Fast GPU computation of 3D isothermal volumes in the vicinity of major blood vessels for multiprobe cryoablation simulation

Percutaneous cryoablation is a minimally invasive procedure of hypothermia for the treatment of tumors. Several needles are inserted in the tumor through the skin, to create an iceball and kill the malignant cells. The procedure consists of several cycles alternating extreme freezing and thawing. This procedure is very complex to plan, as the iceball is formed from multiple needles and influenced by major blood vessels nearby, making its final shape very difficult to anticipate. For computer assistance to cryoablation planning, it is essential to predict accurately the final volume of necrosis. In this paper, a fast GPU implementation of 3D thermal propagation is presented based on heat transfer equation. Our approach accounts for the presence of major blood vessels in the vicinity of the iceball. The method is validated first in gel conditions, then on an actual retrospective patient case of renal cryoablation with complex vascular structure close to the tumor. The results show that the accuracy of our simulated iceball can help surgeons in surgical planning

Learning to segment when experts disagree

Recent years have seen an increasing use of supervised learning methods for segmentation tasks. However, the predictive performance of these algorithms depend on the quality of labels, especially in medical image domain, where both the annotation cost and inter-observer variability are high. In a typical annotation collection process, different clinical experts provide their estimates of the “true” segmentation labels under the influence of their levels of expertise and biases. Treating these noisy labels blindly as the ground truth can adversely affect the performance of supervised segmentation models. In this work, we present a neural network architecture for jointly learning, from noisy observations alone, both the reliability of individual annotators and the true segmentation label distributions. The separation of the annotators’ characteristics and true segmentation label is achieved by encouraging the estimated annotators to be maximally unreliable while achieving high fidelity with the training data. Our method can also be viewed as a translation of STAPLE, an established label aggregation framework proposed in Warfield et al. [1] to the supervised learning paradigm. We demonstrate first on a generic segmentation task using MNIST data and then adapt for usage with MRI scans of multiple sclerosis (MS) patients for lesion labelling. Our method shows considerable improvement over the relevant baselines on both datasets in terms of segmentation accuracy and estimation of annotator reliability, particularly when only a single label is available per image. An open-source implementation of our approach can be found at https://github.com/UCLBrain/MSLS

GPU-based 3D iceball modeling for fast cryoablation simulation and planning

Purpose The elimination of abdominal tumors by percutaneous cryoablation has been shown to be an effective and less invasive alternative to open surgery. Cryoablation destroys malignant cells by freezing them with one or more cryoprobes inserted into the tumor through the skin. Alternating cycles of freezing and thawing produce an enveloping iceball that causes the tumor necrosis. Planning such a procedure is difficult and time-consuming, as it is necessary to plan the number and cryoprobe locations and predict the iceball shape which is also influenced by the presence of heating sources, e.g., major blood vessels and warm saline solution, injected to protect surrounding structures from the cold. Methods This paper describes a method for fast GPU-based iceball modeling based on the simulation of thermal propagation in the tissue. Our algorithm solves the heat equation within a cube around the cryoprobes tips and accounts for the presence of heating sources around the iceball. Results Experimental results of two studies have been obtained: an ex vivo warm gel setup and simulation on five retrospective patient cases of kidney tumors cryoablation with various levels of complexity of the vascular structure and warm saline solution around the tumor tissue. The experiments have been conducted in various conditions of cube size and algorithm implementations. Results show that it is possible to obtain an accurate result within seconds. Conclusion The promising results indicate that our method yields accurate iceball shape predictions in a short time and is suitable for surgical planning

Intra-operative fiducial-based CT/fluoroscope image registration framework for image-guided robot-assisted joint fracture surgery

Purpose Joint fractures must be accurately reduced minimising soft tissue damages to avoid negative surgical outcomes. To this regard, we have developed the RAFS surgical system, which allows the percutaneous reduction of intra-articular fractures and provides intra-operative real-time 3D image guidance to the surgeon. Earlier experiments showed the effectiveness of the RAFS system on phantoms, but also key issues which precluded its use in a clinical application. This work proposes a redesign of the RAFS’s navigation system overcoming the earlier version’s issues, aiming to move the RAFS system into a surgical environment. Methods The navigation system is improved through an image registration framework allowing the intra-operative registration between pre-operative CT images and intra-operative fluoroscopic images of a fractured bone using a custom-made fiducial marker. The objective of the registration is to estimate the relative pose between a bone fragment and an orthopaedic manipulation pin inserted into it intra-operatively. The actual pose of the bone fragment can be updated in real time using an optical tracker, enabling the image guidance. Results Experiments on phantom and cadavers demonstrated the accuracy and reliability of the registration framework, showing a reduction accuracy (sTRE) of about 0.88 ±0.2mm (phantom) and 1.15±0.8mm (cadavers). Four distal femur fractures were successfully reduced in cadaveric specimens using the improved navigation system and the RAFS system following the new clinical workflow (reduction error 1.2±0.3mm, 2±1∘). Conclusion Experiments showed the feasibility of the image registration framework. It was successfully integrated into the navigation system, allowing the use of the RAFS system in a realistic surgical application

Fetal brain tissue annotation and segmentation challenge results.

In-utero fetal MRI is emerging as an important tool in the diagnosis and analysis of the developing human brain. Automatic segmentation of the developing fetal brain is a vital step in the quantitative analysis of prenatal neurodevelopment both in the research and clinical context. However, manual segmentation of cerebral structures is time-consuming and prone to error and inter-observer variability. Therefore, we organized the Fetal Tissue Annotation (FeTA) Challenge in 2021 in order to encourage the development of automatic segmentation algorithms on an international level. The challenge utilized FeTA Dataset, an open dataset of fetal brain MRI reconstructions segmented into seven different tissues (external cerebrospinal fluid, gray matter, white matter, ventricles, cerebellum, brainstem, deep gray matter). 20 international teams participated in this challenge, submitting a total of 21 algorithms for evaluation. In this paper, we provide a detailed analysis of the results from both a technical and clinical perspective. All participants relied on deep learning methods, mainly U-Nets, with some variability present in the network architecture, optimization, and image pre- and post-processing. The majority of teams used existing medical imaging deep learning frameworks. The main differences between the submissions were the fine tuning done during training, and the specific pre- and post-processing steps performed. The challenge results showed that almost all submissions performed similarly. Four of the top five teams used ensemble learning methods. However, one team's algorithm performed significantly superior to the other submissions, and consisted of an asymmetrical U-Net network architecture. This paper provides a first of its kind benchmark for future automatic multi-tissue segmentation algorithms for the developing human brain in utero