The minimally invasive transcatheter aortic valve implantation (TAVI) is the most prevalent method to treat aortic valve stenosis. For pre-operative surgical planning, contrast-enhanced coronary CT angiography (CCTA) is used as the imaging technique to acquire 3-D measurements of the valve. Accurate localization of the eight aortic valve landmarks in CT images plays a vital role in the TAVI workflow because a small error risks blocking the coronary circulation. In order to examine the valve and mark the landmarks, physicians prefer a view parallel to the hinge plane, instead of using the conventional axial, coronal or sagittal view. However, customizing the view is a difficult and time-consuming task because of unclear aorta pose and different artifacts of CCTA. Therefore, automatic localization of landmarks can serve as a useful guide to the physicians customizing the viewpoint. In this paper, we present an automatic method to localize the aortic valve landmarks using colonial walk, a regression tree-based machine-learning algorithm. For efficient learning from the training set, we propose a two-phase optimized search space learning model in which a representative point inside the valvular area is first learned from the whole CT volume. All eight landmarks are then learned from a smaller area around that point. Experiment with preprocedural CCTA images of TAVI undergoing patients showed that our method is robust under high stenotic variation and notably efficient, as it requires only 12 milliseconds to localize all eight landmarks, as tested on a 3.60 GHz single-core CPU.
Utilizing the idea of long-term cumulative return, reinforcement learning (RL) has shown remarkable performance in various fields. We propose a formulation of the landmark localization in 3D medical images as a reinforcement learning problem. Whereas value-based methods have been widely used to solve RLbased localization problems, we adopt an actor-critic based direct policy search method framed in a temporal difference learning approach. In RL problems with large state and/or action spaces, learning the optimal behavior is challenging and requires many trials. To improve the learning, we introduce a partial policybased reinforcement learning to enable solving the large problem of localization by learning the optimal policy on smaller partial domains. Independent actors efficiently learn the corresponding partial policies, each utilizing their own independent critic. The proposed policy reconstruction from the partial policies ensures a robust and efficient localization utilizing the sub-agents solving simple binary decision problems in their corresponding partial action spaces. Experiments with three different localization problems in 3D CT and MR images showed that the proposed reinforcement learning requires a significantly smaller number of trials to learn the optimal behavior compared to the original behavior learning scheme in RL. It also ensures a satisfactory performance when trained on a fewer images.
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