1) The document discusses computational assessment methods for chronic obstructive pulmonary disease (COPD) using medical imaging data. It covers topics like lung segmentation, lobe segmentation, airway measurement, vessel quantification, and texture-based emphysema quantification.
2) Various algorithms are presented for tasks like robust lung and lobe segmentation, left/right lung splitting, airway skeletonization and labeling, and classification of pulmonary arteries and veins.
3) Quantitative image analysis methods are discussed for measuring airway wall thickness, quantifying emphysema heterogeneity, and classifying COPD patterns based on texture and shape features.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Recent advances in diagnosis & treatment plsning /certified fixed orthodonti...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Digital imaging in orthodontics /certified fixed orthodontic courses by India...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Recent advances in diagnosis & treatment plsning /certified fixed orthodonti...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Digital imaging in orthodontics /certified fixed orthodontic courses by India...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Recent advances in diagnosis and treatment planning1 /certified fixed orthod...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Magnetic resonance imaging /certified fixed orthodontic courses by Indian de...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all
aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Recent advances in diagnostic aids /certified fixed orthodontic courses by In...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
principles, applications, advantages, disadvantages, guidelines, uses of cone beam computed tomography in the field of orthodontics and dentistry in general
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Recent advances digital imaging /certified fixed orthodontic courses by India...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Recent advances in diagnosis and treatment planning1 /certified fixed orthod...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Magnetic resonance imaging /certified fixed orthodontic courses by Indian de...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all
aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Recent advances in diagnostic aids /certified fixed orthodontic courses by In...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
principles, applications, advantages, disadvantages, guidelines, uses of cone beam computed tomography in the field of orthodontics and dentistry in general
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Recent advances digital imaging /certified fixed orthodontic courses by India...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Biosensors And Bioelectronics Presentation by Sijung HuConferenceMind
Excellent presentation by Sijung Hu, Loughborough University, United Kingdom. He talks about - "Opto-physiological modeling to drive an effective physiological monitoring: from contact to noncontact, from point to imaging" at the 2nd International Webinar on Biosensors And Bioelectronics
Date: July 12-13, 2021
Visit here for more details:
https://conferencemind.com/conference/biosensorsandbioelectronics
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ASRT at 2015 RSNA Annual Meeting CT scanning Face Transplant Surgical PlanningFrank Rybicki
Frank Rybicki lecture at the 2015 Annual Meeting of the Radiological Society of North America (RSNA). This lecture was invited by the American Society of Radiologic Technologists (ASRT) and features amazing technologists from my past position in Boston Massachusetts, at Brigham and Women's Hospital. Many of these slides were generous provided by Bo Pomahac, MD, brilliant surgeon, caring physician, and wonderful friend. I have removed the images of Bo's patients. We have permission to publish them, but I wanted to play it safe to avoid any possible complaints
Quantitative Image Analysis for Cancer Diagnosis and Radiation TherapyWookjin Choi
1.Lung Cancer Screening
1.1.Deep learning (feasible but not interpretable)
1.2.Radiomics (concise model)
1.3.Spiculation quantification (interpretable feature)
2.PET/CT Tumor Response
2.1.Aggressive Lung ADC subtype prediction (helpful for surgeons)
2.2.Pathologic response prediction (accurate but not concise)
2.3.Local tumor morphological changes (accurate and interpretable)
MEDICAL IMAGE PROCESSING METHODOLOGY FOR LIVER TUMOUR DIAGNOSISijsc
Apply the Image processing techniques to analyse the medical images may assist medical professionals as well as patients, especially in this research apply the algorithms to diagnose the liver tumours from the abdominal CT image. This research proposes a software solution to illustrate the automated liver
segmentation and tumour detection using artificial intelligent techniques. Evaluate the results of the liver segmentation and tumour detection, in-cooperation with the radiologists by using the prototype of the proposed system. This research overcomes the challenges in medical image processing. The 100 samples
collected from ten patients and received 90% accuracy rate.
Medical Image Processing Methodology for Liver Tumour Diagnosis ijsc
Apply the Image processing techniques to analyse the medical images may assist medical professionals as well as patients, especially in this research apply the algorithms to diagnose the liver tumours from the abdominal CT image. This research proposes a software solution to illustrate the automated liver segmentation and tumour detection using artificial intelligent techniques. Evaluate the results of the liver segmentation and tumour detection, in-cooperation with the radiologists by using the prototype of the proposed system. This research overcomes the challenges in medical image processing. The 100 samples collected from ten patients and received 90% accuracy rate.
Impact of Increased PTA Values and Biomechanical Indices on
Visual Outcome up to 5 Years After Small-Incision Lenticule Extraction, presented at ASCRS 2018 – by Timon Ax, D. Breyer, H. Kaymak, K. Klabe, P. Hagen, F. Kretz, G. Auffarth
Chronic Total Occlusions: The Road Less TraveledAllina Health
By M. Nicholas Burke, MD. The use of pioneering percutaneous treatments for chronic total occlusions: indications, limitations, outcomes and current research.
Similar to Basics of computational assessment for COPD: IWPFI 2017 (20)
지난주말에 있었던 제 4회 대한신경집중치료학회 편집위원회 워크샵에서 발표했던 내용중에 발췌한 것입니다. 원래 제목은 "인공지능 관련 연구: 논문 작성과 심사에 관한 요령" 입니다. 최근에 deep learning in medical imaging으로 2편의 리뷰와 논문 1편, CADD 논문, 앙상블 논문 1편이 되면서 요청이 온것 같습니다.부족한 제가 하기 어려운 주제를 맡았는데, 혹시 도움이 되실 분이 있으면 도움을 되시라고 올려드립니다. 결론은 인공지능 연구라고 특별히 다르지는 않지만, 공학 연구와 의학연구가 다르고, 인공지능 특성을 잘 이해해야 한다 정도 될것 같습니다. (상당부분 저희병원 박성호 교수님의 radiology 논문 Methodology for Evaluation of Clinical Performance and Impact of Artificial Intelligence Technology for Medical Diagnosis and Prediction을 참고했습니다.)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basics of computational assessment for COPD: IWPFI 2017
1. BASICS OF COMPUTATIONAL
ASSESSMENT FOR COPD
1st PERFUSE Registry Workshop
Namkug Kim, PhD
Medical Imaging & Robotics Lab.
University of Ulsan College of Medicine
Asan Medical Center
South Korea
2. Researches with
Hyundai Heavy Industries Co. Ltd.
LG Electronics
Coreline Soft Inc.
Osstem Implant
CGBio
VUNO
Kakaobrain
Conflict of Interests
Stockholder
Coreline Soft, Inc.
AnyMedi
Co-Founder
Somansa Inc.
Cybermed Inc.
Clinical Imaging Solution, Inc
AnyMedi, Inc.
Selected Grants as PI
National Research Foundation (한국연구재단),
South Korea
7T용 4D 자기공명유속영상을이용한 심뇌혈관 질환의 in-vivo
유동 정량화 SW개발, 2016
4D flow MRI을 이용한 심혈관 질환의 in-vivo유동 연구, 2015-7
자기공명분광영상 및 MRI의 통합 분석 소프트웨어 개발
KEIT (산업부), South Korea
의료영상 인공지능 과제, 2016-20
3DP 척추 맞춤형 임플란트, 2016-20
3D 프린터 기반 무치악 및 두개악안면결손환자용 수복
보철물 제작, 재건 시스템 개발, 2015-9
근골격계 복구 수술 로봇 개발, 2012-7
영상중재시술 로봇시스템 개발, 2012-7
Spine및Neurosurgery 수술보조용항법 시스템 개발, 2001
의료용 3차원 모델 제작 S/W 기술 개발, 정통부, 2000
의료영상재구성에 의한 가상시술 소프트웨어 개발,
중소기업기술혁신개발,중기청, 2001
KHIDI (보건복지부), South Korea
영상 뇌졸중 예후 예측 및 치료방침 결정 시스템 개발, 2012-8
관동맥 관류 CT 의 자동 진단 프로그램을활용한 허혈성
질환의 진단과 치료, 2013-6
RP를 이용한 척추나사못 삽입술 계획 프로그램 개발, 2000
Commercial collaboration
Hyundai Heavy Industry,Osstem Implant,S&G Biotech, Coreline
soft, MidasIT, AnyMedi,Hitachi Medical, Japan,
3. Overview of Lung Analysis*
512x512x(512~3000) voxels
Anatomical imaging,
Qualitative Diagnosis
Functional Imaging
MR/CT perfusion/ventilation
Classification
On texture , shape, etc
CADD (Computer Aided
Differential Diagnosis)
On diseases distribution, heterogeneity
Surgery Support
(replica model, surgery planning, Robot)
CBIR (Content based
Image Retrieval), CAD
Image
Repositories
Image Queries
Image Retrieval
Virtual bronchoscopy
Quantification
On airway measurement, EI, etc
Segmentation / Registration
Lung/Lobe/Airway Seg.
Full ins/ex lung registration
*Seo JB, Lee SM @ Radiology AMC (2004.8~)
On image based DB query and retrieval
4. Basic Lung Segmentation
Lung
Thoracic
Trunk
Rolling Ball AlgorithmRegion Growing AlgorithmAirway segmentation and left and right lung split
Overall procedure of lung and airway
segmentation Fast Seed Based Region Growing Rolling Ball Algorithm
Valid Region?
Input Seed Points
Save Seed Points
Retrieve a Seed Point
Region segmentation
using region growing
Save Seed Point
Queue Empty
Segmentation Result
5. Hyper-inflated Lung Left/Right Split
Lee MH, Kim N, et al, KSIIM 2011, Best Poster Award, J Digit Imag 2014
Surface fitting with iterative 3D morphological operator with Hessian
matrix analysis
For automatic
lobe
segmentation
Robust
left/right split
algorithm for
preserving lung
volume with
same threshold
6. Thoracic Cavity Segmentation
COPD is systematic
diseases
Quantification of
fat contents in the
thoracic cavity.
For robust
segmentation
Surface-fitting
method with 5
surfaces including
inner rib
boundary and
diaphragm
A two-stage level
set method using
a shape prior.
Additional
heart and its
surrounding
tissue
Volumetric overlap
ratio (VOR)
98.17 ± 0.84%,
6/33Bae JP, Kim N, et al, Med Physics, 2014
Heart and its surrounding tissues Segmentation Results
Surface fitting results
7. Robust Lobe Segmentation
Park JH, Kim N, et al, RSNA 2011, IWPFI 2017
Robust lobe
segmentation is not
easy
Anatomic & diseases
variations including
fake, incomplete
fissures, COPD and
ILD
For robust
segmentation
Surface-fitting
method with Hessian
matrix and machine
learning
Comparison among
machine learnings
9. Robust Airway Measurement
Inflammation -> Airway Remodeling -> Airway
Narrowing
quantify the extent of airway remodeling in vivo
using CT
Typical surrogate marker
MDCT
Provides bronchial tree geometry with sub-
millimeter resolution
Measure the airway wall thickness, luminal diameter,
wall area, lumen area, wall-lumen area ratio and
wall-lumen diameter ratio
Evaluate the regional airway physiology and
structure
– For the development of disease affecting the airways,
such as asthma and chronic obstructive pulmonary
disease (COPD),
Quantitative Imaging Biomarker
For the determination of bronchial tree dimensions
to assess the efficacy of new drug trial [1,2]
1. Weibel ER, et al. Design and structure of human lung. In: Pulmonary disease and disorders. New York: McGraw-Hill, 1988:11-60
2. Barnes PJ, et al. Lancet 2004;364:985-996
Airway Wall Measurement
With FHWM*
11. Airway Phantom Measurement
FWHM method
B: the physical phantom
filled with poly-urethan form
A: eleven artificial tubes of the
physical phantom without filled
poly-urethane foam
C: axial slice of phantom at no tilt.
D: axial slice of phantom tilted at
45’ to the scan plane.
* Kim N, Seo JB et al, Part I, II, Korean J Radiol 2008
Number of
tube
Inner Radius
Mean ± SD
Outer Radius
Mean ± SD
Wall thickness
Mean ± SD
1 0.66 1.56 ± 0.01 0.90 ± 0.01
2 0.63 1.08 ± 0.10 0.45 ± 0.10
3 2.13 5.21 ± 0.02 3.08 ± 0.02
4 1.66 4.12 ± 0.01 2.46 ± 0.01
5 1.8 3.01 ± 0.01 1.21 ± 0.01
6 1.63 2.59 ± 0.00 0.96 ± 0.00
7 1.5 2.06 ± 0.12 0.56 ± 0.12
8 3.23 6.04 ± 0.02 2.81 ± 0.02
9 2.34 4.07 ± 0.01 1.73 ± 0.01
10 4.23 6.01 ± 0.01 1.78 ± 0.01
11 3.51 5.09 ± 0.02 1.58 ± 0.02
Table 1. physical dimensions of artificial airways
Overall flow of airway measurement
Phantom Study Airway measurement
(Green – lumen,
Blue – normal wall
Cyan – mean of nl wall
Pink – outside of 2SD of nl wall
Red – mean of nl wall
Full Width at Half Maximum*
Lung 2008, KJ Radiol 2008, KJ Radiol 2008
12. Airway Phantom Measurement : Band
Integral Method
B: the physical phantom
filled with poly-urethan form
A: eleven artificial tubes of the
physical phantom without filled
poly-urethane foam
C: axial slice of phantom at no tilt.
D: axial slice of phantom tilted at
45’ to the scan plane.
Number of
tube
Inner Radius
Mean ± SD
Outer Radius
Mean ± SD
Wall thickness
Mean ± SD
1 0.66 1.56 ± 0.01 0.90 ± 0.01
2 0.63 1.08 ± 0.10 0.45 ± 0.10
3 2.13 5.21 ± 0.02 3.08 ± 0.02
4 1.66 4.12 ± 0.01 2.46 ± 0.01
5 1.8 3.01 ± 0.01 1.21 ± 0.01
6 1.63 2.59 ± 0.00 0.96 ± 0.00
7 1.5 2.06 ± 0.12 0.56 ± 0.12
8 3.23 6.04 ± 0.02 2.81 ± 0.02
9 2.34 4.07 ± 0.01 1.73 ± 0.01
10 4.23 6.01 ± 0.01 1.78 ± 0.01
11 3.51 5.09 ± 0.02 1.58 ± 0.02
Table 1. physical dimensions of artificial airways
Overall flow of airway measurement
Phantom Study
Band based avg Density Profile
J Comput Assist Tomogr. 2015
13. Classification of Pulmonary Artery and Vein
For COPD and
Pulmonary HT
Subtree extraction
Weighted minimal
spanning tree
by cutting branches
with lower labels
Park SY, Kim N, Seo JB, et al, MIRL, AMCMed Phys. 2013
14. Vessel Quantification
14/33
• 10 control with non-contrast volumetric chest CT scans
• The radius error :1.57±0.51 mm
• The direction error : 8.77±17.20%.
Bae JP, Kim N, et al, RSNA 2014
15. COPD Quantification S/W
Quantification S/W of Emphysema index on
HRCT
LAA (Low-Attenuation Area), Emphysema Index:
Area (volume) % below threshold (-950HU), Mean
Lung Density, Lung Volume
Lee YK, Kim N, Seo JB, et al, Lung 2008
16. Size based Emphysema Analysis
Flow
Hwang JE, Kim N, et al, IJ COPD 2016, Under Review : IJ COPD 2017
17. Quantitative Assessment of Regional
Heterogeneity of Emphysema
Functional silence of
upper lung
Automatic
quantification of
heterogeneity
Central to Peripheral
Anterior to Posterior
Upper to lower
Correlation with PFT FEV1 = 24.9 FEV1 = 22.5
• The severity of emphysema in lower lung affects
values of PFT more significantly than the severity of
emphysema in upper lung.
EJ Choi, N Kim, JB Seo, et al, AJ Radiol 2010
18. What is Texture?
Texton :
fundamental
element
Texture :
statistical
distribution of
texton
* P. Brodatz: Textures, A photographic album for artists and designers, Dover Publications, New York, 1966.
Examples *
Texton
Statistical
distribution
19. Classification of COPD Parenchyma
PLE or severe CLE Mild CLE
Bronchiolitis obliterans (BO) Normal
*Lee YJ, Kim N, Seo JB et al, provisionally accepted at CMPBInv Radiol 2008, Kim N, Seo JB, et al, J Digit Imag 2009
20. Shape Features
Cluster analysis
Preprocessing: segmentation (threshold:
- 960HU) and filtering
Cluster features
Number of Cluster
Size (Mean, SD)
Circularity (Mean, SD)
Aspect ratio: LR/SR (Mean, SD)
Top-hat Transformation
Extract contrasted component
according to the size or shape
Suppress the effect of breathhold
variation
Features from Top-hat
White top-hat: mean, SD
Black top-hat: mead, SD
Original Black Top-hat White Top-hat
Comput Meth Prog Bio 2009
21. Sensitivity/Specificity & Improvement
* Statistically significant difference (p<0.05)
Texture Shape
Texture+S
hape
Normal 92.6 72.5 93.8
BO 76.9 68.1 83.9
Mild CLE 78.5 82.2 92.8
PLE/severe CLE 95.9 87.3 99
Overall 85.8 77.2 92.2
0
10
20
30
40
50
60
70
80
90
100
Normal BO Mild CLE PLE/severe
CLE
Overall
Class
Sensitivity(%)
Texture
Shape
Texture+Shape
0
10
20
30
40
50
60
70
80
90
100
Normal BO Mild CLE PLE/severe
CLE
Class
Specificity(%)
Texture
Shape
Texture+Shape
Texture Shape
Texture+S
hape
Normal 96 90.3 97.3
BO 96.5 90.4 97.4
Mild CLE 91.6 93.2 96.5
PLE/severe CLE 98 96.1 98.6
0
2
4
6
8
10
12
14
16
Normal BO Mild CLE PLE/severe CLE
Improvementofsensitivity(%)
Improvement of
sensitivity (%) after
adding shape features
Normal 1.2
BO 7
Mild CLE 14.3
PLE/severe CLE 3.1
Kim N, Seo JB, et al, JDI 2011 2nd best paperComput Meth Prog Bio 2009
22. Texture-based Quantification
TEI : texture-based emphysema
index of HRCT
= 0.3 x ME% + SE%
DEI : density-based
emphysema index
DEIVol of volumetric CT
DEIHR of HRCT
SE : Severe Emphysema
ME : Mild Emphysema
BO : Bronchiolitis Obliterans
NL : Normal Lung
Park YS, Kim N, Seo JB, et al, Inv Radiol 2008
23. Texture-based Quantification
24
Mean area fraction of texture-based quantification
• Severe Emphysema : 12.5 ± 16.3 %
• Mild Emphysema : 24.0 ± 10.1 %
• Bronchiolitis Obliterans : 16.0 ± 10.1 %
• Normal Lung : 47.4 ± 26.3 %
Severe Emphysema
(SE)
Mild Emphysema
(ME)
Bronchiolitis
Obliterans (BO)
Normal
Lung (NL)
** Texture-based Quantification Image Color
SE ME BO NL
Park YS, Kim N, Seo JB, et al, IR 2008Park YS, Kim N, Seo JB, et al, Inv Radiol 2008
24. Texture analysis over cross-vendors
Study design Training set Test set Bayesian SVM p-value
GE GE GE 82.35 ± 2.82 92.34 ± 2.26 <0.001
Siemens Siemens Siemens 86.26 ± 3.16 91.53 ± 2.07 <0.001
IntegratedSet GE+Siemens GE+Siemens 76.65 ± 2.57 91.18 ± 1.91 <0.001
GE->Siemens GE Siemens 71.98 ± 2.94 82.33 ± 5.75 <0.001
Siemens->GE Siemens GE 71.71 ± 3.6 79.07 ± 3.27 <0.001
Park YJ, Kim N, Med Physics 2013
6 classes (a) Normal lung parenchyma,
(b) ground-glass opacity, (c)
consolidation, (d) reticular opacity, (e)
emphysema, and (f) honeycombing.
(normal; green, ground-glass opacity,
yellow; reticular opacity, cyan,
honeycombing, blue; emphysema, red;
and consolidation, pink). (a) GE CT
images (b) GE training on GE CT images,
(c) the Siemens training on GE CT images,
(d) integrated training data on GE CT
images.
Flow chart
25. Fissure Integrity
Twenty patients with severe COPD
for endobronchial valve volume reduction
procedure
Fissure Integrity Evaluation Process
Lung left and right split
lobe segmentation
Histogram analysis with maximum
likelihood threshold method.
Gold standards
Two thoracic radiologists (rad1, rad2)
Results
Completeness (CAD) : 0.982
Accuracy between computer and
radiologists : 85%
Cohen’s kappa values :
rad1 vs rad2, 0.694 / CAD vs rad1, 0.681 /
CAD vs rad2, 0.588 / CAD vs radc, 0.700).
26/33Lee MH, Kim N, et al, IWPFI 2017
Read CT data
Airway
segmentation
Lung
segmentation
Pulmonary
vessel
segmentation
Lobe
segmentation
Fissure
detection
Complete
fissure
Find FIR
Maximum
density
projection
Thresholding
Incomplete
fissure
Subtraction
Segmentation Fissure detection
Find FIR
Visual Scoring
by radiologists
Validation
Find
Maximum
density
value at z-
axis line
3D fissure
surface
Binary fissure
mask
26. Lung Registration for Air Trapping
Full inspiration CT
Registered full expiration CT
Full
Expiration CT
+
Inspiration + Expiration Subtraction color map
Deformation map**
(with respect to COI)
B-spline+
levelset
registration
Non-rigid Registration Result
**Color means deformable distance ( Near : R-G-B : Far)
Initial Rigid
Registration
27. Air Trapping by Using Automatic Registration in
COPD
Inspiration Expiration Registration
Lee HJ,Seo JB, unpublished dataLung 2008, KJ Radiol 2015, Eur Radiol 2016, Eur Radiol 2016
28. DECT Xenon Ventilation :AMC
First clinical study in the world
Research contract with Siemens Medical, CT (advisory board)
Pilot study
Normal volunteers
Patients: COPD, BE, BO
Protocol
DECT
30% Xenon inhalation
Xe ventilator, monitoring devices
Dynamic and static whole lung scan
Detect in vivo inert Xenon gas
Radiology 2008, Radiology 2010, Inv Radiol 2010, Inv Radiol 2016, Eur Radiol 2016
CT images K map in wash-in
K map in wash-out AUC map
in wash-in
Kinetics of Xe
ventilation according
to Kety’s model
Ct = A (1 – e-Kt)
30. Quantitative Imaging : Phantom calibration
waterarc
Outer air1
Inner air
Bed 1 Bed 2
Outer air2
CT Phantom
Manufact
urer
Scanner kVp Tube cur
rent
(mA)
Average e
ffective tu
be current
(mA)
Slice thick
ness
Pitch Gantry r
otation ti
me
Reconstruc
tion Filter
Siemens Sensation 16 140 200 100 0.7 1.000 0.5 B30
Siemens Sensation 64 140 270 99.9 0.7 1.000 0.37 B30
GE LightSpeed 16 140 190 101.2 0.625 0.938 0.5 Standard
GE LightSpeed VCT
64
140 250 101.6 0.625 0.984 0.4 Standard
Philips Brilliance 16 140 142 100.2 0.8 1.063 0.75 B
Philips Brilliance 64 140 135 99.9 0.625 1.014 0.75 B
Variation in Emphysema indexes (%) from
four different CT scanners.
Before DC After DC
3.4
3.6
3.8
4
4.2
4.4
4.6
4.8
5
Time Point(s)
EmphysemaIndex(%)
Density Correction (outair) ; Standard ; -950 HU Thresholding
Siemens 16
Philips 16 (2)
Philips 40
Toshiba 64
Outsider air volume density correction
based on water and air in four different CT
scanners (Water was assumed as 0 HU and
air as -1000 HU).
FEV1 FEV1/FVC
Emphysema index
(Base)
-0.318
0.002
-0.510
<0.001
Emphysema index
(Inner air correction)
-0.597
<0.001
-0.612
<0.001
Emphysema index
(Outer air correction)
-0.394
<0.001
-0.497
<0.001
Mean lung density
(Base)
0.259
0.011
0.460
<0.001
Mean lung density
(Inner air correction)
0.487
<0.001
0.528
<0.001
Mean lung density
(Outer air correction)
0.383
<0.001
0.499
<0.001. Partial correlation analysis adjusted by age
and sex between CT and PFT parameters in
Philips and Toshiba (n=98).
31. Quantification of EI
DECT Xe Ventilation DECT Perfusion
MR PFT
O2 Ventilation
DCE-MRI perfusion
Wall thickness
Lung Evaluation Metrics
Lobe Segmentation
VQ Mismatch
Map
Size based EI
Disease Classification using Texture
Vessel analysis
Airway analysis
MRICT
Diaphragm
Thoracic Cavity
32
*Radiology, Med Phys 2013, Eur Radiol, JDI, Med Phys 2016, …
32. COPD Characterization
33
Perfusion
MR
Perfusion
Ventilation Emphysema
Structure
Micro
Structure
Machine Learning
Deep Learning
Air flowHemodynamics
Hwang HJ, Investigative Radiology (2016), E Beek, Clinics in chest medicine (2015), J thoracic imaging 29(2):80-
91, Hwang JE, IJ COPD (2016), J Applied Physiology (2007)
DECT
Perfusion
MR
Ventilation
DECT
Ventilation
VQ mismatch
VQ
3He MRI Diffusion
For Emphysema hol
Segmentation / (B0, B1 Correction) / Registration
Single Voxel
: Multi-
dimensional
Data
DWI/DTI
Perfusion
Ventilation
Texture Analysis
Modeling
Structure
VQ mismatch
Diffusion
39. 2.5D CNN Airway Segmentation
80 COPD Patients’ Inspiration CT
69 CT volumes are included in training
11 CT volumes are NOT included in training
GS : Manual segmentation
41
Axial 3 slices, Sagittal 3 slices, Coronal 3 slices
32 x 32 x 3 x 3
Weights are shared
2-class
classification
CT
Volume
Probabilit
y
Volume
CNN
For each voxels inside lungs
Segment
ed
Airway
Hard thresholding (0.51) and
Select the connected component