Yiming Xiao

Soorena Salari, Amirhossein Rasoulian, Hassan Rivaz et al.

Homologous anatomical landmarks between medical scans are instrumental in quantitative assessment of image registration quality in various clinical applications, such as MRI-ultrasound registration for tissue shift correction in ultrasound-guided brain tumor resection. While manually identified landmark pairs between MRI and ultrasound (US) have greatly facilitated the validation of different registration algorithms for the task, the procedure requires significant expertise, labor, and time, and can be prone to inter- and intra-rater inconsistency. So far, many traditional and machine learning approaches have been presented for anatomical landmark detection, but they primarily focus on mono-modal applications. Unfortunately, despite the clinical needs, inter-modal/contrast landmark detection has very rarely been attempted. Therefore, we propose a novel contrastive learning framework to detect corresponding landmarks between MRI and intra-operative US scans in neurosurgery. Specifically, two convolutional neural networks were trained jointly to encode image features in MRI and US scans to help match the US image patch that contain the corresponding landmarks in the MRI. We developed and validated the technique using the public RESECT database. With a mean landmark detection accuracy of 5.88+-4.79 mm against 18.78+-4.77 mm with SIFT features, the proposed method offers promising results for MRI-US landmark detection in neurosurgical applications for the first time.

Soorena Salari, Amirhossein Rasoulian, Hassan Rivaz et al.

In brain tumor resection, accurate removal of cancerous tissues while preserving eloquent regions is crucial to the safety and outcomes of the treatment. However, intra-operative tissue deformation (called brain shift) can move the surgical target and render the pre-surgical plan invalid. Intra-operative ultrasound (iUS) has been adopted to provide real-time images to track brain shift, and inter-modal (i.e., MRI-iUS) registration is often required to update the pre-surgical plan. Quality control for the registration results during surgery is important to avoid adverse outcomes, but manual verification faces great challenges due to difficult 3D visualization and the low contrast of iUS. Automatic algorithms are urgently needed to address this issue, but the problem was rarely attempted. Therefore, we propose a novel deep learning technique based on 3D focal modulation in conjunction with uncertainty estimation to accurately assess MRI-iUS registration errors for brain tumor surgery. Developed and validated with the public RESECT clinical database, the resulting algorithm can achieve an estimation error of 0.59+-0.57 mm.

Soorena Salari, Amirhossein Rasoulian, Hassan Rivaz et al.

Early surgical treatment of brain tumors is crucial in reducing patient mortality rates. However, brain tissue deformation (called brain shift) occurs during the surgery, rendering pre-operative images invalid. As a cost-effective and portable tool, intra-operative ultrasound (iUS) can track brain shift, and accurate MRI-iUS registration techniques can update pre-surgical plans and facilitate the interpretation of iUS. This can boost surgical safety and outcomes by maximizing tumor removal while avoiding eloquent regions. However, manual assessment of MRI-iUS registration results in real-time is difficult and prone to errors due to the 3D nature of the data. Automatic algorithms that can quantify the quality of inter-modal medical image registration outcomes can be highly beneficial. Therefore, we propose a novel deep-learning (DL) based framework with the Swin UNETR to automatically assess 3D-patch-wise dense error maps for MRI-iUS registration in iUS-guided brain tumor resection and show its performance with real clinical data for the first time.

Arash Harirpoush, Amirhossein Rasoulian, Marta Kersten-Oertel et al.

Recent rising interests in patient-specific thoracic surgical planning and simulation require efficient and robust creation of digital anatomical models from automatic medical image segmentation algorithms. Deep learning (DL) is now state-of-the-art in various radiological tasks, and U-shaped DL models have particularly excelled in medical image segmentation since the inception of the 2D UNet. To date, many variants of U-shaped models have been proposed by the integration of different attention mechanisms and network configurations. Systematic benchmark studies which analyze the architecture of these models by leveraging the recent development of the multi-label databases, can provide valuable insights for clinical deployment and future model designs, but such studies are still rare. We conduct the first systematic benchmark study for variants of 3D U-shaped models (3DUNet, STUNet, AttentionUNet, SwinUNETR, FocalSegNet, and a novel 3D SwinUnet with four variants) with a focus on CT-based anatomical segmentation for thoracic surgery. Our study systematically examines the impact of different attention mechanisms, the number of resolution stages, and network configurations on segmentation accuracy and computational complexity. To allow cross-reference with other recent benchmarking studies, we also included a performance assessment of the BTCV abdominal structural segmentation. With the STUNet ranking at the top, our study demonstrated the value of CNN-based U-shaped models for the investigated tasks and the benefit of residual blocks in network configuration designs to boost segmentation performance.

Simon Joseph Clément Crête, Marta Kersten-Oertel, Yiming Xiao

MRI-based brain age estimation models aim to assess a subject's biological brain age based on information, such as neuroanatomical features. Various factors, including neurodegenerative diseases, can accelerate brain aging and measuring this phenomena could serve as a potential biomarker for clinical applications. While deep learning (DL)-based regression has recently attracted major attention, existing approaches often fail to capture the continuous nature of neuromorphological changes, potentially resulting in sub-optimal feature representation and results. To address this, we propose to use supervised contrastive learning with the recent Rank-N-Contrast (RNC) loss to estimate brain age based on widely used T1w structural MRI for the first time and leverage Grad-RAM to visually explain regression results. Experiments show that our proposed method achieves a mean absolute error (MAE) of 4.27 years and an $R^2$ of 0.93 with a limited dataset of training samples, significantly outperforming conventional deep regression with the same ResNet backbone while performing better or comparably with the state-of-the-art methods with significantly larger training data. Furthermore, Grad-RAM revealed more nuanced features related to age regression with the RNC loss than conventional deep regression. As an exploratory study, we employed the proposed method to estimate the gap between the biological and chronological brain ages in Alzheimer's Disease and Parkinson's disease patients, and revealed the correlation between the brain age gap and disease severity, demonstrating its potential as a biomarker in neurodegenerative disorders.

Pascal Spiegler, Arash Harirpoush, Yiming Xiao

Crucial in disease analysis and surgical planning, manual segmentation of volumetric medical scans (e.g. MRI, CT) is laborious, error-prone, and challenging to master, while fully automatic algorithms can benefit from user feedback. Therefore, with the complementary power of the latest radiological AI foundation models and virtual reality (VR)'s intuitive data interaction, we propose SAMIRA, a novel conversational AI agent for medical VR that assists users with localizing, segmenting, and visualizing 3D medical concepts. Through speech-based interaction, the agent helps users understand radiological features, locate clinical targets, and generate segmentation masks that can be refined with just a few point prompts. The system also supports true-to-scale 3D visualization of segmented pathology to enhance patient-specific anatomical understanding. Furthermore, to determine the optimal interaction paradigm under near-far attention-switching for refining segmentation masks in an immersive, human-in-the-loop workflow, we compare VR controller pointing, head pointing, and eye tracking as input modes. With a user study, evaluations demonstrated a high usability score (SUS=90.0 $\pm$ 9.0), low overall task load, as well as strong support for the proposed VR system's guidance, training potential, and integration of AI in radiological segmentation tasks.

Jie Luo, Guangshen Ma, Sarah Frisken et al.

With the increasing availability of new image registration approaches, an unbiased evaluation is becoming more needed so that clinicians can choose the most suitable approaches for their applications. Current evaluations typically use landmarks in manually annotated datasets. As a result, the quality of annotations is crucial for unbiased comparisons. Even though most data providers claim to have quality control over their datasets, an objective third-party screening can be reassuring for intended users. In this study, we use the variogram to screen the manually annotated landmarks in two datasets used to benchmark registration in image-guided neurosurgeries. The variogram provides an intuitive 2D representation of the spatial characteristics of annotated landmarks. Using variograms, we identified potentially problematic cases and had them examined by experienced radiologists. We found that (1) a small number of annotations may have fiducial localization errors; (2) the landmark distribution for some cases is not ideal to offer fair comparisons. If unresolved, both findings could incur bias in registration evaluation.