Predicting the mechanical hip-knee-ankle angle accurately from standard knee radiographs: a cross-validation experiment in 100 patients.

Background and purpose - Being able to predict the hip-knee-ankle angle (HKAA) from standard knee radiographs allows studies on malalignment in cohorts lacking full-limb radiography. We aimed to develop an automated image analysis pipeline to measure the femoro-tibial angle (FTA) from standard knee radiographs and test various FTA definitions to predict the HKAA. Patients and methods - We included 110 pairs of standard knee and full-limb radiographs. Automatic search algorithms found anatomic landmarks on standard knee radiographs. Based on these landmarks, the FTA was automatically calculated according to 9 different definitions (6 described in the literature and 3 newly developed). Pearson and intra-class correlation coefficient [ICC]) were determined between the FTA and HKAA as measured on full-limb radiographs. Subsequently, the top 4 FTA definitions were used to predict the HKAA in a 5-fold cross-validation setting. Results - Across all pairs of images, the Pearson correlations between FTA and HKAA ranged between 0.83 and 0.90. The ICC values from 0.83 to 0.90. In the cross-validation experiments to predict the HKAA, these values decreased only minimally. The mean absolute error for the best method to predict the HKAA from standard knee radiographs was 1.8° (SD 1.3). Interpretation - We showed that the HKAA can be automatically predicted from standard knee radiographs with fair accuracy and high correlation compared with the true HKAA. Therefore, this method enables research of the relationship between malalignment and knee pathology in large (epidemiological) studies lacking full-limb radiography.

Fully Automatic System for Accurate Localisation and Analysis of Cephalometric Landmarks in Lateral Cephalograms.

Cephalometric tracing is a standard analysis tool for orthodontic diagnosis and treatment planning. The aim of this study was to develop and validate a fully automatic landmark annotation (FALA) system for finding cephalometric landmarks in lateral cephalograms and its application to the classification of skeletal malformations. Digital cephalograms of 400 subjects (age range: 7-76 years) were available. All cephalograms had been manually traced by two experienced orthodontists with 19 cephalometric landmarks, and eight clinical parameters had been calculated for each subject. A FALA system to locate the 19 landmarks in lateral cephalograms was developed. The system was evaluated via comparison to the manual tracings, and the automatically located landmarks were used for classification of the clinical parameters. The system achieved an average point-to-point error of 1.2 mm, and 84.7% of landmarks were located within the clinically accepted precision range of 2.0 mm. The automatic landmark localisation performance was within the inter-observer variability between two clinical experts. The automatic classification achieved an average classification accuracy of 83.4% which was comparable to an experienced orthodontist. The FALA system rapidly and accurately locates and analyses cephalometric landmarks in lateral cephalograms, and has the potential to significantly improve the clinical work flow in orthodontic treatment.

A benchmark for comparison of dental radiography analysis algorithms.

Dental radiography plays an important role in clinical diagnosis, treatment and surgery. In recent years, efforts have been made on developing computerized dental X-ray image analysis systems for clinical usages. A novel framework for objective evaluation of automatic dental radiography analysis algorithms has been established under the auspices of the IEEE International Symposium on Biomedical Imaging 2015 Bitewing Radiography Caries Detection Challenge and Cephalometric X-ray Image Analysis Challenge. In this article, we present the datasets, methods and results of the challenge and lay down the principles for future uses of this benchmark. The main contributions of the challenge include the creation of the dental anatomy data repository of bitewing radiographs, the creation of the anatomical abnormality classification data repository of cephalometric radiographs, and the definition of objective quantitative evaluation for comparison and ranking of the algorithms. With this benchmark, seven automatic methods for analysing cephalometric X-ray image and two automatic methods for detecting bitewing radiography caries have been compared, and detailed quantitative evaluation results are presented in this paper. Based on the quantitative evaluation results, we believe automatic dental radiography analysis is still a challenging and unsolved problem. The datasets and the evaluation software will be made available to the research community, further encouraging future developments in this field. (http://www-o.ntust.edu.tw/~cweiwang/ISBI2015/).

Robust and Accurate Shape Model Matching Using Random Forest Regression-Voting.

A widely used approach for locating points on deformable objects in images is to generate feature response images for each point, and then to fit a shape model to these response images. We demonstrate that Random Forest regression-voting can be used to generate high quality response images quickly. Rather than using a generative or a discriminative model to evaluate each pixel, a regressor is used to cast votes for the optimal position of each point. We show that this leads to fast and accurate shape model matching when applied in the Constrained Local Model framework. We evaluate the technique in detail, and compare it with a range of commonly used alternatives across application areas: the annotation of the joints of the hands in radiographs and the detection of feature points in facial images. We show that our approach outperforms alternative techniques, achieving what we believe to be the most accurate results yet published for hand joint annotation and state-of-the-art performance for facial feature point detection.

Indexed distribution analysis for improved significance testing of spatially heterogeneous parameter maps: application to dynamic contrast-enhanced MRI biomarkers.

PURPOSE: To develop significance testing methodology applicable to spatially heterogeneous parametric maps of biophysical and physiological measurements arising from imaging studies. THEORY: Heterogeneity can confound statistical analyses. Indexed distribution analysis (IDA) transforms a reference distribution, establishing correspondences across parameter maps to which significance tests are applied. METHODS: Well-controlled simulated and clinical K(trans) data from a dynamic contrast-enhanced magnetic resonance imaging study of bevacizumab were analyzed using conventional significance tests of parameter averages, histogram analysis, and IDA. Repeated pretreatment scans provided negative control; a post treatment scan provided positive control. RESULTS: Histogram analysis was insensitive to simulated and known effects. Simulation: conventional analysis identified treatment effect (P ≈ 5 × 10(-4)) and direction, but underestimated magnitude (relative error 67-81%); IDA identified treatment effect (P = 0.001), magnitude, direction, and spatial extent (100% accuracy). Bevacizumab: conventional analysis was sensitive to treatment effect (P = 0.01; 95% confidence interval on K(trans) decrease: 23-37%); IDA was sensitive to treatment effect (P < 0.05; K(trans) decrease approximately 25%), inferred its spatial extent to be 94-96%, and inferred that K(trans) decrease is independent of baseline value, an inference that conventional and histogram analyses cannot make. CONCLUSIONS: In the presence of heterogeneity, IDA can accurately infer the magnitude, direction, and spatial extent of between samples of parametric maps, which can be visualized spatially with respect to the original parameter maps.

Accurate bone segmentation in 2D radiographs using fully automatic shape model matching based on regression-voting.

Recent work has shown that using Random Forests (RFs) to vote for the optimal position of model feature points leads to robust and accurate shape model matching. This paper applies RF regression-voting as part of a fully automatic shape model matching (FASMM) system to three different radiograph segmentation problems: the proximal femur, the bones of the knee joint and the joints of the hand. We investigate why this approach works so well and demonstrate that the performance comes from a combination of three properties: (i) The integration of votes from multiple regions around the model point. (ii) The combination of multiple independent votes from each tree. (iii) The use of a coarse to fine strategy. We show that each property can improve performance, and that the best performance comes from using all three. We demonstrate that FASMM based on RF regression-voting generalises well across application areas, achieving state of the art performance in each of the three segmentation problems. This FASMM system provides an accurate and time-efficient way for the segmentation of bony structures in radiographs.

Segmentation of lumbar vertebrae using part-based graphs and active appearance models.

The aim of the work is to provide a fully automatic method of segmenting vertebrae in spinal radiographs. This is of clinical relevance to the diagnosis of osteoporosis by vertebral fracture assessment, and to grading incident fractures in clinical trials. We use a parts based model of small vertebral patches (e.g., corners). Many potential candidates are found in a global search using multi-resolution normalised correlation. The ambiguity in the possible solution is resolved by applying a graphical model of the connections between parts, and applying geometric constraints. The resulting graph optimisation problem is solved using loopy belief propagation. The minimum cost solution is used to initialize a second phase of active appearance model search. The method is applied to a clinical data set of computed radiography images of lumbar spines. The accuracy of this fully automatic method is assessed by comparing the results to a gold standard of manual annotation by expert radiologists.

Shape discrimination in the hippocampus using an MDL model.

We extend recent work on building 3D statistical shape models, automatically, from sets of training shapes and describe an application in shape analysis. Using an existing measure of model quality, based on a minimum description length criterion, and an existing method of surface re-parameterisation, we introduce a new approach to model optimisation that is scalable, more accurate, and involves fewer parameters than previous methods. We use the new approach to build a model of the right hippocampus, using a training set of 82 shapes, manually segmented from 3D MR images of the brain. We compare the results with those obtained using another previously published method for building 3D models, and show that our approach results in a model that is significantly more specific, general, and compact. The two models are used to investigate the hypothesis that there are differences in hippocampal shape between age-matched schizophrenic and normal control subgroups within the training set. Linear discriminant analysis is used to find the combination of shape parameters that best separates the two subgroups. We perform an unbiased test that shows there is a statistically significant shape difference using either shape model, but that the difference is more significant using the model built using our approach. We show also that the difference between the two subgroups can be visualised as a mode of shape variation.

A minimum description length approach to statistical shape modeling.

We describe a method for automatically building statistical shape models from a training set of example boundaries/surfaces. These models show considerable promise as a basis for segmenting and interpreting images. One of the drawbacks of the approach is, however, the need to establish a set of dense correspondences between all members of a set of training shapes. Often this is achieved by locating a set of "landmarks" manually on each training image, which is time consuming and subjective in two dimensions and almost impossible in three dimensions. We describe how shape models can be built automatically by posing the correspondence problem as one of finding the parameterization for each shape in the training set. We select the set of parameterizations that build the "best" model. We define "best" as that which minimizes the description length of the training set, arguing that this leads to models with good compactness, specificity and generalization ability. We show how a set of shape parameterizations can be represented and manipulated in order to build a minimum description length model. Results are given for several different training sets of two-dimensional boundaries, showing that the proposed method constructs better models than other approaches including manual landmarking-the current gold standard. We also show that the method can be extended straightforwardly to three dimensions.