An Edge-Based Selection Method for Improving Regions-of-Interest Localizations Obtained Using Multiple Deep Learning Object-Detection Models in Breast Ultrasound Images.

Computer-aided diagnosis (CAD) systems can be used to process breast ultrasound (BUS) images with the goal of enhancing the capability of diagnosing breast cancer. Many CAD systems operate by analyzing the region-of-interest (ROI) that contains the tumor in the BUS image using conventional texture-based classification models and deep learning-based classification models. Hence, the development of these systems requires automatic methods to localize the ROI that contains the tumor in the BUS image. Deep learning object-detection models can be used to localize the ROI that contains the tumor, but the ROI generated by one model might be better than the ROIs generated by other models. In this study, a new method, called the edge-based selection method, is proposed to analyze the ROIs generated by different deep learning object-detection models with the goal of selecting the ROI that improves the localization of the tumor region. The proposed method employs edge maps computed for BUS images using the recently introduced Dense Extreme Inception Network (DexiNed) deep learning edge-detection model. To the best of our knowledge, our study is the first study that has employed a deep learning edge-detection model to detect the tumor edges in BUS images. The proposed edge-based selection method is applied to analyze the ROIs generated by four deep learning object-detection models. The performance of the proposed edge-based selection method and the four deep learning object-detection models is evaluated using two BUS image datasets. The first dataset, which is used to perform cross-validation evaluation analysis, is a private dataset that includes 380 BUS images. The second dataset, which is used to perform generalization evaluation analysis, is a public dataset that includes 630 BUS images. For both the cross-validation evaluation analysis and the generalization evaluation analysis, the proposed method obtained the overall ROI detection rate, mean precision, mean recall, and mean F1-score values of 98%, 0.91, 0.90, and 0.90, respectively. Moreover, the results show that the proposed edge-based selection method outperformed the four deep learning object-detection models as well as three baseline-combining methods that can be used to combine the ROIs generated by the four deep learning object-detection models. These findings suggest the potential of employing our proposed method to analyze the ROIs generated using different deep learning object-detection models to select the ROI that improves the localization of the tumor region.

Needle detection using ultrasound B-mode and power Doppler analyses.

BACKGROUND: Ultrasound is employed in needle interventions to visualize the anatomical structures and track the needle. Nevertheless, needle detection in ultrasound images is a difficult task, specifically at steep insertion angles. PURPOSE: A new method is presented to enable effective needle detection using ultrasound B-mode and power Doppler analyses. METHODS: A small buzzer is used to excite the needle and an ultrasound system is utilized to acquire B-mode and power Doppler images for the needle. The B-mode and power Doppler images are processed using Radon transform and local-phase analysis to initially detect the axis of the needle. The detection of the needle axis is improved by processing the power Doppler image using alpha shape analysis to define a region of interest (ROI) that contains the needle. Also, a set of feature maps is extracted from the ROI in the B-mode image. The feature maps are processed using a machine learning classifier to construct a likelihood image that visualizes the posterior needle likelihoods of the pixels. Radon transform is applied to the likelihood image to achieve an improved needle axis detection. Additionally, the region in the B-mode image surrounding the needle axis is analyzed to identify the needle tip using a custom-made probabilistic approach. Our method was utilized to detect needles inserted in ex vivo animal tissues at shallow [ 20 ∘ - 40 ∘ $20^\circ -40^\circ$ ), moderate [ 40 ∘ - 60 ∘ $40^\circ -60^\circ$ ), and steep [ 60 ∘ - 85 ∘ $60^\circ -85^\circ$ ] angles. RESULTS: Our method detected the needles with failure rates equal to 0% and mean angle, axis, and tip errors less than or equal to 0.7°, 0.6 mm, and 0.7 mm, respectively. Additionally, our method achieved favorable results compared to two recently introduced needle detection methods. CONCLUSIONS: The results indicate the potential of applying our method to achieve effective needle detection in ultrasound images.

A Game-Based Rehabilitation System for Upper-Limb Cerebral Palsy: A Feasibility Study.

Game-based rehabilitation systems provide an effective tool to engage cerebral palsy patients in physical exercises within an exciting and entertaining environment. A crucial factor to ensure the effectiveness of game-based rehabilitation systems is to assess the correctness of the movements performed by the patient during the game-playing sessions. In this study, we propose a game-based rehabilitation system for upper-limb cerebral palsy that includes three game-based exercises and a computerized assessment method. The game-based exercises aim to engage the participant in shoulder flexion, shoulder horizontal abduction/adduction, and shoulder adduction physical exercises that target the right arm. Human interaction with the game-based rehabilitation system is achieved using a Kinect sensor that tracks the skeleton joints of the participant. The computerized assessment method aims to assess the correctness of the right arm movements during each game-playing session by analyzing the tracking data acquired by the Kinect sensor. To evaluate the performance of the computerized assessment method, two groups of participants volunteered to participate in the game-based exercises. The first group included six cerebral palsy children and the second group included twenty typically developing subjects. For every participant, the computerized assessment method was employed to assess the correctness of the right arm movements in each game-playing session and these computer-based assessments were compared with matching gold standard evaluations provided by an experienced physiotherapist. The results reported in this study suggest the feasibility of employing the computerized assessment method to evaluate the correctness of the right arm movements during the game-playing sessions.

An Adaptive Multipopulation Differential Evolution With Dynamic Population Reduction.

Developing efficient evolutionary algorithms attracts many researchers due to the existence of optimization problems in numerous real-world applications. A new differential evolution algorithm, sTDE-dR, is proposed to improve the search quality, avoid premature convergence, and stagnation. The population is clustered in multiple tribes and utilizes an ensemble of different mutation and crossover strategies. In this algorithm, a competitive success-based scheme is introduced to determine the life cycle of each tribe and its participation ratio for the next generation. In each tribe, a different adaptive scheme is used to control the scaling factor and crossover rate. The mean success of each subgroup is used to calculate the ratio of its participation for the next generation. This guarantees that successful tribes with the best adaptive schemes are only the ones that guide the search toward the optimal solution. The population size is dynamically reduced using a dynamic reduction method. Comprehensive comparison of the proposed heuristic over a challenging set of benchmarks from the CEC2014 real parameter single objective competition against several state-of-the-art algorithms is performed. The results affirm robustness of the proposed approach compared to other state-of-the-art algorithms.

Cystic spinal dysraphism of the cervical region: experience with eight cases including double cervical and lumbosacral meningoceles.

OBJECTIVE: Cervical meningoceles are rare. Clinical, radiological and surgical data of 8 cases were presented, including a unique case of double cervical and lumbosacral meningoceles. METHODS: This retrospective study included all children operated on for cervical meningocele from January 2004 to June 2009 at the Aburish Pediatric Hospital, Cairo University. RESULTS: Eight children (6 boys and 2 girls) were operated on. Their ages ranged between 2 months and 8 years. The clinical picture--apart form posterior cervical swelling--was almost normal. One case had paraplegia due to associated lumbosacral myelomeningocele (double meningocele). Four patients had associated hydrocephalus; 2 had Chiari malformation and 2 hydromyelia. CONCLUSION: The outcome after surgery for these lesions is excellent as the majority of the children have no or minimal neurological deficit and surgery does help in improving cosmesis and preventing the development of neurological deterioration.

Control of emergence hypertension after craniotomy for brain tumor surgery.

OBJECTIVE: To compare the anti-hypertensive effects of both remifentanil and esmolol infusion. METHODS: This prospective comparative study was conducted on 20 patients (10 patients in each group), in the Neurosurgical Theater of Kasr Elaini Hospital, Cairo, Egypt from 2006 to 2008. The patients were divided into 2 equal groups. In group one, remifentanil was used as a bolus of one ug/kg intravenous (iv) in 30-60 seconds, followed by infusion at a rate of 0.25-0.5 ug/kg/min until the systolic blood pressure was <140 mm Hg. In group 2, esmolol was given as a 500 ug/kg iv bolus in 30 seconds followed by continued infusion of 100-300 ug/kg/min until systolic blood pressure was <140 mm Hg. Infusion was continued until the patients left the post anesthesia care unit (PACU). RESULTS: The onset time of decreasing blood pressure was shorter in group 2 (40+/-0.01 seconds) than group one (52.5+/-4.47 seconds). The PACU and hospital stay were comparable between both groups. CONCLUSION: Remifentanil can be used to control blood pressure during emergence of anesthesia after craniotomy for brain tumors. It has higher rapid recovery score than esmolol and other narcotics. In addition, it can be used when esmolol is contraindicated such as in cardiac patients, asthmatics, chronic obstructive pulmonary disease, or during pregnancy. Also, it decreases the need for postoperative analgesia and allows sedation if the infusion is continued as surgical patients are admitted to the ICU.

Awake craniotomy versus general anesthesia for managing eloquent cortex low-grade gliomas.

OBJECTIVE: To compare awake craniotomy using conscious sedation technique versus conventional general anesthesia (GA) for excision of low-grade glioma encroaching on eloquent brain. METHODS: This prospective study included 40 patients ASA classification 1 and 2, aged 23-55 years, harboring low-grade glioma encroaching on eloquent brain. The study was carried out in the Neurosurgical Theatre in Kasr El-Aini Hospital, Cairo, Egypt, from January 2007 to November 2008. Twenty patients (group 1) received GA with endotracheal intubation and controlled ventilation. In group 2, awake craniotomy was carried out using local anesthetic infiltration, and intravenous injection of propofol and fentanyl. RESULTS: Forty patients completed the study. In the awake group, none of the patients received GA, 2 patients developed intraoperative agitation, 5 patients were over-sedated, and none of the awake patients developed intraoperative nausea or vomiting. Four patients in the GA group developed post-operative nausea and vomiting compared to one patient in the awake group, and this difference was statistically significant (p=0.039). The neurological outcome regarding motor power and/or speech was found better or with no fresh deficits, immediately postoperative in 90% of the awake group patients. This is compared to 40% in the GA group. The difference was statistically significant. At 6 months follow up, the results were 90% and 60%, but the difference was not statistically significant. Gross total tumor resection was achieved in 10 cases of the GA group versus 8 in the awake group; however, the difference was not statistically significant. CONCLUSION: Compared to GA, awake craniotomy is a relatively simple non-expensive procedure that allows tumor removal guided by physiology rather than anatomy.