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Marta Diez-Ferrer, Debora Gil, Elena Carreño, Susana Padrones, & Samantha Aso. (2017). Positive Airway Pressure-Enhanced CT to Improve Virtual Bronchoscopic Navigation . Journal of Thoracic Oncology, 12(1S), S596–S597.
Abstract: A main weakness of virtual bronchoscopic navigation (VBN) is unsuccessful segmentation of distal branches approaching peripheral pulmonary nodules (PPN). CT scan acquisition protocol is pivotal for segmentation covering the utmost periphery. We hypothesize that application of continuous positive airway pressure (CPAP) during CT acquisition could improve visualization and segmentation of peripheral bronchi. The purpose of the present pilot study is to compare quality of segmentations under 4 CT acquisition modes: inspiration (INSP), expiration (EXP) and both with CPAP (INSP-CPAP and EXP-CPAP).
Keywords: Thorax CT; diagnosis; Peripheral Pulmonary Nodule
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Jaume Garcia, Debora Gil, Luis Badiella, Aura Hernandez-Sabate, Francesc Carreras, Sandra Pujades, et al. (2010). "A Normalized Framework for the Design of Feature Spaces Assessing the Left Ventricular Function " . IEEE Transactions on Medical Imaging, 29(3), 733–745.
Abstract: A through description of the left ventricle functionality requires combining complementary regional scores. A main limitation is the lack of multiparametric normality models oriented to the assessment of regional wall motion abnormalities (RWMA). This paper covers two main topics involved in RWMA assessment. We propose a general framework allowing the fusion and comparison across subjects of different regional scores. Our framework is used to explore which combination of regional scores (including 2-D motion and strains) is better suited for RWMA detection. Our statistical analysis indicates that for a proper (within interobserver variability) identification of RWMA, models should consider motion and extreme strains.
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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 " . 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, & Petia Radeva. (2004). "A Regularized Curvature Flow Designed for a Selective Shape Restoration " . IEEE Transactions on Image Processing, 13, 1444–1458.
Abstract: Among all filtering techniques, those based exclu- sively on image level sets (geometric flows) have proven to be the less sensitive to the nature of noise and the most contrast preserving. A common feature to existent curvature flows is that they penalize high curvature, regardless of the curve regularity. This constitutes a major drawback since curvature extreme values are standard descriptors of the contour geometry. We argue that an operator designed with shape recovery purposes should include a term penalizing irregularity in the curvature rather than its magnitude. To this purpose, we present a novel geometric flow that includes a function that measures the degree of local irregularity present in the curve. A main advantage is that it achieves non-trivial steady states representing a smooth model of level curves in a noisy image. Performance of our approach is compared to classical filtering techniques in terms of quality in the restored image/shape and asymptotic behavior. We empirically prove that our approach is the technique that achieves the best compromise between image quality and evolution stabilization.
Keywords: Geometric flows, nonlinear filtering, shape recovery.
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Oriol Pujol, Debora Gil, & Petia Radeva. (2005). "Fundamentals of Stop and Go active models " . Image and Vision Computing, 23(8), 681–691.
Abstract: An efficient snake formulation should conform to the idea of picking the smoothest curve among all the shapes approximating an object of interest. In current geodesic snakes, the regularizing curvature also affects the convergence stage, hindering the latter at concave regions. In the present work, we make use of characteristic functions to define a novel geodesic formulation that decouples regularity and convergence. This term decoupling endows the snake with higher adaptability to non-convex shapes. Convergence is ensured by splitting the definition of the external force into an attractive vector field and a repulsive one. In our paper, we propose to use likelihood maps as approximation of characteristic functions of object appearance. The better efficiency and accuracy of our decoupled scheme are illustrated in the particular case of feature space-based segmentation.
Keywords: Deformable models; Geodesic snakes; Region-based segmentation
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Debora Gil, & Petia Radeva. (2005). "Extending anisotropic operators to recover smooth shapes " . Computer Vision and Image Understanding, 99(1), 110–125.
Abstract: Anisotropic differential operators are widely used in image enhancement processes. Recently, their property of smoothly extending functions to the whole image domain has begun to be exploited. Strong ellipticity of differential operators is a requirement that ensures existence of a unique solution. This condition is too restrictive for operators designed to extend image level sets: their own functionality implies that they should restrict to some vector field. The diffusion tensor that defines the diffusion operator links anisotropic processes with Riemmanian manifolds. In this context, degeneracy implies restricting diffusion to the varieties generated by the vector fields of positive eigenvalues, provided that an integrability condition is satisfied. We will use that any smooth vector field fulfills this integrability requirement to design line connection algorithms for contour completion. As application we present a segmenting strategy that assures convergent snakes whatever the geometry of the object to be modelled is.
Keywords: Contour completion; Functional extension; Differential operators; Riemmanian manifolds; Snake segmentation
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Debora Gil, & Petia Radeva. (2004). "Shape Restoration via a Regularized Curvature Flow " . Journal of Mathematical Imaging and Vision, 21(3), 205–223.
Abstract: Any image filtering operator designed for automatic shape restoration should satisfy robustness (whatever the nature and degree of noise is) as well as non-trivial smooth asymptotic behavior. Moreover, a stopping criterion should be determined by characteristics of the evolved image rather than dependent on the number of iterations. Among the several PDE based techniques, curvature flows appear to be highly reliable for strongly noisy images compared to image diffusion processes.
In the present paper, we introduce a regularized curvature flow (RCF) that admits non-trivial steady states. It is based on a measure of the local curve smoothness that takes into account regularity of the curve curvature and serves as stopping term in the mean curvature flow. We prove that this measure decreases over the orbits of RCF, which endows the method with a natural stop criterion in terms of the magnitude of this measure. Further, in its discrete version it produces steady states consisting of piece-wise regular curves. Numerical experiments made on synthetic shapes corrupted with different kinds of noise show the abilities and limitations of each of the current geometric flows and the benefits of RCF. Finally, we present results on real images that illustrate the usefulness of the present approach in practical applications.
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Debora Gil, David Roche, Agnes Borras, & Jesus Giraldo. (2015). "Terminating Evolutionary Algorithms at their Steady State " . Computational Optimization and Applications, 61(2), 489–515.
Abstract: Assessing the reliability of termination conditions for evolutionary algorithms (EAs) is of prime importance. An erroneous or weak stop criterion can negatively affect both the computational effort and the final result. We introduce a statistical framework for assessing whether a termination condition is able to stop an EA at its steady state, so that its results can not be improved anymore. We use a regression model in order to determine the requirements ensuring that a measure derived from EA evolving population is related to the distance to the optimum in decision variable space. Our framework is analyzed across 24 benchmark test functions and two standard termination criteria based on function fitness value in objective function space and EA population decision variable space distribution for the differential evolution (DE) paradigm. Results validate our framework as a powerful tool for determining the capability of a measure for terminating EA and the results also identify the decision variable space distribution as the best-suited for accurately terminating DE in real-world applications.
Keywords: Evolutionary algorithms; Termination condition; Steady state; Differential evolution
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Marta Ligero, Alonso Garcia Ruiz, Cristina Viaplana, Guillermo Villacampa, Maria V Raciti, Jaid Landa, et al. (2021). "A CT-based radiomics signature is associated with response to immune checkpoint inhibitors in advanced solid tumors " . Radiology, 299(1), 109–119.
Abstract: Background Reliable predictive imaging markers of response to immune checkpoint inhibitors are needed. Purpose To develop and validate a pretreatment CT-based radiomics signature to predict response to immune checkpoint inhibitors in advanced solid tumors. Materials and Methods In this retrospective study, a radiomics signature was developed in patients with advanced solid tumors (including breast, cervix, gastrointestinal) treated with anti-programmed cell death-1 or programmed cell death ligand-1 monotherapy from August 2012 to May 2018 (cohort 1). This was tested in patients with bladder and lung cancer (cohorts 2 and 3). Radiomics variables were extracted from all metastases delineated at pretreatment CT and selected by using an elastic-net model. A regression model combined radiomics and clinical variables with response as the end point. Biologic validation of the radiomics score with RNA profiling of cytotoxic cells (cohort 4) was assessed with Mann-Whitney analysis. Results The radiomics signature was developed in 85 patients (cohort 1: mean age, 58 years ± 13 [standard deviation]; 43 men) and tested on 46 patients (cohort 2: mean age, 70 years ± 12; 37 men) and 47 patients (cohort 3: mean age, 64 years ± 11; 40 men). Biologic validation was performed in a further cohort of 20 patients (cohort 4: mean age, 60 years ± 13; 14 men). The radiomics signature was associated with clinical response to immune checkpoint inhibitors (area under the curve [AUC], 0.70; 95% CI: 0.64, 0.77; P < .001). In cohorts 2 and 3, the AUC was 0.67 (95% CI: 0.58, 0.76) and 0.67 (95% CI: 0.56, 0.77; P < .001), respectively. A radiomics-clinical signature (including baseline albumin level and lymphocyte count) improved on radiomics-only performance (AUC, 0.74 [95% CI: 0.63, 0.84; P < .001]; Akaike information criterion, 107.00 and 109.90, respectively). Conclusion A pretreatment CT-based radiomics signature is associated with response to immune checkpoint inhibitors, likely reflecting the tumor immunophenotype. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Summers in this issue.
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Marta Diez-Ferrer, Arturo Morales, Rosa Lopez Lisbona, Noelia Cubero, Cristian Tebe, Susana Padrones, et al. (2019). Ultrathin Bronchoscopy with and without Virtual Bronchoscopic Navigation: Influence of Segmentation on Diagnostic Yield . Respiration, 97(3), 252–258.
Abstract: Background: Bronchoscopy is a safe technique for diagnosing peripheral pulmonary lesions (PPLs), and virtual bronchoscopic navigation (VBN) helps guide the bronchoscope to PPLs. Objectives: We aimed to compare the diagnostic yield of VBN-guided and unguided ultrathin bronchoscopy (UTB) and explore clinical and technical factors associated with better results. We developed a diagnostic algorithm for deciding whether to use VBN to reach PPLs or choose an alternative diagnostic approach. Methods: We compared diagnostic yield between VBN-UTB (prospective cases) and unguided UTB (historical controls) and analyzed the VBN-UTB subgroup to identify clinical and technical variables that could predict the success of VBN-UTB. Results: Fifty-five cases and 110 controls were included. The overall diagnostic yield did not differ between the VBN-guided and unguided arms (47 and 40%, respectively; p = 0.354). Although the yield was slightly higher for PPLs ≤20 mm in the VBN-UTB arm, the difference was not significant (p = 0.069). No other clinical characteristics were associated with a higher yield in a subgroup analysis, but an 85% diagnostic yield was observed when segmentation was optimal and the PPL was endobronchial (vs. 30% when segmentation was suboptimal and 20% when segmentation was optimal but the PPL was extrabronchial). Conclusions: VBN-guided UTB is not superior to unguided UTB. A greater impact of VBN-guided over unguided UTB is highly dependent on both segmentation quality and an endobronchial location of the PPL. Segmentation quality should be considered before starting a procedure, when an alternative technique that may improve yield can be chosen, saving time and resources.
Keywords: Lung cancer; Peripheral lung lesion; Diagnosis; Bronchoscopy; Ultrathin bronchoscopy; Virtual bronchoscopic navigation
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