Intravascular imaging using ultrasound or optical coherence tomography (OCT) is predominantly used to adjunct clinical information in interventional cardiology. OCT provides high-resolution images for detailed investigation of atherosclerosis-induced thickening of the lumen wall resulting in arterial blockage and triggering acute coronary events. However, the stochastic uncertainty of speckles limits effective visual investigation over large volume of pullback data, and clinicians are challenged by their inability to investigate subtle variations in the lumen topology associated with plaque vulnerability and onset of necrosis. This paper presents a lumen segmentation method using OCT imaging physics-based graph representation of signals and random walks image segmentation approaches. The edge weights in the graph are assigned incorporating OCT signal attenuation physics models. Optical backscattering maxima is tracked along each A-scan of OCT and is subsequently refined using global graylevel statistics and used for initializing seeds for the random walks image segmentation. Accuracy of lumen versus tunica segmentation has been measured on 15 in vitro and 6 in vivo pullbacks, each with 150-200 frames using 1) Cohen's kappa coefficient (0.9786 ±0.0061) measured with respect to cardiologist's annotation and 2) divergence of histogram of the segments computed with Kullback-Leibler (5.17 ±2.39) and Bhattacharya measures (0.56 ±0.28). High segmentation accuracy and consistency substantiates the characteristics of this method to reliably segment lumen across pullbacks in the presence of vulnerability cues and necrotic pool and has a deterministic finite time-complexity. This paper in general also illustrates the development of methods and framework for tissue classification and segmentation incorporating cues of tissue-energy interaction physics in imaging.

In this paper, we present a fusion algorithm supplemented with appropriate visualization by selecting relevant information from different modalities in mixed and augmented reality (AR). This encompasses a learning based method upon relevance of information, defined by an expert, which ultimately enables confident interventional decisions based on mixed reality (MR) images. The performance of our developed fusion and tailored visualization techniques was evaluated by employing X-ray/optical images during surgery and validated qualitatively using a 5-point Likert scale. Our observations indicated that the proposed technique provided semantic contextual information about underlying pixels and in general was preferred over the traditional pixel-wise linear alpha-blending method.

Over the past two decades, intravascular ultrasound (IVUS) image segmentation has remained a challenge for researchers while the use of this imaging modality is rapidly growing in catheterization procedures and in research studies. IVUS provides cross-sectional grayscale images of the arterial wall and the extent of atherosclerotic plaques with high spatial resolution in real time. In this paper, we review recently developed image processing methods for the detection of media-adventitia and luminal borders in IVUS images acquired with different transducers operating at frequencies ranging from 20 to 45 MHz. We discuss methodological challenges, lack of diversity in reported datasets, and weaknesses of quantification metrics that make IVUS segmentation still an open problem despite all efforts. In conclusion, we call for a common reference database, validation metrics, and ground-truth definition with which new and existing algorithms could be benchmarked.

In vivo plaque characterization is an important research field in interventional cardiology. We will study the realistic challenges to this goal by deploying 40 MHz single-element, mechanically rotating transducers. The intrinsic variability among the transducers' spectral parameters as well as tissue signals will be demonstrated. Subsequently, we will show that global data normalization is not suited for data calibration, due to the aforementioned variations as well as the stringent characteristics of spectral features. We will describe the sensitivity of an existing feature extraction algorithm based on eight spectral signatures (integrated backscatter coefficient, slope, midband-fit (MBF), intercept, and maximum and minimum powers and their relative frequencies) to a number of factors, such as the window size and order of the autoregressive (AR) model. It will be further demonstrated that the variations in the transducer's spectral parameters (i.e., center frequency and bandwidth) cause inconsistencies among extracted features. In this paper, two fundamental questions are addressed: 1) what is the best reliable way to extract the most informative features? and 2) which classification algorithm is the most appropriate for this problem? We will present a full-spectrum analysis as an alternative to the eight-feature approach. For the first time, different classification algorithms, such as k-nearest neighbors (k-NN) and linear Fisher, will be employed and their performances quantified. Finally, we will explore the reliability of the training dataset and the complexity of the recognition algorithm and illustrate that these two aspects can highly impact the accuracy of the end result, which has not been considered until now.