An extensible software platform for interdisciplinary cardiovascular imaging research

BACKGROUND AND OBJECTIVE Cardiovascular imaging is an exponentially growing field with aspects ranging from image acquisition and analysis to disease characterization, and evaluation of therapy approaches.The transfer of innovative new technological and algorithmic solutions into clinical practice is still slow. In addition to the verification of solutions, their integration in the clinical processing workflow must be enabled for the assessment of clinical impact and risks. The goal of our software platform for cardiac image processing - CAIPI - is to support researchers from different specialties such as imaging physics, computer science, and medicine by a common extensible platform to address typical challenges and hurdles in interdisciplinary cardiovascular imaging research. It provides an integrated solution for method comparison, integrated analysis, and validation in the clinical context. The interface concept enables a combination with existing frameworks that address specific aspects of the pipeline, such as modeling (e.g., OpenCMISS, CARP) or image reconstruction (Gadgetron). METHODS In our platform, we developed a concept for import, integration, and management of cardiac image data. The integration approach considers the spatiotemporal properties of the beating heart through a specific data model. The solution is based on MeVisLab and provides functionalities for data retrieval and storage. Two types of plugins can be added. While ToolPlugins usually provide processing algorithms such as image correction and segmentation, AnalysisPlugins enable interactive data exploration and reporting. GUI integration concepts are presented for both plugin types. We developed domain-specific reporting and visualization tools (e.g., AHA segment model) to enable validation studies by clinical experts. The platform offers plugins for calculating and reporting quantitative parameters such as cardiac function, which can be used to, e.g., evaluate the effect of processing algorithms on clinical parameters. Export functionalities include quantitative measurements to Excel, image data to PACS, and STL models to modeling and simulation tools. RESULTS To demonstrate the applicability of this concept both for method development and clinical application, we present use cases representing different problems along the innovation chain in cardiac MR imaging. Validation of an image reconstruction method (MRI T1 mapping) Validation of an image correction method for real-time 2D-PC MRI Comparison of quantification methods for blood flow analysis Training and integration of machine learning solutions with expert annotations Clinical studies with new imaging techniques (flow measurements in the carotid arteries and peripheral veins as well as cerebral spinal fluid). CONCLUSION The presented platform can be used in interdisciplinary teams, in which engineers or data scientists perform the method validation, followed by clinical research studies in patient collectives. The demonstrated use cases show how it enables the transfer of innovations through validation in the cardiovascular application context.

[1]  Jens Frahm,et al.  Real-time magnetic resonance imaging of deep venous flow during muscular exercise-preliminary experience. , 2016, Cardiovascular diagnosis and therapy.

[2]  Parashkev Nachev,et al.  Computer Methods and Programs in Biomedicine NiftyNet: a deep-learning platform for medical imaging , 2022 .

[3]  Michael J Ackerman,et al.  Engineering and algorithm design for an image processing Api: a technical report on ITK--the Insight Toolkit. , 2002, Studies in health technology and informatics.

[4]  William Schroeder,et al.  The Visualization Toolkit: An Object-Oriented Approach to 3-D Graphics , 1997 .

[5]  Matthew J. McAuliffe,et al.  Medical Image Processing, Analysis and Visualization in clinical research , 2001, Proceedings 14th IEEE Symposium on Computer-Based Medical Systems. CBMS 2001.

[6]  Alejandro F. Frangi,et al.  Benchmarking framework for myocardial tracking and deformation algorithms: An open access database , 2013, Medical Image Anal..

[7]  Jens Frahm,et al.  Respiration and the watershed of spinal CSF flow in humans , 2018, Scientific Reports.

[8]  Jens Frahm,et al.  Real‐time flow MRI of the aorta at a resolution of 40 msec , 2014, Journal of magnetic resonance imaging : JMRI.

[9]  Klaus H. Maier-Hein,et al.  The Medical Imaging Interaction Toolkit: challenges and advances , 2013, International Journal of Computer Assisted Radiology and Surgery.

[10]  Defeng Wang,et al.  Robust recovery of myocardial kinematics using dual ℋ∞$\mathcal {H}_{\infty }$ criteria , 2017, Multimedia Tools and Applications.

[11]  Heye Zhang,et al.  OpenCMISS: a multi-physics & multi-scale computational infrastructure for the VPH/Physiome project. , 2011, Progress in biophysics and molecular biology.

[12]  Marco Eichelberg,et al.  Ten years of medical imaging standardization and prototypical implementation: the DICOM standard and the OFFIS DICOM toolkit (DCMTK) , 2004, SPIE Medical Imaging.

[13]  M. Cerqueira,et al.  Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. , 2002, Circulation.

[14]  Nicolas Toussaint,et al.  MedINRIA: Medical Image Navigation and Research Tool by INRIA , 2007 .

[15]  Oleg S. Pianykh,et al.  Digital Imaging and Communications in Medicine (DICOM) , 2017, Radiopaedia.org.

[16]  Alejandro F. Frangi,et al.  RADStation3G: A platform for cardiovascular image analysis integrating PACS, 3D+t visualization and grid computing , 2013, Comput. Methods Programs Biomed..

[17]  Teodora Chitiboi Myocardium Segmentation and Motion Analysis from Time-varying Cardiac Magnetic Resonance Imaging , 2016 .

[18]  Ola Friman,et al.  The culprit lesion and its consequences: combined visualization of the coronary arteries and delayed myocardial enhancement in dual-source CT: a pilot study , 2010, European Radiology.

[19]  Aaron Carass,et al.  Why rankings of biomedical image analysis competitions should be interpreted with care , 2018, Nature Communications.

[20]  Osman Ratib,et al.  OsiriX: An Open-Source Software for Navigating in Multidimensional DICOM Images , 2004, Journal of Digital Imaging.

[21]  N. Trayanova,et al.  Computational models in cardiology , 2018, Nature Reviews Cardiology.

[22]  M. Fornage,et al.  Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association , 2017, Circulation.

[23]  Dana H. Brooks,et al.  SCIRun/BioPSE: integrated problem solving environment for bioelectric field problems and visualization , 2004, 2004 2nd IEEE International Symposium on Biomedical Imaging: Nano to Macro (IEEE Cat No. 04EX821).

[24]  G Plank,et al.  Computational tools for modeling electrical activity in cardiac tissue. , 2003, Journal of electrocardiology.

[25]  Heinz-Otto Peitgen,et al.  IWT-interactive watershed transform: a hierarchical method for efficient interactive and automated segmentation of multidimensional gray-scale images , 2003, SPIE Medical Imaging.

[26]  Heinz-Otto Peitgen,et al.  A Comprehensive Approach to the Analysis of Contrast Enhanced Cardiac MR Images , 2008, IEEE Transactions on Medical Imaging.

[27]  Kevin W Eliceiri,et al.  NIH Image to ImageJ: 25 years of image analysis , 2012, Nature Methods.

[28]  Guido Gerig,et al.  User-guided 3D active contour segmentation of anatomical structures: Significantly improved efficiency and reliability , 2006, NeuroImage.

[29]  Einar Heiberg,et al.  Design and validation of Segment - freely available software for cardiovascular image analysis , 2010, BMC Medical Imaging.

[30]  Jens Frahm,et al.  Carotid artery flow as determined by real-time phase-contrast flow MRI and neurovascular ultrasound: A comparative study of healthy subjects. , 2018, European journal of radiology.

[31]  Timo Ropinski,et al.  Voreen: A Rapid-Prototyping Environment for Ray-Casting-Based Volume Visualizations , 2009, IEEE Computer Graphics and Applications.

[32]  Michael Schacht Hansen,et al.  Gadgetron: An open source framework for medical image reconstruction , 2013, Magnetic resonance in medicine.

[33]  Heinz-Otto Peitgen,et al.  Motion Analysis with Quadrature Filter Based Registration of Tagged MRI Sequences , 2011, STACOM.

[34]  Theo van Walsum,et al.  Comprehensive visualization of multimodal cardiac imaging data for assessment of coronary artery disease: first clinical results of the SMARTVis tool , 2012, International Journal of Computer Assisted Radiology and Surgery.

[35]  Milan Sonka,et al.  3D Slicer as an image computing platform for the Quantitative Imaging Network. , 2012, Magnetic resonance imaging.

[36]  Jens Frahm,et al.  Identification of the Upward Movement of Human CSF In Vivo and its Relation to the Brain Venous System , 2017, The Journal of Neuroscience.

[37]  P J Hunter,et al.  The IUPS Physiome Project: a framework for computational physiology. , 2004, Progress in biophysics and molecular biology.

[38]  Alejandro F. Frangi,et al.  GIMIAS: An Open Source Framework for Efficient Development of Research Tools and Clinical Prototypes , 2009, FIMH.

[39]  G Plank,et al.  Image-Based Personalization of Cardiac Anatomy for Coupled Electromechanical Modeling , 2015, Annals of Biomedical Engineering.