This study focuses on the challenging problem of labeling a collection of objects with inherent morphological and positional dependencies, where instances may be missing or duplicated. We integrate principles of assignment theory in the design of a convolutional neural network to find the optimal label set given pairwise geometrical features extracted from the candidate objects. The objective function aims to minimize the distance between the one-hot encoded labels of the objects and the scores produced by the model, with added emphasis on the scores corresponding to the optimal assignment plan. We tested our solution in the dental domain on the task of finding the teeth labels given a set of candidate instances. The study database included 1200 dental casts of upper and lower jaws from 600 patients. The model reached identification accuracies of 0.952 and 0.968 for the lower and upper jaws, respectively. Moreover, we presented a solution for generating teeth candidates using a multi-step pipeline consisting of coarse and fine segmentations. The algorithm was tested on a database consisting of 600 dental casts, reaching an F1 score of 0.968.

Morphological abnormalities of the femoroacetabular (hip) joint are among the most common human musculoskeletal disorders and often develop asymptomatically at early easily treatable stages. In this paper, we propose an automated framework for landmark-based detection and quantification of hip abnormalities from magnetic resonance (MR) images. The framework relies on a novel idea of multi-landmark environment analysis with reinforcement learning. In particular, we merge the concepts of the graphical lasso and Morris sensitivity analysis with deep neural networks to quantitatively estimate the contribution of individual landmark and landmark subgroup locations to the other landmark locations. Convolutional neural networks for image segmentation are utilized to propose the initial landmark locations, and landmark detection is then formulated as a reinforcement learning (RL) problem, where each landmark-agent can adjust its position by observing the local MR image neighborhood and the locations of the most-contributive landmarks. The framework was validated on T1-, T2- and proton density-weighted MR images of 260 patients with the aim to measure the lateral center-edge angle (LCEA), femoral neck-shaft angle (NSA), and the anterior and posterior acetabular sector angles (AASA and PASA) of the hip, and derive the quantitative abnormality metrics from these angles. The framework was successfully tested using the UNet and feature pyramid network (FPN) segmentation architectures for landmark proposal generation, and the deep Q-network (DeepQN), deep deterministic policy gradient (DDPG), twin delayed deep deterministic policy gradient (TD3), and actor-critic policy gradient (A2C) RL networks for landmark position optimization. The resulting overall landmark detection error of 1.5 mm and angle measurement error of 1.4° indicates a superior performance in comparison to existing methods. Moreover, the automatically estimated abnormality labels were in 95% agreement with those generated by an expert radiologist.

Computerized segmentation of pathological structures in medical images is challenging, as, in addition to unclear image boundaries, image artifacts, and traces of surgical activities, the shape of pathological structures may be very different from the shape of normal structures. Even if a sufficient number of pathological training samples are collected, statistical shape modeling cannot always capture shape features of pathological samples as they may be suppressed by shape features of a considerably larger number of healthy samples. At the same time, landmarking can be efficient in analyzing pathological structures but often lacks robustness. In this paper, we combine the advantages of landmark detection and deformable models into a novel supervised multi-energy segmentation framework that can efficiently segment structures with pathological shape. The framework adopts the theory of Laplacian shape editing, that was introduced in the field of computer graphics, so that the limitations of statistical shape modeling are avoided. The performance of the proposed framework was validated by segmenting fractured lumbar vertebrae from 3-D computed tomography images, atrophic corpora callosa from 2-D magnetic resonance (MR) cross-sections and cancerous prostates from 3D MR images, resulting respectively in a Dice coefficient of 84.7 ± 5.0%, 85.3 ± 4.8% and 78.3 ± 5.1%, and boundary distance of 1.14 ± 0.49mm, 1.42 ± 0.45mm and 2.27 ± 0.52mm. The obtained results were shown to be superior in comparison to existing deformable model-based segmentation algorithms.

Dental radiography plays an important role in clinical diagnosis, treatment and surgery. In recent years, efforts have been made on developing computerized dental X-ray image analysis systems for clinical usages. A novel framework for objective evaluation of automatic dental radiography analysis algorithms has been established under the auspices of the IEEE International Symposium on Biomedical Imaging 2015 Bitewing Radiography Caries Detection Challenge and Cephalometric X-ray Image Analysis Challenge. In this article, we present the datasets, methods and results of the challenge and lay down the principles for future uses of this benchmark. The main contributions of the challenge include the creation of the dental anatomy data repository of bitewing radiographs, the creation of the anatomical abnormality classification data repository of cephalometric radiographs, and the definition of objective quantitative evaluation for comparison and ranking of the algorithms. With this benchmark, seven automatic methods for analysing cephalometric X-ray image and two automatic methods for detecting bitewing radiography caries have been compared, and detailed quantitative evaluation results are presented in this paper. Based on the quantitative evaluation results, we believe automatic dental radiography analysis is still a challenging and unsolved problem. The datasets and the evaluation software will be made available to the research community, further encouraging future developments in this field. (http://www-o.ntust.edu.tw/~cweiwang/ISBI2015/).

Pathological conditions that cause instability of the spine are commonly treated by vertebral fixation involving pedicle screw placement surgery. However, existing methods for preoperative planning are based only on geometrical properties of vertebral structures (i.e., shape) without taking into account their structural properties (i.e., appearance). We propose a novel automated method for computer-assisted preoperative planning of the thoracic pedicle screw size and insertion trajectory. The proposed method extracts geometrical properties of vertebral structures by parametric modeling of vertebral bodies and pedicles in three dimensions (3D), and combines them with structural properties, evaluated through underlying image intensities in computed tomography (CT) images while considering the guidelines for pedicle screw design. The method was evaluated on 81 pedicles, obtained from 3D CT images of 11 patients that were appointed for pedicle screw placement surgery. In terms of mean absolute difference (MAD) and corresponding standard deviation (SD), the resulting high modeling accuracy of 0.39±0.31 mm for 3D vertebral body models and 0.31±0.25 mm for 3D pedicle models created an adequate anatomical frame for 3D pedicle screw models. When comparing the automatically obtained and manually defined plans for pedicle screw placement, a relatively high agreement was observed, with MAD ±SD of 0.4±0.4 mm for the screw diameter, 5.8±4.2 mm for the screw length, 2.0±1.4 mm for the pedicle crossing point and 7.6±5.8(°) for screw insertion angles. However, a statistically significant increase of 48±26% in the screw fastening strength in favor of the proposed automated method was observed in 99% of the cases.

Automated and semi-automated detection and segmentation of spinal and vertebral structures from computed tomography (CT) images is a challenging task due to a relatively high degree of anatomical complexity, presence of unclear boundaries and articulation of vertebrae with each other, as well as due to insufficient image spatial resolution, partial volume effects, presence of image artifacts, intensity variations and low signal-to-noise ratio. In this paper, we describe a novel framework for automated spine and vertebrae detection and segmentation from 3-D CT images. A novel optimization technique based on interpolation theory is applied to detect the location of the whole spine in the 3-D image and, using the obtained location of the whole spine, to further detect the location of individual vertebrae within the spinal column. The obtained vertebra detection results represent a robust and accurate initialization for the subsequent segmentation of individual vertebrae, which is performed by an improved shape-constrained deformable model approach. The framework was evaluated on two publicly available CT spine image databases of 50 lumbar and 170 thoracolumbar vertebrae. Quantitative comparison against corresponding reference vertebra segmentations yielded an overall mean centroid-to-centroid distance of 1.1 mm and Dice coefficient of 83.6% for vertebra detection, and an overall mean symmetric surface distance of 0.3 mm and Dice coefficient of 94.6% for vertebra segmentation. The results indicate that by applying the proposed automated detection and segmentation framework, vertebrae can be successfully detected and accurately segmented in 3-D from CT spine images.

Cephalometric analysis is an essential clinical and research tool in orthodontics for the orthodontic analysis and treatment planning. This paper presents the evaluation of the methods submitted to the Automatic Cephalometric X-Ray Landmark Detection Challenge, held at the IEEE International Symposium on Biomedical Imaging 2014 with an on-site competition. The challenge was set to explore and compare automatic landmark detection methods in application to cephalometric X-ray images. Methods were evaluated on a common database including cephalograms of 300 patients aged six to 60 years, collected from the Dental Department, Tri-Service General Hospital, Taiwan, and manually marked anatomical landmarks as the ground truth data, generated by two experienced medical doctors. Quantitative evaluation was performed to compare the results of a representative selection of current methods submitted to the challenge. Experimental results show that three methods are able to achieve detection rates greater than 80% using the 4 mm precision range, but only one method achieves a detection rate greater than 70% using the 2 mm precision range, which is the acceptable precision range in clinical practice. The study provides insights into the performance of different landmark detection approaches under real-world conditions and highlights achievements and limitations of current image analysis techniques.

In this paper, we propose a novel approach to landmark-based shape representation that is based on transportation theory, where landmarks are considered as sources and destinations, all possible landmark connections as roads, and established landmark connections as goods transported via these roads. Landmark connections, which are selectively established, are identified through their statistical properties describing the shape of the object of interest, and indicate the least costly roads for transporting goods from sources to destinations. From such a perspective, we introduce three novel shape representations that are combined with an existing landmark detection algorithm based on game theory. To reduce computational complexity, which results from the extension from 2-D to 3-D segmentation, landmark detection is augmented by a concept known in game theory as strategy dominance. The novel shape representations, game-theoretic landmark detection and strategy dominance are combined into a segmentation framework that was evaluated on 3-D computed tomography images of lumbar vertebrae and femoral heads. The best shape representation yielded symmetric surface distance of 0.75 mm and 1.11 mm, and Dice coefficient of 93.6% and 96.2% for lumbar vertebrae and femoral heads, respectively. By applying strategy dominance, the computational costs were further reduced for up to three times.

A novel game-theoretic framework for landmark-based image segmentation is presented. Landmark detection is formulated as a game, in which landmarks are players, landmark candidate points are strategies, and likelihoods that candidate points represent landmarks are payoffs, determined according to the similarity of image intensities and spatial relationships between the candidate points in the target image and their corresponding landmarks in images from the training set. The solution of the formulated game-theoretic problem is the equilibrium of candidate points that represent landmarks in the target image and is obtained by a novel iterative scheme that solves the segmentation problem in polynomial time. The object boundaries are finally extracted by applying dynamic programming to the optimal path searching problem between the obtained adjacent landmarks. The performance of the proposed framework was evaluated for segmentation of lung fields from chest radiographs and heart ventricles from cardiac magnetic resonance cross sections. The comparison to other landmark-based segmentation techniques shows that the results obtained by the proposed game-theoretic framework are highly accurate and precise in terms of mean boundary distance and area overlap. Moreover, the framework overcomes several shortcomings of the existing techniques, such as sensitivity to initialization and convergence to local optima.

We propose an algorithm for automated tracking of the contours of phospholipid vesicles, which can be used to evaluate the power, magnitude and frequency distribution of vesicle contour movements induced by thermal fluctuations. The algorithm was tested on vesicles with different structure composition that were exposed to variable temperature. The results show that the proposed algorithm is fast, robust and reliable, and that the resulting description of vesicle contours enables straightforward spectral analysis of their fluctuations, which can be also used for the determination of other vesicle properties, e.g. the bending rigidity or spontaneous curvature.