A rising conciousness within both the medical community and in the public has been created by the current levels of radiation exposure from increased use of computed tomography. The concern has prompted the need for more data collection and analysis of hospital and imaging center exam doses. This has spurred the American College of Radiology (ACR) to develop the Dose Index Registry (DIR), which will allow participating insitutions to compare the radiation dose from their CT exams to aggregate national CT dose data based on exam type and body part. We outline the steps involved in the process of enrolling in the DIR, the technical requirements, the challenges we encountered, and our solutions to those challenges. A sample of the quaterly report released by the ACR is presented and discussed. Enrolling in the ACR dose registry is a team effort with participation from IT, a site physicist, and a site radiologist. Participation in this registry is a great starting point to initiate a QA process for monitoring CT dose if none has been established at an institution. The ACR has developed an excellent platform for gathering, analyzing, and reporting CT dose data. Even so, each insititutions will have its own unique issues in joining the project.
Computed tomography; Radiation dose; Quality assurance
Automatic tools for detection and identification of lung and lesion from high-resolution CT (HRCT) are becoming increasingly important both for diagnosis and for delivering high-precision radiation therapy. However, development of robust and interpretable classifiers still presents a challenge especially in case of non-small cell lung carcinoma (NSCLC) patients. In this paper, we have attempted to devise such a classifier by extracting fuzzy rules from texture segmented regions from HRCT images of NSCLC patients. A fuzzy inference system (FIS) has been constructed starting from a feature extraction procedure applied on overlapping regions from the same organs and deriving simple if–then rules so that more linguistically interpretable decisions can be implemented. The proposed method has been tested on 138 regions extracted from CT scan images acquired from patients with lung cancer. Assuming two classes of tissues C1 (healthy tissues) and C2 (lesion) as negative and positive, respectively; preliminary results report an AUC = 0.98 for lesions and AUC = 0.93 for healthy tissue, with an optimal operating condition related to sensitivity = 0.96, and specificity = 0.98 for lesions and sensitivity 0.99, and specificity = 0.94 for healthy tissue. Finally, the following results have been obtained: false-negative rate (FNR) = 6 % (C1), FNR = 2 % (C2), false-positive rate (FPR) = 4 % (C1), FPR = 3 % (C2), true-positive rate (TPR) = 94 %, (C1) and TPR = 98 % (C2).
NSCLC; IGRT; FIS; Rule-based classification
The appearance of the retinal blood vessels is an important diagnostic indicator of various clinical disorders of the eye and the body. Retinal blood vessels have been shown to provide evidence in terms of change in diameter, branching angles, or tortuosity, as a result of ophthalmic disease. This paper reports the development for an automated method for segmentation of blood vessels in retinal images. A unique combination of methods for retinal blood vessel skeleton detection and multidirectional morphological bit plane slicing is presented to extract the blood vessels from the color retinal images. The skeleton of main vessels is extracted by the application of directional differential operators and then evaluation of combination of derivative signs and average derivative values. Mathematical morphology has been materialized as a proficient technique for quantifying the retinal vasculature in ocular fundus images. A multidirectional top-hat operator with rotating structuring elements is used to emphasize the vessels in a particular direction, and information is extracted using bit plane slicing. An iterative region growing method is applied to integrate the main skeleton and the images resulting from bit plane slicing of vessel direction-dependent morphological filters. The approach is tested on two publicly available databases DRIVE and STARE. Average accuracy achieved by the proposed method is 0.9423 for both the databases with significant values of sensitivity and specificity also; the algorithm outperforms the second human observer in terms of precision of segmented vessel tree.
Medical imaging; Retinal images; Retinal vessel segmentation; Biomedical image analysis; Image segmentation; Bit planes; Morphological processing
We propose a joint segmentation and groupwise registration method for dynamic cardiac perfusion images that uses temporal information. The nature of perfusion images makes groupwise registration especially attractive as the temporal information from the entire image sequence can be used. Registration aims to maximize the smoothness of the intensity signal while segmentation minimizes a pixel’s dissimilarity with other pixels having the same segmentation label. The cost function is optimized in an iterative fashion using B-splines. Tests on real patient datasets show that compared with two other methods, our method shows lower registration error and higher segmentation accuracy. This is attributed to the use of temporal information for groupwise registration and mutual complementary registration and segmentation information in one framework while other methods solve the two problems separately.
Groupwise registration; Segmentation; Temporal information; Cardiac; Perfusion; MRI
Surface morphology is an important indicator of malignant potential for solid-type lung nodules detected at CT, but is difficult to assess subjectively. Automated methods for morphology assessment have previously been described using a common measure of nodule shape, representative of the broad class of existing methods, termed area-to-perimeter-length ratio (APR). APR is static and thus highly susceptible to alterations by random noise and artifacts in image acquisition. We introduce and analyze the self-overlap (SO) method as a dynamic automated morphology detection scheme. SO measures the degree of change of nodule masks upon Gaussian blurring. We hypothesized that this new metric would afford equally high accuracy and superior precision than APR. Application of the two methods to a set of 119 patient lung nodules and a set of simulation nodules showed our approach to be slightly more accurate and on the order of ten times as precise, respectively. The dynamic quality of this new automated metric renders it less sensitive to image noise and artifacts than APR, and as such, SO is a potentially useful measure of cancer risk for solid-type lung nodules detected on CT.
Computer-aided diagnosis (CAD); Lung neoplasms; Computed tomography; Surface morphology
Wireless capsule endoscopy (WCE) is a novel technology aiming for investigating the diseases and abnormalities in small intestine. The major drawback of WCE examination is that it takes a long time to examine the whole WCE video. In this paper, we present a new reduction scheme for WCE video to reduce the examination time. To achieve this task, a WCE video motion model is proposed. Under this motion model, the WCE imaging motion is estimated in two stages (the coarse level and the fine level). In the coarse level, the WCE camera motion is estimated with a combination of Bee Algorithm and Mutual Information. In the fine level, the local gastrointestinal tract motion is estimated with SIFT flow. Based on the result of WCE imaging motion estimation, the reduction scheme preserves key images in WCE video with scene changes. From experimental results, we notice that the proposed motion model is suitable for the motion estimation in successive WCE images. Through the comparison with APRS and FCM-NMF scheme, our scheme can produce an acceptable reduction sequence for browsing and examination.
Wireless capsule endoscopy; Bee algorithm; SIFT flow; Motion estimation
To develop a generic Open Source MRI perfusion analysis tool for quantitative parameter mapping to be used in a clinical workflow and methods for quality management of perfusion data. We implemented a classic, pixel-by-pixel deconvolution approach to quantify T1-weighted contrast-enhanced dynamic MR imaging (DCE-MRI) perfusion data as an OsiriX plug-in. It features parallel computing capabilities and an automated reporting scheme for quality management. Furthermore, by our implementation design, it could be easily extendable to other perfusion algorithms. Obtained results are saved as DICOM objects and directly added to the patient study. The plug-in was evaluated on ten MR perfusion data sets of the prostate and a calibration data set by comparing obtained parametric maps (plasma flow, volume of distribution, and mean transit time) to a widely used reference implementation in IDL. For all data, parametric maps could be calculated and the plug-in worked correctly and stable. On average, a deviation of 0.032 ± 0.02 ml/100 ml/min for the plasma flow, 0.004 ± 0.0007 ml/100 ml for the volume of distribution, and 0.037 ± 0.03 s for the mean transit time between our implementation and a reference implementation was observed. By using computer hardware with eight CPU cores, calculation time could be reduced by a factor of 2.5. We developed successfully an Open Source OsiriX plug-in for T1-DCE-MRI perfusion analysis in a routine quality managed clinical environment. Using model-free deconvolution, it allows for perfusion analysis in various clinical applications. By our plug-in, information about measured physiological processes can be obtained and transferred into clinical practice.
Algorithms; Perfusion; Image processing; Computer-assisted; Magnetic resonance imaging
Evolution of communication systems, especially internet-based technologies, has probably affected Radiology more than any other medical specialty. Tremendous increase in internet bandwidth has enabled a true revolution in image transmission and easy remote viewing of the static images and real-time video stream. Previous reports of real-time telesonography, such as the ones developed for emergency situations and humanitarian work, rely on high compressions of images utilized by remote sonologist to guide and supervise the unexperienced examiner. We believe that remote sonology could be also utilized in teleultrasound exam of infant hip. We tested feasibility of a low-cost teleultrasound system for infant hip and performed data analysis on the transmitted and original images. Transmission of data was accomplished with Remote Ultrasound (RU), a software package specifically designed for teleultrasound transmission through limited internet bandwidth. While image analysis of image pairs revealed statistically significant loss of information, panel evaluation failed to recognize any clinical difference between the original saved and transmitted still images.
Telemedicine; Image quality analysis; Ultrasound; Teleradiology
Standard X-ray images using conventional screen-film technique have a limited field of view that is insufficient to show the full bone structure of large hands on a single frame. To produce images containing the whole hand structure, digitized images from the X-ray films can be assembled using image stitching. This paper presents a new medical image stitching method that utilizes minimum average correlation energy filters to identify and merge pairs of hand X-ray medical images. The effectiveness of the proposed method is demonstrated in the experiments involving two databases which contain a total of 40 pairs of overlapping and non-overlapping hand images. The experimental results are compared with that of the normalized cross-correlation (NCC) method. It is found that the proposed method outperforms the NCC method in classifying and merging the overlapping and non-overlapping medical images. The efficacy of the proposed method is further indicated by its average execution time, which is about five times shorter than that of the other method.
Medical image stitching; Image registration; Panoramic image; MACE filter
Tamper localization and recovery watermarking scheme can be used to detect manipulation and recover tampered images. In this paper, a tamper localization and lossless recovery scheme that used region of interest (ROI) segmentation and multilevel authentication was proposed. The watermarked images had a high average peak signal-to-noise ratio of 48.7 dB and the results showed that tampering was successfully localized and tampered area was exactly recovered. The usage of ROI segmentation and multilevel authentication had significantly reduced the time taken by approximately 50 % for the tamper localization and recovery processing.
Lossless compression; Tamper localization; Recovery; Medical image; Watermarking
The accuracy of computer-aided diagnosis (CAD) for early detection and classification of breast cancer in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is dependent upon the features used by the CAD classifier. Here, we show that fast orthogonal search (FOS), which provides a more efficient iterative manner of computing stepwise regression feature selection, can select features with predictive value from a set of kinetic and texture candidate features computed from dynamic contrast-enhanced magnetic resonance images. FOS can in minutes search candidate feature sets of millions of terms, which may include cross-products of features up to second-, third- or fourth-order. This method is tested on a set of 83 DCE-MRI images, of which 20 are for cancerous and 63 for benign cases, using a leave-one-out trial. The features selected by FOS were used in a FOS predictor and nearest-neighbour predictor and had an area under the receiver operating curve (AUC) of 0.889 and 0.791 respectively. The FOS predictor AUC is significantly improved over the signal enhancement ratio predictor with an AUC of 0.706 (p = 0.0035 for the difference in the AUCs). Moreover, using FOS-selected features in a support vector machine increased the AUC over that resulting when the features were manually selected.
Breast cancer; Computer-aided diagnosis; Stepwise regression; Fast orthogonal search
In this study, we have introduced an accurate retinal images registration method using affine moment invariants (AMI’s) which are the shape descriptors. First, some closed-boundary regions are extracted in both reference and sensed images. Then, AMI’s are computed for each of those regions. The centers of gravity of three pairs of regions which have the minimum of distances are selected as the control points. The region matching is performed by the distance measurements of AMI’s. The evaluation of region matching is performed by comparing the angles of three triangles which are built on these three-point pairs in reference and sensed images. The parameters of affine transform can be computed using these three pairs of control points. The proposed algorithm is applied on the valid DRIVE database. In general (for the case, each sensed image is produced by rotating, scaling, and translating the reference image with different angles, scale factors, and translation factors), the success rate and accuracy is 95 and 96 %, respectively.
Image registration; Retinal images; Affine moment invariant (AMI); Affine transformation
The National Institute of Respiratory Diseases is a third level public hospital in Mexico City, which in 2007 acquired an RIS-PACS to be implemented at its Imaging Department (ID), with the objective to enhance its service. This department attends an average of 3,500 patients per month developing different image modalities. The objective of this work was to determine the overall sigma level performance of four processes of the ID: reception, X-ray, computed tomography, and radiologist diagnosis, considering process analysis and innovation through Six Sigma methodology, measuring the innovation effectiveness by means of indicators and learning curves. Initially, a first measurement (M1) of the original processes was determined; once 13 innovations were implemented in a pilot program, two more measurements were done, 15 days after (M2) and 30 days after (M3), in order to know the impact of the innovations in the ID processes. The initial sigma level of the ID before innovations was σ1 = 2.0, which means that there were 36 patients per day with a process defect during their stay at the ID. In the two following measurements, σ2 = 2.2 which means that there were 28 patients per day with a process defect, and σ3 = 2.3 with 24 patients per day with a process defect. These results demonstrate that the percentage of performance enhancement between the original process and 15 days later was 23 % and 30 days later an enhancement of 15 %. In total, an overall enhancement of 38 % was obtained at the ID of the institute.
Imaging Department performance; Process innovation; Six Sigma methodology; Sigma level
High-resolution large datasets were acquired to improve the understanding of murine bone physiology. The purpose of this work is to present the challenges and solutions in segmenting and visualizing bone in such large datasets acquired using micro-CT scan of mice. The analyzed dataset is more than 50 GB in size with more than 6,000 2,048 × 2,048 slices. The study was performed to automatically measure the bone mineral density (BMD) of the entire skeleton. A global Renyi entropy (GREP) method was initially used for bone segmentation. This method consistently oversegmented skeletal region. A new method called adaptive local Renyi entropy (ALREP) is proposed to improve the segmentation results. To study the efficacy of the ALREP, manual segmentation was performed. Finally, a specialized high-end remote visualization system along with the software, VirtualGL, was used to perform remote rendering of this large dataset. It was determined that GREP overestimated the bone cross-section by around 30 % compared with ALREP. The manual segmentation process took 6,300 min for 6,300 slices while ALREP took only 150 min for segmentation. Automatic image processing with ALREP method may facilitate BMD measurement of the entire skeleton in a significantly reduced time, compared with manual process.
Electronic supplementary material
The online version of this article (doi:10.1007/s10278-012-9498-y) contains supplementary material, which is available to authorized users.
Segmentation; Visualization; High resolution; Bone mineral density
Teleradiology allows medical images to be transmitted over electronic networks for clinical interpretation and for improved healthcare access, delivery, and standards. Although such remote transmission of the images is raising various new and complex legal and ethical issues, including image retention and fraud, privacy, malpractice liability, etc., considerations of the security measures used in teleradiology remain unchanged. Addressing this problem naturally warrants investigations on the security measures for their relative functional limitations and for the scope of considering them further. In this paper, starting with various security and privacy standards, the security requirements of medical images as well as expected threats in teleradiology are reviewed. This will make it possible to determine the limitations of the conventional measures used against the expected threats. Furthermore, we thoroughly study the utilization of digital watermarking for teleradiology. Following the key attributes and roles of various watermarking parameters, justification for watermarking over conventional security measures is made in terms of their various objectives, properties, and requirements. We also outline the main objectives of medical image watermarking for teleradiology and provide recommendations on suitable watermarking techniques and their characterization. Finally, concluding remarks and directions for future research are presented.
Digital watermark; Teleradiology; Security
Human identification using dental radiographs is important in biometrics. Dental radiographs are mainly helpful for individual and mass disaster identification. In the 2004 tsunami, dental records were proven as the primary identifier of victims. So, this work aims to produce an automatic person identification system with shape extraction and matching techniques. For shape extraction, the available information is edge details, structural content, salient points derived from contours and surfaces, and statistical moments. Out of all these features, tooth contour information is a suitable choice here because it can provide better matching. This proposed method consists of four stages. The first step is preprocessing. The second one involves integral intensity projection for segmenting upper jaw, lower jaw, and individual tooth separately. Using connected component labeling, shape extraction was done in the third stage. The outputs obtained from the previous stage for some misaligned images are not satisfactory. So, it is improved by fast connected component labeling. The fourth stage is calculating Mahalanobis distance measure as a means of matching dental records. The matching distance observed for this method is comparatively better when it is compared with the semi-automatic contour extraction method which is our earlier work.
Teeth segmentation; Dental CT; Homomorphic filtering; Integral intensity projection; Connected component labeling
A new restoration methodology is proposed to enhance mammographic images through the improvement of contrast features and the simultaneous suppression of noise. Denoising is performed in the first step using the Anscombe transformation to convert the signal-dependent quantum noise into an approximately signal-independent Gaussian additive noise. In the Anscombe domain, noise is filtered through an adaptive Wiener filter, whose parameters are obtained by considering local image statistics. In the second step, a filter based on the modulation transfer function of the imaging system in the whole radiation field is applied for image enhancement. This methodology can be used as a preprocessing module for computer-aided detection (CAD) systems to improve the performance of breast cancer screening. A preliminary assessment of the restoration algorithm was performed using synthetic images with different levels of quantum noise. Afterward, we evaluated the effect of the preprocessing on the performance of a previously developed CAD system for clustered microcalcification detection in mammographic images. The results from the synthetic images showed an increase of up to 11.5 dB (p = 0.002) in the peak signal-to-noise ratio. Moreover, the mean structural similarity index increased up to 8.3 % (p < 0.001). Regarding CAD performance, the results suggested that the preprocessing increased the detectability of microcalcifications in mammographic images without increasing the false-positive rates. Receiver operating characteristic analysis revealed an average increase of 14.1 % (p = 0.01) in overall CAD performance when restored image sets were used.
Image denoising; Quantum noise; Computer-aided detection (CAD); Mammography; Modulation transfer function; Anscombe transformation; Wiener filter
In recent years, the number of obese population in Korea has been growing up along with the economic development, environmental factors, and the change in life style. Considering the growth of obese population and the adverse effect of obesity on health, it is getting more important to prevent and diagnose the obesity with the quantitative measurement of body fat that has become an important indicator for obesity. In this study, we proposed a procedure for the automated fat assessment from computed tomography (CT) data using image processing technique. The proposed method was applied to a single-CT image as well as CT-volume data, and results were correlated to those of dual-energy X-ray absorptiometry (DEXA) that is known as the reliable method for evaluating body fat. Using single-CT images, correlation coefficients between DEXA and the automated assessment and DEXA and the manual assessment were 0.038 and 0.058, respectively (P > 0.05). Hence, there was no significant correlation between three methods using the proposed method with single-CT images. On the other hand, in case of CT-volume data, the above correlation coefficients were increased to 0.826, 0.812, and 0.805, respectively (P < 0.01). Thus, DEXA and the proposed methods with CT-volume data showed highly significant correlation with each other. The results suggest that the proposed automated assessment using CT-volume data is a reliable method for the evaluation of body fat. It is expected that the clinical application of the proposed procedure will be helpful to reduce the time for the quantitative evaluation of patient’s body fat.
Body fat; Fat assessment; Computed tomography (CT); DEXA; Separation mask
Three-dimensional (3-D) surface imaging has gained clinical acceptance, especially in the field of cranio-maxillo-facial and plastic, reconstructive, and aesthetic surgery. Six scanners based on different scanning principles (Minolta Vivid 910®, Polhemus FastSCAN™, GFM PRIMOS®, GFM TopoCAM®, Steinbichler Comet® Vario Zoom 250, 3dMD DSP 400®) were used to measure five sheep skulls of different sizes. In three areas with varying anatomical complexity (areas, 1 = high; 2 = moderate; 3 = low), 56 distances between 20 landmarks are defined on each skull. Manual measurement (MM), coordinate machine measurements (CMM) and computer tomography (CT) measurements were used to define a reference method for further precision and accuracy evaluation of different 3-D scanning systems. MM showed high correlation to CMM and CT measurements (both r = 0.987; p < 0.001) and served as the reference method. TopoCAM®, Comet® and Vivid 910® showed highest measurement precision over all areas of complexity; Vivid 910®, the Comet® and the DSP 400® demonstrated highest accuracy over all areas with Vivid 910® being most accurate in areas 1 and 3, and the DSP 400® most accurate in area 2. In accordance to the measured distance length, most 3-D devices present higher measurement precision and accuracy for large distances and lower degrees of precision and accuracy for short distances. In general, higher degrees of complexity are associated with lower 3-D assessment accuracy, suggesting that for optimal results, different types of scanners should be applied to specific clinical applications and medical problems according to their special construction designs and characteristics.
Accuracy; Biomedical; Fringe projection; Laser scanning; Precision; Stereo-photogrammetry; Surface imaging; 3D
Digital imaging; Digital imaging and communications in medicine (DICOM); Systems integration; Oral and maxillofacial radiology