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Antonio Esteban Lansaque, Carles Sanchez, Agnes Borras, Marta Diez-Ferrer, Antoni Rosell, & Debora Gil. (2016). "Stable Anatomical Structure Tracking for video-bronchoscopy Navigation " In 19th International Conference on Medical Image Computing and Computer Assisted Intervention Workshops.
Abstract: Bronchoscopy allows to examine the patient airways for detection of lesions and sampling of tissues without surgery. A main drawback in lung cancer diagnosis is the diculty to check whether the exploration is following the correct path to the nodule that has to be biopsied. The most extended guidance uses uoroscopy which implies repeated radiation of clinical sta and patients. Alternatives such as virtual bronchoscopy or electromagnetic navigation are very expensive and not completely robust to blood, mocus or deformations as to be extensively used. We propose a method that extracts and tracks stable lumen regions at dierent levels of the bronchial tree. The tracked regions are stored in a tree that encodes the anatomical structure of the scene which can be useful to retrieve the path to the lesion that the clinician should follow to do the biopsy. We present a multi-expert validation of our anatomical landmark extraction in 3 intra-operative ultrathin explorations.
Keywords: Lung cancer diagnosis; video-bronchoscopy; airway lumen detection; region tracking
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Antonio Esteban Lansaque, Carles Sanchez, Agnes Borras, Marta Diez-Ferrer, Antoni Rosell, & Debora Gil. (2016). "Stable Airway Center Tracking for Bronchoscopic Navigation " In 28th Conference of the international Society for Medical Innovation and Technology.
Abstract: Bronchoscopists use X‐ray fluoroscopy to guide bronchoscopes to the lesion to be biopsied without any kind of incisions. Reducing exposure to X‐ray is important for both patients and doctors but alternatives like electromagnetic navigation require specific equipment and increase the cost of the clinical procedure. We propose a guiding system based on the extraction of airway centers from intra‐operative videos. Such anatomical landmarks could be
matched to the airway centerline extracted from a pre‐planned CT to indicate the best path to the lesion. We present an extraction of lumen centers
from intra‐operative videos based on tracking of maximal stable regions of energy maps.
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Carles Sanchez, Antonio Esteban Lansaque, Agnes Borras, Marta Diez-Ferrer, Antoni Rosell, & Debora Gil. (2017). "Towards a Videobronchoscopy Localization System from Airway Centre Tracking " In 12th International Conference on Computer Vision Theory and Applications (pp. 352–359).
Abstract: Bronchoscopists use fluoroscopy to guide flexible bronchoscopy to the lesion to be biopsied without any kind of incision. Being fluoroscopy an imaging technique based on X-rays, the risk of developmental problems and cancer is increased in those subjects exposed to its application, so minimizing radiation is crucial. Alternative guiding systems such as electromagnetic navigation require specific equipment, increase the cost of the clinical procedure and still require fluoroscopy. In this paper we propose an image based guiding system based on the extraction of airway centres from intra-operative videos. Such anatomical landmarks are matched to the airway centreline extracted from a pre-planned CT to indicate the best path to the nodule. We present a
feasibility study of our navigation system using simulated bronchoscopic videos and a multi-expert validation of landmarks extraction in 3 intra-operative ultrathin explorations.
Keywords: Video-bronchoscopy; Lung cancer diagnosis; Airway lumen detection; Region tracking; Guided bronchoscopy navigation
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Sonia Baeza, Debora Gil, I.Garcia Olive, M.Salcedo, J.Deportos, Carles Sanchez, et al. (2022). "A novel intelligent radiomic analysis of perfusion SPECT/CT images to optimize pulmonary embolism diagnosis in COVID-19 patients " . EJNMMI Physics, 9(1, Article 84), 1–17.
Abstract: Background: COVID-19 infection, especially in cases with pneumonia, is associated with a high rate of pulmonary embolism (PE). In patients with contraindications for CT pulmonary angiography (CTPA) or non-diagnostic CTPA, perfusion single-photon emission computed tomography/computed tomography (Q-SPECT/CT) is a diagnostic alternative. The goal of this study is to develop a radiomic diagnostic system to detect PE based only on the analysis of Q-SPECT/CT scans.
Methods: This radiomic diagnostic system is based on a local analysis of Q-SPECT/CT volumes that includes both CT and Q-SPECT values for each volume point. We present a combined approach that uses radiomic features extracted from each scan as input into a fully connected classifcation neural network that optimizes a weighted crossentropy loss trained to discriminate between three diferent types of image patterns (pixel sample level): healthy lungs (control group), PE and pneumonia. Four types of models using diferent confguration of parameters were tested.
Results: The proposed radiomic diagnostic system was trained on 20 patients (4,927 sets of samples of three types of image patterns) and validated in a group of 39 patients (4,410 sets of samples of three types of image patterns). In the training group, COVID-19 infection corresponded to 45% of the cases and 51.28% in the test group. In the test group, the best model for determining diferent types of image patterns with PE presented a sensitivity, specifcity, positive predictive value and negative predictive value of 75.1%, 98.2%, 88.9% and 95.4%, respectively. The best model for detecting
pneumonia presented a sensitivity, specifcity, positive predictive value and negative predictive value of 94.1%, 93.6%, 85.2% and 97.6%, respectively. The area under the curve (AUC) was 0.92 for PE and 0.91 for pneumonia. When the results obtained at the pixel sample level are aggregated into regions of interest, the sensitivity of the PE increases to 85%, and all metrics improve for pneumonia.
Conclusion: This radiomic diagnostic system was able to identify the diferent lung imaging patterns and is a frst step toward a comprehensive intelligent radiomic system to optimize the diagnosis of PE by Q-SPECT/CT.
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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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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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Debora Gil, Aura Hernandez-Sabate, David Castells, & Jordi Carrabina. (2017). "CYBERH: Cyber-Physical Systems in Health for Personalized Assistance " In International Symposium on Symbolic and Numeric Algorithms for Scientific Computing.
Abstract: Assistance systems for e-Health applications have some specific requirements that demand of new methods for data gathering, analysis and modeling able to deal with SmallData:
1) systems should dynamically collect data from, both, the environment and the user to issue personalized recommendations; 2) data analysis should be able to tackle a limited number of samples prone to include non-informative data and possibly evolving in time due to changes in patient condition; 3) algorithms should run in real time with possibly limited computational resources and fluctuant internet access.
Electronic medical devices (and CyberPhysical devices in general) can enhance the process of data gathering and analysis in several ways: (i) acquiring simultaneously multiple sensors data instead of single magnitudes (ii) filtering data; (iii) providing real-time implementations condition by isolating tasks in individual processors of multiprocessors Systems-on-chip (MPSoC) platforms and (iv) combining information through sensor fusion
techniques.
Our approach focus on both aspects of the complementary role of CyberPhysical devices and analysis of SmallData in the process of personalized models building for e-Health applications. In particular, we will address the design of Cyber-Physical Systems in Health for Personalized Assistance (CyberHealth) in two specific application cases: 1) A Smart Assisted Driving System (SADs) for dynamical assessment of the driving capabilities of Mild Cognitive Impaired (MCI) people; 2) An Intelligent Operating Room (iOR) for improving the yield of bronchoscopic interventions for in-vivo lung cancer diagnosis.
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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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Patricia Marquez, Debora Gil, & Aura Hernandez-Sabate. (2013). "Evaluation of the Capabilities of Confidence Measures for Assessing Optical Flow Quality " In ICCV Workshop on Computer Vision in Vehicle Technology: From Earth to Mars (pp. 624–631).
Abstract: Assessing Optical Flow (OF) quality is essential for its further use in reliable decision support systems. The absence of ground truth in such situations leads to the computation of OF Confidence Measures (CM) obtained from either input or output data. A fair comparison across the capabilities of the different CM for bounding OF error is required in order to choose the best OF-CM pair for discarding points where OF computation is not reliable. This paper presents a statistical probabilistic framework for assessing the quality of a given CM. Our quality measure is given in terms of the percentage of pixels whose OF error bound can not be determined by CM values. We also provide statistical tools for the computation of CM values that ensures a given accuracy of the flow field.
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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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