A Workflow to Visually Assess Interobserver Variability in Medical Image Segmentation.

We introduce a workflow for the visual assessment of interobserver variability in medical image segmentation. Image segmentation is a crucial step in the diagnosis, prognosis, and treatment of many diseases. Despite the advancements in autosegmentation, clinical practice widely relies on manual delineations performed by radiologists. Our work focuses on designing a solution for understanding the radiologists' thought processes during segmentation and for unveiling reasons that lead to interobserver variability. To this end, we propose a visual analysis tool connecting multiple radiologists' delineation processes with their outcomes, and we demonstrate its potential in a case study.

Breast cancer patient characterisation and visualisation using deep learning and fisher information networks.

Breast cancer is the most commonly diagnosed female malignancy globally, with better survival rates if diagnosed early. Mammography is the gold standard in screening programmes for breast cancer, but despite technological advances, high error rates are still reported. Machine learning techniques, and in particular deep learning (DL), have been successfully used for breast cancer detection and classification. However, the added complexity that makes DL models so successful reduces their ability to explain which features are relevant to the model, or whether the model is biased. The main aim of this study is to propose a novel visualisation to help characterise breast cancer patients using Fisher Information Networks on features extracted from mammograms using a DL model. In the proposed visualisation, patients are mapped out according to their similarities and can be used to study new patients as a 'patient-like-me' approach. When applied to the CBIS-DDSM dataset, it was shown that it is a competitive methodology that can (i) facilitate the analysis and decision-making process in breast cancer diagnosis with the assistance of the FIN visualisations and 'patient-like-me' analysis, and (ii) help improve diagnostic accuracy and reduce overdiagnosis by identifying the most likely diagnosis based on clinical similarities with neighbouring patients.

Principles of Visualization in Radiation Oncology.

BACKGROUND: Medical visualization employs elements from computer graphics to create meaningful, interactive visual representations of medical data, and it has become an influential field of research for many advanced applications like radiation oncology, among others. Visual representations employ the user's cognitive capabilities to support and accelerate diagnostic, planning, and quality assurance workflows based on involved patient data. SUMMARY: This article discusses the basic underlying principles of visualization in the application domain of radiation oncology. The main visualization strategies, such as slice-based representations and surface and volume rendering are presented. Interaction topics, i.e., the combination of visualization and automated analysis methods, are also discussed. Key Messages: Slice-based representations are a common approach in radiation oncology, while volume visualization also has a long-standing history in the field. Perception within both representations can benefit further from advanced approaches, such as image fusion and multivolume or hybrid rendering. While traditional slice-based and volume representations keep evolving, the dimensionality and complexity of medical data are also increasing. To address this, visual analytics strategies are valuable, particularly for cohort or uncertainty visualization. Interactive visual analytics approaches represent a new opportunity to integrate knowledgeable experts and their cognitive abilities in exploratory processes which cannot be conducted by solely automatized methods.

Relaxing Dense Scatter Plots with Pixel-Based Mappings.

Scatter plots are the most commonly employed technique for the visualization of bivariate data. Despite their versatility and expressiveness in showing data aspects, such as clusters, correlations, and outliers, scatter plots face a main problem. For large and dense data, the representation suffers from clutter due to overplotting. This is often partially solved with the use of density plots. Yet, data overlap may occur in certain regions of a scatter or density plot, while other regions may be partially, or even completely empty. Adequate pixel-based techniques can be employed for effectively filling the plotting space, giving an additional notion of the numerosity of data motifs or clusters. We propose the Pixel-Relaxed Scatter Plots, a new and simple variant, to improve the display of dense scatter plots, using pixel-based, space-filling mappings. Our Pixel-Relaxed Scatter Plots make better use of the plotting canvas, while avoiding data overplotting, and optimizing space coverage and insight in the presence and size of data motifs. We have employed different methods to map scatter plot points to pixels and to visually present this mapping. We demonstrate our approach on several synthetic and realistic datasets, and we discuss the suitability of our technique for different tasks. Our conducted user evaluation shows that our Pixel-Relaxed Scatter Plots can be a useful enhancement to traditional scatter plots.

Uncertainty evaluation of image-based tumour control probability models in radiotherapy of prostate cancer using a visual analytic tool.

Functional imaging techniques provide radiobiological information that can be included into tumour control probability (TCP) models to enable individualized outcome predictions in radiotherapy. However, functional imaging and the derived radiobiological information are influenced by uncertainties, translating into variations in individual TCP predictions. In this study we applied a previously developed analytical tool to quantify dose and TCP uncertainty bands when initial cell density is estimated from MRI-based apparent diffusion coefficient maps of eleven patients. TCP uncertainty bands of 16% were observed at patient level, while dose variations bands up to 8 Gy were found at voxel level for an iso-TCP approach.

A fluoroscopy-based planning and guidance software tool for minimally invasive hip refixation by cement injection.

PURPOSE: In orthopaedics, minimally invasive injection of bone cement is an established technique. We present HipRFX, a software tool for planning and guiding a cement injection procedure for stabilizing a loosening hip prosthesis. HipRFX works by analysing a pre-operative CT and intraoperative C-arm fluoroscopic images. METHODS: HipRFX simulates the intraoperative fluoroscopic views that a surgeon would see on a display panel. Structures are rendered by modelling their X-ray attenuation. These are then compared to actual fluoroscopic images which allow cement volumes to be estimated. Five human cadaver legs were used to validate the software in conjunction with real percutaneous cement injection into artificially created periprothetic lesions. RESULTS: Based on intraoperatively obtained fluoroscopic images, our software was able to estimate the cement volume that reached the pre-operatively planned targets. The actual median target lesion volume was 3.58 ml (range 3.17-4.64 ml). The median error in computed cement filling, as a percentage of target volume, was 5.3% (range 2.2-14.8%). Cement filling was between 17.6 and 55.4% (median 51.8%). CONCLUSIONS: As a proof of concept, HipRFX was capable of simulating intraoperative fluoroscopic C-arm images. Furthermore, it provided estimates of the fraction of injected cement deposited at its intended target location, as opposed to cement that leaked away. This level of knowledge is usually unavailable to the surgeon viewing a fluoroscopic image and may aid in evaluating the success of a percutaneous cement injection intervention.