@article{LingelHausPaschkeetal., author = {Lingel, Maximilian P. and Haus, Moritz and Paschke, Lukas and Foltan, Maik and Lubnow, Matthias and Gruber, Michael and Krenkel, Lars and Lehle, Karla}, title = {Clinical relevance of cell-free DNA during venovenous extracorporeal membrane oxygenation}, series = {Artificial organs}, volume = {47}, journal = {Artificial organs}, number = {11}, publisher = {Wiley}, issn = {1525-1594}, doi = {10.1111/aor.14616}, pages = {1720 -- 1731}, abstract = {BACKGROUND: Thrombosis remains a critical complication during venovenous extracorporeal membrane oxygenation (VV ECMO). The involvement of neutrophil extracellular traps (NETs) in thrombogenesis has to be discussed. The aim was to verify NETs in the form of cell-free DNA (cfDNA) in the plasma of patients during ECMO. METHODS: A fluorescent DNA-binding dye (QuantifFluor®, Promega) was used to detect cell-free DNA in plasma samples. cfDNA concentrations from volunteers (n = 21) and patients (n = 9) were compared and correlated with clinical/technical data before/during support, ECMO end and time of a system exchange. RESULTS: Before ECMO, patients with a median (IQR) age of 59 (51/63) years, SOFA score of 11 (10/15), and ECMO run time of 9.0 (7.0/19.5) days presented significantly higher levels of cfDNA compared to volunteers (6.4 (5.8/7.9) ng/μL vs. 5.9 (5.4/6.3) ng/μL; p = 0.044). Within 2 days after ECMO start, cfDNA, inflammatory, and hemolysis parameters remained unchanged, while platelets decreased (p = 0.005). After ECMO removal at the end of therapy, cfDNA, inflammation, and coagulation data (except antithrombin III) remained unchanged. The renewal of a system resulted in known alterations in fibrinogen, d-dimers, and platelets, while cfDNA remained unchanged. CONCLUSION: Detection of cfDNA in plasma of ECMO patients was not an indicator of acute and circuit-induced thrombogenesis.}, language = {en} } @article{FoltanDinhGruberetal., author = {Foltan, Maik and Dinh, D. and Gruber, Michael and M{\"u}ller, Thomas and Hart, C. and Krenkel, Lars and Schmid, C. and Lehle, Karla}, title = {Incidence of neutrophil extracellular traps (NETs) in different membrane oxygenators: pilot in vitro experiments in commercially available coated membranes}, series = {Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs}, journal = {Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs}, doi = {10.1007/s10047-024-01486-4}, abstract = {Neutrophil extracellular traps (NETs) were detected in blood samples and in cellular deposits of oxygenator membranes during extracorporeal membrane oxygenation (ECMO) therapy and may be responsible for thrombogenesis. The aim was to evaluate the effect of the base material of gas fiber (GF, polymethylpentene) and heat exchange (HE) membranes and different antithrombogenic coatings on isolated granulocytes from healthy volunteers under static culture conditions. Contact of granulocytes with membranes from different ECMO oxygenators (with different surface coatings) and uncoated-GFs allowed detection of adherent cells and NETotic nuclear structures (normal, swollen, ruptured) using nuclear staining. Flow cytometry was used to identify cell activation (CD11b/CD62L, oxidative burst) of non-adherent cells. Uncoated-GFs were used as a reference. Within 3 h, granulocytes adhered to the same extent on all surfaces. In contrast, the ratio of normal to NETotic cells was significantly higher for uncoated-GFs (56-83\%) compared to all coated GFs (34-72\%) (p < 0.001) with no difference between the coatings. After material contact, non-adherent cells remained vital with unchanged oxidative burst function and the proportion of activated cells remained low. The expression of activation markers was independent of the origin of the GF material. In conclusion, the polymethylpentene surfaces of the GFs already induce NET formation. Antithrombogenic coatings can already reduce the proportion of NETotic nuclei. However, it cannot be ruled out that NET formation can induce thrombotic events. Therefore, new surfaces or coatings are required for future ECMO systems and long-term implantable artificial lungs.}, language = {en} } @article{SteigerFoltanPhilippetal., author = {Steiger, Tamara and Foltan, Maik and Philipp, Alois and M{\"u}ller, Thomas and Gruber, Michael and Bredthauer, Andre and Krenkel, Lars and Birkenmaier, Clemens and Lehle, Karla}, title = {Accumulations of von Willebrand factor within ECMO oxygenators: Potential indicator of coagulation abnormalities in critically ill patients?}, series = {Artificial Organs}, volume = {43}, journal = {Artificial Organs}, number = {11}, publisher = {Wiley}, address = {Hoboken}, issn = {1525-1594}, doi = {10.1111/aor.13513}, pages = {1065 -- 1076}, abstract = {Clot formation within membrane oxygenators (MOs) remains a critical problem during extracorporeal membrane oxygenation (ECMO). The composition of the clots-in particular, the presence of von Willebrand factor (vWF)-may be an indicator for prevalent nonphysiological flow conditions, foreign body reactions, or coagulation abnormalities in critically ill patients. Mats of interwoven gas exchange fibers from randomly collected MOs (PLS, Maquet, Rastatt, Germany) of 21 patients were stained with antibodies (anti-vWF and anti-P-selectin) and counterstained with 4 ',6-diamidino-2-phenylindole. The extent of vWF-loading was correlated with patient and technical data. While 12 MOs showed low vWF-loadings, 9 MOs showed high vWF-loading with highest accumulations close to crossing points of adjacent gas fibers. The presence and the extent of vWF-fibers/"cobwebs," leukocytes, platelet-leukocyte aggregates (PLAs), and P-selectin-positive platelet aggregates were independent of the extent of vWF-loading. However, the highly loaded MOs were obtained from patients with a significantly elevated SOFA score, severe thrombocytopenia, and persistent liver dysfunction. The coagulation abnormalities of these critically ill patients may cause an accumulation of the highly thrombogenic and elongated high-molecular-weight vWF multimers in the plasma which will be trapped in the MOs during the ECMO therapy.}, language = {en} } @misc{KrenkelMichelKeiletal., author = {Krenkel, Lars and Michel, Johanna and Keil, Niklas and Daschner, Jan}, title = {Experimental Investigation of Logitudinal Folds in Endotracheal Tube Cuffs and their Correlation to Silent Breathing}, series = {23. DGLR Fach-Symposium Str{\"o}mungen mit Abl{\"o}sung, 09./10. November 2022, Berlin, Deutschland}, journal = {23. DGLR Fach-Symposium Str{\"o}mungen mit Abl{\"o}sung, 09./10. November 2022, Berlin, Deutschland}, address = {G{\"o}ttingen}, organization = {Deutsche Gesellschaft f{\"u}r Luft- und Raumfahrt e.V. / Arbeitsgemeinschaft Str{\"o}mungen mit Abl{\"o}sung, AG STAB}, abstract = {Air leakage past High-Volume-Low-Pressure (HVLP) endotracheal tube (ETT) cuffs creates a potential infection risk for health care professionals during ventilation of patients suffering from contagious airborne diseases. However, unlike silent aspiration, a phenomenon where fluids enter the airways of intubated patients, the aspect of aerosol emergence through cuff folds -what we called accordingly "silent breathing" (SB)- has not been investigated in detail so far. This study investigates air leakage past HVLP cuffs with varying cuff pressures under realistic artificial breathing scenarios experimentally and in addition numerically. The focus was laid on the parametric investigation of the occurrence and furthermore on different influencing factors of silent breathing. The morphology of the folds responsible for the leakage was captured using high-resolution 3D microcomputed tomography (μCT). For the numerical investigations (Com-putational Fluid Dynamics - CFD), the commercial CFD Software package FLUENT 2021 R2 (ANSYS, Inc., Canonsburg, PA, US), as well as the DLR in-house research code THETA has been used.}, language = {en} } @article{DeuterHajBrawanskietal., author = {Deuter, Daniel and Haj, Amer and Brawanski, Alexander and Krenkel, Lars and Schmidt, Nils Ole and Doenitz, Christian}, title = {Fast simulation of hemodynamics in intracranial aneurysms for clinical use}, series = {Acta Neurochirurgica}, volume = {167}, journal = {Acta Neurochirurgica}, publisher = {Springer}, doi = {10.1007/s00701-025-06469-9}, pages = {14}, abstract = {BACKGROUND: A widely accepted tool to assess hemodynamics, one of the most important factors in aneurysm pathophysiology, is Computational Fluid Dynamics (CFD). As current workflows are still time consuming and difficult to operate, CFD is not yet a standard tool in the clinical setting. There it could provide valuable information on aneurysm treatment, especially regarding local risks of rupture, which might help to optimize the individualized strategy of neurosurgical dissection during microsurgical aneurysm clipping. METHOD: We established and validated a semi-automated workflow using 3D rotational angiographies of 24 intracranial aneurysms from patients having received aneurysm treatment at our centre. Reconstruction of vessel geometry and generation of volume meshes was performed using AMIRA 6.2.0 and ICEM 17.1. For solving ANSYS CFX was used. For validational checks, tests regarding the volumetric impact of smoothing operations, the impact of mesh sizes on the results (grid convergence), geometric mesh quality and time tests for the time needed to perform the workflow were conducted in subgroups. RESULTS: Most of the steps of the workflow were performed directly on the 3D images requiring no programming experience. The workflow led to final CFD results in a mean time of 22 min 51.4 s (95\%-CI 20 min 51.562 s-24 min 51.238 s, n = 5). Volume of the geometries after pre-processing was in mean 4.46\% higher than before in the analysed subgroup (95\%-CI 3.43-5.50\%). Regarding mesh sizes, mean relative aberrations of 2.30\% (95\%-CI 1.51-3.09\%) were found for surface meshes and between 1.40\% (95\%-CI 1.07-1.72\%) and 2.61\% (95\%-CI 1.93-3.29\%) for volume meshes. Acceptable geometric mesh quality of volume meshes was found. CONCLUSIONS: We developed a semi-automated workflow for aneurysm CFD to benefit from hemodynamic data in the clinical setting. The ease of handling opens the workflow to clinicians untrained in programming. As previous studies have found that the distribution of hemodynamic parameters correlates with thin-walled aneurysm areas susceptible to rupture, these data might be beneficial for the operating neurosurgeon during aneurysm surgery, even in acute cases.}, language = {en} } @inproceedings{RuettenKrenkelQuadrio, author = {R{\"u}tten, Markus and Krenkel, Lars and Quadrio, Maurizio}, title = {Simulation and Analyis of the Unsteady Flow within Nasal Airways}, series = {9th European Congress on Computational Methods in Applied Sciences and Engineering - ECCOMAS Congress, 3-7 June 2024, Lisbon, Portugal}, booktitle = {9th European Congress on Computational Methods in Applied Sciences and Engineering - ECCOMAS Congress, 3-7 June 2024, Lisbon, Portugal}, language = {en} } @misc{SaffertMelznerDendorfer, author = {Saffert, Anne-Sophie and Melzner, Maximilian and Dendorfer, Sebastian}, title = {Biomechanical Analysis of the Right Elevated Glenohumeral Joint in Violinists during Legato-Playing}, series = {Biomdlore 2021: 21-23 October 2021 Vilnius/Trakai, Lithuania}, journal = {Biomdlore 2021: 21-23 October 2021 Vilnius/Trakai, Lithuania}, doi = {10.3233/THC-219001}, abstract = {BACKGROUND: Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements. OBJECTIVE: For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture. METHODS: Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position. RESULTS: The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture. CONCLUSIONS: Elevating the right shoulder while playing the violin may pose a potential problem.}, language = {en} } @article{KheiroddinSchoeberlAlthammeretal., author = {Kheiroddin, Parastoo and Sch{\"o}berl, Patricia and Althammer, Michael and Cibali, Ezgi and W{\"u}rfel, Thea and Wein, Hannah and Kulawik, Birgit and Buntrock-D{\"o}pke, Heike and Weigl, Eva and Gran, Silvia and Gr{\"u}ndl, Magdalena and Langguth, Jana and Lampl, Benedikt and Judex, Guido and Niggel, Jakob and Pagel, Philipp and Schratzenstaller, Thomas and Schneider-Brachert, Wulf and Gastiger, Susanne and Bodenschatz, Mona and Konrad, Maike and Levchuk, Artem and Roth, Cornelius and Sch{\"o}ner, David and Schneebauer, Florian and Rohrmanstorfer, Ren{\´e} and Burkovski, Andreas and Ambrosch, Andreas and Wagner, Thomas and Kabesch, Michael}, title = {Results of WICOVIR Gargle Pool PCR Testing in German Schools Based on the First 100,000 Tests}, series = {Frontiers in Pediatrics}, volume = {9}, journal = {Frontiers in Pediatrics}, editor = {Buonsenso, Danilo}, publisher = {frontiers}, issn = {2296-2360}, doi = {10.3389/fped.2021.721518}, abstract = {Background: Opening schools and keeping children safe from SARS-CoV-2 infections at the same time is urgently needed to protect children from direct and indirect consequences of the COVID-19 pandemic. To achieve this goal, a safe, efficient, and cost-effective SARS-CoV-2 testing system for schools in addition to standard hygiene measures is necessary. Methods: We implemented the screening WICOVIR concept for schools in the southeast of Germany, which is based on gargling at home, pooling of samples in schools, and assessment of SARS-CoV-2 by pool rRT-PCR, performed decentralized in numerous participating laboratories. Depooling was performed if pools were positive, and results were transmitted with software specifically developed for the project within a day. Here, we report the results after the first 13 weeks in the project. Findings: We developed and implemented the proof-of-concept test system within a pilot phase of 7 weeks based on almost 17,000 participants. After 6 weeks in the main phase of the project, we performed >100,000 tests in total, analyzed in 7,896 pools, identifying 19 cases in >100 participating schools. On average, positive children showed an individual CT value of 31 when identified in the pools. Up to 30 samples were pooled (mean 13) in general, based on school classes and attached school staff. All three participating laboratories detected positive samples reliably with their previously established rRT-PCR standard protocols. When self-administered antigen tests were performed concomitantly in positive cases, only one of these eight tests was positive, and when antigen tests performed after positive pool rRT-PCR results were already known were included, 3 out of 11 truly positive tests were also identified by antigen testing. After 3 weeks of repetitive WICOVIR testing twice weekly, the detection rate of positive children in that cohort decreased significantly from 0.042 to 0.012 (p = 0.008). Interpretation: Repeated gargle pool rRT-PCR testing can be implemented quickly in schools. It is an effective, valid, and well-received test system for schools, superior to antigen tests in sensitivity, acceptance, and costs.}, subject = {Covid-19}, language = {en} } @article{SchaefferHerrmannSchratzenstalleretal., author = {Schaeffer, Leon and Herrmann, David and Schratzenstaller, Thomas and Dendorfer, Sebastian and B{\"o}hm, Valter}, title = {Theoretical considerations on stiffness characteristics of a 3-dimensional tensegrity joint model for the use in dynamic hand orthoses}, series = {Journal of Medical Robotics Research}, journal = {Journal of Medical Robotics Research}, publisher = {World Scientific}, doi = {10.1142/S2424905X25400069}, language = {en} } @article{MaierZentgrafAngeleetal., author = {Maier, Eva and Zentgraf, Jan and Angele, Eveline and Zorzin, Jos{\´e} and Taschner, Michael and Widbiller, Matthias and Galler, Kerstin and Schratzenstaller, Thomas}, title = {A re-usable 3D-printed training model for the endodontic management of dental trauma in immature teeth}, series = {International endodontic journal}, volume = {2025}, journal = {International endodontic journal}, publisher = {Wiley}, issn = {1365-2591}, doi = {10.1111/iej.14235}, pages = {12}, abstract = {AIM: To develop a 3D-printed model enabling treatment simulation of trauma-related endodontic and restorative procedures like revitalization or placement of an apical plug on teeth with incomplete root formation. METHODOLOGY: To generate a realistic training model suitable for trauma-related simulations, CT-Data sets were segmented, combined, adjusted and optimized using computer-aided design features. Specific focus was on optimally reflecting characteristics of immature teeth like open apical foramina and thin root walls. For reflection of the revitalization process, a set-up including a tube filled with red liquid under pressure was developed to be perforated during the procedure by the trainee, simulating bleeding from the apical papilla into the root canal system. Design was based on a combination of cost-effective simple parts combined with 3D-printed components to achieve maximal accessibility, exchangeability and re-usability. Model assembly and preparation were described in step-by-step instructions. RESULTS: As a result of the developmental process, the presented model qualifies for the training of the endodontic management of complications on immature teeth after dental trauma. Step-by-step descriptions aligned with the clinical procedures are performable for a revitalization procedure, for pulpotomy followed by fragment re-attachment and splint application and for placement of an apical plug using hydraulic calcium silicate cements. CONCLUSIONS: The model successfully achieved its intended objectives, so that it may be used in the future in various dental trauma treatment simulations for undergraduate and postgraduate education on the endodontic management of trauma-related therapies in immature teeth. Its common manufacturing process, affordability and re-usability support accessibility and sustainability.}, language = {en} } @inproceedings{SchaefferSchmausserHerrmannetal., author = {Schaeffer, Leon and Schmaußer, Theresa and Herrmann, David and Lehmann, Lukas and Dendorfer, Sebastian and B{\"o}hm, Valter}, title = {Multi-Body Simulation of a Dynamic Hand Orthosis based on a Prestressed Compliant Structure Incorporating the Human Hand}, series = {2025 International Symposium on Medical Robotics (ISMR), May 14-16, 2025, Atlanta, GA, USA,}, booktitle = {2025 International Symposium on Medical Robotics (ISMR), May 14-16, 2025, Atlanta, GA, USA,}, publisher = {IEEE}, doi = {10.1109/ISMR67322.2025.11025982}, pages = {80 -- 86}, abstract = {Many dynamic hand orthoses use one degree of freedom joints, such as hinge joints. Therefore, these orthoses can only partially replicate the complex, multi-axis movement of the hand. A possible solution for this is the use of prestressed compliant structures as the basis for orthoses. Determining the joint forces in the wrist and optimizing the dynamic orthosis to influence these forces as well as acting muscle forces are important steps in the development of these orthoses. For this reason, in this work multi-body simulation models of an orthosis with human hand models are presented. Based on these theoretical investigations, more detailed orthosis models as well as initial prototypes of prestressed compliant dynamic hand orthoses can be developed.}, language = {en} } @article{HartmannNieberlePalmetal., author = {Hartmann, Robin and Nieberle, Felix and Palm, Christoph and Br{\´e}bant, Vanessa and Prantl, Lukas and Kuehle, Reinald and Reichert, Torsten E. and Taxis, Juergen and Ettl, Tobias}, title = {Utility of Smartphone-based Three-dimensional Surface Imaging for Digital Facial Anthropometry}, series = {JPRAS Open}, volume = {39}, journal = {JPRAS Open}, publisher = {Elsevier}, doi = {10.1016/j.jpra.2024.01.014}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-70348}, pages = {330 -- 343}, abstract = {Background The utilization of three-dimensional (3D) surface imaging for facial anthropometry is a significant asset for patients undergoing maxillofacial surgery. Notably, there have been recent advancements in smartphone technology that enable 3D surface imaging. In this study, anthropometric assessments of the face were performed using a smartphone and a sophisticated 3D surface imaging system. Methods 30 healthy volunteers (15 females and 15 males) were included in the study. An iPhone 14 Pro (Apple Inc., USA) using the application 3D Scanner App (Laan Consulting Corp., USA) and the Vectra M5 (Canfield Scientific, USA) were employed to create 3D surface models. For each participant, 19 anthropometric measurements were conducted on the 3D surface models. Subsequently, the anthropometric measurements generated by the two approaches were compared. The statistical techniques employed included the paired t-test, paired Wilcoxon signed-rank test, Bland-Altman analysis, and calculation of the intraclass correlation coefficient (ICC). Results All measurements showed excellent agreement between smartphone-based and Vectra M5-based measurements (ICC between 0.85 and 0.97). Statistical analysis revealed no statistically significant differences in the central tendencies for 17 of the 19 linear measurements. Despite the excellent agreement found, Bland-Altman analysis revealed that the 95\% limits of agreement between the two methods exceeded ±3 mm for the majority of measurements. Conclusion Digital facial anthropometry using smartphones can serve as a valuable supplementary tool for surgeons, enhancing their communication with patients. However, the proposed data suggest that digital facial anthropometry using smartphones may not yet be suitable for certain diagnostic purposes that require high accuracy.}, language = {en} } @article{SouzaJrPalmMendeletal., author = {Souza Jr., Luis Antonio de and Palm, Christoph and Mendel, Robert and Hook, Christian and Ebigbo, Alanna and Probst, Andreas and Messmann, Helmut and Weber, Silke A. T. and Papa, Jo{\~a}o Paulo}, title = {A survey on Barrett's esophagus analysis using machine learning}, series = {Computers in Biology and Medicine}, volume = {96}, journal = {Computers in Biology and Medicine}, publisher = {Elsevier}, doi = {10.1016/j.compbiomed.2018.03.014}, pages = {203 -- 213}, abstract = {This work presents a systematic review concerning recent studies and technologies of machine learning for Barrett's esophagus (BE) diagnosis and treatment. The use of artificial intelligence is a brand new and promising way to evaluate such disease. We compile some works published at some well-established databases, such as Science Direct, IEEEXplore, PubMed, Plos One, Multidisciplinary Digital Publishing Institute (MDPI), Association for Computing Machinery (ACM), Springer, and Hindawi Publishing Corporation. Each selected work has been analyzed to present its objective, methodology, and results. The BE progression to dysplasia or adenocarcinoma shows a complex pattern to be detected during endoscopic surveillance. Therefore, it is valuable to assist its diagnosis and automatic identification using computer analysis. The evaluation of the BE dysplasia can be performed through manual or automated segmentation through machine learning techniques. Finally, in this survey, we reviewed recent studies focused on the automatic detection of the neoplastic region for classification purposes using machine learning methods.}, subject = {Speiser{\"o}hrenkrankheit}, language = {en} } @inproceedings{WoehlHuberLoibletal., author = {W{\"o}hl, Rebecca and Huber, Michaela and Loibl, Markus and Riebschl{\"a}ger, Birgit and Nerlich, Michael and Palm, Christoph}, title = {The Impact of Semi-Automated Segmentation and 3D Analysis on Testing New Osteosynthesis Material}, series = {Bildverarbeitung f{\"u}r die Medizin 2017; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 12. bis 14. M{\"a}rz 2017 in Heidelberg}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2017; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 12. bis 14. M{\"a}rz 2017 in Heidelberg}, publisher = {Springer}, address = {Berlin}, doi = {10.1007/978-3-662-54345-0_30}, pages = {122 -- 127}, abstract = {A new protocol for testing osteosynthesis material postoperatively combining semi-automated segmentation and 3D analysis of surface meshes is proposed. By various steps of transformation and measuring, objective data can be collected. In this study the specifications of a locking plate used for mediocarpal arthrodesis of the wrist were examined. The results show, that union of the lunate, triquetrum, hamate and capitate was achieved and that the plate is comparable to coexisting arthrodesis systems. Additionally, it was shown, that the complications detected correlate to the clinical outcome. In synopsis, this protocol is considered beneficial and should be taken into account in further studies.}, subject = {Osteosynthese}, language = {en} } @inproceedings{Palm, author = {Palm, Christoph}, title = {Fusion of Serial 2D Section Images and MRI Reference}, series = {Workshop Innovative Verarbeitung bioelektrischer und biomagnetischer Signale (bbs2014), Berlin, 10.04.2014}, booktitle = {Workshop Innovative Verarbeitung bioelektrischer und biomagnetischer Signale (bbs2014), Berlin, 10.04.2014}, doi = {10.13140/RG.2.1.1358.3449}, abstract = {Serial 2D section images with high resolution, resulting from innovative imaging methods become even more valuable, if they are fused with in vivo volumes. Achieving this goal, the 3D context of the sections would be restored, the deformations would be corrected and the artefacts would be eliminated. However, the registration in this field faces big challenges and is not solved in general. On the other hand, several approaches have been introduced dealing at least with some of these difficulties. Here, a brief overview of the topic is given and some of the solutions are presented. It does not constitute the claim to be a complete review, but could be a starting point for those who are interested in this field.}, subject = {Kernspintomografie}, language = {en} } @misc{EbigboMendelProbstetal., author = {Ebigbo, Alanna and Mendel, Robert and Probst, Andreas and Manzeneder, Johannes and Souza Jr., Luis Antonio de and Papa, Jo{\~a}o Paulo and Palm, Christoph and Messmann, Helmut}, title = {Artificial Intelligence in Early Barrett's Cancer: The Segmentation Task}, series = {Endoscopy}, volume = {51}, journal = {Endoscopy}, number = {04}, publisher = {Georg Thieme Verlag}, address = {Stuttgart}, doi = {10.1055/s-0039-1681187}, pages = {6}, abstract = {Aims: The delineation of outer margins of early Barrett's cancer can be challenging even for experienced endoscopists. Artificial intelligence (AI) could assist endoscopists faced with this task. As of date, there is very limited experience in this domain. In this study, we demonstrate the measure of overlap (Dice coefficient = D) between highly experienced Barrett endoscopists and an AI system in the delineation of cancer margins (segmentation task). Methods: An AI system with a deep convolutional neural network (CNN) was trained and tested on high-definition endoscopic images of early Barrett's cancer (n = 33) and normal Barrett's mucosa (n = 41). The reference standard for the segmentation task were the manual delineations of tumor margins by three highly experienced Barrett endoscopists. Training of the AI system included patch generation, patch augmentation and adjustment of the CNN weights. Then, the segmentation results from patch classification and thresholding of the class probabilities. Segmentation results were evaluated using the Dice coefficient (D). Results: The Dice coefficient (D) which can range between 0 (no overlap) and 1 (complete overlap) was computed only for images correctly classified by the AI-system as cancerous. At a threshold of t = 0.5, a mean value of D = 0.72 was computed. Conclusions: AI with CNN performed reasonably well in the segmentation of the tumor region in Barrett's cancer, at least when compared with expert Barrett's endoscopists. AI holds a lot of promise as a tool for better visualization of tumor margins but may need further improvement and enhancement especially in real-time settings.}, subject = {Speiser{\"o}hrenkrankheit}, language = {en} } @inproceedings{ChangLinLeeetal., author = {Chang, Ching-Sheng and Lin, Jin-Fa and Lee, Ming-Ching and Palm, Christoph}, title = {Semantic Lung Segmentation Using Convolutional Neural Networks}, series = {Bildverarbeitung f{\"u}r die Medizin 2020. Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 15. bis 17. M{\"a}rz 2020 in Berlin}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2020. Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 15. bis 17. M{\"a}rz 2020 in Berlin}, editor = {Tolxdorff, Thomas and Deserno, Thomas M. and Handels, Heinz and Maier, Andreas and Maier-Hein, Klaus H. and Palm, Christoph}, publisher = {Springer Vieweg}, address = {Wiesbaden}, isbn = {978-3-658-29266-9}, doi = {10.1007/978-3-658-29267-6_17}, pages = {75 -- 80}, abstract = {Chest X-Ray (CXR) images as part of a non-invasive diagnosis method are commonly used in today's medical workflow. In traditional methods, physicians usually use their experience to interpret CXR images, however, there is a large interobserver variance. Computer vision may be used as a standard for assisted diagnosis. In this study, we applied an encoder-decoder neural network architecture for automatic lung region detection. We compared a three-class approach (left lung, right lung, background) and a two-class approach (lung, background). The differentiation of left and right lungs as direct result of a semantic segmentation on basis of neural nets rather than post-processing a lung-background segmentation is done here for the first time. Our evaluation was done on the NIH Chest X-ray dataset, from which 1736 images were extracted and manually annotated. We achieved 94:9\% mIoU and 92\% mIoU as segmentation quality measures for the two-class-model and the three-class-model, respectively. This result is very promising for the segmentation of lung regions having the simultaneous classification of left and right lung in mind.}, subject = {Neuronales Netz}, language = {en} } @inproceedings{WeihererZornWittenbergetal., author = {Weiherer, Maximilian and Zorn, Martin and Wittenberg, Thomas and Palm, Christoph}, title = {Retrospective Color Shading Correction for Endoscopic Images}, series = {Bildverarbeitung f{\"u}r die Medizin 2020. Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 15. bis 17. M{\"a}rz 2020 in Berlin}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2020. Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 15. bis 17. M{\"a}rz 2020 in Berlin}, editor = {Tolxdorff, Thomas and Deserno, Thomas M. and Handels, Heinz and Maier, Andreas and Maier-Hein, Klaus H. and Palm, Christoph}, publisher = {Springer Vieweg}, address = {Wiesbaden}, isbn = {978-3-658-29266-9}, doi = {10.1007/978-3-658-29267-6}, pages = {14 -- 19}, abstract = {In this paper, we address the problem of retrospective color shading correction. An extension of the established gray-level shading correction algorithm based on signal envelope (SE) estimation to color images is developed using principal color components. Compared to the probably most general shading correction algorithm based on entropy minimization, SE estimation does not need any computationally expensive optimization and thus can be implemented more effciently. We tested our new shading correction scheme on artificial as well as real endoscopic images and observed promising results. Additionally, an indepth analysis of the stop criterion used in the SE estimation algorithm is provided leading to the conclusion that a fixed, user-defined threshold is generally not feasible. Thus, we present new ideas how to develop a non-parametric version of the SE estimation algorithm using entropy.}, subject = {Endoskopie}, language = {en} } @unpublished{WeihererEigenbergerBrebantetal., author = {Weiherer, Maximilian and Eigenberger, Andreas and Br{\´e}bant, Vanessa and Prantl, Lukas and Palm, Christoph}, title = {Learning the shape of female breasts: an open-access 3D statistical shape model of the female breast built from 110 breast scans}, pages = {15}, abstract = {We present the Regensburg Breast Shape Model (RBSM) - a 3D statistical shape model of the female breast built from 110 breast scans, and the first ever publicly available. Together with the model, a fully automated, pairwise surface registration pipeline used to establish correspondence among 3D breast scans is introduced. Our method is computationally efficient and requires only four landmarks to guide the registration process. In order to weaken the strong coupling between breast and thorax, we propose to minimize the variance outside the breast region as much as possible. To achieve this goal, a novel concept called breast probability masks (BPMs) is introduced. A BPM assigns probabilities to each point of a 3D breast scan, telling how likely it is that a particular point belongs to the breast area. During registration, we use BPMs to align the template to the target as accurately as possible inside the breast region and only roughly outside. This simple yet effective strategy significantly reduces the unwanted variance outside the breast region, leading to better statistical shape models in which breast shapes are quite well decoupled from the thorax. The RBSM is thus able to produce a variety of different breast shapes as independently as possible from the shape of the thorax. Our systematic experimental evaluation reveals a generalization ability of 0.17 mm and a specificity of 2.8 mm for the RBSM. Ultimately, our model is seen as a first step towards combining physically motivated deformable models of the breast and statistical approaches in order to enable more realistic surgical outcome simulation.}, language = {en} } @article{MaierDesernoHandelsetal., author = {Maier, Andreas and Deserno, Thomas M. and Handels, Heinz and Maier-Hein, Klaus H. and Palm, Christoph and Tolxdorff, Thomas}, title = {IJCARS: BVM 2021 special issue}, series = {International Journal of Computer Assisted Radiology and Surgery}, volume = {16}, journal = {International Journal of Computer Assisted Radiology and Surgery}, publisher = {Springer}, doi = {10.1007/s11548-021-02534-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-21666}, pages = {2067 -- 2068}, abstract = {The German workshop on medical image computing (BVM) has been held in different locations in Germany for more than 20 years. In terms of content, BVM focused on the computer-aided analysis of medical image data with a wide range of applications, e.g. in the area of imaging, diagnostics, operation planning, computer-aided intervention and visualization. During this time, there have been remarkable methodological developments and upheavals, on which the BVM community has worked intensively. The area of machine learning should be emphasized, which has led to significant improvements, especially for tasks of classification and segmentation, but increasingly also in image formation and registration. As a result, work in connection with deep learning now dominates the BVM. These developments have also contributed to the establishment of medical image processing at the interface between computer science and medicine as one of the key technologies for the digitization of the health system. In addition to the presentation of current research results, a central aspect of the BVM is primarily the promotion of young scientists from the diverse BVM community, covering not only Germany but also Austria, Switzerland, The Netherland and other European neighbors. The conference serves primarily doctoral students and postdocs, but also students with excellent bachelor and master theses as a platform to present their work, to enter into professional discourse with the community, and to establish networks with specialist colleagues. Despite the many conferences and congresses that are also relevant for medical image processing, the BVM has therefore lost none of its importance and attractiveness and has retained its permanent place in the annual conference rhythm. Building on this foundation, there are some innovations and changes this year. The BVM 2021 was organized for the first time at the Ostbayerische Technische Hochschule Regensburg (OTH Regensburg, a technical university of applied sciences). After Aachen, Berlin, Erlangen, Freiburg, Hamburg, Heidelberg, Leipzig, L{\"u}beck, and Munich, Regensburg is not just a new venue. OTH Regensburg is the first representative of the universities of applied sciences (HAW) to organize the conference, which differs to universities, university hospitals, or research centers like Fraunhofer or Helmholtz. This also considers the further development of the research landscape in Germany, where HAWs increasingly contribute to applied research in addition to their focus on teaching. This development is also reflected in the contributions submitted to the BVM in recent years. At BVM 2021, which was held in a virtual format for the first time due to the Corona pandemic, an attractive and high-quality program was offered. Fortunately, the number of submissions increased significantly. Out of 97 submissions, 26 presentations, 51 posters and 5 software demonstrations were accepted via an anonymized reviewing process with three reviews each. The three best works have been awarded BVM prizes, selected by a separate committee. Based on these high-quality submissions, we are able to present another special issue in the International Journal of Computer Assisted Radiology and Surgery (IJCARS). Out of the 97 submissions, the ones with the highest scores have been invited to submit an extended version of their paper to be presented in IJCARS. As a result, we are now able to present this special issue with seven excellent articles. Many submissions focus on machine learning in a medical context.}, subject = {Bildgebendes Verfahren}, language = {en} } @article{HartmannWeihererSchiltzetal., author = {Hartmann, Robin and Weiherer, Maximilian and Schiltz, Daniel and Seitz, Stephan and Lotter, Luisa and Anker, Alexandra and Palm, Christoph and Prantl, Lukas and Br{\´e}bant, Vanessa}, title = {A Novel Method of Outcome Assessment in Breast Reconstruction Surgery: Comparison of Autologous and Alloplastic Techniques Using Three-Dimensional Surface Imaging}, series = {Aesthetic Plastic Surgery}, volume = {44}, journal = {Aesthetic Plastic Surgery}, publisher = {Springer}, address = {Heidelberg}, doi = {10.1007/s00266-020-01749-4}, pages = {1980 -- 1987}, abstract = {Background Breast reconstruction is an important coping tool for patients undergoing a mastectomy. There are numerous surgical techniques in breast reconstruction surgery (BRS). Regardless of the technique used, creating a symmetric outcome is crucial for patients and plastic surgeons. Three-dimensional surface imaging enables surgeons and patients to assess the outcome's symmetry in BRS. To discriminate between autologous and alloplastic techniques, we analyzed both techniques using objective optical computerized symmetry analysis. Software was developed that enables clinicians to assess optical breast symmetry using three-dimensional surface imaging. Methods Twenty-seven patients who had undergone autologous (n = 12) or alloplastic (n = 15) BRS received three-dimensional surface imaging. Anthropomorphic data were collected digitally using semiautomatic measurements and automatic measurements. Automatic measurements were taken using the newly developed software. To quantify symmetry, a Symmetry Index is proposed. Results Statistical analysis revealed that there is no dif- ference in the outcome symmetry between the two groups (t test for independent samples; p = 0.48, two-tailed). Conclusion This study's findings provide a foundation for qualitative symmetry assessment in BRS using automatized digital anthropometry. In the present trial, no difference in the outcomes' optical symmetry was detected between autologous and alloplastic approaches.}, subject = {Mammoplastik}, language = {en} } @article{HartmannWeihererSchiltzetal., author = {Hartmann, Robin and Weiherer, Maximilian and Schiltz, Daniel and Baringer, Magnus and Noisser, Vivien and H{\"o}sl, Vanessa and Eigenberger, Andreas and Seitz, Stefan and Palm, Christoph and Prantl, Lukas and Br{\´e}bant, Vanessa}, title = {New aspects in digital breast assessment: further refinement of a method for automated digital anthropometry}, series = {Archives of Gynecology and Obstetrics}, volume = {303}, journal = {Archives of Gynecology and Obstetrics}, publisher = {Springer Nature}, address = {Heidelberg}, issn = {1432-0711}, doi = {10.1007/s00404-020-05862-2}, pages = {721 -- 728}, abstract = {Purpose: In this trial, we used a previously developed prototype software to assess aesthetic results after reconstructive surgery for congenital breast asymmetry using automated anthropometry. To prove the consensus between the manual and automatic digital measurements, we evaluated the software by comparing the manual and automatic measurements of 46 breasts. Methods: Twenty-three patients who underwent reconstructive surgery for congenital breast asymmetry at our institution were examined and underwent 3D surface imaging. Per patient, 14 manual and 14 computer-based anthropometric measurements were obtained according to a standardized protocol. Manual and automatic measurements, as well as the previously proposed Symmetry Index (SI), were compared. Results: The Wilcoxon signed-rank test revealed no significant differences in six of the seven measurements between the automatic and manual assessments. The SI showed robust agreement between the automatic and manual methods. Conclusion: The present trial validates our method for digital anthropometry. Despite the discrepancy in one measurement, all remaining measurements, including the SI, showed high agreement between the manual and automatic methods. The proposed data bring us one step closer to the long-term goal of establishing robust instruments to evaluate the results of breast surgery.}, language = {en} } @article{GrassmannMengelkampBrandletal., author = {Graßmann, Felix and Mengelkamp, Judith and Brandl, Caroline and Harsch, Sebastian and Zimmermann, Martina E. and Linkohr, Birgit and Peters, Annette and Heid, Iris M. and Palm, Christoph and Weber, Bernhard H. F.}, title = {A Deep Learning Algorithm for Prediction of Age-Related Eye Disease Study Severity Scale for Age-Related Macular Degeneration from Color Fundus Photography}, series = {Ophtalmology}, volume = {125}, journal = {Ophtalmology}, number = {9}, publisher = {Elsevier}, doi = {10.1016/j.ophtha.2018.02.037}, pages = {1410 -- 1420}, abstract = {Purpose Age-related macular degeneration (AMD) is a common threat to vision. While classification of disease stages is critical to understanding disease risk and progression, several systems based on color fundus photographs are known. Most of these require in-depth and time-consuming analysis of fundus images. Herein, we present an automated computer-based classification algorithm. Design Algorithm development for AMD classification based on a large collection of color fundus images. Validation is performed on a cross-sectional, population-based study. Participants. We included 120 656 manually graded color fundus images from 3654 Age-Related Eye Disease Study (AREDS) participants. AREDS participants were >55 years of age, and non-AMD sight-threatening diseases were excluded at recruitment. In addition, performance of our algorithm was evaluated in 5555 fundus images from the population-based Kooperative Gesundheitsforschung in der Region Augsburg (KORA; Cooperative Health Research in the Region of Augsburg) study. Methods. We defined 13 classes (9 AREDS steps, 3 late AMD stages, and 1 for ungradable images) and trained several convolution deep learning architectures. An ensemble of network architectures improved prediction accuracy. An independent dataset was used to evaluate the performance of our algorithm in a population-based study. Main Outcome Measures. κ Statistics and accuracy to evaluate the concordance between predicted and expert human grader classification. Results. A network ensemble of 6 different neural net architectures predicted the 13 classes in the AREDS test set with a quadratic weighted κ of 92\% (95\% confidence interval, 89\%-92\%) and an overall accuracy of 63.3\%. In the independent KORA dataset, images wrongly classified as AMD were mainly the result of a macular reflex observed in young individuals. By restricting the KORA analysis to individuals >55 years of age and prior exclusion of other retinopathies, the weighted and unweighted κ increased to 50\% and 63\%, respectively. Importantly, the algorithm detected 84.2\% of all fundus images with definite signs of early or late AMD. Overall, 94.3\% of healthy fundus images were classified correctly. Conclusions Our deep learning algoritm revealed a weighted κ outperforming human graders in the AREDS study and is suitable to classify AMD fundus images in other datasets using individuals >55 years of age.}, subject = {Senile Makuladegeneration}, language = {en} } @article{MaierPerretSimonetal., author = {Maier, Johannes and Perret, Jerome and Simon, Martina and Schmitt-R{\"u}th, Stephanie and Wittenberg, Thomas and Palm, Christoph}, title = {Force-feedback assisted and virtual fixtures based K-wire drilling simulation}, series = {Computers in Biology and Medicine}, volume = {114}, journal = {Computers in Biology and Medicine}, publisher = {Elsevier}, doi = {10.1016/j.compbiomed.2019.103473}, pages = {1 -- 10}, abstract = {One common method to fix fractures of the human hand after an accident is an osteosynthesis with Kirschner wires (K-wires) to stabilize the bone fragments. The insertion of K-wires is a delicate minimally invasive surgery, because surgeons operate almost without a sight. Since realistic training methods are time consuming, costly and insufficient, a virtual-reality (VR) based training system for the placement of K-wires was developed. As part of this, the current work deals with the real-time bone drilling simulation using a haptic force-feedback device. To simulate the drilling, we introduce a virtual fixture based force-feedback drilling approach. By decomposition of the drilling task into individual phases, each phase can be handled individually to perfectly control the drilling procedure. We report about the related finite state machine (FSM), describe the haptic feedback of each state and explain, how to avoid jerking of the haptic force-feedback during state transition. The usage of the virtual fixture approach results in a good haptic performance and a stable drilling behavior. This was confirmed by 26 expert surgeons, who evaluated the virtual drilling on the simulator and rated it as very realistic. To make the system even more convincing, we determined real drilling feed rates through experimental pig bone drilling and transferred them to our system. Due to a constant simulation thread we can guarantee a precise drilling motion. Virtual fixtures based force-feedback calculation is able to simulate force-feedback assisted bone drilling with high quality and, thus, will have a great potential in developing medical applications.}, subject = {Handchirurgie}, language = {en} } @inproceedings{SzaloZehnerPalm, author = {Szalo, Alexander Eduard and Zehner, Alexander and Palm, Christoph}, title = {GraphMIC: Medizinische Bildverarbeitung in der Lehre}, series = {Bildverarbeitung f{\"u}r die Medizin 2015; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 15. bis 17. M{\"a}rz 2015 in L{\"u}beck}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2015; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 15. bis 17. M{\"a}rz 2015 in L{\"u}beck}, publisher = {Springer}, address = {Berlin}, doi = {10.1007/978-3-662-46224-9_68}, pages = {395 -- 400}, abstract = {Die Lehre der medizinischen Bildverarbeitung vermittelt Kenntnisse mit einem breiten Methodenspektrum. Neben den Grundlagen der Verfahren soll ein Gef{\"u}hl f{\"u}r eine geeignete Ausf{\"u}hrungsreihenfolge und ihrer Wirkung auf medizinische Bilddaten entwickelt werden. Die Komplexit{\"a}t der Methoden erfordert vertiefte Programmierkenntnisse, sodass bereits einfache Operationen mit großem Programmieraufwand verbunden sind. Die Software GraphMIC stellt Bildverarbeitungsoperationen in Form interaktiver Knoten zur Verf{\"u}gung und erlaubt das Arrangieren, Parametrisieren und Ausf{\"u}hren komplexer Verarbeitungssequenzen in einem Graphen. Durch den Fokus auf das Design einer Pipeline, weg von sprach- und frameworkspezifischen Implementierungsdetails, lassen sich grundlegende Prinzipien der Bildverarbeitung anschaulich erlernen. In diesem Beitrag stellen wir die visuelle Programmierung mit GraphMIC der nativen Implementierung {\"a}quivalenter Funktionen gegen{\"u}ber. Die in C++ entwickelte Applikation basiert auf Qt, ITK, OpenCV, VTK und MITK.}, subject = {Bildverarbeitung}, language = {de} } @inproceedings{NunesHammerHammeretal., author = {Nunes, Danilo Weber and Hammer, Michael and Hammer, Simone and Uller, Wibke and Palm, Christoph}, title = {Classification of Vascular Malformations Based on T2 STIR Magnetic Resonance Imaging}, series = {Bildverarbeitung f{\"u}r die Medizin 2022: Proceedings, German Workshop on Medical Image Computing, Heidelberg, June 26-28, 2022}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2022: Proceedings, German Workshop on Medical Image Computing, Heidelberg, June 26-28, 2022}, publisher = {Springer Vieweg}, address = {Wiesbaden}, doi = {10.1007/978-3-658-36932-3_57}, pages = {267 -- 272}, abstract = {Vascular malformations (VMs) are a rare condition. They can be categorized into high-flow and low-flow VMs, which is a challenging task for radiologists. In this work, a very heterogeneous set of MRI images with only rough annotations are used for classification with a convolutional neural network. The main focus is to describe the challenging data set and strategies to deal with such data in terms of preprocessing, annotation usage and choice of the network architecture. We achieved a classification result of 89.47 \% F1-score with a 3D ResNet 18.}, language = {en} } @inproceedings{RauberMendelScheppachetal., author = {Rauber, David and Mendel, Robert and Scheppach, Markus W. and Ebigbo, Alanna and Messmann, Helmut and Palm, Christoph}, title = {Analysis of Celiac Disease with Multimodal Deep Learning}, series = {Bildverarbeitung f{\"u}r die Medizin 2022: Proceedings, German Workshop on Medical Image Computing, Heidelberg, June 26-28, 2022}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2022: Proceedings, German Workshop on Medical Image Computing, Heidelberg, June 26-28, 2022}, publisher = {Springer Vieweg}, address = {Wiesbaden}, doi = {10.1007/978-3-658-36932-3_25}, pages = {115 -- 120}, abstract = {Celiac disease is an autoimmune disorder caused by gluten that results in an inflammatory response of the small intestine.We investigated whether celiac disease can be detected using endoscopic images through a deep learning approach. The results show that additional clinical parameters can improve the classification accuracy. In this work, we distinguished between healthy tissue and Marsh III, according to the Marsh score system. We first trained a baseline network to classify endoscopic images of the small bowel into these two classes and then augmented the approach with a multimodality component that took the antibody status into account.}, language = {en} } @inproceedings{WeberBrawanskiPalm, author = {Weber, Joachim and Brawanski, Alexander and Palm, Christoph}, title = {Parallelization of FSL-Fast segmentation of MRI brain data}, series = {58. Jahrestagung der Deutschen Gesellschaft f{\"u}r Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS 2013), L{\"u}beck, 01.-05.09.2013}, booktitle = {58. Jahrestagung der Deutschen Gesellschaft f{\"u}r Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS 2013), L{\"u}beck, 01.-05.09.2013}, number = {DocAbstr. 329}, publisher = {German Medical Science GMS Publishing House}, address = {D{\"u}sseldorf}, doi = {10.3205/13gmds261}, language = {en} } @article{HuberSchlosserStenzeletal., author = {Huber, Michaela and Schlosser, Daniela and Stenzel, Susanne and Maier, Johannes and Pattappa, Girish and Kujat, Richard and Striegl, Birgit and Docheva, Denitsa}, title = {Quantitative Analysis of Surface Contouring with Pulsed Bipolar Radiofrequency on Thin Chondromalacic Cartilage}, series = {BioMed Research International}, journal = {BioMed Research International}, publisher = {HINDAWI}, doi = {10.1155/2020/1242086}, pages = {1 -- 8}, abstract = {The purpose of this study was to evaluate the quality of surface contouring of chondromalacic cartilage by bipolar radio frequency energy using different treatment patterns in an animal model, as well as examining the impact of the treatment onto chondrocyte viability by two different methods. Our experiments were conducted on 36 fresh osteochondral sections from the tibia plateau of slaughtered 6-month-old pigs, where the thickness of the cartilage is similar to that of human wrist cartilage. An area of 1 cm(2) was first treated with emery paper to simulate the chondromalacic cartilage. Then, the treatment with RFE followed in 6 different patterns. The osteochondral sections were assessed for cellular viability (live/dead assay, caspase (cell apoptosis marker) staining, and quantitative analysed images obtained by fluorescent microscopy). For a quantitative characterization of none or treated cartilage surfaces, various roughness parameters were measured using confocal laser scanning microscopy (Olympus LEXT OLS 4000 3D). To describe the roughness, the Root-Mean-Square parameter (Sq) was calculated. A smoothing effect of the cartilage surface was detectable upon each pattern of RFE treatment. The Sq for native cartilage was Sq=3.8 +/- 1.1 mu m. The best smoothing pattern was seen for two RFE passes and a 2-second pulsed mode (B2p2) with an Sq=27.3 +/- 4.9 mu m. However, with increased smoothing, an augmentation in chondrocyte death up to 95\% was detected. Using bipolar RFE treatment in arthroscopy for small joints like the wrist or MCP joints should be used with caution. In the case of chondroplasty, there is a high chance to destroy the joint cartilage.}, language = {en} } @inproceedings{PalmSiegmundSemmelmannetal., author = {Palm, Christoph and Siegmund, Heiko and Semmelmann, Matthias and Grafe, Claudia and Evert, Matthias and Schroeder, Josef A.}, title = {Interactive Computer-assisted Approach for Evaluation of Ultrastructural Cilia Abnormalities}, series = {Medical Imaging 2016: Computer-Aided Diagnosis, San Diego, California, United States, 27 February - 3 March, SPIE Proceedings 97853N, 2016, ISBN 9781510600201}, booktitle = {Medical Imaging 2016: Computer-Aided Diagnosis, San Diego, California, United States, 27 February - 3 March, SPIE Proceedings 97853N, 2016, ISBN 9781510600201}, doi = {10.1117/12.2214976}, pages = {7}, abstract = {Introduction - Diagnosis of abnormal cilia function is based on ultrastructural analysis of axoneme defects, especialy the features of inner and outer dynein arms which are the motors of ciliar motility. Sub-optimal biopsy material, methodical, and intrinsic electron microscopy factors pose difficulty in ciliary defects evaluation. We present a computer-assisted approach based on state-of-the-art image analysis and object recognition methods yielding a time-saving and efficient diagnosis of cilia dysfunction. Method - The presented approach is based on a pipeline of basal image processing methods like smoothing, thresholding and ellipse fitting. However, integration of application specific knowledge results in robust segmentations even in cases of image artifacts. The method is build hierarchically starting with the detection of cilia within the image, followed by the detection of nine doublets within each analyzable cilium, and ending with the detection of dynein arms of each doublet. The process is concluded by a rough classification of the dynein arms as basis for a computer-assisted diagnosis. Additionally, the interaction possibilities are designed in a way, that the results are still reproducible given the completion report. Results - A qualitative evaluation showed reasonable detection results for cilia, doublets and dynein arms. However, since a ground truth is missing, the variation of the computer-assisted diagnosis should be within the subjective bias of human diagnosticians. The results of a first quantitative evaluation with five human experts and six images with 12 analyzable cilia showed, that with default parameterization 91.6\% of the cilia and 98\% of the doublets were found. The computer-assisted approach rated 66\% of those inner and outer dynein arms correct, where all human experts agree. However, especially the quality of the dynein arm classification may be improved in future work.}, subject = {Zilie}, language = {en} } @article{HuttererHattingenPalmetal., author = {Hutterer, Markus and Hattingen, Elke and Palm, Christoph and Proescholdt, Martin Andreas and Hau, Peter}, title = {Current standards and new concepts in MRI and PET response assessment of antiangiogenic therapies in high-grade glioma patients}, series = {Neuro-Oncology}, volume = {17}, journal = {Neuro-Oncology}, number = {6}, doi = {10.1093/neuonc/nou322}, pages = {784 -- 800}, abstract = {Despite multimodal treatment, the prognosis of high-grade gliomas is grim. As tumor growth is critically dependent on new blood vessel formation, antiangiogenic treatment approaches offer an innovative treatment strategy. Bevacizumab, a humanized monoclonal antibody, has been in the spotlight of antiangiogenic approaches for several years. Currently, MRI including contrast-enhanced T1-weighted and T2/fluid-attenuated inversion recovery (FLAIR) images is routinely used to evaluate antiangiogenic treatment response (Response Assessment in Neuro-Oncology criteria). However, by restoring the blood-brain barrier, bevacizumab may reduce T1 contrast enhancement and T2/FLAIR hyperintensity, thereby obscuring the imaging-based detection of progression. The aim of this review is to highlight the recent role of imaging biomarkers from MR and PET imaging on measurement of disease progression and treatment effectiveness in antiangiogenic therapies. Based on the reviewed studies, multimodal imaging combining standard MRI with new physiological MRI techniques and metabolic PET imaging, in particular amino acid tracers, may have the ability to detect antiangiogenic drug susceptibility or resistance prior to morphological changes. As advances occur in the development of therapies that target specific biochemical or molecular pathways and alter tumor physiology in potentially predictable ways, the validation of physiological and metabolic imaging biomarkers will become increasingly important in the near future.}, subject = {Gliom}, language = {en} } @inproceedings{MendelRauberPalm, author = {Mendel, Robert and Rauber, David and Palm, Christoph}, title = {Exploring the Effects of Contrastive Learning on Homogeneous Medical Image Data}, series = {Bildverarbeitung f{\"u}r die Medizin 2023: Proceedings, German Workshop on Medical Image Computing, July 2- 4, 2023, Braunschweig}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2023: Proceedings, German Workshop on Medical Image Computing, July 2- 4, 2023, Braunschweig}, publisher = {Springer Vieweg}, address = {Wiesbaden}, doi = {10.1007/978-3-658-41657-7}, pages = {128 -- 13}, abstract = {We investigate contrastive learning in a multi-task learning setting classifying and segmenting early Barrett's cancer. How can contrastive learning be applied in a domain with few classes and low inter-class and inter-sample variance, potentially enabling image retrieval or image attribution? We introduce a data sampling strategy that mines per-lesion data for positive samples and keeps a queue of the recent projections as negative samples. We propose a masking strategy for the NT-Xent loss that keeps the negative set pure and removes samples from the same lesion. We show cohesion and uniqueness improvements of the proposed method in feature space. The introduction of the auxiliary objective does not affect the performance but adds the ability to indicate similarity between lesions. Therefore, the approach could enable downstream auto-documentation tasks on homogeneous medical image data.}, language = {en} } @misc{OPUS4-1458, title = {Bildverarbeitung f{\"u}r die Medizin 2021}, editor = {Palm, Christoph and Deserno, Thomas M. and Handels, Heinz and Maier, Andreas and Maier-Hein, Klaus H. and Tolxdorff, Thomas}, publisher = {Springer Vieweg}, address = {Wiesbdaden}, isbn = {978-3-658-33197-9}, issn = {1431-472X}, doi = {10.1007/978-3-658-33198-6}, pages = {361}, abstract = {In den letzten Jahren hat sich der Workshop "Bildverarbeitung f{\"u}r die Medizin" durch erfolgreiche Veranstaltungen etabliert. Ziel ist auch 2021 wieder die Darstellung aktueller Forschungsergebnisse und die Vertiefung der Gespr{\"a}che zwischen Wissenschaftlern, Industrie und Anwendern. Die Beitr{\"a}ge dieses Bandes - einige davon in englischer Sprache - umfassen alle Bereiche der medizinischen Bildverarbeitung, insbesondere Bildgebung und -akquisition, Maschinelles Lernen, Bildsegmentierung und Bildanalyse, Visualisierung und Animation, Zeitreihenanalyse, Computerunterst{\"u}tzte Diagnose, Biomechanische Modellierung, Validierung und Qualit{\"a}tssicherung, Bildverarbeitung in der Telemedizin u.v.m.}, subject = {Bildanalyse}, language = {de} } @article{EbigboPalmMessmann, author = {Ebigbo, Alanna and Palm, Christoph and Messmann, Helmut}, title = {Barrett esophagus: What to expect from Artificial Intelligence?}, series = {Best Practice \& Research Clinical Gastroenterology}, volume = {52-53}, journal = {Best Practice \& Research Clinical Gastroenterology}, number = {June-August}, publisher = {Elsevier}, issn = {1521-6918}, doi = {10.1016/j.bpg.2021.101726}, abstract = {The evaluation and assessment of Barrett's esophagus is challenging for both expert and nonexpert endoscopists. However, the early diagnosis of cancer in Barrett's esophagus is crucial for its prognosis, and could save costs. Pre-clinical and clinical studies on the application of Artificial Intelligence (AI) in Barrett's esophagus have shown promising results. In this review, we focus on the current challenges and future perspectives of implementing AI systems in the management of patients with Barrett's esophagus.}, subject = {Deep Learning}, language = {en} } @inproceedings{SouzaJrAfonsoPalmetal., author = {Souza Jr., Luis Antonio de and Afonso, Luis Claudio Sugi and Palm, Christoph and Papa, Jo{\~a}o Paulo}, title = {Barrett's Esophagus Identification Using Optimum-Path Forest}, series = {Proceedings of the 30th Conference on Graphics, Patterns and Images Tutorials (SIBGRAPI-T 2017), Niter{\´o}i, Rio de Janeiro, Brazil, 2017, 17-20 October}, booktitle = {Proceedings of the 30th Conference on Graphics, Patterns and Images Tutorials (SIBGRAPI-T 2017), Niter{\´o}i, Rio de Janeiro, Brazil, 2017, 17-20 October}, doi = {10.1109/SIBGRAPI.2017.47}, pages = {308 -- 314}, abstract = {Computer-assisted analysis of endoscopic images can be helpful to the automatic diagnosis and classification of neoplastic lesions. Barrett's esophagus (BE) is a common type of reflux that is not straight forward to be detected by endoscopic surveillance, thus being way susceptible to erroneous diagnosis, which can cause cancer when not treated properly. In this work, we introduce the Optimum-Path Forest (OPF) classifier to the task of automatic identification of Barrett'sesophagus, with promising results and outperforming the well known Support Vector Machines (SVM) in the aforementioned context. We consider describing endoscopic images by means of feature extractors based on key point information, such as the Speeded up Robust Features (SURF) and Scale-Invariant Feature Transform (SIFT), for further designing a bag-of-visual-wordsthat is used to feed both OPF and SVM classifiers. The best results were obtained by means of the OPF classifier for both feature extractors, with values lying on 0.732 (SURF) - 0.735(SIFT) for sensitivity, 0.782 (SURF) - 0.806 (SIFT) for specificity, and 0.738 (SURF) - 0.732 (SIFT) for the accuracy.}, subject = {Speiser{\"o}hrenkrankheit}, language = {en} } @inproceedings{ZehnerSzaloPalm, author = {Zehner, Alexander and Szalo, Alexander Eduard and Palm, Christoph}, title = {GraphMIC: Easy Prototyping of Medical Image Computing Applications}, series = {Interactive Medical Image Computing (IMIC), Workshop at the Medical Image Computing and Computer Assisted Interventions (MICCAI 2015), 2015, Munich}, booktitle = {Interactive Medical Image Computing (IMIC), Workshop at the Medical Image Computing and Computer Assisted Interventions (MICCAI 2015), 2015, Munich}, doi = {10.13140/RG.2.1.3718.4725}, pages = {395 -- 400}, abstract = {GraphMIC is a cross-platform image processing application utilizing the libraries ITK and OpenCV. The abstract structure of image processing pipelines is visually represented by user interface components based on modern QtQuick technology and allows users to focus on arrangement and parameterization of operations rather than implementing the equivalent functionality natively in C++. The application's central goal is to improve and simplify the typical workflow by providing various high level features and functions like multi threading, image sequence processing and advanced error handling. A built-in python interpreter allows the creation of custom nodes, where user defined algorithms can be integrated to extend basic functionality. An embedded 2d/3d visual-izer gives feedback of the resulting image of an operation or the whole pipeline. User inputs like seed points, contours or regions are forwarded to the processing pipeline as parameters to offer semi-automatic image computing. We report the main concept of the application and introduce several features and their implementation. Finally, the current state of development as well as future perspectives of GraphMIC are discussed}, subject = {Bildverarbeitung}, language = {en} } @inproceedings{WeberDoenitzBrawanskietal., author = {Weber, Joachim and Doenitz, Christian and Brawanski, Alexander and Palm, Christoph}, title = {Data-Parallel MRI Brain Segmentation in Clinicial Use}, series = {Bildverarbeitung f{\"u}r die Medizin 2015; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 15. bis 17. M{\"a}rz 2015 in L{\"u}beck}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2015; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 15. bis 17. M{\"a}rz 2015 in L{\"u}beck}, publisher = {Springer}, address = {Berlin}, doi = {10.1007/978-3-662-46224-9_67}, pages = {389 -- 394}, abstract = {Structural MRI brain analysis and segmentation is a crucial part in the daily routine in neurosurgery for intervention planning. Exemplarily, the free software FSL-FAST (FMRIB's Segmentation Library - FMRIB's Automated Segmentation Tool) in version 4 is used for segmentation of brain tissue types. To speed up the segmentation procedure by parallel execution, we transferred FSL-FAST to a General Purpose Graphics Processing Unit (GPGPU) using Open Computing Language (OpenCL) [1]. The necessary steps for parallelization resulted in substantially different and less useful results. Therefore, the underlying methods were revised and adapted yielding computational overhead. Nevertheless, we achieved a speed-up factor of 3.59 from CPU to GPGPU execution, as well providing similar useful or even better results.}, subject = {Kernspintomografie}, language = {en} } @misc{MaierWeihererHuberetal., author = {Maier, Johannes and Weiherer, Maximilian and Huber, Michaela and Palm, Christoph}, title = {Abstract: Imitating Human Soft Tissue with Dual-Material 3D Printing}, series = {Bildverarbeitung f{\"u}r die Medizin 2019, Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 17. bis 19. M{\"a}rz 2019 in L{\"u}beck}, journal = {Bildverarbeitung f{\"u}r die Medizin 2019, Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 17. bis 19. M{\"a}rz 2019 in L{\"u}beck}, editor = {Handels, Heinz and Deserno, Thomas M. and Maier, Andreas and Maier-Hein, Klaus H. and Palm, Christoph and Tolxdorff, Thomas}, publisher = {Springer Vieweg}, address = {Wiesbaden}, isbn = {978-3-658-25325-7}, doi = {10.1007/978-3-658-25326-4_48}, pages = {218}, abstract = {Currently, it is common practice to use three-dimensional (3D) printers not only for rapid prototyping in the industry, but also in the medical area to create medical applications for training inexperienced surgeons. In a clinical training simulator for minimally invasive bone drilling to fix hand fractures with Kirschner-wires (K-wires), a 3D printed hand phantom must not only be geometrically but also haptically correct. Due to a limited view during an operation, surgeons need to perfectly localize underlying risk structures only by feeling of specific bony protrusions of the human hand.}, subject = {Handchirurgie}, language = {en} } @misc{OPUS4-7115, title = {Bildverarbeitung f{\"u}r die Medizin 2024}, editor = {Maier, Andreas and Deserno, Thomas M. and Handels, Heinz and Maier-Hein, Klaus H. and Palm, Christoph and Tolxdorff, Thomas}, publisher = {Springer}, address = {Wiesbaden}, isbn = {978-3-658-44037-4}, issn = {1431-472X}, doi = {10.1007/978-3-658-44037-4}, pages = {370}, abstract = {Seit mehr als 25 Jahren ist der Workshop "Bildverarbeitung f{\"u}r die Medizin" als erfolgreiche Veranstaltung etabliert. Ziel ist auch 2024 wieder die Darstellung aktueller Forschungsergebnisse und die Vertiefung der Gespr{\"a}che zwischen Wissenschaftlern, Industrie und Anwendern. Die Beitr{\"a}ge dieses Bandes - viele davon in englischer Sprache - umfassen alle Bereiche der medizinischen Bildverarbeitung, insbesondere die Bildgebung und -akquisition, Segmentierung und Analyse, Visualisierung und Animation, computerunterst{\"u}tzte Diagnose sowie bildgest{\"u}tzte Therapieplanung und Therapie. Hierbei kommen Methoden des maschinelles Lernens, der biomechanischen Modellierung sowie der Validierung und Qualit{\"a}tssicherung zum Einsatz.}, subject = {Bildverarbeitung}, language = {de} } @article{MaerklRueckertRauberetal., author = {Maerkl, Raphaela and Rueckert, Tobias and Rauber, David and Gutbrod, Max and Weber Nunes, Danilo and Palm, Christoph}, title = {Enhancing generalization in zero-shot multi-label endoscopic instrument classification}, series = {International Journal of Computer Assisted Radiology and Surgery}, volume = {20}, journal = {International Journal of Computer Assisted Radiology and Surgery}, publisher = {Springer Nature}, doi = {10.1007/s11548-025-03439-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-85674}, pages = {1577 -- 1587}, abstract = {Purpose Recognizing previously unseen classes with neural networks is a significant challenge due to their limited generalization capabilities. This issue is particularly critical in safety-critical domains such as medical applications, where accurate classification is essential for reliability and patient safety. Zero-shot learning methods address this challenge by utilizing additional semantic data, with their performance relying heavily on the quality of the generated embeddings. Methods This work investigates the use of full descriptive sentences, generated by a Sentence-BERT model, as class representations, compared to simpler category-based word embeddings derived from a BERT model. Additionally, the impact of z-score normalization as a post-processing step on these embeddings is explored. The proposed approach is evaluated on a multi-label generalized zero-shot learning task, focusing on the recognition of surgical instruments in endoscopic images from minimally invasive cholecystectomies. Results The results demonstrate that combining sentence embeddings and z-score normalization significantly improves model performance. For unseen classes, the AUROC improves from 43.9\% to 64.9\%, and the multi-label accuracy from 26.1\% to 79.5\%. Overall performance measured across both seen and unseen classes improves from 49.3\% to 64.9\% in AUROC and from 37.3\% to 65.1\% in multi-label accuracy, highlighting the effectiveness of our approach. Conclusion These findings demonstrate that sentence embeddings and z-score normalization can substantially enhance the generalization performance of zero-shot learning models. However, as the study is based on a single dataset, future work should validate the method across diverse datasets and application domains to establish its robustness and broader applicability.}, language = {en} } @article{BarthelSuessDendorfer, author = {Barthel, Mareike and S{\"u}ß, Franz and Dendorfer, Sebastian}, title = {Application of a transformer encoder for the prediction of intra-abdominal pressure}, series = {Computer Methods in Biomechanics and Biomedical Engineering}, journal = {Computer Methods in Biomechanics and Biomedical Engineering}, publisher = {Taylor \& Francis}, doi = {10.1080/10255842.2025.2586143}, pages = {11}, abstract = {Intra-abdominal pressure is a significant physiological parameter influencing spinal stability and pelvic floor health. This study investigates the potential of a transformer encoder model to predict IAP using motion capture data and musculoskeletal modeling. Data from 211 subjects performing walking, fast walking, and running were used to train a transformer encoder. The model showed promising results with an overall Mean Absolute Percentage Error of 13.5\% and a Pearson correlation coefficient of 0.85. Predictions for fast walking and running proved to be more challenging compared to walking, which was attributed to the greater variability and complexity of faster movements.}, language = {en} } @article{WeihererEigenbergerEggeretal., author = {Weiherer, Maximilian and Eigenberger, Andreas and Egger, Bernhard and Br{\´e}bant, Vanessa and Prantl, Lukas and Palm, Christoph}, title = {Learning the shape of female breasts: an open-access 3D statistical shape model of the female breast built from 110 breast scans}, series = {The Visual Computer}, volume = {39}, journal = {The Visual Computer}, number = {4}, publisher = {Springer Nature}, doi = {10.1007/s00371-022-02431-3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-30506}, pages = {1597 -- 1616}, abstract = {We present the Regensburg Breast Shape Model (RBSM)—a 3D statistical shape model of the female breast built from 110 breast scans acquired in a standing position, and the first publicly available. Together with the model, a fully automated, pairwise surface registration pipeline used to establish dense correspondence among 3D breast scans is introduced. Our method is computationally efficient and requires only four landmarks to guide the registration process. A major challenge when modeling female breasts from surface-only 3D breast scans is the non-separability of breast and thorax. In order to weaken the strong coupling between breast and surrounding areas, we propose to minimize the variance outside the breast region as much as possible. To achieve this goal, a novel concept called breast probability masks (BPMs) is introduced. A BPM assigns probabilities to each point of a 3D breast scan, telling how likely it is that a particular point belongs to the breast area. During registration, we use BPMs to align the template to the target as accurately as possible inside the breast region and only roughly outside. This simple yet effective strategy significantly reduces the unwanted variance outside the breast region, leading to better statistical shape models in which breast shapes are quite well decoupled from the thorax. The RBSM is thus able to produce a variety of different breast shapes as independently as possible from the shape of the thorax. Our systematic experimental evaluation reveals a generalization ability of 0.17 mm and a specificity of 2.8 mm. To underline the expressiveness of the proposed model, we finally demonstrate in two showcase applications how the RBSM can be used for surgical outcome simulation and the prediction of a missing breast from the remaining one. Our model is available at https://www.rbsm.re-mic.de/.}, language = {en} } @article{MaierWeihererHuberetal., author = {Maier, Johannes and Weiherer, Maximilian and Huber, Michaela and Palm, Christoph}, title = {Imitating human soft tissue on basis of a dual-material 3D print using a support-filled metamaterial to provide bimanual haptic for a hand surgery training system}, series = {Quantitative Imaging in Medicine and Surgery}, volume = {9}, journal = {Quantitative Imaging in Medicine and Surgery}, number = {1}, publisher = {AME Publishing Company}, doi = {10.21037/qims.2018.09.17}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-979}, pages = {30 -- 42}, abstract = {Background: Currently, it is common practice to use three-dimensional (3D) printers not only for rapid prototyping in the industry, but also in the medical area to create medical applications for training inexperienced surgeons. In a clinical training simulator for minimally invasive bone drilling to fix hand fractures with Kirschner-wires (K-wires), a 3D-printed hand phantom must not only be geometrically but also haptically correct. Due to a limited view during an operation, surgeons need to perfectly localize underlying risk structures only by feeling of specific bony protrusions of the human hand. Methods: The goal of this experiment is to imitate human soft tissue with its haptic and elasticity for a realistic hand phantom fabrication, using only a dual-material 3D printer and support-material-filled metamaterial between skin and bone. We present our workflow to generate lattice structures between hard bone and soft skin with iterative cube edge (CE) or cube face (CF) unit cells. Cuboid and finger shaped sample prints with and without inner hard bone in different lattice thickness are constructed and 3D printed. Results: The most elastic available rubber-like material is too firm to imitate soft tissue. By reducing the amount of rubber in the inner volume through support material (SUP), objects become significantly softer. Without metamaterial, after disintegration, the SUP can be shifted through the volume and thus the body loses its original shape. Although the CE design increases the elasticity, it cannot restore the fabric form. In contrast to CE, the CF design increases not only the elasticity but also guarantees a local limitation of the SUP. Therefore, the body retains its shape and internal bones remain in its intended place. Various unit cell sizes, lattice thickening and skin thickness regulate the rubber material and SUP ratio. Test prints with higher SUP and lower rubber material percentage appear softer and vice versa. This was confirmed by an expert surgeon evaluation. Subjects adjudged pure rubber-like material as too firm and samples only filled with SUP or lattice structure in CE design as not suitable for imitating tissue. 3D-printed finger samples in CF design were rated as realistic compared to the haptic of human tissue with a good palpable bone structure. Conclusions: We developed a new dual-material 3D print technique to imitate soft tissue of the human hand with its haptic properties. Blowy SUP is trapped within a lattice structure to soften rubber-like 3D print material, which makes it possible to reproduce a realistic replica of human hand soft tissue.}, subject = {Handchirurgie}, language = {en} } @article{MaierWeihererHuberetal., author = {Maier, Johannes and Weiherer, Maximilian and Huber, Michaela and Palm, Christoph}, title = {Optically tracked and 3D printed haptic phantom hand for surgical training system}, series = {Quantitative Imaging in Medicine and Surgery}, volume = {10}, journal = {Quantitative Imaging in Medicine and Surgery}, number = {02}, publisher = {AME Publishing Company}, address = {Hong Kong, China}, doi = {10.21037/qims.2019.12.03}, pages = {340 -- 455}, abstract = {Background: For surgical fixation of bone fractures of the human hand, so-called Kirschner-wires (K-wires) are drilled through bone fragments. Due to the minimally invasive drilling procedures without a view of risk structures like vessels and nerves, a thorough training of young surgeons is necessary. For the development of a virtual reality (VR) based training system, a three-dimensional (3D) printed phantom hand is required. To ensure an intuitive operation, this phantom hand has to be realistic in both, its position relative to the driller as well as in its haptic features. The softest 3D printing material available on the market, however, is too hard to imitate human soft tissue. Therefore, a support-material (SUP) filled metamaterial is used to soften the raw material. Realistic haptic features are important to palpate protrusions of the bone to determine the drilling starting point and angle. An optical real-time tracking is used to transfer position and rotation to the training system. Methods: A metamaterial already developed in previous work is further improved by use of a new unit cell. Thus, the amount of SUP within the volume can be increased and the tissue is softened further. In addition, the human anatomy is transferred to the entire hand model. A subcutaneous fat layer and penetration of air through pores into the volume simulate shiftability of skin layers. For optical tracking, a rotationally symmetrical marker attached to the phantom hand with corresponding reference marker is developed. In order to ensure trouble-free position transmission, various types of marker point applications are tested. Results: Several cuboid and forearm sample prints lead to a final 30 centimeter long hand model. The whole haptic phantom could be printed faultless within about 17 hours. The metamaterial consisting of the new unit cell results in an increased SUP share of 4.32\%. Validated by an expert surgeon study, this allows in combination with a displacement of the uppermost skin layer a good palpability of the bones. Tracking of the hand marker in dodecahedron design works trouble-free in conjunction with a reference marker attached to the worktop of the training system. Conclusions: In this work, an optically tracked and haptically correct phantom hand was developed using dual-material 3D printing, which can be easily integrated into a surgical training system.}, subject = {Handchirurgie}, language = {en} } @inproceedings{FranzDreherPrinzenetal., author = {Franz, Daniela and Dreher, Maria and Prinzen, Martin and Teßmann, Matthias and Palm, Christoph and Katzky, Uwe and Perret, Jerome and Hofer, Mathias and Wittenberg, Thomas}, title = {CT-basiertes virtuelles Fr{\"a}sen am Felsenbein}, series = {Bildverarbeitung f{\"u}r die Medizin 2018; Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 11. bis 13. M{\"a}rz 2018 in Erlangen}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2018; Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 11. bis 13. M{\"a}rz 2018 in Erlangen}, publisher = {Springer}, address = {Berlin}, isbn = {978-3-662-56537-7}, doi = {10.1007/978-3-662-56537-7_51}, pages = {176 -- 181}, abstract = {Im Rahmen der Entwicklung eines haptisch-visuellen Trainingssystems f{\"u}r das Fr{\"a}sen am Felsenbein werden ein Haptikarm und ein autostereoskopischer 3D-Monitor genutzt, um Chirurgen die virtuelle Manipulation von kn{\"o}chernen Strukturen im Kontext eines sog. Serious Game zu erm{\"o}glichen. Unter anderem sollen Assistenz{\"a}rzte im Rahmen ihrer Ausbildung das Fr{\"a}sen am Felsenbein f{\"u}r das chirurgische Einsetzen eines Cochlea-Implantats {\"u}ben k{\"o}nnen. Die Visualisierung des virtuellen Fr{\"a}sens muss daf{\"u}r in Echtzeit und m{\"o}glichst realistisch modelliert, implementiert und evaluiert werden. Wir verwenden verschiedene Raycasting Methoden mit linearer und Nearest Neighbor Interpolation und vergleichen die visuelle Qualit{\"a}t und die Bildwiederholfrequenzen der Methoden. Alle verglichenen Verfahren sind sind echtzeitf{\"a}hig, unterscheiden sich aber in ihrer visuellen Qualit{\"a}t.}, subject = {Felsenbein}, language = {de} } @inproceedings{MaierHuberKatzkyetal., author = {Maier, Johannes and Huber, Michaela and Katzky, Uwe and Perret, Jerome and Wittenberg, Thomas and Palm, Christoph}, title = {Force-Feedback-assisted Bone Drilling Simulation Based on CT Data}, series = {Bildverarbeitung f{\"u}r die Medizin 2018; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 11. bis 13. M{\"a}rz 2018 in Erlangen}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2018; Algorithmen - Systeme - Anwendungen; Proceedings des Workshops vom 11. bis 13. M{\"a}rz 2018 in Erlangen}, publisher = {Springer}, address = {Berlin}, doi = {10.1007/978-3-662-56537-7_78}, pages = {291 -- 296}, abstract = {In order to fix a fracture using minimally invasive surgery approaches, surgeons are drilling complex and tiny bones with a 2 dimensional X-ray as single imaging modality in the operating room. Our novel haptic force-feedback and visual assisted training system will potentially help hand surgeons to learn the drilling procedure in a realistic visual environment. Within the simulation, the collision detection as well as the interaction between virtual drill, bone voxels and surfaces are important. In this work, the chai3d collision detection and force calculation algorithms are combined with a physics engine to simulate the bone drilling process. The chosen Bullet-Physics-Engine provides a stable simulation of rigid bodies, if the collision model of the drill and the tool holder is generated as a compound shape. Three haptic points are added to the K-wire tip for removing single voxels from the bone. For the drilling process three modes are proposed to emulate the different phases of drilling in restricting the movement of a haptic device.}, subject = {Handchirurgie}, language = {en} } @inproceedings{EixelbergerWittenbergPerretetal., author = {Eixelberger, Thomas and Wittenberg, Thomas and Perret, Jerome and Katzky, Uwe and Simon, Martina and Schmitt-R{\"u}th, Stephanie and Hofer, Mathias and Sorge, M. and Jacob, R. and Engel, Felix B. and Gostian, A. and Palm, Christoph and Franz, Daniela}, title = {A haptic model for virtual petrosal bone milling}, series = {17. Jahrestagung der Deutschen Gesellschaft f{\"u}r Computer- und Roboterassistierte Chirurgie (CURAC2018), Tagungsband, 2018, Leipzig, 13.-15. September}, volume = {17}, booktitle = {17. Jahrestagung der Deutschen Gesellschaft f{\"u}r Computer- und Roboterassistierte Chirurgie (CURAC2018), Tagungsband, 2018, Leipzig, 13.-15. September}, pages = {214 -- 219}, abstract = {Virtual training of bone milling requires realtime and realistic haptics of the interaction between the "virtual mill" and a "virtual bone". We propose an exponential abrasion model between a virtual one and the mill bit and combine it with a coarse representation of the virtual bone and the mill shaft for collision detection using the Bullet Physics Engine. We compare our exponential abrasion model to a widely used linear abrasion model and evaluate it quantitatively and qualitatively. The evaluation results show, that we can provide virtual milling in real-time, with an abrasion behavior similar to that proposed in the literature and with a realistic feeling of five different surgeons.}, subject = {Osteosynthese}, language = {en} } @phdthesis{Maier, author = {Maier, Johannes}, title = {Entwicklung eines Haptisch und Visuell unterst{\"u}tzten Trainingssystems (HaptiVisT) f{\"u}r komplexe Knochenbohrungen in der minimalinvasiven Handchirurgie}, publisher = {Shaker}, address = {D{\"u}ren}, isbn = {978-3-8440-7547-2}, pages = {236}, abstract = {Eine g{\"a}ngige Operationsmethode, um Frakturen der menschlichen Hand nach einem Unfall zu korrigieren, ist eine Osteosynthese mit sogenannten Kirschnerdr{\"a}hten (K-Dr{\"a}hten) zur Stabilisierung von Knochenfragmenten. Die Einf{\"u}hrung dieser langen, d{\"u}nnen und scharfen Dr{\"a}hte durch manuelles Bohren ist eine komplexe minimalinvasive Operation, bei der ein Chirurg nahezu ohne visuelle Orientierung und nur durch eine kleine {\"O}ffnung der Haut des Patienten arbeitet. Als Orientierungshilfe f{\"u}r die optimale Lage der K-Dr{\"a}hte bleibt dem Chirurgen lediglich eine zweidimensionale (2D)-R{\"o}ntgendarstellung und das Ertasten von kn{\"o}chernen Vorspr{\"u}ngen auf der menschlichen Hand, um Verletzungen an Risikostrukturen (Nerven, Gef{\"a}ße usw.), die im Weichteilgewebe der Hand eingebettet sind, zu vermeiden. F{\"u}r eine sichere und fehlerfreie Durchf{\"u}hrung einer K-Draht-Osteosynthese ist deswegen eine gr{\"u}ndliche theoretische und praktische Ausbildung junger Chirurgen notwendig. Da traditionelle Trainingsmethoden zeitaufwendig, kostspielig, ethisch nicht korrekt und unzureichend realistisch sind, wird in dieser Arbeit ein innovativer, auf virtueller Realit{\"a}t (VR) basierender, Haptisch und Visuell unterst{\"u}tzter Trainingssimulator (HaptiVisT) f{\"u}r die Platzierung von K-Dr{\"a}hten entwickelt, der vor allem Handchirurgen mit {\"U}bungs- und Perfektionierungsbedarf dabei unterst{\"u}tzt, das Bohrverfahren in einer realistischen aber virtuellen Umgebung zu erlernen. Beim HaptiVisT-Prototypenaufbau werden reale Patientendaten segmentierter Volumendaten aus einer Computertomographie (CT) und einer Magnetresonanztomographie (MRT) im virtuellen, dreidimensionalen (3D) Raum auf einem 3D-Monitor visualisiert und f{\"u}r eine intuitive bimanuelle Haptik sowohl mit einem Kraftfeedback-Ger{\"a}t f{\"u}r den Bohrprozess und einer 3D-gedruckten und optisch getrackten Phantomhand kombiniert. Die vorliegende Arbeit beschreibt zun{\"a}chst alle verwendeten Hardwareger{\"a}te, die C++-Softwareumgebung, aufgebaut auf Multithreading (gleichzeitige Ausf{\"u}hrung mehrerer Anweisungsfolgen in einem Prozess), und die auf Oberfl{\"a}chen- und Volumenrendering basierte Visualisierung. Die Kollisionsdetektion zwischen Bohrer und Knochen im virtuellen Raum wird in zwei separate Ereignisse unterteilt: Kollisionen zwischen Objekten als Gesamtes (Simulation der Kollision {\"u}ber die gesamte Objektoberfl{\"a}che) und Kollisionen zwischen einer K-Draht-Spitze und dem Knochenvolumen f{\"u}r die Entfernung kleiner Volumenelemente (Voxel). Das Herzst{\"u}ck des Trainingssystems bildet eine echtzeitf{\"a}hige Bohrsimulation, die den gesamten Bohrprozess in eine endliche Anzahl logischer Unterprozesse gliedert und diese Zust{\"a}nde in einen endlichen Zustandsautomaten (FSM, engl.: Finite State Machine) zusammenfasst. Das Kraftfeedback w{\"a}hrend einer Bohrung wird mit sogenannten „Virtual Fixtures" (abstrakten sensorischen Informationen) berechnet und {\"u}ber einen Haptikarm auf den Benutzer {\"u}bertragen. Damit die Simulation der Realit{\"a}t entspricht, wird unter Zuhilfenahme eines experimentellen Aufbaus die reale Bohrgeschwindigkeit durch kortikale Knochen ermittelt. Anschließend werden ein Levelkonzept und alle im System verf{\"u}gbaren Bohrunterst{\"u}tzungswerkzeuge, wie haptische Korridore als Goldstandard oder eine R{\"o}ntgenbildsimulation, vorgestellt. Mit ihnen ist es m{\"o}glich, ausgesuchte Operationsf{\"a}lle in Level unterschiedlicher Schwierigkeit zu unterteilen und den Operationsvorgang qualitativ zu bewerten. Der 3D-Druck einer Phantomhand (realit{\"a}tsnahe Nachbildung einer Patientenhand) mit realistischen haptischen Eigenschaften zum Ertasten von Knochenvorspr{\"u}ngen wird {\"u}ber einen metamaterialbasierten Ansatz (Neuanordnung des Grundmaterials durch eine k{\"u}nstlich angelegte, sich wiederholende Struktur) realisiert, da das aktuell am Markt verf{\"u}gbare 3D-Druckmaterial f{\"u}r den Druck menschlichen Weichteilgewebes zu hart ist. Die Echtzeitverfolgung der Phantomhand beruht auf einem mit einer Stereokamera optisch getrackten Marker in Form eines Dodekaeders (K{\"o}rper mit zw{\"o}lf Fl{\"a}chen). Abschließend wird das HaptiVisT-Gesamtsystem in drei und der 3D-Druck einer Phantomhand in zwei Expertenevaluationen ausf{\"u}hrlich untersucht und ausgewertet. Das HaptiVisT-System versteht sich als notwendiges Komplement f{\"u}r den ersten und weltweit einzigen funktionsf{\"a}higen, kompakten Prototypen f{\"u}r virtuelle K-DrahtOsteosynthesen mit haptischen Kraftfeedback, der in Zukunft Chirurgen in Aus- und Weiterbildung an Kliniken oder Trainingszentren ein risikofreies, zeit- und ortsunabh{\"a}ngiges Training erm{\"o}glicht. Die Kernelemente dieser Arbeit sind: • Stereoskopische 3D-Darstellung von realen Patientendaten. • Bimanuelle Haptik aus haptischen Kraftfeedback des Bohrens verbunden mit einer optisch getrackten, haptisch korrekten und 3D-gedruckten Phantomhand. • Zuverl{\"a}ssige Kollisionsdetektion zwischen virtuellen Objekten als Grundlage f{\"u}r das Kraftfeedback und die Abtragung von Knochen. • Echtzeitf{\"a}hige Bohrsimulation durch Reduzierung des Bohrprozesses auf logische Bohr-Teilprozesse kombiniert mit einer Virtual Fixtures basierten Kraftberechnung. Haptisch korrekte Phantome sind vor allem im medizinischen Training von hoher Relevanz und die Berechnung des Kraftfeedbacks beruht erstmals auf der performanten und stabilen Simulation von Bohr-Teilprozessen unter Verwendung von Virtual Fixtures. Der Prototyp wird von Experten durchgehend positiv bewertet und bietet nach deren Einsch{\"a}tzung einen hohen Mehrwert f{\"u}r das chirurgische Training. Zuk{\"u}nftige Arbeiten k{\"o}nnten den Lerneffekt durch das HaptiVisT-Trainingssystem in stichhaltigen Evaluationen mit jungen Medizinstudenten unter Vorhandensein einer Kontrollgruppe statistisch validieren. Bei Best{\"a}tigung dieses Lerneffekts ist eine Ausgr{\"u}ndung als eigenst{\"a}ndiges Unternehmen und Weiterentwicklung des Prototyps mit Ausweitung auf weitere chirurgische Bereiche wie Knie- oder H{\"u}ftchirurgie denkbar. Unter Zuhilfenahme von automatischer Segmentierung k{\"o}nnten in Zukunft akut zu behandelnde Br{\"u}che abgebildet, vorab einer tats{\"a}chlichen Operation ge{\"u}bt und anschließend komplikationslos unter reduzierter Operationszeit durchgef{\"u}hrt werden.}, language = {de} } @article{WoehlMaierGehmertetal., author = {W{\"o}hl, Rebecca and Maier, Johannes and Gehmert, Sebastian and Palm, Christoph and Riebschl{\"a}ger, Birgit and Nerlich, Michael and Huber, Michaela}, title = {3D Analysis of Osteosyntheses Material using semi-automated CT Segmentation}, series = {BMC Musculoskeletal Disorders}, volume = {19}, journal = {BMC Musculoskeletal Disorders}, publisher = {Springer Nature}, doi = {10.1186/s12891-018-1975-0}, pages = {1 -- 8}, abstract = {Backround Scaphoidectomy and midcarpal fusion can be performed using traditional fixation methods like K-wires, staples, screws or different dorsal (non)locking arthrodesis systems. The aim of this study is to test the Aptus four corner locking plate and to compare the clinical findings to the data revealed by CT scans and semi-automated segmentation. Methods: This is a retrospective review of eleven patients suffering from scapholunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist, who received a four corner fusion between August 2011 and July 2014. The clinical evaluation consisted of measuring the range of motion (ROM), strength and pain on a visual analogue scale (VAS). Additionally, the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Mayo Wrist Score were assessed. A computerized tomography (CT) of the wrist was obtained six weeks postoperatively. After semi-automated segmentation of the CT scans, the models were post processed and surveyed. Results During the six-month follow-up mean range of motion (ROM) of the operated wrist was 60°, consisting of 30° extension and 30° flexion. While pain levels decreased significantly, 54\% of grip strength and 89\% of pinch strength were preserved compared to the contralateral healthy wrist. Union could be detected in all CT scans of the wrist. While X-ray pictures obtained postoperatively revealed no pathology, two user related technical complications were found through the 3D analysis, which correlated to the clinical outcome. Conclusion Due to semi-automated segmentation and 3D analysis it has been proved that the plate design can keep up to the manufacturers' promises. Over all, this case series confirmed that the plate can compete with the coexisting techniques concerning clinical outcome, union and complication rate.}, subject = {Handchirurgie}, language = {en} } @inproceedings{FranzKatzkyNeumannetal., author = {Franz, Daniela and Katzky, Uwe and Neumann, Sabine and Perret, Jerome and Hofer, Mathias and Huber, Michaela and Schmitt-R{\"u}th, Stephanie and Haug, Sonja and Weber, Karsten and Prinzen, Martin and Palm, Christoph and Wittenberg, Thomas}, title = {Haptisches Lernen f{\"u}r Cochlea Implantationen}, series = {15. Jahrestagung der Deutschen Gesellschaft f{\"u}r Computer- und Roboterassistierte Chirurgie (CURAC2016), Tagungsband, 2016, Bern, 29.09. - 01.10.}, booktitle = {15. Jahrestagung der Deutschen Gesellschaft f{\"u}r Computer- und Roboterassistierte Chirurgie (CURAC2016), Tagungsband, 2016, Bern, 29.09. - 01.10.}, pages = {21 -- 26}, abstract = {Die Implantation eines Cochlea Implantates ben{\"o}tigt einen chirurgischen Zugang im Felsenbein und durch die Paukenh{\"o}hle des Patienten. Der Chirurg hat eine eingeschr{\"a}nkte Sicht im Operationsgebiet, die weiterhin viele Risikostrukturen enth{\"a}lt. Um eine Cochlea Implantation sicher und fehlerfrei durchzuf{\"u}hren, ist eine umfangreiche theoretische und praktische (teilweise berufsbegleitende) Fortbildung sowie langj{\"a}hrige Erfahrung notwendig. Unter Nutzung von realen klinischen CT/MRT Daten von Innen- und Mittelohr und der interaktiven Segmentierung der darin abgebildeten Strukturen (Nerven, Cochlea, Geh{\"o}rkn{\"o}chelchen,...) wird im HaptiVisT Projekt ein haptisch-visuelles Trainingssystem f{\"u}r die Implantation von Innen- und Mittelohr-Implantaten realisiert, das als sog. „Serious Game" mit immersiver Didaktik gestaltet wird. Die Evaluierung des Demonstrators hinsichtlich Zweckm{\"a}ßigkeit erfolgt prozessbegleitend und ergebnisorientiert, um m{\"o}gliche technische oder didaktische Fehler vor Fertigstellung des Systems aufzudecken. Drei zeitlich versetzte Evaluationen fokussieren dabei chirurgisch-fachliche, didaktische sowie haptisch-ergonomische Akzeptanzkriterien.}, subject = {Cochlea-Implantat}, language = {de} } @inproceedings{SouzaJrHookPapaetal., author = {Souza Jr., Luis Antonio de and Hook, Christian and Papa, Jo{\~a}o Paulo and Palm, Christoph}, title = {Barrett's Esophagus Analysis Using SURF Features}, series = {Bildverarbeitung f{\"u}r die Medizin 2017; Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 12. bis 14. M{\"a}rz 2017 in Heidelberg}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2017; Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 12. bis 14. M{\"a}rz 2017 in Heidelberg}, publisher = {Springer}, address = {Berlin}, doi = {10.1007/978-3-662-54345-0_34}, pages = {141 -- 146}, abstract = {The development of adenocarcinoma in Barrett's esophagus is difficult to detect by endoscopic surveillance of patients with signs of dysplasia. Computer assisted diagnosis of endoscopic images (CAD) could therefore be most helpful in the demarcation and classification of neoplastic lesions. In this study we tested the feasibility of a CAD method based on Speeded up Robust Feature Detection (SURF). A given database containing 100 images from 39 patients served as benchmark for feature based classification models. Half of the images had previously been diagnosed by five clinical experts as being "cancerous", the other half as "non-cancerous". Cancerous image regions had been visibly delineated (masked) by the clinicians. SURF features acquired from full images as well as from masked areas were utilized for the supervised training and testing of an SVM classifier. The predictive accuracy of the developed CAD system is illustrated by sensitivity and specificity values. The results based on full image matching where 0.78 (sensitivity) and 0.82 (specificity) were achieved, while the masked region approach generated results of 0.90 and 0.95, respectively.}, subject = {Speiser{\"o}hrenkrankheit}, language = {en} } @inproceedings{MendelEbigboProbstetal., author = {Mendel, Robert and Ebigbo, Alanna and Probst, Andreas and Messmann, Helmut and Palm, Christoph}, title = {Barrett's Esophagus Analysis Using Convolutional Neural Networks}, series = {Bildverarbeitung f{\"u}r die Medizin 2017; Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 12. bis 14. M{\"a}rz 2017 in Heidelberg}, booktitle = {Bildverarbeitung f{\"u}r die Medizin 2017; Algorithmen - Systeme - Anwendungen. Proceedings des Workshops vom 12. bis 14. M{\"a}rz 2017 in Heidelberg}, publisher = {Springer}, address = {Berlin}, doi = {10.1007/978-3-662-54345-0_23}, pages = {80 -- 85}, abstract = {We propose an automatic approach for early detection of adenocarcinoma in the esophagus. High-definition endoscopic images (50 cancer, 50 Barrett) are partitioned into a dataset containing approximately equal amounts of patches showing cancerous and non-cancerous regions. A deep convolutional neural network is adapted to the data using a transfer learning approach. The final classification of an image is determined by at least one patch, for which the probability being a cancer patch exceeds a given threshold. The model was evaluated with leave one patient out cross-validation. With sensitivity and specificity of 0.94 and 0.88, respectively, our findings improve recently published results on the same image data base considerably. Furthermore, the visualization of the class probabilities of each individual patch indicates, that our approach might be extensible to the segmentation domain.}, subject = {Speiser{\"o}hrenkrebs}, language = {en} } @inproceedings{MaierHaugHuberetal., author = {Maier, Johannes and Haug, Sonja and Huber, Michaela and Katzky, Uwe and Neumann, Sabine and Perret, J{\´e}r{\^o}me and Prinzen, Martin and Weber, Karsten and Wittenberg, Thomas and W{\"o}hl, Rebecca and Scorna, Ulrike and Palm, Christoph}, title = {Development of a haptic and visual assisted training simulation concept for complex bone drilling in minimally invasive hand surgery}, series = {CARS Conference, 5.10.-7.10.2017}, booktitle = {CARS Conference, 5.10.-7.10.2017}, language = {en} } @misc{OPUS4-6079, title = {Bildverarbeitung f{\"u}r die Medizin 2023}, editor = {Deserno, Thomas M. and Handels, Heinz and Maier, Andreas and Maier-Hein, Klaus H. and Palm, Christoph and Tolxdorff, Thomas}, publisher = {Springer Vieweg}, address = {Wiesbaden}, isbn = {978-3-658-41656-0}, issn = {1431-472X}, doi = {10.1007/978-3-658-41657-7}, pages = {317}, abstract = {Seit mehr als 25 Jahren ist der Workshop "Bildverarbeitung f{\"u}r die Medizin" als erfolgreiche Veranstaltung etabliert. Ziel ist auch 2023 wieder die Darstellung aktueller Forschungsergebnisse und die Vertiefung der Gespr{\"a}che zwischen Wissenschaftlern, Industrie und Anwendern. Die Beitr{\"a}ge dieses Bandes - viele davon in englischer Sprache - umfassen alle Bereiche der medizinischen Bildverarbeitung, insbesondere die Bildgebung und -akquisition, Segmentierung und Analyse, Visualisierung und Animation, computerunterst{\"u}tzte Diagnose sowie bildgest{\"u}tzte Therapieplanung und Therapie. Hierbei kommen Methoden des maschinelles Lernens, der biomechanischen Modellierung sowie der Validierung und Qualit{\"a}tssicherung zum Einsatz.}, subject = {Bildverarbeitung}, language = {de} } @misc{SchroederSemmelmannSiegmundetal., author = {Schroeder, Josef A. and Semmelmann, Matthias and Siegmund, Heiko and Grafe, Claudia and Evert, Matthias and Palm, Christoph}, title = {Improved interactive computer-assisted approach for evaluation of ultrastructural cilia abnormalities}, series = {Ultrastructural Pathology}, volume = {41}, journal = {Ultrastructural Pathology}, number = {1}, doi = {10.1080/01913123.2016.1270978}, pages = {112 -- 113}, subject = {Zilie}, language = {en} } @misc{OPUS4-7967, title = {Bildverarbeitung f{\"u}r die Medizin 2025}, editor = {Palm, Christoph and Breininger, Katharina and Deserno, Thomas M. and Handels, Heinz and Maier, Andreas and Maier-Hein, Klaus H. and Tolxdorff, Thomas M.}, publisher = {Springer Fachmedien Wiesbaden}, address = {Wiesbaden}, isbn = {978-3-658-47421-8}, issn = {1431-472X}, doi = {10.1007/978-3-658-47422-5}, pages = {XXIII, 354}, abstract = {Die Konferenz "BVM - Bildverarbeitung f{\"u}r die Medizin" ist seit vielen Jahren als die nationale Plattform f{\"u}r den Austausch von Ideen und die Diskussion der neuesten Forschungsergebnisse im Bereich der Medizinischen Bildverarbeitung und der K{\"u}nstlichen Intelligenz (KI) etabliert. Auch 2025 werden wir aktuelle Forschungsergebnisse vorstellen und Gespr{\"a}che zwischen (jungen) Wissenschaftler*innen, Industrie und Anwender*innen vertiefen. Die Beitr{\"a}ge dieses Bandes - die meisten davon in englischer Sprache - umfassen alle Bereiche der medizinischen Bildverarbeitung, insbesondere die Bildgebung und -akquisition, Segmentierung und Analyse, Registrierung, Visualisierung und Animation, computerunterst{\"u}tzte Diagnose sowie bildgest{\"u}tzte Therapieplanung und Therapie. Hierbei kommen Methoden des maschinellen Lernens, der biomechanischen Modellierung sowie der Validierung und Qualit{\"a}tssicherung zum Einsatz. Das Kapitel "Leveraging multiple total body segmentators and anatomy-informed post-processing for segmenting bones in Lung CTs" ist unter einer Creative Commons Attribution 4.0 International License {\"u}ber link.springer.com frei verf{\"u}gbar (Open Access). Die Herausgebenden Prof. Palm forscht im Bereich KI f{\"u}r die Medizin mit einem Schwerpunkt in der Analyse endoskopischer Bilddaten zur computerunterst{\"u}tzten Diagnose und Therapie. Prof. Breininger entwickelt robuste Ans{\"a}tze des maschinellen Lernens in verschiedenen interdisziplin{\"a}ren Bereichen, mit einem Schwerpunkt auf medizinischen Bilddaten. Prof. Deserno forscht in Biosignal- und Bilderzeugung und -verarbeitung, insbesondere in der videobasierten Vitaldatenmessung. Prof. Handels entwickelt problemoptimierte, lernf{\"a}hige Bildverarbeitungsmethoden und integriert diese in hybride Bildverarbeitungssysteme zur Unterst{\"u}tzung der medizinischen Diagnostik und Therapie. Prof. Maier entwickelt Anwendungen in der medizinischen Bildverarbeitung zur Diagnoseunterst{\"u}tzung bis hin zur Schichtbildberechnung durch k{\"u}nstliche Intelligenz. Prof. Maier-Hein forscht im Bereich maschinelles Lernen und entwickelt Open-Source-L{\"o}sungen wie das Medical Imaging Interaction Toolkit (MITK), Kaapana oder das nnU-Net. Prof. em. Tolxdorff ist Experte f{\"u}r maschinelles Lernen, biomedizinisches Datenmanagement, Datenvisualisierung und -analyse sowie Medizinproduktentwicklung in klinischen Workflows.}, subject = {Bildverarbeitung}, language = {de} } @misc{ScheppachMendelProbstetal., author = {Scheppach, Markus W. and Mendel, Robert and Probst, Andreas and Meinikheim, Michael and Palm, Christoph and Messmann, Helmut and Ebigbo, Alanna}, title = {Artificial Intelligence (AI) - assisted vessel and tissue recognition during third space endoscopy (Smart ESD)}, series = {Zeitschrift f{\"u}r Gastroenterologie}, volume = {60}, journal = {Zeitschrift f{\"u}r Gastroenterologie}, number = {08}, publisher = {Georg Thieme Verlag}, address = {Stuttgart}, doi = {10.1055/s-0042-1755110}, abstract = {Clinical setting Third space procedures such as endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) are complex minimally invasive techniques with an elevated risk for operator-dependent adverse events such as bleeding and perforation. This risk arises from accidental dissection into the muscle layer or through submucosal blood vessels as the submucosal cutting plane within the expanding resection site is not always apparent. Deep learning algorithms have shown considerable potential for the detection and characterization of gastrointestinal lesions. So-called AI - clinical decision support solutions (AI-CDSS) are commercially available for polyp detection during colonoscopy. Until now, these computer programs have concentrated on diagnostics whereas an AI-CDSS for interventional endoscopy has not yet been introduced. We aimed to develop an AI-CDSS („Smart ESD") for real-time intra-procedural detection and delineation of blood vessels, tissue structures and endoscopic instruments during third-space endoscopic procedures. Characteristics of Smart ESD An AI-CDSS was invented that delineates blood vessels, tissue structures and endoscopic instruments during third-space endoscopy in real-time. The output can be displayed by an overlay over the endoscopic image with different modes of visualization, such as a color-coded semitransparent area overlay, or border tracing (demonstration video). Hereby the optimal layer for dissection can be visualized, which is close above or directly at the muscle layer, depending on the applied technique (ESD or POEM). Furthermore, relevant blood vessels (thickness> 1mm) are delineated. Spatial proximity between the electrosurgical knife and a blood vessel triggers a warning signal. By this guidance system, inadvertent dissection through blood vessels could be averted. Technical specifications A DeepLabv3+ neural network architecture with KSAC and a 101-layer ResNeSt backbone was used for the development of Smart ESD. It was trained and validated with 2565 annotated still images from 27 full length third-space endoscopic videos. The annotation classes were blood vessel, submucosal layer, muscle layer, electrosurgical knife and endoscopic instrument shaft. A test on a separate data set yielded an intersection over union (IoU) of 68\%, a Dice Score of 80\% and a pixel accuracy of 87\%, demonstrating a high overlap between expert and AI segmentation. Further experiments on standardized video clips showed a mean vessel detection rate (VDR) of 85\% with values of 92\%, 70\% and 95\% for POEM, rectal ESD and esophageal ESD respectively. False positive measurements occurred 0.75 times per minute. 7 out of 9 vessels which caused intraprocedural bleeding were caught by the algorithm, as well as both vessels which required hemostasis via hemostatic forceps. Future perspectives Smart ESD performed well for vessel and tissue detection and delineation on still images, as well as on video clips. During a live demonstration in the endoscopy suite, clinical applicability of the innovation was examined. The lag time for processing of the live endoscopic image was too short to be visually detectable for the interventionist. Even though the algorithm could not be applied during actual dissection by the interventionist, Smart ESD appeared readily deployable during visual assessment by ESD experts. Therefore, we plan to conduct a clinical trial in order to obtain CE-certification of the algorithm. This new technology may improve procedural safety and speed, as well as training of modern minimally invasive endoscopic resection techniques.}, subject = {Bildgebendes Verfahren}, language = {en} } @article{LehlePhilippKrenkeletal., author = {Lehle, Karla and Philipp, Alois and Krenkel, Lars and Gruber, Michael and Hiller, Karl-Anton and M{\"u}ller, Thomas and Lubnow, Matthias}, title = {Thrombocytopenia During Venovenous Extracorporeal Membrane Oxygenation in Adult Patients With Bacterial, Viral, and COVID-19 Pneumonia}, series = {ASAIO Journal}, journal = {ASAIO Journal}, publisher = {Wolters Kluwer}, issn = {1058-2916}, doi = {10.1097/MAT.0000000000002383}, abstract = {Contact of blood with artificial surfaces triggers platelet activation. The aim was to compare platelet kinetics after venovenous extracorporeal membrane oxygenation (V-V ECMO) start and after system exchange in different etiologies of acute lung failure. Platelet counts and coagulation parameters were analyzed from adult patients with long and exchange-free (≥8 days) ECMO runs (n = 330) caused by bacterial (n = 142), viral (n = 76), or coronavirus disease 2019 (COVID-19) (n = 112) pneumonia. A subpopulation requiring a system exchange and with long, exchange-free runs of the second oxygenator (≥7 days) (n = 110) was analyzed analogously. Patients with COVID-19 showed the highest platelet levels before ECMO implantation. Independent of the underlying disease and ECMO type, platelet counts decreased significantly within 24 hours and reached a steady state after 5 days. In the subpopulation, at the day of a system exchange, platelet counts were lower compared with ECMO start, but without differences between underlying diseases. Subsequently, platelets remained unchanged in the bacterial pneumonia group, but increased in the COVID-19 and viral pneumonia groups within 2-4 days, whereas D-dimers decreased and fibrinogen levels increased. Thus, overall platelet counts on V-V ECMO show disease-specific initial dynamics followed by an ongoing consumption by the ECMO device, which is not boosted by new artificial surfaces after a system exchange.}, language = {en} } @misc{Dendorfer, author = {Dendorfer, Sebastian}, title = {Towards a deeper understanding of Pelvic Floor Disorders via Biomechanical Models}, language = {en} } @misc{Dendorfer, author = {Dendorfer, Sebastian}, title = {Zahlen statt Meinung - virtuelle Ganzk{\"o}rpermodelle f{\"u}r die Mensch-Fahrzeug-Interaktion}, language = {de} } @article{TroesterEcksteinKenneletal., author = {Tr{\"o}ster, Mark and Eckstein, Simon and Kennel, Paula and Kopp, Verna and Benkiser, Alina and Bihlmeier, Felicitas and Daub, Urban and Maufroy, Christophe and Dendorfer, Sebastian and Fritzsche, Lars and Schneider, Urs and Bauernhasl, Thomas}, title = {Person-specific evaluation method for occupational exoskeletons - Biomechanical body heat map}, series = {Applied Ergonomics}, volume = {132}, journal = {Applied Ergonomics}, publisher = {Elsevier}, doi = {10.1016/j.apergo.2025.104671}, pages = {30}, abstract = {Human-centred and ergonomic work design is one of the most important drivers for increasing the competitiveness of the European Union. As a flexible, person-specific occupational measure, exoskeletons promise great potential for effectively reducing individual ergonomic stress. Digital human models can provide important insights and offer great potential for systematising the effect and targeted use of exoskeletons, supporting their effective implementation in practice. In this article, digital human models are applied on two levels. Firstly, a realistic industrial logistics scenario in which boxes had to be relocated is designed with the help of a digital human model for workplace and process planning and secondly, a new biomechanical evaluation methodology to analyse intended and unintended effects on internal stress on the human body is demonstrated by applying musculoskeletal exoskeleton human models of four test subjects. Finally, the modelled biomechanical support tendencies of one exoskeleton are preliminary validated using EMG measurement data of the back muscles collected from the four male workers. The preliminary analysis of two back-support exoskeletons to demonstrate the new methodological approach confirms the expected, intended effects in the lower back and reveals unintended effects, such as e.g. changes in knee kinetics when applying a soft or hard-frame exoskeleton. Furthermore, the exemplary results to demonstrate the methodological approach expose notable differences between the test subjects, which underlines the relevance of person-specific evaluation and consideration of exoskeleton support. The preliminary validation shows a correlation between the modelled and the EMG-measured biomechanical exoskeleton support of the considered back muscles.}, language = {en} } @misc{GschossmannSuessDendorfer, author = {Gschoßmann, Lukas and S{\"u}ß, Franz and Dendorfer, Sebastian}, title = {Impact of Model Parameters on Ground Reaction Force Predictions in Musculoskeletal Modelling}, series = {ISB 2025 - The XXX Congress of the International Society of Biomechanics, 27-31 July, Stockholm}, journal = {ISB 2025 - The XXX Congress of the International Society of Biomechanics, 27-31 July, Stockholm}, abstract = {This study evaluated how model parameters affect ground reaction force (GRF) predictions in musculoskeletal simulations. A parameter study varying contact height and velocity thresholds and marker weights was conducted. While height and velocity thresholds had minimal impact, marker weights impact prediction errors. These findings highlight the importance of carefully selecting model parameters.}, language = {en} } @article{WinterArtingerBoecketal., author = {Winter, Lina and Artinger, Annalena and B{\"o}ck, Hendrik and Ramakrishnan, Vignesh and Reible, Bruno and Albin, Jan and Sch{\"u}ffler, Peter J. and Raptis, Georgios and Brochhausen, Christoph}, title = {Developing a smart and scalable tool for histopathological education—PATe 2.0}, series = {Journal of Pathology Informatics}, volume = {20}, journal = {Journal of Pathology Informatics}, publisher = {Elsevier}, issn = {2153-3539}, doi = {10.1016/j.jpi.2025.100535}, abstract = {Digital microscopy plays a crucial role in pathology education, providing scalable and standardized access to learning resources. In response, we present PATe 2.0, a scalable redeveloped web-application of the former PATe system from 2015. PATe 2.0 was developed using an agile, iterative process and built on a microservices architecture to ensure modularity, scalability, and reliability. It integrates a modern web-based user interface optimized for desktop and tablet use and automates key workflows such as whole-slide image uploads and processing. Performance tests demonstrated that PATe 2.0 significantly reduces tile request times compared to PATe, despite handling larger tiles. The platform supports open formats like DICOM and OpenSlide, enhancing its interoperability and adaptability across institutions. PATe 2.0 represents a robust digital microscopy solution in pathology education enhancing usability, performance, and flexibility. Its design enables future integration of research algorithms and highlights it as a pivotal tool for advancing pathology education and research.}, language = {en} } @misc{SteinSchmitzKretschmeretal., author = {Stein, Leonhard and Schmitz, Paul and Kretschmer, Rainer and Dendorfer, Sebastian}, title = {Gait parameter based fall risk scoring}, abstract = {This study explored the connection between subjective self-assessed gait insecurities and objective movement scores. 93 subjects answered detailed fall risk questionnaires and performed functional tests. Significantly different movement patterns between fallers and non-fallers were found.}, language = {en} } @misc{FoerstlAdlerSuessetal., author = {F{\"o}rstl, Nikolas and Adler, Ina and S{\"u}ß, Franz and Jansov{\´a}, Magdalena and Vychytil, Jan and Dendorfer, Sebastian}, title = {Evaluating the loads on the female pelvic floor during full-body activities using computational models}, abstract = {This work investigated the loads on the female pelvic floor during various full-body movements using computational models to calculate abdominal pressure and organ dynamic loads. While high-impact exercises resulted in higher loads, other movements showed lower loads, potentially indicating, which movements may be performed without risking pelvic floor overload and subsequent dysfunctions.}, language = {en} } @misc{BarthelSuessDendorfer, author = {Barthel, Mareike and S{\"u}ß, Franz and Dendorfer, Sebastian}, title = {Predicting intra-abdominal pressure during walking and running}, series = {ISB 2025 - The XXX Congress of the International Society of Biomechanics, 27-31. July 2025, Stockholm}, journal = {ISB 2025 - The XXX Congress of the International Society of Biomechanics, 27-31. July 2025, Stockholm}, abstract = {Intra-abdominal pressure (IAP) is an important physiological parameter, which is difficult to measure during physical activity. In this study, motion capture, musculoskeletal modeling and a transformer encoder model are used to predict IAP during walking and running. The model showed promising results with an overall mean percentage error of 13.5\% and a Pearson correlation coefficient of 0.85. Minor challenges included the lower accuracy for fast walking and running and the limited amount of data. All in all, the prediction of IAP was successful, which opens up prospects for further applications.}, language = {en} } @unpublished{RueckertRauberMaerkletal., author = {R{\"u}ckert, Tobias and Rauber, David and Maerkl, Raphaela and Klausmann, Leonard and Yildiran, Suemeyye R. and Gutbrod, Max and Nunes, Danilo Weber and Moreno, Alvaro Fernandez and Luengo, Imanol and Stoyanov, Danail and Toussaint, Nicolas and Cho, Enki and Kim, Hyeon Bae and Choo, Oh Sung and Kim, Ka Young and Kim, Seong Tae and Arantes, Gon{\c{c}}alo and Song, Kehan and Zhu, Jianjun and Xiong, Junchen and Lin, Tingyi and Kikuchi, Shunsuke and Matsuzaki, Hiroki and Kouno, Atsushi and Manesco, Jo{\~a}o Renato Ribeiro and Papa, Jo{\~a}o Paulo and Choi, Tae-Min and Jeong, Tae Kyeong and Park, Juyoun and Alabi, Oluwatosin and Wei, Meng and Vercauteren, Tom and Wu, Runzhi and Xu, Mengya and an Wang, and Bai, Long and Ren, Hongliang and Yamlahi, Amine and Hennighausen, Jakob and Maier-Hein, Lena and Kondo, Satoshi and Kasai, Satoshi and Hirasawa, Kousuke and Yang, Shu and Wang, Yihui and Chen, Hao and Rodr{\´i}guez, Santiago and Aparicio, Nicol{\´a}s and Manrique, Leonardo and Lyons, Juan Camilo and Hosie, Olivia and Ayobi, Nicol{\´a}s and Arbel{\´a}ez, Pablo and Li, Yiping and Khalil, Yasmina Al and Nasirihaghighi, Sahar and Speidel, Stefanie and R{\"u}ckert, Daniel and Feussner, Hubertus and Wilhelm, Dirk and Palm, Christoph}, title = {Comparative validation of surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation in endoscopy: Results of the PhaKIR 2024 challenge}, pages = {36}, abstract = {Reliable recognition and localization of surgical instruments in endoscopic video recordings are foundational for a wide range of applications in computer- and robot-assisted minimally invasive surgery (RAMIS), including surgical training, skill assessment, and autonomous assistance. However, robust performance under real-world conditions remains a significant challenge. Incorporating surgical context - such as the current procedural phase - has emerged as a promising strategy to improve robustness and interpretability. To address these challenges, we organized the Surgical Procedure Phase, Keypoint, and Instrument Recognition (PhaKIR) sub-challenge as part of the Endoscopic Vision (EndoVis) challenge at MICCAI 2024. We introduced a novel, multi-center dataset comprising thirteen full-length laparoscopic cholecystectomy videos collected from three distinct medical institutions, with unified annotations for three interrelated tasks: surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation. Unlike existing datasets, ours enables joint investigation of instrument localization and procedural context within the same data while supporting the integration of temporal information across entire procedures. We report results and findings in accordance with the BIAS guidelines for biomedical image analysis challenges. The PhaKIR sub-challenge advances the field by providing a unique benchmark for developing temporally aware, context-driven methods in RAMIS and offers a high-quality resource to support future research in surgical scene understanding.}, language = {en} } @misc{AdlerFoerstlČechovaetal., author = {Adler, Ina and F{\"o}rstl, Nikolas and Čechov{\´a}, Hana and Nov{\´a}ček, V{\´i}t and S{\"u}ß, Franz and Dendorfer, Sebastian}, title = {Mechanistic analysis of pelvic floor functionality using musculoskeletal simulation}, series = {ISB 2025 - The XXX Congress of the International Society of Biomechanics, 27-31 July 2025, Stockholm}, journal = {ISB 2025 - The XXX Congress of the International Society of Biomechanics, 27-31 July 2025, Stockholm}, doi = {10.35096/othr/pub-8729}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-87294}, pages = {1}, abstract = {There is consensus that knowledge about the fundamentals of the pelvic floor remains incomplete, particularly regarding the sensitivity of individual pelvic floor muscles to posture variations. This study aimed to investigate the effects of variations in pelvic tilt and the point of force application induced by changes in posture on pelvic floor activity using musculoskeletal simulation. A parameter study analysed various loading cases, highlighting the coherent response of individual pelvic floor muscles to loads. Muscle activities and forces were compared across different force application points and pelvic tilt angles. A key finding was identifying peak muscle activity conditions that could help better understand the causes of pelvic floor disorders.}, language = {en} } @misc{GschossmannSchedelSuessetal., author = {Gschoßmann, Lukas and Schedel, Valentin and S{\"u}ß, Franz and Weber, Markus and Pfingsten, Andrea and Dendorfer, Sebastian}, title = {Evaluating Knee Joint Loads Across Exercises and Activities of Daily Living to Personalize TKA Rehabilitation}, series = {ISB 2025 - The XXX Congress of the International Society of Biomechanics, 27.-31. July 2025, Stockholm}, journal = {ISB 2025 - The XXX Congress of the International Society of Biomechanics, 27.-31. July 2025, Stockholm}, doi = {10.35096/othr/pub-8725}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-87252}, pages = {1}, abstract = {This study assessed knee joint loading during various physiotherapy exercises and activities of daily living in 30 healthy subjects. Results showed that lunges and squats caused the highest joint forces, while gait and stair activities also imposed substantial loads. These findings support datadriven exercise selection for personalized rehabilitation after total knee arthroplasty.}, language = {en} } @article{RueckertRauberMaerkletal., author = {Rueckert, Tobias and Rauber, David and Maerkl, Raphaela and Klausmann, Leonard and Yildiran, Suemeyye R. and Gutbrod, Max and Nunes, Danilo Weber and Moreno, Alvaro Fernandez and Luengo, Imanol and Stoyanov, Danail and Toussaint, Nicolas and Cho, Enki and Kim, Hyeon Bae and Choo, Oh Sung and Kim, Ka Young and Kim, Seong Tae and Arantes, Gon{\c{c}}alo and Song, Kehan and Zhu, Jianjun and Xiong, Junchen and Lin, Tingyi and Kikuchi, Shunsuke and Matsuzaki, Hiroki and Kouno, Atsushi and Manesco, Jo{\~a}o Renato Ribeiro and Papa, Jo{\~a}o Paulo and Choi, Tae-Min and Jeong, Tae Kyeong and Park, Juyoun and Alabi, Oluwatosin and Wei, Meng and Vercauteren, Tom and Wu, Runzhi and Xu, Mengya and Wang, An and Bai, Long and Ren, Hongliang and Yamlahi, Amine and Hennighausen, Jakob and Maier-Hein, Lena and Kondo, Satoshi and Kasai, Satoshi and Hirasawa, Kousuke and Yang, Shu and Wang, Yihui and Chen, Hao and Rodr{\´i}guez, Santiago and Aparicio, Nicol{\´a}s and Manrique, Leonardo and Palm, Christoph and Wilhelm, Dirk and Feussner, Hubertus and Rueckert, Daniel and Speidel, Stefanie and Nasirihaghighi, Sahar and Al Khalil, Yasmina and Li, Yiping and Arbel{\´a}ez, Pablo and Ayobi, Nicol{\´a}s and Hosie, Olivia and Lyons, Juan Camilo}, title = {Comparative validation of surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation in endoscopy: Results of the PhaKIR 2024 challenge}, series = {Medical Image Analysis}, volume = {109}, journal = {Medical Image Analysis}, publisher = {Elsevier}, issn = {1361-8415}, doi = {10.1016/j.media.2026.103945}, pages = {31}, abstract = {Reliable recognition and localization of surgical instruments in endoscopic video recordings are foundational for a wide range of applications in computer- and robot-assisted minimally invasive surgery (RAMIS), including surgical training, skill assessment, and autonomous assistance. However, robust performance under real-world conditions remains a significant challenge. Incorporating surgical context - such as the current procedural phase - has emerged as a promising strategy to improve robustness and interpretability. To address these challenges, we organized the Surgical Procedure Phase, Keypoint, and Instrument Recognition (PhaKIR) sub-challenge as part of the Endoscopic Vision (EndoVis) challenge at MICCAI 2024. We introduced a novel, multi-center dataset comprising thirteen full-length laparoscopic cholecystectomy videos collected from three distinct medical institutions, with unified annotations for three interrelated tasks: surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation. Unlike existing datasets, ours enables joint investigation of instrument localization and procedural context within the same data while supporting the integration of temporal information across entire procedures. We report results and findings in accordance with the BIAS guidelines for biomedical image analysis challenges. The PhaKIR sub-challenge advances the field by providing a unique benchmark for developing temporally aware, context-driven methods in RAMIS and offers a high-quality resource to support future research in surgical scene understanding.}, language = {en} } @misc{RueckertRauberKlausmannetal., author = {Rueckert, Tobias and Rauber, David and Klausmann, Leonard and Gutbrod, Max and Rueckert, Daniel and Feussner, Hubertus and Wilhelm, Dirk and Palm, Christoph}, title = {PhaKIR Dataset - Surgical Procedure Phase, Keypoint, and Instrument Recognition [Data set]}, doi = {10.5281/zenodo.15740620}, abstract = {Note: A script for extracting the individual frames from the video files while preserving the challenge-compliant directory structure and frame-to-mask naming conventions is available on GitHub and can be accessed here: https://github.com/remic-othr/PhaKIR_Dataset. The dataset is described in the following publications: Rueckert, Tobias et al.: Comparative validation of surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation in endoscopy: Results of the PhaKIR 2024 challenge. arXiv preprint, https://arxiv.org/abs/2507.16559. 2025. Rueckert, Tobias et al.: Video Dataset for Surgical Phase, Keypoint, and Instrument Recognition in Laparoscopic Surgery (PhaKIR). arXiv preprint, https://arxiv.org/abs/2511.06549. 2025. The proposed dataset was used as the training dataset in the PhaKIR challenge (https://phakir.re-mic.de/) as part of EndoVis-2024 at MICCAI 2024 and consists of eight real-world videos of human cholecystectomies ranging from 23 to 60 minutes in duration. The procedures were performed by experienced physicians, and the videos were recorded in three hospitals. In addition to existing datasets, our annotations provide pixel-wise instance segmentation masks of surgical instruments for a total of 19 categories, coordinates of relevant instrument keypoints (instrument tip(s), shaft-tip transition, shaft), both at an interval of one frame per second, and specifications regarding the intervention phases for a total of eight different phase categories for each individual frame in one dataset and thus comprehensively cover instrument localization and the context of the operation. Furthermore, the provision of the complete video sequences offers the opportunity to include the temporal information regarding the respective tasks and thus further optimize the resulting methods and outcomes.}, language = {en} } @misc{MichelKrenkel, author = {Michel, Johanna and Krenkel, Lars}, title = {Experimental Investigation of Shear-Induced Generation of Respiratory Aerosol: Simultaneous Measurements of Particle Quantities and Wave Topology}, series = {2nd European Fluid Dynamics Conference (EFDC2), 26-29 August 2025, Dublin, Ireland}, journal = {2nd European Fluid Dynamics Conference (EFDC2), 26-29 August 2025, Dublin, Ireland}, doi = {10.35096/othr/pub-8859}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-88593}, pages = {1}, abstract = {Despite the high level of attention on infectious respiratory aerosol during the Covid19 pandemic, little is known about the processes how these particles form inside the respiratory system. Understanding the underlying fluid mechanical processes and their influencing factors would enable the development of drugs to suppress the generation of infectious aerosol. In the proposed work, we focus on the shear-induced mechanism of aerosol generation, which is supposed to occur mostly in the larger airways during coughing. In this process, high air velocities trigger Kelvin-Helmholtz waves in the mucus film, which lines the air vessels. Through a series of instabilities, particles detach from the crest of these waves. In the proposed work, we investigate the process of shear-induced aerosol generation in idealized experiments where we vary the air-flow characteristics and the properties of the mucus fluid. Our central aim here is to deduct an empirical model of the quantity and size distribution of generated particles depending on the mucus rheology and the local shear flow. Further, we observe the wave topology to better understand the coupling between the air flow and the waves. In our experimental setup, we measure the quantity of created particles and the emerging waves simultaneously. To ensure controllable conditions, we simplify the complex flow conditions in the airways. We use a rectangular channel with the bottom wall covered in a mucus mimetic. The mucus mimetic fluid is a synthetic hydrogel developed to recreate the viscoelastic properties and low surface tensions of the mucus. Filtered pressurized air is guided through the channel to trigger shear-induced aerosol generation. After passing the mucus mimetic, the air enters into a collection chamber from where particles are sampled continuously by an aerosol spectrometer. To measure wave topology, we use planar laser induced fluorescence. For this, we stain the mucus mimetic with fluorescent dyes and illuminate a line on the surface of the fluid film with a 532 nm laser. A high-resolution camera captures the resulting fluorescent glow of the mucus mimetic. Figure 1 presents exemplary wave topology results from the experiments, employing varying air flow volume rates, mucus mimetic gel properties, and different configurations of the laser and camera. The resulting wave topologies exhibit significant variation. For the conference, we will conduct parameter studies of the particle quantities and wave topology while varying the mucus mimetic properties and the flow rate of the air. Additionally, we will present grid projection-based techniques to extend the single-line wave measurements and asses the entire surface of the mucus film.}, language = {en} } @article{KrausKnipferJacobetal., author = {Kraus, Richard and Knipfer, Maximilian and Jacob, Matthias and Kienninger, Baerbel and Alikhani, Jasmine and Ghamsary, Parham Heydarzadeh and Reinker, Lukas and Adler, Ina and Dendorfer, Sebastian and Kieninger, Martin}, title = {Effectiveness and safety of techniques for cervical spine immobilization in mountain rescue}, series = {Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine}, volume = {34}, journal = {Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine}, publisher = {Springer}, doi = {10.1186/s13049-025-01530-z}, pages = {10}, abstract = {Background Cervical spine injuries in alpine sports require immediate immobilization at the site of the accident to avoid possible secondary damage caused by transportation. Using special sensor technology, this study investigated whether a cervical spine orthosis (cervical collar, Stifneck collar (Laerdal Medical GmbH, Puchheim, Germany)) provides greater stability than a vacuum mattress alone. Methods Using one male test person, we simulated transporting a patient with a spinal injury in steep alpine terrain. A wireless motion capture system (Xsens Technologies, Movella™ Inc., Henderson, USA) was used to record motion in three-dimensional space within a standardized environment. All tests were performed on a set course by the Bavarian Mountain Rescue Service. The test person lay on a mountain rescue stretcher and was immobilized with a vacuum mattress, either with or without a cervical orthosis. The axes of cervical spine movements were analyzed separately. Results There were no significant differences between immobilization with and without a cervical orthosis with regard to lateral flexion (max. 3.7° compared to 3.0°) in the frontal plane and maximum excursion in flexion (max. 1.6° compared to 2.8°) or extension (max. -1.6° compared to -1.7°). There was significantly greater rotation movement around the craniocaudal axis without an orthosis (max. 2.4° compared to 1.3°). Conclusion During mountain rescues, the cervical spine can be immobilized without a rigid cervical spine orthosis. Future research should explore the fundamental benefits of cervical spine immobilization, while the findings of this work contribute to the safe care of patients by avoiding the disadvantages associated with rigid cervical orthoses.}, language = {en} } @phdthesis{Auer, author = {Auer, Simon}, title = {Musculoskeletal models in highly dynamic motion: effects of model parameters and mental stress}, address = {Regensburg}, doi = {10.5283/epub.55106}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:355-epub-551061}, pages = {ii, 85}, abstract = {The analysis and understanding of highly dynamic movements is a fundamental part of biomechanics. Since sports injuries often involve the lower extremities and muscles, musculoskeletal models can help to prevent them. These models allow the calculation of ground and joint reaction forces as well as muscle forces and activities for individual muscle strands. One goal of this work is to use musculoskeletal models to investigate the influence of mental stress on lower extremity loading. Moreover, the models themselves are evaluated for highly dynamic movements and practical recommendations for action will be derived. For this purpose, fast movements of youth competitive and amateur athletes will be recorded using different measurement systems. Subsequently, the models calculate the target parameters using inverse dynamics. Furthermore, measured and calculated muscle activities of the lower extremities are compared and artificial balancing forces (residuals) in the models are analyzed and minimization approaches are presented. The investigation of muscle and joint loading under mental stress has shown that the response to mental stress is highly individual. Athletes may experience a significant increase in muscle and knee forces with a simultaneous decrease in performance. The comparison of measured and calculated muscle activity proved the reliability of the models also for highly dynamic movements. With the frequently used default settings in the model and optical and inertial motion capture, the muscle activities in the model could be calculated reliably. The residual forces were highest, when the model transitioned from foot-ground contact to no contact and vice versa. By adjusting the settings of the kinematic filter and the ground reaction force prediction, the residuals were reduced by up to 54\%. The analysis of musculoskeletal loading under mental stress has shown that the models can make a valuable contribution to the biomechanical analysis of highly dynamic movements. Subsequently, the models have also proven to be a reliable tool for the analysis of highly dynamic movements when the calculated parameters as well as the model-specific optimization options are reviewed. With this in mind, these models can contribute to further understand highly dynamic movements and prevent muscle injuries in athletes.}, language = {en} } @inproceedings{KranzPointnerWagneretal., author = {Kranz, Michael and Pointner, Daniel and Wagner, Maria Stella and Lubnow, Matthias and Lehle, Karla and Krenkel, Lars}, title = {High-Resolution Flow Investigations in Membrane-Lungs for Understanding Shear-Induced Blood Clot Formation}, series = {New Results in Numerical and Experimental Fluid Mechanics XV : Contributions to the 24th STAB/DGLR Symposium, Regensburg, Germany, 2024}, booktitle = {New Results in Numerical and Experimental Fluid Mechanics XV : Contributions to the 24th STAB/DGLR Symposium, Regensburg, Germany, 2024}, editor = {Dillmann, Andreas and Heller, Gerd and Kr{\"a}mer, Ewald and Breitsamter, Christian and Wagner, Claus and Krenkel, Lars}, publisher = {Springer}, address = {Cham}, doi = {10.1007/978-3-032-11115-9_12}, pages = {125 -- 134}, abstract = {Complex blood flow phenomena in membrane lungs (MLs) play a crucial role in intra-device clot formation and the occurrence of thromboembolic events. At present, however, the local flow conditions within an ML are not yet sufficiently known. The aim was to gain a deeper understanding of local flow regimes inside MLs by performing highly resolved computational fluid dynamics (CFD) of generic and native fiber mat bundles. Straight cylinders with a diameter of 380 μm in parallel arrangement were the foundation of the generic model. For validation, a method for reconstructing a native geometry from a microcomputed tomography (μCT) scan was established, with both models used for CFD. While the generic model showed a symmetrical flow regime without indicating any pathological flow, the native model did show an irregular fiber arrangement and no symmetrical flow regime. In conclusion, the fiber arrangement significantly affects the local flow regimes inside MLs.}, language = {en} } @misc{OPUS4-8913, title = {New Results in Numerical and Experimental Fluid Mechanics XV : Contributions to the 24th STAB/DGLR Symposium, Regensburg, Germany, 2024}, series = {Notes on Numerical Fluid Mechanics and Multidisciplinary Design}, volume = {156}, journal = {Notes on Numerical Fluid Mechanics and Multidisciplinary Design}, editor = {Dillmann, Andreas and Heller, Gerd and Kr{\"a}mer, Ewald and Breitsamter, Christian and Wagner, Claus and Krenkel, Lars}, publisher = {Springer}, address = {Cham (CH)}, isbn = {978-3-032-11114-2}, doi = {10.1007/978-3-032-11115-9}, pages = {xxi, 873}, abstract = {This book offers timely insights into research on numerical and experimental fluid mechanics and aerodynamics. It reports on findings by members of the Deutsche Str{\"o}mungsmechanische Arbeitsgemeinschaft, STAB (German Aerodynamics/Fluid Mechanics Association) and the Deutsche Gesellschaft f{\"u}r Luft- und Raumfahrt - Lilienthal Oberth e.V., DGLR (German Society for Aeronautics and Astronautics) and covers both nationally and EC-funded projects. Continuing on the tradition of the previous volumes, the book highlights innovative solutions, promoting translation from fundamental research to industrial applications. It addresses academics and professionals in the field of aeronautics, astronautics, ground transportation, and energy alike.}, language = {en} } @misc{KranzPointnerLehleetal., author = {Kranz, Michael and Pointner, Daniel and Lehle, Karla and Lubnow, Matthias and Krenkel, Lars}, title = {High-resolution flow field investigations in membrane lungs, considering the complex blood rheology}, series = {1st European Fluid Dynamics Conference (EFDC1), 16-20.September 2024, Aachen}, journal = {1st European Fluid Dynamics Conference (EFDC1), 16-20.September 2024, Aachen}, doi = {10.35096/othr/pub-8921}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-89214}, pages = {2}, abstract = {Despite major improvements over the last years, coagulative disorders and clotting phenomena in membrane lungs (MLs) are still considerable complications in extracorporeal membrane oxygenation (ECMO). ECMO is an increasingly used treatment for patients with severe respiratory failure or cardiac arrest [1]. For both, evaluation of therapeutic decisions and fundamental research on patient specific intra-device clotting phenomena, the direct visualization and analysis of clot formation in combination with a detailed flow field correlation is highly desirable and therefore an intensively followed research topic. Modelling blood flow and shear induced coagulation in MLs is challenging. The relevant geometry of oxygenator fibers and chaining threads is complex and spans several length scales. In relevant scales and regimes, blood shows several significant non-Newtonian effects. Viscosity impacts shear rate, which is important in several coagulation mechanisms. Additionally, coagulation processes are influencing fluid properties and geometry significantly. Existing approaches of previous research work are only able to consider some, but not all relevant effects and geometrical details. Due to the enormous size of the discretized geometries, highly detailed viscosity and coagulations models are not applicable. Our goal is to develop a model for combined viscosity and coagulation properties of blood flow in MLs. In our work, we compare the influence of different levels of detail of the ML geometry as well as the influence of considering realistic blood flow behavior (viscosity change by considering the local hematocrit distribution within the F{\aa}hraeus-Lindqvist-Effect) on the resulting flow field in relevant subsections of a ML. High-resolution micro-CT geometry reconstructions [1] are compared to idealized generic fiber representations. For realistic blood flow modelling, Newtonian representation is compared to the established Carreau-Yasuda and a multiphase Euler-Euler approach. Results are presented for relevant subsections as well as for the complete ML.}, language = {en} } @misc{KranzWagnerPointneretal., author = {Kranz, Michael and Wagner, Maria Stella and Pointner, Daniel and Waldbauer, Selina and M{\"u}ller, Thomas and Lubnow, Matthias and Foltan, Maik and Krenkel, Lars and Lehle, Karla}, title = {Polymeric Embedding of Membrane Lungs: A Novel Method for Histological Investigations of Intra-Device Clot Formation}, series = {12th EuroELSO Congress, 24-27. April 2024, Krakow}, journal = {12th EuroELSO Congress, 24-27. April 2024, Krakow}, language = {en} } @misc{KranzWagnerKrenkeletal., author = {Kranz, Michael and Wagner, Maria Stella and Krenkel, Lars and M{\"u}ller, Thomas and Lubnow, Matthias and Philipp, Alois and Lehle, Karla}, title = {Clot Localization within Membrane Lungs using different Imaging Methods and Histological Clot Characterization as a way to prevent Thrombosis in Extracorporeal Membrane Oxygenation}, volume = {2023}, language = {en} } @misc{KoesterKranzWagneretal., author = {K{\"o}ster, Leonie and Kranz, Michael and Wagner, Maria Stella and Foltan, Maik and M{\"u}ller, Thomas and Lubnow, Matthias and Krenkel, Lars and Lehle, Karla}, title = {Histological Investigations of Intra-Device Clot Formation in ECMO Pumps}, series = {12th EuroELSO Congress, 24-27. April 2024, Krakow}, journal = {12th EuroELSO Congress, 24-27. April 2024, Krakow}, language = {en} } @misc{KlausmannRueckertRauberetal., author = {Klausmann, Leonard and Rueckert, Tobias and Rauber, David and Maerkl, Raphaela and Yildiran, Suemeyye R. and Gutbrod, Max and Palm, Christoph}, title = {Abstract: DIY Challenge Blueprint}, series = {Bildverarbeitung f{\"u}r die Medizin 2025: Proceedings, German Conference on Medical Image Computing, L{\"u}beck March 15-17, 2026}, journal = {Bildverarbeitung f{\"u}r die Medizin 2025: Proceedings, German Conference on Medical Image Computing, L{\"u}beck March 15-17, 2026}, editor = {Handels, Heinz and Breininger, Katharina and Deserno, Thomas M. and Maier, Andreas and Maier-Hein, Klaus H. and Palm, Christoph and Tolxdorff, Thomas}, publisher = {Springer Vieweg}, address = {Wiesbaden}, doi = {10.1007/978-3-658-51100-5_27}, pages = {131 -- 131}, abstract = {The high cost of challenge platforms prevents many people from organizing their own competitions. The do-it-yourself (DIY) challenge blueprint [1] allows you to host your own biomedical AI benchmark challenge. Our DIY approach circumvents the current constraints of commercial challenge platforms. A sovereign, extensible and cost-efficient deployment is provided via containerised, identity-managed and reproducible pipelines. Focus lies on GDPR-compliant hosting via infrastructure-as-code, automated evaluation, modular orchestration, and role-based identity and access management. The framework integrates Docker-based execution and standardised interfaces for task definitions, dataset curation and evaluation. All in all it is designed to be flexible and modular, as demonstrated in the MICCAI 2024 PhaKIR challenge [2, 3]. In this case study, different medical tasks on a multicentre laparoscopic dataset with framewise labels for phases and spatial annotations for instruments across fulllength videos were supported. This case study empirically validates the DIY challenge blueprint as a reproducible and customizable challenge-hosting infrastructure. The full code can be found at https://github.com/remic-othr/PhaKIR_DIY.}, subject = {Bildverarbeitung}, language = {en} } @article{PointnerKranzWagneretal., author = {Pointner, Daniel and Kranz, Michael and Wagner, Maria Stella and Haus, Moritz and Lehle, Karla and Krenkel, Lars}, title = {Automated deep learning based detection of cellular deposits on clinically used ECMO membrane lungs}, series = {Frontiers in Bioinformatics}, volume = {6}, journal = {Frontiers in Bioinformatics}, publisher = {Frontiers}, doi = {10.3389/fbinf.2026.1771574}, pages = {18}, abstract = {Introduction: Despite the promising application of extracorporeal membrane oxygenation (ECMO) in the treatment of critically ill patients, coagulation-associated technical complications, primarily clot formation and critical bleeding, remain a major challenge during ECMO therapy. The deposition of nucleated cells on the surface has been shown, yet the role of these cells towards complication development is still matter of ongoing research. In particular, the membrane lung (MemL) is prone to clot formation. Therefore, the investigation of nuclear deposits on its hollow-fibers may provide insights for a better understanding of the cellular mechanisms involved in the development of ECMO complications. Methods: To support current research, this study aimed to develop a deep learning-based tool for the automated detection and quantitative analysis of nuclear depositions on MemL hollow-fiber mats. A customized fluorescence microscopy workflow, combined with a semi-automated iterative labeling strategy, was used to generate a high-quality dataset for model training. Results: Six configurations of instance segmentation models were evaluated, with a Mask R-CNN with ResNet 101 backbone using dilated convolution providing the most balanced performance in both nuclei count and area accuracy. Compared with U-Net-based approaches such as Cellpose or StarDist, the proposed model demonstrated superior segmentation of overlapping and low-intensity nuclei, maintaining accuracy even in densely packed cellular regions. Discussion: We present an automated image analysis tool for clinically used MemLs, which exhibit complex three-dimensional hollow-fiber architectures and irregular cellular deposits that challenge conventional tools. A dedicated graphical user interface enables streamlined detection, morphometric analysis, and spatial clustering of nuclei, establishing a reproducible workflow for high-throughput analysis of fluorescence microscopy images. This approach eliminates labor-intensive manual counting and facilitates large-scale studies on cell-fiber interactions and disease-related correlations.}, language = {en} } @inproceedings{MichelKrenkel, author = {Michel, Johanna and Krenkel, Lars}, title = {Towards Experimental Validation of Models of Shear-Induced Aerosol Generation in the Human Respiratory System}, series = {New Results in Numerical and Experimental Fluid Mechanics XV : Contributions to the 24th STAB/DGLR Symposium, Regensburg, Germany, 2024}, booktitle = {New Results in Numerical and Experimental Fluid Mechanics XV : Contributions to the 24th STAB/DGLR Symposium, Regensburg, Germany, 2024}, editor = {Dillmann, Andreas and Heller, Gerd and Kr{\"a}mer, Ewald and Breitsamter, Christian and Wagner, Claus and Krenkel, Lars}, publisher = {Springer Nature}, address = {Cham}, isbn = {978-3-032-11114-2}, doi = {10.1007/978-3-032-11115-9_13}, pages = {135 -- 144}, abstract = {Numerical modeling is a valuable tool to research shear-induced aerosol generation inside the human respiratory system. While the volume of fluid method and Eulerian wall film models have been used to predict the stripping of particles from the mucus film, sufficient validation data is lacking. Here, we present an experimental method to create such validation data. A film of mucus mimetic hydrogel with an initial thickness of 1 mm covering the floor of a rectangular channel (75.5 mm 25.5 mm 3 mm) was exposed to an airflow with a flow rate of 9.5 and 21.6 L/min. The number of created particles and the emergence of waves on the mucus surface were measured. Shear-induced aerosol generation was triggered successfully and caused an increase of mean particle flow. Different wave profiles were observed at varying film depths.}, language = {en} } @article{GschossmannSchedelSuessetal., author = {Gschoßmann, Lukas and Schedel, Valentin and S{\"u}ß, Franz and Weber, Markus and Pfingsten, Andrea and Dendorfer, Sebastian}, title = {Comparing kinematic and kinetic demands on the knee joint during selected physiotherapy exercises and activities of daily living}, series = {Technology and health care ; Special issue: BIOMDLORE}, journal = {Technology and health care ; Special issue: BIOMDLORE}, publisher = {Sage}, doi = {10.1177/09287329251413413}, pages = {14}, abstract = {Background: The knee is one of the most common areas to suffer injuries or be affected by surgery. Physiotherapy rehabilitation was shown to support recovery, but evidence guiding optimal rehabilitation practices is limited. To recommend appropriate exercises, it is essential to understand the musculoskeletal requirements involved in both physiotherapy and activities of daily living (ADLs).ObjectiveThis study aimed to evaluate and compare the knee joint kinematics, joint forces and muscle activity in knee flexors and extensors during selected rehabilitation exercises and ADLs.MethodsKinematic and kinetic data from 30 healthy participants were collected during 20 different tasks. Full-body musculoskeletal simulations were performed to estimate peak knee joint angles, angular velocities, joint reaction forces, and muscle activity of the knee flexors and extensors.ResultsComparatively high requirements were observed for lunges, squats, stair walking and gait. Medium requirements were observed for sitting down and rising from a chair. Low requirements were observed for balance shifts and variations of the single leg stand.ConclusionOverall, ADLs like gait and stair walking show surprisingly high requirements compared to many exercises employed in physiotherapy. These findings are a step towards biomechanically informed exercise selection and the development of personalized rehabilitation programs.}, language = {en} }