Boosting Personalised Musculoskeletal Modelling with Physics-informed Knowledge Transfer

Data-driven methods have become increasingly more prominent for musculoskeletal modelling due to their conceptually intuitive simple and fast implementation. However, the performance of a pre-trained data-driven model using the data from specific subject(s) may be seriously degraded when validated using the data from a new subject, hindering the utility of the personalised musculoskeletal model in clinical applications. This paper develops an active physics-informed deep transfer learning framework to enhance the dynamic tracking capability of the musculoskeletal model on the unseen data. The salient advantages of the proposed framework are twofold: 1) For the generic model, physics-based domain knowledge is embedded into the loss function of the data-driven model as soft constraints to penalise/regularise the data-driven model. 2) For the personalised model, the parameters relating to the feature extraction will be directly inherited from the generic model, and only the parameters relating to the subject-specific inference will be finetuned by jointly minimising the conventional data prediction loss and the modified physics-based loss. In this paper, we use the synchronous muscle forces and joint kinematics prediction from surface electromyogram (sEMG) as the exemplar to illustrate the proposed framework. Moreover, convolutional neural network (CNN) is employed as the deep neural network to implement the proposed framework, and the physics law between muscle forces and joint kinematics is utilised as the soft constraints. Results of comprehensive experiments on a self-collected dataset from eight healthy subjects indicate the effectiveness and great generalization of the proposed framework.

A Generative Shape Compositional Framework: Towards Representative Populations of Virtual Heart Chimaeras

Generating virtual populations of anatomy that capture sufficient variability while remaining plausible is essential for conducting in-silico trials of medical devices. However, not all anatomical shapes of interest are always available for each individual in a population. Hence, missing/partially-overlapping anatomical information is often available across individuals in a population. We introduce a generative shape model for complex anatomical structures, learnable from datasets of unpaired datasets. The proposed generative model can synthesise complete whole complex shape assemblies coined virtual chimaeras, as opposed to natural human chimaeras. We applied this framework to build virtual chimaeras from databases of whole-heart shape assemblies that each contribute samples for heart substructures. Specifically, we propose a generative shape compositional framework which comprises two components - a part-aware generative shape model which captures the variability in shape observed for each structure of interest in the training population; and a spatial composition network which assembles/composes the structures synthesised by the former into multi-part shape assemblies (viz. virtual chimaeras). We also propose a novel self supervised learning scheme that enables the spatial composition network to be trained with partially overlapping data and weak labels. We trained and validated our approach using shapes of cardiac structures derived from cardiac magnetic resonance images available in the UK Biobank. Our approach significantly outperforms a PCA-based shape model (trained with complete data) in terms of generalisability and specificity. This demonstrates the superiority of the proposed approach as the synthesised cardiac virtual populations are more plausible and capture a greater degree of variability in shape than those generated by the PCA-based shape model.

Three-dimensional micro-structurally informed in silico myocardium -- towards virtual imaging trials in cardiac diffusion weighted MRI

In silico tissue models enable evaluating quantitative models of magnetic resonance imaging. This includes validating and sensitivity analysis of imaging biomarkers and tissue microstructure parameters. We propose a novel method to generate a realistic numerical phantom of myocardial microstructure. We extend previous studies accounting for the cardiomyocyte shape variability, water exchange between the cardiomyocytes (intercalated discs), myocardial microstructure disarray, and four sheetlet orientations. In the first stage of the method, cardiomyocytes and sheetlets are generated by considering the shape variability and intercalated discs in cardiomyocyte-to-cardiomyocyte connections. Sheetlets are then aggregated and oriented in the directions of interest. Our morphometric study demonstrates no significant difference ($p>0.01$) between the distribution of volume, length, and primary and secondary axes of the numerical and real (literature) cardiomyocyte data. Structural correlation analysis validates that the in-silico tissue is in the same class of disorderliness as the real tissue. Additionally, the absolute angle differences between the simulated helical angle (HA) and input HA (reference value) of the cardiomyocytes ($4.3^\circ\pm 3.1^\circ$) demonstrate a good agreement with the absolute angle difference between the measured HA using experimental cardiac diffusion tensor imaging (cDTI) and histology (reference value) reported by (Holmes et al., 2000) ($3.7^\circ\pm6.4^\circ$) and (Scollan et al., 1998) ($4.9^\circ\pm 14.6^\circ$). The angular distance between eigenvectors and sheetlet angles of the input and simulated cDTI is smaller than those between measured angles using structural tensor imaging (gold standard) and experimental cDTI. These results confirm that the proposed method can generate richer numerical phantoms for the myocardium than previous studies.

Physics-informed Deep Learning for Musculoskeletal Modelling: Predicting Muscle Forces and Joint Kinematics from Surface EMG

Musculoskeletal models have been widely used for detailed biomechanical analysis to characterise various functional impairments given their ability to estimate movement variables (i.e., muscle forces and joint moment) which cannot be readily measured in vivo. Physics-based computational neuromusculoskeletal models can interpret the dynamic interaction between neural drive to muscles, muscle dynamics, body and joint kinematics and kinetics. Still, such set of solutions suffers from slowness, especially for the complex models, hindering the utility in real-time applications. In recent years, data-driven methods has emerged as a promising alternative due to the benefits in speedy and simple implementation, but they cannot reflect the underlying neuromechanical processes. This paper proposes a physics-informed deep learning framework for musculoskeletal modelling, where physics-based domain knowledge is brought into the data-driven model as soft constraints to penalise/regularise the data-driven model. We use the synchronous muscle forces and joint kinematics prediction from surface electromyogram (sEMG) as the exemplar to illustrate the proposed framework. Convolutional neural network (CNN) is employed as the deep neural network to implement the proposed framework. At the same time, the physics law between muscle forces and joint kinematics is used the soft constraint. Experimental validations on two groups of data, including one benchmark dataset and one self-collected dataset from six healthy subjects, are performed. The experimental results demonstrate the effectiveness and robustness of the proposed framework.

Agent with Tangent-based Formulation and Anatomical Perception for Standard Plane Localization in 3D Ultrasound

Standard plane (SP) localization is essential in routine clinical ultrasound (US) diagnosis. Compared to 2D US, 3D US can acquire multiple view planes in one scan and provide complete anatomy with the addition of coronal plane. However, manually navigating SPs in 3D US is laborious and biased due to the orientation variability and huge search space. In this study, we introduce a novel reinforcement learning (RL) framework for automatic SP localization in 3D US. Our contribution is three-fold. First, we formulate SP localization in 3D US as a tangent-point-based problem in RL to restructure the action space and significantly reduce the search space. Second, we design an auxiliary task learning strategy to enhance the model's ability to recognize subtle differences crossing Non-SPs and SPs in plane search. Finally, we propose a spatial-anatomical reward to effectively guide learning trajectories by exploiting spatial and anatomical information simultaneously. We explore the efficacy of our approach on localizing four SPs on uterus and fetal brain datasets. The experiments indicate that our approach achieves a high localization accuracy as well as robust performance.

Localizing the Recurrent Laryngeal Nerve via Ultrasound with a Bayesian Shape Framework

Tumor infiltration of the recurrent laryngeal nerve (RLN) is a contraindication for robotic thyroidectomy and can be difficult to detect via standard laryngoscopy. Ultrasound (US) is a viable alternative for RLN detection due to its safety and ability to provide real-time feedback. However, the tininess of the RLN, with a diameter typically less than 3mm, poses significant challenges to the accurate localization of the RLN. In this work, we propose a knowledge-driven framework for RLN localization, mimicking the standard approach surgeons take to identify the RLN according to its surrounding organs. We construct a prior anatomical model based on the inherent relative spatial relationships between organs. Through Bayesian shape alignment (BSA), we obtain the candidate coordinates of the center of a region of interest (ROI) that encloses the RLN. The ROI allows a decreased field of view for determining the refined centroid of the RLN using a dual-path identification network, based on multi-scale semantic information. Experimental results indicate that the proposed method achieves superior hit rates and substantially smaller distance errors compared with state-of-the-art methods.

Fully Automated Assessment of Cardiac Coverage in Cine Cardiovascular Magnetic Resonance Images using an Explainable Deep Visual Salient Region Detection Model

Cardiovascular magnetic resonance (CMR) imaging has become a modality with superior power for the diagnosis and prognosis of cardiovascular diseases. One of the essential basic quality controls of CMR images is to investigate the complete cardiac coverage, which is necessary for the volumetric and functional assessment. This study examines the full cardiac coverage using a 3D convolutional model and then reduces the number of false predictions using an innovative salient region detection model. Salient regions are extracted from the short-axis cine CMR stacks using a three-step proposed algorithm. Combining the 3D CNN baseline model with the proposed salient region detection model provides a cascade detector that can reduce the number of false negatives of the baseline model. The results obtained on the images of over 6,200 participants of the UK Biobank population cohort study show the superiority of the proposed model over the previous state-of-the-art studies. The dataset is the largest regarding the number of participants to control the cardiac coverage. The accuracy of the baseline model in identifying the presence/absence of basal/apical slices is 96.25\% and 94.51\%, respectively, which increases to 96.88\% and 95.72\% after improving using the proposed salient region detection model. Using the salient region detection model by forcing the baseline model to focus on the most informative areas of the images can help the model correct misclassified samples' predictions. The proposed fully automated model's performance indicates that this model can be used in image quality control in population cohort datasets and also real-time post-imaging quality assessments.

Automatic Multi-Class Cardiovascular Magnetic Resonance Image Quality Assessment using Unsupervised Domain Adaptation in Spatial and Frequency Domains

Population imaging studies rely upon good quality medical imagery before downstream image quantification. This study provides an automated approach to assess image quality from cardiovascular magnetic resonance (CMR) imaging at scale. We identify four common CMR imaging artefacts, including respiratory motion, cardiac motion, Gibbs ringing, and aliasing. The model can deal with images acquired in different views, including two, three, and four-chamber long-axis and short-axis cine CMR images. Two deep learning-based models in spatial and frequency domains are proposed. Besides recognising these artefacts, the proposed models are suitable to the common challenges of not having access to data labels. An unsupervised domain adaptation method and a Fourier-based convolutional neural network are proposed to overcome these challenges. We show that the proposed models reliably allow for CMR image quality assessment. The accuracies obtained for the spatial model in supervised and weakly supervised learning are 99.41+0.24 and 96.37+0.66 for the UK Biobank dataset, respectively. Using unsupervised domain adaptation can somewhat overcome the challenge of not having access to the data labels. The maximum achieved domain gap coverage in unsupervised domain adaptation is 16.86%. Domain adaptation can significantly improve a 5-class classification task and deal with considerable domain shift without data labels. Increasing the speed of training and testing can be achieved with the proposed model in the frequency domain. The frequency-domain model can achieve the same accuracy yet 1.548 times faster than the spatial model. This model can also be used directly on k-space data, and there is no need for image reconstruction.

AI-based Aortic Vessel Tree Segmentation for Cardiovascular Diseases Treatment: Status Quo

The aortic vessel tree is composed of the aorta and its branching arteries, and plays a key role in supplying the whole body with blood. Aortic diseases, like aneurysms or dissections, can lead to an aortic rupture, whose treatment with open surgery is highly risky. Therefore, patients commonly undergo drug treatment under constant monitoring, which requires regular inspections of the vessels through imaging. The standard imaging modality for diagnosis and monitoring is computed tomography (CT), which can provide a detailed picture of the aorta and its branching vessels if combined with a contrast agent, resulting in a CT angiography (CTA). Optimally, the whole aortic vessel tree geometry from consecutive CTAs, are overlaid and compared. This allows to not only detect changes in the aorta, but also more peripheral vessel tree changes, caused by the primary pathology or newly developed. When performed manually, this reconstruction requires slice by slice contouring, which could easily take a whole day for a single aortic vessel tree and, hence, is not feasible in clinical practice. Automatic or semi-automatic vessel tree segmentation algorithms, on the other hand, can complete this task in a fraction of the manual execution time and run in parallel to the clinical routine of the clinicians. In this paper, we systematically review computing techniques for the automatic and semi-automatic segmentation of the aortic vessel tree. The review concludes with an in-depth discussion on how close these state-of-the-art approaches are to an application in clinical practice and how active this research field is, taking into account the number of publications, datasets and challenges.

Modality Completion via Gaussian Process Prior Variational Autoencoders for Multi-Modal Glioma Segmentation

In large studies involving multi protocol Magnetic Resonance Imaging (MRI), it can occur to miss one or more sub-modalities for a given patient owing to poor quality (e.g. imaging artifacts), failed acquisitions, or hallway interrupted imaging examinations. In some cases, certain protocols are unavailable due to limited scan time or to retrospectively harmonise the imaging protocols of two independent studies. Missing image modalities pose a challenge to segmentation frameworks as complementary information contributed by the missing scans is then lost. In this paper, we propose a novel model, Multi-modal Gaussian Process Prior Variational Autoencoder (MGP-VAE), to impute one or more missing sub-modalities for a patient scan. MGP-VAE can leverage the Gaussian Process (GP) prior on the Variational Autoencoder (VAE) to utilize the subjects/patients and sub-modalities correlations. Instead of designing one network for each possible subset of present sub-modalities or using frameworks to mix feature maps, missing data can be generated from a single model based on all the available samples. We show the applicability of MGP-VAE on brain tumor segmentation where either, two, or three of four sub-modalities may be missing. Our experiments against competitive segmentation baselines with missing sub-modality on BraTS'19 dataset indicate the effectiveness of the MGP-VAE model for segmentation tasks.