Temporal Evaluation of the Surface Area of Treated Skin Ulcers Caused by Cutaneous Leishmaniasis and Relation with Optical Parameters in an Animal Model: A Proof of Concept.

Cutaneous leishmaniasis (CL) is a neglected disease caused by an intracellular parasite of the Leishmania genus. CL lacks tools that allow its understanding and treatment follow-up. This article presents the use of metrical and optical tools for the analysis of the temporal evolution of treated skin ulcers caused by CL in an animal model. Leishmania braziliensis and L. panamensis were experimentally inoculated in golden hamsters, which were treated with experimental and commercial drugs. The temporal evolution was monitored by means of ulcers' surface areas, as well as absorption and scattering optical parameters. Ulcers' surface areas were obtained via photogrammetry, which is a procedure that allowed for 3D modeling of the ulcer using specialized software. Optical parameters were obtained from a spectroscopy study, representing the cutaneous tissue's biological components. A one-way ANOVA analysis was conducted to identify relationships between both the ulcers' areas and optical parameters. As a result, ulcers' surface areas were found to be related to the following optical parameters: epidermis thickness, collagen, keratinocytes, volume-fraction of blood, and oxygen saturation. This study is a proof of concept that shows that optical parameters could be associated with metrical ones, giving a more reliable concept during the assessment of a skin ulcer's healing.

Optical biopsy mapping on endoscopic image mosaics with a marker-free probe.

Gastric cancer is the second leading cause of cancer-related deaths worldwide. Early diagnosis significantly increases the chances of survival; therefore, improved assisted exploration and screening techniques are necessary. Previously, we made use of an augmented multi-spectral endoscope by inserting an optical probe into the instrumentation channel. However, the limited field of view and the lack of markings left by optical biopsies on the tissue complicate the navigation and revisit of the suspect areas probed in-vivo. In this contribution two innovative tools are introduced to significantly increase the traceability and monitoring of patients in clinical practice: (i) video mosaicing to build a more comprehensive and panoramic view of large gastric areas; (ii) optical biopsy targeting and registration with the endoscopic images. The proposed optical flow-based mosaicing technique selects images that minimize texture discontinuities and is robust despite the lack of texture and illumination variations. The optical biopsy targeting is based on automatic tracking of a free-marker probe in the endoscopic view using deep learning to dynamically estimate its pose during exploration. The accuracy of pose estimation is sufficient to ensure a precise overlapping of the standard white-light color image and the hyperspectral probe image, assuming that the small target area of the organ is almost flat. This allows the mapping of all spatio-temporally tracked biopsy sites onto the panoramic mosaic. Experimental validations are carried out from videos acquired on patients in hospital. The proposed technique is purely software-based and therefore easily integrable into clinical practice. It is also generic and compatible to any imaging modality that connects to a fiberscope.

Pose estimation of a markerless fiber bundle for endoscopic optical biopsy.

Purpose: We present a markerless vision-based method for on-the-fly three-dimensional (3D) pose estimation of a fiberscope instrument to target pathologic areas in the endoscopic view during exploration. Approach: A 2.5-mm-diameter fiberscope is inserted through the endoscope's operating channel and connected to an additional camera to perform complementary observation of a targeted area such as a multimodal magnifier. The 3D pose of the fiberscope is estimated frame-by-frame by maximizing the similarity between its silhouette (automatically detected in the endoscopic view using a deep learning neural network) and a cylindrical shape bound to a kinematic model reduced to three degrees-of-freedom. An alignment of the cylinder axis, based on Plücker coordinates from the straight edges detected in the image, makes convergence faster and more reliable. Results: The performance on simulations has been validated with a virtual trajectory mimicking endoscopic exploration and on real images of a chessboard pattern acquired with different endoscopic configurations. The experiments demonstrated a good accuracy and robustness of the proposed algorithm with errors of 0.33 ± 0.68 mm in distance position and 0.32 ± 0.11 deg in axis orientation for the 3D pose estimation, which reveals its superiority over previous approaches. This allows multimodal image registration with sufficient accuracy of < 3 pixels . Conclusion: Our pose estimation pipeline was executed on simulations and patterns; the results demonstrate the robustness of our method and the potential of fiber-optical instrument image-based tracking for pose estimation and multimodal registration. It can be fully implemented in software and therefore easily integrated into a routine clinical environment.

Wound Size Imaging: Ready for Smart Assessment and Monitoring.

Significance: We introduce and evaluate emerging devices and modalities for wound size imaging and also promising image processing tools for smart wound assessment and monitoring. Recent Advances: Some commercial devices are available for optical wound assessment but with limited possibilities compared to the power of multimodal imaging. With new low-cost devices and machine learning, wound assessment has become more robust and accurate. Wound size imaging not only provides area and volume but also the proportion of each tissue on the wound bed. Near-infrared and thermal spectral bands also enhance the classical visual assessment. Critical Issues: The ability to embed advanced imaging technology in portable devices such as smartphones and tablets with tissue analysis software tools will significantly improve wound care. As wound care and measurement are performed by nurses, the equipment needs to remain user-friendly, enable quick measurements, provide advanced monitoring, and be connected to the patient data management system. Future Directions: Combining several image modalities and machine learning, optical wound assessment will be smart enough to enable real wound monitoring, to provide clinicians with relevant indications to adapt the treatments and to improve healing rates and speed. Sharing the wound care histories of a number of patients on databases and through telemedicine practice could induce a better knowledge of the healing process and thus a better efficiency when the recorded clinical experience has been converted into knowledge through deep learning.

Markerless tracking of micro-endoscope for optical biopsy in stomach.

This paper presents a landmark-free approach to estimate the fiberscope pose during endoscopic exploration for in-vivo optical biopsy. The fiberscope pose is estimated by fitting the projection of a virtual 3D cylinder into the endoscopic images. The cylinder axis is estimated based on the apparent contours using Plücker coordinates and its insertion is estimated by maximizing the similarity between binary masks. The performance of the method is evaluated on simulations: the mean Euclidian distance of fiberscopic tip between estimated pose and ground truth is 0.158 ± 0.113 mm. The in-vivo performance is assessed in two endoscopic sequences by comparing automatic RCF and manual segmentations in terms of angular deviation of the axis and Euclidian distance between the tip location. The estimation of the relative position of both cameras allows to perform registration between the two image modalities.

Hyperspectral interventional imaging for enhanced tissue visualization and discrimination combining band selection methods.

PURPOSE: Hyperspectral imaging is an emerging technology recently introduced in medical applications inasmuch as it provides a powerful tool for noninvasive tissue characterization. In this context, a new system was designed to be easily integrated in the operating room in order to detect anatomical tissues hardly noticed by the surgeon's naked eye. METHOD: Our LCTF-based spectral imaging system is operative over visible, near- and middle-infrared spectral ranges (400-1700 nm). It is dedicated to enhance critical biological tissues such as the ureter and the facial nerve. We aim to find the best three relevant bands to create a RGB image to display during the intervention with maximal contrast between the target tissue and its surroundings. A comparative study is carried out between band selection methods and band transformation methods. Combined band selection methods are proposed. All methods are compared using different evaluation criteria. RESULTS: Experimental results show that the proposed combined band selection methods provide the best performance with rich information, high tissue separability and short computational time. These methods yield a significant discrimination between biological tissues. CONCLUSION: We developed a hyperspectral imaging system in order to enhance some biological tissue visualization. The proposed methods provided an acceptable trade-off between the evaluation criteria especially in SWIR spectral band that outperforms the naked eye's capacities.

Enhanced assessment of the wound-healing process by accurate multiview tissue classification.

With the widespread use of digital cameras, freehand wound imaging has become common practice in clinical settings. There is however still a demand for a practical tool for accurate wound healing assessment, combining dimensional measurements and tissue classification in a single user-friendly system. We achieved the first part of this objective by computing a 3-D model for wound measurements using uncalibrated vision techniques. We focus here on tissue classification from color and texture region descriptors computed after unsupervised segmentation. Due to perspective distortions, uncontrolled lighting conditions and view points, wound assessments vary significantly between patient examinations. The main contribution of this paper is to overcome this drawback with a multiview strategy for tissue classification, relying on a 3-D model onto which tissue labels are mapped and classification results merged. The experimental classification tests demonstrate that enhanced repeatability and robustness are obtained and that metric assessment is achieved through real area and volume measurements and wound outline extraction. This innovative tool is intended for use not only in therapeutic follow-up in hospitals but also for telemedicine purposes and clinical research, where repeatability and accuracy of wound assessment are critical.

Three-dimensional assessment of skin wounds using a standard digital camera.

In this paper, after an overview of the literature concerning the imaging technologies applied to skin wounds assessment, we present an original approach to build 3-D models of skin wounds from color images. The method can deal with uncalibrated images acquired with a handheld digital camera with free zooming. Compared with the cumbersome imaging systems already proposed, this novel solution uses a low-cost and user-friendly image acquisition device suitable for widespread application in health care centers. However, this method entails the development of a robust image processing chain. An original iterative matching scheme is used to generate a dense estimation of the surface geometry from two widely separated views. The best configuration for taking photographs lies between 15 ( degrees ) and 30 ( degrees ) for the vergency angle. The metric reconstruction of the skin wound is fully automated through self-calibration. From the 3-D model of the skin wound, accurate volumetric measurements are achieved. The accuracy of the inferred 3-D surface is validated by registration to a ground truth and repetitive tests on volume. The global precision around 3% is in accordance with the clinical requirement of 5% for assessing the healing process.

Supervised tissue classification from color images for a complete wound assessment tool.

This work is part of the ESCALE project dedicated to the design of a complete 3D and color wound assessment tool using a simple free handled digital camera. The first part was concerned with the computation of a 3D model for wound measurements using uncalibrated vision techniques. This paper presents the second part which deals with color classification of wound tissues, a prior step before to combine shape and color analysis in a single tool for real tissue surface measurements. As direct pixel classification proved to be inefficient for tissue wound labeling, we have adopted an original approach based on unsupervised segmentation prior to classification, to improve the robustness of the labeling step by considering spatial continuity and homogeneity. A ground truth is first provided by merging the images collected and labeled by clinicians. Then, color and texture tissue descriptors are extracted on labeled regions of this learning database to design a SVM region classifier, achieving 88% success overlap score. Finally, we apply unsupervised color region segmentation on test images and classify the regions. Compared to the ground truth, segmentation driven classification and clinician labeling achieve similar performance, around 75% for granulation and 60% for slough.