Johannes Görich

Philipp D. Lösel, Jacob J. Relle, Samuel Voß et al.

Abdominal wall defects often lead to pain, discomfort, and recurrence of incisional hernias, resulting in significant morbidity and repeated surgical repairs worldwide. Mesh repair for large hernias is usually based on the defect area with a fixed overlap, neglecting biomechanical factors such as muscle activation, intra-abdominal pressure, tissue elasticity, and abdominal wall distension. To address this issue, we present a biomechanical approach to incisional hernia repair that takes into account the unstable abdominal wall. Additionally, we introduce HEDI, a tool that uses computed tomography with Valsalva maneuver to automatically detect and assess hernia size, volume, and abdominal wall instability. Our first clinical application of HEDI in the preoperative evaluation of 31 patients shows significantly improved success rates compared to reported rates, with all patients remaining pain-free and experiencing no hernia recurrence after three years of follow-up.

Felix Denzinger, Michael Wels, Oliver Taubmann et al.

Coronary artery disease (CAD) is often treated minimally invasively with a catheter being inserted into the diseased coronary vessel. If a patient exhibits a Shepherd's Crook (SC) Right Coronary Artery (RCA) - an anatomical norm variant of the coronary vasculature - the complexity of this procedure is increased. Automated reporting of this variant from coronary CT angiography screening would ease prior risk assessment. We propose a 1D convolutional neural network which leverages a sequence of residual dilated convolutions to automatically determine this norm variant from a prior extracted vessel centerline. As the SC RCA is not clearly defined with respect to concrete measurements, labeling also includes qualitative aspects. Therefore, 4.23% samples in our dataset of 519 RCA centerlines were labeled as unsure SC RCAs, with 5.97% being labeled as sure SC RCAs. We explore measures to handle this label uncertainty, namely global/model-wise random assignment, exclusion, and soft label assignment. Furthermore, we evaluate how this uncertainty can be leveraged for the determination of a rejection class. With our best configuration, we reach an area under the receiver operating characteristic curve (AUC) of 0.938 on confident labels. Moreover, we observe an increase of up to 0.020 AUC when rejecting 10% of the data and leveraging the labeling uncertainty information in the exclusion process.

Felix Denzinger, Michael Wels, Oliver Taubmann et al.

With coronary artery disease (CAD) persisting to be one of the leading causes of death worldwide, interest in supporting physicians with algorithms to speed up and improve diagnosis is high. In clinical practice, the severeness of CAD is often assessed with a coronary CT angiography (CCTA) scan and manually graded with the CAD-Reporting and Data System (CAD-RADS) score. The clinical questions this score assesses are whether patients have CAD or not (rule-out) and whether they have severe CAD or not (hold-out). In this work, we reach new state-of-the-art performance for automatic CAD-RADS scoring. We propose using severity-based label encoding, test time augmentation (TTA) and model ensembling for a task-specific deep learning architecture. Furthermore, we introduce a novel task- and model-specific, heuristic coronary segment labeling, which subdivides coronary trees into consistent parts across patients. It is fast, robust, and easy to implement. We were able to raise the previously reported area under the receiver operating characteristic curve (AUC) from 0.914 to 0.942 in the rule-out and from 0.921 to 0.950 in the hold-out task respectively.