Sorting lung tumor volumes from 4D-MRI data using an automatic tumor-based signal reduces stitching artifacts.

PURPOSE: To investigate whether a novel signal derived from tumor motion allows more precise sorting of 4D-magnetic resonance (4D-MR) image data than do signals based on normal anatomy, reducing levels of stitching artifacts within sorted lung tumor volumes. METHODS: (4D-MRI) scans were collected for 10 lung cancer patients using a 2D T2-weighted single-shot turbo spin echo sequence, obtaining 25 repeat frames per image slice. For each slice, a tumor-motion signal was generated using the first principal component of movement in the tumor neighborhood (TumorPC1). Signals were also generated from displacements of the diaphragm (DIA) and upper and lower chest wall (UCW/LCW) and from slice body area changes (BA). Pearson r coefficients of correlations between observed tumor movement and respiratory signals were determined. TumorPC1, DIA, and UCW signals were used to compile image stacks showing each patient's tumor volume in a respiratory phase. Unsorted image stacks were also built for comparison. For each image stack, the presence of stitching artifacts was assessed by measuring the roughness of the compiled tumor surface according to a roughness metric (Rg). Statistical differences in weighted means of Rg between any two signals were determined using an exact permutation test. RESULTS: The TumorPC1 signal was most strongly correlated with superior-inferior tumor motion, and had significantly higher Pearson r values (median 0.86) than those determined for correlations of UCW, LCW, and BA with superior-inferior tumor motion (p < 0.05). Weighted means of ratios of Rg values in TumorPC1 image stacks to those in unsorted, UCW, and DIA stacks were 0.67, 0.69, and 0.71, all significantly favoring TumorPC1 (p = 0.02-0.05). For other pairs of signals, weighted mean ratios did not differ significantly from one. CONCLUSION: Tumor volumes were smoother in 3D image stacks compiled using the first principal component of tumor motion than in stacks compiled with signals based on normal anatomy.

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.

Robot-assistant for MRI-guided liver ablation: A pilot study.

PURPOSE: Percutaneous ablation under MRI-guidance allows treating otherwise inoperable liver tumors locally using a catheter probe. However, manually placing the probe is an error-prone and time consuming task that requires a considerable amount of training. The aim of this paper was to present a pneumatically actuated robotic instrument that can assist clinicians in MRI-guided percutaneous intervention of the liver and to assess its functionality in a clinical setting. The robot positions a needle-guide inside the MRI scanner bore and assists manual needle insertions outside the bore. METHODS: The robot supports double oblique insertions that are particularly challenging for less experienced clinicians. Additionally, the system employs only standard imaging sequences and can therefore be used on different MRI scanners without requiring prior integration. The repeatability and the accuracy of the robot were evaluated with an optical tracking system. The functionality of the robot was assessed in an initial pilot study on two patients that underwent MRI-guided laser ablation of the liver. RESULTS: The robot positioned the needle-guide in a repeatable manner with a mean error of 0.35 mm and a standard deviation of 0.32 mm. The mean position error corresponding to the needle tip, measured for an equivalent needle length of 195 mm over 25 fixed points, was 2.5 mm with a standard deviation of 1.2 mm. The pilot study confirmed that the robot does not interfere with the equipment used for MRI-guided laser ablation and does not visibly affect the MR images. The robot setup integrated seamlessly within the established clinical workflow. The robot-assisted procedure was successfully completed on two patients, one of which required a complex double oblique insertion. For both patients, the insertion depth and the tumor size were within the range reported for previous MRI-guided percutaneous interventions. A third patient initially enrolled in the pilot study and was considerably heavier than the others, preventing the use of the robot and requiring several freehand insertion attempts. CONCLUSIONS: The robot repeatability and accuracy are appropriate for liver tumors normally treated with MRI-guided ablation. The results of the pilot study endorse the clinical use of the robot in its current form: the robot is fully functional and MRI-compatible in a clinical setting and is suitable for double-oblique needle insertions.

Optothermal profile of an ablation catheter with integrated microcoil for MR-thermometry during Nd:YAG laser interstitial thermal therapies of the liver­an in-vitro experimental and theoretical study.

PURPOSE: Flexible microcoils integrated with ablation catheters can improve the temperature accuracy during local MR-thermometry in Nd:YAG laser interstitial thermal therapies. Here, the authors are concerned with obtaining a preliminary confirmation of the clinical utility of the modified catheter. They investigate whether the thin-film substrate and copper tracks of the printed coil inductor affect the symmetry of the thermal profile, and hence of the lesion produced. METHODS: Transmission spectroscopy in the near infrared was performed to test for the attenuation at 1064 nm through the 25 µm thick Kapton substrate of the microcoil. The radial transmission profile of an infrared high-power, light emitting diode with >80% normalized power at 1064 nm was measured through a cross section of the modified applicator to assess the impact of the copper inductor on the optical profile. The measurements were performed in air, as well as with the applicator surrounded by two types of scattering media; crystals of NaCl and a layer of liver-mimicking gel phantom. A numerical model based on Huygens-Fresnel principle and finite element simulations, using a commercially available package (COMSOL Multiphysics), were employed to compare with the optical measurements. The impact of the modified optical profile on the thermal symmetry was assessed by examining the high resolution microcoil derived thermal maps from a Nd:YAG laser ablation performed on a liver-mimicking gel phantom. RESULTS: Less than 30% attenuation through the Kapton film was verified. Shadowing behind the copper tracks was observed in air and the measured radial irradiation correlated well with the diffraction pattern calculated numerically using the Huygens-Fresnel principle. Both optical experiments and simulations, demonstrate that shadowing is mitigated by the scattering properties of a turbid medium. The microcoil derived thermal maps at the end of a Nd:YAG laser ablation performed on a gel phantom in a 3 T scanner confirm that the modified irradiation pattern does not disrupt the thermal symmetry, even though, unlike tissue, the gel is minimally scattering. CONCLUSIONS: The results from this initial assessment indicate that microcoils can be safely integrated with ablation catheters and ensure that the complete necrosis of the liver tumor can still be achieved.

Fast and accurate localization of multiple RF markers for tracking in MRI-guided interventions.

OBJECT: A new method for 3D localization of N fiducial markers from 1D projections is presented and analysed. It applies to semi-active markers and active markers using a single receiver channel. MATERIALS AND METHODS: The novel algorithm computes candidate points using peaks in three optimally selected projections and removes fictitious points by verifying detected peaks in additional projections. Computational complexity was significantly reduced by avoiding cluster analysis, while higher accuracy was achieved by using optimal projections and by applying Gaussian interpolation in peak detection. Computational time, accuracy and robustness were analysed through Monte Carlo simulations and experiments. The method was employed in a prototype MRI guided prostate biopsy system and used in preclinical experiments. RESULTS: The computational time for 6 markers was better than 2 ms, an improvement of up to 100 times, compared to the method by Flask et al. (J Magn Reson Imaging 14(5):617-627, 2001). Experimental maximum localization error was lower than 0.3 mm; standard deviation was 0.06 mm. Targeting error was about 1 mm. Tracking update rate was about 10 Hz. CONCLUSION: The proposed method is particularly suitable in systems requiring any of the following: high frame rate, tracking of three or more markers, data filtering or interleaving.

Magnetic Resonance Imaging Duodenoscope.

A side-viewing duodenoscope capable of both optical and magnetic resonance imaging (MRI) is described. The instrument is constructed from MR-compatible materials and combines a coherent fiber bundle for optical imaging, an irrigation channel and a side-opening biopsy channel for the passage of catheter tools with a tip saddle coil for radio-frequency signal reception. The receiver coil is magnetically coupled to an internal pickup coil to provide intrinsic safety. Impedance matching is achieved using a mechanically variable mutual inductance, and active decoupling by PIN-diode switching. (1)H MRI of phantoms and ex vivo porcine liver specimens was carried out at 1.5 T. An MRI field-of-view appropriate for use during endoscopic retrograde cholangiopancreatography (ERCP) was obtained, with limited artefacts, and a signal-to-noise ratio advantage over a surface array coil was demonstrated.

Magneto-inductive catheter receiver for magnetic resonance imaging.

A catheter-based RF receiver for internal magnetic resonance imaging is demonstrated. The device consists of a double-sided thin-film circuit, wrapped around a hollow catheter and sealed in place with heat-shrink tubing. Signals are detected using a resonant LC circuit at the catheter tip and transmitted along the catheter using an array of coupled LC circuits arranged as a magneto-inductive waveguide, a form of low frequency metamaterial. Coupling to a conventional RF system is accomplished using a demountable inductive transducer. Protection against external B 1 and E fields is obtained by using figure-of-eight elements with an electrical length shorter than that of an immersed dipole. The system is primarily designed for biliary imaging, can pass the biopsy channel of a side-opening duodenoscope, and is guidewire-compatible, potentially allowing clinicians to implement MR image guided procedures without changing their standard practice. Decoupling against B 1 and E fields is verified, and in vitro (1)H magnetic resonance imaging with submillimeter resolution is demonstrated at 1.5 T using phantoms.

Finite-element analysis for magnetic resonance image artifact evaluation.

The static magnetic field of a magnetic resonance imaging scanner can be distorted by the presence of materials, perturbing the spatial encoding process in magnetic resonance imaging and often resulting in image artifacts. The relationship between the image artifact size and magnetic susceptibility of the material specimen is of interest to engineers for the design of devices that are to be compatible with the imaging volume of the scanner. In this study, a finite-element method was used to simulate the distorted magnetic field of samples with different susceptibilities. With the knowledge of the external- and self- magnetic field interactions, a Lorentz correction was applied to compute the magnetic field deviation. The simulated results were then validated by the corresponding experimental magnetic resonance images.

Robotic system for transrectal biopsy of the prostate: real-time guidance under MRI.

In this paper, to harness the possibility of real-time guidance of MRI, a robotic system has been developed to perform transrectal prostate biopsy inside a 1.5-T closed bore scanner. A specially developed MR pulse sequence is capable of tracking the needle location in real time while dynamically updating the scan planes to always include the needle and target.

Sub-pixel localisation of passive micro-coil fiducial markers in interventional MRI.

OBJECTIVE: Electromechanical devices enable increased accuracy in surgical procedures, and the recent development of MRI-compatible mechatronics permits the use of MRI for real-time image guidance. Integrated imaging of resonant micro-coil fiducials provides an accurate method of tracking devices in a scanner with increased flexibility compared to gradient tracking. Here we report on the ability of ten different image-processing algorithms to track micro-coil fiducials with sub-pixel accuracy. MATERIALS AND METHODS: Five algorithms: maximum pixel, barycentric weighting, linear interpolation, quadratic fitting and Gaussian fitting were applied both directly to the pixel intensity matrix and to the cross-correlation matrix obtained by 2D convolution with a reference image. RESULTS: Using images of a 3 mm fiducial marker and a pixel size of 1.1 mm, intensity linear interpolation, which calculates the position of the fiducial centre by interpolating the pixel data to find the fiducial edges, was found to give the best performance for minimal computing power; a maximum error of 0.22 mm was observed in fiducial localisation for displacements up to 40 mm. The inherent standard deviation of fiducial localisation was 0.04 mm. CONCLUSION: This work enables greater accuracy to be achieved in passive fiducial tracking.

The case for MR-compatible robotics: a review of the state of the art.

BACKGROUND: The numerous imaging capabilities of magnetic resonance imaging (MRI) coupled with its lack of ionizing radiation has made it a desirable modality for real-time guidance of interventional procedures. The combination of these abilities with the advantages granted by robotic systems to perform accurate and precise positioning of tools has driven the recent development of MR-compatible interventional and assistive devices. METHODS: The challenges in this field are presented, including the selection of suitable materials, actuators and sensors in the intense magnetic fields of the MR environment. RESULTS: Only a small number of developed systems have made it to the clinical level (only two have become commercial ventures), showing that the field has not yet reached maturity. CONCLUSIONS: A brief overview of the current state of the art is given, along with a description of the main opportunities, possibilities and challenges that the future will bring to this exciting and promising field.

A MR compatible mechatronic system to facilitate magic angle experiments in vivo.

When imaging tendons and cartilage in a MRI scanner, an increase in signal intensity is observed when they are oriented at 55 degrees with respect to Bo (the "magic angle"). There is a clear clinical importance for considering this effect as part of the diagnosis of orthopaedic and other injury. Experimental studies of this phenomenon have been made harder by practical difficulties of tissue positioning and orientation in the confined environment of cylindrical scanners. An MRI compatible mechatronic system has been developed to position a variety of limbs inside the field of view of the scanner, to be used as a diagnostic and research tool. It is actuated with a novel pneumatic motor comprised of a heavily geared down air turbine, and is controlled in a closed loop using standard optical encoders. MR compatibility is demonstrated as well as the results of preliminary trials used to image the Achilles tendon of human volunteers at different orientations. A 4 to 13 fold increase in signal at the tendon is observed at the magic angle.

The feasibility of MR-image guided prostate biopsy using piezoceramic motors inside or near to the magnet isocentre.

The excellent soft tissue contrast of Magnetic Resonance Imaging (MRI) has encouraged the development of MRI compatible systems capable of combining the advantages of robotic manipulators with high quality anatomical images. Continuing this development, a new five DOF prostate biopsy manipulator has been designed for use inside a closed 1.5T MRI scanner. Space constraints in the bore and the current trend to restrict field strength exposure for operators indicate that a master-slave configuration is ideal for controlling the robotic system from outside the bore. This system has been designed to work with piezoceramic motors and optical encoders placed inside or near the field of view of the scanner, using real time image guidance for targeting biopsies to specific lesions in the prostate. MRI tests have been performed to prove the feasibility of this concept and a one DOF proof-of-concept test rig implementing closed loop position control has been tested and is presented here. A first prototype of the slave manipulator has been designed and manufactured incorporating this new technology.