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Oligodendroglioma, IDH-mutant and 1p/19q-codeleted has highly variable outcomes that are strongly influenced by patient age. The distribution of oligodendroglioma age is non-Gaussian and reportedly bimodal, which motivated our investigation of age-associated molecular alterations that may drive poorer outcomes. We found that elevated HOXD12 expression was associated with both older patient age and shorter survival in the TCGA (FDR < 0.01, FDR = 1e-5) and the CGGA (p = 0.03, p < 1e-3). HOXD12 gene body hypermethylation was associated with older age, higher WHO grade, and shorter survival in the TCGA (p < 1e-6, p < 0.001, p < 1e-3) and with older age and higher WHO grade in Capper et al. (p < 0.002, p = 0.014). In the TCGA, HOXD12 gene body hypermethylation and elevated expression were independently prognostic of NOTCH1 and PIK3CA mutations, loss of 15q, MYC activation, and standard histopathological features. Single-nucleus RNA and ATAC sequencing data showed that HOXD12 activity was elevated in neoplastic tissue, particularly within cycling and OPC-like cells, and was associated with a stem-like phenotype. A pan-HOX DNA methylation analysis revealed an age and survival-associated HOX-high signature that was tightly associated with HOXD12 gene body methylation. Overall, HOXD12 expression and gene body hypermethylation were associated with an older, atypically aggressive subtype of oligodendroglioma., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Deep learning techniques offer improvements in computer-aided diagnosis systems. However, acquiring image domain annotations is challenging due to the knowledge and commitment required of expert pathologists. Pathologists often identify regions in whole slide images with diagnostic relevance rather than examining the entire slide, with a positive correlation between the time spent on these critical image regions and diagnostic accuracy. In this paper, a heatmap is generated to represent pathologists' viewing patterns during diagnosis and used to guide a deep learning architecture during training. The proposed system outperforms traditional approaches based on color and texture image characteristics, integrating pathologists' domain expertise to enhance region of interest detection without needing individual case annotations. Evaluating our best model, a U-Net model with a pre-trained ResNet-18 encoder, on a skin biopsy whole slide image dataset for melanoma diagnosis, shows its potential in detecting regions of interest, surpassing conventional methods with an increase of 20%, 11%, 22%, and 12% in precision, recall, F1-score, and Intersection over Union, respectively. In a clinical evaluation, three dermatopathologists agreed on the model's effectiveness in replicating pathologists' diagnostic viewing behavior and accurately identifying critical regions. Finally, our study demonstrates that incorporating heatmaps as supplementary signals can enhance the performance of computer-aided diagnosis systems. Without the availability of eye tracking data, identifying precise focus areas is challenging, but our approach shows promise in assisting pathologists in improving diagnostic accuracy and efficiency, streamlining annotation processes, and aiding the training of new pathologists., (© 2024. The Author(s).)

Recent accelerations in multi-modal applications have been made possible with the plethora of image and text data available online. However, the scarcity of analogous data in the medical field, specifically in histopathology, has halted comparable progress. To enable similar representation learning for histopathology, we turn to YouTube, an untapped resource of videos, offering 1,087 hours of valuable educational histopathology videos from expert clinicians. From YouTube, we curate Quilt: a large-scale vision-language dataset consisting of 768,826 image and text pairs. Quilt was automatically curated using a mixture of models, including large language models, handcrafted algorithms, human knowledge databases, and automatic speech recognition. In comparison, the most comprehensive datasets curated for histopathology amass only around 200K samples. We combine Quilt with datasets from other sources, including Twitter, research papers, and the internet in general, to create an even larger dataset: Quilt-1M, with 1M paired image-text samples, marking it as the largest vision-language histopathology dataset to date. We demonstrate the value of Quilt-1M by fine-tuning a pre-trained CLIP model. Our model outperforms state-of-the-art models on both zero-shot and linear probing tasks for classifying new histopathology images across 13 diverse patch-level datasets of 8 different sub-pathologies and cross-modal retrieval tasks.

The number of melanoma diagnoses has increased dramatically over the past three decades, outpacing almost all other cancers. Nearly 1 in 4 skin biopsies is of melanocytic lesions, highlighting the clinical and public health importance of correct diagnosis. Deep learning image analysis methods may improve and complement current diagnostic and prognostic capabilities. The histologic evaluation of melanocytic lesions, including melanoma and its precursors, involves determining whether the melanocytic population involves the epidermis, dermis, or both. Semantic segmentation of clinically important structures in skin biopsies is a crucial step towards an accurate diagnosis. While training a segmentation model requires ground-truth labels, annotation of large images is a labor-intensive task. This issue becomes especially pronounced in a medical image dataset in which expert annotation is the gold standard. In this paper, we propose a two-stage segmentation pipeline using coarse and sparse annotations on a small region of the whole slide image as the training set. Segmentation results on whole slide images show promising performance for the proposed pipeline., (© 2022. The Author(s) under exclusive licence to Society for Imaging Informatics in Medicine.)

A rapidly increasing rate of melanoma diagnosis has been noted over the past three decades, and nearly 1 in 4 skin biopsies are diagnosed as melanocytic lesions. The gold standard for diagnosis of melanoma is the histopathological examination by a pathologist to analyze biopsy material at both the cellular and structural levels. A pathologist's diagnosis is often subjective and prone to variability, while deep learning image analysis methods may improve and complement current diagnostic and prognostic capabilities. Mitoses are important entities when reviewing skin biopsy cases as their presence carries prognostic information; thus, their precise detection is an important factor for clinical care. In addition, semantic segmentation of clinically important structures in skin biopsies might help the diagnosis pipeline with an accurate classification. We aim to provide prognostic and diagnostic information on skin biopsy images, including the detection of cellular level entities, segmentation of clinically important tissue structures, and other important factors toward the accurate diagnosis of skin biopsy images. This paper is an overview of our work on analysis of digital whole slide skin biopsy images, including mitotic figure (mitosis) detection, semantic segmentation, diagnosis, and analysis of pathologists' viewing patterns, and with new work on melanocyte detection. Deep learning has been applied to our methods for all the detection, segmentation, and diagnosis work. In our studies, deep learning is proven superior to prior approaches to skin biopsy analysis. Our work on analysis of pathologists' viewing patterns is the only such work in the skin biopsy literature. Our work covers the whole spectrum from low-level entities through diagnosis and understanding what pathologists do in performing their diagnoses., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nofallah, Wu, Liu, Ghezloo, Elmore and Shapiro.)

Invasive melanoma, a common type of skin cancer, is considered one of the deadliest. Pathologists routinely evaluate melanocytic lesions to determine the amount of atypia, and if the lesion represents an invasive melanoma, its stage. However, due to the complicated nature of these assessments, inter- and intra-observer variability among pathologists in their interpretation are very common. Machine-learning techniques have shown impressive and robust performance on various tasks including healthcare. In this work, we study the potential of including semantic segmentation of clinically important tissue structure in improving the diagnosis of skin biopsy images. Our experimental results show a 6% improvement in F-score when using whole slide images along with epidermal nests and cancerous dermal nest segmentation masks compared to using whole-slide images alone in training and testing the diagnosis pipeline.

Diagnostic disagreements among pathologists occur throughout the spectrum of benign to malignant lesions. A computer-aided diagnostic system capable of reducing uncertainties would have important clinical impact. To develop a computer-aided diagnosis method for classifying breast biopsy images into a range of diagnostic categories (benign, atypia, ductal carcinoma in situ, and invasive breast cancer), we introduce a transformer-based hollistic attention network called HATNet. Unlike state-of-the-art histopathological image classification systems that use a two pronged approach, i.e., they first learn local representations using a multi-instance learning framework and then combine these local representations to produce image-level decisions, HATNet streamlines the histopathological image classification pipeline and shows how to learn representations from gigapixel size images end-to-end. HATNet extends the bag-of-words approach and uses self-attention to encode global information, allowing it to learn representations from clinically relevant tissue structures without any explicit supervision. It outperforms the previous best network Y-Net, which uses supervision in the form of tissue-level segmentation masks, by 8%. Importantly, our analysis reveals that HATNet learns representations from clinically relevant structures, and it matches the classification accuracy of 87 U.S. pathologists for this challenging test set., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Although pathologists have their own viewing habits while diagnosing, viewing behaviors leading to the most accurate diagnoses are under-investigated. Digital whole slide imaging has enabled investigators to analyze pathologists' visual interpretation of histopathological features using mouse and viewport tracking techniques. In this study, we provide definitions for basic viewing behavior variables and investigate the association of pathologists' characteristics and viewing behaviors, and how they relate to diagnostic accuracy when interpreting whole slide images. We use recordings of 32 pathologists' actions while interpreting a set of 36 digital whole slide skin biopsy images (5 sets of 36 cases; 180 cases total). These viewport tracking data include the coordinates of a viewport scene on pathologists' screens, the magnification level at which that viewport was viewed, as well as a timestamp. We define a set of variables to quantify pathologists' viewing behaviors such as zooming, panning, and interacting with a consensus reference panel's selected region of interest (ROI). We examine the association of these viewing behaviors with pathologists' demographics, clinical characteristics, and diagnostic accuracy using cross-classified multilevel models. Viewing behaviors differ based on clinical experience of the pathologists. Pathologists with a higher caseload of melanocytic skin biopsy cases and pathologists with board certification and/or fellowship training in dermatopathology have lower average zoom and lower variance of zoom levels. Viewing behaviors associated with higher diagnostic accuracy include higher average and variance of zoom levels, a lower magnification percentage (a measure of consecutive zooming behavior), higher total interpretation time, and higher amount of time spent viewing ROIs. Scanning behavior, which refers to panning with a fixed zoom level, has marginally significant positive association with accuracy. Pathologists' training, clinical experience, and their exposure to a range of cases are associated with their viewing behaviors, which may contribute to their diagnostic accuracy. Research in computational pathology integrating digital imaging and clinical informatics opens up new avenues for leveraging viewing behaviors in medical education and training, potentially improving patient care and the effectiveness of clinical workflow., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Knowledge of 1p/19q-codeletion and IDH1/2 mutational status is necessary to interpret any investigational study of diffuse gliomas in the modern era. While DNA sequencing is the gold standard for determining IDH mutational status, genome-wide methylation arrays and gene expression profiling have been used for surrogate mutational determination. Previous studies by our group suggest that 1p/19q-codeletion and IDH mutational status can be predicted by genome-wide somatic copy number alteration (SCNA) data alone, however a rigorous model to accomplish this task has yet to be established. In this study, we used SCNA data from 786 adult diffuse gliomas in The Cancer Genome Atlas (TCGA) to develop a two-stage classification system that identifies 1p/19q-codeleted oligodendrogliomas and predicts the IDH mutational status of astrocytic tumors using a machine-learning model. Cross-validated results on TCGA SCNA data showed near perfect classification results. Furthermore, our astrocytic IDH mutation model validated well on four additional datasets (AUC = 0.97, AUC = 0.99, AUC = 0.95, AUC = 0.96) as did our 1p/19q-codeleted oligodendroglioma screen on the two datasets that contained oligodendrogliomas (MCC = 0.97, MCC = 0.97). We then retrained our system using data from these validation sets and applied our system to a cohort of REMBRANDT study subjects for whom SCNA data, but not IDH mutational status, is available. Overall, using genome-wide SCNAs, we successfully developed a system to robustly predict 1p/19q-codeletion and IDH mutational status in diffuse gliomas. This system can assign molecular subtype labels to tumor samples of retrospective diffuse glioma cohorts that lack 1p/19q-codeletion and IDH mutational status, such as the REMBRANDT study, recasting these datasets as validation cohorts for diffuse glioma research., (© 2021. The Author(s).)

This paper studies why pathologists can misdiagnose diagnostically challenging breast biopsy cases, using a data set of 240 whole slide images (WSIs). Three experienced pathologists agreed on a consensus reference ground-truth diagnosis for each slide and also a consensus region of interest (ROI) from which the diagnosis could best be made. A study group of 87 other pathologists then diagnosed test sets (60 slides each) and marked their own regions of interest. Diagnoses and ROIs were categorized such that if on a given slide, their ROI differed from the consensus ROI and their diagnosis was incorrect, that ROI was called a distractor . We used the HATNet transformer-based deep learning classifier to evaluate the visual similarities and differences between the true (consensus) ROIs and the distractors. Results showed high accuracy for both the similarity and difference networks, showcasing the challenging nature of feature classification with breast biopsy images. This study is important in the potential use of its results for teaching pathologists how to diagnose breast biopsy slides.

Objective: Modeling variable-sized regions of interest (ROIs) in whole slide images using deep convolutional networks is a challenging task, as these networks typically require fixed-sized inputs that should contain sufficient structural and contextual information for classification. We propose a deep feature extraction framework that builds an ROI-level feature representation via weighted aggregation of the representations of variable numbers of fixed-sized patches sampled from nuclei-dense regions in breast histopathology images., Methods: First, the initial patch-level feature representations are extracted from both fully-connected layer activations and pixel-level convolutional layer activations of a deep network, and the weights are obtained from the class predictions of the same network trained on patch samples. Then, the final patch-level feature representations are computed by concatenation of weighted instances of the extracted feature activations. Finally, the ROI-level representation is obtained by fusion of the patch-level representations by average pooling., Results: Experiments using a well-characterized data set of 240 slides containing 437 ROIs marked by experienced pathologists with variable sizes and shapes result in an accuracy score of 72.65% in classifying ROIs into four diagnostic categories that cover the whole histologic spectrum., Conclusion: The results show that the proposed feature representations are superior to existing approaches and provide accuracies that are higher than the average accuracy of another set of pathologists., Significance: The proposed generic representation that can be extracted from any type of deep convolutional architecture combines the patch appearance information captured by the network activations and the diagnostic relevance predicted by the class-specific scoring of patches for effective modeling of variable-sized ROIs.

In this study, we propose the Ductal Instance-Oriented Pipeline (DIOP) that contains a duct-level instance segmentation model, a tissue-level semantic segmentation model, and three-levels of features for diagnostic classification. Based on recent advancements in instance segmentation and the Mask RCNN model, our duct-level segmenter tries to identify each ductal individual inside a microscopic image; then, it extracts tissue-level information from the identified ductal instances. Leveraging three levels of information obtained from these ductal instances and also the histopathology image, the proposed DIOP outperforms previous approaches (both feature-based and CNN-based) in all diagnostic tasks; for the four-way classification task, the DIOP achieves comparable performance to general pathologists in this unique dataset. The proposed DIOP only takes a few seconds to run in the inference time, which could be used interactively on most modern computers. More clinical explorations are needed to study the robustness and generalizability of this system in the future.

Diagnosing melanocytic lesions is one of the most challenging areas of pathology with extensive intra- and inter-observer variability. The gold standard for a diagnosis of invasive melanoma is the examination of histopathological whole slide skin biopsy images by an experienced dermatopathologist. Digitized whole slide images offer novel opportunities for computer programs to improve the diagnostic performance of pathologists. In order to automatically classify such images, representations that reflect the content and context of the input images are needed. In this paper, we introduce a novel self-attention-based network to learn representations from digital whole slide images of melanocytic skin lesions at multiple scales. Our model softly weighs representations from multiple scales, allowing it to discriminate between diagnosis-relevant and -irrelevant information automatically. Our experiments show that our method outperforms five other state-of-the-art whole slide image classification methods by a significant margin. Our method also achieves comparable performance to 187 practicing U.S. pathologists who interpreted the same cases in an independent study. To facilitate relevant research, full training and inference code is made publicly available at https://github.com/meredith-wenjunwu/ScATNet.

Purpose: Machine Learning Package for Cancer Diagnosis (MLCD) is the result of a National Institutes of Health/National Cancer Institute (NIH/NCI)-sponsored project for developing a unified software package from state-of-the-art breast cancer biopsy diagnosis and machine learning algorithms that can improve the quality of both clinical practice and ongoing research., Methods: Whole-slide images of 240 well-characterized breast biopsy cases, initially assembled under R01 CA140560, were used for developing the algorithms and training the machine learning models. This software package is based on the methodology developed and published under our recent NIH/NCI-sponsored research grant (R01 CA172343) for finding regions of interest (ROIs) in whole-slide breast biopsy images, for segmenting ROIs into histopathologic tissue types and for using this segmentation in classifiers that can suggest final diagnoses., Result: The package provides an ROI detector for whole-slide images and modules for semantic segmentation into tissue classes and diagnostic classification into 4 classes (benign, atypia, ductal carcinoma in situ, invasive cancer) of the ROIs. It is available through the GitHub repository under the Massachusetts Institute of Technology license and will later be distributed with the Pathology Image Informatics Platform system. A Web page provides instructions for use., Conclusion: Our tools have the potential to provide help to other cancer researchers and, ultimately, to practicing physicians and will motivate future research in this field. This article describes the methodology behind the software development and gives sample outputs to guide those interested in using this package.

Importance: Following recent US Food and Drug Administration approval, adoption of whole slide imaging in clinical settings may be imminent, and diagnostic accuracy, particularly among challenging breast biopsy specimens, may benefit from computerized diagnostic support tools., Objective: To develop and evaluate computer vision methods to assist pathologists in diagnosing the full spectrum of breast biopsy samples, from benign to invasive cancer., Design, Setting, and Participants: In this diagnostic study, 240 breast biopsies from Breast Cancer Surveillance Consortium registries that varied by breast density, diagnosis, patient age, and biopsy type were selected, reviewed, and categorized by 3 expert pathologists as benign, atypia, ductal carcinoma in situ (DCIS), and invasive cancer. The atypia and DCIS cases were oversampled to increase statistical power. High-resolution digital slide images were obtained, and 2 automated image features (tissue distribution feature and structure feature) were developed and evaluated according to the consensus diagnosis of the expert panel. The performance of the automated image analysis methods was compared with independent interpretations from 87 practicing US pathologists. Data analysis was performed between February 2017 and February 2019., Main Outcomes and Measures: Diagnostic accuracy defined by consensus reference standard of 3 experienced breast pathologists., Results: The accuracy of machine learning tissue distribution features, structure features, and pathologists for classification of invasive cancer vs noninvasive cancer was 0.94, 0.91, and 0.98, respectively; the accuracy of classification of atypia and DCIS vs benign tissue was 0.70, 0.70, and 0.81, respectively; and the accuracy of classification of DCIS vs atypia was 0.83, 0.85, and 0.80, respectively. The sensitivity of both machine learning features was lower than that of the pathologists for the invasive vs noninvasive classification (tissue distribution feature, 0.70; structure feature, 0.49; pathologists, 0.84) but higher for the classification of atypia and DCIS vs benign cases (tissue distribution feature, 0.79; structure feature, 0.85; pathologists, 0.72) and the classification of DCIS vs atypia (tissue distribution feature, 0.88; structure feature, 0.89; pathologists, 0.70). For the DCIS vs atypia classification, the specificity of the machine learning feature classification was similar to that of the pathologists (tissue distribution feature, 0.78; structure feature, 0.80; pathologists, 0.82)., Conclusion and Relevance: The computer-based automated approach to interpreting breast pathology showed promise, especially as a diagnostic aid in differentiating DCIS from atypical hyperplasia.

Background: To assess reproducibility and accuracy of overall Nottingham grade and component scores using digital whole slide images (WSIs) compared to glass slides., Methods: Two hundred and eight pathologists were randomized to independently interpret 1 of 4 breast biopsy sets using either glass slides or digital WSI. Each set included 5 or 6 invasive carcinomas (22 total invasive cases). Participants interpreted the same biopsy set approximately 9 months later following a second randomization to WSI or glass slides. Nottingham grade, including component scores, was assessed on each interpretation, providing 2045 independent interpretations of grade. Overall grade and component scores were compared between pathologists (interobserver agreement) and for interpretations by the same pathologist (intraobserver agreement). Grade assessments were compared when the format (WSI vs. glass slides) changed or was the same for the two interpretations., Results: Nottingham grade intraobserver agreement was highest using glass slides for both interpretations (73%, 95% confidence interval [CI]: 68%, 78%) and slightly lower but not statistically different using digital WSI for both interpretations (68%, 95% CI: 61%, 75%; P = 0.22). The agreement was lowest when the format changed between interpretations (63%, 95% CI: 59%, 68%). Interobserver agreement was significantly higher ( P < 0.001) using glass slides versus digital WSI (68%, 95% CI: 66%, 70% versus 60%, 95% CI: 57%, 62%, respectively). Nuclear pleomorphism scores had the lowest inter- and intra-observer agreement. Mitotic scores were higher on glass slides in inter- and intra-observer comparisons., Conclusions: Pathologists' intraobserver agreement (reproducibility) is similar for Nottingham grade using glass slides or WSI. However, slightly lower agreement between pathologists suggests that verification of grade using digital WSI may be more challenging., Competing Interests: The data in this manuscript were presented in part at the 106th annual meeting of the United States and Canadian Academy of Pathology, March 4-10, 2017, San Antonio, TX, USA. (Platform presentation, Abstract 2032).

Generalizability of algorithms for binary cancer vs. no cancer classification is unknown for clinically more significant multi-class scenarios where intermediate categories have different risk factors and treatment strategies. We present a system that classifies whole slide images (WSI) of breast biopsies into five diagnostic categories. First, a saliency detector that uses a pipeline of four fully convolutional networks, trained with samples from records of pathologists' screenings, performs multi-scale localization of diagnostically relevant regions of interest in WSI. Then, a convolutional network, trained from consensus-derived reference samples, classifies image patches as non-proliferative or proliferative changes, atypical ductal hyperplasia, ductal carcinoma in situ, and invasive carcinoma. Finally, the saliency and classification maps are fused for pixel-wise labeling and slide-level categorization. Experiments using 240 WSI showed that both saliency detector and classifier networks performed better than competing algorithms, and the five-class slide-level accuracy of 55% was not statistically different from the predictions of 45 pathologists. We also present example visualizations of the learned representations for breast cancer diagnosis., Competing Interests: Conflict of interest We confirm that there are no known conflicts of interest associated with this work.

Following a baseline demographic survey, 87 pathologists interpreted 240 digital whole slide images of breast biopsy specimens representing a range of diagnostic categories from benign to atypia, ductal carcinoma in situ, and invasive cancer. A web-based viewer recorded pathologists' behaviors while interpreting a subset of 60 randomly selected and randomly ordered slides. To characterize diagnostic search patterns, we used the viewport location, time stamp, and zoom level data to calculate four variables: average zoom level, maximum zoom level, zoom level variance, and scanning percentage. Two distinct search strategies were confirmed: scanning is characterized by panning at a constant zoom level, while drilling involves zooming in and out at various locations. Statistical analysis was applied to examine the associations of different visual interpretive strategies with pathologist characteristics, diagnostic accuracy, and efficiency. We found that females scanned more than males, and age was positively correlated with scanning percentage, while the facility size was negatively correlated. Throughout 60 cases, the scanning percentage and total interpretation time per slide decreased, and these two variables were positively correlated. The scanning percentage was not predictive of diagnostic accuracy. Increasing average zoom level, maximum zoom level, and zoom variance were correlated with over-interpretation.

Background: Optimization of treatment of the unilateral cleft lip nasal deformity (uCLND) is hampered by lack of objective means to assess initial severity and changes produced by treatment and growth. The purpose of this study was to develop automated 3D image analysis specific to the uCLND; assess the correlation of these measures to esthetic appraisal; measure changes that occur with treatment and differences amongst cleft types., Methods: Dorsum Deviation, Tip-Alar Volume Ratio, Alar-Cheek Definition, and Columellar Angle were assessed using computer-vision techniques. Subjects included infants before and after primary cleft lip repair (N = 50) and children aged 8-10 years with previous cleft lip (N = 50). Two expert surgeons ranked subjects according to esthetic nose appearance., Results: Computer-based measurements strongly correlated with rankings of infants pre-repair (r = 0.8, 0.75, 0.41 and 0.54 for Dorsum Deviation, Tip-Alar Volume Ratio, Alar-Cheek Definition, and Columellar Angle, p < 0.01) while all measurements except Alar-Cheek Definition correlated moderately with rankings of older children post-repair (r ∼ 0.35, p < 0.01). Measurements were worse with greater severity of cleft type but improved following initial repair. Abnormal Dorsum Deviation and Columellar Angle persisted after surgery and were more severe with greater cleft type., Conclusions: Four fully-automated measures were developed that are clinically relevant, agree with expert evaluations and can be followed through initial surgery and in older children. Computer vision analysis techniques can quantify the nasal deformity at different stages, offering efficient and standardized tools for large studies and data-driven conclusions., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Digital pathology has entered a new era with the availability of whole slide scanners that create the high-resolution images of full biopsy slides. Consequently, the uncertainty regarding the correspondence between the image areas and the diagnostic labels assigned by pathologists at the slide level, and the need for identifying regions that belong to multiple classes with different clinical significances have emerged as two new challenges. However, generalizability of the state-of-the-art algorithms, whose accuracies were reported on carefully selected regions of interest (ROIs) for the binary benign versus cancer classification, to these multi-class learning and localization problems is currently unknown. This paper presents our potential solutions to these challenges by exploiting the viewing records of pathologists and their slide-level annotations in weakly supervised learning scenarios. First, we extract candidate ROIs from the logs of pathologists' image screenings based on different behaviors, such as zooming, panning, and fixation. Then, we model each slide with a bag of instances represented by the candidate ROIs and a set of class labels extracted from the pathology forms. Finally, we use four different multi-instance multi-label learning algorithms for both slide-level and ROI-level predictions of diagnostic categories in whole slide breast histopathology images. Slide-level evaluation using 5-class and 14-class settings showed average precision values up to 81% and 69%, respectively, under different weakly labeled learning scenarios. ROI-level predictions showed that the classifier could successfully perform multi-class localization and classification within whole slide images that were selected to include the full range of challenging diagnostic categories.

Background: Digital whole slide imaging may be useful for obtaining second opinions and is used in many countries. However, the U.S. Food and Drug Administration requires verification studies., Methods: Pathologists were randomized to interpret one of four sets of breast biopsy cases during two phases, separated by ≥9 months, using glass slides or digital format (sixty cases per set, one slide per case, n = 240 cases). Accuracy was assessed by comparing interpretations to a consensus reference standard. Intraobserver reproducibility was assessed by comparing the agreement of interpretations on the same cases between two phases. Estimated probabilities of confirmation by a reference panel (i.e., predictive values) were obtained by incorporating data on the population prevalence of diagnoses., Results: Sixty-five percent of responding pathologists were eligible, and 252 consented to randomization; 208 completed Phase I (115 glass, 93 digital); and 172 completed Phase II (86 glass, 86 digital). Accuracy was slightly higher using glass compared to digital format and varied by category: invasive carcinoma, 96% versus 93% ( P = 0.04); ductal carcinoma in situ (DCIS), 84% versus 79% ( P < 0.01); atypia, 48% versus 43% ( P = 0.08); and benign without atypia, 87% versus 82% ( P < 0.01). There was a small decrease in intraobserver agreement when the format changed compared to when glass slides were used in both phases ( P = 0.08). Predictive values for confirmation by a reference panel using glass versus digital were: invasive carcinoma, 98% and 97% (not significant [NS]); DCIS, 70% and 57% ( P = 0.007); atypia, 38% and 28% ( P = 0.002); and benign without atypia, 97% and 96% (NS)., Conclusions: In this large randomized study, digital format interpretations were similar to glass slide interpretations of benign and invasive cancer cases. However, cases in the middle of the spectrum, where more inherent variability exists, may be more problematic in digital format. Future studies evaluating the effect these findings exert on clinical practice and patient outcomes are required., Competing Interests: There are no conflicts of interest.

A pathologist's accurate interpretation relies on identifying relevant histopathological features. Little is known about the precise relationship between feature identification and diagnostic decision making. We hypothesized that greater overlap between a pathologist's selected diagnostic region of interest (ROI) and a consensus derived ROI is associated with higher diagnostic accuracy. We developed breast biopsy test cases that included atypical ductal hyperplasia (n=80); ductal carcinoma in situ (n=78); and invasive breast cancer (n=22). Benign cases were excluded due to the absence of specific abnormalities. Three experienced breast pathologists conducted an independent review of the 180 digital whole slide images, established a reference consensus diagnosis and marked one or more diagnostic ROIs for each case. Forty-four participating pathologists independently diagnosed and marked ROIs on the images. Participant diagnoses and ROI were compared with consensus reference diagnoses and ROI. Regression models tested whether percent overlap between participant ROI and consensus reference ROI predicted diagnostic accuracy. Each of the 44 participants interpreted 39-50 cases for a total of 1972 individual diagnoses. Percent ROI overlap with the expert reference ROI was higher in pathologists who self-reported academic affiliation (69 vs 65%, P=0.002). Percent overlap between participants' ROI and consensus reference ROI was then classified into ordinal categories: 0, 1-33, 34-65, 66-99 and 100% overlap. For each incremental change in the ordinal percent ROI overlap, diagnostic agreement increased by 60% (OR 1.6, 95% CI (1.5-1.7), P<0.001) and the association remained significant even after adjustment for other covariates. The magnitude of the association between ROI overlap and diagnostic agreement increased with increasing diagnostic severity. The findings indicate that pathologists are more likely to converge with an expert reference diagnosis when they identify an overlapping diagnostic image region, suggesting that future computer-aided detection systems that highlight potential diagnostic regions could be a helpful tool to improve accuracy and education.

Whole slide digital imaging technology enables researchers to study pathologists' interpretive behavior as they view digital slides and gain new understanding of the diagnostic medical decision-making process. In this study, we propose a simple yet important analysis to extract diagnostically relevant regions of interest (ROIs) from tracking records using only pathologists' actions as they viewed biopsy specimens in the whole slide digital imaging format (zooming, panning, and fixating). We use these extracted regions in a visual bag-of-words model based on color and texture features to predict diagnostically relevant ROIs on whole slide images. Using a logistic regression classifier in a cross-validation setting on 240 digital breast biopsy slides and viewport tracking logs of three expert pathologists, we produce probability maps that show 74 % overlap with the actual regions at which pathologists looked. We compare different bag-of-words models by changing dictionary size, visual word definition (patches vs. superpixels), and training data (automatically extracted ROIs vs. manually marked ROIs). This study is a first step in understanding the scanning behaviors of pathologists and the underlying reasons for diagnostic errors.

Landmark-based morphometric analyses are used by anthropologists, developmental and evolutionary biologists to understand shape and size differences (eg. in the cranioskeleton) between groups of specimens. The standard, labor intensive approach is for researchers to manually place landmarks on 3D image datasets. As landmark recognition is subject to inaccuracies of human perception, digitization of landmark coordinates is typically repeated (often by more than one person) and the mean coordinates are used. In an attempt to improve efficiency and reproducibility between researchers, we have developed an algorithm to locate landmarks on CT mouse hemi-mandible data. The method is evaluated on 3D meshes of 28-day old mice, and results compared to landmarks manually identified by experts. Quantitative shape comparison between two inbred mouse strains demonstrate that data obtained using our algorithm also has enhanced statistical power when compared to data obtained by manual landmarking.

We present an algorithm that takes a single frame of a person's face from a depth camera, e.g., Kinect, and produces a high-resolution 3D mesh of the input face. We leverage a dataset of 3D face meshes of 1204 distinct individuals ranging from age 3 to 40, captured in a neutral expression. We divide the input depth frame into semantically significant regions (eyes, nose, mouth, cheeks) and search the database for the best matching shape per region. We further combine the input depth frame with the matched database shapes into a single mesh that results in a highresolution shape of the input person. Our system is fully automatic and uses only depth data for matching, making it invariant to imaging conditions. We evaluate our results using ground truth shapes, as well as compare to state-of-the-art shape estimation methods. We demonstrate the robustness of our local matching approach with high-quality reconstruction of faces that fall outside of the dataset span, e.g., faces older than 40 years old, facial expressions, and different ethnicities.

A pilot study examined the extent to which eye movements occurring during interpretation of digitized breast biopsy whole slide images (WSI) can distinguish novice interpreters from experts, informing assessments of competency progression during training and across the physician-learning continuum. A pathologist with fellowship training in breast pathology interpreted digital WSI of breast tissue and marked the region of highest diagnostic relevance (dROI). These same images were then evaluated using computer vision techniques to identify visually salient regions of interest (vROI) without diagnostic relevance. A non-invasive eye tracking system recorded pathologists' (N = 7) visual behavior during image interpretation, and we measured differential viewing of vROIs versus dROIs according to their level of expertise. Pathologists with relatively low expertise in interpreting breast pathology were more likely to fixate on, and subsequently return to, diagnostically irrelevant vROIs relative to experts. Repeatedly fixating on the distracting vROI showed limited value in predicting diagnostic failure. These preliminary results suggest that eye movements occurring during digital slide interpretation can characterize expertise development by demonstrating differential attraction to diagnostically relevant versus visually distracting image regions. These results carry both theoretical implications and potential for monitoring and evaluating student progress and providing automated feedback and scanning guidance in educational settings.

Cleft lip is a birth defect that results in deformity of the upper lip and nose. Its severity is widely variable and the results of treatment are influenced by the initial deformity. Objective assessment of severity would help to guide prognosis and treatment. However, most assessments are subjective. The purpose of this study is to develop and test quantitative computer-based methods of measuring cleft lip severity. In this paper, a grid-patch based measurement of symmetry is introduced, with which a computer program learns to rank the severity of cleft lip on 3D meshes of human infant faces. Three computer-based methods to define the midfacial reference plane were compared to two manual methods. Four different symmetry features were calculated based upon these reference planes, and evaluated. The result shows that the rankings predicted by the proposed features were highly correlated with the ranking orders provided by experts that were used as the ground truth.

3D stereophotography is rapidly being adopted by medical researchers for analysis of facial forms and features. An essential step for many applications using 3D face data is to first crop the head and face from the raw images. The goal of this paper is to develop a reliable automatic methodology for extracting the face from raw data with texture acquired from a stereo imaging system, based on the medical researchers' specific requirements. We present an automated process, including eye and nose estimation, face detection, Procrustes analysis and final noise removal to crop out the faces and normalize them. The proposed method shows very reliable results on several datasets, including a normal adult dataset and a very challenging dataset consisting of infants with cleft lip and palate.

We introduce the Ontology of Craniofacial Development and Malformation (OCDM) as a mechanism for representing knowledge about craniofacial development and malformation, and for using that knowledge to facilitate integrating craniofacial data obtained via multiple techniques from multiple labs and at multiple levels of granularity. The OCDM is a project of the NIDCR-sponsored FaceBase Consortium, whose goal is to promote and enable research into the genetic and epigenetic causes of specific craniofacial abnormalities through the provision of publicly accessible, integrated craniofacial data. However, the OCDM should be usable for integrating any web-accessible craniofacial data, not just those data available through FaceBase. The OCDM is based on the Foundational Model of Anatomy (FMA), our comprehensive ontology of canonical human adult anatomy, and includes modules to represent adult and developmental craniofacial anatomy in both human and mouse, mappings between homologous structures in human and mouse, and associated malformations. We describe these modules, as well as prototype uses of the OCDM for integrating craniofacial data. By using the terms from the OCDM to annotate data, and by combining queries over the ontology with those over annotated data, it becomes possible to create "intelligent" queries that can, for example, find gene expression data obtained from mouse structures that are precursors to homologous human structures involved in malformations such as cleft lip. We suggest that the OCDM can be useful not only for integrating craniofacial data, but also for expressing new knowledge gained from analyzing the integrated data., (© 2013 Wiley Periodicals, Inc.)

In this paper we describe an ontological scheme for representing anatomical entities undergoing morphological transformation and changes in phenotype during prenatal development. This is a proposed component of the Anatomical Transformation Abstraction (ATA) of the Foundational Model of Anatomy (FMA) Ontology that was created to provide an ontological framework for capturing knowledge about human development from the zygote to postnatal life. It is designed to initially describe the structural properties of the anatomical entities that participate in human development and then enhance their description with developmental properties, such as temporal attributes and developmental processes. This approach facilitates the correlation and integration of the classical but static representation of embryology with the evolving novel concepts of developmental biology, which primarily deals with the experimental data on the mechanisms of embryogenesis and organogenesis. This is important for describing and understanding the underlying processes involved in structural malformations. In this study we focused on the development of the lips and the palate in conjunction with our work on the pathogenesis and classification of cleft lip and palate (CL/P) in the FaceBase program. Our aim here is to create the Craniofacial Human Development Ontology (CHDO) to support the Ontology of Craniofacial Development and Malformation (OCDM), which provides the infrastructure for integrating multiple and disparate craniofacial data generated by FaceBase researchers.

This paper presents a method for selecting salient 2D views to describe 3D objects for the purpose of retrieval. The views are obtained by first identifying salient points via a learning approach that uses shape characteristics of the 3D points (Atmosukarto and Shapiro in International workshop on structural, syntactic, and statistical pattern recognition, 2008; Atmosukarto and Shapiro in ACM multimedia information retrieval, 2008). The salient views are selected by choosing views with multiple salient points on the silhouette of the object. Silhouette-based similarity measures from Chen et al. (Comput Graph Forum 22(3):223-232, 2003) are then used to calculate the similarity between two 3D objects. Retrieval experiments were performed on three datasets: the Heads dataset, the SHREC2008 dataset, and the Princeton dataset. Experimental results show that the retrieval results using the salient views are comparable to the existing light field descriptor method (Chen et al. in Comput Graph Forum 22(3):223-232, 2003), and our method achieves a 15-fold speedup in the feature extraction computation time.

We introduce the Ontology of Craniofacial Development and Malformation (OCDM), a project of the NIH-funded FaceBase consortium, whose goal is to gather data from multiple species, at levels ranging from genes to gross anatomy, in order to understand the causes of craniofacial abnormalities. The OCDM is being developed in order to facilitate integration of these diverse forms of data in a central Hub. It currently consists of several components, including human adult and developmental anatomy, corresponding mouse structures, and malformations. Example queries show the potential of the OCDM for intelligent data annotation and querying.

Morphometrics, the quantitative analysis of shape, is used by craniofacial researchers to study abnormalities in human face shapes. Most of the work in craniofacial morphometrics uses landmark points that are manually marked on 3D face data and processed via a generalized Procrustes analysis. For large data sets this manual process is very time-consuming. Dense sets of pseudo-landmarks have also been proposed and successfully used for classification and clustering, but the two main methods in the literature are very computationally intensive. We have developed a computationally simple method that can compute pseudo-landmark points at different resolutions from 3D meshes of human faces. In this paper, we perform a comparative study employing L1-regularized logistic regression to train a classifier that predicts the sex of 500 normal adult face meshes in order to compare our method to two alternative pseudo-landmark methods and a distance matrix approach.Our results show that our method, which is fully automatic, achieved similar results to the best-scoring methods with no manual landmarking and with much lower computation time. Use of the distance matrix did not improve classification results.

Craniofacial researchers make heavy use of established facial landmarks in their morphometric analyses. For studies on very large facial image datasets, the standard approach of manual landmarking is very labor intensive. With the goal of producing 20 established landmarks, we have developed a geometric methodology that can automatically locate 10 established landmark points and 7 other supporting points on human 3D facial scans. Then, to improve accuracy and produce all 20 landmarks, a deformable matching procedure establishes a dense correspondence from a template 3D mesh with a full set of 20 landmarks to each individual 3D mesh. The 17 geometrically-determined points on the individual 3D mesh are used for the initial correspondence required by the deformable matching. The method is evaluated on 115 3D facial meshes of normal adults, and results are compared to landmarks manually identified by medical experts. Our results show a marked improvement to prior results in the recent literature.

This paper introduces a new tool to quantify and characterize asymmetry in bilaterally paired structures. This method uses deformable registration to produce a dense vector field describing the point correspondences between two images of bilaterally paired structures. The deformation vector field properties are clustered to detect and describe regions of relevant asymmetry. Three methods are provided to analyze the asymmetries: the global asymmetry score uses cluster features to quantify overall asymmetry, the local asymmetry score quantifies asymmetry in user-defined regions of interest, and the asymmetry similarity measure quantifies pairwise similarity of individual asymmetry. The scores and image distances generated by this tool are shown to correlate highly with asymmetry ratings assigned by an expert.

Context: Digital pathology has the potential to dramatically alter the way pathologists work, yet little is known about pathologists' viewing behavior while interpreting digital whole slide images. While tracking pathologist eye movements when viewing digital slides may be the most direct method of capturing pathologists' viewing strategies, this technique is cumbersome and technically challenging to use in remote settings. Tracking pathologist mouse cursor movements may serve as a practical method of studying digital slide interpretation, and mouse cursor data may illuminate pathologists' viewing strategies and time expenditures in their interpretive workflow., Aims: To evaluate the utility of mouse cursor movement data, in addition to eye-tracking data, in studying pathologists' attention and viewing behavior., Settings and Design: Pathologists (N = 7) viewed 10 digital whole slide images of breast tissue that were selected using a random stratified sampling technique to include a range of breast pathology diagnoses (benign/atypia, carcinoma in situ, and invasive breast cancer). A panel of three expert breast pathologists established a consensus diagnosis for each case using a modified Delphi approach., Materials and Methods: Participants' foveal vision was tracked using SensoMotoric Instruments RED 60 Hz eye-tracking system. Mouse cursor movement was tracked using a custom MATLAB script., Statistical Analysis Used: Data on eye-gaze and mouse cursor position were gathered at fixed intervals and analyzed using distance comparisons and regression analyses by slide diagnosis and pathologist expertise. Pathologists' accuracy (defined as percent agreement with the expert consensus diagnoses) and efficiency (accuracy and speed) were also analyzed., Results: Mean viewing time per slide was 75.2 seconds (SD = 38.42). Accuracy (percent agreement with expert consensus) by diagnosis type was: 83% (benign/atypia); 48% (carcinoma in situ); and 93% (invasive). Spatial coupling was close between eye-gaze and mouse cursor positions (highest frequency ∆x was 4.00px (SD = 16.10), and ∆y was 37.50px (SD = 28.08)). Mouse cursor position moderately predicted eye gaze patterns (Rx = 0.33 and Ry = 0.21)., Conclusions: Data detailing mouse cursor movements may be a useful addition to future studies of pathologists' accuracy and efficiency when using digital pathology.

This paper introduces a new method to quantify and characterize shape changes during early facial development without the use of landmarks. Landmarks are traditionally used in morphometric analysis, but very few can be identified reliably across all stages of embryonic development. This method uses deformable registration to produce a dense vector field describing the point correspondences between two images. Low and mid-level features are extracted from the deformable vector field to find regions of organized differences that are biologically relevant. These methods are shown to detect regions of difference when evaluated on chick embryo images warped with small magnitude deformations in regions critical to midfacial development.

Introduction: This paper describes the design, implementation, and potential use of a comparative anatomy information system (CAIS) for querying on similarities and differences between homologous anatomical structures across species, the knowledge base it operates upon, the method it uses for determining the answers to the queries, and the user interface it employs to present the results. The relevant informatics contributions of our work include (1) the development and application of the structural difference method, a formalism for symbolically representing anatomical similarities and differences across species; (2) the design of the structure of a mapping between the anatomical models of two different species and its application to information about specific structures in humans, mice, and rats; and (3) the design of the internal syntax and semantics of the query language. These contributions provide the foundation for the development of a working system that allows users to submit queries about the similarities and differences between mouse, rat, and human anatomy; delivers result sets that describe those similarities and differences in symbolic terms; and serves as a prototype for the extension of the knowledge base to any number of species. Additionally, we expanded the domain knowledge by identifying medically relevant structural questions for the human, the mouse, and the rat, and made an initial foray into the validation of the application and its content by means of user questionnaires, software testing, and other feedback., Methods: The anatomical structures of the species to be compared, as well as the mappings between species, are modeled on templates from the Foundational Model of Anatomy knowledge base, and compared using graph-matching techniques. A graphical user interface allows users to issue queries that retrieve information concerning similarities and differences between structures in the species being examined. Queries from diverse information sources, including domain experts, peer-reviewed articles, and reference books, have been used to test the system and to illustrate its potential use in comparative anatomy studies., Results: 157 test queries were submitted to the CAIS system, and all of them were correctly answered. The interface was evaluated in terms of clarity and ease of use. This testing determined that the application works well, and is fairly intuitive to use, but users want to see more clarification of the meaning of the different types of possible queries. Some of the interface issues will naturally be resolved as we refine our conceptual model to deal with partial and complex homologies in the content., Conclusions: The CAIS system and its associated methods are expected to be useful to biologists and translational medicine researchers. Possible applications range from supporting theoretical work in clarifying and modeling ontogenetic, physiological, pathological, and evolutionary transformations, to concrete techniques for improving the analysis of genotype-phenotype relationships among various animal models in support of a wide array of clinical and scientific initiatives., (Copyright © 2010 Elsevier B.V. All rights reserved.)

A general framework is proposed for solving groupwise pose normalization problems and is analyzed in detail under different feature spaces. The analysis shows that using principal component analysis for pose normalization is a special case of using the proposed framework under a special feature space. The experimental results on two craniofacial datasets show the proposed method achieved promising results for solving groupwise pose normalization problems for craniofacial applications.

Objective: The authors developed and tested three-dimensional (3D) indices for quantifying the severity of deformational plagiocephaly (DP)., Design: The authors evaluated the extent to which infants with and without DP (as determined by clinic referral and two experts' ratings) could be correctly classified., Participants: Infants aged 4 to 11 months, including 154 with diagnosed DP and 100 infants without a history of DP or other craniofacial condition. After excluding participants with discrepant expert ratings, data from 90 infants with DP and 50 infants without DP were retained., Measurements: Two-dimensional (2D) histograms of surface normal vector angles were extracted from 3D mesh data and used to compute the severity scores., Outcome Measures: Left posterior flattening score (LPFS), right posterior flattening score (RPFS), asymmetry score (AS), absolute asymmetry score (AAS), and an approximation of a previously described 2D measure, the oblique cranial length ratio (aOCLR). Two-dimensional histograms localized the posterior flatness for each participant., Analysis: The authors fit receiver operating characteristic curves and calculated the area under the curves (AUC) to evaluate the relative accuracy of DP classification using the above measures., Results: The AUC statistics were AAS = 91%, LPFS = 97%, RPFS = 91%, AS = 99%, and aOCLR = 79%., Conclusion: Novel 3D-based plagiocephaly posterior severity scores provided better sensitivity and specificity in the discrimination of plagiocephalic and typical head shapes than the 2D measurements provided by a close approximation of OCLR. These indices will allow for more precise quantification of the DP phenotype in future studies on the prevalence of this condition, which may lead to improved clinical care.

Background: The success of radiation therapy depends critically on accurately delineating the target volume, which is the region of known or suspected disease in a patient. Methods that can compute a contour set defining a target volume on a set of patient images will contribute greatly to the success of radiation therapy and dramatically reduce the workload of radiation oncologists, who currently draw the target by hand on the images using simple computer drawing tools. The most challenging part of this process is to estimate where there is microscopic spread of disease., Methods: Given a set of reference CT images with "gold standard" lymph node regions drawn by the experts, we are proposing an image registration based method that could automatically contour the cervical lymph code levels for patients receiving radiation therapy. We are also proposing a method that could help us identify the reference models which could potentially produce the best results., Results: The computer generated lymph node regions are evaluated quantitatively and qualitatively., Conclusions: Although not conforming to clinical criteria, the results suggest the technique has promise.

Finding point correspondences plays an important role in automatically building statistical shape models from a training set of 3D surfaces. For the point correspondence problem, Davies et al. [1] proposed a minimum-description-length-based objective function to balance the training errors and generalization ability. A recent evaluation study [2] that compares several well-known 3D point correspondence methods for modeling purposes shows that the MDL-based approach [1] is the best method. We adapt the MDL-based objective function for a feature space that can exploit nonlinear properties in point correspondences, and propose an efficient optimization method to minimize the objective function directly in the feature space, given that the inner product of any vector pair can be computed in the feature space. We further employ a Mercer kernel [3] to define the feature space implicitly. A key aspect of our proposed framework is the generalization of the MDL-based objective function to kernel principal component analysis (KPCA) [4] spaces and the design of a gradient-descent approach to minimize such an objective function. We compare the generalized MDL objective function on KPCA spaces with the original one and evaluate their abilities in terms of reconstruction errors and specificity. From our experimental results on different sets of 3D shapes of human body organs, the proposed method performs significantly better than the original method.

Craniofacial disorders commonly result in various head shape dysmorphologies. The goal of this work is to quantify the various 3D shape variations that manifest in the different facial abnormalities in individuals with a craniofacial disorder called 22q11.2 Deletion Syndrome. Genetic programming (GP) is used to learn the different 3D shape quantifications. Experimental results show that the GP method achieves a higher classification rate than those of human experts and existing computer algorithms [1], [2].

Doppler ultrasound is an important noninvasive diagnostic tool for cardiovascular diseases. Modern ultrasound imaging systems utilize spectral Doppler techniques for quantitative evaluation of blood flow velocities, and these measurements play a crucial rule in the diagnosis and grading of arterial stenosis. One drawback of Doppler-based blood flow quantification is that the operator has to manually specify the angle between the Doppler ultrasound beam and the vessel orientation, which is called the Doppler angle, in order to calculate flow velocities. In this paper, we will describe a computer vision approach to automate the Doppler angle estimation. Our approach starts with the segmentation of blood vessels in ultrasound color Doppler images. The segmentation step is followed by an estimation technique for the Doppler angle based on a skeleton representation of the segmented vessel. We conducted preliminary clinical experiments to evaluate the agreement between the expert operator's angle specification and the new automated method. Statistical regression analysis showed strong agreement between the manual and automated methods. We hypothesize that the automation of the Doppler angle will enhance the workflow of the ultrasound Doppler exam and achieve more standardized clinical outcome.

Finding point correspondences plays an important role in automatically building statistical shape models from a training set of 3D surfaces. Davies et al. assumed the projected coefficients have a multivariate Gaussian distributions and derived an objective function for the point correspondence problem that uses minimum description length to balance the training errors and generalization ability. Recently, two-dimensional principal component analysis has been shown to achieve better performance than PCA in face recognition. Motivated by the better performance of 2DPCA, we generalize the MDL-based objective function to 2DPCA in this paper. We propose a gradient descent approach to minimize the objective function. We evaluate the generalization abilities of the proposed and original methods in terms of reconstruction errors. From our experimental results on different sets of 3D shapes of different human body organs, the proposed method performs significantly better than the original method.

Recent studies have shown an increase in the occurrence of deformational plagiocephaly and brachycephaly in children. This increase has coincided with the "Back to Sleep" campaign that was introduced to reduce the risk of Sudden Infant Death Syndrome (SIDS). However, there has yet to be an objective quantification of the degree of severity for these two conditions. Most diagnoses are done on subjective factors such as patient history and physician examination. The existence of an objective quantification would help research in areas of diagnosis and intervention measures, as well as provide a tool for finding correlation between the shape severity and cognitive outcome. This paper describes a new shape severity quantification and localization method for deformational plagiocephaly and brachycephaly. Our results show that there is a positive correlation between the new shape severity measure and the scores entered by a human expert.

How to model shape variations plays an important role in active shape models that is widely used in model-based medical image segmentation, and principal component analysis is a common approach for this task. Recently, different tensor-based dimension reduction methods have been proposed and have achieved better performances than PCA in face recognition. However, how they perform in modeling 3D shape variations of organs in terms of reconstruction errors in medical image analysis is still unclear. In this paper, we propose to use tensor-based dimension reduction methods to model shape variations. We empirically compare two-dimensional principal component analysis, the parallel factor model and the Tucker decomposition with PCA in terms of the reconstruction errors. From our experimental results on several different organs such as livers, spleens and kidneys, 2DPCA performs best among the four compared methods, and the performance differences between 2DPCA and the other methods are statistically significant.

Longitudinal studies of a variety of transgenic mouse models for lens development can create substantial challenges in database management and analysis. We report a novel, automated, feature-based informatics approach to screening lens phenotypes in a large database of slit lamp images. Digital slit lamp images of normal and abnormal lenses in eyes of wild type (wt), SC1 null and SPARC null transgenic mice were recorded for quantitative evaluation of their structural phenotype. The images were processed to improve the contrast of structural features that corresponded to rings of opacity and fluctuations in scattering intensity in the lenses. Measurable attributes were assigned to the features in the lens images and given as an output vector of 46 dimensions. Characteristic patterns were correlated with the structural phenotype of each mutant and wt lens and a statistical fit for each phenotype was defined. The genotype was identified correctly in nearly 85% of the slit lamp images on the basis of an automated computer analysis of the lens structural phenotype. The automated computer algorithm has the potential to evaluate a large database of slit lamp images and distinguish mouse genotypes on the basis of lens phenotypes objectively using a neural network analysis of the structural features observed in the slit lamp images. The neural network approach is a promising technology for objective evaluation of genotype/phenotype relationships based on structural features and light scattering in lenses. Further improvements in the automated method can be expected to simplify and increase the accuracy and efficiency of the feature based analysis of structural phenotypes linked to genetic variation.

Single-suture craniosynostosis is a condition of the sutures of the infant's skull that causes major craniofacial deformities and is associated with an increased risk of cognitive deficits and learning/language disabilities. In this paper we adapt to classification of synostostic head shapes a Bayesian methodology that overcomes the limitations of our previously published shape representation and classification techniques. We evaluate our approach in a series of large-scale experiments and show performance superior to those of standard approaches such as Fourier descriptors, cranial spectrum, and Euclidian-distance-based analyses.