Walter Simson

Yordanka Velikova, Walter Simson, Mehrdad Salehi et al.

Abdominal aortic aneurysm (AAA) is a vascular disease in which a section of the aorta enlarges, weakening its walls and potentially rupturing the vessel. Abdominal ultrasound has been utilized for diagnostics, but due to its limited image quality and operator dependency, CT scans are usually required for monitoring and treatment planning. Recently, abdominal CT datasets have been successfully utilized to train deep neural networks for automatic aorta segmentation. Knowledge gathered from this solved task could therefore be leveraged to improve US segmentation for AAA diagnosis and monitoring. To this end, we propose CACTUSS: a common anatomical CT-US space, which acts as a virtual bridge between CT and US modalities to enable automatic AAA screening sonography. CACTUSS makes use of publicly available labelled data to learn to segment based on an intermediary representation that inherits properties from both US and CT. We train a segmentation network in this new representation and employ an additional image-to-image translation network which enables our model to perform on real B-mode images. Quantitative comparisons against fully supervised methods demonstrate the capabilities of CACTUSS in terms of Dice Score and diagnostic metrics, showing that our method also meets the clinical requirements for AAA scanning and diagnosis.

Felix Duelmer, Walter Simson, Mohammad Farid Azampour et al.

Ultrasound is widely used in medical diagnostics allowing for accessible and powerful imaging but suffers from resolution limitations due to diffraction and the finite aperture of the imaging system, which restricts diagnostic use. The impulse function of an ultrasound imaging system is called the point spread function (PSF), which is convolved with the spatial distribution of reflectors in the image formation process. Recovering high-resolution reflector distributions by removing image distortions induced by the convolution process improves image clarity and detail. Conventionally, deconvolution techniques attempt to rectify the imaging system's dependent PSF, working directly on the radio-frequency (RF) data. However, RF data is often not readily accessible. Therefore, we introduce a physics-based deconvolution process using a modeled PSF, working directly on the more commonly available B-mode images. By leveraging Implicit Neural Representations (INRs), we learn a continuous mapping from spatial locations to their respective echogenicity values, effectively compensating for the discretized image space. Our contribution consists of a novel methodology for retrieving a continuous echogenicity map directly from a B-mode image through a differentiable physics-based rendering pipeline for ultrasound resolution enhancement. We qualitatively and quantitatively evaluate our approach on synthetic data, demonstrating improvements over traditional methods in metrics such as PSNR and SSIM. Furthermore, we show qualitative enhancements on an ultrasound phantom and an in-vivo acquisition of a carotid artery.

Yordanka Velikova, Mohammad Farid Azampour, Walter Simson et al.

Anatomical segmentation of organs in ultrasound images is essential to many clinical applications, particularly for diagnosis and monitoring. Existing deep neural networks require a large amount of labeled data for training in order to achieve clinically acceptable performance. Yet, in ultrasound, due to characteristic properties such as speckle and clutter, it is challenging to obtain accurate segmentation boundaries, and precise pixel-wise labeling of images is highly dependent on the expertise of physicians. In contrast, CT scans have higher resolution and improved contrast, easing organ identification. In this paper, we propose a novel approach for learning to optimize task-based ultra-sound image representations. Given annotated CT segmentation maps as a simulation medium, we model acoustic propagation through tissue via ray-casting to generate ultrasound training data. Our ultrasound simulator is fully differentiable and learns to optimize the parameters for generating physics-based ultrasound images guided by the downstream segmentation task. In addition, we train an image adaptation network between real and simulated images to achieve simultaneous image synthesis and automatic segmentation on US images in an end-to-end training setting. The proposed method is evaluated on aorta and vessel segmentation tasks and shows promising quantitative results. Furthermore, we also conduct qualitative results of optimized image representations on other organs.

Louise Zhuang, Samuel Beuret, Ben Frey et al.

In pulse-echo ultrasound, aberration often degrades image quality when beamforming does not account for wavefront distortions. To address this issue, local sound speed estimators have been developed in the past decade for distributed aberration correction. Recently, methods based on iterative optimization have improved sound speed accuracy with respect to earlier approaches. However, the accuracy of these newer methods is limited by media with reverberation clutter and by the straight-ray model of wave propagation. To address these challenges, we propose using wavefield correlation (WFC) beamforming when performing sound speed optimization. WFC, an ultrasound adaptation of reverse time migration, correlates simulated forward-propagated transmit wavefields and backwards-propagated receive wavefields in order to reconstruct images. This process more accurately models wave propagation in heterogeneous media and can decrease diffuse clutter due to its spatiotemporal matched filtering effect. We implement herein a WFC beamformer using an auto-differentiation software and estimate the sound speed map by optimizing a regularized common-midpoint phase focusing criterion using gradient descent. This approach is compared to a previous method relying on delay and sum (DAS) with straight-ray time delay calculations on a variety of simulated, phantom, and in vivo data with large sound speed variations and clutter. Results show that using WFC decreases sound speed estimation error, leading to improvements in resolution and contrast in the corrected image. In particular, these promising results have potential to improve pulse-echo imaging for challenging clinical scenarios.

Francesca De Benetti, Walter Simson, Magdalini Paschali et al.

Dynamic positron emission tomography imaging (dPET) provides temporally resolved images of a tracer enabling a quantitative measure of physiological processes. Voxel-wise physiologically-based pharmacokinetic (PBPK) modeling of the time activity curves (TAC) can provide relevant diagnostic information for clinical workflow. Conventional fitting strategies for TACs are slow and ignore the spatial relation between neighboring voxels. We train a spatio-temporal UNet to estimate the kinetic parameters given TAC from F-18-fluorodeoxyglucose (FDG) dPET. This work introduces a self-supervised loss formulation to enforce the similarity between the measured TAC and those generated with the learned kinetic parameters. Our method provides quantitatively comparable results at organ-level to the significantly slower conventional approaches, while generating pixel-wise parametric images which are consistent with expected physiology. To the best of our knowledge, this is the first self-supervised network that allows voxel-wise computation of kinetic parameters consistent with a non-linear kinetic model. The code will become publicly available upon acceptance.

Maria Tirindelli, Christine Eilers, Walter Simson et al.

Medical Ultrasound (US), despite its wide use, is characterized by artifacts and operator dependency. Those attributes hinder the gathering and utilization of US datasets for the training of Deep Neural Networks used for Computer-Assisted Intervention Systems. Data augmentation is commonly used to enhance model generalization and performance. However, common data augmentation techniques, such as affine transformations do not align with the physics of US and, when used carelessly can lead to unrealistic US images. To this end, we propose a set of physics-inspired transformations, including deformation, reverb and Signal-to-Noise Ratio, that we apply on US B-mode images for data augmentation. We evaluate our method on a new spine US dataset for the tasks of bone segmentation and classification.

Hannes Hase, Mohammad Farid Azampour, Maria Tirindelli et al.

In this paper we introduce the first reinforcement learning (RL) based robotic navigation method which utilizes ultrasound (US) images as an input. Our approach combines state-of-the-art RL techniques, specifically deep Q-networks (DQN) with memory buffers and a binary classifier for deciding when to terminate the task. Our method is trained and evaluated on an in-house collected data-set of 34 volunteers and when compared to pure RL and supervised learning (SL) techniques, it performs substantially better, which highlights the suitability of RL navigation for US-guided procedures. When testing our proposed model, we obtained a 82.91% chance of navigating correctly to the sacrum from 165 different starting positions on 5 different unseen simulated environments.

Tobias Czempiel, Magdalini Paschali, Matthias Keicher et al.

Automatic surgical phase recognition is a challenging and crucial task with the potential to improve patient safety and become an integral part of intra-operative decision-support systems. In this paper, we propose, for the first time in workflow analysis, a Multi-Stage Temporal Convolutional Network (MS-TCN) that performs hierarchical prediction refinement for surgical phase recognition. Causal, dilated convolutions allow for a large receptive field and online inference with smooth predictions even during ambiguous transitions. Our method is thoroughly evaluated on two datasets of laparoscopic cholecystectomy videos with and without the use of additional surgical tool information. Outperforming various state-of-the-art LSTM approaches, we verify the suitability of the proposed causal MS-TCN for surgical phase recognition.

Walter Simson, Rüdiger Göbl, Magdalini Paschali et al.

Ultrasound imaging is caught between the quest for the highest image quality, and the necessity for clinical usability. Our contribution is two-fold: First, we propose a novel fully convolutional neural network for ultrasound reconstruction. Second, a custom loss function tailored to the modality is employed for end-to-end training of the network. We demonstrate that training a network to map time-delayed raw data to a minimum variance ground truth offers performance increases in a clinical environment. In doing so, a path is explored towards improved clinically viable ultrasound reconstruction. The proposed method displays both promising image reconstruction quality and acquisition frequency when integrated for live ultrasound scanning. A clinical evaluation is conducted to verify the diagnostic usefulness of the proposed method in a clinical setting.

Magdalini Paschali, Muhammad Ferjad Naeem, Walter Simson et al.

In this paper, we propose a novel interpretation method tailored to histological Whole Slide Image (WSI) processing. A Deep Neural Network (DNN), inspired by Bag-of-Features models is equipped with a Multiple Instance Learning (MIL) branch and trained with weak supervision for WSI classification. MIL avoids label ambiguity and enhances our model's expressive power without guiding its attention. We utilize a fine-grained logit heatmap of the models activations to interpret its decision-making process. The proposed method is quantitatively and qualitatively evaluated on two challenging histology datasets, outperforming a variety of baselines. In addition, two expert pathologists were consulted regarding the interpretability provided by our method and acknowledged its potential for integration into several clinical applications.

Magdalini Paschali, Walter Simson, Abhijit Guha Roy et al.

In this paper we propose a novel augmentation technique that improves not only the performance of deep neural networks on clean test data, but also significantly increases their robustness to random transformations, both affine and projective. Inspired by ManiFool, the augmentation is performed by a line-search manifold-exploration method that learns affine geometric transformations that lead to the misclassification on an image, while ensuring that it remains on the same manifold as the training data. This augmentation method populates any training dataset with images that lie on the border of the manifolds between two-classes and maximizes the variance the network is exposed to during training. Our method was thoroughly evaluated on the challenging tasks of fine-grained skin lesion classification from limited data, and breast tumor classification of mammograms. Compared with traditional augmentation methods, and with images synthesized by Generative Adversarial Networks our method not only achieves state-of-the-art performance but also significantly improves the network's robustness.