The diploma thesis deals with registration and analysis of images from the experimental low-cost fundus camera that reaches a low SNR (around 10 dB) and low temporal and spatial resolution. The aim of the diploma tesis is to explore the possibilities of digital processing leading to the creation of a videosequence that has real benefits for medical diagnostics. The well-known program elastix is used for registration. Preprocessing filters and interpolation are implemented in Matlab. The program provides a wide range of setting options, out of which many combinations were tested and evaluated. To assess the accuracy achieved, spatial variations in the detected motion of blood-vessels are evaluated. Best results with a precision below 0.3 px were achieved by using a band-pass filter, a~suitably sized mask, rigid registration and a metric of the mutual information. Test sequences were registered precisely enough both for visual assessment and basic computational analysis. Registered sequences and the developed application that both can be used in the further development of the experimental camera are the main contributions of the diploma thesis.

Image registration is widely used in clinical practice. However image registration and its~evaluation is still challenging especially with regards to new possibilities of various modalities. One of these areas is contrast-enhanced ultrasound imaging. The time-dependent image contrast, low signal-to-noise ratio and specific speckle pattern make preprocessing and image registration difficult. In this thesis a method for registration of images in ultrasound contrast-enhanced sequences is proposed. The method is based on automatic fragmentation into image subsequences in which the images with similar characteristics are registered. The new evaluation method based on comparison of perfusion model is proposed. Registration and evaluation method was tested on a flow phantom and real patient data and compared with a standard methods proposed i literature. The second part of this thesis contains examples of application of image registration in~ophthalmology and proposition for its improvement. In this area the image registration methods are widely used, especially landmark based image registration method. In this thesis methods for landmark detection and its correspondence estimation are proposed.

Diabetic retinopathy and age-related macular degeneration are two of the most common retinal diseases in these days, which can lead to partial or full loss of sight. Due to it, it is necessary to create new approaches enabling to detect these diseases and inform the patient about his condition in advance. The main objective of this work is to design and to implement an algorithm for retinal diseases classification based on images of the patient's retina of previously mentioned diseases. In the first part of this work, there is described in detail each stage of each disease and its the most frequent symptoms. In this thesis, there is also a chapter about fundus camera, which is a tool for image creation of human eye retina. In the second part of this thesis, there is proposed an approach for classification of diabetic retinopathy and age-related macular degeneration. There is also a chapter about algorithmic methods which can be used for image processing and object detection in image. The last part of this thesis contains the test results and their evaluation. Assessment of success of proposed and implemented methods is also part of this chapter.

Bakgrund: Diabetesretinopati är den vanligaste ögonsjukdomen hos personer med diabetes och är en ledande orsak till synnedsättning och blindhet världen över. Patienter som har diabetesretinopati kan vara symptomfria och patienten märker inte att han/hon är drabbad. Det är därför viktigt att patienter som har diabetes screenas regelbundet för att synhotande diabetesretinopati ska upptäckas i ett tidigt stadium så att rätt behandling kan sättas in för att undvika synnedsättning. Syfte: Syftet med studien var att belysa ögonsjuksköterskans uppfattning av olika faktorer som påverkar diabetespatientens följsamhet till ögonbottenfotografering. Metod: En kvalitativ metod med en fenomenografisk ansats användes i studien. Studien har genomförts genom åtta intervjuer med ögonsjuksköterskor på två olika ögonmottagningar i södra Sverige. Resultat: Dataanalysen mynnade ut i fyra olika beskrivningskategorier: Patientens förståelse för sjukdomen, Patientens hälsa och syn, Ögonsjuksköterskans tid med patienten samt Generella hinder. Slutsats: Under studien framkom flera olika faktorer som påverkade patienten att delta eller inte delta vid ögonbottenfotografering. Utifrån resultatet i denna studie drog vi slutsatsen att en ögonsjuksköterska framförallt behöver mer tid tillsammans med varje enskild patient för att kunna informera patienten om diabetes och diabetesretinopati samt motivera till deltagande vid regelbunden ögonbottenscreening. / Background: Diabetic retinopathy is the most common eye disease among people with diabetes and it is a leading cause for sight impairment and blindness all over the world. Patients with diabetic retinopathy can be asymptomatic and the patient can´t tell that he/she is affected. Because of this, it is important that patients with diabetes regularly are screened so that sight threatening retinopathy can be detected in an early state so the proper treatment can be inserted to prevent a sight impairment. Aim: The aim of the study was to illuminate the ophthalmic nurse’s perception of different factors influencing the diabetic patient´s compliance to fundus photography. Method: A qualitative method with a phenomenographic onset has been used in the study. The study has been conducted through eight interviews with ophthalmic nurses working in two different eye clinics in the south of Sweden. Results: The data analysis resulted in four different categories: The patient´s understanding of the disease, The patient´s health and vision, The ophthalmic nurse´s time with the patient and General obstacles. Conclusion: During the study several different factors which influenced the patient to participate or not to participate in fundus photography were found. Based on the result of this study we concluded that an ophthalmic nurse especially needs more time with each patient to be able to inform the patient about diabetes and diabetic retinopathy and to motivate the patient to participate in regular diabetic retinopathy screening.

A retinografia e angiografia digital são técnicas de observação e captura de imagens do fundo do olho que permitem o diagnóstico de diversas patologias. O aperfeiçoamento dos retinógrafos digitais, viabilizado pelos avanços tecnológicos observados nas últimas décadas, tornou possíveis modificações sistêmicas inovadoras como a apresentada e discutida neste trabalho. O principal objetivo é avaliar comparativamente a resolução espacial de imagens captadas com uma configuração que utiliza apenas um sensor monocromático e um conjunto de LEDs cromáticos, com imagens geradas por um sensor com filtro cromático integrado. A proposta é suportada por resultados teóricos que indicam um desempenho superior do uso de sensores monocromáticos em retinografia. Para validação da nova metodologia o sistema descrito foi montado e várias fotos da retina foram capturadas. Todo o processo de imageamento do fundo do olho é descrito, incluindo rotinas de software que precisaram ser criadas em decorrência das inovações. A partir das imagens capturadas foram aplicadas técnicas de avaliação global de maneira que as previsões teóricas puderam ser verificadas. Por fim são apresentadas conclusões sobre o desempenho global do sistema e adicionados tópicos como sugestões para continuidade futura do trabalho. / The digital retinography and angiography are techniques to observe and capture images of the eye fundus that allows the diagnosis of several diseases. The improvements of digital fundus camera made possible by technological advances seen in recent decades have made possible innovative systemic changes, as the presented and discussed in this work. The main objective is to comparatively evaluate the spatial resolution of images captured with a configuration that uses only a monochrome sensor and a set of chromatic LEDs, with images generated by a sensor with integrated color filter. The proposal is supported by theoretical results that indicate a superior performance when using a monochrome sensor to get fundus images. To validate the new methodology, the system described was assembled and several retina pictures were taken. The whole process of imaging the eye fundus is described, including software procedures that had to be created as a consequence of the innovations. From the images captured, overall evaluation techniques have been applied, so that theoretical forecasts could be verified. Finally, conclusions are presented on the overall performance of the system and suggestions for topics for future work were added.

O principal intento deste trabalho é demonstrar como a combinação de resultados de modelos radiométricos e de análises do limite de resolução de imagens produzem impactos positivos não apenas no projeto óptico de retinógrafos de alta resolução, mas que também geram ferramentas que auxiliam na definição da arquitetura de todo o equipamento, considerando, inclusive, os limites impostos por normas internacionais para a segurança do paciente em relação a radiação emitida na realização dos exames. Particularmente ao projeto óptico, foram desenvolvidos os sistemas de iluminação e imageamento da retina, onde se destacam duas propostas de metodologias: a primeira para a implementação da técnica de eliminação das bem conhecidas retro-reflexões geradas no conjunto óptico que é comum à iluminação e ao imageamento da retina, e a segunda para a obtenção de soluções efetivas em sistemas imageadores, que prima pela diminuição da sensibilidade dos componentes aos erros que são introduzidos pelos processos de fabricação e montagem. Analisando os resultados obtidos com o protótipo, foram validados os sistemas e modelos propostos, que se tornaram parte integrante de um produto oftalmológico aprovado para a comercialização, o retinógrafo Kiron. / The fundamental objective of this work is to demonstrate how radiometric models and analysis of the limit of resolution can provide not only positive impacts to the optical project of high resolution fundus cameras, but also creates tools to perform an optimization of all the equipment, considering the limits imposed by international standards to ensure security to the patient regarding the equipment radiation emission. In the optical project in particular, the imaging and illuminating systems of the retina were developed, in which stands out two proposed methodologies: first, to eliminate the well known retro-reflections in the common optical assembly of the imaging and illuminating systems, and a second one that helps the optical designer to find effective solutions in imaging systems, focused in the reduction of the component sensitivity to the fabrication and assembly processes errors. Analyzing the results from the prototypes the systems and the models proposed were validated, becoming integrant part of an ophthalmic product approved for commercialization, the Kiron fundus camera.

Submitted by Sandro Camargo (sandro.camargo@unipampa.edu.br) on 2015-05-09T18:40:27Z No. of bitstreams: 1 117110023.pdf: 2523085 bytes, checksum: 76eb3f9960e2b4f9df14435d3092b156 (MD5) / Made available in DSpace on 2015-05-09T18:40:27Z (GMT). No. of bitstreams: 1 117110023.pdf: 2523085 bytes, checksum: 76eb3f9960e2b4f9df14435d3092b156 (MD5) Previous issue date: 2013-12-13 / Este trabalho tem como objetivo a proposição de um novo método para a detecção automática de microaneurismas e hemorragias em imagens de fundo do olho. Essas lesões são consideradas o primeiro sinal de retinopatia diabética. A retinopatia diabética é uma doença originada pelo diabetes e é apontada com a principal causa de cegueira na população com idade ativa de trabalho. O método proposto é fundamentado em conceitos de morfologia matemática e consiste em eliminar os componentes da anatomia da retina até atingir o conjunto de lesões. Este método é formado por cinco etapas: a) pré-processamento; b) destaque das estruturas escuras; c) detecção dos vasos sanguíneos; d) eliminação dos vasos sanguíneos; e) eliminação da fóvea. A precisão do método foi testada num banco de dados público de imagens de fundo do olho, onde o mesmo obteve resultados satisfatórios e comparáveis aos demais métodos da literatura, reportando médias de sensitividade e especificidade de 87.69% e 92.44%, respectivamente. / This contribution presents an approach for automatic detection of microaneurysms and hemorrhages in fundus images. These lesions are considered the earliest signs of diabetic retinopathy. The diabetic retinopathy is a disease caused by diabetes and is considered as the major cause of blindness in working age population. The proposed method is based on mathematical morphology and consists in removing components of retinal anatomy to reach the lesions. This method consists of five steps: a) pre-processing; b) enhancement of low intensity structures; c) detection of blood vessels; d) elimination of blood vessels; e) elimination of the fovea. The accuracy of the method was tested on a public database of fundus images, where it achieved satisfactory results, comparable to other methods from the literature, reporting 87.69% and 92.44% of mean sensitivity and specificity, respectively.

A retinografia e angiografia digital são técnicas de observação e captura de imagens do fundo do olho que permitem o diagnóstico de diversas patologias. O aperfeiçoamento dos retinógrafos digitais, viabilizado pelos avanços tecnológicos observados nas últimas décadas, tornou possíveis modificações sistêmicas inovadoras como a apresentada e discutida neste trabalho. O principal objetivo é avaliar comparativamente a resolução espacial de imagens captadas com uma configuração que utiliza apenas um sensor monocromático e um conjunto de LEDs cromáticos, com imagens geradas por um sensor com filtro cromático integrado. A proposta é suportada por resultados teóricos que indicam um desempenho superior do uso de sensores monocromáticos em retinografia. Para validação da nova metodologia o sistema descrito foi montado e várias fotos da retina foram capturadas. Todo o processo de imageamento do fundo do olho é descrito, incluindo rotinas de software que precisaram ser criadas em decorrência das inovações. A partir das imagens capturadas foram aplicadas técnicas de avaliação global de maneira que as previsões teóricas puderam ser verificadas. Por fim são apresentadas conclusões sobre o desempenho global do sistema e adicionados tópicos como sugestões para continuidade futura do trabalho. / The digital retinography and angiography are techniques to observe and capture images of the eye fundus that allows the diagnosis of several diseases. The improvements of digital fundus camera made possible by technological advances seen in recent decades have made possible innovative systemic changes, as the presented and discussed in this work. The main objective is to comparatively evaluate the spatial resolution of images captured with a configuration that uses only a monochrome sensor and a set of chromatic LEDs, with images generated by a sensor with integrated color filter. The proposal is supported by theoretical results that indicate a superior performance when using a monochrome sensor to get fundus images. To validate the new methodology, the system described was assembled and several retina pictures were taken. The whole process of imaging the eye fundus is described, including software procedures that had to be created as a consequence of the innovations. From the images captured, overall evaluation techniques have been applied, so that theoretical forecasts could be verified. Finally, conclusions are presented on the overall performance of the system and suggestions for topics for future work were added.

Ocular fundus image can provide information on pathological changes caused by local ocular diseases and early signs of certain systemic diseases. Automated analysis and interpretation of fundus images has become a necessary and important diagnostic procedure in ophthalmology. Among the features in ocular fundus image are the optic disc, fovea (central vision area), lesions, and retinal vessels. These features are useful in revealing the states of diseases in the form of measurable abnormalities such as length of diameter, change in color, and degree of tortuosity in the vessels. In addition, retinal vessels can also serve as landmarks for image-guided laser treatment of choroidal neovascularization. Thus, reliable methods for blood vessel detection that preserve various vessel measurements are needed. In this paper, we will examine the pathological issues in the analysis of retinal vessels in digital fundus images and give a survey of current image processing methods for extracting vessels in retinal images with a view to categorize them and highlight their differences and similarities. We have also implemented two major approaches using matched filter and mathematical morphology respectively and compared their performances. Some prospective research directions are identified. / Singapore-MIT Alliance (SMA)

Thesis (MScEng)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Diabetic- and hypertensive retinopathy are two common causes of blindness that can be prevented by managing the underlying conditions. Patients suffering from these conditions are encouraged to undergo regular examinations to monitor the retina for signs of deterioration. For these routine examinations an ophthalmoscope is used. An ophthalmoscope is a relatively inexpensive device that allows an examiner to directly observe the ocular fundus (the interior back wall of the eye that contains the retina). These devices are analog and do not allow the capture of digital imagery. Fundus cameras, on the other hand, are larger devices that o er high quality digital images. They do, however, come at an increased cost and are not practical for use in the eld. In this thesis the design and implementation of a system that digitises imagery from an ophthalmoscope is discussed. The main focus is the development of software algorithms to increase the quality of the images to yield results of a quality closer to that of a fundus camera. The aim is not to match the capabilities of a fundus camera, but rather to o er a cost-e ective alternative that delivers su cient quality for use in conducting routine monitoring of the aforementioned conditions. For the digitisation the camera of a mobile phone is proposed. The camera is attached to an ophthalmoscope to record a video of an examination. Software algorithms are then developed to parse the video frames and combine those that are of better quality. For the parsing a method of rapidly selecting valid frames based on colour thresholding and spatial ltering techniques are developed. Registration is the process of determining how the selected frames t together. Spatial cross-correlation is used to register the frames. Only translational transformations are assumed between frames and the designed algorithms focuses on estimating this relative translation in a large set of frames. Methods of optimising these operations are also developed. For the combination of the frames, averaging is used to form a composite image. The results obtained are in the form of enhanced grayscale images of the fundus. These images do not match those captured with fundus cameras in terms of quality, but do show a signi cant increase when compared to the individual frames that they consists of. Collectively a set of video frames can cover a larger region of the fundus than what they do individually. By combining these frames an e ective increase in the eld of view is obtained. Due to low light exposure, the individual frames also contain signi cant noise. In the results the noise is reduced through the averaging of several frames that overlap at the same location. / AFRIKAANSE OPSOMMING: Diabetiese- en hipertensiewe retinopatie is twee algemene oorsake van blindheid wat deur middel van die behandeling van die onderliggende oorsake voorkom kan word. Pasiënte met hierdie toestande word aangemoedig om gereeld ondersoeke te ondergaan om die toestand van die retina te monitor. 'n Oftalmoskoop word gebruik vir hierdie roetine ondersoeke. 'n Oftalmoskoop is 'n relatiewe goedkoop, analoë toestel wat 'n praktisyn toelaat om die agterste interne wand van die oog the ondersoek waar die retina geleë is. Fundus kameras, aan die ander kant, is groter toestelle wat digitale beelde van 'n hoë gehalte kan neem. Dit kos egter aansienlik meer en is dus nie geskik vir gebruik in die veld nie. In hierdie tesis word die ontwerp en implementering van 'n stelsel wat beelde digitaliseer vanaf 'n oftalmoskoop ondersoek. Die fokus is op die ontwikkeling van sagteware algoritmes om die gehalte van die beelde te verhoog. Die doel is nie om die vermoëns van 'n fundus kamera te ewenaar nie, maar eerder om 'n koste-e ektiewe alternatief te lewer wat voldoende is vir gebruik in die veld tydens die roetine monitering van die bogenoemde toestande. 'n Selfoonkamera word vir die digitaliserings proses voorgestel. Die kamera word aan 'n oftalmoskoop geheg om 'n video van 'n ondersoek af te neem. Sagteware algoritmes word dan ontwikkel om die videos te ontleed en om videogrepe van goeie kwaliteit te selekteer en te kombineer. Vir die aanvanklike ontleding van die videos word kleurband drempel tegnieke voorgestel. Registrasie is die proses waarin die gekose rame bymekaar gepas word. Direkte kruiskorrelasie tegnieke word gebruik om die videogrepe te registreer. Daar word aanvaar dat die videogrepe slegs translasie tussen hulle het en die voorgestelde registrasie metodes fokus op die beraming van die relatiewe translasie van 'n groot versameling videogrepe. Vir die kombinering van die grepe, word 'n gemiddeld gebruik om 'n saamgestelde beeld te vorm. Die resultate wat verkry word, word in die vorm van verbeterde gryskleur beelde van die fundus ten toon gestel. Hierdie beelde is nie gelykstaande aan die kwaliteit van beelde wat deur 'n fundus kamera geneem is nie. Hulle toon wel 'n beduidende verbetering teenoor individuele videogrepe. Deur dat 'n groot versameling videogrepe wat gesamentlik 'n groter area van die fundus dek gekombineer word, word 'n e ektiewe verhoging van data in die area van die saamgestelde beeld verkry. As gevolg van lae lig blootstelling van die individuele grepe bevat hul beduidende ruis. In die saamgestelde beelde is die ruis aansienlik minder as gevolg van 'n groter hoeveelheid data wat gekombineer is om sodoende die ruis uit te sluit.