# Patent

## Title
Methods, systems, and media for generating and analyzing medical images having elongated structures

## Abstract

Methods, systems, and media for generating and/or analyzing medical images having elongated structures are provided. In some embodiments, a method for analyzing medical images is provided, the method comprising: receiving a plurality of images, wherein each of the plurality of images includes a portion of an elongated structure; receiving a location of interest within a least one of the plurality of images; determining an orientation of the elongated structure in response to receiving the location of interest; adjusting image planes of each of the plurality of images to correspond with the orientation of the elongated structure; and causing the elongated structure to be displayed in the adjusted image planes.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application claims the benefit of U.S. Provisional Patent Application No. 61/699,114, filed Sep. 10, 2012, which is hereby incorporated by reference herein in its entirety.


TECHNICAL FIELD
The disclosed subject matter relates to methods, systems, and media for generating and analyzing medical images. More particularly, the disclosed subject matter relates to generating and analyzing medical images having elongated structures, such as blood vessels, lymphatic vessels, airways, gastrointestinal tracts (e.g., portions of the large or small intestine, colon, etc.), and the like.
BACKGROUND
In an x-ray computed tomography (“CT”) system, an x-ray source projects a fan- or cone-shaped beam of x-rays that is collimated to lie within an x-y plane of a Cartesian coordinate system, termed the “imaging plane.” The x-ray beam passes through the object being imaged, such as a medical patient, and impinges upon an array of radiation detectors. The intensity of the transmitted radiation is dependent upon the attenuation of the x-ray beam by the object, and each detector produces a separate electrical signal that is a measurement of the beam attenuation. The attenuation measurements from all of the detectors are acquired separately to produce a transmission profile at a particular view angle.
The source and detector array in a conventional CT system are rotated on a gantry within the imaging plane, and around the object so that the angle at which the x-ray beam intersects the object constantly changes. A group of x-ray attenuation measurements from the detector array at a given angle is referred to as a “view,” and a “scan” of the object includes a set of views acquired at different angular orientations during one revolution of the x-ray source and detector. In a 2D scan, data is processed to reconstruct an image that corresponds to a two-dimensional slice taken through the object. The prevailing method for reconstructing an image from 2D data is referred to in the art as the filtered backprojection technique. This process converts the attenuation measurements from a scan into integers called “CT numbers,” or “Hounsfield units,” which are used to control the brightness of a corresponding pixel on a display.
CT imaging is well suited to provide clinically useful images related to a variety of medical conditions. For example, CT pulmonary angiography (CTPA) is currently the diagnostic standard for investigating a suspected pulmonary embolism. A pulmonary embolism is a sudden blockage, such as a clot, in a lung artery due to an embolus that is formed in one part of the body and travels through the bloodstream to an artery of the lung. It is a common cardiovascular emergency with about 600,000 cases occurring annually and causing approximately 200,000 deaths in the United States. Most patients who succumb to pulmonary embolism do so within the first few hours following the event.
A major clinical challenge, particularly in an emergency department, is to quickly and correctly diagnose patients with a pulmonary embolism and dispatch them to treatment, so that hazardous yet life-saving therapy can be prescribed appropriately. Unfortunately, pulmonary embolisms are among the most difficult conditions to diagnose because its primary symptoms are protean and may be manifested by a number of other conditions that require different therapeutic interventions. The correct diagnosis of a pulmonary embolism has been found to be overlooked in as many as 84% of cases (which is estimated at about 450,000 cases each year in the United States), resulting in more than 34,000 preventable deaths, assuming a mortality rate of 7.7%. Not surprisingly then, the Surgeon General has called for action to help prevent deep vein thrombosis (DVT) and pulmonary embolisms.
As noted above, computed tomography or CT is used to visualize the pulmonary arteries so that a highly trained medical professional, such as a radiologist, can examine the CT images for indications of a pulmonary embolism. As such, medical imaging plays a key role in conducting clinical evaluations to diagnose pulmonary embolisms. Specifically, CTPA reveals embolus as a dark region residing in bright vessel lumen. As an imaging protocol, each CTPA scan consists of hundreds of axial images. The interpretation of these images is complex and time consuming because of the intricate branching structure of the pulmonary arteries, the demand for specialized knowledge to distinguish a pulmonary embolism from the various causes of cardiopulmonary pathology that may resemble a pulmonary embolism, and a myriad of artifacts that may obscure or mimic emboli (e.g., flow-related artifacts, streak artifacts, lymph nodes, and the like). The accuracy and efficiency of interpreting such large 3-D image datasets is further limited by human factors, such as attention span and eye fatigue.
Unfortunately, incorrect CTPA interpretations are not infrequent in clinical practice. The number of CTPA examinations has increased by an order of magnitude over the past decade, while studies have found that the rate of true positive examinations has fallen to about 5-10%.
There is therefore a need to mitigate rapidly mounting radiologist workloads and improve the efficiency and accuracy of a pulmonary embolism diagnosis. Accordingly, it is desirable to provide methods, systems, and media for generating and analyzing medical images having elongated structures that overcome these and other deficiencies of the prior art. For example, methods, systems, and media are provided that process one or more images by reformatting the image planes to be in alignment with the longitudinal axis of an elongated structure, such as a vessel, so that the user can scroll along the axis, spin around the longitudinal axis, and perform other operations, thereby facilitating a thorough inspection of the elongated structure from multiple perspectives and providing compelling demonstration of any defects (e.g., arterial filling defects).
SUMMARY
Mechanisms for generating and analyzing medical images having elongated structures are provided.
These mechanisms include, for example, receiving one or more images containing an elongated structure. The elongated structure can include portions of a blood vessel, a lymphatic vessel, an airway, a gastrointestinal tract (e.g., portions of the large or small intestine, the colon, etc.), etc. In a more particular example, the one or more images can be computed tomography pulmonary angiography images that are obtained for the computer-aided detection of indications of emboli.
These mechanisms can be initiated by receiving a location of interest in an image. For example, in some embodiments, the mechanisms can receive a user-selected location of interest in an image (e.g., a user using a user input device to select a location of interest within a displayed image). In a more particular example, the mechanisms can be used at any suitable location of interest including, for example, a radiologist's findings in a particular image. Additionally or alternatively, the mechanisms can receive a computer-generated location of interest in an image, such as, for example, a finding within an image from one or more computer-aided detection (CAD) systems. For example, the mechanisms can receive a computer-generated location of interest as an initial location and receive user-selected locations of interest as the user examines the elongated structure.
Upon receiving the location of interest, the location can be set as the center of the reformatted image plane in which the elongated structure is automatically rotated to align its longitudinal axis along the vertical centerline of the image plane for inspection and/or examination. In some embodiments, the mechanisms can animate the rotation from the initial image of the elongated structure to the reformatted image of the aligned elongated structure. The animation can be generated using, for example, the rotation matrices derived in accordance with Euler's rotation theorem. In some embodiments, the mechanism can provide additional inspection features for examining the elongated structure in the image, such as zooming into or out of an image, scrolling along the longitudinal axis of the aligned elongated structure, selecting an image plane, etc.
In some embodiments, the mechanisms can receive a new or updated location of interest. For example, the mechanisms can receive a new location of interest within a different elongated structure contained in the image. In response to receiving the new or updated location of interest, the mechanisms can continue to determine the orientation of the selected elongated structure and align the selected elongated structure based on its orientation or longitudinal axis.
It should be noted that these mechanisms can be used in a variety of applications. For example, these mechanisms can be used in a clinical environment to interpret image data received from a computed tomography imaging device. In another example, these mechanisms can be used by radiologists to accept or reject findings made by a computer-aided detection system. In yet another example, these mechanisms can be used by medical professional to further inspect and/or examine particular structures shown in the image data from multiple perspectives.
In accordance with various embodiments of the disclosed subject matter, a method for analyzing medical images is provided. The method comprises: receiving a plurality of images, wherein each of the plurality of images includes a portion of an elongated structure; receiving a location of interest within at least one of the plurality of images; determining an orientation of the elongated structure in response to receiving the location of interest; adjusting image planes of each of the plurality of images to correspond with the orientation of the elongated structure; and causing the elongated structure to be displayed in the adjusted image planes.
In some embodiments, the orientation of the elongated structure is represented by a longitudinal axis of the elongated structure. In some embodiments, the longitudinal axis of the elongated structure can be determined using a structure tensor, wherein the structure tensor summarizes predominant directions of a gradient in a neighborhood of the location. In some embodiments, the longitudinal axis of the elongated structure can be determined by segmenting the elongated structure. Additionally or alternatively, in some embodiments, the longitudinal axis of the elongated structure can be based on eigenvectors of the Hessian matrix.
In accordance with some embodiments, a system for analyzing medical images is provided, the system comprising: an imaging device that captures a plurality of medical images, wherein each of the plurality of medical images includes a portion of an elongated structure; and a processor connected to the imaging device. The processor is configured to: receive a plurality of images, wherein each of the plurality of images includes a portion of an elongated structure; receive a location of interest within at least one of the plurality of images; determine an orientation of the elongated structure in response to receiving the location of interest; adjust image planes of each of the plurality of images to correspond with the orientation of the elongated structure; and cause the elongated structure to be displayed in the adjusted image planes.
In accordance with some embodiments, a non-transitory computer-readable medium containing computer-executable instructions that, when executed by a processor, cause the processor to perform a method for analyzing medical images is provided, the method comprising: receiving a plurality of images, wherein each of the plurality of images includes a portion of an elongated structure; receiving a location of interest within at least one of the plurality of images; determining an orientation of the elongated structure in response to receiving the location of interest; adjusting image planes of each of the plurality of images to correspond with the orientation of the elongated structure; and causing the elongated structure to be displayed in the adjusted image planes.



BRIEF DESCRIPTION OF THE DRAWINGS
The above and other objects and advantages of the invention will be apparent upon consideration of the following detailed description, taken in conjunction with the accompanying drawings, in which like reference characters refer to like parts throughout, and in which:
FIG. 1 is a perspective view of an illustrative computed tomography (CT) imaging system for use with some embodiments of the disclosed subject matter;
FIG. 2 is a block diagram of an illustrative computed tomography (CT) imaging system shown in FIG. 1;
FIG. 3 is an illustrative example of a process for generating and/or analyzing one or more images containing an elongated structure in accordance with some embodiments of the disclosed subject matter;
FIG. 4 is an illustrative representation of aligning, reformatting, and/or adjusting an elongated structure contained in an image in accordance with some embodiments of the disclosed subject matter;
FIGS. 5A-L is an illustrative series of images showing an elongated structure, such as a vessel, as it is rotated into an imaging plane aligned with a longitudinal axis of the elongated structure in accordance with some embodiments of the disclosed subject matter; and
FIGS. 6A-L is an illustrative series of images showing an elongated structure, such as a vessel, as it is spun about a longitudinal axis of the elongated structure in accordance with some embodiments of the disclosed subject matter; and
FIGS. 7A-H is an illustrative series of images showing the alignment, reformatting, or adjustment of the elongated structure as an updated location of interest is received in accordance with some embodiments of the disclosed subject matter.
FIG. 8 is an illustrative three-dimensional image of the elongated structure, such as a vessel, in accordance with some embodiments of the disclosed subject matter.



DETAILED DESCRIPTION
In describing exemplary embodiments of the disclosed subject matter illustrated in the drawings, specific terminology may be employed for the sake of clarity. However, the disclosed subject matter is not intended to be limited to the specific terminology so selected, and it is to be understood that each specific element includes all technical equivalents which operate in a similar manner.
As used herein, the term “image” may refer to multi-dimensional data composed of discrete image elements (e.g., pixels for two-dimensional images and voxels for three-dimensional images). The image may be, for example, a medical image of a subject collected using a computer tomography system, a magnetic resonance imaging system, an ultrasound imaging system, or any other medical imaging system or imaging modality known to one of skill in the art. The image may also be provided from non-medical contexts, such as, for example, remote sensing systems, electron microscopy systems, etc. Although an image can be thought of as a function from R3 to R, the methods of the disclosed subject matter are not limited to such images, and can be applied to images of any dimension, e.g., a two-dimensional picture, a three-dimensional volume, or a four-dimensional space. For a two-dimensional or three-dimensional image, the domain of the image is typically a two-dimensional or three-dimensional rectangular array, where each pixel or voxel can be addressed with reference to a set of two or three mutually orthogonal axes.
It should also be noted that, although the embodiments described herein generally relate to analyzing images that contain blood vessels and, more particularly, vessel lumen for detecting emboli, this is merely illustrative. The disclosed subject matter can be used to analyze images having any suitable elongated structure, such as blood vessels, lymphatic vessels, airways, gastrointestinal tracts (e.g., portions of the large or small intestine, colon, etc.), and the like.
In accordance with some embodiments of the disclosed subject matter, an image inspection application (sometimes referred to herein as “the application”) is provided. The image inspection application can receive images of an elongated structure, receive a location of interest within the images of the elongated structure, determine an orientation of the elongated structure in response to the location of interest, and reformat the images of the elongated structure in alignment with the determined orientation of the elongated structure.
With initial reference to FIGS. 1 and 2, an x-ray CT imaging system 10 includes a gantry 12 representative of a “third generation” CT scanner. However, this is for exemplary purposes only, as the present invention is not limited to any particular “generation” of CT system or, for that matter, a specific instantiation of imaging modality, as long as the medical imaging system is capable of providing images or imaging data with the features or information described in detail below.
The gantry 12 has an x-ray source 14 that projects a fan-beam, or cone-beam, of x-rays 16 toward a detector array 18 on the opposite side of the gantry 12. The detector array 18 is formed by a number of detector elements 20, which together sense the projected x-rays 16 that pass through a medical patient or subject 22 being imaged. Each detector element 20 produces an electrical signal that represents the intensity of an impinging x-ray beam and hence the attenuation of the beam as it passes through the subject 22.
During a scan to acquire x-ray projection data, the gantry 12 and the components mounted thereon rotate about a center of rotation 24 located within the subject 22. The rotation of the gantry 12 and the operation of the x-ray source 14 are governed by a control mechanism 26 of the CT system. The control mechanism 26 includes an x-ray controller 28 that provides power and timing signals to the x-ray source 14 and a gantry motor controller 30 that controls the rotational speed and position of the gantry 12. A data acquisition system (“DAS”) 32 in the control mechanism 26 samples analog data from detector elements 20 and converts the data to digital signals for subsequent processing. An image reconstructor 34, receives sampled and digitized x-ray data from the DAS 32 and performs image reconstruction, for example, using a filtered backprojection or other image reconstruction process. The reconstructed image is applied as an input to a computer 36 that stores the image and the raw imaging or attenuation data in a mass storage device 38.
The computer 36 also receives commands and scanning parameters from an operator via console 40. An associated display 42 allows the operator to observe the reconstructed image and other data from the computer 36. The operator supplied commands and parameters are used by the computer 36 to provide control signals and information to the DAS 32, the x-ray controller 28 and the gantry motor controller 30. In addition, the computer 36 operates a table motor controller 44 that controls a motorized table 46 to position the subject 22 in the gantry 12. As will be described, the present invention may be performed in conjunction with or programmed to operate on the computer 36, the display 42 and/or operator console 40 and/or may utilize or be programmed to operate as a separate system 48 that is connected to or separate from the computer 36, display 42, and operator console 40.
As will be described below, the disclosed subject matter may be implemented with a computer aided detection (CAD) system or a more general inspection system that works not only for general processing of images and analysis of computer aided detection findings, but at any suitable location of interest, including a radiologist's own findings.
For example, the disclosed subject matter can be utilized with a system for image analysis and processing that includes scanning the images of the lungs with a concentration-oriented tobogganing algorithm to form PE candidates. Generally speaking, it should be noted that the hardware and/or software of the disclosed subject matter can be implemented as part of other equipment or can be implemented as stand-alone equipment (which can be coupled to other equipment). For example, an exemplary system is described in J. Liang and J. Bi, “Computer-aided detection of pulmonary embolism with tobogganing and multiple instance classification in CT pulmonary angiography,” in Proceedings of the 20th International Conference on Information Processing in Medical Imaging, 20th International Conference, IPMI 2007, Kerkrade, The Netherlands, 2007, pp. 630-641; J. Liang and J. Bi, “Local Characteristic Features for Computer-Aided Detection of Pulmonary Embolism in CT Angiography,” Proceedings of the First Workshop on Pulmonary Image Analysis, New York, N.Y., Sep. 6, 2008, pp. 263-272; and J. Bi and J. Liang, “Multiple instance learning of pulmonary embolism detection with geodesic distance along vascular structure,” in Proceedings of IEEE Computer Society Conference on Computer Vision and Pattern Recognition (CVPR'07), Minneapolis, Minn., USA, 2007, which are hereby incorporated by reference herein in their entireties.
Additionally or alternatively, the disclosed subject matter may be used independently of any computer aided detection system. That is, in addition or alternatively to starting from CAD-identified prospects, the inspect ion system can be focused on a location selected by a clinician, for example, by clinician selection of a location via a mouse click or touch indication within an image. Some embodiments of the inspection system can be launched by clicking at any location of an elongated structure of interest in an image. Some examples of elongated structures include blood vessels, lymphatic vessels, airways, gastrointestinal tracts, the colon, and other such structures.
Turning to FIG. 3, FIG. 3 shows an illustrative flow diagram 300 for generating and/or analyzing an image containing an elongated structure in accordance with some embodiments of the disclosed subject matter.
At 310, a location of interest in an initial image containing an elongated structure can be received. As described above, the initial image may refer to multi-dimensional data composed of discrete image elements (e.g., pixels for two-dimensional images and voxels for three-dimensional images). The image can be, for example, a medical image of a subject collected using a computer tomography system, a magnetic resonance imaging system, an ultrasound imaging system, or any other medical imaging system or imaging modality known to one of skill in the art. The image can also be provided from non-medical contexts, such as, for example, remote sensing systems, electron microscopy systems, etc. Although an image can be thought of as a function from R3 to R, the methods of the disclosed subject matter are not limited to such images, and can be applied to images of any dimension, e.g., a two-dimensional picture, a three-dimensional volume, or a four-dimensional space. For a two-dimensional or three-dimensional image, the domain of the image is typically a two-dimensional or three-dimensional rectangular array, where each pixel or voxel can be addressed with reference to a set of two or three mutually orthogonal axes.
In some embodiments, the location of interest can be received from a user selection. For example, a user using a user input device can select a point within an elongated structure in a displayed image as the location of interest. In response, the location of interest selected by the user can be highlighted or otherwise indicated. In another example, the location of interest associated with the image can be retrieved from a database of findings provided by a radiologist or any other suitable medical professional. Alternatively, the location of interest can be received from a remote system. For example, a computer-aided detection system can review the image and determine the location of interest.
It should be noted that, in some embodiments, the location of interest can be received from both a user selection and a remote system, such as a computer-aided detection system. For example, an initial location of interest can be determined, retrieved, and/or indicated by a computer-aided detection system and a user can be provided with an opportunity to confirm the initial location of interest or select an alternate location of interest within the elongated structure in the displayed image. In another example, an initial location of interest can be received from a user selection and the user-selected location can be transmitted to a remote system, such as a computer-aided detection system, for verification.
It should also be noted that, in some embodiments, the user selection or a computer-aided finding of a location of interest is the only location received prior to automatically generating an adjusted image of the elongated structure (e.g., where the longitudinal axis of the elongated structure is aligned with the vertical centerline of the display window, where an axis of the elongated structure is aligned with the horizontal centerline of the display, etc.).
Regardless of whether the locations of interest and/or localizations are determined by a computer-aided detection system or user input, the inspection system of the disclosed subject matter can allow the image planes to be adjusted or reformatted to be in alignment with a longitudinal axis of an elongated structures. In doing so, the user can be provided with an opportunity to navigate along the longitudinal axis and rotate around the axis, thereby facilitating a thorough inspection of the structure from multiple perspectives and providing a compelling demonstration of any defects inside the structure.
Referring back to FIG. 3, in response to receiving the location of interest, an orientation of the elongated structure within the image can be determined based on the location of interest. In some embodiments, the orientation of the elongated structure can be determined by determining the longitudinal axis of the elongated structure.
For example, FIG. 4 shows general orientation axes x-y-z 400 with an image 402 aligned in plane x-y 404 such that the image 402 is displayed with axis x generally pointing to the right, axis y generally pointing to the top, and axis z generally pointing out of the image. The orientation of the image 402, as defined by a longitudinal axis 406 of a segment of an elongated structure 408, such as a vessel, at the location of interest can be determined using a structure tensor. It should be noted that the structure tensor can be used to summarize the predominant directions of a gradient in a specified neighborhood of the location of interest.
Given a three-dimensional (3D) volume image dataset f(x, y, z) with gradient ∇f(f′x, f′y, f′z), the gradient tensor T(v) at voxel v can be represented as:




  
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The structure tensor can be obtained by spatially averaging the entries of the gradient tensor with a Gaussian filter:

S(v)=[sij(v)];

sij=gσ*tij;

i,j∈1,2,3;

where gσ is a Gaussian with standard deviation σ and * denotes convolution. Each entry sij(v) in the structure tensor S(v) may not simply be a product of the gradients at voxel, v, as in gradient tensor T(v), but a spatially-weighted average of the products of gradients in the neighborhood of voxel, v, with a Gaussian. The Gaussian weighted spatial averaging can combine gradient information over a neighborhood, providing a robust solution in determining the orientation of the elongated structure. From structure tensor, as illustrated in FIG. 4, the orientation of the elongated structure can be determined as denoted with axis Y′, yielding a new image in plane (x′-y′) illustrated relative to general orientation axes x-y-z 400.

It should be noted that the three-dimensional structure tensor S(v) includes three eigenvalues λ1, λ2, and λ3, where λ1≧λ2≧λ3, and their corresponding eigenvectors e1, e2, and e3 that summarize the distribution of the gradient ∇f(f′x, f′y, f′z) within the window defined by σ centered at voxel, v. Therefore, in case of an elongated structure, such as a vessel, λ1≈λ2≈λ3 is expected. The eigenvector e3 associated with the smallest eigenvalue λ3 corresponds to the longitudinal axis of the elongated structure, while e1 and e2 form an image plane perpendicular to the orientation of the elongated structure. In some embodiments, the inspection system can choose to reformat an image plane based on eigenvectors e1 and e3, in which e1 is referred as the x axis, and e3 is referred as y axis (aligned with the vertical centerline), and e2 is referred as the z axis (pointing to the user).
It should be noted that, although the embodiments described herein generally determine the orientation of the elongated structure using a structure tensor, any suitable approach for determining the orientation or longitudinal axis of the structure can be used. For example, in some embodiments, the orientation of the elongated structure can be determined by segmenting the elongated structure. In another example, the orientation of the elongated structure can be determined by the eigenvectors of the Hessian matrix.
In response to determining the orientation of the elongated structure, an adjusted image can be displayed at 330, where the longitudinal axis of the elongated structure can be aligned with the vertical centerline of the display window. For example, as shown in FIG. 5A, the location of interest 510 can be received. In response to determining the orientation of the elongated structure of FIG. 5A, an adjusted image shown in FIG. 5L can be displayed, where the longitudinal axis of the elongated structure is aligned with the vertical centerline 520 of the display window 530.
It should be noted that the elongated structure can be aligned with any suitable portion of the display window 530. For example, an axis of the elongated structure can be aligned with the horizontal centerline of the display window 530.
In some embodiments, an animation (or any other suitable sequence of images) of the elongated structure from the initial image to the adjusted image can be provided to a user of the inspection system at 340. For example, to maintain visual context and/or maintain the visual orientation of a user of the inspection system, the inspection system can animate the rotation and/or adjustment of the elongated structure as a movie or any other suitable series of images. In a more particular example, FIGS. 5A-5L show an illustrative series of images showing an elongated structure, such as a vessel, as it is rotated into an adjusted imaging plane aligned with the longitudinal axis of the elongated structure.
In some embodiments, the animation or series of images can be created using rotation matrices in accordance with Euler's rotation theorem. For example, referring back to FIG. 4 and, more particularly, to axes 410 in FIG. 4, given display axes (x-y-z) 400, the inspection system can represent orientation axes (x′-y′-z′) 410 of the elongated structure as rotation matrixes, A and A′, relative to the global coordinate system. The rotation matrix for aligning display axes (x-y-z) 400 with orientation axes (x′-y′-z′) 410 of the elongated structure can be computed as:




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In accordance with Euler's rotation theorem, in a three-dimensional space, any two Cartesian coordinate systems with a common origin are related by a rotation about some fixed axis K at some degree of angle θ:



  
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            ⁢
            sin
            ⁢
            
              
            
            ⁢
            θ
          
        
        ⁡
        
          [
          
            
              
                
                  
                    r
                    32
                  
                  -
                  
                    r
                    23
                  
                
              
            
            
              
                
                  
                    r
                    13
                  
                  -
                  
                    r
                    31
                  
                
              
            
            
              
                
                  
                    r
                    21
                  
                  -
                  
                    r
                    12
                  
                
              
            
          
          ]
        
      
    
  



As also shown in FIG. 4, with the availability of the fixed axis K and the degree of angle θ, the rotation about axis K can be animated by gradually changing the rotation angle from 0 to θ. For an arbitrary intermediate angle φ (0≦φ≦θ), the inspection system can compute the rotation matrix as:




  
    R
    φ
  
  =
  
    [
    
      
        
          
            
              
                k
                x
              
              ⁢
              
                
                  k
                  x
                
                ⁡
                
                  (
                  
                    1
                    -
                    
                      cos
                      ⁡
                      
                        (
                        φ
                        )
                      
                    
                  
                  )
                
              
            
            +
            
              cos
              ⁡
              
                (
                φ
                )
              
            
          
        
        
          
            
              
                k
                y
              
              ⁢
              
                
                  k
                  x
                
                ⁡
                
                  (
                  
                    1
                    -
                    
                      cos
                      ⁡
                      
                        (
                        φ
                        )
                      
                    
                  
                  )
                
              
            
            -
            
              
                k
                z
              
              ⁢
              
                sin
                ⁡
                
                  (
                  φ
                  )
                
              
            
          
        
        
          
            
              
                k
                z
              
              ⁢
              
                
                  k
                  x
                
                ⁡
                
                  (
                  
                    1
                    -
                    
                      cos
                      ⁡
                      
                        (
                        φ
                        )
                      
                    
                  
                  )
                
              
            
            +
            
              
                k
                y
              
              ⁢
              
                sin
                ⁡
                
                  (
                  φ
                  )
                
              
            
          
        
      
      
        
          
            
              
                k
                x
              
              ⁢
              
                
                  k
                  y
                
                ⁡
                
                  (
                  
                    1
                    -
                    
                      cos
                      ⁡
                      
                        (
                        φ
                        )
                      
                    
                  
                  )
                
              
            
            +
            
              
                k
                z
              
              ⁢
              
                sin
                ⁡
                
                  (
                  φ
                  )
                
              
            
          
        
        
          
            
              
                k
                y
              
              ⁢
              
                
                  k
                  y
                
                ⁡
                
                  (
                  
                    1
                    -
                    
                      cos
                      ⁡
                      
                        (
                        φ
                        )
                      
                    
                  
                  )
                
              
            
            +
            
              cos
              ⁡
              
                (
                φ
                )
              
            
          
        
        
          
            
              
                k
                z
              
              ⁢
              
                
                  k
                  y
                
                ⁡
                
                  (
                  
                    1
                    -
                    
                      cos
                      ⁡
                      
                        (
                        φ
                        )
                      
                    
                  
                  )
                
              
            
            -
            
              
                k
                x
              
              ⁢
              
                cos
                ⁡
                
                  (
                  φ
                  )
                
              
            
          
        
      
      
        
          
            
              
                k
                x
              
              ⁢
              
                
                  k
                  z
                
                ⁡
                
                  (
                  
                    1
                    -
                    
                      cos
                      ⁡
                      
                        (
                        φ
                        )
                      
                    
                  
                  )
                
              
            
            -
            
              
                k
                y
              
              ⁢
              
                sin
                ⁡
                
                  (
                  φ
                  )
                
              
            
          
        
        
          
            
              
                k
                y
              
              ⁢
              
                
                  k
                  z
                
                ⁡
                
                  (
                  
                    1
                    -
                    
                      cos
                      ⁡
                      
                        (
                        φ
                        )
                      
                    
                  
                  )
                
              
            
            +
            
              
                k
                x
              
              ⁢
              
                sin
                ⁡
                
                  (
                  φ
                  )
                
              
            
          
        
        
          
            
              
                k
                z
              
              ⁢
              
                
                  k
                  z
                
                ⁡
                
                  (
                  
                    1
                    -
                    
                      cos
                      ⁡
                      
                        (
                        φ
                        )
                      
                    
                  
                  )
                
              
            
            +
            
              cos
              ⁡
              
                (
                φ
                )
              
            
          
        
      
    
    ]
  




As a result, the inspection system can use the above-mentioned equations to yield the intermediate display axes Aφ=ARφ, from whose x-y plane a new image is reformatted for display, resulting in a “rotating,” “flying,” or otherwise animated effect with φ running from 0 to θ. For example, using the above-mentioned equations, the inspection system can determine the rotation matrices for generating an animation of images, where some of the images contained in the animation are shown in FIGS. 5A-5L. As shown, an elongated structure, such as a vessel, is rotated and animated into an adjusted imaging plane aligned with the longitudinal axis of the elongated structure (shown in FIG. 5L).
Referring back to FIG. 3, in some embodiments, the inspection system can provide the user of the inspection system with one or more navigational features for analyzing the elongated structure at 350.
For example, in some embodiments, the inspection system can allow the user to spin the elongated structure about its longitudinal axis. As shown in FIGS. 6A-6L, in response to determining the orientation of the elongated structure for the location of interest 510, the inspection system can use the above-mentioned rotation matrices or any other suitable matrices to generate intermediary image frames showing the elongated structure spinning around the longitudinal axis or the vertical centerline 520 of the display window. In some embodiments, the inspection system can generate one or more intermediary image frames showing the rotation of the elongated structure around its longitudinal axis in response to receiving a direction indication from the user (e.g., spin left, spin right, etc.).
In another example, the inspection system can allow the user to zoom into a portion of the aligned elongated structure for further analysis. The user can zoom into and out of a particular portion of the elongated structure. In yet another example, the inspection system can allow the user to scroll in any suitable direction (e.g., up, down, left, right, along the longitudinal axis, etc.) within an image plane. In a further example, the inspection system can allow the user to select an adjacent image plane (e.g., selecting the next image plane in an animation or sequence of images, selecting the next image plane when the elongated structure is rotating about its longitudinal axis, etc.).
Referring back to FIG. 3, in some embodiments, the inspection system can allow the user to select a new or updated location of interest within the elongated structure. For example, the inspection system can provide the user with an opportunity to select a new location within the same vessel branch or proceed to a different vessel branch in the image. For example, as shown in FIG. 3, in response to detecting that a new location has been received (e.g., a user selection at a new location of interest, a new finding by a computer-assisted detection system), the inspection system can return back to step 320. For example, in response to receiving the new location of interest, the inspection system can determine the orientation or longitudinal axis of the elongated structure based on the new location of interest, generate an adjusted image that includes rotating the elongated structure to align the newly determined longitudinal axis with the vertical centerline of the display window, and/or providing an animation of the elongated structure to the adjusted image and other navigation features to the user.
In a more particular example, FIGS. 7A-7H show a series of images illustrating the alignment, reformatting, or adjustment of the elongated structure as an updated location of interest is received in accordance with some embodiments of the disclosed subject matter. As shown, in response to detecting that a new location 700 has been received from a user selection, the inspection system determines the longitudinal axis of the structure corresponding to the new location 700, and aligns the longitudinal axis of the structure with the vertical centerline of the display window. As also shown by the intermediary images in FIGS. 7B-7G, the inspection system can generate an animation from the structure shown in FIG. 7A to the aligned structure shown in FIG. 7H. In some embodiments, the inspection system can provide additional navigational features for inspecting the structure corresponding to the new location 700 (e.g., zoom, scroll, image plane selection, etc.).
It should be noted that, although FIGS. 5A-5L, 6A-6L, and 7A-7H show multiple exemplary series of images, these are merely illustrative. For example, although FIGS. 6A-6L show intermediary image frames that are generated to show the elongated structure as it spins around the longitudinal axis or the vertical centerline of the display window, this is merely illustrative. Rather than two-dimensional slices, the inspection system can allow a user to navigate a four-dimensional or three-dimensional image. For example, as described above, the inspection system can use an imaging system, such as CT imaging system 10, to acquire three-dimensional data from an image of a vessel or any other suitable elongated structure. The imaging system 10 can then scan the vessel to generate a series of two-dimensional images associated with the vessel. The two-dimensional images can then be converted or transformed into a three-dimensional image of the vessel.
An illustrative example of such a three-dimensional representation of the elongated structure in accordance with some embodiments of the disclosed subject matter is shown in FIG. 8. As shown, the inspection system can allow a user to navigate a three-dimensional image of an elongated structure. As described above, in response to receiving a location of interest 800, the inspection system can align, orient, reformat, and/or adjust the elongated structure in the three-dimensional image to show the location of interest in the orientation shown in FIG. 8. It should be noted that the location of interest 800 can be a user-provided region (e.g., provided using an input device) or a computer-provided region (e.g., provided by a computer-aided detection system). Additionally, in some embodiments, the inspection system can determine and/or highlight a region of interest on the three-dimensional image for diagnosing and/or evaluating the elongated structure (e.g., for detecting pulmonary emboli, for providing visualization of vascular intensity levels and local vascular structure and occlusion, etc.).
It should be understood that the above steps of the flow diagrams of FIG. 3 may be executed or performed in any order or sequence not limited to the order and sequence shown and described in the figure. Also, some of the above steps of the flow diagrams of FIG. 3 may be executed or performed substantially simultaneously where appropriate or in parallel to reduce latency and processing times.
Any suitable hardware and/or software can be used to perform the mechanisms described herein. For example, a general purpose device such as a computer or a special purpose device such as a client, a server, etc. can be used to execute software for performing the mechanisms described herein. Any of these general or special purpose devices can include any suitable components such as a hardware processor (which can be a microprocessor, digital signal processor, a controller, etc.), memory, communication interfaces, display controllers, input devices, etc. This hardware and/or software can be implemented as part of other equipment or can be implemented as stand-alone equipment (which can be coupled to other equipment).
In some embodiments, any suitable computer readable media can be used for storing instructions for performing the processes described herein. For example, in some embodiments, computer readable media can be transitory or non-transitory. For example, non-transitory computer readable media can include media such as magnetic media (such as hard disks, floppy disks, etc.), optical media (such as compact discs, digital video discs, Blu-ray discs, etc.), semiconductor media (such as flash memory, electrically programmable read only memory (EPROM), electrically erasable programmable read only memory (EEPROM), etc.), any suitable media that is not fleeting or devoid of any semblance of permanence during transmission, and/or any suitable tangible media. As another example, transitory computer readable media can include signals on networks, in wires, conductors, optical fibers, circuits, any suitable media that is fleeting and devoid of any semblance of permanence during transmission, and/or any suitable intangible media.
Accordingly, methods, systems, and media for generating and/or analyzing medical images having elongated structures are provided.
Although the invention has been described and illustrated in the foregoing illustrative embodiments, it is understood that the present disclosure has been made only by way of example, and that numerous changes in the details of implementation of the invention can be made without departing from the spirit and scope of the invention, which is only limited by the claims which follow. Features of the disclosed embodiments can be combined and rearranged in various ways.

## Claims

1. A method for analyzing medical images, the method comprising:
receiving, using a hardware processor, image data that includes a first plurality of image planes of an elongated structure;
receiving, in a display window that displays the image data, a location of interest within an image plane of the first plurality of image planes that is currently being presented;
determining an orientation of the elongated structure that is represented by a longitudinal axis based on the location of interest;
aligning the longitudinal axis of the elongated structure in the first plurality of image planes with a centerline of the display window;
generating a second plurality of image planes from the received image data based on the aligned longitudinal axis of the elongated structure, wherein the location of interest automatically becomes the center of each of the second plurality of image planes;
in response to receiving the location of interest, causing an image sequence to be displayed in the display window that illustrates the elongated structure being rotated from the orientation to a resulting orientation in which the longitudinal axis is aligned with the centerline of the display window; and
causing the second plurality of image planes of the elongated structure to be displayed in the display window.

2. The method of claim 1, wherein the longitudinal axis of the elongated structure is determined using a structure tensor, wherein the structure tensor summarizes predominant directions of a gradient in a neighborhood of the location of interest.

3. The method of claim 1, wherein the longitudinal axis of the elongated structure is determined by segmenting the elongated structure.

4. The method of claim 1, wherein the longitudinal axis of the elongated structure is determined using eigenvectors of a Hessian matrix.

5. The method of claim 1, further comprising causing an animation including at least one of the first plurality of image planes, the image sequence that includes at least one intermediary image plane that falls between the image plane and one of the second plurality of image planes, and at least one of the second plurality of image planes to be displayed within the display window.

6. The method of claim 5, wherein the animation includes an initial image plane that includes the elongated structure and a reformatted image plane that includes the elongated structure, wherein, in the reformatted image plane, the longitudinal axis of the elongated structure is aligned with a centerline of the display window.

7. The method of claim 5, wherein the animation is generated using rotation matrices by changing a rotation angle from 0 degrees to θ degrees.

8. The method of claim 5, wherein the centerline of the display window is at least one of: a vertical centerline and a horizontal centerline.

9. The method of claim 1, further comprising, in response to receiving an indication from a user, spinning the elongated structure in the second plurality of image planes around the longitudinal axis in the display window.

10. The method of claim 1, further comprising, in response to receiving an indication from a user, scrolling along the elongated structure in the second plurality of image planes along the longitudinal axis in the display window.

11. The method of claim 1, further comprising, in response to receiving an indication from a user, zooming in to or out of the elongated structure in the second plurality of image planes in the display window.

12. The method of claim 1, further comprising, in response to receiving an indication from a user, navigating around the elongated structure in the second plurality of image planes in the display window.

13. The method of claim 1, further comprising, in response to receiving a user selection of one of the second plurality of image planes, causing the selected image plane to be displayed to the user.

14. The method of claim 1, further comprising:
receiving an updated location of interest;
determining an updated orientation of the elongated structure that is represented by the longitudinal axis of the elongated structure at the updated location of interest;
aligning the longitudinal axis of the elongated structure with the centerline of the display window;
generating a third plurality of image planes from the received image data based on the aligned longitudinal axis to correspond with the updated orientation of the elongated structure at the updated location of interest;
in response to receiving the updated location of interest, causing a second image sequence to be displayed in the display window that illustrates the elongated structure being rotated to the updated orientation of the elongated structure; and
causing the elongated structure to be displayed in the third plurality of image planes.

15. The method of claim 14, wherein at least one of the location of interest and the updated location of interest is received from a computer-aided detection system.

16. The method of claim 1, wherein the location of interest is received from a user.

17. The method of claim 1, wherein the location of interest is generated by a computer system.

18. The method of claim 1, wherein the elongated structure includes at least one of a blood vessel, a lymphatic vessel, an airway, a gastrointestinal tract, and a colon.

19. A system for analyzing medical images, the system comprising:
a processor that is configured to:
receive image data that includes a first plurality of image planes of an elongated structure;
receive, in a display window that displays the image data, a location of interest within an image plane of the first plurality of image planes that is currently being presented;
determine an orientation of the elongated structure that is represented by a longitudinal axis based on the location of interest;
align the longitudinal axis of the elongated structure in the first plurality of image planes with a centerline of the display window;
generate a second plurality of image planes from the received image data based on the aligned longitudinal axis of the elongated structure, wherein the location of interest automatically becomes the center of each of the second plurality of image planes;
in response to receiving the location of interest, cause an image sequence to be displayed in the display window that illustrates the elongated structure being rotated from the orientation to a resulting orientation in which the longitudinal axis is aligned with the centerline of the display window; and
cause the second plurality of image planes of the elongated structure to be displayed in the display window.

20. A non-transitory computer-readable medium containing computer-executable instructions that, when executed by a processor, cause the processor to perform a method for analyzing medical images, the method comprising:
receiving image data that includes a first plurality of image planes of an elongated structure;
receiving, in a display window that displays the image data, a location of interest within an image plane of the first plurality of image planes that is currently being presented;
determining an orientation of the elongated structure that is represented by a longitudinal axis based on the location of interest;
aligning the longitudinal axis of the elongated structure in the first plurality of image planes with a centerline of the display window;
generating a second plurality of image planes from the received image date based on the aligned longitudinal axis of the elongated structure, wherein the location of interest automatically becomes the center of each of the second plurality of image planes;
in response to receiving the location of interest, causing an image sequence to be displayed in the display window that illustrates the elongated structure being rotated from the orientation to a resulting orientation in which the longitudinal axis is aligned with the centerline of the display window; and
causing the second plurality of image planes of the elongated structure to be displayed in the display window.