Cardiac ultrasound simulation for autonomous ultrasound navigation

Ultrasound is well-established as an imaging modality for diagnostic and interventional purposes. However, the image quality varies with operator skills as acquiring and interpreting ultrasound images requires extensive training due to the imaging artefacts, the range of acquisition parameters and the variability of patient anatomies. Automating the image acquisition task could improve acquisition reproducibility and quality but training such an algorithm requires large amounts of navigation data, not saved in routine examinations. Thus, we propose a method to generate large amounts of ultrasound images from other modalities and from arbitrary positions, such that this pipeline can later be used by learning algorithms for navigation. We present a novel simulation pipeline which uses segmentations from other modalities, an optimized volumetric data representation and GPU-accelerated Monte Carlo path tracing to generate view-dependent and patient-specific ultrasound images. We extensively validate the correctness of our pipeline with a phantom experiment, where structures' sizes, contrast and speckle noise properties are assessed. Furthermore, we demonstrate its usability to train neural networks for navigation in an echocardiography view classification experiment by generating synthetic images from more than 1000 patients. Networks pre-trained with our simulations achieve significantly superior performance in settings where large real datasets are not available, especially for under-represented classes. The proposed approach allows for fast and accurate patient-specific ultrasound image generation, and its usability for training networks for navigation-related tasks is demonstrated.

A multi-organ point cloud registration algorithm for abdominal CT registration

Registering CT images of the chest is a crucial step for several tasks such as disease progression tracking or surgical planning. It is also a challenging step because of the heterogeneous content of the human abdomen which implies complex deformations. In this work, we focus on accurately registering a subset of organs of interest. We register organ surface point clouds, as may typically be extracted from an automatic segmentation pipeline, by expanding the Bayesian Coherent Point Drift algorithm (BCPD). We introduce MO-BCPD, a multi-organ version of the BCPD algorithm which explicitly models three important aspects of this task: organ individual elastic properties, inter-organ motion coherence and segmentation inaccuracy. This model also provides an interpolation framework to estimate the deformation of the entire volume. We demonstrate the efficiency of our method by registering different patients from the LITS challenge dataset. The target registration error on anatomical landmarks is almost twice as small for MO-BCPD compared to standard BCPD while imposing the same constraints on individual organs deformation.

Automated Catheter Tip Repositioning for Intra-cardiac Echocardiography

Purpose: Intra-Cardiac Echocardiography (ICE) is a powerful imaging modality for guiding cardiac electrophysiology and structural heart interventions. ICE provides real-time observation of anatomy and devices, while enabling direct monitoring of potential complications. In single operator settings, the physician needs to switch back-and-forth between the ICE catheter and therapy device, making continuous ICE support impossible. Two operators setup are therefore sometimes implemented, with the challenge of increase room occupation and cost. Two operator setups are sometimes implemented, but increase procedural costs and room occupation. Methods: ICE catheter robotic control system is developed with automated catheter tip repositioning (i.e. view recovery) method, which can reproduce important views previously navigated to and saved by the user. The performance of the proposed method is demonstrated and evaluated in a combination of heart phantom and animal experiments. Results: Automated ICE view recovery achieved catheter tip position accuracy of 2.09 +/-0.90 mm and catheter image orientation accuracy of 3.93 +/- 2.07 degree in animal studies, and 0.67 +/- 0.79 mm and 0.37 +/- 0.19 degree in heart phantom studies, respectively. Our proposed method is also successfully used during transeptal puncture in animals without complications, showing the possibility for fluoro-less transeptal puncture with ICE catheter robot. Conclusion: Robotic ICE imaging has the potential to provide precise and reproducible anatomical views, which can reduce overall execution time, labor burden of procedures, and x-ray usage for a range of cardiac procedures. Keywords: Automated View Recovery, Path Planning, Intra-cardiac echocardiography (ICE), Catheter, Tendon-driven manipulator, Cardiac Imaging

A Wide-area, Low-latency, and Power-efficient 6-DoF Pose Tracking System for Rigid Objects

Position sensitive detectors (PSDs) offer possibility to track single active marker's two (or three) degrees of freedom (DoF) position with a high accuracy, while having a fast response time with high update frequency and low latency, all using a very simple signal processing circuit. However they are not particularly suitable for 6-DoF object pose tracking system due to lack of orientation measurement, limited tracking range, and sensitivity to environmental variation. We propose a novel 6-DoF pose tracking system for a rigid object tracking requiring a single active marker. The proposed system uses a stereo-based PSD pair and multiple Inertial Measurement Units (IMUs). This is done based on a practical approach to identify and control the power of Infrared-Light Emitting Diode (IR-LED) active markers, with an aim to increase the tracking work space and reduce the power consumption. Our proposed tracking system is validated with three different work space sizes and for static and dynamic positional accuracy using robotic arm manipulator with three different dynamic motion patterns. The results show that the static position root-mean-square (RMS) error is 0.6mm. The dynamic position RMS error is 0.7-0.9mm. The orientation RMS error is between 0.04 and 0.9 degree at varied dynamic motion. Overall, our proposed tracking system is capable of tracking a rigid object pose with sub-millimeter accuracy at the mid range of the work space and sub-degree accuracy for all work space under a lab setting.

Shape-adaptive Hysteresis Compensation for Tendon-driven Continuum Manipulators

Tendon-driven continuum manipulators (TDCM) are commonly used in minimally invasive surgical systems due to their long, thin, flexible structure that is compliant in narrow or tortuous environments. There exist many researches for precise tip control of the articulating section. However, these models do not account for the proximal shaft shape of TDCM, affecting the tip controls in practical settings. In this paper, we propose a gradient-based shift detection method based on motor current that can easily find the offset of task space models (i.e., hysteresis). We analyze our proposed methods with multiple Intra-cardiac Echocardiography catheters, which are typical commercial example of TDCM. Our results show that the errors from varied proximal shape are considerably reduced, and the accuracy of the tip manipulation is improved when changing external environmental structures.

Non-linear Hysteresis Compensation of a Tendon-sheath-driven Robotic Manipulator using Motor Current

Tendon-sheath-driven manipulators (TSM) are widely used in minimally invasive surgical systems due to their long, thin shape, flexibility, and compliance making them easily steerable in narrow or tortuous environments. Many commercial TSM-based medical devices have non-linear phenomena resulting from their composition such as backlash and dead zone hysteresis, which lead to a considerable challenge for achieving precise control of the end effector pose. However, many recent works in the literature do not consider the combined effects and compensation of these phenomena, and less focus on practical ways to identify model parameters in real field. In this paper, we propose a simplified piece-wise linear model to compensate both backlash and dead zone hysteresis together. Further, we introduce a practical method to identify model parameters using motor current from a robotic controller for the TSM. We analyze our proposed methods with multiple Intra-cardiac Echocardiography catheters, which are typical commercial example of TSM. Our results show that the errors from backlash and dead zone hysteresis are considerably reduced and therefore the accuracy of robotic control is improved when applying the presented methods.

Learning a Generative Motion Model from Image Sequences based on a Latent Motion Matrix

We propose to learn a probabilistic motion model from a sequence of images for spatio-temporal registration. Our model encodes motion in a low-dimensional probabilistic space - the motion matrix - which enables various motion analysis tasks such as simulation and interpolation of realistic motion patterns allowing for faster data acquisition and data augmentation. More precisely, the motion matrix allows to transport the recovered motion from one subject to another simulating for example a pathological motion in a healthy subject without the need for inter-subject registration. The method is based on a conditional latent variable model that is trained using amortized variational inference. This unsupervised generative model follows a novel multivariate Gaussian process prior and is applied within a temporal convolutional network which leads to a diffeomorphic motion model. Temporal consistency and generalizability is further improved by applying a temporal dropout training scheme. Applied to cardiac cine-MRI sequences, we show improved registration accuracy and spatio-temporally smoother deformations compared to three state-of-the-art registration algorithms. Besides, we demonstrate the model's applicability for motion analysis, simulation and super-resolution by an improved motion reconstruction from sequences with missing frames compared to linear and cubic interpolation.

Graph convolutional regression of cardiac depolarization from sparse endocardial maps

Electroanatomic mapping as routinely acquired in ablation therapy of ventricular tachycardia is the gold standard method to identify the arrhythmogenic substrate. To reduce the acquisition time and still provide maps with high spatial resolution, we propose a novel deep learning method based on graph convolutional neural networks to estimate the depolarization time in the myocardium, given sparse catheter data on the left ventricular endocardium, ECG, and magnetic resonance images. The training set consists of data produced by a computational model of cardiac electrophysiology on a large cohort of synthetically generated geometries of ischemic hearts. The predicted depolarization pattern has good agreement with activation times computed by the cardiac electrophysiology model in a validation set of five swine heart geometries with complex scar and border zone morphologies. The mean absolute error hereby measures 8 ms on the entire myocardium when providing 50\% of the endocardial ground truth in over 500 computed depolarization patterns. Furthermore, when considering a complete animal data set with high density electroanatomic mapping data as reference, the neural network can accurately reproduce the endocardial depolarization pattern, even when a small percentage of measurements are provided as input features (mean absolute error of 7 ms with 50\% of input samples). The results show that the proposed method, trained on synthetically generated data, may generalize to real data.

Towards Automatic Manipulation of Intra-cardiac Echocardiography Catheter

Intra-cardiac Echocardiography (ICE) has been evolving as a real-time imaging modality of choice for guiding electrophiosology and structural heart interventions. ICE provides real-time imaging of anatomy, catheters, and complications such as pericardial effusion or thrombus formation. However, there now exists a high cognitive demand on physicians with the increased reliance on intraprocedural imaging. In response, we present a robotic manipulator for AcuNav ICE catheters to alleviate the physician's burden and support applied methods for more automated. Herein, we introduce two methods towards these goals: (1) a data-driven method to compensate kinematic model errors due to non-linear elasticity in catheter bending, providing more precise robotic control and (2) an automated image recovery process that allows physicians to bookmark images during intervention and automatically return with the push of a button. To validate our error compensation method, we demonstrate a complex rotation of the ultrasound imaging plane evaluated on benchtop. Automated view recovery is validated by repeated imaging of landmarks on benchtop and in vivo experiments with position- and image-based analysis. Results support that a robotic-assist system for more autonomous ICE can provide a safe and efficient tool, potentially reducing the execution time and allowing more complex procedures to become common place.

Probabilistic Motion Modeling from Medical Image Sequences: Application to Cardiac Cine-MRI

We propose to learn a probabilistic motion model from a sequence of images. Besides spatio-temporal registration, our method offers to predict motion from a limited number of frames, useful for temporal super-resolution. The model is based on a probabilistic latent space and a novel temporal dropout training scheme. This enables simulation and interpolation of realistic motion patterns given only one or any subset of frames of a sequence. The encoded motion also allows to be transported from one subject to another without the need of inter-subject registration. An unsupervised generative deformation model is applied within a temporal convolutional network which leads to a diffeomorphic motion model, encoded as a low-dimensional motion matrix. Applied to cardiac cine-MRI sequences, we show improved registration accuracy and spatio-temporally smoother deformations compared to three state-of-the-art registration algorithms. Besides, we demonstrate the model's applicability to motion transport by simulating a pathology in a healthy case. Furthermore, we show an improved motion reconstruction from incomplete sequences compared to linear and cubic interpolation.