Harmonic field extension for QSM with reduced spatial coverage using physics-informed generative adversarial network.

Quantitative susceptibility mapping (QSM) is frequently employed in investigating brain iron related to brain development and diseases within deep gray matter (DGM). Nonetheless, the acquisition of whole-brain QSM data is time-intensive. An alternative approach, focusing the QSM specifically on areas of interest such as the DGM by reducing the field-of-view (FOV), can significantly decrease scan times. However, severe susceptibility value underestimations have been reported during QSM reconstruction with a limited FOV, largely attributable to artifacts from incorrect background field removal in the boundary region. This presents a considerable barrier to the clinical use of QSM with small spatial coverages using conventional methods alone. To mitigate the propagation of these errors, we proposed a harmonic field extension method based on a physics-informed generative adversarial network. Both quantitative and qualitative results demonstrate that our method outperforms conventional methods and delivers results comparable to those obtained with full FOV. Furthermore, we demonstrate the versatility of our method by applying it to data acquired prospectively with limited FOV and to data from patients with Parkinson's disease. The method has shown significant improvements in local field results, with QSM outcomes. In a clear illustration of its feasibility and effectiveness in real clinical environments, our proposed method addresses the prevalent issue of susceptibility underestimation in QSM with small spatial coverage.

Data-driven electrical conductivity brain imaging using 3 T MRI.

Magnetic resonance electrical properties tomography (MR-EPT) is a non-invasive measurement technique that derives the electrical properties (EPs, e.g., conductivity or permittivity) of tissues in the radiofrequency range (64 MHz for 1.5 T and 128 MHz for 3 T MR systems). Clinical studies have shown the potential of tissue conductivity as a biomarker. To date, model-based conductivity reconstructions rely on numerical assumptions and approximations, leading to inaccuracies in the reconstructed maps. To address such limitations, we propose an artificial neural network (ANN)-based non-linear conductivity estimator trained on simulated data for conductivity brain imaging. Network training was performed on 201 synthesized T2-weighted spin-echo (SE) data obtained from the finite-difference time-domain (FDTD) electromagnetic (EM) simulation. The dataset was composed of an approximated T2-w SE magnitude and transceive phase information. The proposed method was tested three in-silico and in-vivo on two volunteers and three patients' data. For comparison purposes, various conventional phase-based EPT reconstruction methods were used that ignore B 1 + magnitude information, such as Savitzky-Golay kernel combined with Gaussian filter (S-G Kernel), phase-based convection-reaction EPT (cr-EPT), magnitude-weighted polynomial-fitting phase-based EPT (Poly-Fit), and integral-based phase-based EPT (Integral-based). From the in-silico experiments, quantitative analysis showed that the proposed method provides more accurate and improved quality (e.g., high structural preservation) conductivity maps compared to conventional reconstruction methods. Representatively, in the healthy brain in-silico phantom experiment, the proposed method yielded mean conductivity values of 1.97 ± 0.20 S/m for CSF, 0.33 ± 0.04 S/m for WM, and 0.52 ± 0.08 S/m for GM, which were closer to the ground-truth conductivity (2.00, 0.30, 0.50 S/m) than the integral-based method (2.56 ± 2.31, 0.39 ± 0.12, 0.68 ± 0.33 S/m). In-vivo ANN-based conductivity reconstructions were also of improved quality compared to conventional reconstructions and demonstrated network generalizability and robustness to in-vivo data and pathologies. The reported in-vivo brain conductivity values were in agreement with literatures. In addition, the proposed method was observed for various SNR levels (SNR levels = 10, 20, 40, and 58) and repeatability conditions (the eight acquisitions with the number of signal averages = 1). The preliminary investigations on brain tumor patient datasets suggest that the network trained on simulated dataset can generalize to unforeseen in-vivo pathologies, thus demonstrating its potential for clinical applications.

A single stage knowledge distillation network for brain tumor segmentation on limited MR image modalities.

BACKGROUND AND OBJECTIVE: Precisely segmenting brain tumors using multimodal Magnetic Resonance Imaging (MRI) is an essential task for early diagnosis, disease monitoring, and surgical planning. Unfortunately, the complete four image modalities utilized in the well-known BraTS benchmark dataset: T1, T2, Fluid-Attenuated Inversion Recovery (FLAIR), and T1 Contrast-Enhanced (T1CE) are not regularly acquired in clinical practice due to the high cost and long acquisition time. Rather, it is common to utilize limited image modalities for brain tumor segmentation. METHODS: In this paper, we propose a single stage learning of knowledge distillation algorithm that derives information from the missing modalities for better segmentation of brain tumors. Unlike the previous works that adopted a two-stage framework to distill the knowledge from a pre-trained network into a student network, where the latter network is trained on limited image modality, we train both models simultaneously using a single-stage knowledge distillation algorithm. We transfer the information by reducing the redundancy from a teacher network trained on full image modalities to the student network using Barlow Twins loss on a latent-space level. To distill the knowledge on the pixel level, we further employ a deep supervision idea that trains the backbone networks of both teacher and student paths using Cross-Entropy loss. RESULTS: We demonstrate that the proposed single-stage knowledge distillation approach enables improving the performance of the student network in each tumor category with overall dice scores of 91.11% for Tumor Core, 89.70% for Enhancing Tumor, and 92.20% for Whole Tumor in the case of only using the FLAIR and T1CE images, outperforming the state-of-the-art segmentation methods. CONCLUSIONS: The outcomes of this work prove the feasibility of exploiting the knowledge distillation in segmenting brain tumors using limited image modalities and hence make it closer to clinical practices.

Technical note: Multi-receiver combination method for phase-based electrical property tomography of the breast.

BACKGROUND: Phase-based electrical property tomography (EPT) is a technique that allows conductivity reconstruction with only phase of the B1 field under the assumption that the magnitude of the B1 fields are homogeneous. The more this assumption is violated, the less accurate the reconstructed conductivity. Thus, a method that ensures homogeneity of | B 1 - | $| {{\rm{B}}_1^ - } |$ field is important for breast image using multi-receiver coil. PURPOSE: To develop a method for multi-receiver combination for phase-based EPT usable for breast EPT imaging in the clinic. METHODS: Theory of the proposed method is presented. To validate the proposed method, the phantom and in-vivo experiments were conducted. Conductivity images were reconstructed using the transceive phase of the combined image and results were compared with another combination method. RESULTS: The proposed method's conductivity results were more stable than those of the previous method when | B 1 + | $| {{\rm{B}}_1^ + } |$ was not homogeneous and when the homogeneous contrast region was small. The phantom and in-vivo results indicate that the proposed method produces improved conductivity images than the previous method. The proposed combination method also increased the conductivity contrast between benign and cancerous tissues. CONCLUSION: The proposed method produced more stable multi-receiver combination for phase-based EPT of the breast in a clinical environment.

Detection of Cerebral Microbleeds in MR Images Using a Single-Stage Triplanar Ensemble Detection Network (TPE-Det).

BACKGROUND: Cerebral microbleeds (CMBs) are microscopic brain hemorrhages with implications for various diseases. Automated detection of CMBs is a challenging task due to their wide distribution throughout the brain, small size, and visual similarity to their mimics. For this reason, most of the previously proposed methods have been accomplished through two distinct stages, which may lead to difficulties in integrating them into clinical workflows. PURPOSE: To develop a clinically feasible end-to-end CMBs detection network with a single-stage structure utilizing 3D information. This study proposes triplanar ensemble detection network (TPE-Det), ensembling 2D convolutional neural networks (CNNs) based detection networks on axial, sagittal, and coronal planes. STUDY TYPE: Retrospective. SUBJECTS: Two datasets (DS1 and DS2) were used: 1) 116 patients with 367 CMBs and 12 patients without CMBs for training, validation, and testing (70.39 ± 9.30 years, 68 women, 60 men, DS1); 2) 58 subjects with 148 microbleeds and 21 subjects without CMBs only for testing (76.13 ± 7.89 years, 47 women, 32 men, DS2). FIELD STRENGTH/SEQUENCE: A 3 T field strength and 3D GRE sequence scan for SWI reconstructions. ASSESSMENT: The sensitivity, FPavg (false-positive per subject), and precision measures were computed and analyzed with statistical analysis. STATISTICAL TESTS: A paired t-test was performed to investigate the improvement of detection performance by the suggested ensembling technique in this study. A P value < 0.05 was considered significant. RESULTS: The proposed TPE-Det detected CMBs on the DS1 testing set with a sensitivity of 96.05% and an FPavg of 0.88, presenting statistically significant improvement. Even when the testing on DS2 was performed without retraining, the proposed model provided a sensitivity of 85.03% and an FPavg of 0.55. The precision was significantly higher than the other models. DATA CONCLUSION: The ensembling of multidimensional networks significantly improves precision, suggesting that this new approach could increase the benefits of detecting lesions in the clinic. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 2.

Point Cloud Resampling by Simulating Electric Charges on Metallic Surfaces.

3D point cloud resampling based on computational geometry is still a challenging problem. In this paper, we propose a point cloud resampling algorithm inspired by the physical characteristics of the repulsion forces between point electrons. The points in the point cloud are considered as electrons that reside on a virtual metallic surface. We iteratively update the positions of the points by simulating the electromagnetic forces between them. Intuitively, the input point cloud becomes evenly distributed by the repulsive forces. We further adopt an acceleration and damping terms in our simulation. This system can be viewed as a momentum method in mathematical optimization and thus increases the convergence stability and uniformity performance. The net force of the repulsion forces may contain a normal directional force with respect to the local surface, which can make the point diverge from the surface. To prevent this, we introduce a simple restriction method that limits the repulsion forces between the points to an approximated local plane. This approach mimics the natural phenomenon in which positive electrons cannot escape from the metallic surface. However, this is still an approximation because the surfaces are often curved rather than being strict planes. Therefore, we project the points to the nearest local surface after the movement. In addition, we approximate the net repulsion force using the K-nearest neighbor to accelerate our algorithm. Furthermore, we propose a new measurement criterion that evaluates the uniformity of the resampled point cloud to compare the proposed algorithm with baselines. In experiments, our algorithm demonstrates superior performance in terms of uniformization, convergence, and run-time.

Improving phase-based conductivity reconstruction by means of deep learning-based denoising of B1+ phase data for 3T MRI.

PURPOSE: To denoise B1+ phase using a deep learning method for phase-based in vivo electrical conductivity reconstruction in a 3T MR system. METHODS: For B1+ phase deep-learning denoising, a convolutional neural network (U-net) was chosen. Training was performed on data sets from 10 healthy volunteers. Input data were the real and imaginary components of single averaged spin-echo data (SNR = 45), which was used to approximate the B1+ phase. For label data, multiple signal-averaged spin-echo data (SNR = 128) were used. Testing was performed on in silico and in vivo data. Reconstructed conductivity maps were derived using phase-based conductivity reconstructions. Additionally, we investigated the usability of the network to various SNR levels, imaging contrasts, and anatomical sites (ie, T1 , T2 , and proton density-weighted brain images and proton density-weighted breast images. In addition, conductivity reconstructions from deep learning-based denoised data were compared with conventional image filters, which were used for data denoising in electrical properties tomography (ie, the Gaussian filtering and the Savitzky-Golay filtering). RESULTS: The proposed deep learning-based denoising approach showed improvement for B1+ phase for both in silico and in vivo experiments with reduced quantitative error measures compared with other methods. Subsequently, this resulted in an improvement of reconstructed conductivity maps from the denoised B1+ phase with deep learning. CONCLUSION: The results suggest that the proposed approach can be used as an alternative preprocessing method to denoise B1+ maps for phase-based conductivity reconstruction without relying on image filters or signal averaging.

Factors Influencing the Response to Infectious Diseases: Focusing on the Case of SARS and MERS in South Korea.

Following the 2003 the severe acute respiratory syndrome (SARS) and the 2015 Middle East Respiratory Syndrome (MERS) outbreak in South Korea, this research aims to explore and examine the factors influencing the response to infectious diseases, which encompasses both communicable and non-communicable diseases. Through a qualitative research method, this research categorizes the factors as inputs, processes and outputs and applies them into the 2003 SARS and MERS outbreak in South Korea. As the results conducted meta-analyses to comprehensively analyze the correlations of factors influencing disaster response from a Korean context, the findings show that the legislative factor had direct and indirect influence on the overall process of infectious disease response and that Leadership of the central government, establishment of an intergovernmental response system, the need for communication, information sharing and disclosure and onsite response were identified as key factors influencing effective infectious disease response.

The Effectiveness of International Non-Governmental Organizations' Response Operations during Public Health Emergency: Lessons Learned from the 2014 Ebola Outbreak in Sierra Leone.

International Nongovernmental Organizations (INGOs) have played critical roles in improving the quality of primary health care in ordinary time and, indeed, responding to epidemic crises in developing countries. Due to a lack of empirical research for effectiveness of their responding activities, the legitimacy and accountability of nonprofits' engagement in the health crisis as a critical responder is doubted. This paper aims to examine the effectiveness of INGOs in a context of managing a fatal epidemic outbreak of Ebola in Sierra Leone during May-November, 2014; building healthcare infrastructures, providing medical supplies, educating local residents, and training response staffs. The analysis results show that development of healthcare infrastructures and provision of medical supplies have been significantly effective in terms of decreasing the severity of the crisis in chiefdoms. The findings imply that policy tools, which allow INGOs to enter to the field in a timely manner, can improve the effectiveness of INGOs' responses in current and future epidemic outbreaks in developing countries where people suffer from a lack of health infrastructures.

Dynamics of Interorganizational Public Health Emergency Management Networks: Following the 2015 MERS Response in South Korea.

We investigated public health emergency management networks during the recent outbreak of Middle East respiratory syndrome coronavirus that affected more than 17 000 people in South Korea. We administered a survey to 169 organizations in order to map the pattern of communication and response networks during the Middle East respiratory syndrome outbreak. We also conducted 11 semistructured interviews with national, regional, and local government officials to comprehend inhibiting and facilitating factors in risk communication and response to the system. National ministries or agencies play central roles in coordinating and supporting the overall response, and local and regional governments or agencies interact with other governments and agencies. Governmental agencies coordinating and/or supporting the outbreak response had difficulties in communicating with other agencies because of the ambiguity of the nature of the infectious disease, slow information disclosure, differences in the organizational priorities, different information standards, and the limitations of the information system. To better respond to a virus outbreak, government agencies need to improve hierarchical communication among different levels of governments, horizontal communication and cooperation between same types or different types of agencies, and information systems.

Unveiling cultures in emergency response communication networks on social media: following the 2016 Louisiana floods.

While culture in emergency management has gained attention from the field of risk communication, few have systemically dealt with the nuances of general culture involved in the formation and differentiation of risk communication. To fill this gap, this research aims to first examine cultural nuances from the 2016 Louisiana flood response by primarily focusing on communications embedded in social media. The results from social network analysis and content analysis highlight that the flood response communication had strong cultural characteristics, highlighting the notion that of the cultures in Louisiana-faith-based, local authority, and nonprofits-were the prominent cultural responders in the flood response communication. In particular, cultural similarity in both intra/inter group response communication was observed, with each communication group comprising actors who shared a common cultural background and spoke similar keywords.

Public Health Network Structure and Collaboration Effectiveness during the 2015 MERS Outbreak in South Korea: An Institutional Collective Action Framework.

Following the 2015 Middle East Respiratory Syndrome (MERS) outbreak in South Korea, this research aims to examine the structural effect of public health network explaining collaboration effectiveness, which is defined as joint efforts to improve quality of service provision, cost savings, and coordination. We tested the bonding and bridging effects on collaboration effectiveness during the MERS outbreak response by utilizing an institutional collective action framework. The analysis results of 114 organizations responding during the crisis show a significant association between the bonding effect and the effectiveness of collaboration, as well as a positive association between risk communication in disseminating public health information and the effectiveness of collaboration.

Filling the gap between disaster preparedness and response networks of urban emergency management: Following the 2013 Seoul Floods.

OBJECTIVE: To examine the gap between disaster preparedness and response networks following the 2013 Seoul Floods in which the rapid transmission of disaster information and resources was impeded by severe changes of interorganizational collaboration networks. DESIGN/SETTING/METHODOLOGY/APPROACH: This research uses the 2013 Seoul Emergency Management Survey data that were collected before and after the floods, and total 94 organizations involving in coping with the floods were analyzed in bootstrap independent-sample t-test and social network analysis through UCINET 6 and STATA 12. RESULTS: The findings show that despite the primary network form that is more hierarchical, horizontal collaboration has been relatively invigorated in actual response. Also, interorganizational collaboration networks for response operations seem to be more flexible grounded on improvisation to coping with unexpected victims and damages. CONCLUSIONS: Local organizations under urban emergency management are recommended to tightly build a strong commitment for joint response operations through full-size exercises at the metropolitan level before a catastrophic event. Also, interorganizational emergency management networks need to be restructured by reflecting the actual response networks to reduce collaboration risk during a disaster. ORIGINALITY/INNOVATIONS: This research presents a critical insight into inverse thinking of the view designing urban emergency management networks and provides original evidences for filling the gap between previously coordinated networks for disaster preparedness and practical response operations after a disaster.