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Interactive 3D Image Analysis for Cranio-Maxillofacial Surgery Planning and Orthopedic Applications
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Modern medical imaging devices are able to generate highly detailed three-dimensional (3D) images of the skeleton. Computerized image processing and analysis methods, combined with real-time volume visualization techniques, can greatly facilitate the interpretation of such images and are increasingly used in surgical planning to aid reconstruction of the skeleton after trauma or disease. Two key challenges are to accurately separate (segment) bone structures or cavities of interest from the rest of the image and to interact with the 3D data in an efficient way. This thesis presents efficient and precise interactive methods for segmenting, visualizing, and analysing 3D computed tomography (CT) images of the skeleton. The methods are validated on real CT datasets and are primarily intended to support planning and evaluation of cranio-maxillofacial (CMF) and orthopedic surgery.

Two interactive methods for segmenting the orbit (eye-socket) are introduced. The first method implements a deformable model that is guided and fitted to the orbit via haptic 3D interaction, whereas the second method implements a user-steered volumetric brush that uses distance and gradient information to find exact object boundaries.

The thesis also presents a semi-automatic method for measuring 3D angulation changes in wrist fractures. The fractured bone is extracted with interactive mesh segmentation, and the angulation is determined with a technique based on surface registration and RANSAC.

Lastly, the thesis presents an interactive and intuitive tool for segmenting individual bones and bone fragments. This type of segmentation is essential for virtual surgery planning, but takes several hours to perform with conventional manual methods. The presented tool combines GPU-accelerated random walks segmentation with direct volume rendering and interactive 3D texture painting to enable quick marking and separation of bone structures. It enables the user to produce an accurate segmentation within a few minutes, thereby removing a major bottleneck in the planning procedure.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , 58 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Science and Technology, ISSN 1651-6214 ; 1411
Keyword [en]
medical image analysis, interactive segmentation, volume rendering, computed tomography
National Category
Computer Science Medical Image Processing
Research subject
Computerized Image Processing
Identifiers
URN: urn:nbn:se:uu:diva-301180ISBN: 978-91-554-9668-5OAI: oai:DiVA.org:uu-301180DiVA: diva2:954103
Public defence
2016-09-30, ITC 2446, Lägerhyddsvägen 2, Uppsala, 10:15 (English)
Opponent
Supervisors
Available from: 2016-09-09 Created: 2016-08-19 Last updated: 2016-09-13
List of papers
1. Visualization and Haptics for Interactive Medical Image Analysis: Image Segmentation in Cranio-Maxillofacial Surgery Planning
Open this publication in new window or tab >>Visualization and Haptics for Interactive Medical Image Analysis: Image Segmentation in Cranio-Maxillofacial Surgery Planning
2011 (English)In: Visual Informatics: Sustaining Research and Innovations / [ed] H. Badioze Zaman, et al. (Eds.), Berlin Heidelberg: Springer-Verlag , 2011, 1-12 p.Conference paper (Refereed)
Abstract [en]

A central problem in cranio-maxillofacial (CMF) surgery is to restore the normal anatomy of the skeleton after defects, e.g., trauma to the face. With careful pre-operative planning, the precision and predictability of the craniofacial reconstruction can be significantly improved. In addition, morbidity can be reduced thanks to shorter operation time. An important component in surgery planning is to be able to accurately measure the extent of anatomical structures. Of particular interest are the shape and volume of the orbits (eye sockets). These properties can be measured in 3D CT images of the skull, provided that an accurate segmentation of the orbits is available. Here, we present a system for interactive segmentation of the orbit in CT images. The system utilizes 3D visualization and haptic feedback to facilitate efficient exploration and manipulation of 3D data.

Place, publisher, year, edition, pages
Berlin Heidelberg: Springer-Verlag, 2011
Series
, Lecture Notes in Computer Science, 7066
National Category
Medical Image Processing
Research subject
Computerized Image Analysis; Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-161227 (URN)10.1007/978-3-642-25191-7_1 (DOI)978-3-642-25190-0 (ISBN)
Conference
2nd International Visual Informatics Conference (IVIC 2011)
Available from: 2011-11-10 Created: 2011-11-09 Last updated: 2016-09-06
2. Towards User-Guided Quantitative Evaluation of Wrist Fractures in CT Images
Open this publication in new window or tab >>Towards User-Guided Quantitative Evaluation of Wrist Fractures in CT Images
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2012 (English)In: Computer Vision and Graphics: ICCVG 2012 / [ed] Bolc, Leonard; Tadeusiewicz, Ryszard; Chmielewski, Leszek J; Wojciechowski, Konrad, Springer Berlin/Heidelberg, 2012, 204-211 p.Conference paper (Refereed)
Abstract [en]

The wrist is the most common location for long-bone fractures in humans. To evaluate the healing process of such fractures, it is of interest to measure the fracture displacement, particularly the angle between the joint line and the long axis of the fractured long bone. We propose to measure this angle in 3D computed tomography (CT) images of fractured wrists. As a first step towards this goal, we here present a fast and precise semi-automatic method for determining the long axis of the radius bone in CT images. To facilitate user interaction in 3D, we utilize stereo graphics, head tracking, 3D input, and haptic feedback.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2012
Series
, Lecture Notes in Computer Science, ISSN 0302-9743 ; 7594
National Category
Medical Image Processing
Research subject
Computerized Image Analysis
Identifiers
urn:nbn:se:uu:diva-185557 (URN)10.1007/978-3-642-33564-8_25 (DOI)000313005700025 ()978-3-642-33563-1 (ISBN)
Conference
ICCVG 2012, September 24-26, 2012, Warsaw, Poland
Available from: 2012-11-26 Created: 2012-11-26 Last updated: 2016-09-06Bibliographically approved
3. Shape and volume of craniofacial cavities in intentional skull deformations
Open this publication in new window or tab >>Shape and volume of craniofacial cavities in intentional skull deformations
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2013 (English)In: American Journal of Physical Anthropology, ISSN 0002-9483, E-ISSN 1096-8644, Vol. 151, no 1, 110-119 p.Article in journal (Refereed) Published
Abstract [en]

Intentional cranial deformations (ICD) have been observed worldwide but are especially prevalent in preColombian cultures. The purpose of this study was to assess the consequences of ICD on three cranial cavities (intracranial cavity, orbits, and maxillary sinuses) and on cranial vault thickness, in order to screen for morphological changes due to the external constraints exerted by the deformation device. We acquired CT-scans for 39 deformed and 19 control skulls. We studied the thickness of the skull vault using qualitative and quantitative methods. We computed the volumes of the orbits, of the maxillary sinuses, and of the intracranial cavity using haptic-aided semi-automatic segmentation. We finally defined 3D distances and angles within orbits and maxillary sinuses based on 27 anatomical landmarks and measured these features on the 58 skulls. Our results show specific bone thickness patterns in some types of ICD, with localized thinning in regions subjected to increased pressure and thickening in other regions. Our findings confirm that volumes of the cranial cavities are not affected by ICDs but that the shapes of the orbits and of the maxillary sinuses are modified in circumferential deformations. We conclude that ICDs can modify the shape of the cranial cavities and the thickness of their walls but conserve their volumes. These results provide new insights into the morphological effects associated with ICDs and call for similar investigations in subjects with deformational plagiocephalies and craniosynostoses.

National Category
Surgery Medical Image Processing
Identifiers
urn:nbn:se:uu:diva-198978 (URN)10.1002/ajpa.22263 (DOI)000318040200011 ()23553676 (PubMedID)
Available from: 2013-04-30 Created: 2013-04-30 Last updated: 2016-09-06Bibliographically approved
4. Precise 3D Angle Measurements in CT Wrist Images
Open this publication in new window or tab >>Precise 3D Angle Measurements in CT Wrist Images
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2013 (English)In: Image Analysis and Processing – ICIAP 2013: Part II, Springer Berlin/Heidelberg, 2013, 479-488 p.Conference paper (Refereed)
Abstract [en]

The clinically established method to assess the displacement of a distal radius fracture is to manually measure two reference angles,the dorsal angle and the radial angle, in consecutive 2D X-ray images of the wrist. This approach has the disadvantage of being sensitive to operator errors since the measurements are performed on 2D projections of a 3D structure. In this paper, we present a semi-automatic system for measuring relative changes in the dorsal angle in 3D computed tomography (CT) images of fractured wrists. We evaluate the proposed 3D measurement method on 28 post-operative CT images of fractured wrists and compare it with the radiographic 2D measurement method used in clinical practice. The results show that our proposed 3D measurement method has a high intra- and inter-operator precision and is more precise and robust than the conventional 2D measurement method.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2013
Series
, Lecture Notes in Computer Science, ISSN 0302-9743 ; 8157
Keyword
Wrist fractures, CT, angle measurements, bone segmentation, interactive mesh segmentation, surface registration
National Category
Medical Image Processing
Research subject
Computerized Image Analysis; Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-211749 (URN)10.1007/978-3-642-41184-7_49 (DOI)000329811200049 ()978-3-642-41183-0 (ISBN)
Conference
17th International Conference on Image Analysis and Processing (ICIAP), Naples, Italy, September 9-13, 2013
Available from: 2013-11-30 Created: 2013-11-30 Last updated: 2016-09-06Bibliographically approved
5. Optimal RANSAC - Towards a Repeatable Algorithm for Finding the Optimal Set
Open this publication in new window or tab >>Optimal RANSAC - Towards a Repeatable Algorithm for Finding the Optimal Set
2013 (English)In: Journal of WSCG, ISSN 1213-6972, Vol. 21, no 1, 21-30 p.Article in journal (Refereed) Published
National Category
Computer Vision and Robotics (Autonomous Systems)
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-200593 (URN)
Conference
International Conferences in Central Europe on Computer Graphics, Visualization and Computer Vision
Available from: 2013-05-31 Created: 2013-05-31 Last updated: 2016-09-06Bibliographically approved
6. BoneSplit - A 3D Texture Painting Tool for Interactive Bone Separation in CT Images
Open this publication in new window or tab >>BoneSplit - A 3D Texture Painting Tool for Interactive Bone Separation in CT Images
2015 (English)In: Journal of WSCG, ISSN 1213-6972, E-ISSN 1213-6964, Vol. 23, no 2, 157-166 p.Article in journal (Refereed) Published
Abstract [en]

We present an efficient interactive tool for separating collectively segmented bones and bone fragments in 3D computed tomography (CT) images. The tool, which is primarily intended for virtual cranio-maxillofacial (CMF) surgery planning, combines direct volume rendering with an interactive 3D texture painting interface to enable quick identification and marking of individual bone structures. The user can paint markers (seeds) directly on the rendered bone surfaces as well as on individual CT slices. Separation of the marked bones is then achieved through the random walks segmentation algorithm, which is applied on a graph constructed from the collective bone segmentation. The segmentation runs on the GPU and can achieve close to real-time update rates for volumes as large as 512^3. Segmentation editing can be performed both in the random walks segmentation stage and in a separate post-processing stage using a local 3D editing tool. In a preliminary evaluation of the tool, we demonstrate that segmentation results comparable with manual segmentations can be obtained within a few minutes.

National Category
Medical Image Processing
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-268818 (URN)
Available from: 2015-12-09 Created: 2015-12-09 Last updated: 2016-09-06
7. Comparison of 2D radiography and a semi-automatic CT-based 3D method for measuring change in dorsal angulation over time in distal radius fractures
Open this publication in new window or tab >>Comparison of 2D radiography and a semi-automatic CT-based 3D method for measuring change in dorsal angulation over time in distal radius fractures
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2016 (English)In: Skeletal Radiology, ISSN 0364-2348, E-ISSN 1432-2161, Vol. 45, no 6, 763-769 p.Article in journal (Refereed) Published
Abstract [en]

Objective The aim of the present study was to compare the reliability and agreement between a computer tomography-based method (CT) and digitalised 2D radiographs (XR) when measuring change in dorsal angulation over time in distal radius fractures. Materials and methods Radiographs from 33 distal radius fractures treated with external fixation were retrospectively analysed. All fractures had been examined using both XR and CT at six times over 6 months postoperatively. The changes in dorsal angulation between the first reference images and the following examinations in every patient were calculated from 133 follow-up measurements by two assessors and repeated at two different time points. The measurements were analysed using Bland-Altman plots, comparing intra- and inter-observer agreement within and between XR and CT. Results The mean differences in intra- and inter-observer measurements for XR, CT, and between XR and CT were close to zero, implying equal validity. The average intra- and inter-observer limits of agreement for XR, CT, and between XR and CT were +/- 4.4 degrees, +/- 1.9 degrees and +/- 6.8 degrees respectively. Conclusions For scientific purpose, the reliability of XR seems unacceptably low when measuring changes in dorsal angulation in distal radius fractures, whereas the reliability for the semi-automatic CT-based method was higher and is therefore preferable when a more precise method is requested.

National Category
Orthopedics Medical Image Processing
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-297776 (URN)10.1007/s00256-016-2350-6 (DOI)000374476200003 ()26922189 (PubMedID)
Available from: 2016-02-27 Created: 2016-06-28 Last updated: 2016-09-06Bibliographically approved
8. Rapid and Precise Orbit Segmentation through Interactive 3D Painting
Open this publication in new window or tab >>Rapid and Precise Orbit Segmentation through Interactive 3D Painting
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

In this paper, we present an efficient interactive tool for segmenting and measuring the volume of the bony orbit (eye-socket) in computed tomography (CT) images. The tool implements a 3D painting interface that allows the user to quickly segment or "paint" the fat and soft-tissue content of the orbit by sweeping a volumetric brush over the image. The brush modifies and updates the segmentation result in real-time and takes distance and gradient information into account to fill out and find the exact boundaries of the orbit. A smooth and consistent delineation of the anterior boundary is obtained by fitting a thin-plate spline to user-selected landmarks. We evaluate the tool on 10 CT images of intact and fractured orbits and show that it achieves high intra- and inter-operator precision (mean spatial overlap 95%, less than 1 ml volume variability) and produces segmentation results that are similar to manually corrected reference segmentations, but only requires a few minutes of interaction time.

Keyword
interactive segmentation, volume rendering, computed tomography, orbit
National Category
Medical Image Processing
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-301179 (URN)
Available from: 2016-08-19 Created: 2016-08-19 Last updated: 2016-09-06

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