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Marta Diez-Ferrer, Debora Gil, Cristian Tebe, & Carles Sanchez. (2018). Positive Airway Pressure to Enhance Computed Tomography Imaging for Airway Segmentation for Virtual Bronchoscopic Navigation. RES - Respiration, 96(6), 525–534.
Abstract: Abstract
RATIONALE:
Virtual bronchoscopic navigation (VBN) guidance to peripheral pulmonary lesions is often limited by insufficient segmentation of the peripheral airways.
OBJECTIVES:
To test the effect of applying positive airway pressure (PAP) during CT acquisition to improve segmentation, particularly at end-expiration.
METHODS:
CT acquisitions in inspiration and expiration with 4 PAP protocols were recorded prospectively and compared to baseline inspiratory acquisitions in 20 patients. The 4 protocols explored differences between devices (flow vs. turbine), exposures (within seconds vs. 15-min) and pressure levels (10 vs. 14 cmH2O). Segmentation quality was evaluated with the number of airways and number of endpoints reached. A generalized mixed-effects model explored the estimated effect of each protocol.
MEASUREMENTS AND MAIN RESULTS:
Patient characteristics and lung function did not significantly differ between protocols. Compared to baseline inspiratory acquisitions, expiratory acquisitions after 15 min of 14 cmH2O PAP segmented 1.63-fold more airways (95% CI 1.07-2.48; p = 0.018) and reached 1.34-fold more endpoints (95% CI 1.08-1.66; p = 0.004). Inspiratory acquisitions performed immediately under 10 cmH2O PAP reached 1.20-fold (95% CI 1.09-1.33; p < 0.001) more endpoints; after 15 min the increase was 1.14-fold (95% CI 1.05-1.24; p < 0.001).
CONCLUSIONS:
CT acquisitions with PAP segment more airways and reach more endpoints than baseline inspiratory acquisitions. The improvement is particularly evident at end-expiration after 15 min of 14 cmH2O PAP. Further studies must confirm that the improvement increases diagnostic yield when using VBN to evaluate peripheral pulmonary lesions.
Keywords: Multidetector computed tomography; Bronchoscopy; Continuous positive airway pressure; Image enhancement; Virtual bronchoscopic navigation
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Debora Gil, Rosa Maria Ortiz, Carles Sanchez, & Antoni Rosell. (2018). Objective endoscopic measurements of central airway stenosis. A pilot study. RES - Respiration, 95, 63–69.
Abstract: Endoscopic estimation of the degree of stenosis in central airway obstruction is subjective and highly variable. Objective: To determine the benefits of using SENSA (System for Endoscopic Stenosis Assessment), an image-based computational software, for obtaining objective stenosis index (SI) measurements among a group of expert bronchoscopists and general pulmonologists. Methods: A total of 7 expert bronchoscopists and 7 general pulmonologists were enrolled to validate SENSA usage. The SI obtained by the physicians and by SENSA were compared with a reference SI to set their precision in SI computation. We used SENSA to efficiently obtain this reference SI in 11 selected cases of benign stenosis. A Web platform with three user-friendly microtasks was designed to gather the data. The users had to visually estimate the SI from videos with and without contours of the normal and the obstructed area provided by SENSA. The users were able to modify the SENSA contours to define the reference SI using morphometric bronchoscopy. Results: Visual SI estimation accuracy was associated with neither bronchoscopic experience (p = 0.71) nor the contours of the normal and the obstructed area provided by the system (p = 0.13). The precision of the SI by SENSA was 97.7% (95% CI: 92.4-103.7), which is significantly better than the precision of the SI by visual estimation (p < 0.001), with an improvement by at least 15%. Conclusion: SENSA provides objective SI measurements with a precision of up to 99.5%, which can be calculated from any bronchoscope using an affordable scalable interface. Providing normal and obstructed contours on bronchoscopic videos does not improve physicians' visual estimation of the SI.
Keywords: Bronchoscopy; Tracheal stenosis; Airway stenosis; Computer-assisted analysis
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H. Martin Kjer, Jens Fagertun, Sergio Vera, Debora Gil, Miguel Angel Gonzalez Ballester, & Rasmus R. Paulsena. (2016). Free-form image registration of human cochlear uCT data using skeleton similarity as anatomical prior. PRL - Patter Recognition Letters, 76(1), 76–82.
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Ferran Poveda, Debora Gil, Enric Marti, Albert Andaluz, Manel Ballester, & Francesc Carreras Costa. (2013). Helical structure of the cardiac ventricular anatomy assessed by Diffusion Tensor Magnetic Resonance Imaging multi-resolution tractography. REC - Revista Española de Cardiología, 66(10), 782–790.
Abstract: Deep understanding of myocardial structure linking morphology and function of the heart would unravel crucial knowledge for medical and surgical clinical procedures and studies. Several conceptual models of myocardial fiber organization have been proposed but the lack of an automatic and objective methodology prevented an agreement. We sought to deepen in this knowledge through advanced computer graphic representations of the myocardial fiber architecture by diffusion tensor magnetic resonance imaging (DT-MRI).
We performed automatic tractography reconstruction of unsegmented DT-MRI canine heart datasets coming from the public database of the Johns Hopkins University. Full scale tractographies have been build with 200 seeds and are composed by streamlines computed on the vectorial field of primary eigenvectors given at the diffusion tensor volumes. Also, we introduced a novel multi-scale visualization technique in order to obtain a simplified tractography. This methodology allowed to keep the main geometric features of the fiber tracts, making easier to decipher the main properties of the architectural organization of the heart.
On the analysis of the output from our tractographic representations we found exact correlation with low-level details of myocardial architecture, but also with the more abstract conceptualization of a continuous helical ventricular myocardial fiber array.
Objective analysis of myocardial architecture by an automated method, including the entire myocardium and using several 3D levels of complexity, reveals a continuous helical myocardial fiber arrangement of both right and left ventricles, supporting the anatomical model of the helical ventricular myocardial band described by Torrent-Guasp.
Keywords: Heart;Diffusion magnetic resonance imaging;Diffusion tractography;Helical heart;Myocardial ventricular band.
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Jaume Garcia, Debora Gil, Sandra Pujades, & Francesc Carreras. (2008). Valoracion de la Funcion del Ventriculo Izquierdo mediante Modelos Regionales Hiperparametricos. Revista Española de Cardiologia, 61(3), 79.
Abstract: La mayoría de la enfermedades cardiovasculares afectan a las propiedades contráctiles de la banda ventricular helicoidal. Esto se refleja en una variación del comportamiento normal de la función ventricular. Parámetros locales tales como los strains, o la deformación experimentada por el tejido, son indicadores capaces de detectar anomalías funcionales en territorios específicos. A menudo, dichos parámetros son considerados de forma separada. En este trabajo presentamos un marco computacional (el Dominio Paramétrico Normalizado, DPN) que permite integrarlos en hiperparámetros funcionales y estudiar sus rangos de normalidad. Dichos rangos permiten valorar de forma objetiva la función regional de cualquier nuevo paciente. Para ello, consideramos secuencias de resonancia magnética etiquetada a nivel basal, medio y apical. Los hiperparámetros se obtienen a partir del movimiento intramural del VI estimado mediante el método Harmonic Phase Flow. El DPN se define a partir de en una parametrización del Ventrículo Izquierdo (VI) en sus coordenadas radiales y circunferencial basada en criterios anatómicos. El paso de los hiperparámetros al DPN hace posible la comparación entre distintos pacientes. Los rangos de normalidad se definen mediante análisis estadístico de valores de voluntarios sanos en 45 regiones del DPN a lo largo de 9 fases sistólicas. Se ha usado un conjunto de 19 (14 H; E: 30.7±7.5) voluntarios sanos para crear los patrones de normalidad y se han validado usando 2 controles sanos y 3 pacientes afectados de contractilidad global reducida. Para los controles los resultados regionales se han ajustado dentro de la normalidad, mientras que para los pacientes se han obtenido valores anormales en las zonas descritas, localizando y cuantificando así el diagnóstico empírico.
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