@article{AmiranashviliLuedkeLietal., author = {Amiranashvili, Tamaz and L{\"u}dke, David and Li, Hongwei Bran and Zachow, Stefan and Menze, Bjoern}, title = {Learning continuous shape priors from sparse data with neural implicit functions}, series = {Medical Image Analysis}, volume = {94}, journal = {Medical Image Analysis}, doi = {10.1016/j.media.2024.103099}, pages = {103099}, abstract = {Statistical shape models are an essential tool for various tasks in medical image analysis, including shape generation, reconstruction and classification. Shape models are learned from a population of example shapes, which are typically obtained through segmentation of volumetric medical images. In clinical practice, highly anisotropic volumetric scans with large slice distances are prevalent, e.g., to reduce radiation exposure in CT or image acquisition time in MR imaging. For existing shape modeling approaches, the resolution of the emerging model is limited to the resolution of the training shapes. Therefore, any missing information between slices prohibits existing methods from learning a high-resolution shape prior. We propose a novel shape modeling approach that can be trained on sparse, binary segmentation masks with large slice distances. This is achieved through employing continuous shape representations based on neural implicit functions. After training, our model can reconstruct shapes from various sparse inputs at high target resolutions beyond the resolution of individual training examples. We successfully reconstruct high-resolution shapes from as few as three orthogonal slices. Furthermore, our shape model allows us to embed various sparse segmentation masks into a common, low-dimensional latent space — independent of the acquisition direction, resolution, spacing, and field of view. We show that the emerging latent representation discriminates between healthy and pathological shapes, even when provided with sparse segmentation masks. Lastly, we qualitatively demonstrate that the emerging latent space is smooth and captures characteristic modes of shape variation. We evaluate our shape model on two anatomical structures: the lumbar vertebra and the distal femur, both from publicly available datasets.}, language = {en} } @inproceedings{SiqueiraRodriguesRiehmZachowetal., author = {Siqueira Rodrigues, Lucas and Riehm, Felix and Zachow, Stefan and Israel, Johann Habakuk}, title = {VoxSculpt: An Open-Source Voxel Library for Tomographic Volume Sculpting in Virtual Reality}, series = {2023 9th International Conference on Virtual Reality (ICVR), Xianyang, China, 2023}, booktitle = {2023 9th International Conference on Virtual Reality (ICVR), Xianyang, China, 2023}, doi = {10.1109/ICVR57957.2023.10169420}, pages = {515 -- 523}, abstract = {Manual processing of tomographic data volumes, such as interactive image segmentation in medicine or paleontology, is considered a time-consuming and cumbersome endeavor. Immersive volume sculpting stands as a potential solution to improve its efficiency and intuitiveness. However, current open-source software solutions do not yield the required performance and functionalities. We address this issue by contributing a novel open-source game engine voxel library that supports real-time immersive volume sculpting. Our design leverages GPU instancing, parallel computing, and a chunk-based data structure to optimize collision detection and rendering. We have implemented features that enable fast voxel interaction and improve precision. Our benchmark evaluation indicates that our implementation offers a significant improvement over the state-of-the-art and can render and modify millions of visible voxels while maintaining stable performance for real-time interaction in virtual reality.}, language = {en} } @article{WagendorfNahlesVachetal., author = {Wagendorf, Oliver and Nahles, Susanne and Vach, Kirstin and Kernen, Florian and Zachow, Stefan and Heiland, Max and Fl{\"u}gge, Tabea}, title = {The impact of teeth and dental restorations on gray value distribution in cone-beam computer tomography - a pilot study}, series = {International Journal of Implant Dentistry}, volume = {9}, journal = {International Journal of Implant Dentistry}, number = {27}, doi = {10.1186/s40729-023-00493-z}, abstract = {Purpose: To investigate the influence of teeth and dental restorations on the facial skeleton's gray value distributions in cone-beam computed tomography (CBCT). Methods: Gray value selection for the upper and lower jaw segmentation was performed in 40 patients. In total, CBCT data of 20 maxillae and 20 mandibles, ten partial edentulous and ten fully edentulous in each jaw, respectively, were evaluated using two different gray value selection procedures: manual lower threshold selection and automated lower threshold selection. Two sample t tests, linear regression models, linear mixed models, and Pearson's correlation coefficients were computed to evaluate the influence of teeth, dental restorations, and threshold selection procedures on gray value distributions. Results: Manual threshold selection resulted in significantly different gray values in the fully and partially edentulous mandible. (p = 0.015, difference 123). In automated threshold selection, only tendencies to different gray values in fully edentulous compared to partially edentulous jaws were observed (difference: 58-75). Significantly different gray values were evaluated for threshold selection approaches, independent of the dental situation of the analyzed jaw. No significant correlation between the number of teeth and gray values was assessed, but a trend towards higher gray values in patients with more teeth was noted. Conclusions: Standard gray values derived from CT imaging do not apply for threshold-based bone segmentation in CBCT. Teeth influence gray values and segmentation results. Inaccurate bone segmentation may result in ill-fitting surgical guides produced on CBCT data and misinterpreting bone density, which is crucial for selecting surgical protocols.}, language = {en} } @inproceedings{SiqueiraRodriguesNyakaturaZachowetal., author = {Siqueira Rodrigues, Lucas and Nyakatura, John and Zachow, Stefan and Israel, Johann Habakuk}, title = {Design Challenges and Opportunities of Fossil Preparation Tools and Methods}, series = {Proceedings of the 20th International Conference on Culture and Computer Science: Code and Materiality}, booktitle = {Proceedings of the 20th International Conference on Culture and Computer Science: Code and Materiality}, publisher = {Association for Computing Machinery}, address = {New York, NY, USA}, doi = {10.1145/3623462.3623470}, abstract = {Fossil preparation is the activity of processing paleontological specimens for research and exhibition purposes. In addition to traditional mechanical extraction of fossils, preparation presently comprises non-destructive digital methods that are part of a relatively new field, namely virtual paleontology. Despite significant technological advances, both traditional and digital preparation remain cumbersome and time-consuming endeavors. However, this field has received scarce attention from a human-computer interaction perspective. The present study aims to elucidate the state-of-the-art for paleontological fossil preparation in order to determine its main challenges and start a conversation regarding opportunities for creating novel designs that tackle the field's current issues. We conducted a qualitative study involving both technical preparators and virtual paleontologists. The study was divided into two parts: First, we assembled technical preparators and paleontology researchers in a focus group session to discuss their workflows, obtain a preliminary understanding of their issues, and ideate solutions based on their counterparts' workflows. Next, we conducted a series of contextual inquiries involving direct observation and semi-structured in-depth interviews. We transcribed our recordings and examined the data through theoretical and inductive thematic analysis, clustering emerging themes and applying concepts from human-computer interaction and related fields. Our findings report on challenges faced by traditional and digital fossil preparators and potential opportunities to improve their tools and workflows. We contribute with a novel analysis of fossil preparation from an HCI perspective.}, language = {en} } @inproceedings{LuedkeAmiranashviliAmbellanetal., author = {L{\"u}dke, David and Amiranashvili, Tamaz and Ambellan, Felix and Ezhov, Ivan and Menze, Bjoern and Zachow, Stefan}, title = {Landmark-free Statistical Shape Modeling via Neural Flow Deformations}, series = {Medical Image Computing and Computer Assisted Intervention - MICCAI 2022}, volume = {13432}, booktitle = {Medical Image Computing and Computer Assisted Intervention - MICCAI 2022}, publisher = {Springer, Cham}, doi = {10.1007/978-3-031-16434-7_44}, abstract = {Statistical shape modeling aims at capturing shape variations of an anatomical structure that occur within a given population. Shape models are employed in many tasks, such as shape reconstruction and image segmentation, but also shape generation and classification. Existing shape priors either require dense correspondence between training examples or lack robustness and topological guarantees. We present FlowSSM, a novel shape modeling approach that learns shape variability without requiring dense correspondence between training instances. It relies on a hierarchy of continuous deformation flows, which are parametrized by a neural network. Our model outperforms state-of-the-art methods in providing an expressive and robust shape prior for distal femur and liver. We show that the emerging latent representation is discriminative by separating healthy from pathological shapes. Ultimately, we demonstrate its effectiveness on two shape reconstruction tasks from partial data. Our source code is publicly available (https://github.com/davecasp/flowssm).}, language = {en} } @inproceedings{SiqueiraRodriguesNyakaturaZachowetal., author = {Siqueira Rodrigues, Lucas and Nyakatura, John and Zachow, Stefan and Israel, Johann Habakuk}, title = {An Immersive Virtual Paleontology Application}, series = {13th International Conference on Human Haptic Sensing and Touch Enabled Computer Applications, EuroHaptics 2022}, booktitle = {13th International Conference on Human Haptic Sensing and Touch Enabled Computer Applications, EuroHaptics 2022}, doi = {10.1007/978-3-031-06249-0}, pages = {478 -- 481}, abstract = {Virtual paleontology studies digital fossils through data analysis and visualization systems. The discipline is growing in relevance for the evident advantages of non-destructive imaging techniques over traditional paleontological methods, and it has made significant advancements during the last few decades. However, virtual paleontology still faces a number of technological challenges, amongst which are interaction shortcomings of image segmentation applications. Whereas automated segmentation methods are seldom applicable to fossil datasets, manual exploration of these specimens is extremely time-consuming as it impractically delves into three-dimensional data through two-dimensional visualization and interaction means. This paper presents an application that employs virtual reality and haptics to virtual paleontology in order to evolve its interaction paradigms and address some of its limitations. We provide a brief overview of the challenges faced by virtual paleontology practitioners, a description of our immersive virtual paleontology prototype, and the results of a heuristic evaluation of our design.}, language = {en} } @article{GlatzederKomnikAmbellanetal., author = {Glatzeder, Korbinian and Komnik, Igor and Ambellan, Felix and Zachow, Stefan and Potthast, Wolfgang}, title = {Dynamic pressure analysis of novel interpositional knee spacer implants in 3D-printed human knee models}, series = {Scientific Reports}, volume = {12}, journal = {Scientific Reports}, doi = {10.1038/s41598-022-20463-6}, abstract = {Alternative treatment methods for knee osteoarthritis (OA) are in demand, to delay the young (< 50 Years) patient's need for osteotomy or knee replacement. Novel interpositional knee spacers shape based on statistical shape model (SSM) approach and made of polyurethane (PU) were developed to present a minimally invasive method to treat medial OA in the knee. The implant should be supposed to reduce peak strains and pain, restore the stability of the knee, correct the malalignment of a varus knee and improve joint function and gait. Firstly, the spacers were tested in artificial knee models. It is assumed that by application of a spacer, a significant reduction in stress values and a significant increase in the contact area in the medial compartment of the knee will be registered. Biomechanical analysis of the effect of novel interpositional knee spacer implants on pressure distribution in 3D-printed knee model replicas: the primary purpose was the medial joint contact stress-related biomechanics. A secondary purpose was a better understanding of medial/lateral redistribution of joint loading. Six 3D printed knee models were reproduced from cadaveric leg computed tomography. Each of four spacer implants was tested in each knee geometry under realistic arthrokinematic dynamic loading conditions, to examine the pressure distribution in the knee joint. All spacers showed reduced mean stress values by 84-88\% and peak stress values by 524-704\% in the medial knee joint compartment compared to the non-spacer test condition. The contact area was enlarged by 462-627\% as a result of the inserted spacers. Concerning the appreciable contact stress reduction and enlargement of the contact area in the medial knee joint compartment, the premises are in place for testing the implants directly on human knee cadavers to gain further insights into a possible tool for treating medial knee osteoarthritis.}, language = {en} } @inproceedings{AmiranashviliLuedkeLietal., author = {Amiranashvili, Tamaz and L{\"u}dke, David and Li, Hongwei and Menze, Bjoern and Zachow, Stefan}, title = {Learning Shape Reconstruction from Sparse Measurements with Neural Implicit Functions}, series = {Medical Imaging with Deep Learning}, booktitle = {Medical Imaging with Deep Learning}, abstract = {Reconstructing anatomical shapes from sparse or partial measurements relies on prior knowledge of shape variations that occur within a given population. Such shape priors are learned from example shapes, obtained by segmenting volumetric medical images. For existing models, the resolution of a learned shape prior is limited to the resolution of the training data. However, in clinical practice, volumetric images are often acquired with highly anisotropic voxel sizes, e.g. to reduce image acquisition time in MRI or radiation exposure in CT imaging. The missing shape information between the slices prohibits existing methods to learn a high-resolution shape prior. We introduce a method for high-resolution shape reconstruction from sparse measurements without relying on high-resolution ground truth for training. Our method is based on neural implicit shape representations and learns a continuous shape prior only from highly anisotropic segmentations. Furthermore, it is able to learn from shapes with a varying field of view and can reconstruct from various sparse input configurations. We demonstrate its effectiveness on two anatomical structures: vertebra and femur, and successfully reconstruct high-resolution shapes from sparse segmentations, using as few as three orthogonal slices.}, language = {en} } @article{GreweLiuHildebrandtetal., author = {Grewe, Carl Martin and Liu, Tuo and Hildebrandt, Andrea and Zachow, Stefan}, title = {The Open Virtual Mirror Framework for Enfacement Illusions - Enhancing the Sense of Agency With Avatars That Imitate Facial Expressions}, series = {Behavior Research Methods}, journal = {Behavior Research Methods}, publisher = {Springer}, doi = {10.3758/s13428-021-01761-9}, language = {de} } @article{AmbellanZachowvonTycowicz, author = {Ambellan, Felix and Zachow, Stefan and von Tycowicz, Christoph}, title = {Rigid Motion Invariant Statistical Shape Modeling based on Discrete Fundamental Forms}, series = {Medical Image Analysis}, volume = {73}, journal = {Medical Image Analysis}, doi = {10.1016/j.media.2021.102178}, abstract = {We present a novel approach for nonlinear statistical shape modeling that is invariant under Euclidean motion and thus alignment-free. By analyzing metric distortion and curvature of shapes as elements of Lie groups in a consistent Riemannian setting, we construct a framework that reliably handles large deformations. Due to the explicit character of Lie group operations, our non-Euclidean method is very efficient allowing for fast and numerically robust processing. This facilitates Riemannian analysis of large shape populations accessible through longitudinal and multi-site imaging studies providing increased statistical power. Additionally, as planar configurations form a submanifold in shape space, our representation allows for effective estimation of quasi-isometric surfaces flattenings. We evaluate the performance of our model w.r.t. shape-based classification of hippocampus and femur malformations due to Alzheimer's disease and osteoarthritis, respectively. In particular, we achieve state-of-the-art accuracies outperforming the standard Euclidean as well as a recent nonlinear approach especially in presence of sparse training data. To provide insight into the model's ability of capturing biological shape variability, we carry out an analysis of specificity and generalization ability.}, language = {en} } @article{SahuMukhopadhyayZachow, author = {Sahu, Manish and Mukhopadhyay, Anirban and Zachow, Stefan}, title = {Simulation-to-Real domain adaptation with teacher-student learning for endoscopic instrument segmentation}, series = {International Journal of Computer Assisted Radiology and Surgery}, volume = {16}, journal = {International Journal of Computer Assisted Radiology and Surgery}, publisher = {Springer Nature}, doi = {10.1007/s11548-021-02383-4}, pages = {849 -- 859}, abstract = {Purpose Segmentation of surgical instruments in endoscopic video streams is essential for automated surgical scene understanding and process modeling. However, relying on fully supervised deep learning for this task is challenging because manual annotation occupies valuable time of the clinical experts. Methods We introduce a teacher-student learning approach that learns jointly from annotated simulation data and unlabeled real data to tackle the challenges in simulation-to-real unsupervised domain adaptation for endoscopic image segmentation. Results Empirical results on three datasets highlight the effectiveness of the proposed framework over current approaches for the endoscopic instrument segmentation task. Additionally, we provide analysis of major factors affecting the performance on all datasets to highlight the strengths and failure modes of our approach. Conclusions We show that our proposed approach can successfully exploit the unlabeled real endoscopic video frames and improve generalization performance over pure simulation-based training and the previous state-of-the-art. This takes us one step closer to effective segmentation of surgical instrument in the annotation scarce setting.}, language = {en} } @inproceedings{EstacioEhlkeTacketal., author = {Estacio, Laura and Ehlke, Moritz and Tack, Alexander and Castro-Gutierrez, Eveling and Lamecker, Hans and Mora, Rensso and Zachow, Stefan}, title = {Unsupervised Detection of Disturbances in 2D Radiographs}, series = {2021 IEEE 18th International Symposium on Biomedical Imaging (ISBI)}, booktitle = {2021 IEEE 18th International Symposium on Biomedical Imaging (ISBI)}, doi = {10.1109/ISBI48211.2021.9434091}, pages = {367 -- 370}, abstract = {We present a method based on a generative model for detection of disturbances such as prosthesis, screws, zippers, and metals in 2D radiographs. The generative model is trained in an unsupervised fashion using clinical radiographs as well as simulated data, none of which contain disturbances. Our approach employs a latent space consistency loss which has the benefit of identifying similarities, and is enforced to reconstruct X-rays without disturbances. In order to detect images with disturbances, an anomaly score is computed also employing the Frechet distance between the input X-ray and the reconstructed one using our generative model. Validation was performed using clinical pelvis radiographs. We achieved an AUC of 0.77 and 0.83 with clinical and synthetic data, respectively. The results demonstrated a good accuracy of our method for detecting outliers as well as the advantage of utilizing synthetic data.}, language = {en} } @misc{AmbellanZachowvonTycowicz, author = {Ambellan, Felix and Zachow, Stefan and von Tycowicz, Christoph}, title = {Geodesic B-Score for Improved Assessment of Knee Osteoarthritis}, issn = {1438-0064}, url = {http://nbn-resolving.de/urn:nbn:de:0297-zib-81930}, abstract = {Three-dimensional medical imaging enables detailed understanding of osteoarthritis structural status. However, there remains a vast need for automatic, thus, reader-independent measures that provide reliable assessment of subject-specific clinical outcomes. To this end, we derive a consistent generalization of the recently proposed B-score to Riemannian shape spaces. We further present an algorithmic treatment yielding simple, yet efficient computations allowing for analysis of large shape populations with several thousand samples. Our intrinsic formulation exhibits improved discrimination ability over its Euclidean counterpart, which we demonstrate for predictive validity on assessing risks of total knee replacement. This result highlights the potential of the geodesic B-score to enable improved personalized assessment and stratification for interventions.}, language = {en} } @article{TackPreimZachow, author = {Tack, Alexander and Preim, Bernhard and Zachow, Stefan}, title = {Fully automated Assessment of Knee Alignment from Full-Leg X-Rays employing a "YOLOv4 And Resnet Landmark regression Algorithm" (YARLA): Data from the Osteoarthritis Initiative}, series = {Computer Methods and Programs in Biomedicine}, volume = {205}, journal = {Computer Methods and Programs in Biomedicine}, number = {106080}, doi = {https://doi.org/10.1016/j.cmpb.2021.106080}, abstract = {We present a method for the quantification of knee alignment from full-leg X-Rays. A state-of-the-art object detector, YOLOv4, was trained to locate regions of interests (ROIs) in full-leg X-Ray images for the hip joint, the knee, and the ankle. Residual neural networks (ResNets) were trained to regress landmark coordinates for each ROI.Based on the detected landmarks the knee alignment, i.e., the hip-knee-ankle (HKA) angle, was computed. The accuracy of landmark detection was evaluated by a comparison to manually placed landmarks for 360 legs in 180 X-Rays. The accuracy of HKA angle computations was assessed on the basis of 2,943 X-Rays. Results of YARLA were compared to the results of two independent image reading studies(Cooke; Duryea) both publicly accessible via the Osteoarthritis Initiative. The agreement was evaluated using Spearman's Rho, and weighted kappa as well as regarding the correspondence of the class assignment (varus/neutral/valgus). The average difference between YARLA and manually placed landmarks was less than 2.0+- 1.5 mm for all structures (hip, knee, ankle). The average mismatch between HKA angle determinations of Cooke and Duryea was 0.09 +- 0.63°; YARLA resulted in a mismatch of 0.10 +- 0.74° compared to Cooke and of 0.18 +- 0.64° compared to Duryea. Cooke and Duryea agreed almost perfectly with respect to a weighted kappa value of 0.86, and showed an excellent reliability as measured by a Spearman's Rho value of 0.99. Similar values were achieved by YARLA, i.e., a weighted kappa value of0.83 and 0.87 and a Spearman's Rho value of 0.98 and 0.99 to Cooke and Duryea,respectively. Cooke and Duryea agreed in 92\% of all class assignments and YARLA did so in 90\% against Cooke and 92\% against Duryea. In conclusion, YARLA achieved results comparable to those of human experts and thus provides a basis for an automated assessment of knee alignment in full-leg X-Rays.}, language = {de} } @inproceedings{AmbellanZachowvonTycowicz, author = {Ambellan, Felix and Zachow, Stefan and von Tycowicz, Christoph}, title = {Geodesic B-Score for Improved Assessment of Knee Osteoarthritis}, series = {Proc. Information Processing in Medical Imaging (IPMI)}, booktitle = {Proc. Information Processing in Medical Imaging (IPMI)}, doi = {10.1007/978-3-030-78191-0_14}, pages = {177 -- 188}, abstract = {Three-dimensional medical imaging enables detailed understanding of osteoarthritis structural status. However, there remains a vast need for automatic, thus, reader-independent measures that provide reliable assessment of subject-specific clinical outcomes. To this end, we derive a consistent generalization of the recently proposed B-score to Riemannian shape spaces. We further present an algorithmic treatment yielding simple, yet efficient computations allowing for analysis of large shape populations with several thousand samples. Our intrinsic formulation exhibits improved discrimination ability over its Euclidean counterpart, which we demonstrate for predictive validity on assessing risks of total knee replacement. This result highlights the potential of the geodesic B-score to enable improved personalized assessment and stratification for interventions.}, language = {en} } @article{HembusAmbellanZachowetal.2021, author = {Hembus, Jessica and Ambellan, Felix and Zachow, Stefan and Bader, Rainer}, title = {Establishment of a rolling-sliding test bench to analyze abrasive wear propagation of different bearing materials for knee implants}, series = {Applied Sciences}, volume = {11}, journal = {Applied Sciences}, number = {4}, doi = {10.3390/app11041886}, pages = {15}, year = {2021}, abstract = {Currently, new materials for knee implants need to be extensively and expensive tested in a knee wear simulator in a realized design. However, using a rolling-sliding test bench, these materials can be examined under the same test conditions but with simplified geometries. In the present study, the test bench was optimized, and forces were adapted to the physiological contact pressure in the knee joint using the available geometric parameters. Various polymers made of polyethylene and polyurethane articulating against test wheels made of cobalt-chromium and aluminum titanate were tested in the test bench using adapted forces based on ISO 14243-1. Polyurethane materials showed distinctly higher wear rates than polyethylene materials and showed inadequate wear resistance for use as knee implant material. Thus, the rolling-sliding test bench is an adaptable test setup for evaluating newly developed bearing materials for knee implants. It combines the advantages of screening and simulator tests and allows testing of various bearing materials under physiological load and tribological conditions of the human knee joint. The wear behavior of different material compositions and the influence of surface geometry and quality can be initially investigated without the need to produce complex implant prototypes of total knee endoprosthesis or interpositional spacers.}, language = {en} } @article{LiPimentelSzengeletal., author = {Li, Jianning and Pimentel, Pedro and Szengel, Angelika and Ehlke, Moritz and Lamecker, Hans and Zachow, Stefan and Estacio, Laura and Doenitz, Christian and Ramm, Heiko and Shi, Haochen and Chen, Xiaojun and Matzkin, Franco and Newcombe, Virginia and Ferrante, Enzo and Jin, Yuan and Ellis, David G. and Aizenberg, Michele R. and Kodym, Oldrich and Spanel, Michal and Herout, Adam and Mainprize, James G. and Fishman, Zachary and Hardisty, Michael R. and Bayat, Amirhossein and Shit, Suprosanna and Wang, Bomin and Liu, Zhi and Eder, Matthias and Pepe, Antonio and Gsaxner, Christina and Alves, Victor and Zefferer, Ulrike and von Campe, Cord and Pistracher, Karin and Sch{\"a}fer, Ute and Schmalstieg, Dieter and Menze, Bjoern H. and Glocker, Ben and Egger, Jan}, title = {AutoImplant 2020 - First MICCAI Challenge on Automatic Cranial Implant Design}, series = {IEEE Transactions on Medical Imaging}, volume = {40}, journal = {IEEE Transactions on Medical Imaging}, number = {9}, issn = {0278-0062}, doi = {10.1109/TMI.2021.3077047}, pages = {2329 -- 2342}, abstract = {The aim of this paper is to provide a comprehensive overview of the MICCAI 2020 AutoImplant Challenge. The approaches and publications submitted and accepted within the challenge will be summarized and reported, highlighting common algorithmic trends and algorithmic diversity. Furthermore, the evaluation results will be presented, compared and discussed in regard to the challenge aim: seeking for low cost, fast and fully automated solutions for cranial implant design. Based on feedback from collaborating neurosurgeons, this paper concludes by stating open issues and post-challenge requirements for intra-operative use.}, language = {en} } @article{PichtLeCalveTomaselloetal., author = {Picht, Thomas and Le Calve, Maxime and Tomasello, Rosario and Fekonja, Lucius and Gholami, Mohammad Fardin and Bruhn, Matthias and Zwick, Carola and Rabe, J{\"u}rgen P. and M{\"u}ller-Birn, Claudia and Vajkoczy, Peter and Sauer, Igor M. and Zachow, Stefan and Nyakatura, John A. and Ribault, Patricia and Pulverm{\"u}ller, Friedemann}, title = {A note on neurosurgical resection and why we need to rethink cutting}, series = {Neurosurgery}, volume = {89}, journal = {Neurosurgery}, number = {5}, doi = {10.1093/neuros/nyab326}, pages = {289 -- 291}, language = {en} } @misc{TackAmbellanZachow2021, author = {Tack, Alexander and Ambellan, Felix and Zachow, Stefan}, title = {Towards novel osteoarthritis biomarkers: Multi-criteria evaluation of 46,996 segmented knee MRI data from the Osteoarthritis Initiative (Supplementary Material)}, series = {PLOS One}, volume = {16}, journal = {PLOS One}, number = {10}, doi = {10.12752/8328}, year = {2021}, abstract = {Convolutional neural networks (CNNs) are the state-of-the-art for automated assessment of knee osteoarthritis (KOA) from medical image data. However, these methods lack interpretability, mainly focus on image texture, and cannot completely grasp the analyzed anatomies' shapes. In this study we assess the informative value of quantitative features derived from segmentations in order to assess their potential as an alternative or extension to CNN-based approaches regarding multiple aspects of KOA A fully automated method is employed to segment six anatomical structures around the knee (femoral and tibial bones, femoral and tibial cartilages, and both menisci) in 46,996 MRI scans. Based on these segmentations, quantitative features are computed, i.e., measurements such as cartilage volume, meniscal extrusion and tibial coverage, as well as geometric features based on a statistical shape encoding of the anatomies. The feature quality is assessed by investigating their association to the Kellgren-Lawrence grade (KLG), joint space narrowing (JSN), incident KOA, and total knee replacement (TKR). Using gold standard labels from the Osteoarthritis Initiative database the balanced accuracy (BA), the area under the Receiver Operating Characteristic curve (AUC), and weighted kappa statistics are evaluated. Features based on shape encodings of femur, tibia, and menisci plus the performed measurements showed most potential as KOA biomarkers. Differentiation between healthy and severely arthritic knees yielded BAs of up to 99\%, 84\% were achieved for diagnosis of early KOA. Substantial agreement with weighted kappa values of 0.73, 0.73, and 0.79 were achieved for classification of the grade of medial JSN, lateral JSN, and KLG, respectively. The AUC was 0.60 and 0.75 for prediction of incident KOA and TKR within 5 years, respectively. Quantitative features from automated segmentations yield excellent results for KLG and JSN classification and show potential for incident KOA and TKR prediction. The validity of these features as KOA biomarkers should be further evaluated, especially as extensions of CNN-based approaches. To foster such developments we make all segmentations publicly available together with this publication.}, language = {en} } @misc{TackShestakovLuedkeetal., author = {Tack, Alexander and Shestakov, Alexey and L{\"u}dke, David and Zachow, Stefan}, title = {A deep multi-task learning method for detection of meniscal tears in MRI data from the Osteoarthritis Initiative database}, issn = {1438-0064}, url = {http://nbn-resolving.de/urn:nbn:de:0297-zib-84415}, abstract = {We present a novel and computationally efficient method for the detection of meniscal tears in Magnetic Resonance Imaging (MRI) data. Our method is based on a Convolutional Neural Network (CNN) that operates on a complete 3D MRI scan. Our approach detects the presence of meniscal tears in three anatomical sub-regions (anterior horn, meniscal body, posterior horn) for both the Medial Meniscus (MM) and the Lateral Meniscus (LM) individually. For optimal performance of our method, we investigate how to preprocess the MRI data or how to train the CNN such that only relevant information within a Region of Interest (RoI) of the data volume is taken into account for meniscal tear detection. We propose meniscal tear detection combined with a bounding box regressor in a multi-task deep learning framework to let the CNN implicitly consider the corresponding RoIs of the menisci. We evaluate the accuracy of our CNN-based meniscal tear detection approach on 2,399 Double Echo Steady-State (DESS) MRI scans from the Osteoarthritis Initiative database. In addition, to show that our method is capable of generalizing to other MRI sequences, we also adapt our model to Intermediate-Weighted Turbo Spin-Echo (IW TSE) MRI scans. To judge the quality of our approaches, Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC) values are evaluated for both MRI sequences. For the detection of tears in DESS MRI, our method reaches AUC values of 0.94, 0.93, 0.93 (anterior horn, body, posterior horn) in MM and 0.96, 0.94, 0.91 in LM. For the detection of tears in IW TSE MRI data, our method yields AUC values of 0.84, 0.88, 0.86 in MM and 0.95, 0.91, 0.90 in LM. In conclusion, the presented method achieves high accuracy for detecting meniscal tears in both DESS and IW TSE MRI data. Furthermore, our method can be easily trained and applied to other MRI sequences.}, language = {en} } @article{TackShestakovLuedkeetal., author = {Tack, Alexander and Shestakov, Alexey and L{\"u}dke, David and Zachow, Stefan}, title = {A deep multi-task learning method for detection of meniscal tears in MRI data from the Osteoarthritis Initiative database}, series = {Frontiers in Bioengineering and Biotechnology, section Biomechanics}, journal = {Frontiers in Bioengineering and Biotechnology, section Biomechanics}, doi = {10.3389/fbioe.2021.747217}, pages = {28 -- 41}, abstract = {We present a novel and computationally efficient method for the detection of meniscal tears in Magnetic Resonance Imaging (MRI) data. Our method is based on a Convolutional Neural Network (CNN) that operates on a complete 3D MRI scan. Our approach detects the presence of meniscal tears in three anatomical sub-regions (anterior horn, meniscal body, posterior horn) for both the Medial Meniscus (MM) and the Lateral Meniscus (LM) individually. For optimal performance of our method, we investigate how to preprocess the MRI data or how to train the CNN such that only relevant information within a Region of Interest (RoI) of the data volume is taken into account for meniscal tear detection. We propose meniscal tear detection combined with a bounding box regressor in a multi-task deep learning framework to let the CNN implicitly consider the corresponding RoIs of the menisci. We evaluate the accuracy of our CNN-based meniscal tear detection approach on 2,399 Double Echo Steady-State (DESS) MRI scans from the Osteoarthritis Initiative database. In addition, to show that our method is capable of generalizing to other MRI sequences, we also adapt our model to Intermediate-Weighted Turbo Spin-Echo (IW TSE) MRI scans. To judge the quality of our approaches, Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC) values are evaluated for both MRI sequences. For the detection of tears in DESS MRI, our method reaches AUC values of 0.94, 0.93, 0.93 (anterior horn, body, posterior horn) in MM and 0.96, 0.94, 0.91 in LM. For the detection of tears in IW TSE MRI data, our method yields AUC values of 0.84, 0.88, 0.86 in MM and 0.95, 0.91, 0.90 in LM. In conclusion, the presented method achieves high accuracy for detecting meniscal tears in both DESS and IW TSE MRI data. Furthermore, our method can be easily trained and applied to other MRI sequences.}, language = {en} } @article{TackAmbellanZachow, author = {Tack, Alexander and Ambellan, Felix and Zachow, Stefan}, title = {Towards novel osteoarthritis biomarkers: Multi-criteria evaluation of 46,996 segmented knee MRI data from the Osteoarthritis Initiative}, series = {PLOS One}, volume = {16}, journal = {PLOS One}, number = {10}, doi = {10.1371/journal.pone.0258855}, abstract = {Convolutional neural networks (CNNs) are the state-of-the-art for automated assessment of knee osteoarthritis (KOA) from medical image data. However, these methods lack interpretability, mainly focus on image texture, and cannot completely grasp the analyzed anatomies' shapes. In this study we assess the informative value of quantitative features derived from segmentations in order to assess their potential as an alternative or extension to CNN-based approaches regarding multiple aspects of KOA. Six anatomical structures around the knee (femoral and tibial bones, femoral and tibial cartilages, and both menisci) are segmented in 46,996 MRI scans. Based on these segmentations, quantitative features are computed, i.e., measurements such as cartilage volume, meniscal extrusion and tibial coverage, as well as geometric features based on a statistical shape encoding of the anatomies. The feature quality is assessed by investigating their association to the Kellgren-Lawrence grade (KLG), joint space narrowing (JSN), incident KOA, and total knee replacement (TKR). Using gold standard labels from the Osteoarthritis Initiative database the balanced accuracy (BA), the area under the Receiver Operating Characteristic curve (AUC), and weighted kappa statistics are evaluated. Features based on shape encodings of femur, tibia, and menisci plus the performed measurements showed most potential as KOA biomarkers. Differentiation between non-arthritic and severely arthritic knees yielded BAs of up to 99\%, 84\% were achieved for diagnosis of early KOA. Weighted kappa values of 0.73, 0.72, and 0.78 were achieved for classification of the grade of medial JSN, lateral JSN, and KLG, respectively. The AUC was 0.61 and 0.76 for prediction of incident KOA and TKR within one year, respectively. Quantitative features from automated segmentations provide novel biomarkers for KLG and JSN classification and show potential for incident KOA and TKR prediction. The validity of these features should be further evaluated, especially as extensions of CNN- based approaches. To foster such developments we make all segmentations publicly available together with this publication.}, language = {en} } @article{SekuboyinaHusseiniBayatetal., author = {Sekuboyina, Anjany and Husseini, Malek E. and Bayat, Amirhossein and L{\"o}ffler, Maximilian and Liebl, Hans and Li, Hongwei and Tetteh, Giles and Kukačka, Jan and Payer, Christian and Štern, Darko and Urschler, Martin and Chen, Maodong and Cheng, Dalong and Lessmann, Nikolas and Hu, Yujin and Wang, Tianfu and Yang, Dong and Xu, Daguang and Ambellan, Felix and Amiranashvili, Tamaz and Ehlke, Moritz and Lamecker, Hans and Lehnert, Sebastian and Lirio, Marilia and de Olaguer, Nicol{\´a}s P{\´e}rez and Ramm, Heiko and Sahu, Manish and Tack, Alexander and Zachow, Stefan and Jiang, Tao and Ma, Xinjun and Angerman, Christoph and Wang, Xin and Brown, Kevin and Kirszenberg, Alexandre and Puybareau, {\´E}lodie and Chen, Di and Bai, Yiwei and Rapazzo, Brandon H. and Yeah, Timyoas and Zhang, Amber and Xu, Shangliang and Hou, Feng and He, Zhiqiang and Zeng, Chan and Xiangshang, Zheng and Liming, Xu and Netherton, Tucker J. and Mumme, Raymond P. and Court, Laurence E. and Huang, Zixun and He, Chenhang and Wang, Li-Wen and Ling, Sai Ho and Huynh, L{\^e} Duy and Boutry, Nicolas and Jakubicek, Roman and Chmelik, Jiri and Mulay, Supriti and Sivaprakasam, Mohanasankar and Paetzold, Johannes C. and Shit, Suprosanna and Ezhov, Ivan and Wiestler, Benedikt and Glocker, Ben and Valentinitsch, Alexander and Rempfler, Markus and Menze, Bj{\"o}rn H. and Kirschke, Jan S.}, title = {VerSe: A Vertebrae labelling and segmentation benchmark for multi-detector CT images}, series = {Medical Image Analysis}, volume = {73}, journal = {Medical Image Analysis}, doi = {10.1016/j.media.2021.102166}, abstract = {Vertebral labelling and segmentation are two fundamental tasks in an automated spine processing pipeline. Reliable and accurate processing of spine images is expected to benefit clinical decision support systems for diagnosis, surgery planning, and population-based analysis of spine and bone health. However, designing automated algorithms for spine processing is challenging predominantly due to considerable variations in anatomy and acquisition protocols and due to a severe shortage of publicly available data. Addressing these limitations, the Large Scale Vertebrae Segmentation Challenge (VerSe) was organised in conjunction with the International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) in 2019 and 2020, with a call for algorithms tackling the labelling and segmentation of vertebrae. Two datasets containing a total of 374 multi-detector CT scans from 355 patients were prepared and 4505 vertebrae have individually been annotated at voxel level by a human-machine hybrid algorithm (https://osf.io/nqjyw/, https://osf.io/t98fz/). A total of 25 algorithms were benchmarked on these datasets. In this work, we present the results of this evaluation and further investigate the performance variation at the vertebra level, scan level, and different fields of view. We also evaluate the generalisability of the approaches to an implicit domain shift in data by evaluating the top-performing algorithms of one challenge iteration on data from the other iteration. The principal takeaway from VerSe: the performance of an algorithm in labelling and segmenting a spine scan hinges on its ability to correctly identify vertebrae in cases of rare anatomical variations. The VerSe content and code can be accessed at: https://github.com/anjany/verse.}, language = {en} } @misc{GreweZachow, author = {Grewe, C. Martin and Zachow, Stefan}, title = {Release of the FexMM for the Open Virtual Mirror Framework}, doi = {10.12752/8532}, abstract = {THIS MODEL IS FOR NON-COMMERCIAL RESEARCH PURPOSES. ONLY MEMBERS OF UNIVERSITIES OR NON-COMMERCIAL RESEARCH INSTITUTES ARE ELIGIBLE TO APPLY. 1. Download, fill, and sign the form available from: https://media.githubusercontent.com/media/mgrewe/ovmf/main/data/fexmm_license_agreement.pdf 2. Send the signed form to: fexmm@zib.de NOTE: Use an official email address of your institution for the request.}, language = {en} } @article{GreweLiuKahletal., author = {Grewe, Carl Martin and Liu, Tuo and Kahl, Christoph and Andrea, Hildebrandt and Zachow, Stefan}, title = {Statistical Learning of Facial Expressions Improves Realism of Animated Avatar Faces}, series = {Frontiers in Virtual Reality}, volume = {2}, journal = {Frontiers in Virtual Reality}, publisher = {Frontiers}, doi = {10.3389/frvir.2021.619811}, pages = {1 -- 13}, language = {en} } @inproceedings{SahuStroemsdoerferMukhopadhyayetal., author = {Sahu, Manish and Str{\"o}msd{\"o}rfer, Ronja and Mukhopadhyay, Anirban and Zachow, Stefan}, title = {Endo-Sim2Real: Consistency learning-based domain adaptation for instrument segmentation}, series = {Proc. Medical Image Computing and Computer Assisted Intervention (MICCAI), Part III}, volume = {12263}, booktitle = {Proc. Medical Image Computing and Computer Assisted Intervention (MICCAI), Part III}, publisher = {Springer Nature}, doi = {https://doi.org/10.1007/978-3-030-59716-0_75}, abstract = {Surgical tool segmentation in endoscopic videos is an important component of computer assisted interventions systems. Recent success of image-based solutions using fully-supervised deep learning approaches can be attributed to the collection of big labeled datasets. However, the annotation of a big dataset of real videos can be prohibitively expensive and time consuming. Computer simulations could alleviate the manual labeling problem, however, models trained on simulated data do not generalize to real data. This work proposes a consistency-based framework for joint learning of simulated and real (unlabeled) endoscopic data to bridge this performance generalization issue. Empirical results on two data sets (15 videos of the Cholec80 and EndoVis'15 dataset) highlight the effectiveness of the proposed Endo-Sim2Real method for instrument segmentation. We compare the segmentation of the proposed approach with state-of-the-art solutions and show that our method improves segmentation both in terms of quality and quantity.}, language = {en} } @article{SahuSzengelMukhopadhyayetal.2020, author = {Sahu, Manish and Szengel, Angelika and Mukhopadhyay, Anirban and Zachow, Stefan}, title = {Surgical phase recognition by learning phase transitions}, series = {Current Directions in Biomedical Engineering (CDBME)}, volume = {6}, journal = {Current Directions in Biomedical Engineering (CDBME)}, number = {1}, publisher = {De Gruyter}, doi = {https://doi.org/10.1515/cdbme-2020-0037}, pages = {20200037}, year = {2020}, abstract = {Automatic recognition of surgical phases is an important component for developing an intra-operative context-aware system. Prior work in this area focuses on recognizing short-term tool usage patterns within surgical phases. However, the difference between intra- and inter-phase tool usage patterns has not been investigated for automatic phase recognition. We developed a Recurrent Neural Network (RNN), in particular a state-preserving Long Short Term Memory (LSTM) architecture to utilize the long-term evolution of tool usage within complete surgical procedures. For fully automatic tool presence detection from surgical video frames, a Convolutional Neural Network (CNN) based architecture namely ZIBNet is employed. Our proposed approach outperformed EndoNet by 8.1\% on overall precision for phase detection tasks and 12.5\% on meanAP for tool recognition tasks.}, language = {en} } @misc{SahuSzengelMukhopadhyayetal., author = {Sahu, Manish and Szengel, Angelika and Mukhopadhyay, Anirban and Zachow, Stefan}, title = {Analyzing laparoscopic cholecystectomy with deep learning: automatic detection of surgical tools and phases}, series = {28th International Congress of the European Association for Endoscopic Surgery (EAES)}, journal = {28th International Congress of the European Association for Endoscopic Surgery (EAES)}, abstract = {Motivation: The ever-rising volume of patients, high maintenance cost of operating rooms and time consuming analysis of surgical skills are fundamental problems that hamper the practical training of the next generation of surgeons. The hospitals prefer to keep the surgeons busy in real operations over training young surgeons for obvious economic reasons. One fundamental need in surgical training is the reduction of the time needed by the senior surgeon to review the endoscopic procedures performed by the young surgeon while minimizing the subjective bias in evaluation. The unprecedented performance of deep learning ushers the new age of data-driven automatic analysis of surgical skills. Method: Deep learning is capable of efficiently analyzing thousands of hours of laparoscopic video footage to provide an objective assessment of surgical skills. However, the traditional end-to-end setting of deep learning (video in, skill assessment out) is not explainable. Our strategy is to utilize the surgical process modeling framework to divide the surgical process into understandable components. This provides the opportunity to employ deep learning for superior yet automatic detection and evaluation of several aspects of laparoscopic cholecystectomy such as surgical tool and phase detection. We employ ZIBNet for the detection of surgical tool presence. ZIBNet employs pre-processing based on tool usage imbalance, a transfer learned 50-layer residual network (ResNet-50) and temporal smoothing. To encode the temporal evolution of tool usage (over the entire video sequence) that relates to the surgical phases, Long Short Term Memory (LSTM) units are employed with long-term dependency. Dataset: We used CHOLEC 80 dataset that consists of 80 videos of laparoscopic cholecystectomy performed by 13 surgeons, divided equally for training and testing. In these videos, up to three different tools (among 7 types of tools) can be present in a frame. Results: The mean average precision of the detection of all tools is 93.5 ranging between 86.8 and 99.3, a significant improvement (p <0.01) over the previous state-of-the-art. We observed that less frequent tools like Scissors, Irrigator, Specimen Bag etc. are more related to phase transitions. The overall precision (recall) of the detection of all surgical phases is 79.6 (81.3). Conclusion: While this is not the end goal for surgical skill analysis, the development of such a technological platform is essential toward a data-driven objective understanding of surgical skills. In future, we plan to investigate surgeon-in-the-loop analysis and feedback for surgical skill analysis.}, language = {en} } @article{PimentelSzengelEhlkeetal., author = {Pimentel, Pedro and Szengel, Angelika and Ehlke, Moritz and Lamecker, Hans and Zachow, Stefan and Estacio, Laura and Doenitz, Christian and Ramm, Heiko}, title = {Automated Virtual Reconstruction of Large Skull Defects using Statistical Shape Models and Generative Adversarial Networks}, series = {Towards the Automatization of Cranial Implant Design in Cranioplasty}, volume = {12439}, journal = {Towards the Automatization of Cranial Implant Design in Cranioplasty}, editor = {Li, Jianning and Egger, Jan}, edition = {1}, publisher = {Springer International Publishing}, doi = {10.1007/978-3-030-64327-0_3}, pages = {16 -- 27}, abstract = {We present an automated method for extrapolating missing regions in label data of the skull in an anatomically plausible manner. The ultimate goal is to design patient-speci� c cranial implants for correcting large, arbitrarily shaped defects of the skull that can, for example, result from trauma of the head. Our approach utilizes a 3D statistical shape model (SSM) of the skull and a 2D generative adversarial network (GAN) that is trained in an unsupervised fashion from samples of healthy patients alone. By � tting the SSM to given input labels containing the skull defect, a First approximation of the healthy state of the patient is obtained. The GAN is then applied to further correct and smooth the output of the SSM in an anatomically plausible manner. Finally, the defect region is extracted using morphological operations and subtraction between the extrapolated healthy state of the patient and the defective input labels. The method is trained and evaluated based on data from the MICCAI 2020 AutoImplant challenge. It produces state-of-the art results on regularly shaped cut-outs that were present in the training and testing data of the challenge. Furthermore, due to unsupervised nature of the approach, the method generalizes well to previously unseen defects of varying shapes that were only present in the hidden test dataset.}, language = {en} } @article{BrueningHildebrandtHepptetal., author = {Br{\"u}ning, Jan and Hildebrandt, Thomas and Heppt, Werner and Schmidt, Nora and Lamecker, Hans and Szengel, Angelika and Amiridze, Natalja and Ramm, Heiko and Bindernagel, Matthias and Zachow, Stefan and Goubergrits, Leonid}, title = {Characterization of the Airflow within an Average Geometry of the Healthy Human Nasal Cavity}, series = {Scientific Reports}, volume = {3755}, journal = {Scientific Reports}, number = {10}, doi = {10.1038/s41598-020-60755-3}, abstract = {This study's objective was the generation of a standardized geometry of the healthy nasal cavity. An average geometry of the healthy nasal cavity was generated using a statistical shape model based on 25 symptom-free subjects. Airflow within the average geometry and these geometries was calculated using fluid simulations. Integral measures of the nasal resistance, wall shear stresses (WSS) and velocities were calculated as well as cross-sectional areas (CSA). Furthermore, individual WSS and static pressure distributions were mapped onto the average geometry. The average geometry featured an overall more regular shape that resulted in less resistance, reduced wall shear stresses and velocities compared to the median of the 25 geometries. Spatial distributions of WSS and pressure of average geometry agreed well compared to the average distributions of all individual geometries. The minimal CSA of the average geometry was larger than the median of all individual geometries (83.4 vs. 74.7 mm²). The airflow observed within the average geometry of the healthy nasal cavity did not equal the average airflow of the individual geometries. While differences observed for integral measures were notable, the calculated values for the average geometry lay within the distributions of the individual parameters. Spatially resolved parameters differed less prominently.}, language = {en} } @article{SekuboyinaBayatHusseinietal., author = {Sekuboyina, Anjany and Bayat, Amirhossein and Husseini, Malek E. and L{\"o}ffler, Maximilian and Li, Hongwei and Tetteh, Giles and Kukačka, Jan and Payer, Christian and Štern, Darko and Urschler, Martin and Chen, Maodong and Cheng, Dalong and Lessmann, Nikolas and Hu, Yujin and Wang, Tianfu and Yang, Dong and Xu, Daguang and Ambellan, Felix and Amiranashvili, Tamaz and Ehlke, Moritz and Lamecker, Hans and Lehnert, Sebastian and Lirio, Marilia and de Olaguer, Nicol{\´a}s P{\´e}rez and Ramm, Heiko and Sahu, Manish and Tack, Alexander and Zachow, Stefan and Jiang, Tao and Ma, Xinjun and Angerman, Christoph and Wang, Xin and Wei, Qingyue and Brown, Kevin and Wolf, Matthias and Kirszenberg, Alexandre and Puybareau, {\´E}lodie and Valentinitsch, Alexander and Rempfler, Markus and Menze, Bj{\"o}rn H. and Kirschke, Jan S.}, title = {VerSe: A Vertebrae Labelling and Segmentation Benchmark for Multi-detector CT Images}, series = {arXiv}, journal = {arXiv}, language = {en} } @inproceedings{TackZachow, author = {Tack, Alexander and Zachow, Stefan}, title = {Accurate Automated Volumetry of Cartilage of the Knee using Convolutional Neural Networks: Data from the Osteoarthritis Initiative}, series = {IEEE 16th International Symposium on Biomedical Imaging (ISBI 2019)}, booktitle = {IEEE 16th International Symposium on Biomedical Imaging (ISBI 2019)}, doi = {10.1109/ISBI.2019.8759201}, pages = {40 -- 43}, abstract = {Volumetry of cartilage of the knee is needed for knee osteoarthritis (KOA) assessment. It is typically performed manually in a tedious and subjective process. We developed a method for an automated, segmentation-based quantification of cartilage volume by employing 3D Convolutional Neural Networks (CNNs). CNNs were trained in a supervised manner using magnetic resonance imaging data and cartilage volumetry readings performed by clinical experts for 1378 subjects provided by the Osteoarthritis Initiative. It was shown that 3D CNNs are able to achieve volume measures comparable to the magnitude of variation between expert readings and the real in vivo situation. In the future, accurate automated cartilage volumetry might support both, diagnosis of KOA as well as longitudinal analysis of KOA progression.}, language = {en} } @inproceedings{NeumannHellwichZachow, author = {Neumann, Mario and Hellwich, Olaf and Zachow, Stefan}, title = {Localization and Classification of Teeth in Cone Beam CT using Convolutional Neural Networks}, series = {Proc. of the 18th annual conference on Computer- and Robot-assisted Surgery (CURAC)}, booktitle = {Proc. of the 18th annual conference on Computer- and Robot-assisted Surgery (CURAC)}, isbn = {978-3-00-063717-9}, pages = {182 -- 188}, abstract = {In dentistry, software-based medical image analysis and visualization provide efficient and accurate diagnostic and therapy planning capabilities. We present an approach for the automatic recognition of tooth types and positions in digital volume tomography (DVT). By using deep learning techniques in combination with dimensionality reduction through non-planar reformatting of the jaw anatomy, DVT data can be efficiently processed and teeth reliably recognized and classified, even in the presence of imaging artefacts, missing or dislocated teeth. We evaluated our approach, which is based on 2D Convolutional Neural Networks (CNNs), on 118 manually annotated cases of clinical DVT datasets. Our proposed method correctly classifies teeth with an accuracy of 94\% within a limit of 2mm distance to ground truth labels.}, language = {en} } @inproceedings{JoachimskyMaIckingetal., author = {Joachimsky, Robert and Ma, Lihong and Icking, Christian and Zachow, Stefan}, title = {A Collision-Aware Articulated Statistical Shape Model of the Human Spine}, series = {Proc. of the 18th annual conference on Computer- and Robot-assisted Surgery (CURAC)}, booktitle = {Proc. of the 18th annual conference on Computer- and Robot-assisted Surgery (CURAC)}, pages = {58 -- 64}, abstract = {Statistical Shape Models (SSMs) are a proven means for model-based 3D anatomy reconstruction from medical image data. In orthopaedics and biomechanics, SSMs are increasingly employed to individualize measurement data or to create individualized anatomical models to which implants can be adapted to or functional tests can be performed on. For modeling and analysis of articulated structures, so called articulated SSMs (aSSMs) have been developed. However, a missing feature of aSSMs is the consideration of collisions in the course of individual fitting and articulation. The aim of our work was to develop aSSMs that handle collisions between components correctly. That way it becomes possible to adjust shape and articulation in view of a physically and geometrically plausible individualization. To be able to apply collision-aware aSSMs in simulation and optimisation, our approach is based on an e� cient collision detection method employing Graphics Processing Units (GPUs).}, language = {en} } @article{KraemerMaggioniBrissonetal., author = {Kr{\"a}mer, Martin and Maggioni, Marta and Brisson, Nicholas and Zachow, Stefan and Teichgr{\"a}ber, Ulf and Duda, Georg and Reichenbach, J{\"u}rgen}, title = {T1 and T2* mapping of the human quadriceps and patellar tendons using ultra-short echo-time (UTE) imaging and bivariate relaxation parameter-based volumetric visualization}, series = {Magnetic Resonance Imaging}, volume = {63}, journal = {Magnetic Resonance Imaging}, number = {11}, doi = {10.1016/j.mri.2019.07.015}, pages = {29 -- 36}, abstract = {Quantification of magnetic resonance (MR)-based relaxation parameters of tendons and ligaments is challenging due to their very short transverse relaxation times, requiring application of ultra-short echo-time (UTE) imaging sequences. We quantify both T1 and T2⁎ in the quadriceps and patellar tendons of healthy volunteers at a field strength of 3 T and visualize the results based on 3D segmentation by using bivariate histogram analysis. We applied a 3D ultra-short echo-time imaging sequence with either variable repetition times (VTR) or variable flip angles (VFA) for T1 quantification in combination with multi-echo acquisition for extracting T2⁎. The values of both relaxation parameters were subsequently binned for bivariate histogram analysis and corresponding cluster identification, which were subsequently visualized. Based on manually-drawn regions of interest in the tendons on the relaxation parameter maps, T1 and T2⁎ boundaries were selected in the bivariate histogram to segment the quadriceps and patellar tendons and visualize the relaxation times by 3D volumetric rendering. Segmentation of bone marrow, fat, muscle and tendons was successfully performed based on the bivariate histogram analysis. Based on the segmentation results mean T2⁎ relaxation times, over the entire tendon volumes averaged over all subjects, were 1.8 ms ± 0.1 ms and 1.4 ms ± 0.2 ms for the patellar and quadriceps tendons, respectively. The mean T1 value of the patellar tendon, averaged over all subjects, was 527 ms ± 42 ms and 476 ms ± 40 ms for the VFA and VTR acquisitions, respectively. The quadriceps tendon had higher mean T1 values of 662 ms ± 97 ms (VFA method) and 637 ms ± 40 ms (VTR method) compared to the patellar tendon. 3D volumetric visualization of the relaxation times revealed that T1 values are not constant over the volume of both tendons, but vary locally. This work provided additional data to build upon the scarce literature available on relaxation times in the quadriceps and patellar tendons. We were able to segment both tendons and to visualize the relaxation parameter distributions over the entire tendon volumes.}, language = {en} } @inproceedings{AmbellanZachowvonTycowicz, author = {Ambellan, Felix and Zachow, Stefan and von Tycowicz, Christoph}, title = {An as-invariant-as-possible GL+(3)-based Statistical Shape Model}, series = {Proc. 7th MICCAI workshop on Mathematical Foundations of Computational Anatomy (MFCA)}, volume = {11846}, booktitle = {Proc. 7th MICCAI workshop on Mathematical Foundations of Computational Anatomy (MFCA)}, publisher = {Springer}, doi = {10.1007/978-3-030-33226-6_23}, pages = {219 -- 228}, abstract = {We describe a novel nonlinear statistical shape model basedon differential coordinates viewed as elements of GL+(3). We adopt an as-invariant-as possible framework comprising a bi-invariant Lie group mean and a tangent principal component analysis based on a unique GL+(3)-left-invariant, O(3)-right-invariant metric. Contrary to earlier work that equips the coordinates with a specifically constructed group structure, our method employs the inherent geometric structure of the group-valued data and therefore features an improved statistical power in identifying shape differences. We demonstrate this in experiments on two anatomical datasets including comparison to the standard Euclidean as well as recent state-of-the-art nonlinear approaches to statistical shape modeling.}, language = {en} } @misc{AmbellanZachowvonTycowicz, author = {Ambellan, Felix and Zachow, Stefan and von Tycowicz, Christoph}, title = {A Surface-Theoretic Approach for Statistical Shape Modeling}, issn = {1438-0064}, url = {http://nbn-resolving.de/urn:nbn:de:0297-zib-74497}, abstract = {We present a novel approach for nonlinear statistical shape modeling that is invariant under Euclidean motion and thus alignment-free. By analyzing metric distortion and curvature of shapes as elements of Lie groups in a consistent Riemannian setting, we construct a framework that reliably handles large deformations. Due to the explicit character of Lie group operations, our non-Euclidean method is very efficient allowing for fast and numerically robust processing. This facilitates Riemannian analysis of large shape populations accessible through longitudinal and multi-site imaging studies providing increased statistical power. We evaluate the performance of our model w.r.t. shape-based classification of pathological malformations of the human knee and show that it outperforms the standard Euclidean as well as a recent nonlinear approach especially in presence of sparse training data. To provide insight into the model's ability of capturing natural biological shape variability, we carry out an analysis of specificity and generalization ability.}, language = {en} } @misc{AmbellanZachowvonTycowicz, author = {Ambellan, Felix and Zachow, Stefan and von Tycowicz, Christoph}, title = {An as-invariant-as-possible GL+(3)-based Statistical Shape Model}, issn = {1438-0064}, url = {http://nbn-resolving.de/urn:nbn:de:0297-zib-74566}, abstract = {We describe a novel nonlinear statistical shape model basedon differential coordinates viewed as elements of GL+(3). We adopt an as-invariant-as possible framework comprising a bi-invariant Lie group mean and a tangent principal component analysis based on a unique GL+(3)-left-invariant, O(3)-right-invariant metric. Contrary to earlier work that equips the coordinates with a specifically constructed group structure, our method employs the inherent geometric structure of the group-valued data and therefore features an improved statistical power in identifying shape differences. We demonstrate this in experiments on two anatomical datasets including comparison to the standard Euclidean as well as recent state-of-the-art nonlinear approaches to statistical shape modeling.}, language = {en} } @article{OeltzeJaffraMeuschkeNeugebaueretal., author = {Oeltze-Jaffra, Steffen and Meuschke, Monique and Neugebauer, Mathias and Saalfeld, Sylvia and Lawonn, Kai and Janiga, Gabor and Hege, Hans-Christian and Zachow, Stefan and Preim, Bernhard}, title = {Generation and Visual Exploration of Medical Flow Data: Survey, Research Trends, and Future Challenges}, series = {Computer Graphics Forum}, volume = {38}, journal = {Computer Graphics Forum}, number = {1}, publisher = {Wiley}, doi = {10.1111/cgf.13394}, pages = {87 -- 125}, abstract = {Simulations and measurements of blood and air flow inside the human circulatory and respiratory system play an increasingly important role in personalized medicine for prevention, diagnosis, and treatment of diseases. This survey focuses on three main application areas. (1) Computational Fluid Dynamics (CFD) simulations of blood flow in cerebral aneurysms assist in predicting the outcome of this pathologic process and of therapeutic interventions. (2) CFD simulations of nasal airflow allow for investigating the effects of obstructions and deformities and provide therapy decision support. (3) 4D Phase-Contrast (4D PC) Magnetic Resonance Imaging (MRI) of aortic hemodynamics supports the diagnosis of various vascular and valve pathologies as well as their treatment. An investigation of the complex and often dynamic simulation and measurement data requires the coupling of sophisticated visualization, interaction, and data analysis techniques. In this paper, we survey the large body of work that has been conducted within this realm. We extend previous surveys by incorporating nasal airflow, addressing the joint investigation of blood flow and vessel wall properties, and providing a more fine-granular taxonomy of the existing techniques. From the survey, we extract major research trends and identify open problems and future challenges. The survey is intended for researchers interested in medical flow but also more general, in the combined visualization of physiology and anatomy, the extraction of features from flow field data and feature-based visualization, the visual comparison of different simulation results, and the interactive visual analysis of the flow field and derived characteristics.}, language = {en} } @misc{AmbellanLameckervonTycowiczetal., author = {Ambellan, Felix and Lamecker, Hans and von Tycowicz, Christoph and Zachow, Stefan}, title = {Statistical Shape Models - Understanding and Mastering Variation in Anatomy}, issn = {1438-0064}, doi = {10.1007/978-3-030-19385-0_5}, url = {http://nbn-resolving.de/urn:nbn:de:0297-zib-72699}, abstract = {In our chapter we are describing how to reconstruct three-dimensional anatomy from medical image data and how to build Statistical 3D Shape Models out of many such reconstructions yielding a new kind of anatomy that not only allows quantitative analysis of anatomical variation but also a visual exploration and educational visualization. Future digital anatomy atlases will not only show a static (average) anatomy but also its normal or pathological variation in three or even four dimensions, hence, illustrating growth and/or disease progression. Statistical Shape Models (SSMs) are geometric models that describe a collection of semantically similar objects in a very compact way. SSMs represent an average shape of many three-dimensional objects as well as their variation in shape. The creation of SSMs requires a correspondence mapping, which can be achieved e.g. by parameterization with a respective sampling. If a corresponding parameterization over all shapes can be established, variation between individual shape characteristics can be mathematically investigated. We will explain what Statistical Shape Models are and how they are constructed. Extensions of Statistical Shape Models will be motivated for articulated coupled structures. In addition to shape also the appearance of objects will be integrated into the concept. Appearance is a visual feature independent of shape that depends on observers or imaging techniques. Typical appearances are for instance the color and intensity of a visual surface of an object under particular lighting conditions, or measurements of material properties with computed tomography (CT) or magnetic resonance imaging (MRI). A combination of (articulated) statistical shape models with statistical models of appearance lead to articulated Statistical Shape and Appearance Models (a-SSAMs).After giving various examples of SSMs for human organs, skeletal structures, faces, and bodies, we will shortly describe clinical applications where such models have been successfully employed. Statistical Shape Models are the foundation for the analysis of anatomical cohort data, where characteristic shapes are correlated to demographic or epidemiologic data. SSMs consisting of several thousands of objects offer, in combination with statistical methods ormachine learning techniques, the possibility to identify characteristic clusters, thus being the foundation for advanced diagnostic disease scoring.}, language = {en} } @inproceedings{AmbellanZachowvonTycowicz, author = {Ambellan, Felix and Zachow, Stefan and von Tycowicz, Christoph}, title = {A Surface-Theoretic Approach for Statistical Shape Modeling}, series = {Proc. Medical Image Computing and Computer Assisted Intervention (MICCAI), Part IV}, volume = {11767}, booktitle = {Proc. Medical Image Computing and Computer Assisted Intervention (MICCAI), Part IV}, publisher = {Springer}, doi = {10.1007/978-3-030-32251-9_3}, pages = {21 -- 29}, abstract = {We present a novel approach for nonlinear statistical shape modeling that is invariant under Euclidean motion and thus alignment-free. By analyzing metric distortion and curvature of shapes as elements of Lie groups in a consistent Riemannian setting, we construct a framework that reliably handles large deformations. Due to the explicit character of Lie group operations, our non-Euclidean method is very efficient allowing for fast and numerically robust processing. This facilitates Riemannian analysis of large shape populations accessible through longitudinal and multi-site imaging studies providing increased statistical power. We evaluate the performance of our model w.r.t. shape-based classification of pathological malformations of the human knee and show that it outperforms the standard Euclidean as well as a recent nonlinear approach especially in presence of sparse training data. To provide insight into the model's ability of capturing natural biological shape variability, we carry out an analysis of specificity and generalization ability.}, language = {en} } @article{HildebrandtBrueningSchmidtetal., author = {Hildebrandt, Thomas and Bruening, Jan Joris and Schmidt, Nora Laura and Lamecker, Hans and Heppt, Werner and Zachow, Stefan and Goubergrits, Leonid}, title = {The Healthy Nasal Cavity - Characteristics of Morphology and Related Airflow Based on a Statistical Shape Model Viewed from a Surgeon's Perspective}, series = {Facial Plastic Surgery}, volume = {35}, journal = {Facial Plastic Surgery}, number = {1}, doi = {10.1055/s-0039-1677721}, pages = {9 -- 13}, abstract = {Functional surgery on the nasal framework requires referential criteria to objectively assess nasal breathing for indication and follow-up. Thismotivated us to generate amean geometry of the nasal cavity based on a statistical shape model. In this study, the authors could demonstrate that the introduced nasal cavity's mean geometry features characteristics of the inner shape and airflow, which are commonly observed in symptom-free subjects. Therefore, the mean geometry might serve as a reference-like model when one considers qualitative aspects. However, to facilitate quantitative considerations and statistical inference, further research is necessary. Additionally, the authorswere able to obtain details about the importance of the isthmus nasi and the inferior turbinate for the intranasal airstream.}, language = {en} } @article{HildebrandtBrueningLameckeretal., author = {Hildebrandt, Thomas and Bruening, Jan Joris and Lamecker, Hans and Zachow, Stefan and Heppt, Werner and Schmidt, Nora and Goubergrits, Leonid}, title = {Digital Analysis of Nasal Airflow Facilitating Decision Support in Rhinosurgery}, series = {Facial Plastic Surgery}, volume = {35}, journal = {Facial Plastic Surgery}, number = {1}, doi = {10.1055/s-0039-1677720}, pages = {1 -- 8}, abstract = {Successful functional surgery on the nasal framework requires reliable and comprehensive diagnosis. In this regard, the authors introduce a new methodology: Digital Analysis of Nasal Airflow (diANA). It is based on computational fluid dynamics, a statistical shape model of the healthy nasal cavity and rhinologic expertise. diANA necessitates an anonymized tomographic dataset of the paranasal sinuses including the complete nasal cavity and, when available, clinical information. The principle of diANA is to compare the morphology and the respective airflow of an individual nose with those of a reference. This enablesmorphometric aberrations and consecutive flow field anomalies to localize and quantify within a patient's nasal cavity. Finally, an elaborated expert opinion with instructive visualizations is provided. Using diANA might support surgeons in decision-making, avoiding unnecessary surgery, gaining more precision, and target-orientation for indicated operations.}, language = {en} } @incollection{AmbellanLameckervonTycowiczetal., author = {Ambellan, Felix and Lamecker, Hans and von Tycowicz, Christoph and Zachow, Stefan}, title = {Statistical Shape Models - Understanding and Mastering Variation in Anatomy}, series = {Biomedical Visualisation}, volume = {3}, booktitle = {Biomedical Visualisation}, number = {1156}, editor = {Rea, Paul M.}, edition = {1}, publisher = {Springer Nature Switzerland AG}, isbn = {978-3-030-19384-3}, doi = {10.1007/978-3-030-19385-0_5}, pages = {67 -- 84}, abstract = {In our chapter we are describing how to reconstruct three-dimensional anatomy from medical image data and how to build Statistical 3D Shape Models out of many such reconstructions yielding a new kind of anatomy that not only allows quantitative analysis of anatomical variation but also a visual exploration and educational visualization. Future digital anatomy atlases will not only show a static (average) anatomy but also its normal or pathological variation in three or even four dimensions, hence, illustrating growth and/or disease progression. Statistical Shape Models (SSMs) are geometric models that describe a collection of semantically similar objects in a very compact way. SSMs represent an average shape of many three-dimensional objects as well as their variation in shape. The creation of SSMs requires a correspondence mapping, which can be achieved e.g. by parameterization with a respective sampling. If a corresponding parameterization over all shapes can be established, variation between individual shape characteristics can be mathematically investigated. We will explain what Statistical Shape Models are and how they are constructed. Extensions of Statistical Shape Models will be motivated for articulated coupled structures. In addition to shape also the appearance of objects will be integrated into the concept. Appearance is a visual feature independent of shape that depends on observers or imaging techniques. Typical appearances are for instance the color and intensity of a visual surface of an object under particular lighting conditions, or measurements of material properties with computed tomography (CT) or magnetic resonance imaging (MRI). A combination of (articulated) statistical shape models with statistical models of appearance lead to articulated Statistical Shape and Appearance Models (a-SSAMs).After giving various examples of SSMs for human organs, skeletal structures, faces, and bodies, we will shortly describe clinical applications where such models have been successfully employed. Statistical Shape Models are the foundation for the analysis of anatomical cohort data, where characteristic shapes are correlated to demographic or epidemiologic data. SSMs consisting of several thousands of objects offer, in combination with statistical methods ormachine learning techniques, the possibility to identify characteristic clusters, thus being the foundation for advanced diagnostic disease scoring.}, language = {en} } @article{AlHajjSahuLamardetal., author = {Al Hajj, Hassan and Sahu, Manish and Lamard, Mathieu and Conze, Pierre-Henri and Roychowdhury, Soumali and Hu, Xiaowei and Marsalkaite, Gabija and Zisimopoulos, Odysseas and Dedmari, Muneer Ahmad and Zhao, Fenqiang and Prellberg, Jonas and Galdran, Adrian and Araujo, Teresa and Vo, Duc My and Panda, Chandan and Dahiya, Navdeep and Kondo, Satoshi and Bian, Zhengbing and Bialopetravicius, Jonas and Qiu, Chenghui and Dill, Sabrina and Mukhopadyay, Anirban and Costa, Pedro and Aresta, Guilherme and Ramamurthy, Senthil and Lee, Sang-Woong and Campilho, Aurelio and Zachow, Stefan and Xia, Shunren and Conjeti, Sailesh and Armaitis, Jogundas and Heng, Pheng-Ann and Vahdat, Arash and Cochener, Beatrice and Quellec, Gwenole}, title = {CATARACTS: Challenge on Automatic Tool Annotation for cataRACT Surgery}, series = {Medical Image Analysis}, volume = {52}, journal = {Medical Image Analysis}, number = {2}, publisher = {Elsevier}, doi = {10.1016/j.media.2018.11.008}, pages = {24 -- 41}, abstract = {Surgical tool detection is attracting increasing attention from the medical image analysis community. The goal generally is not to precisely locate tools in images, but rather to indicate which tools are being used by the surgeon at each instant. The main motivation for annotating tool usage is to design efficient solutions for surgical workflow analysis, with potential applications in report generation, surgical training and even real-time decision support. Most existing tool annotation algorithms focus on laparoscopic surgeries. However, with 19 million interventions per year, the most common surgical procedure in the world is cataract surgery. The CATARACTS challenge was organized in 2017 to evaluate tool annotation algorithms in the specific context of cataract surgery. It relies on more than nine hours of videos, from 50 cataract surgeries, in which the presence of 21 surgical tools was manually annotated by two experts. With 14 participating teams, this challenge can be considered a success. As might be expected, the submitted solutions are based on deep learning. This paper thoroughly evaluates these solutions: in particular, the quality of their annotations are compared to that of human interpretations. Next, lessons learnt from the differential analysis of these solutions are discussed. We expect that they will guide the design of efficient surgery monitoring tools in the near future.}, language = {en} } @misc{TackZachow, author = {Tack, Alexander and Zachow, Stefan}, title = {Accurate Automated Volumetry of Cartilage of the Knee using Convolutional Neural Networks: Data from the Osteoarthritis Initiative}, issn = {1438-0064}, url = {http://nbn-resolving.de/urn:nbn:de:0297-zib-71439}, abstract = {Volumetry of the cartilage of the knee, as needed for the assessment of knee osteoarthritis (KOA), is typically performed in a tedious and subjective process. We present an automated segmentation-based method for the quantification of cartilage volume by employing 3D Convolutional Neural Networks (CNNs). CNNs were trained in a supervised manner using magnetic resonance imaging data as well as cartilage volumetry readings given by clinical experts for 1378 subjects. It was shown that 3D CNNs can be employed for cartilage volumetry with an accuracy similar to expert volumetry readings. In future, accurate automated cartilage volumetry might support both, diagnosis of KOA as well as assessment of KOA progression via longitudinal analysis.}, language = {en} } @misc{AmbellanTackEhlkeetal., author = {Ambellan, Felix and Tack, Alexander and Ehlke, Moritz and Zachow, Stefan}, title = {Automated Segmentation of Knee Bone and Cartilage combining Statistical Shape Knowledge and Convolutional Neural Networks: Data from the Osteoarthritis Initiative}, issn = {1438-0064}, url = {http://nbn-resolving.de/urn:nbn:de:0297-zib-72704}, abstract = {We present a method for the automated segmentation of knee bones and cartilage from magnetic resonance imaging (MRI) that combines a priori knowledge of anatomical shape with Convolutional Neural Networks (CNNs).The proposed approach incorporates 3D Statistical Shape Models (SSMs) as well as 2D and 3D CNNs to achieve a robust and accurate segmentation of even highly pathological knee structures.The shape models and neural networks employed are trained using data from the Osteoarthritis Initiative (OAI) and the MICCAI grand challenge "Segmentation of Knee Images 2010" (SKI10), respectively. We evaluate our method on 40 validation and 50 submission datasets from the SKI10 challenge.For the first time, an accuracy equivalent to the inter-observer variability of human readers is achieved in this challenge.Moreover, the quality of the proposed method is thoroughly assessed using various measures for data from the OAI, i.e. 507 manual segmentations of bone and cartilage, and 88 additional manual segmentations of cartilage. Our method yields sub-voxel accuracy for both OAI datasets. We make the 507 manual segmentations as well as our experimental setup publicly available to further aid research in the field of medical image segmentation.In conclusion, combining localized classification via CNNs with statistical anatomical knowledge via SSMs results in a state-of-the-art segmentation method for knee bones and cartilage from MRI data.}, language = {en} } @misc{AmbellanTackEhlkeetal., author = {Ambellan, Felix and Tack, Alexander and Ehlke, Moritz and Zachow, Stefan}, title = {Automated Segmentation of Knee Bone and Cartilage combining Statistical Shape Knowledge and Convolutional Neural Networks: Data from the Osteoarthritis Initiative (Supplementary Material)}, series = {Medical Image Analysis}, volume = {52}, journal = {Medical Image Analysis}, number = {2}, doi = {10.12752/4.ATEZ.1.0}, pages = {109 -- 118}, abstract = {We present a method for the automated segmentation of knee bones and cartilage from magnetic resonance imaging that combines a priori knowledge of anatomical shape with Convolutional Neural Networks (CNNs). The proposed approach incorporates 3D Statistical Shape Models (SSMs) as well as 2D and 3D CNNs to achieve a robust and accurate segmentation of even highly pathological knee structures. The shape models and neural networks employed are trained using data of the Osteoarthritis Initiative (OAI) and the MICCAI grand challenge "Segmentation of Knee Images 2010" (SKI10), respectively. We evaluate our method on 40 validation and 50 submission datasets of the SKI10 challenge. For the first time, an accuracy equivalent to the inter-observer variability of human readers has been achieved in this challenge. Moreover, the quality of the proposed method is thoroughly assessed using various measures for data from the OAI, i.e. 507 manual segmentations of bone and cartilage, and 88 additional manual segmentations of cartilage. Our method yields sub-voxel accuracy for both OAI datasets. We made the 507 manual segmentations as well as our experimental setup publicly available to further aid research in the field of medical image segmentation. In conclusion, combining statistical anatomical knowledge via SSMs with the localized classification via CNNs results in a state-of-the-art segmentation method for knee bones and cartilage from MRI data.}, language = {en} } @article{AmbellanTackEhlkeetal., author = {Ambellan, Felix and Tack, Alexander and Ehlke, Moritz and Zachow, Stefan}, title = {Automated Segmentation of Knee Bone and Cartilage combining Statistical Shape Knowledge and Convolutional Neural Networks: Data from the Osteoarthritis Initiative}, series = {Medical Image Analysis}, volume = {52}, journal = {Medical Image Analysis}, number = {2}, doi = {10.1016/j.media.2018.11.009}, pages = {109 -- 118}, abstract = {We present a method for the automated segmentation of knee bones and cartilage from magnetic resonance imaging that combines a priori knowledge of anatomical shape with Convolutional Neural Networks (CNNs). The proposed approach incorporates 3D Statistical Shape Models (SSMs) as well as 2D and 3D CNNs to achieve a robust and accurate segmentation of even highly pathological knee structures. The shape models and neural networks employed are trained using data of the Osteoarthritis Initiative (OAI) and the MICCAI grand challenge "Segmentation of Knee Images 2010" (SKI10), respectively. We evaluate our method on 40 validation and 50 submission datasets of the SKI10 challenge. For the first time, an accuracy equivalent to the inter-observer variability of human readers has been achieved in this challenge. Moreover, the quality of the proposed method is thoroughly assessed using various measures for data from the OAI, i.e. 507 manual segmentations of bone and cartilage, and 88 additional manual segmentations of cartilage. Our method yields sub-voxel accuracy for both OAI datasets. We made the 507 manual segmentations as well as our experimental setup publicly available to further aid research in the field of medical image segmentation. In conclusion, combining statistical anatomical knowledge via SSMs with the localized classification via CNNs results in a state-of-the-art segmentation method for knee bones and cartilage from MRI data.}, language = {en} } @article{AkbariShandizBoulosSavarssonetal.2017, author = {Akbari Shandiz, Mohsen and Boulos, Paul and S{\ae}varsson, Stefan and Ramm, Heiko and Fu, Chun Kit and Miller, Stephen and Zachow, Stefan and Anglin, Carolyn}, title = {Changes in Knee Shape and Geometry Resulting from Total Knee Arthroplasty}, series = {Journal of Engineering in Medicine}, volume = {232}, journal = {Journal of Engineering in Medicine}, number = {1}, doi = {10.1177/0954411917743274}, pages = {67 -- 79}, year = {2017}, abstract = {Changes in knee shape and geometry resulting from total knee arthroplasty can affect patients in numerous important ways: pain, function, stability, range of motion, and kinematics. Quantitative data concerning these changes have not been previously available, to our knowledge, yet are essential to understand individual experiences of total knee arthroplasty and thereby improve outcomes for all patients. The limiting factor has been the challenge of accurately measuring these changes. Our study objective was to develop a conceptual framework and analysis method to investigate changes in knee shape and geometry, and prospectively apply it to a sample total knee arthroplasty population. Using clinically available computed tomography and radiography imaging systems, the three-dimensional knee shape and geometry of nine patients (eight varus and one valgus) were compared before and after total knee arthroplasty. All patients had largely good outcomes after their total knee arthroplasty. Knee shape changed both visually and numerically. On average, the distal condyles were slightly higher medially and lower laterally (range: +4.5 mm to -4.4 mm), the posterior condyles extended farther out medially but not laterally (range: +1.8 to -6.4 mm), patellofemoral distance increased throughout flexion by 1.8-3.5 mm, and patellar thickness alone increased by 2.9 mm (range: 0.7-5.2 mm). External femoral rotation differed preop and postop. Joint line distance, taking cartilage into account, changed by +0.7 to -1.5 mm on average throughout flexion. Important differences in shape and geometry were seen between pre-total knee arthroplasty and post-total knee arthroplasty knees. While this is qualitatively known, this is the first study to report it quantitatively, an important precursor to identifying the reasons for the poor outcome of some patients. Using the developed protocol and visualization techniques to compare patients with good versus poor clinical outcomes could lead to changes in implant design, implant selection, component positioning, and surgical technique. Recommendations based on this sample population are provided. Intraoperative and postoperative feedback could ultimately improve patient satisfaction.}, language = {en} }