Shape Completion in the Dark: Completing Vertebrae Morphology from 3D Ultrasound

Purpose: Ultrasound (US) imaging, while advantageous for its radiation-free nature, is challenging to interpret due to only partially visible organs and a lack of complete 3D information. While performing US-based diagnosis or investigation, medical professionals therefore create a mental map of the 3D anatomy. In this work, we aim to replicate this process and enhance the visual representation of anatomical structures. Methods: We introduce a point-cloud-based probabilistic DL method to complete occluded anatomical structures through 3D shape completion and choose US-based spine examinations as our application. To enable training, we generate synthetic 3D representations of partially occluded spinal views by mimicking US physics and accounting for inherent artifacts. Results: The proposed model performs consistently on synthetic and patient data, with mean and median differences of 2.02 and 0.03 in CD, respectively. Our ablation study demonstrates the importance of US physics-based data generation, reflected in the large mean and median difference of 11.8 CD and 9.55 CD, respectively. Additionally, we demonstrate that anatomic landmarks, such as the spinous process (with reconstruction CD of 4.73) and the facet joints (mean distance to GT of 4.96mm) are preserved in the 3D completion. Conclusion: Our work establishes the feasibility of 3D shape completion for lumbar vertebrae, ensuring the preservation of level-wise characteristics and successful generalization from synthetic to real data. The incorporation of US physics contributes to more accurate patient data completions. Notably, our method preserves essential anatomic landmarks and reconstructs crucial injections sites at their correct locations. The generated data and source code will be made publicly available (https://github.com/miruna20/Shape-Completion-in-the-Dark).

Implicit Neural Representations for Breathing-compensated Volume Reconstruction in Robotic Ultrasound Aorta Screening

Ultrasound (US) imaging is widely used in diagnosing and staging abdominal diseases due to its lack of non-ionizing radiation and prevalent availability. However, significant inter-operator variability and inconsistent image acquisition hinder the widespread adoption of extensive screening programs. Robotic ultrasound systems have emerged as a promising solution, offering standardized acquisition protocols and the possibility of automated acquisition. Additionally, these systems enable access to 3D data via robotic tracking, enhancing volumetric reconstruction for improved ultrasound interpretation and precise disease diagnosis. However, the interpretability of 3D US reconstruction of abdominal images can be affected by the patient's breathing motion. This study introduces a method to compensate for breathing motion in 3D US compounding by leveraging implicit neural representations. Our approach employs a robotic ultrasound system for automated screenings. To demonstrate the method's effectiveness, we evaluate our proposed method for the diagnosis and monitoring of abdominal aorta aneurysms as a representative use case. Our experiments demonstrate that our proposed pipeline facilitates robust automated robotic acquisition, mitigating artifacts from breathing motion, and yields smoother 3D reconstructions for enhanced screening and medical diagnosis.

LOTUS: Learning to Optimize Task-based US representations

Anatomical segmentation of organs in ultrasound images is essential to many clinical applications, particularly for diagnosis and monitoring. Existing deep neural networks require a large amount of labeled data for training in order to achieve clinically acceptable performance. Yet, in ultrasound, due to characteristic properties such as speckle and clutter, it is challenging to obtain accurate segmentation boundaries, and precise pixel-wise labeling of images is highly dependent on the expertise of physicians. In contrast, CT scans have higher resolution and improved contrast, easing organ identification. In this paper, we propose a novel approach for learning to optimize task-based ultra-sound image representations. Given annotated CT segmentation maps as a simulation medium, we model acoustic propagation through tissue via ray-casting to generate ultrasound training data. Our ultrasound simulator is fully differentiable and learns to optimize the parameters for generating physics-based ultrasound images guided by the downstream segmentation task. In addition, we train an image adaptation network between real and simulated images to achieve simultaneous image synthesis and automatic segmentation on US images in an end-to-end training setting. The proposed method is evaluated on aorta and vessel segmentation tasks and shows promising quantitative results. Furthermore, we also conduct qualitative results of optimized image representations on other organs.

Ultra-NeRF: Neural Radiance Fields for Ultrasound Imaging

We present a physics-enhanced implicit neural representation (INR) for ultrasound (US) imaging that learns tissue properties from overlapping US sweeps. Our proposed method leverages a ray-tracing-based neural rendering for novel view US synthesis. Recent publications demonstrated that INR models could encode a representation of a three-dimensional scene from a set of two-dimensional US frames. However, these models fail to consider the view-dependent changes in appearance and geometry intrinsic to US imaging. In our work, we discuss direction-dependent changes in the scene and show that a physics-inspired rendering improves the fidelity of US image synthesis. In particular, we demonstrate experimentally that our proposed method generates geometrically accurate B-mode images for regions with ambiguous representation owing to view-dependent differences of the US images. We conduct our experiments using simulated B-mode US sweeps of the liver and acquired US sweeps of a spine phantom tracked with a robotic arm. The experiments corroborate that our method generates US frames that enable consistent volume compounding from previously unseen views. To the best of our knowledge, the presented work is the first to address view-dependent US image synthesis using INR.

CACTUSS: Common Anatomical CT-US Space for US examinations

Abdominal aortic aneurysm (AAA) is a vascular disease in which a section of the aorta enlarges, weakening its walls and potentially rupturing the vessel. Abdominal ultrasound has been utilized for diagnostics, but due to its limited image quality and operator dependency, CT scans are usually required for monitoring and treatment planning. Recently, abdominal CT datasets have been successfully utilized to train deep neural networks for automatic aorta segmentation. Knowledge gathered from this solved task could therefore be leveraged to improve US segmentation for AAA diagnosis and monitoring. To this end, we propose CACTUSS: a common anatomical CT-US space, which acts as a virtual bridge between CT and US modalities to enable automatic AAA screening sonography. CACTUSS makes use of publicly available labelled data to learn to segment based on an intermediary representation that inherits properties from both US and CT. We train a segmentation network in this new representation and employ an additional image-to-image translation network which enables our model to perform on real B-mode images. Quantitative comparisons against fully supervised methods demonstrate the capabilities of CACTUSS in terms of Dice Score and diagnostic metrics, showing that our method also meets the clinical requirements for AAA scanning and diagnosis.

Weakly-supervised Biomechanically-constrained CT/MRI Registration of the Spine

CT and MRI are two of the most informative modalities in spinal diagnostics and treatment planning. CT is useful when analysing bony structures, while MRI gives information about the soft tissue. Thus, fusing the information of both modalities can be very beneficial. Registration is the first step for this fusion. While the soft tissues around the vertebra are deformable, each vertebral body is constrained to move rigidly. We propose a weakly-supervised deep learning framework that preserves the rigidity and the volume of each vertebra while maximizing the accuracy of the registration. To achieve this goal, we introduce anatomy-aware losses for training the network. We specifically design these losses to depend only on the CT label maps since automatic vertebra segmentation in CT gives more accurate results contrary to MRI. We evaluate our method on an in-house dataset of 167 patients. Our results show that adding the anatomy-aware losses increases the plausibility of the inferred transformation while keeping the accuracy untouched.

Uncertainty quantification in non-rigid image registration via stochastic gradient Markov chain Monte Carlo

We develop a new Bayesian model for non-rigid registration of three-dimensional medical images, with a focus on uncertainty quantification. Probabilistic registration of large images with calibrated uncertainty estimates is difficult for both computational and modelling reasons. To address the computational issues, we explore connections between the Markov chain Monte Carlo by backpropagation and the variational inference by backpropagation frameworks, in order to efficiently draw samples from the posterior distribution of transformation parameters. To address the modelling issues, we formulate a Bayesian model for image registration that overcomes the existing barriers when using a dense, high-dimensional, and diffeomorphic transformation parametrisation. This results in improved calibration of uncertainty estimates. We compare the model in terms of both image registration accuracy and uncertainty quantification to VoxelMorph, a state-of-the-art image registration model based on deep learning.

Position-based Dynamics Simulator of Brain Deformations for Path Planning and Intra-Operative Control in Keyhole Neurosurgery

Many tasks in robot-assisted surgery require planning and controlling manipulators' motions that interact with highly deformable objects. This study proposes a realistic, time-bounded simulator based on Position-based Dynamics (PBD) simulation that mocks brain deformations due to catheter insertion for pre-operative path planning and intra-operative guidance in keyhole surgical procedures. It maximizes the probability of success by accounting for uncertainty in deformation models, noisy sensing, and unpredictable actuation. The PBD deformation parameters were initialized on a parallelepiped-shaped simulated phantom to obtain a reasonable starting guess for the brain white matter. They were calibrated by comparing the obtained displacements with deformation data for catheter insertion in a composite hydrogel phantom. Knowing the gray matter brain structures' different behaviors, the parameters were fine-tuned to obtain a generalized human brain model. The brain structures' average displacement was compared with values in the literature. The simulator's numerical model uses a novel approach with respect to the literature, and it has proved to be a close match with real brain deformations through validation using recorded deformation data of in-vivo animal trials with a mean mismatch of 4.73$\pm$2.15%. The stability, accuracy, and real-time performance make this model suitable for creating a dynamic environment for KN path planning, pre-operative path planning, and intra-operative guidance.

Rethinking Ultrasound Augmentation: A Physics-Inspired Approach

Medical Ultrasound (US), despite its wide use, is characterized by artifacts and operator dependency. Those attributes hinder the gathering and utilization of US datasets for the training of Deep Neural Networks used for Computer-Assisted Intervention Systems. Data augmentation is commonly used to enhance model generalization and performance. However, common data augmentation techniques, such as affine transformations do not align with the physics of US and, when used carelessly can lead to unrealistic US images. To this end, we propose a set of physics-inspired transformations, including deformation, reverb and Signal-to-Noise Ratio, that we apply on US B-mode images for data augmentation. We evaluate our method on a new spine US dataset for the tasks of bone segmentation and classification.

Ultrasound-Guided Robotic Navigation with Deep Reinforcement Learning

In this paper we introduce the first reinforcement learning (RL) based robotic navigation method which utilizes ultrasound (US) images as an input. Our approach combines state-of-the-art RL techniques, specifically deep Q-networks (DQN) with memory buffers and a binary classifier for deciding when to terminate the task. Our method is trained and evaluated on an in-house collected data-set of 34 volunteers and when compared to pure RL and supervised learning (SL) techniques, it performs substantially better, which highlights the suitability of RL navigation for US-guided procedures. When testing our proposed model, we obtained a 82.91% chance of navigating correctly to the sacrum from 165 different starting positions on 5 different unseen simulated environments.