Kirby G. Vosburgh

Oriented Speckle Reducing Anisotropic Diffusion

Ultrasound imaging systems provide the clinician with noninvasive, low-cost, and real-time images that can help them in diagnosis, planning, and therapy. However, although the human eye is able to derive the meaningful information from these images, automatic processing is very difficult due to noise and artifacts present in the image. The speckle reducing anisotropic diffusion filter was recently proposed to adapt the anisotropic diffusion filter to the characteristics of the speckle noise present in the ultrasound images and to facilitate automatic processing of images. We analyze the properties of the numerical scheme associated with this filter, using a semi-explicit scheme. We then extend the filter to a matrix anisotropic diffusion, allowing different levels of filtering across the image contours and in the principal curvature directions. We also show a relation between the local directional variance of the image intensity and the local geometry of the image, which can justify the choice of the gradient and the principal curvature directions as a basis for the diffusion matrix. Finally, different filtering techniques are compared on a 2-D synthetic image with two different levels of multiplicative noise and on a 3-D synthetic image of a Y-junction, and the new filter is applied on a 3-D real ultrasound image of the liver

In vitro simulation : Early results of stereotaxy for pedicle screw placement

Study Design. Frameless stereotaxy with doppler ultrasound and three dimensional computer model registration is assessed in vitro for pedicle screw placement. Objective. To identify feasibility of pedicle screw navigation and placement using this technology. Summary of Background Data. Inaccurate pedicle screw placement can lead to neurovascular injury or suboptimal fixation. Present techniques in pedicle screw placement involve only confirmation of hole orientation. Method. Forty‐four pedicle screws were placed in lumbosacral models and cadaver specimens. Accuracy was assessed with a computed tomography scan and vertebral cross sectioning. Results. All screws were intrapedicular. Accuracy of anterior cortical fixation was 1.5 mm, with a range of 2.5 mm. Conclusion. In vitro frameless stereotaxy is accurate for pedicle screw placement. This technology adds a component of navigation to pedicle screw placement.

A Navigation System for Augmenting Laparoscopic Ultrasound

Establishing image context is the major difficulty of performing laparoscopic ultrasound. The standard techniques used by transabdominal ultrasonographers to understand image orientation are difficult to apply with laparoscopic instruments. In this paper, we describe a navigation system that displays the position and orientation of laparoscopic ultrasound images to the operating surgeon in real time. The display technique we developed for showing the orientation information uses a 3D model of the aorta as the main visual reference. This technique is helpful because it provides surgeons with important spatial cues, which we show improves their ability to interpret the laparoscopic ultrasound.

Speckle-constrained filtering of ultrasound images

Ultrasound images provide the clinician with non-invasive, low cost, and real-time images that can help them in diagnosis, planning and therapy. However, although the human eye is able to derive the meaningful information from these images, automatic processing is very difficult because of the noise and artefacts present in the image. In this work, we propose to extend the current anisotropic diffusion technique to deal with the speckle noise present in the Ultrasound images. To this end, we use a previously derived model of the noise, and we write the restoration scheme as a energy minimization constrained by the noise model and parameters. This approach leads to a new data attachment term whose optimal weight can be automatically estimated.

A Colon Video Analysis Framework for Polyp Detection

This paper presents an automated video analysis framework for the detection of colonic polyps in optical colonoscopy. Our proposed framework departs from previous methods in that we include spatial frame-based analysis and temporal video analysis using time-course image sequences. We also provide a video quality assessment scheme including two measures of frame quality. We extract colon-specific anatomical features from different image regions using a windowing approach for intraframe spatial analysis. Anatomical features are described using an eigentissue model. We apply a conditional random field to model interframe dependences in tissue types and handle variations in imaging conditions and modalities. We validate our method by comparing our polyp detection results to colonoscopy reports from physicians. Our method displays promising preliminary results and shows strong invariance when applied to both white light and narrow-band video. Our proposed video analysis system can provide objective diagnostic support to physicians by locating polyps during colon cancer screening exams. Furthermore, our system can be used as a cost-effective video annotation solution for the large backlog of existing colonoscopy videos.

Towards scarless surgery: an endoscopic ultrasound navigation system for transgastric access procedures.

Objective: Scarless surgery is an innovative and promising technique that may herald a new era in surgical procedures. We have created a navigation system, named IRGUS, for endoscopic and transgastric access interventions and have validated it in in vivo pilot studies. Our hypothesis is that endoscopic ultrasound procedures will be performed more easily and efficiently if the operator is provided with approximately registered 3D and 2D processed CT images in real time that correspond to the probe position and ultrasound image. Materials and Methods: The system provides augmented visual feedback and additional contextual information to assist the operator. It establishes correspondence between the real-time endoscopic ultrasound image and a preoperative CT volume registered using electromagnetic tracking of the endoscopic ultrasound probe position. Based on this positional information, the CT volume is reformatted in approximately the same coordinate frame as the ultrasound image and displayed to the operator. Results: The system reduces the mental burden of probe navigation and enhances the operators ability to interpret the ultrasound image. Using an initial rigid body registration, we measured the mis-registration error between the ultrasound image and the reformatted CT plane to be less than 5 mm, which is sufficient to enable the performance of novice users of endoscopic systems to approach that of expert users. Conclusions: Our analysis shows that real-time display of data using rigid registration is sufficiently accurate to assist surgeons in performing endoscopic abdominal procedures. By using preoperative data to provide context and support for image interpretation and real-time imaging for targeting, it appears probable that both preoperative and intraoperative data may be used to improve operator performance.

Assessing technical skill in surgery and endoscopy: a set of metrics and an algorithm (C-PASS) to assess skills in surgical and endoscopic procedures.

Historically, the performance of surgeons has been assessed subjectively by senior surgical staff in both training and operating environments. In this work, the position and motion of surgical instruments are analyzed through an objective process, denoted C-PASS, to measure surgeon performance of laparoscopic, endoscopic, and image-guided procedures. To develop C-PASS, clinically relevant performance characteristics were identified. Then measurement techniques for parameters that represented each characteristic were derived, and analytic techniques were implemented to transform these parameters into explicit, robust metrics. The metrics comprise the C-PASS performance assessment method, which has been validated over the last 3 years in studies of laparoscopy and endoscopy. These studies show that C-PASS is straightforward, reproducible, and accurate. It is sufficiently powerful to assess the efficiency of these complex processes. It is likely that C-PASS and similar approaches will improve skills acquisition and learning and also enable the objective comparison of systems and techniques.

Evaluation of colonoscopy technical skill levels by use of an objective kinematic-based system.

BACKGROUND Colonoscopy requires training and experience to ensure accuracy and safety. Currently, no objective, validated process exists to determine when an endoscopist has attained technical competence. Kinematics data describing movements of laparoscopic instruments have been used in surgical skill assessment to define expert surgical technique. We have developed a novel system to record kinematics data during colonoscopy and quantitatively assess colonoscopist performance. OBJECTIVE To use kinematic analysis of colonoscopy to quantitatively assess endoscopic technical performance. DESIGN Prospective cohort study. SETTING Tertiary-care academic medical center. POPULATION This study involved physicians who perform colonoscopy. INTERVENTION Application of a kinematics data collection system to colonoscopy evaluation. MAIN OUTCOME MEASUREMENTS Kinematics data, validated task load assessment instrument, and technical difficulty visual analog scale. RESULTS All 13 participants completed the colonoscopy to the terminal ileum on the standard colon model. Attending physicians reached the terminal ileum quicker than fellows (median time, 150.19 seconds vs 299.86 seconds; p<.01) with reduced path lengths for all 4 sensors, decreased flex (1.75 m vs 3.14 m; P=.03), smaller tip angulation, reduced absolute roll, and lower curvature of the endoscope. With performance of attending physicians serving as the expert reference standard, the mean kinematic score increased by 19.89 for each decrease in postgraduate year (P<.01). Overall, fellows experienced greater mental, physical, and temporal demand than did attending physicians. LIMITATION Small cohort size. CONCLUSION Kinematic data and score calculation appear useful in the evaluation of colonoscopy technical skill levels. The kinematic score appears to consistently vary by year of training. Because this assessment is nonsubjective, it may be an improvement over current methods for determination of competence. Ongoing studies are establishing benchmarks and characteristic profiles of skill groups based on kinematics data.

Challenges in image-guided therapy system design

System development for image-guided therapy (IGT), or image-guided interventions (IGI), continues to be an area of active interest across academic and industry groups. This is an emerging field that is growing rapidly: major academic institutions and medical device manufacturers have produced IGT technologies that are in routine clinical use, dozens of high-impact publications are published in well regarded journals each year, and several small companies have successfully commercialized sophisticated IGT systems. In meetings between IGT investigators over the last two years, a consensus has emerged that several key areas must be addressed collaboratively by the community to reach the next level of impact and efficiency in IGT research and development to improve patient care. These meetings culminated in a two-day workshop that brought together several academic and industrial leaders in the field today. The goals of the workshop were to identify gaps in the engineering infrastructure available to IGT researchers, develop the role of research funding agencies and the recently established US-based National Center for Image Guided Therapy (NCIGT), and ultimately to facilitate the transfer of technology among research centers that are sponsored by the National Institutes of Health (NIH). Workshop discussions spanned many of the current challenges in the development and deployment of new IGT systems. Key challenges were identified in a number of areas, including: validation standards; workflows, use-cases, and application requirements; component reusability; and device interface standards. This report elaborates on these key points and proposes research challenges that are to be addressed by a joint effort between academic, industry, and NIH participants.

Multiscale segmentation of the aorta in 3D ultrasound images

Fast, reliable segmentation of the abdominal aorta from three dimensional ultrasound remains a difficult problem. Standard methods based on local information like thresholding, region growing or active contours fail in separating the arteries from the veins and suffer from the lack of homogeneity of the vessel intensity and from the partial contour information. We propose to use a model-based multiscale detection of the vessels centerlines based on a cylindrical model with circular cross-section, and adapted from previous work. Our method provides a set of centerlines and an estimate of the vessel radii along each line. After an interactive selection of the desired lines, a model of the aorta is generated using the radii information and compared to a manual segmentation. This model can also be locally improved using a level set technique in order to stick to the contours of the image and to allow non-circular cross-section.