Este trabalho apresenta um estudo sobre segmentação de volumes médicos e uma solução para se obter malhas poligonais de pacientes específicos para uso em simulações de cirurgia. Malhas de pacientes específicos são importantes para planejamento de intervenções cirúrgicas e permitem uma melhor visualização de condições patológicas em um paciente, coisa não obtível em malhas geradas artisticamente. Nós analisamos quais são os fatores complicantes para se obter estas malhas de um paciente específico usando apenas imagens médicas obtidas em exames padrões. Para isso, nós revisamos diversos métodos existentes para segmentação de volumes médicos. Isso nos levou a definir os problemas com as técnicas existentes, e a desenvolver um método que não sofra destes problemas, utilizando pouca interação humana e não tendo dependências de mais dados que não o exame do paciente. Nosso alvo para obter malhas especificas foram órgãos de tecido mole, que são um caso especialmente complicado da área, graças a várias questões relacionadas às imagens médicas e à anatomia humana. Atacamos esse problema aplicando modificações geométricas em malhas especiais, que deformam até atingir a forma dos órgãos que se deseja segmentar. Os resultados mostram que nossa técnica conseguiu obter malhas específicas de pacientes a partir de volumes médicos com qualidade superior a de outros algoritmos de mesma classe. Graças a simplicidade do método desenvolvido, nossos resultados são facilmente implementáveis e reproduzidos. / This work presents a study about medical-volume segmentation and a solution to generate patient-specific meshes to use in patient-specific surgery simulations. Patientspecific meshes are useful assets for surgery planning and to allow better visualization of certain pathological conditions of a given patient, which are not obtainable by artistically designed meshes. We analyzed what are the complications to obtain a patient-specific mesh using only standard medical imagery exams. For that, we reviewed several medical volume segmentation techniques. It led us to define the problems within the existing techniques and to develop a method that does not suffer from these problems, with the least possible user interaction or relying on any other data other then the patient exam. Our target for obtaining specific meshes were soft tissue organs, which are a specially complicated case due to various issues related to the medical images and human anatomy. This is accomplished by geometrical operations over special meshes that deform until achieving the shape of the desired organ. Results show that our technique was able to obtain patient-specific meshes from medical images with superior quality than algorithms of the same class. Thanks to the simplicity of the developed approach, its also easy to implement and to reproduce our obtained results.

Este trabalho apresenta um estudo sobre segmentação de volumes médicos e uma solução para se obter malhas poligonais de pacientes específicos para uso em simulações de cirurgia. Malhas de pacientes específicos são importantes para planejamento de intervenções cirúrgicas e permitem uma melhor visualização de condições patológicas em um paciente, coisa não obtível em malhas geradas artisticamente. Nós analisamos quais são os fatores complicantes para se obter estas malhas de um paciente específico usando apenas imagens médicas obtidas em exames padrões. Para isso, nós revisamos diversos métodos existentes para segmentação de volumes médicos. Isso nos levou a definir os problemas com as técnicas existentes, e a desenvolver um método que não sofra destes problemas, utilizando pouca interação humana e não tendo dependências de mais dados que não o exame do paciente. Nosso alvo para obter malhas especificas foram órgãos de tecido mole, que são um caso especialmente complicado da área, graças a várias questões relacionadas às imagens médicas e à anatomia humana. Atacamos esse problema aplicando modificações geométricas em malhas especiais, que deformam até atingir a forma dos órgãos que se deseja segmentar. Os resultados mostram que nossa técnica conseguiu obter malhas específicas de pacientes a partir de volumes médicos com qualidade superior a de outros algoritmos de mesma classe. Graças a simplicidade do método desenvolvido, nossos resultados são facilmente implementáveis e reproduzidos. / This work presents a study about medical-volume segmentation and a solution to generate patient-specific meshes to use in patient-specific surgery simulations. Patientspecific meshes are useful assets for surgery planning and to allow better visualization of certain pathological conditions of a given patient, which are not obtainable by artistically designed meshes. We analyzed what are the complications to obtain a patient-specific mesh using only standard medical imagery exams. For that, we reviewed several medical volume segmentation techniques. It led us to define the problems within the existing techniques and to develop a method that does not suffer from these problems, with the least possible user interaction or relying on any other data other then the patient exam. Our target for obtaining specific meshes were soft tissue organs, which are a specially complicated case due to various issues related to the medical images and human anatomy. This is accomplished by geometrical operations over special meshes that deform until achieving the shape of the desired organ. Results show that our technique was able to obtain patient-specific meshes from medical images with superior quality than algorithms of the same class. Thanks to the simplicity of the developed approach, its also easy to implement and to reproduce our obtained results.

Este trabalho apresenta um estudo sobre segmentação de volumes médicos e uma solução para se obter malhas poligonais de pacientes específicos para uso em simulações de cirurgia. Malhas de pacientes específicos são importantes para planejamento de intervenções cirúrgicas e permitem uma melhor visualização de condições patológicas em um paciente, coisa não obtível em malhas geradas artisticamente. Nós analisamos quais são os fatores complicantes para se obter estas malhas de um paciente específico usando apenas imagens médicas obtidas em exames padrões. Para isso, nós revisamos diversos métodos existentes para segmentação de volumes médicos. Isso nos levou a definir os problemas com as técnicas existentes, e a desenvolver um método que não sofra destes problemas, utilizando pouca interação humana e não tendo dependências de mais dados que não o exame do paciente. Nosso alvo para obter malhas especificas foram órgãos de tecido mole, que são um caso especialmente complicado da área, graças a várias questões relacionadas às imagens médicas e à anatomia humana. Atacamos esse problema aplicando modificações geométricas em malhas especiais, que deformam até atingir a forma dos órgãos que se deseja segmentar. Os resultados mostram que nossa técnica conseguiu obter malhas específicas de pacientes a partir de volumes médicos com qualidade superior a de outros algoritmos de mesma classe. Graças a simplicidade do método desenvolvido, nossos resultados são facilmente implementáveis e reproduzidos. / This work presents a study about medical-volume segmentation and a solution to generate patient-specific meshes to use in patient-specific surgery simulations. Patientspecific meshes are useful assets for surgery planning and to allow better visualization of certain pathological conditions of a given patient, which are not obtainable by artistically designed meshes. We analyzed what are the complications to obtain a patient-specific mesh using only standard medical imagery exams. For that, we reviewed several medical volume segmentation techniques. It led us to define the problems within the existing techniques and to develop a method that does not suffer from these problems, with the least possible user interaction or relying on any other data other then the patient exam. Our target for obtaining specific meshes were soft tissue organs, which are a specially complicated case due to various issues related to the medical images and human anatomy. This is accomplished by geometrical operations over special meshes that deform until achieving the shape of the desired organ. Results show that our technique was able to obtain patient-specific meshes from medical images with superior quality than algorithms of the same class. Thanks to the simplicity of the developed approach, its also easy to implement and to reproduce our obtained results.

This thesis proposes a probabilistic level set method to be used in segmentation of tumors with heterogeneous intensities. It models the intensities of the tumor and surrounding tissue using Gaussian mixture models. Through a contour based initialization procedure samples are gathered to be used in expectation maximization of the mixture model parameters. The proposed method is compared against a threshold-based segmentation method using MRI images retrieved from The Cancer Imaging Archive. The cases are manually segmented and an automated testing procedure is used to find optimal parameters for the proposed method and then it is tested against the threshold-based method. Segmentation times, dice coefficients, and volume errors are compared. The evaluation reveals that the proposed method has a comparable mean segmentation time to the threshold-based method, and performs faster in cases where the volume error does not exceed 40%. The mean dice coefficient and volume error are also improved while achieving lower deviation.

<p dir="ltr">Cystic fibrosis is a genetic disease that affects over 162,428 people worldwide. Currently, assessing cystic fibrosis from medical images requires a trained expert to manually annotate regions in the patient's lungs to determine the stage and severity of the disease. This process takes a substantial amount of time and effort to achieve an accurate assessment. </p><p dir="ltr">Recent advancements in machine learning and deep learning have been effective in solving classification, decision-making, identification, and segmentation problems in various disciplines. In medical research, these techniques have been used to perform image analyses that aid in organ identification, tissue classification, and lesion segmentation, which reduces the time required for physicians to analyze medical images. However, these techniques have yet to be widely applied in the assessment of cystic fibrosis. </p><p dir="ltr">This thesis describes an automated framework employed to assess the severity and extent of cystic fibrosis. The framework comprises three analysis stages: airways analysis, texture analysis, and lung lesions detection, that are utilized to extract cystic fibrosis features from CT scans, and which are used to assess the severity and extent of cystic fibrosis. The framework achieved an accuracy of 86.96\% in the staging process. The main contribution of this work is the development of a data-driven methodology used to design a quantitative cystic fibrosis staging and grading model.</p>

Malignant pleural mesothelioma (MPM) is a form of aggressive tumour that is almost always associated with prior exposure to asbestos. Currently responsible for over 47,000 deaths worldwide each year and rising, it poses a serious threat to global public health. Many clinical studies of MPM, including its diagnosis, prognostic planning, and the evaluation of a treatment, necessitate the accurate quantification of tumours based on medical image scans, primarily computed tomography (CT). Currently, clinical best practice requires application of the MPM-adapted Response Evaluation Criteria in Solid Tumours (MPM-RECIST) scheme, which provides a uni-dimensional measure of the tumour's size. However, the low CT contrast between the tumour and surrounding tissues, the extensive elongated growth pattern characteristic of MPM, and, as a consequence, the pronounced partial volume effect, collectively contribute to the significant intra- and inter-observer variations in MPM-RECIST values seen in clinical practice, which in turn greatly affect clinical judgement and outcome. In this thesis, we present a novel computer-assisted approach to evaluate MPM patient response to treatments, based on the volumetric segmentation of tumours (VTA) on CT. We have developed a 3D segmentation routine based on the Random Walk (RW) segmentation framework by L. Grady, which is notable for its good performance in handling weak tissue boundaries and the ability to segment any arbitrary shapes with appropriately placed initialisation points. Results also show its benefit with regard to computation time, as compared to other candidate methods such as level sets. We have also added a boundary enhancement regulariser to RW, to improve its performance with smooth MPM boundaries. The regulariser is inspired by anisotropic diffusion. To reduce the required level of user supervision, we developed a registration-assisted segmentation option. Finally, we achieved effective and highly manoeuvrable partial volume correction by applying a reverse diffusion-based interpolation. To assess its clinical utility, we applied our method to a set of 48 CT studies from a group of 15 MPM patients and compared the findings to the MPM-RECIST observations made by a clinical specialist. Correlations confirm the utility of our algorithm for assessing MPM treatment response. Furthermore, our 3D algorithm found applications in monitoring the patient quality of life and palliative care planning. For example, segmented aerated lungs demonstrated very good correlation with the VTA-derived patient responses, suggesting their use in assessing the pulmonary function impairment caused by the disease. Likewise, segmented fluids highlight sites of pleural effusion and may potentially assist in intra-pleural fluid drainage planning. Throughout this thesis, to meet the demands of probabilistic analyses of data, we have used the Non-Parametric Windows (NPW) probability density estimator. NPW outperforms the histogram in terms of its smoothness and kernel density estimator in its parameter setting, and preserves signal properties such as the order of occurrence and band-limitedness of the sample, which are important for tissue reconstruction from discrete image data. We have also worked on extending this estimator to analysing vector-valued quantities; which are essential for multi-feature studies involving values such as image colour, texture, heterogeneity and entropy.

A displasia cortical focal (DCF) é uma das causas mais frequentes de epilepsia refratária. Na clínica, diferentes informações são usadas para localizar o foco epileptogênico, mas nenhum método é autossuficiente para evidenciar o local original das crises, associado com a presença da DCF. Embora haja relatos na literatura indicando alterações no padrão de distribuição de tons de cinza e morfologia dos voxels decorrentes da DCF, algumas limitações dos métodos desenvolvidos ainda impedem a utilização clínica. Nossa proposta foi investigar a capacidade de identificar DCF através de análises de espessura cortical e padrões de textura em imagens estruturais de Ressonância Magnética (RM), validando os métodos desenvolvidos a partir uma base de imagens retrospectiva, cujo tecido epileptogênico já havia sido ressecado e a DCF confirmada em análise histológica. A caracterização das DCF foi feita a partir da segmentação automática de tecido cortical saudável em conjunto com a segmentação manual da DCF feita por um especialista, e consiste na geração de mapas de característica e extração de valores de distribuições para comparação em análise estatística. Investigamos também a eficácia da detecção de DCF através do uso de algoritmos de aprendizado de máquina para classificação automática. Obtivemos precisão 0,81 e sensitividade 0,87, colocando o método desenvolvido em par com outros métodos presentes na literatura. Entretanto, foi identificada uma grande dependência do desempenho de métodos de pré-processamento, como corregistro e segmentação automática. / Focal Cortical Dysplasia (FCD) is one of the most frequent causes of refractory epilepsy. In clinical procedures, the information gathered from different techniques is used in order to locate the epileptogenic focus, associated with the presence of FCD. However, there is no self sufficient method to evidence the presence and location of such lesions and especially its extension. Although there are reports indicating change in gray scale intensity patterns and voxel morphology in the presence of DCF, limitations in developed methods still prevent their clinical use. Our proposal was to investigate the capability of identifying FCD through cortical thickness and texture patter analysis in structural MRI images, validating developed methods by utilizing a retrospective base of images from patients that were subjected to surgery, with the FCD being confirmed in histological analysis. Characterization of FCD was achieved from automatic segmentation of healthy cortex and manual segmentation of FCD tissue made by an specialist, and consists in the generation of texture or structural feature maps and comparison of distribution values in healthy or FCD tissue with statistical analysis. We also investigate the efficiency of FCD detection with Machine Learning automatic classification, obtaining precision of 0,81 and sensitivity of 0,87, placing our method on par with other methods in the literature. However, there is a major performance dependency of proposed method with pre-processing steps, like registration and automatic segmentation.

A displasia cortical focal (DCF) é uma das causas mais frequentes de epilepsia refratária. Na clínica, diferentes informações são usadas para localizar o foco epileptogênico, mas nenhum método é autossuficiente para evidenciar o local original das crises, associado com a presença da DCF. Embora haja relatos na literatura indicando alterações no padrão de distribuição de tons de cinza e morfologia dos voxels decorrentes da DCF, algumas limitações dos métodos desenvolvidos ainda impedem a utilização clínica. Nossa proposta foi investigar a capacidade de identificar DCF através de análises de espessura cortical e padrões de textura em imagens estruturais de Ressonância Magnética (RM), validando os métodos desenvolvidos a partir uma base de imagens retrospectiva, cujo tecido epileptogênico já havia sido ressecado e a DCF confirmada em análise histológica. A caracterização das DCF foi feita a partir da segmentação automática de tecido cortical saudável em conjunto com a segmentação manual da DCF feita por um especialista, e consiste na geração de mapas de característica e extração de valores de distribuições para comparação em análise estatística. Investigamos também a eficácia da detecção de DCF através do uso de algoritmos de aprendizado de máquina para classificação automática. Obtivemos precisão 0,81 e sensitividade 0,87, colocando o método desenvolvido em par com outros métodos presentes na literatura. Entretanto, foi identificada uma grande dependência do desempenho de métodos de pré-processamento, como corregistro e segmentação automática. / Focal Cortical Dysplasia (FCD) is one of the most frequent causes of refractory epilepsy. In clinical procedures, the information gathered from different techniques is used in order to locate the epileptogenic focus, associated with the presence of FCD. However, there is no self sufficient method to evidence the presence and location of such lesions and especially its extension. Although there are reports indicating change in gray scale intensity patterns and voxel morphology in the presence of DCF, limitations in developed methods still prevent their clinical use. Our proposal was to investigate the capability of identifying FCD through cortical thickness and texture patter analysis in structural MRI images, validating developed methods by utilizing a retrospective base of images from patients that were subjected to surgery, with the FCD being confirmed in histological analysis. Characterization of FCD was achieved from automatic segmentation of healthy cortex and manual segmentation of FCD tissue made by an specialist, and consists in the generation of texture or structural feature maps and comparison of distribution values in healthy or FCD tissue with statistical analysis. We also investigate the efficiency of FCD detection with Machine Learning automatic classification, obtaining precision of 0,81 and sensitivity of 0,87, placing our method on par with other methods in the literature. However, there is a major performance dependency of proposed method with pre-processing steps, like registration and automatic segmentation.