Jack H. Noble

Yike Zhang, Eduardo Davalos, Dingjie Su et al.

Cochlear Implant (CI) procedures require the insertion of an electrode array into the cochlea within the inner ear. To achieve this, mastoidectomy, a surgical procedure involving the removal of part of the mastoid region of the temporal bone using a high-speed drill provides safe access to the cochlea through the middle and inner ear. In this paper, we propose a novel Mamba-based method to synthesize the mastoidectomy volume using only preoperative Computed Tomography (CT) scans, where the mastoid remains intact. Our approach introduces a self-supervised learning framework designed to predict the mastoidectomy shape and reconstruct a 3D post-mastoidectomy surface directly from preoperative CT scans. This reconstruction aligns with intraoperative microscope views, enabling various downstream surgical applications. For training, we leverage postoperative CT scans to bypass manual data cleaning and labeling, even when the region removed during mastoidectomy is affected by challenges such as metal artifacts, low signal-to-noise ratio, or electrode wiring. Our method achieves a mean Dice score of 0.70 in estimating mastoidectomy regions, demonstrating its effectiveness for accurate and efficient surgical preoperative planning.

Yike Zhang, Eduardo Davalos, Dingjie Su et al.

For those experiencing severe-to-profound sensorineural hearing loss, the cochlear implant (CI) is the preferred treatment. Augmented reality (AR) aided surgery can potentially improve CI procedures and hearing outcomes. Typically, AR solutions for image-guided surgery rely on optical tracking systems to register pre-operative planning information to the display so that hidden anatomy or other important information can be overlayed and co-registered with the view of the surgical scene. In this paper, our goal is to develop a method that permits direct 2D-to-3D registration of the microscope video to the pre-operative Computed Tomography (CT) scan without the need for external tracking equipment. Our proposed solution involves using surface mapping of a portion of the incus in surgical recordings and determining the pose of this structure relative to the surgical microscope by performing pose estimation via the perspective-n-point (PnP) algorithm. This registration can then be applied to pre-operative segmentations of other anatomy-of-interest, as well as the planned electrode insertion trajectory to co-register this information for the AR display. Our results demonstrate the accuracy with an average rotation error of less than 25 degrees and a translation error of less than 2 mm, 3 mm, and 0.55% for the x, y, and z axes, respectively. Our proposed method has the potential to be applicable and generalized to other surgical procedures while only needing a monocular microscope during intra-operation.

Hannah G. Mason, Jack H. Noble

Cochlear implants (CIs) are neural prosthetics used to treat patients with severe-to-profound hearing loss. Patient-specific modeling of CI stimulation of the auditory nerve fiber (ANFs) can help audiologists improve the CI programming. These models require localization of the ANFs relative to surrounding anatomy and the CI. Localization is challenging because the ANFs are so small they are not directly visible in clinical imaging. In this work, we hypothesize the position of the ANFs can be accurately inferred from the location of the internal auditory canal (IAC), which has high contrast in CT, since the ANFs pass through this canal between the cochlea and the brain. Inspired by VoxelMorph, in this paper we propose a deep atlas-based IAC segmentation network. We create a single atlas in which the IAC and ANFs are pre-localized. Our network is trained to produce deformation fields (DFs) mapping coordinates from the atlas to new target volumes and that accurately segment the IAC. We hypothesize that DFs that accurately segment the IAC in target images will also facilitate accurate atlas-based localization of the ANFs. As opposed to VoxelMorph, which aims to produce DFs that accurately register the entire volume, our novel contribution is an entirely self-supervised training scheme that aims to produce DFs that accurately segment the target structure. This self-supervision is facilitated using a regional level set (LS) inspired loss function. We call our method Deep Atlas Based Segmentation using Level Sets (DABS-LS). Results show that DABS-LS outperforms VoxelMorph for IAC segmentation. Tests with publicly available datasets for trachea and kidney segmentation also show significant improvement in segmentation accuracy, demonstrating the generalizability of the method.

Yike Zhang, Jack H. Noble

Cochlear implant surgery is a treatment for individuals with severe hearing loss. It involves inserting an array of electrodes inside the cochlea to electrically stimulate the auditory nerve and restore hearing sensation. A crucial step in this procedure is mastoidectomy, a surgical intervention that removes part of the mastoid region of the temporal bone, providing a critical pathway to the cochlea for electrode placement. Accurate prediction of the mastoidectomy region from preoperative imaging assists presurgical planning, reduces surgical risks, and improves surgical outcomes. In previous work, a self-supervised network was introduced to predict the mastoidectomy region using only preoperative CT scans. While promising, the method suffered from suboptimal robustness, limiting its practical application. To address this limitation, we propose a novel weakly-supervised Mamba-based framework to predict accurate mastoidectomy regions directly from preoperative CT scans. Our approach utilizes a 3D T-Distribution loss function inspired by the Student-t distribution, which effectively handles the complex geometric variability inherent in mastoidectomy shapes. Weak supervision is achieved using the segmentation results from the prior self-supervised network to eliminate the need for manual data cleaning or labeling throughout the training process. The proposed method is extensively evaluated against state-of-the-art approaches, demonstrating superior performance in predicting accurate and clinically relevant mastoidectomy regions. Our findings highlight the robustness and efficiency of the weakly-supervised learning framework with the proposed novel 3D T-Distribution loss.

Yike Zhang, Eduardo Davalos Anaya, Jack H. Noble

This paper presents a novel method for monocular patient-to-image intraoperative registration, specifically designed to operate without any external hardware tracking equipment or fiducial point markers. Leveraging a synthetic microscopy surgical scene dataset with a wide range of transformations, our approach directly maps preoperative CT scans to 2D intraoperative surgical frames through a lightweight neural network for real-time cochlear implant surgery guidance via a zero-shot learning approach. Unlike traditional methods, our framework seamlessly integrates with monocular surgical microscopes, making it highly practical for clinical use without additional hardware dependencies and requirements. Our method estimates camera poses, which include a rotation matrix and a translation vector, by learning from the synthetic dataset, enabling accurate and efficient intraoperative registration. The proposed framework was evaluated on nine clinical cases using a patient-specific and cross-patient validation strategy. Our results suggest that our approach achieves clinically relevant accuracy in predicting 6D camera poses for registering 3D preoperative CT scans to 2D surgical scenes with an angular error within 10 degrees in most cases, while also addressing limitations of traditional methods, such as reliance on external tracking systems or fiducial markers.

Jianing Wang, Dingjie Su, Yubo Fan et al.

We propose an atlas-based method to segment the intracochlear anatomy (ICA) in the post-implantation CT (Post-CT) images of cochlear implant (CI) recipients that preserves the point-to-point correspondence between the meshes in the atlas and the segmented volumes. To solve this problem, which is challenging because of the strong artifacts produced by the implant, we use a pair of co-trained deep networks that generate dense deformation fields (DDFs) in opposite directions. One network is tasked with registering an atlas image to the Post-CT images and the other network is tasked with registering the Post-CT images to the atlas image. The networks are trained using loss functions based on voxel-wise labels, image content, fiducial registration error, and cycle-consistency constraint. The segmentation of the ICA in the Post-CT images is subsequently obtained by transferring the predefined segmentation meshes of the ICA in the atlas image to the Post-CT images using the corresponding DDFs generated by the trained registration networks. Our model can learn the underlying geometric features of the ICA even though they are obscured by the metal artifacts. We show that our end-to-end network produces results that are comparable to the current state of the art (SOTA) that relies on a two-steps approach that first uses conditional generative adversarial networks to synthesize artifact-free images from the Post-CT images and then uses an active shape model-based method to segment the ICA in the synthetic images. Our method requires a fraction of the time needed by the SOTA, which is important for end-user acceptance.

Yiyuan Zhao, Jianing Wang, Rui Li et al.

Cochlear implants (CIs) are a standard treatment for patients who experience severe to profound hearing loss. Recent studies have shown that hearing outcome is correlated with intra-cochlear anatomy and electrode placement. Our group has developed image-guided CI programming (IGCIP) techniques that use image analysis methods to both segment the inner ear structures in pre- or post-implantation CT images and localize the CI electrodes in post-implantation CT images. This permits to assist audiologists with CI programming by suggesting which among the contacts should be deactivated to reduce electrode interaction that is known to affect outcomes. Clinical studies have shown that IGCIP can improve hearing outcomes for CI recipients. However, the sensitivity of IGCIP with respect to the accuracy of the two major steps: electrode localization and intra-cochlear anatomy segmentation, is unknown. In this article, we create a ground truth dataset with conventional CT and micro-CT images of 35 temporal bone specimens to both rigorously characterize the accuracy of these two steps and assess how inaccuracies in these steps affect the overall results. Our study results show that when clinical pre- and post-implantation CTs are available, IGCIP produces results that are comparable to those obtained with the corresponding ground truth in 86.7% of the subjects tested. When only post-implantation CTs are available, this number is 83.3%. These results suggest that our current method is robust to errors in segmentation and localization but also that it can be improved upon. Keywords: cochlear implant, ground truth, segmentation, validation

Dongqing Zhang, Jianing Wang, Jack H. Noble et al.

Cochlear implants (CIs) are neural prosthetics which are used to treat patients with hearing loss. CIs use an array of electrodes which are surgically inserted into the cochlea to stimulate the auditory nerve endings. After surgery, CIs need to be programmed. Studies have shown that the spatial relationship between the intra-cochlear anatomy and electrodes derived from medical images can guide CI programming and lead to significant improvement in hearing outcomes. However, clinical head CT images are usually obtained from scanners of different brands with different protocols. The field of view thus varies greatly and visual inspection is needed to document their content prior to applying algorithms for electrode localization and intra-cochlear anatomy segmentation. In this work, to determine the presence/absence of inner ears and to accurately localize them in head CTs, we use a volume-to-volume convolutional neural network which can be trained end-to-end to map a raw CT volume to probability maps which indicate inner ear positions. We incorporate a false positive suppression strategy in training and apply a shape-based constraint. We achieve a labeling accuracy of 98.59% and a localization error of 2.45mm. The localization error is significantly smaller than a random forest-based approach that has been proposed recently to perform the same task.