This thesis explores and explains a method using discrete curvature as a feature to find regions of vertices that can be classified as being likely to indicate the presence of an underlying tumor on a kidney surface mesh. Vertices are tagged based on curvature type and mathematical morphology is used to form regions on the mesh. The size and location of the tumor is approximated by fitting a sphere to this region. The method is intended to be employed in noninvasive radiotherapy with a dynamic soft tissue model. It could also provide an alternative to volumetric methods used to segment tumors. A validation is made using the images from which the kidney mesh was constructed, the tumor is visible as a comparison to the method result. The dynamic kidney model is validated using the Hausdorff distance and it is explained how this can be computed in an effective way using bounding volume hierarchies. Both the tumor finding method and the dynamic model show promising results since they lie within the limit used by practitioners during therapy.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Images captured in endoscopy examinations show some distortion, the radial is the most visible. The radial distortion appears in images due to lens used in endoscopes. When a doctor or researcher is analyzing a distorted image, he can not see the exact size of an organ, tumor or lesion, due the magnification in the center of the image and a contraction in the peripheral regions caused by such distortion. This paper aims to propose a new method for correction of radial distortion in endoscopic images. The proposed method is based on concepts of Morphing and Warping, which are techniques widely used in computer graphics to transform the image of one person to another or to cause objects deformations. The system presents the advantage of automatic application of these techniques, since the vast majority of correction algorithms need user interaction. The proposed method uses a pattern image, created for the calibration of the transformations that are applied to the images of endoscopy. The developed system receives the pattern image captured by endoscope, divides the image into a triangular mesh, make the matching of each triangle of the meshes and store the affine transformations of each triangular region of the mesh separately. After calibration, the affine transformations of each triangular region are used in real image of endoscopic examinations performed by the same endoscope used for calibration to correct the images. Finally, the method was compared with others in the literature and has been made quantitative and qualitative analysis with the results. / Imagens capturadas em exames de endoscopia apresentam algumas distorções, sendo a distorção radial a principal. A distorção radial surge na imagem devido ao sistema de lentes utilizado nos endoscópios. Quando um médico ou pesquisador está analisando uma imagem distorcida, não consegue perceber qual o tamanho exato de um órgão, lesão ou tumor, pois tal distorção causa uma ampliação no centro da imagem e uma contração nas regiões periféricas. Este trabalho tem como objetivo propor um novo método para a correção de distorções radiais em imagens de endoscopia. O método proposto baseia-se em conceitos de Morphing e Warping, que são técnicas bastante utilizadas em computação gráfica para transformar a imagem de uma pessoa em outra ou para causar deformações em objetos. O sistema apresentado tem como diferencial a aplicação automática destas técnicas, visto que a grande maioria de algoritmos que fazem uso delas funciona com interação do usuário. O método proposto utiliza uma imagem padrão, criada para a calibração das transformações que serão aplicadas nas imagens de exames de endoscopia. O sistema desenvolvido recebe a imagem padrão capturada por endoscópio, divide a imagem em uma malha triangular, faz a correspondência de cada triângulo desta malha com a malha da imagem padrão original e armazena as transformações afins em cada região da malha separadamente, transformando assim a imagem capturada na imagem original. Após a calibração, as mesmas transformações afins armazenadas para cada elemento triangular da malha são utilizadas em imagem reais de exames endoscópicos feitos pelo mesmo endoscópio utilizado na calibração, para corrigir a deformação. Por fim, o método desenvolvido foi comparado com outros da literatura e foram feitas análises quantitativas e qualitativas dos resultados obtidos.

Dental radiography is one of the most frequent types of diagnostic radiological investigations performed. The equipment and techniques used are constantly evolving. However, dental healthcare has long been an area neglected by radiation safety legislation and the medical physicist community, and thus, the quality assurance (QA) regime needs an update. This project aimed to implement and evaluate objective tests of key image quality parameters for intra-oral (IO) X-ray images. The image quality parameters assessed were sensitivity, noise, uniformity, low-contrast resolution, and spatial resolution. These parameters were evaluated for repeatability at typical tube current, voltage, and exposure time settings by computing the coefficient of variation (CV) of the mean value of each parameter from multiple images. A further aim was to develop a semi-quantitative test for the correct alignment of the position indicating device (PID) with the primary collimator. The overall purpose of this thesis was to look at ways to improve the QA of IO X-rays systems by digitizing and automating part of the process. A single image receptor and an X-ray tube were used in this study. Incident doses at the receptor were measured using a radiation meter. The relationship between incident dose at the receptor and the output signal was used to determine the signal transfer curve for the receptor. The principal sources of noise in the practical exposure range of the system were investigated using a separation of noise sources based upon variance. The transfer curve of the receptor was found to be linear. Noise separation showed that quantum noise was the dominant noise. Repeatability of the image quality parameters assessed was found to be acceptable. The CV for sensitivity was less than 3%, while that for noise was less than 1%. For the uniformity measured at the center, the CV was less than 10%, while the CV was less than 5% for the uniformity measured at the edge. The low-contrast resolution varied the most at all exposure settings investigated with CV between 6 - 13%. Finally, the CV for the spatial resolution parameters was less than 5%. The method described to test for the correct alignment of the PID with the primary collimator was found to be practical and easy to interpret manually. The tests described here were implemented for a specific sensor and X-ray tube combination, but the methods could easily be adapted for different systems by simply adjusting certain parameters.

Osteoarthritis is a large problem affecting many patients globally, and diagnosis of osteoarthritis is often done using evidence from arthroscopic surgeries. Making a correct diagnosis is hard, and takes years of experience and training on thousands of images. Therefore, developing an automatic solution to perform the diagnosis would be extremely helpful to the medical field. Since machine learning has been proven to be useful and effective at classifying and segmenting medical images, this thesis aimed at solving the problem using machine learning methods. Multifractal analysis has also been used extensively for medical imaging segmentation. This study proposes two methods of automatic segmentation using neural networks and multifractal analysis. The thesis was performed using real arthroscopic images from surgeries. MultiResUnet architecture is shown to be well suited for pixel perfect segmentation. Classification of multifractal features using neural networks is also shown to perform well when compared to related studies.

This report contains a summation of a variety of articles that have been read and analysed. Each article describes different methods that can be used to detect lesions, optic disks, drusen and exudates in retinal images. I.e. diagnose e.g. Diabetic Retinopathy and Age-Related Macular Degeneration. A general approach is presented, which all methods more or less is based on. Methods to locate the optic disk The PCA  kNN Regression Hough Transform Fuzzy Convergence Vessel Direction Matched Filter Etc. The best method based on result, reliability, number of images and publisher is kNN regression. The result of this method is remarkably good and that brings some doubt about its reliability. Though the method was published at IEEE and that gives the method a more trustful look. A next best method which also is very useful is Vessel Direction Matched Filter. Methods to detect drusen – diagnose Age-Related Macular Degeneration PNN classifier Histogram approach Etc. The best method based on result, reliability, number of images and publisher is the PNN classifier. The method had a sensitivity of 94 % and a specificity of 95 %. 300 images were used in the experiment which was published by the IEEE in 2011. Methods to detect exudates – diagnose Diabetic Retinopathy Morphological techniques Luv colour space, Wiener filter an Canny edge detector. The best method based on result, reliability, number of images and publisher is an experiment called “Feature Extraction”. The method includes the Luv colour space, Wiener filter (remove noise) and the Canny edge detector. / Den här rapporten innehåller en sammanfattning av ett flertal artiklar som har blivit studerade. Varje artikel har beskrivit en metod som kan användas för att upptäcka sjuka förändringar i ögonbottenbilder, det vill säga, åldersförändringar i gula fläcken och diabetisk retinopati. Metoder för att lokalisera blinda fläcken PCA kNN regression Hough omvandling Suddig konvergens Filtrering beroende på kärlens riktning Mm. Den bästa metoden baserat på resultat, pålitlighet, antal bilder och utgivare är kNN regression. De förvånansvärt goda resultaten kan inbringa lite tvivel på huruvida resultaten stämmer. Artikeln publicerades dock av IEEE och det gör artikeln mer trovärdig. Den näst bästa metoden är filtrering beroende på kärlens riktning. Metoder för att diagnosticera åldersförändringar i gula fläcken PNN klassificeraren Histogram Mm. Den bästa metoden baserat på resultat, pålitlighet, antal bilder och utgivare är PNN klassificeraren. Metoden hade en sensitivitet på 94 % och en specificitet på 95 %. 300 bilder användes i experimentet som publicerades av IEEE år 2011. Metoder att diagnosticera diabetisk retinopati Morfologiska tekniker Luv colour space, Wiener filter and Canny edge detector. Den bästa metoden baserat på resultat, pålitlighet, antal bilder och utgivare är ett experimentet som heter ”Feature Extraction”. Experimentet inkluderar Luv colour space, Wiener filter (brus borttagning) och Canny edge detector

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The purpose of this master thesis was to investigate if using both X-ray images and patient's register data could increase the performance of a neural network in discrimination of two types of fractures in the thigh bone, called atypical femoral fractures (AFF) and normal femoral fractures (NFF). We also examined and evaluated how the fusion of the two data types could be done and how different types of fusion affect the performance. Finally, we evaluated how the number of variables in the register data affect a network's performance. Our image dataset consisted of 1,442 unique images from 580 patients (16.85% of the images were labelled AFF corresponding to 15.86% of the patients). Since the dataset is very imbalanced, sensitivity is a prioritized evaluation metric. The register data network was evaluated using five different versions of register data parameters: two (age and sex), seven (binary and non-binary) and 44 (binary and non-binary). Having only age and sex as input resulted in a classifier predicting all samples to class 0 (NFF), for all tested network architectures. Using a certain network structure (celled register data model 2), in combination with the seven non-binary parameters outperforms using both two and 44 (both binary and non-binary) parameters regarding mean AUC and sensitivity. Highest mean accuracy is obtained by using 44 non-binary parameters. The seven register data parameters have a known connection to AFF and includes age and sex. The network with X-ray images as input uses a transfer learning approach with a pre-trained ResNet50-base. This model performed better than all the register data models, regarding all considered evaluation metrics.        Three fusion architectures were implemented and evaluated: probability fusion (PF), feature fusion (FF) and learned feature fusion (LFF). PF concatenates the prediction provided from the two separate baseline models. The combined vector is fed into a shallow neural network, which are the only trainable part in this architecture. FF fuses a feature vector provided from the image baseline model, with the raw register data parameters. Prior to the concatenation both vectors were normalized and the fused vector is then fed into a shallow trainable network. The final architecture, LFF, does not have completely frozen baseline models but instead learns two separate feature vectors. These feature vectors are then concatenated and fed into a shallow neural network to obtain a final prediction. The three fusion architectures were evaluated twice: using seven non-binary register data parameters, or only age and sex. When evaluated patient-wise, all three fusion architectures using the seven non-binary parameters obtain higher mean AUC and sensitivity than the single modality baseline models. All fusion architectures with only age and sex as register data parameters results in higher mean sensitivity than the baseline models. Overall, probability fusion with the seven non-binary parameters results in the highest mean AUC and sensitivity, and learned feature fusion with the seven non-binary parameters results in the highest mean accuracy.

Development of image-guided interventional systems is growing up rapidly in the recent years. These new systems become an essential part of the modern minimally invasive surgical procedures, especially for the cardiac surgery. Transcatheter aortic valve implantation (TAVI) is a recently developed surgical technique to treat severe aortic valve stenosis in elderly and high-risk patients. The placement of stented aortic valve prosthesis is crucial and typically performed under live 2D fluoroscopy guidance. To assist the placement of the prosthesis during the surgical procedure, a new fluoroscopy-based TAVI assistance system has been developed. The developed assistance system integrates a 3D geometrical aortic mesh model and anatomical valve landmarks with live 2D fluoroscopic images. The 3D aortic mesh model and landmarks are reconstructed from interventional angiographic and fluoroscopic C-arm CT system, and a target area of valve implantation is automatically estimated using these aortic mesh models. Based on template-based tracking approach, the overlay of visualized 3D aortic mesh model, landmarks and target area of implantation onto fluoroscopic images is updated by approximating the aortic root motion from a pigtail catheter motion without contrast agent. A rigid intensity-based registration method is also used to track continuously the aortic root motion in the presence of contrast agent. Moreover, the aortic valve prosthesis is tracked in fluoroscopic images to guide the surgeon to perform the appropriate placement of prosthesis into the estimated target area of implantation. An interactive graphical user interface for the surgeon is developed to initialize the system algorithms, control the visualization view of the guidance results, and correct manually overlay errors if needed. Retrospective experiments were carried out on several patient datasets from the clinical routine of the TAVI in a hybrid operating room. The maximum displacement errors were small for both the dynamic overlay of aortic mesh models and tracking the prosthesis, and within the clinically accepted ranges. High success rates of the developed assistance system were obtained for all tested patient datasets. The results show that the developed surgical assistance system provides a helpful tool for the surgeon by automatically defining the desired placement position of the prosthesis during the surgical procedure of the TAVI. / Die Entwicklung bildgeführter interventioneller Systeme wächst rasant in den letzten Jahren. Diese neuen Systeme werden zunehmend ein wesentlicher Bestandteil der technischen Ausstattung bei modernen minimal-invasiven chirurgischen Eingriffen. Diese Entwicklung gilt besonders für die Herzchirurgie. Transkatheter Aortenklappen-Implantation (TAKI) ist eine neue entwickelte Operationstechnik zur Behandlung der schweren Aortenklappen-Stenose bei alten und Hochrisiko-Patienten. Die Platzierung der Aortenklappenprothese ist entscheidend und wird in der Regel unter live-2D-fluoroskopischen Bildgebung durchgeführt. Zur Unterstützung der Platzierung der Prothese während des chirurgischen Eingriffs wurde in dieser Arbeit ein neues Fluoroskopie-basiertes TAKI Assistenzsystem entwickelt. Das entwickelte Assistenzsystem überlagert eine 3D-Geometrie des Aorten-Netzmodells und anatomischen Landmarken auf live-2D-fluoroskopische Bilder. Das 3D-Aorten-Netzmodell und die Landmarken werden auf Basis der interventionellen Angiographie und Fluoroskopie mittels eines C-Arm-CT-Systems rekonstruiert. Unter Verwendung dieser Aorten-Netzmodelle wird das Zielgebiet der Klappen-Implantation automatisch geschätzt. Mit Hilfe eines auf Template Matching basierenden Tracking-Ansatzes wird die Überlagerung des visualisierten 3D-Aorten-Netzmodells, der berechneten Landmarken und der Zielbereich der Implantation auf fluoroskopischen Bildern korrekt überlagert. Eine kompensation der Aortenwurzelbewegung erfolgt durch Bewegungsverfolgung eines Pigtail-Katheters in Bildsequenzen ohne Kontrastmittel. Eine starrere Intensitätsbasierte Registrierungsmethode wurde verwendet, um kontinuierlich die Aortenwurzelbewegung in Bildsequenzen mit Kontrastmittelgabe zu detektieren. Die Aortenklappenprothese wird in die fluoroskopischen Bilder eingeblendet und dient dem Chirurg als Leitfaden für die richtige Platzierung der realen Prothese. Eine interaktive Benutzerschnittstelle für den Chirurg wurde zur Initialisierung der Systemsalgorithmen, zur Steuerung der Visualisierung und für manuelle Korrektur eventueller Überlagerungsfehler entwickelt. Retrospektive Experimente wurden an mehreren Patienten-Datensätze aus der klinischen Routine der TAKI in einem Hybrid-OP durchgeführt. Hohe Erfolgsraten des entwickelten Assistenzsystems wurden für alle getesteten Patienten-Datensätze erzielt. Die Ergebnisse zeigen, dass das entwickelte chirurgische Assistenzsystem ein hilfreiches Werkzeug für den Chirurg bei der Platzierung Position der Prothese während des chirurgischen Eingriffs der TAKI bietet.

Magnetic resonance imaging (MRI) utilizes the magnetic properties of tissues to generate image-forming signals. MRI has exquisite soft-tissue contrast and since tumors are mainly soft-tissues, it offers improved delineation of the target volume and nearby organs at risk. The proposed Magnetic Resonance-only Radiotherapy (MR-only RT) work flow allows for the use of MRI as the sole imaging modality in the radiotherapy (RT) treatment planning of cancer. There are, however, issues with geometric distortions inherent with MR image acquisition processes. These distortions result from imperfections in the main magnetic field, nonlinear gradients, as well as field disturbances introduced by the imaged object. In this thesis, we quantified the effect of system related and patient-induced susceptibility geometric distortions on dose distributions for prostate as well as head and neck cancers. Methods to mitigate these distortions were also studied. In Study I, mean worst system related residual distortions of 3.19, 2.52 and 2.08 mm at bandwidths (BW) of 122, 244 and 488 Hz/pixel up to a radial distance of 25 cm from a 3T PET/MR scanner was measured with a large field of view (FoV) phantom. Subsequently, we estimated maximum shifts of 5.8, 2.9 and 1.5 mm due to patient-induced susceptibility distortions. VMAT-optimized treatment plans initially performed on distorted CT (dCT) images and recalculated on real CT datasets resulted in a dose difference of less than 0.5%.  The magnetic susceptibility differences at tissue-metallic,-air and -bone interfaces result in local B0 magnetic field inhomogeneities. The distortion shifts caused by these field inhomogeneities can be reduced by shimming.  Study II aimed to investigate the use of shimming to improve the homogeneity of local  B0 magnetic field which will be beneficial for radiotherapy applications. A shimming simulation based on spherical harmonics modeling was developed. The spinal cord, an organ at risk is surrounded by bone and in close proximity to the lungs may have high susceptibility differences. In this region, mean pixel shifts caused by local B0 field inhomogeneities were reduced from 3.47±1.22 mm to 1.35±0.44 mm and 0.99±0.30 mm using first and second order shimming respectively. This was for a bandwidth of 122 Hz/pixel and an in-plane voxel size of 1×1 mm2.  Also examined in Study II as in Study I was the dosimetric effect of geometric distortions on 21 Head and Neck cancer treatment plans. The dose difference in D50 at the PTV between distorted CT and real CT plans was less than 1.0%. In conclusion, the effect of MR geometric distortions on dose plans was small. Generally, we found patient-induced susceptibility distortions were larger compared with residual system distortions at all delineated structures except the external contour. This information will be relevant when setting margins for treatment volumes and organs at risk.   The current practice of characterizing MR geometric distortions utilizing spatial accuracy phantoms alone may not be enough for an MR-only radiotherapy workflow. Therefore, measures to mitigate patient-induced susceptibility effects in clinical practice such as patient-specific correction algorithms are needed to complement existing distortion reduction methods such as high acquisition bandwidth and shimming.

Syftet med aktuellt arbete var att kalibrera en kamera i MATLAB, med hjälp av tillägget Computer Vision Toolbox, samt utforma ett skript som kan konvertera pixelkoordinater i MATLAB till rumskoordinater. Resultatet av arbetet agerar som ett komplement till en studie på Gymnastik- och idrottshögskolan, där kompression av skosulor undersöks med hjälp av kamera och MATLAB-skript. Flertalet tester utfördes för att säkerställa kalibreringens tillförlitlighet samt kompatibiliteten mellan de två MATLAB-skripten. Kalibreringen anses tillförlitlig, och kompatibiliteten mellan skripten anses god. Vidare utfördes en mindre kompressionsstudie på löpband. Resultaten från denna studie är ej tillförlitliga, eftersom väldigt stora fel behövde tillåtas för att möjliggöra skriptets så kallade pixelspårning. Detta anses vara på grund av ljussättningen vid testerna, samt att kamerans videoupptagning ej hade hög nog bildupptagning per sekund till att följa skornas höga hastighet på löpbandet. Vidare studier av kompression rekommenderas att utföras på stilla underlag, där foten är huvudsakligen stilla i bildens synfält under markkontakt. / The purpose of this work was to calibrate a camera in MATLAB using the Computer Vision Toolbox add-on and to design a script to convert pixel coordinates in MATLAB into spatial coordinates in the room. The result of this work serves as a complement to a study conducted at Gymnastik- och idrottshögskolan in Stockholm, where they are investigating the compression of shoe soles with a camera and a MATLAB-script. Several tests were conducted to ensure the reliability of the calibration along with the compatibility of the two MATLAB scripts. The calibration is considered reliable, and the compatibility of the two scripts is considered satisfactory. Furthermore, a smaller compression study was performed on a treadmill. The results from this study are considered unreliable, as large errors were allowed in the so-called pixel tracking of the MATLAB script. This is considered to be due to bad lighting, and because the video recording did not have a high enough frames-per-second to follow the high velocity of the shoes on the treadmill. Further compression studies are recommended to be performed on stable, non-moving surfaces, where the foot is principally still in the camera’s field of view during ground contact.