Digital X-ray stereophotogrammetry for cochlear implantation

Multielectrode, intracochlear implant systems are effective treatment for profound sensorineural hearing loss. In some cases, these systems do not perform well, which may be partially due to variations in implant location within the cochlea. Determination of each electrode's position in a patient's inner ear provides an in vivo basis for both the cochlear modeling of electrical fields and the future design of electrode arrays that deliver electrical stimulation to surviving auditory neurons, and may improve speech processor programming for better speech recognition. We developed an X-ray stereophotogrammetric approach to localize implanted electrodes in three dimensions. Stereophotogrammetry of implanted electrodes is formulated in weak perspective geometry, with knowledge of a three-dimensional (3-D) reference structure and electrode positions in each of two digital stereo-images. The localization error is theoretically, numerically, and experimentally quantified. Both numerical and experimental results demonstrate the feasibility of the technique.     

An advanced multiple channel cochlear implant

An advanced multiple channel cochlear implant hearing prosthesis is described. Stimulation is presented through an array of 20 electrodes located in the scala tympani. Any two electrodes can be configured as a bipolar pair to conduct a symmetrical, biphasic, constant-current pulsatile stimulus. Up to three stimuli can be presented in rapid succession or effectively simultaneously. For simultaneous stimulation, a novel time-division current multiplexing technique has been developed to obviate electrode interactions that may compromise safety. The stimuli are independently controllable in current amplitude, duration, and onset time. Groups of three stimuli can be generated at a rate of typically 500 Hz. Stimulus control data and power are conveyed to the implant through a single transcutaneous inductive link. The device also incorporates a telemetry system that enables electrode voltage waveforms to be monitored externally in real time. The electronics of the implant are contained almost entirely on a custom designed integrated circuit. Preliminary results obtained with the first patient to receive the advanced implant are included.     

Spiral CT image deblurring for cochlear implantation

Cochlear implantation is the standard treatment for profound hearing loss, Preimplantation and postimplantation spiral computed tomography (CT) is essential in several key clinical and research aspects. The maximum image resolution with commercial spiral CT scanners is insufficient to define clearly anatomical features and implant electrode positions in the inner ear, In this paper, the authors develop an expectation maximization (EM)-like iterative deblurring algorithm to achieve spiral CT image super-resolution for cochlear implantation, assuming a spatially invariant linear spiral CT system with a three-dimensional (3-D) separable Gaussian point spread function (PSF). The authors experimentally validate the 3-D Gaussian blurring model via phantom measurement and profile fitting. The imaging process is further expressed as convolution of an isotropic 3-D Gaussian PSF and a blurred underlying volumetric image. Under practical conditions, an oblique reconstructed section is approximated as convolution of an isotropic two dimensional (2-D) Gaussian PSF and the corresponding actual cross section. The spiral CT image deblurring algorithm is formulated with sieve and resolution kernels for suppressing noise and edge artifacts. A typical cochlear cross section is used for evaluation, demonstrating a resolution gain up to 30%-40% according to the correlation criterion. Physical phantoms, preimplantation and postimplantation patients are reconstructed into volumes of 0.1-mm cubic voxels. The patient images are digitally unwrapped along the central axis of the cochlea and the implanted electrode array respectively, then oblique sections orthogonal to the central axis formed. After deblurring, representation of structural features is substantially improved in all the cases     

Constrained registration for motion compensation in atrial fibrillation ablation procedures

Fluoroscopic overlay images rendered from preoperative volumetric data can provide additional anatomical details to guide physicians during catheter ablation procedures for treatment of atrial fibrillation (AFib). As these overlay images are often compromised by cardiac and respiratory motion, motion compensation methods are needed to keep the overlay images in sync with the fluoroscopic images. So far, these approaches have either required simultaneous biplane imaging for 3-D motion compensation, or in case of monoplane X-ray imaging, provided only a limited 2-D functionality. To overcome the downsides of the previously suggested methods, we propose an approach that facilitates a full 3-D motion compensation even if only monoplane X-ray images are available. To this end, we use a training phase that employs a biplane sequence to establish a patient specific motion model. Afterwards, a constrained model-based 2-D/3-D registration method is used to track a circumferential mapping catheter. This device is commonly used for AFib catheter ablation procedures. Based on the experiments on real patient data, we found that our constrained monoplane 2-D/3-D registration outperformed the unconstrained counterpart and yielded an average 2-D tracking error of 0.6 mm and an average 3-D tracking error of 1.6 mm. The unconstrained 2-D/3-D registration technique yielded a similar 2-D performance, but the 3-D tracking error increased to 3.2 mm mostly due to wrongly estimated 3-D motion components in X-ray view direction. Compared to the conventional 2-D monoplane method, the proposed method provides a more seamless workflow by removing the need for catheter model re-initialization otherwise required when the C-arm view orientation changes. In addition, the proposed method can be straightforwardly combined with the previously introduced biplane motion compensation technique to obtain a good trade-off between accuracy and radiation dose reduction.     

Postoperative Calculation of Acetabular Cup Position Using 2-D–3-D Registration

A method to accurately measure the position and orientation of an acetabular cup implant from postoperative X-rays has been designed and validated. The method uses 2-D-3-D registration to align both the prosthesis and the preoperative computed tomography (CT) volume to the X-ray image. This allows the position of the implant to be calculated with respect to a CT-based surgical plan. Experiments have been carried out using ten sets of patient data. A conventional plain-film measurement technique was also investigated. A gold standard implant position and orientation was calculated using postoperative CT. Results show our method to be significantly more accurate than the plain-film method for calculating cup anteversion. Cup orientation and position could be measured to within a mean absolute error of 1.4 mm or degrees.     

Postoperative calculation of acetabular cup position using 2-D-3-D registration.

A method to accurately measure the position and orientation of an acetabular cup implant from postoperative X-rays has been designed and validated. The method uses 2-D-3-D registration to align both the prosthesis and the preoperative computed tomography (CT) volume to the X-ray image. This allows the position of the implant to be calculated with respect to a CT-based surgical plan. Experiments have been carried out using ten sets of patient data. A conventional plain-film measurement technique was also investigated. A gold standard implant position and orientation was calculated using postoperative CT. Results show our method to be significantly more accurate than the plain-film method for calculating cup anteversion. Cup orientation and position could be measured to within a mean absolute error of 1.4 mm or degrees.     

Force application during cochlear implant insertion: an analysis for improvement of surgeon technique

Highly invasive surgical procedures, such as the implantation of a prosthetic device, require correct force delivery to achieve desirable outcomes and minimize trauma induced during the operation. Improvement in surgeon technique can reduce the chances of excessive force application and lead to optimal placement of the electrode array. The fundamental factors that affect the degree of success for cochlear implant recipients are identified through empirical methods. Insertion studies are performed to assess force administration and electrode trajectories during implantations of the Nucleus 24 Contour and Nucleus 24 Contour Advance electrodes into a synthetic model of the human Scala Tympani, using associated methods. Results confirm that the Advance Off- Stylet insertion of the soft-tipped Contour Advance electrode gives an overall reduction in insertion force. Analysis of force delivery and electrode positioning during cochlear implantation can help identify and control key factors for improvement of insertion method. Based on the findings, suggestions are made to enhance surgeon technique.     

Effect of electrode size on impedance images of two- andthree-dimensional objects

The sensitivity of an impedance imaging system to small cylindrical inhomogeneities in two-dimensional (2-D) and three-dimensional (3-D) saline tanks was studied for different height electrodes and different height targets. Experimental results were compared with analytical models. Inhomogeneities in the 3-D tank having limited vertical extent were detected by electrodes of vertical size comparable to that of the inhomogeneity. Taller electrodes had increased sensitivity to short targets to only a limited extent. When the electrode height was more than twice that of the target, sensitivity decreased or remained the same with further increases in electrode height. The system was less sensitive to inhomogeneities in the 3-D tank than to those in the 2-D tank. The distinguishability of conductors was greater than that of insulators in the 3-D tank, and the opposite was true in the 2-D tank, consistent with an analytical result     

Three-dimensional geometric modeling of the cochlea using helico-spiral approximation

In this paper, the three-dimensional geometry of the human cochlea is modeled by the helico-spiral seashell model. The 3-D helico-spiral model, the generalized representation of the Archimedian spiral model, provides a framework for measuring cochlear features based on consistent estimation of model parameters. Nonlinear least square minimization based algorithms are developed for the identification of rotation, center and intrinsic parameters of the helico-spiral representation. Two algorithms are designed for the rotation axis aligned to the modiolar axis: one is more susceptible in the presence of noise, while the other allows applicability to two-dimensional data sets. The estimated center and intrinsic parameters allow the calculation of length, height and angular positions needed for frequency mapping of multichannel cochlear implant electrodes. Model performance is evaluated with numerically synthesized curves with different levels of added random noise, histologic data and real human cochlear spiral computed tomography data.     

Model-based design of artificial zero power cochlear implant

This paper deals with a model-based design of an autonomous biomechatronic device for sensing and analog signal processing of acoustic signals. The aim is to develop a biomechatronic artificial cochlear implant for people with hearing loss due to damage or disease of their cochlea. The unique artificial electronic cochlear implant is based on an array of microelectromechanical piezoelectric membranes. Oscillations of membranes detect and filter acoustic signals in individual acoustic frequencies. The proposed biomechatronic device of the artificial cochlear implant consists of an active filters array, signal processing electronics, stimulation nerves electrodes and energy harvesting system for autonomous powering of the device. This solution differs from current cochlear implants solutions, which are bulky electronic systems limited by their high power consumption. The multidisciplinary models of the artificial cochlea implant concept are presented. The mechatronic approach based on model seems to be very useful for development of the full implantable cochlear implant which is designed for the sensing and processing of acoustic signals without external energy source.     

Implementation of uniform and simultaneous ART for 3-D reconstruction in an X-ray imaging system

The authors propose a 3-D volume reconstruction method using X-ray images with a calibration method to implement it in an X-ray imaging system. Previously the authors have proposed an advanced 3-D reconstruction algorithm based on an algebraic reconstruction technique (ART), called a uniform and simultaneous ART (USART). In practice, however, there are two main issues in implementing it in a realised X-ray imaging system. The first one is the huge computation time and memory required in achieving 3-D volume, which is a common limitation in most ART methods. The second issue is the system calibration for determining the geometry of the X-ray imaging conditions needed for the ART method. These two critical problems are addressed. A fast computing model of USART is proposed, where spherical voxel elements are employed in computation to reduce the computation time and memory. Then, a calibration method is proposed to identify the X-ray imaging geometry based on a cone beam projection model. For this purpose, a set of X-ray images of a reference grid pattern is used and the X-ray source positions are determined from the analysis of the image features, the centres of the grid points in the X-ray images. The validity of the proposed 3-D reconstruction method is investigated using a series of experiments.     

Methods for Compensating for Variable Electrode Contact in EIT

Electrical impedance tomography (EIT) is an imaging modality that currently shows promise for the detection and characterization of breast cancer. A very significant problem in EIT imaging is the proper modeling of the interface between the body and the electrodes. We have found empirically that it is very difficult, in a clinical setting, to assure that all electrodes make satisfactory contact with the body. In addition, we have observed a capacitive effect at the skin/electrode boundary that is spatially heterogeneous. To compensate for these problems, we have developed a hybrid nonlinear–linear reconstruction algorithm using the complete electrode model in which we first estimate electrode surface impedances, by means of a Levenberg–Marquardt iterative optimization procedure with an analytically computed Jacobian matrix. We, subsequently, use a linearized algorithm to perform a 3-D reconstruction of perturbations in both contact impedances, and in the spatial distributions of conductivity and permittivity. Results show that, with this procedure, artifacts due to electrodes making poor contact can be greatly reduced. If the experimental apparatus physically applies voltages and measures currents, we show that it is preferable to compute the reconstruction with respect to the Dirichlet-to-Neumann map rather than the Neumann-to-Dirichlet map if there is a significant possibility that electrodes will be fully disconnected. Finally, we test our electrode compensation algorithms for a set of clinical data, showing that we can significantly improve the fit of our model to the measurements by allowing the electrode surface impedances to vary.      

Ultrawideband microwave breast cancer detection: a detection-theoretic approach using the generalized likelihood ratio test

Microwave imaging has been suggested as a promising modality for early-stage breast cancer detection. In this paper, we propose a statistical microwave imaging technique wherein a set of generalized likelihood ratio tests (GLRT) is applied to microwave backscatter data to determine the presence and location of strong scatterers such as malignant tumors in the breast. The GLRT is formulated assuming that the backscatter data is Gaussian distributed with known covariance matrix. We describe the method for estimating this covariance matrix offline and formulating a GLRT for several heterogeneous two-dimensional (2-D) numerical breast phantoms, several three-dimensional (3-D) experimental breast phantoms, and a 3-D numerical breast phantom with a realistic half-ellipsoid shape. Using the GLRT with the estimated covariance matrix and a threshold chosen to constrain the false discovery rate (FDR) of the image, we show the capability to detect and localize small (<0.6 cm) tumors in our numerical and experimental breast phantoms even when the dielectric contrast of the malignant-to-normal tissue is below 2:1.     

Dimensions in Medical Imaging: The More the Better?

"We need to add more dimensions to our effort!" This is probably a typical comment in any business or research meeting. This was exactly what we did in 2003: we expanded our research efforts from two dimensional (2-D) X-ray breast imaging into three dimensional (3-D) imaging. Actually, we are now looking to expand from 3-D X-ray breast imaging into 4-D imaging. Similar efforts are ongoing with many other imaging modalities. The question to be addressed in this article is whether it is indeed worthwhile pursuing to add more dimensions to a medical imaging modality. For us physicists or engineers, the answer tends to be "Of course, the more dimensions the better because it would provide more information about the patient." In reality, adding more dimensions is often achieved with a stiff price. Sometimes this means higher cost of the imaging modality or increased radiation risk to the patient, which we may be willing to incur if the benefit is worth it. However, the price could also be an excessively long scanning time or excessively high patient dose, either of which may make the new imaging technique impractical to implement and use. In this article, we will discuss the benefits of moving to higher dimensionality and the pitfalls of doing so. We will also discuss how we may judge whether to add more dimensions to a medical imaging modality and how we can achieve the same improvement without doing so.     

Clinical evaluation of respiratory motion compensation for anatomical roadmap guided cardiac electrophysiology procedures

X-ray fluoroscopically guided cardiac electrophysiological procedures are routinely carried out for diagnosis and treatment of cardiac arrhythmias. X-ray images have poor soft tissue contrast and, for this reason, overlay of static 3-D roadmaps derived from preprocedural volumetric data can be used to add anatomical information. However, the registration between the 3-D roadmap and the 2-D X-ray image can be compromised by patient respiratory motion. Three methods were designed and evaluated to correct for respiratory motion using features in the 2-D X-ray images. The first method is based on tracking either the diaphragm or the heart border using the image intensity in a region of interest. The second method detects the tracheal bifurcation using the generalized Hough transform and a 3-D model derived from 3-D preoperative volumetric data. The third method is based on tracking the coronary sinus (CS) catheter. This method uses blob detection to find all possible catheter electrodes in the X-ray image. A cost function is applied to select one CS catheter from all catheter-like objects. All three methods were applied to X-ray images from 18 patients undergoing radiofrequency ablation for the treatment of atrial fibrillation. The 2-D target registration errors (TRE) at the pulmonary veins were calculated to validate the methods. A TRE of 1.6 mm ± 0.8 mm was achieved for the diaphragm tracking; 1.7 mm ± 0.9 mm for heart border tracking, 1.9 mm ± 1.0 mm for trachea tracking, and 1.8 mm ± 0.9 mm for CS catheter tracking. We present a comprehensive comparison between the techniques in terms of robustness, as computed by tracking errors, and accuracy, as computed by TRE using two independent approaches.     

Parallelized Bayesian inversion for three-dimensional dental X-ray imaging

Diagnostic and operational tasks based on dental radiology often require three-dimensional (3-D) information that is not available in a single X-ray projection image. Comprehensive 3-D information about tissues can be obtained by computerized tomography (CT) imaging. However, in dental imaging a conventional CT scan may not be available or practical because of high radiation dose, low-resolution or the cost of the CT scanner equipment. In this paper, we consider a novel type of 3-D imaging modality for dental radiology. We consider situations in which projection images of the teeth are taken from a few sparsely distributed projection directions using the dentist's regular (digital) X-ray equipment and the 3-D X-ray attenuation function is reconstructed. A complication in these experiments is that the reconstruction of the 3-D structure based on a few projection images becomes an ill-posed inverse problem. Bayesian inversion is a well suited framework for reconstruction from such incomplete data. In Bayesian inversion, the ill-posed reconstruction problem is formulated in a well-posed probabilistic form in which a priori information is used to compensate for the incomplete information of the projection data. In this paper we propose a Bayesian method for 3-D reconstruction in dental radiology. The method is partially based on Kolehmainen et al. 2003. The prior model for dental structures consist of a weighted /spl lscr//sup 1/ and total variation (TV)-prior together with the positivity prior. The inverse problem is stated as finding the maximum a posteriori (MAP) estimate. To make the 3-D reconstruction computationally feasible, a parallelized version of an optimization algorithm is implemented for a Beowulf cluster computer. The method is tested with projection data from dental specimens and patient data. Tomosynthetic reconstructions are given as reference for the proposed method.     

Magnetic resonance diffractive imaging

Magnetic resonance (MR) diffractive imaging is proposed as a new approach to MR angiography. The expression of the nuclear MR signal is similar to the equation for the Fresnel diffraction of a three-dimensional (3-D) object in light or sound waves. The proposed technique offers the possibility of fast angiographic imaging and the on-line reconstruction of 3-D volumetric images using the holographic technique. Static imaging experiments using an ultra-low-field MRI system are performed to verify the feasibility of the technique. It is shown that the images focused on an arbitrary plane can be reconstructed from data scanned in two dimensions, even though blurred image data is superimposed on the image. Moreover, the 3-D image can be observed in a coherent optical imaging system. This study demonstrates the possibility of the proposed method as a fast imaging technique for MR angiography.     

A Speech Processor with Lateral Inhibition for an Eight Channel Cochlear Implant and its Evaluation

A speech processor including the function of lateral inhibition was proposed to compensate for the wide current spread for an eight channel cochlear implant. Our cochlear implant system is composed of a speech processor, percutaneous connector and an eight channel electrode array made of Pt?Ir wires.     

Three-dimensional modeling and visualization of the cochlea on theInternet

3D modeling and visualization of the cochlea using the World Wide Web (WWW) is an effective way of sharing anatomic information for cochlear implantation over the Internet, particularly for morphometry-based research and resident training in otolaryngology and neuroradiology. In this paper, 3D modeling, visualization and animation techniques are integrated in an interactive and platform-independent manner and implemented over the WWW. L.T. Cohen et al.'s (1996) template shape with mean cross-sectional areas of the human cochlea is extended into a 3D geometrical model. Also, spiral computer tomography data of a patient's cochlea is digitally segmented and geometrically represented. The cochlear electrode array is synthesized according to its specification. Then, cochlear implantation is animated with both idealized and real cochlear models. The insertion length, angular position and characteristic frequency of individual electrodes are estimated online during the virtual insertion. The optimization of the processing parameters is done to demonstrate the feasibility of this technology for clinical applications     

Left ventricular volume estimation for real-time three-dimensional echocardiography

The application of level set techniques to echocardiographic data is presented. This method allows semiautomatic segmentation of heart chambers, which regularizes the shapes and improves edge fidelity, especially in the presence of gaps, as is common in ultrasound data. The task of the study was to reconstruct left ventricular shape and to evaluate left ventricular volume. Data were acquired with a real-time three-dimensional (3-D) echocardiographic system. The method was applied directly in the three-dimensional domain and was based on a geometric-driven scheme. The numerical scheme for solving the proposed partial differential equation is borrowed from numerical methods for conservation law. Results refer to in vitro and human in vivo acquired 3-D + time echocardiographic data. Quantitative validation was performed on in vitro balloon phantoms. Clinical application of this segmentation technique is reported for 20 patient cases providing measures of left ventricular volumes and ejection fraction.