighted graph. The method combines an effective region force with the Laplacian and total variation boundary forces, respectively, to give the two models. This region force can be interpreted as a conditional probability of a pixel belonging to a certain class (cell or background) given a small set of already labeled pixels. For practicality, we use a small set of only background pixels from the border of cell images as the labeled set. Both algorithms are tested on bright-field images to give good results. Due to faster performance, the Laplacian-based algorithm is also tested on a variety of other datasets, including fluorescent images, phase-contrast images, and 2-D and 3-D simulated images. The results show that the algorithm performs well and consistently across a range of various cell image features, such as the cell shape, size, contrast, and noise levels.

Glaucoma is a progressive optic neuropathy characterized by peripheral visual field loss, which is caused by degeneration of retinal nerve fibers. The peripheral vision loss due to glaucoma is asymptomatic. If not detected and treated at an early stage, it leads to complete blindness, which is irreversible in nature. The retinal nerve fiber layer defect (RNFLD) provides an earliest objective evidence of glaucoma. In this regard, we explore cost-effective redfree fundus imaging for RNFLD detection to be practically useful for computer-assisted early glaucoma risk assessment. RNFLD appears as a wedge shaped arcuate structure radiating from the optic disc. The very low contrast between RNFLD and background makes its visual detection quite challenging even by medical experts. In our study, we formulate a deep convolutional neural network (CNN) based patch classification strategy for RNFLD boundary localization. A large number of RNFLD and background image patches train the deep CNN model, which extracts sufficient discriminative information from the patches and results in accurate RNFLD boundary pixel classification. The proposed approach is found to achieve enhanced RNFLD detection performance with sensitivity of 0.8205 and false positive per image of 0.2000 on a newly created early glaucomatic fundus image database.

Ultrasound images acquired during axillary nerve block procedures can be difficult to interpret. Highlighting the important structures, such as nerves and blood vessels, may be useful for the training of inexperienced users. A deep convolutional neural network is used to identify the musculocutaneous, median, ulnar, and radial nerves, as well as the blood vessels in ultrasound images. A dataset of 49 subjects is collected and used for training and evaluation of the neural network. Several image augmentations, such as rotation, elastic deformation, shadows, and horizontal flipping, are tested. The neural network is evaluated using cross validation. The results showed that the blood vessels were the easiest to detect with a precision and recall above 0.8. Among the nerves, the median and ulnar nerves were the easiest to detect with an F-score of 0.73 and 0.62, respectively. The radial nerve was the hardest to detect with an F-score of 0.39. Image augmentations proved effective, increasing F-score by as much as 0.13. A Wilcoxon signed-rank test showed that the improvement from rotation, shadow, and elastic deformation augmentations were significant and the combination of all augmentations gave the best result. The results are promising; however, there is more work to be done, as the precision and recall are still too low. A larger dataset is most likely needed to improve accuracy, in combination with anatomical and temporal models.

Grand challenges stimulate advances within the medical imaging research community; within a competitive yet friendly environment, they allow for a direct comparison of algorithms through a well-defined, centralized infrastructure. The tasks of the two-part PROSTATEx Challenges (the PROSTATEx Challenge and the PROSTATEx-2 Challenge) are (1) the computerized classification of clinically significant prostate lesions and (2) the computerized determination of Gleason Grade Group in prostate cancer, both based on multiparametric magnetic resonance images. The challenges incorporate well-vetted cases for training and testing, a centralized performance assessment process to evaluate results, and an established infrastructure for case dissemination, communication, and result submission. In the PROSTATEx Challenge, 32 groups apply their computerized methods (71 methods total) to 208 prostate lesions in the test set. The area under the receiver operating characteristic curve for these methods in the task of differentiating between lesions that are and are not clinically significant ranged from 0.45 to 0.87; statistically significant differences in performance among the top-performing methods, however, are not observed. In the PROSTATEx-2 Challenge, 21 groups apply their computerized methods (43 methods total) to 70 prostate lesions in the test set. When compared with the reference standard, the quadratic-weighted kappa values for these methods in the task of assigning a five-point Gleason Grade Group to each lesion range from −0.24 to 0.27; superiority to random guessing can be established for only two methods. When approached with a sense of commitment and scientific rigor, challenges foster interest in the designated task and encourage innovation in the field.

Multiobjective optimization approaches for deformable image registration (DIR) remove the need for manual adjustment of key parameters and provide a set of solutions that represent high-quality trade-offs between objectives of interest. Choosing a desired outcome a posteriori is potentially far more insightful as differences between solutions can be immediately visualized. The purpose of this work is to investigate whether such an approach allows clinical experts to intuitively select their preferred DIR outcome. To this end, we developed a simplex-based tool for solution navigation and asked 10 clinical experts to use it to choose their preferred DIR outcome from sets of trade-off solutions obtained for 10 breast magnetic resonance DIR cases of low (prone-prone DIR; n  =  5) and high (prone-supine DIR; n  =  5) difficulty, of patients and volunteers, respectively. The usability of the software is subsequently evaluated by the observers using the system usability scale. Further, the quality of the selected DIR outcomes is evaluated using the mean target registration error. Results show that the users are able to identify and select high-quality DIR outcomes, and attested to high learnability and usability of our software, supporting the validity of the presumed added value of taking a multiobjective perspective on DIR in clinical practice.

Early detection of cancer can significantly increase the survival chances of patients. Palpation is a traditional method in order to detect cancer; however, in minimally invasive surgery the surgeon is deprived of the sense of touch. We demonstrate how shearing elastography can recover elastic parameters and furthermore can be used to localize stiffness imhomogenities even if hidden underneath the surface. Furthermore, the influence of size and depth of the stiffness imhomogenities on the detection accuracy and localization is investigated.

Prostate cancer is the most common nonskin-related cancer, affecting one in seven men in the United States. Gleason score, a sum of the primary and secondary Gleason patterns, is one of the best predictors of prostate cancer outcomes. Recently, significant progress has been made in molecular subtyping prostate cancer through the use of genomic sequencing. It has been established that prostate cancer patients presented with a Gleason score 7 show heterogeneity in both disease recurrence and survival. We built a unified system using publicly available whole-slide images and genomic data of histopathology specimens through deep neural networks to identify a set of computational biomarkers. Using a survival model, the experimental results on the public prostate dataset showed that the computational biomarkers extracted by our approach had hazard ratio as 5.73 and C-index as 0.74, which were higher than standard clinical prognostic factors and other engineered image texture features. Collectively, the results of this study highlight the important role of neural network analysis of prostate cancer and the potential of such approaches in other precision medicine applications.