Walter F. Good’s research while affiliated with University of Pittsburgh and other places

Airway diseases are frequently associated with morphological changes that may affect the physiology of the lungs. Accurate characterization of airways may be useful for quantitatively assessing prognosis and for monitoring therapeutic efficacy. The information gained may also provide insight into the underlying mechanisms of various lung diseases. We developed a computerized scheme to automatically segment the 3-D human airway tree depicted on computed tomography (CT) images. The method takes advantage of both principal curvatures and principal directions in differentiating airways from other tissues in geometric space. A "puzzle game" procedure is used to identify false negative regions and reduce false positive regions that do not meet the shape analysis criteria. The negative impact of partial volume effects on small airway detection is partially alleviated by repeating the developed differential geometric analysis on lung anatomical structures modeled at multiple iso-values (thresholds). In addition to having advantages, such as full automation, easy implementation and relative insensitivity to image noise and/or artifacts, this scheme has virtually no leakage issues and can be easily extended to the extraction or the segmentation of other tubular type structures (e.g., vascular tree). The performance of this scheme was assessed quantitatively using 75 chest CT examinations acquired on 45 subjects with different slice thicknesses and using 20 publicly available test cases that were originally designed for evaluating the performance of different airway tree segmentation algorithms.

This study investigated the relative efficiencies of a stereographic display and two monoscopic display schemes for detecting lung nodules in chest computed tomography (CT). The ultimate goal was to determine whether stereoscopic display provides advantages for visualization and interpretation of three-dimensional (3D) medical image datasets. A retrospective study that compared lung nodule detection performances achieved using three different schemes for displaying 3D CT data was conducted. The display modes included slice-by-slice, orthogonal maximum intensity projection (MIP), and stereoscopic display. One hundred lung-cancer screening CT examinations containing 647 nodules were interpreted by eight radiologists, in each of the display modes. Reading times and displayed slab thickness versus time were recorded, as well as the probability, location, and size for each detected nodule. Nodule detection performance was analyzed using the receiver operating characteristic method. The stereo display mode provided higher detection performance with a shorter interpretation time, as compared to the other display modes tested in the study, although the difference was not statistically significant. The analysis also showed that there was no difference in the patterns of displayed slab thickness versus time between the stereo and MIP display modes. Most radiologists preferred reading the 3D data at a slab thickness that corresponded to five CT slices. Our results indicate that stereo display has the potential to improve radiologists' performance for detecting lung nodules in CT datasets. The experience gained in conducting the study also strongly suggests that further benefits can be achieved through providing readers with additional functionality.

The main purpose of this project is to investigate the feasibility and efficacy of using a stereo display workstation for lung cancer screening on CT images. The tasks included in this project are development and evaluation of stereo image projection and display for chest CT images, observer performance evaluation for the stereo display, and stereo feature analysis and comparison to the conventionally used display methods for lung cancer detection. During the funding period, we have made progress in following tasks. 1. We have built stereo display workstation for chest CT images and investigated effects of several commonly used compositing methods for nodule representation and detection in stereo CT images. Among these methods, conventional maximum intensity projection (MIP) produced the highest image contrast, but gave ambiguities in local geometric detail and texture, whereas averaging compositing resulted in the lowest contrast, but preserved geometric details. Distance-weighted MIP partially recovered geometric information, which was lost in images composited by conventional MIP, therefore is the best compositing method for stereo display. 2. Consensus truth of the cases collected for this project has been done by three experienced radiologists. 3. A pilot observer performance study was conducted. Six radiologists participated the pilot observer performance study. The study has three display modes, conventional slice-by-slice mode, conventional MIP display mode and stereo display mode. The performance of lung nodule detection are examined and compared for the three modes with Free-response Receiver Operating Characteristic (FROC) statistic method. The results indicate that the stereo display achieved the best performance followed by the slice by-slice display, and the conventional MIP display gave the worst performance, although there is no statistically significant difference between the three display modes.

The objective of our study was to assess ergonomic and diagnostic performance-related issues associated with the interpretation of digital breast tomosynthesis-generated examinations. Thirty selected cases were read under three different display conditions by nine experienced radiologists in a fully crossed, mode-balanced observer performance study. The reading modes included full-field digital mammography (FFDM) alone, the 11 low-dose projections acquired for the reconstruction of tomosynthesis images, and the reconstructed digital breast tomosynthesis examination. Observers rated cases under the free-response receiver operating characteristic, as well as a screening paradigm, and provided subjective assessments of the relative diagnostic value of the two digital breast tomosynthesis-based image sets as compared with FFDM. The time to review and diagnose each case was also evaluated. Observer performance measures were not statistically significant (p > 0.05) primarily because of the small sample size in this pilot study, suggesting that showing significant improvements in diagnosis, if any, will require a larger study. Several radiologists did perceive the digital breast tomosynthesis image set and the projection series to be better than FFDM (p < 0.05) for diagnosing this specific case set. The time to review, interpret, and rate the examinations was significantly different for the techniques in question (p < 0.05). Tomosynthesis-based breast imaging may have great potential, but much work is needed before its optimal role in the clinical environment is known.

The study was to explore the power and feasibility of using programmable graphics processing units (GPUs) for real-time rendering and displaying large 3D medical datasets for stereoscopic display workstation. Lung cancer screening CT images were used for developing GPU-based stereo rendering and displaying. The study was run on a personal computer with a 128 MB NVIDIA Quadro FX 1100 graphics card. The performance of rendering and displaying was measured and compared between GPU-based and central processing unit (CPU)-based programming. The results indicate that GPU-based programming was capable of rendering large 3D datasets at real-time interactive rates with stereographic displays.

Using electrical impedance spectroscopy (EIS) technology to detect breast abnormalities in general and cancer in particular has been attracting research interests for decades. Large clinical tests suggest that current EIS systems can achieve high specificity (>= 90%) at a relatively low sensitivity ranging from 15% to 35%. In this study, we explore a new resonance frequency based electrical impedance spectroscopy (REIS) technology to measure breast tissue EIS signals in vivo, which aims to be more sensitive to small tissue changes. Through collaboration between our imaging research group and a commercial company, a unique prototype REIS system has been assembled and preliminary signal acquisition has commenced. This REIS system has two detection probes mounted in the two ends of a Y-shape support device with probe separation of 60 mm. During REIS measurement, one probe touches the nipple and the other touches to an outer point of the breast. The electronic system continuously generates sweeps of multi-frequency electrical pulses ranging from 100 to 4100 kHz. The maximum electric voltage and the current applied to the probes are 1.5V and 30mA, respectively. Once a "record" command is entered, multi-frequency sweeps are recorded every 12 seconds until the program receives a "stop recording" command. In our imaging center, we have collected REIS measurements from 150 women under an IRB approved protocol. The database includes 58 biopsy cases, 78 screening negative cases, and other "recalled" cases (for additional imaging procedures). We measured eight signal features from the effective REIS sweep of each breast. We applied a multi-feature based artificial neural network (ANN) to classify between "biopsy" and normal "non-biopsy" breasts. The ANN performance is evaluated using a leave-one-out validation method and ROC analysis. We conducted two experiments. The first experiment attempted to classify 58 "biopsy" breasts and 58 "non-biopsy" breasts acquired on 58 women each having one breast recommended for biopsy. The second experiment attempted to classify 58 "biopsy" breasts and 58 negative breasts from the set of screening negative cases. The areas under ROC curves are 0.679 +/- 0.033 and 0.606 +/- 0.035 for the first and the second experiment, respectively. The preliminary results demonstrate (1) even with this rudimentary system with only one paired probes there is a measurable signal of changes in breast tissue demonstrating the feasibility of applying REIS technology for identifying at least some women with highly suspicious breast abnormalities and (2) the electromagnetic asymmetry between two breasts may be more sensitive in detecting changes in the abnormal breast. To further improve the REIS system performance, we are currently designing a new REIS system with multiple electrical probes and a more sophisticated analysis scheme.

Currently, breast cancer screening protocols are based on a woman's age, but not on other risk factors or on the physical characteristics of her breasts. One commonly cited risk factor is dense breast tissue. This study is part of an effort to provide basic information needed to develop automatically, individualized screening protocols, by clarifying the relationships between age, risk, breast composition, lesion conspicuity, and other factors. In this project, a database was established that includes 227 cancer negative cases and 116 cancer positive cases across a wide range of age groups. In the cancer positive cases, we included a subgroup in which the cancer had been missed in the previous exam. Using our physics based model of breast density, we quantified percentage of breast parenchyma as an index of density. Density distributions and changes over time were analyzed. The most significant finding within this data was a significantly slower density decrease over the time in the cancer positive group than in the cancer negative group, with no overall difference in the density distribution in those two groups. False negative cases were found to be significantly more dense than true positive cases. In addition, our results showed a trend of density decrease with increasing age, which is in agreement with others' widely reported results.

The goal of this study was to assess whether radiologists' search paths for lung nodule detection in chest computed tomography (CT) between different rendering and display schemes have reliable properties that can be exploited as an indicator of ergonomic efficiency for the purpose of comparing different display paradigms. Eight radiologists retrospectively viewed 30 lung cancer screening CT exams, containing a total of 91 nodules, in each of three display modes [i.e., slice-by-slice, orthogonal maximum intensity projection (MIP) and stereoscopic] for the purpose of detecting and classifying lung nodules. Radiologists' search patterns in the axial direction were recorded and analyzed along with the location, size, and shape for each detected feature, and the likelihood that the feature is an actual nodule. Nodule detection performance was analyzed by employing free-response receiver operating characteristic methods. Search paths were clearly different between slice-by-slice displays and volumetric displays but, aside from training and novelty effects, not between MIP and stereographic displays. Novelty and training effects were associated with the stereographic display mode, as evidenced by differences between the beginning and end of the study. The stereo display provided higher detection and classification performance with less interpretation time compared to other display modes tested in the study; however, the differences were not statistically significant. Our preliminary results indicate a potential role for the use of radiologists' search paths in evaluating the relative ergonomic efficiencies of different display paradigms, but systematic training and practice is necessary to eliminate training curve and novelty effects before search strategies can be meaningfully compared.

To improve radiologist's performance in lesion detection and diagnosis on 3D medical image dataset, we have conducted a pilot study to test viability and efficiency of the stereo display for lung nodule detection and classification. Using our previously developed stereo compositing methods, stereo image pairs were prestaged and precalculated from CT slices for real-time interactive display. Three display modes (i.e., stereoscopic 3D, orthogonal MIP and slice-by-slice) were compared for lung nodule detection and total of eight radiologists have participated this pilot study to interpret the images. The performance of lung nodule detection was analyzed and compared between the modes using FROC analysis. Subjective assessment indicates that stereo display was well accepted by the radiologists, despite some uncertainty of beneficial results due to the novelty of the display. The FROC analysis indicates a trend that, among the three display modes, stereo display resulted in the best performance of nodule detection followed by slice-based display, although no statistically significant difference was shown between the three modes. The stereo display of a stack of thin CT slices has the potential to clarify three-dimensional structures, while avoiding ambiguities due to tissue superposition. Few studies, however, have addressed actual utility of stereo display for medical diagnosis. Our preliminary results suggest a potential role of stereo display for improving radiologists' performance in medical detection and diagnosis, and also indicate some factors likely affect the performance with new display, such as novelty of the display, training effect from projected radiography interpretation and confidence with the new technology.

Many diagnostic problems involve the assessment of vascular structures or bronchial trees depicted in volumetric datasets, but previous algorithms for segmenting cylindrical structures are not sufficiently robust for them to be widely applied clinically. Local geometric information that is of importance in segmentation consists of voxel values and their first and second derivatives. First derivatives can be generalized to the gradient and more generally the structure tensor, while the second derivatives can be represented by Hessian matrices. It is desirable to exploit both kinds of information, at the same time, in any voxel classification process, but few segmentation algorithms have attempted to do this. This project compares segmentation based on the structure tensor to that based on the Hessian matrix, and attempts to determine whether some combination of the two can demonstrate better performance than either individually. To compare performance in a situation where a gold standard exists, the methods were tested on simulated tree structures. We generated 3D tree structures with varying amounts of added noise, and processed them with algorithms based on the structure tensor, the Hessian matrix, and a combination of the two. We applied an orientation-sensitive filter to smooth the tensor fields. The results suggest that the structure tensor by itself is more effective in detecting cylindrical structures than the Hessian tensor, and the combined tensor is better than either of the other tensors.