A longitudinal pilot study to compare, in children with reduced overbite malocclusions associated with oral habits (finger-sucking and tongue-thrusting), the effects of the experimental Myofunctional Trainer (MFT; Myofunctional Research Co.) and the conventional Bluegrass appliance (BG) on dento-alveolar relations, tongue position, and on speech. Methods: The experimental group received the MFT appliance while the control group received the BG appliance. Dento-alveolar changes were assessed by cephalometry and study models. Longitudinal midsagittal 2-dimensional B-mode ultrasound scans of the tongue surface were performed to determine tongue position. Speech acceptability tests were also performed. Results & Conclusions: The BG appliance was successful in breaking the finger-sucking habit. The MFT appliance showed only partial success which could be attributed to lack of compliance. At the end of treatment, the open bite was reduced in both groups due to dento-alveolar changes. The BG appliance had a deleterious effect on speech acceptability while in place, while there was no such effect with the MFT appliance.

A longitudinal pilot study to compare, in children with reduced overbite malocclusions associated with oral habits (finger-sucking and tongue-thrusting), the effects of the experimental Myofunctional Trainer (MFT; Myofunctional Research Co.) and the conventional Bluegrass appliance (BG) on dento-alveolar relations, tongue position, and on speech. Methods: The experimental group received the MFT appliance while the control group received the BG appliance. Dento-alveolar changes were assessed by cephalometry and study models. Longitudinal midsagittal 2-dimensional B-mode ultrasound scans of the tongue surface were performed to determine tongue position. Speech acceptability tests were also performed. Results & Conclusions: The BG appliance was successful in breaking the finger-sucking habit. The MFT appliance showed only partial success which could be attributed to lack of compliance. At the end of treatment, the open bite was reduced in both groups due to dento-alveolar changes. The BG appliance had a deleterious effect on speech acceptability while in place, while there was no such effect with the MFT appliance.

An adequate vascular perfusion status is essential not only to maintain life, but to ensure the proper physiology of the different systems that form the animal’s body. Due to its role in the transport of oxygen and nutrients toward, and the removal of cellular waste products away from the body’s tissues, the circulatory system is responsible for the maintenance of body homeostasis. Production related functions in farm animals are not an exception, and directly depend on sufficient vascular physiology. In the past, the study of blood flow in large domestic species was restricted to highly invasive techniques. However, even when such techniques are the foundation for the actual understanding of vascular dynamics in these animals, their limited feasibility and potential impact over the normal vascular physiology represent significant limitations to these approaches. Recently, the development and application of non-invasive technologies (i.e., Doppler and B- mode ultrasound) to the area of animal sciences has provided the potential for the study of vascular dynamics while, the negative implications aforementioned are avoided. In our studies, these technologies were applied to assess the role of the circulatory system on different production related variables such as: temperament, reproduction, and milk production in the bovine. A tendency toward differences in jugular blood flow was associated with the temperament in beef calves in this study. Also, a significant increase in vasodilation in the uterine arteries of beef cows was found to be associated with a numerically higher reproductive efficiency (i.e., pregnancy rates). Moreover, an increase in blood flow towards the mammary gland in dairy cows was associated with administration of bovine somatotropin. In conclusion, B- mode and Doppler ultrasound resulted in tools able to reflect the essential role of an adequate vascular perfusion in the normal physiology and productive performance in the bovine. However, in real farm scenarios the feasibility of these techniques in large domestic species is limited. Therefore, further specialization of this instrument to the conditions existent in such farm scenarios are recommended to improve its feasibility and to significantly accelerate the rate of knowledge acquisition in this area.

Muitos procedimentos vêm sendo desenvolvidos para auxiliar no diagnóstico precoce do câncer de mama. Devido a subjetividade na interpretação de imagens, os sistemas de diagnóstico auxiliado por computador (CADx) têm oferecido ao especialista uma segunda opinião mais precisa e confiável. Nesse propósito, essa pesquisa apresenta uma metodologia de investigação da potencialidade diagnóstica de um sistema computacional na classificação de achados suspeitos em imagens de ultrassom modo-B e de elastografia da mama. A base de dados foi constituída por 31 lesões malignas e 52 benignas e um conjunto adicional contendo 206 lesões de ultrassom modo-B (144 benignas e 62 malignas) para a realização dos testes de aprendizado de máquina. O contorno foi determinado automaticamente e através do delineamento manual de três radiologistas sob a imagem de ultrassom modo-B e, em seguida, mapeado na imagem elastográfica. As lesões foram classificadas pelo sistema CADx desenvolvido para ultrassom modo-B e elastografia do tipo strain. Os dados foram avaliados por meio da sensibilidade, especificidade e AUC. O sistema CADx desenvolvido proporcionou equivalência diagnóstica para a classificação das lesões a partir das diversas formas de determinação do contorno (manual e automática), permitindo a redução da variabilidade. Além disso, o sistema apontou resultados superiores à análise visual do radiologista que, quando considerado o resultado fornecido pela associação entre as imagens de ultrassom modo-B e elastografia, proporcionou um aumento comparativo de cerca de 7% em sensibilidade e 17,2% em especificidade nos testes com o sistema CADx usando o contorno feito pelo radiologista mais experiente. Além disso, constatou-se uma influência positiva no uso da ferramenta computacional pelos radiologistas, pois, na média, seus índices de sensibilidade e especificidade diagnóstica aumentaram também em relação à situação de análise convencional, passando de 87,1% e 55,8% para 90,3% e 73,1%, respectivamente. / Many procedures have been developed to aid in the early detection and diagnosis of breast cancer. In this context, Computer-Aided Diagnosis (CADx) systems were designed to provide to the specialist a reliable second opinion. This study presents the proposal of investigating the diagnostic ability of a computational system in the characterization of suspicious findings in B-mode ultrasound and breast elastography imaging. The database consisted of 31 malignant and 52 benign lesions and an additional data set containing 206 lesions (144 benign and 62 malignant) seen only on the B-mode ultrasound for performing the machine learning tests. Three radiologists drew manually the contour of the lesions in B-mode ultrasound and we used an automatic technique to segment the lesions. Then, the contour was mapped in the elastography image. The lesions were classified using the CADx system developed for B-mode ultrasound and strain elastography. We calculated the sensitivity, specificity and AUC to evaluate the data. The developed CADx system provided a diagnostic concordance in the classification of breast lesions from the different ways of contour determination (manual and automatic), allowing to reduce the diagnostic variability. In addition, the CADx system showed superior results to the visual analysis of the radiologist. When the radiologist associated both examinations (B-mode ultrasound and elastography), his visual analysis provided 87.10%, 55.77% and 0.714 of sensitivity, specificity and AUC, respectively. When we considered the result provided by the association between B-mode ultrasound and elastography images, the CADx system provided a comparative increase of about 7% of sensitivity and 17.2% of specificity, using the contour delimited by the most experienced radiologist. In addition, a positive influence was observed in the use of the computational tool by radiologists, since, on average, their sensitivity and specificity indexes also increased in relation to the conventional analysis, from 87.1% and 55.8% to 90.3% and 73.1%, respectively.

Muitos procedimentos vêm sendo desenvolvidos para auxiliar no diagnóstico precoce do câncer de mama. Devido a subjetividade na interpretação de imagens, os sistemas de diagnóstico auxiliado por computador (CADx) têm oferecido ao especialista uma segunda opinião mais precisa e confiável. Nesse propósito, essa pesquisa apresenta uma metodologia de investigação da potencialidade diagnóstica de um sistema computacional na classificação de achados suspeitos em imagens de ultrassom modo-B e de elastografia da mama. A base de dados foi constituída por 31 lesões malignas e 52 benignas e um conjunto adicional contendo 206 lesões de ultrassom modo-B (144 benignas e 62 malignas) para a realização dos testes de aprendizado de máquina. O contorno foi determinado automaticamente e através do delineamento manual de três radiologistas sob a imagem de ultrassom modo-B e, em seguida, mapeado na imagem elastográfica. As lesões foram classificadas pelo sistema CADx desenvolvido para ultrassom modo-B e elastografia do tipo strain. Os dados foram avaliados por meio da sensibilidade, especificidade e AUC. O sistema CADx desenvolvido proporcionou equivalência diagnóstica para a classificação das lesões a partir das diversas formas de determinação do contorno (manual e automática), permitindo a redução da variabilidade. Além disso, o sistema apontou resultados superiores à análise visual do radiologista que, quando considerado o resultado fornecido pela associação entre as imagens de ultrassom modo-B e elastografia, proporcionou um aumento comparativo de cerca de 7% em sensibilidade e 17,2% em especificidade nos testes com o sistema CADx usando o contorno feito pelo radiologista mais experiente. Além disso, constatou-se uma influência positiva no uso da ferramenta computacional pelos radiologistas, pois, na média, seus índices de sensibilidade e especificidade diagnóstica aumentaram também em relação à situação de análise convencional, passando de 87,1% e 55,8% para 90,3% e 73,1%, respectivamente. / Many procedures have been developed to aid in the early detection and diagnosis of breast cancer. In this context, Computer-Aided Diagnosis (CADx) systems were designed to provide to the specialist a reliable second opinion. This study presents the proposal of investigating the diagnostic ability of a computational system in the characterization of suspicious findings in B-mode ultrasound and breast elastography imaging. The database consisted of 31 malignant and 52 benign lesions and an additional data set containing 206 lesions (144 benign and 62 malignant) seen only on the B-mode ultrasound for performing the machine learning tests. Three radiologists drew manually the contour of the lesions in B-mode ultrasound and we used an automatic technique to segment the lesions. Then, the contour was mapped in the elastography image. The lesions were classified using the CADx system developed for B-mode ultrasound and strain elastography. We calculated the sensitivity, specificity and AUC to evaluate the data. The developed CADx system provided a diagnostic concordance in the classification of breast lesions from the different ways of contour determination (manual and automatic), allowing to reduce the diagnostic variability. In addition, the CADx system showed superior results to the visual analysis of the radiologist. When the radiologist associated both examinations (B-mode ultrasound and elastography), his visual analysis provided 87.10%, 55.77% and 0.714 of sensitivity, specificity and AUC, respectively. When we considered the result provided by the association between B-mode ultrasound and elastography images, the CADx system provided a comparative increase of about 7% of sensitivity and 17.2% of specificity, using the contour delimited by the most experienced radiologist. In addition, a positive influence was observed in the use of the computational tool by radiologists, since, on average, their sensitivity and specificity indexes also increased in relation to the conventional analysis, from 87.1% and 55.8% to 90.3% and 73.1%, respectively.

Une interface vocale silencieuse (SSI) est un système permettant une communication vocale à partir d’un signal non audible. Un tel système emploie des capteurs qui enregistrent des données non-acoustiques, pour la reconnaissance et la synthèse vocales. Cependant, l’extraction des caractéristiques articulatoires robustes à partir de ces signaux reste un défi. La langue est une composante majeure de l'appareil vocal, et l'articulateur le plus important dans la production de parole. Une simulation réaliste du mouvement de la langue en 3D peut fournir une représentation visuelle directe et efficace de la production de parole. Cette représentation pourrait à son tour être utilisée pour améliorer les performances de reconnaissance vocale d'un SSI, ou servir d'outil dans le cadre de recherches sur la production de parole et de l'étude des troubles de l'articulation. Dans cette thèse, nous explorons un nouveau cadre de visualisation en trois dimensions de la langue, qui combine l'imagerie échographique 2D et une technique de modélisation tridimensionnelle fondée sur la physique. Tout d'abord, différentes approches sont utilisées pour suivre le mouvement de la langue dans les séquences d'images échographiques, qui peuvent être regroupées en deux principaux types de méthodes : le suivi de la granularité et le suivi de contour. Les méthodes de suivi du chatoiement (speckle tracking) comprennent le recalage de déformations (deformation registration), le flux optique, et la méthode de transformation de caractéristiques visuelles invariante à l'échelle (Scale-invariant feature transform, ou SIFT). En outre, une méthode de suivi réinitialisation basée sur l'image est proposée afin d'améliorer la robustesse du suivi du chatoiement. En comparaison avec le suivi de chatoiement, l'extraction du contour de la surface de la langue à partir d'images échographiques présente des performances supérieures et une meilleure robustesse. Dans cette thèse, un nouvel algorithme de suivi de contour est présenté pour des séquences d'images échographiques de la langue. Cet algorithme permet de suivre le mouvement des contours de la langue sur de longues durées avec une bonne robustesse. Pour résoudre la difficulté causée par les segments manquants dus au bruit ou celle causée par la surface mi-sagittale de la langue qui est parallèle à la direction de propagation de l'onde ultrasonore, nous proposons d’utiliser des contours actifs avec une contrainte de similitude de contour, qui fournissent des informations a priori sur la forme de la langue. Des expériences sur des données synthétiques et sur des images réelles acquises sur différents sujets à la cadence de 60 images par seconde montrent que la méthode proposée donne un bon contour de suivi pour ultrasons des séquences d'images, même sur des durées de quelques minutes. Cette technique peut par conséquent être utile dans des applications telles que la reconnaissance vocale où de très longues séquences doivent être analysées dans leur intégralité… / A silent speech interface (SSI) is a system to enable speech communication with non-audible signal, that employs sensors to capture non-acoustic features for speech recognition and synthesis. Extracting robust articulatory features from such signals, however, remains a challenge. As the tongue is a major component of the vocal tract, and the most important articulator during speech production, a realistic simulation of tongue motion in 3D can provide a direct, effective visual representation of speech production. This representation could in turn be used to improve the performance of speech recognition of an SSI, or serve as a tool for speech production research and the study of articulation disorders. In this thesis, we explore a novel 3D tongue visualization framework, which combines the 2D ultrasound imaging and 3D physics-based modeling technique. Firstly, different approaches are employed to follow the motion of the tongue in the ultrasound image sequences, which can be divided into two main types of methods: speckle tracking and contour tracking. The methods to track speckles include deformation registration, optical-flow, and local invariant features-based method. Moreover, an image-based tracking re-initialization method is proposed to improve the robustness of speckle tracking. Compared to speckle tracking, the extraction of the contour of the tongue surface from ultrasound images exhibits superior performance and robustness. In this thesis, a novel contour-tracking algorithm is presented for ultrasound tongue image sequences, which can follow the motion of tongue contours over long durations with good robustness. To cope with missing segments caused by noise, or by the tongue midsagittal surface being parallel to the direction of ultrasound wave propagation, active contours with a contour-similarity constraint are introduced, which can be used to provide “prior” shape information. Experiments on synthetic data and on real 60 frame per second data from different subjects demonstrate that the proposed method gives good contour tracking for ultrasound image sequences even over durations of minutes, which can be useful in applications such as speech recognition where very long sequences must be analyzed in their entirety…

No campo da medicina diagnóstica através de imagens, o baixo custo e a característica não-invasiva da ultrassonografia modo-B favoreceram as pesquisas que analisam a relação entre a espessura íntima-média (EIM) da artéria carótida e o desenvolvimento de doenças cardiovasculares. Outra técnica de ultrassonografia, baseada no efeito Doppler, também tem sido extensivamente empregada em ambientes clínicos para a medição da velocidade e do fluxo de sangue das artérias periféricas, oferecendo uma abordagem distinta para estudar as doenças cardiovasculares. Neste trabalho, métodos computacionais foram implementados e analisados para extrair informações quantitativas de artérias a partir de imagens 2D. Os ensaios com imagens em modo-B contemplaram a combinação de técnicas de filtragem e algoritmos de contornos ativos para a detecção das interfaces das paredes arteriais e medições da EIM e do diâmetro da luz (DL). Um modelo matemático e 7 imagens reais da artéria carótida comum foram utilizados neste estudo que, dentre as diversas combinações de filtros e algoritmos, apresentou resultados quantitativos similares no cálculo do DL. Para a EIM, porém, a reduzida dimensão da camada íntima-média proporcionou variações indesejadas dos cálculos. Para medir a velocidade do sangue utilizando o modo Doppler, um método semiautomático foi incorporado a um aplicativo computacional para a detecção da envoltória do espectro do gráfico de velocidades. Uma análise comparativa entre sistemas de ultrassonografia comerciais operados por especialistas e este aplicativo incluiu a velocidade de pico sistólico e a integral de velocidade e tempo (VTI) das artérias carótida comum e braquial e de exames ecocardiográficos. A análise de Bland-Altman e o coeficiente de correlação validaram esta metodologia que, complementada pela interface gráfica amigável do aplicativo, pode auxiliar os clínicos em seus estudos de larga escala, baseados nas imagens Doppler ultrassonográficas, com as seguintes vantagens: redução do tempo operacional e de resultados subjetivos e aumento do grau de reprodutibilidade dos resultados. / In the field of image-based diagnostic medicine, low cost and noninvasive B-mode ultrasound technique have supported the researches which investigates the relation between the carotid intima-media thickness (IMT) and the development of cardiovascular diseases. Other ultrasound technique, that offers a different approach to study these diseases, is based on Doppler effect and has also been extensively used in clinical sites to measure blood velocity and flow in peripheral arteries. In this work, computational methods were implemented and analyzed to extract quantitative data from 2D images of arteries. Tests with B-mode images covered the combination of filtering techniques and active contour algorithms, in order to detect the arterial wall interfaces and to measure IMT and lumen diameter (LD). One mathematical model and seven real images of the common carotid artery were used in this study which, among several filters and algorithms combinations, showed similar quantitative results for DL measurements. However, for IMT, the small thickness of intima-media layer led to undesirable variation results. To measure blood velocity by using Doppler mode, a semi-automatic methodology was implemented in a computational tool to detect the spectrum envelope of the velocity graphic. A comparative analysis between commercial ultrasound systems operated by specialists and this tool included systolic peak velocities and velocity-time integral (VTI) of the common carotid and brachial arteries and of echocardiographic exams. Bland-Altmans analysis and the correlation coefficient validated this methodology which, besides the user friendly graphical interface of the tool, may help the clinicians for their large-scale studies based on Doppler ultrasound images, with the following advantages: to save operational time, to lower subjective results, and to support measurement reproducibility.

No campo da medicina diagnóstica através de imagens, o baixo custo e a característica não-invasiva da ultrassonografia modo-B favoreceram as pesquisas que analisam a relação entre a espessura íntima-média (EIM) da artéria carótida e o desenvolvimento de doenças cardiovasculares. Outra técnica de ultrassonografia, baseada no efeito Doppler, também tem sido extensivamente empregada em ambientes clínicos para a medição da velocidade e do fluxo de sangue das artérias periféricas, oferecendo uma abordagem distinta para estudar as doenças cardiovasculares. Neste trabalho, métodos computacionais foram implementados e analisados para extrair informações quantitativas de artérias a partir de imagens 2D. Os ensaios com imagens em modo-B contemplaram a combinação de técnicas de filtragem e algoritmos de contornos ativos para a detecção das interfaces das paredes arteriais e medições da EIM e do diâmetro da luz (DL). Um modelo matemático e 7 imagens reais da artéria carótida comum foram utilizados neste estudo que, dentre as diversas combinações de filtros e algoritmos, apresentou resultados quantitativos similares no cálculo do DL. Para a EIM, porém, a reduzida dimensão da camada íntima-média proporcionou variações indesejadas dos cálculos. Para medir a velocidade do sangue utilizando o modo Doppler, um método semiautomático foi incorporado a um aplicativo computacional para a detecção da envoltória do espectro do gráfico de velocidades. Uma análise comparativa entre sistemas de ultrassonografia comerciais operados por especialistas e este aplicativo incluiu a velocidade de pico sistólico e a integral de velocidade e tempo (VTI) das artérias carótida comum e braquial e de exames ecocardiográficos. A análise de Bland-Altman e o coeficiente de correlação validaram esta metodologia que, complementada pela interface gráfica amigável do aplicativo, pode auxiliar os clínicos em seus estudos de larga escala, baseados nas imagens Doppler ultrassonográficas, com as seguintes vantagens: redução do tempo operacional e de resultados subjetivos e aumento do grau de reprodutibilidade dos resultados. / In the field of image-based diagnostic medicine, low cost and noninvasive B-mode ultrasound technique have supported the researches which investigates the relation between the carotid intima-media thickness (IMT) and the development of cardiovascular diseases. Other ultrasound technique, that offers a different approach to study these diseases, is based on Doppler effect and has also been extensively used in clinical sites to measure blood velocity and flow in peripheral arteries. In this work, computational methods were implemented and analyzed to extract quantitative data from 2D images of arteries. Tests with B-mode images covered the combination of filtering techniques and active contour algorithms, in order to detect the arterial wall interfaces and to measure IMT and lumen diameter (LD). One mathematical model and seven real images of the common carotid artery were used in this study which, among several filters and algorithms combinations, showed similar quantitative results for DL measurements. However, for IMT, the small thickness of intima-media layer led to undesirable variation results. To measure blood velocity by using Doppler mode, a semi-automatic methodology was implemented in a computational tool to detect the spectrum envelope of the velocity graphic. A comparative analysis between commercial ultrasound systems operated by specialists and this tool included systolic peak velocities and velocity-time integral (VTI) of the common carotid and brachial arteries and of echocardiographic exams. Bland-Altmans analysis and the correlation coefficient validated this methodology which, besides the user friendly graphical interface of the tool, may help the clinicians for their large-scale studies based on Doppler ultrasound images, with the following advantages: to save operational time, to lower subjective results, and to support measurement reproducibility.

Σε αυτή την εργασία παρουσιάζεται μια πλήρως αυτοματοποιημένη μεθοδολογία κατάτμησης για την ανίχνευση των ορίων του αρτηριακού τοιχώματος σε διαμήκεις εικόνες καρωτίδας β-σάρωσης. Συγκεκριμένα υλοποιείται ένας συνδυασμός της μεθοδολογίας του μετασχηματισμού Hough για την ανίχνευση ευθειών με μια μεθοδολογία ενεργών καμπυλών. Η μεθοδολογία του μετασχηματισμού Hough χρησιμοποιείται για τον ορισμό της αρχικής καμπύλης, η οποία στη συνέχεια παραμορφώνεται σύμφωνα με ένα μοντέλο ενεργών καμπυλών βασισμένων σε πεδίο ροής του διανύσματος κλίσης (Gradient Vector Flow - GVF). Το GVF μοντέλο ενεργών καμπυλών βασίζεται στον υπολογισμό του χάρτη ακμών της εικόνας και τον μετέπειτα υπολογισμό του διανυσματικού πεδίου ροής κλίσης, το οποίο με τη σειρά του προκαλεί την παραμόρφωση της αρχικής καμπύλης με σκοπό την εκτίμηση των πραγματικών ορίων του αρτηριακού τοιχώματος. Η προτεινόμενη μεθοδολογία εφαρμόστηκε σε είκοσι (20) εικόνες υγιών περιπτώσεων και δεκαοχτώ (18) εικόνες περιπτώσεων με αθηρωμάτωση για τον υπολογισμό της διαμέτρου του αυλού και την αξιολόγηση της μεθόδου από ποσοτικούς δείκτες ανάλυσης κατά ROC (Receiver Operating Characteristic – ROC). Σύμφωνα με τα αποτελέσματα, δεν παρατηρήθηκαν στατιστικά σημαντικές διαφορές ανάμεσα στις μετρήσεις της διαμέτρου που πραγματοποιήθηκαν από τη διαδικασία της αυτόματης ανίχνευσης και τις αντίστοιχες μετρήσεις που προέκυψαν από την χειροκίνητη ανίχνευση. Οι τιμές της ευαισθησίας, της ειδικότητας και της ακρίβειας στις υγιείς περιπτώσεις ήταν αντίστοιχα 0.97, 0.99 και 0.98 για τις διαστολικές και τις συστολικές εικόνες. Στις παθολογικές περιπτώσεις οι αντίστοιχες τιμές ήταν μεγαλύτερες από 0.89, 0.96 και 0.93. Συμπερασματικά, η προτεινόμενη μεθοδολογία αποτελεί μια ακριβή και αξιόπιστη μέθοδο κατάτμησης εικόνων καρωτίδας και μπορεί να χρησιμοποιηθεί στην κλινική πράξη. / In this thesis, a fully automatic segmentation method based on a combination of a combination of the Hough Transform for the detection of straight lines with active contours is presented, for detecting the carotid artery wall in longitudinal B-mode ultrasound images. A Hough-transform-based methodology is used for the definition of the initial snake, followed by a gradient vector flow (GVF) snake deformation. The GVF snake is based on the calculation of the image edge map and the calculation of the gradient vector flow field which guides its deformation for the estimation of the real arterial wall boundaries. The proposed methodology was applied in twenty and eighteen cases of healthy and atherosclerotic carotid respectively, in order to calculate the lumen diameter and evaluate the method by means of ROC analysis (Receiver Operating Characteristic – ROC). According to the results, there was no significant difference between the automated segmentation and the manual diameter measurements. In healthy cases the sensitivity, specificity and accuracy were 0.97, 0.99 and 0.98, respectively, for both diastolic and systolic phase. In atherosclerotic cases the calculated values of the indices were larger than 0.89, 0.96 and 0.93, respectively. In conclusion, the proposed methodology provides an accurate and reliable way to segment ultrasound images of the carotid wall and can be used in clinical practice.