CARES 3.0: A two stage system combining feature-based recognition and edge-based segmentation for CIMT measurement on a multi-institutional ultrasound database of 300 images

The intima-media thickness of the carotid artery (CIMT) is a validated marker of atherosclerosis. Accurate CIMT measurement can be performed by specifically designed computer algorithms. We improved a previous CIMT measurement technique by introducing a smart heuristic search for the lumen-intima (LI) and media-adventitia (MA) interfaces of the carotid distal wall. We called this new release as CARES 3.0 (a class of AtheroEdge™ system, a patented technology from Global Biomedical Technologies, Inc., CA, USA). CARES 3.0 is completely automated and adopts an integrated approach for carotid location in the image frame, followed by segmentation based on edge snapper and heuristic search. CARES 3.0 was benchmarked against three other techniques on a 300 image multi-institutional database. One of the techniques was user-driven. The CARES 3.0 CIMT measurement bias was −0.021±0.182 mm, which was better than that of the semi automated method (−0.036±0.183 mm). CARES 3.0 outperformed the other two fully automated methods. The Figure-of-Merit of CARES 3.0 was 97.4%, better than that of the semi-automated technique (95.4%).