ITK-SNAP is an interactive software tool for manual and semi-automatic segmentation of 3D medical images. This paper summarizes major new features added to ITK-SNAP over the last decade. The main focus of the paper is on new features that support semi-automatic segmentation of multi-modality imaging datasets, such as MRI scans acquired using different contrast mechanisms (e.g., T1, T2, FLAIR). The new functionality uses decision forest classifiers trained interactively by the user to transform multiple input image volumes into a foreground/background probability map; this map is then input as the data term to the active contour evolution algorithm, which yields regularized surface representations of the segmented objects of interest. The new functionality is evaluated in the context of high-grade and low-grade glioma segmentation by three expert neuroradiogists and a non-expert on a reference dataset from the MICCAI 2013 Multi-Modal Brain Tumor Segmentation Challenge (BRATS). The accuracy of semi-automatic segmentation is competitive with the top specialized brain tumor segmentation methods evaluated in the BRATS challenge, with most results obtained in ITK-SNAP being more accurate, relative to the BRATS reference manual segmentation, than the second-best performer in the BRATS challenge; and all results being more accurate than the fourth-best performer. Segmentation time is reduced over manual segmentation by 2.5 and 5 times, depending on the rater. Additional experiments in interactive placenta segmentation in 3D fetal ultrasound illustrate the generalizability of the new functionality to a different problem domain.
We seek a form of object model that exactly and completely captures the interior of most non-branching anatomic objects and simultaneously is well suited for probabilistic analysis on populations of such objects. We show that certain nearly medial, skeletal models satisfy these requirements. These models are first mathematically defined in continuous 3-space, and then discrete representations formed by a tuple of spoke vectors are derived. We describe means of fitting these skeletal models into manual or automatic segmentations of objects in a way stable enough to support statistical analysis, and we sketch means of modifying these fits to provide good correspondences of spoke vectors across a training population of objects. Understanding will be developed that these discrete skeletal models live in an abstract space made of a Cartesian product of a Euclidean space and a collection of spherical spaces. Based on this understanding and the way objects change under various rigid and nonrigid transformations, a method analogous to principal component analysis called composite principal nested spheres will be seen to apply to learning a more efficient collection of modes of object variation about a new and more representative mean object than those provided by other representations and other statistical analysis methods. The methods are illustrated by application to hippocampi.
The Pulse Physiology Platform is an open-source software application designed to enable accurate and consistent, real-time physiologic simulations for improved medical training and clinical decision-making tools. The platform includes a physiology engine comprised of well-validated lumped-parameter models, differential equations representing feedback mechanisms, and a pharmacokinetic/pharmacodynamic model. The platform also includes a common data model for standard model and data definitions and a common software interface for engine control and robust physics-based circuit and transport solvers. The Pulse Platform has been incorporated into a number of commercial, research, and academic tools for medical simulation. Significance: The Pulse Platform is an innovative, well-validated, open-source tool for medical modeling and simulation in the training and clinical decision-making field.
A multimodal micro-computed tomography (CT) and multi-spectral structured light imaging (SLI) system is introduced and systematically analyzed to test its feasibility to aid in margin delineation during breast conserving surgery (BCS). Phantom analysis of the micro-CT yielded a signal-to-noise ratio (SNR) of 34, a contrast of 1.64, and a minimum detectable resolution of 240 µm for a 1.2 min scan. The SLI system, spanning wavelengths 490 nm to 800 nm and spatial frequencies up to 1.37 mm−1, was evaluated with aqueous tissue simulating phantoms having variations in particle size distribution, scatter density, and blood volume fraction. The reduced scattering coefficient, μs′ and phase function parameter, γ, were accurately recovered over all wavelengths independent of blood volume fractions from 0% to 4%, assuming a flat sample geometry perpendicular to the imaging plane. The resolution of the optical system was tested with a step phantom, from which the modulation transfer function (MTF) was calculated yielding a maximum resolution of 3.78 cycles per mm. The three dimensional (3D) spatial co-registration between the CT and optical imaging space was tested and shown to be accurate within 0.7 mm. A freshly resected breast specimen, with lobular carcinoma, fibrocystic disease, and adipose, was imaged with the system. The micro-CT provided visualization of the tumor mass and its spiculations, and SLI yielded superficial quantification of light scattering parameters for the malignant and benign tissue types. These results appear to be the first demonstration of SLI combined with standard medical tomography for imaging excised tumor specimens. While further investigations are needed to determine and test the spectral, spatial, and CT features required to classify tissue, this study demonstrates the ability of multimodal CT/SLI to quantify, visualize, and spatially navigate breast tumor specimens, which could potentially aid in the assessment of tumor margin status during BCS.
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