Abstract:
Embodiments of the present invention relate to discriminating between normal and abnormal left ventricles in echocardiography. In one embodiment, a method of and computer program product for discriminating between normal and abnormal left ventricles in echocardiography are provided. A first region of a first image of a heart is located. The first region depicts a chamber of the heart. A boundary of the first region is determined. A predetermined shape is compared to the boundary. A first plurality of parameters is determined that, when applied to the predetermined shape, conforms the predetermined shape to the boundary. The first plurality of parameters is provided to a classifier. An indication of normality or abnormality is received from the classifier.

Description:
BACKGROUND 
       [0001]    Embodiments of the present invention relate to analysis of echocardiograms, and more specifically, to discriminating between normal and abnormal left ventricles in echocardiography. 
       BRIEF SUMMARY 
       [0002]    According to one embodiment of the present invention, a method of and computer program product for discriminating between normal and abnormal left ventricles in echocardiography are provided. A first region of a first image of a heart is located. The first region depicts a chamber of the heart. A boundary of the first region is determined. A predetermined shape is compared to the boundary. A first plurality of parameters is determined that, when applied to the predetermined shape, conforms the predetermined shape to the boundary. The first plurality of parameters is provided to a classifier. An indication of normality or abnormality is received from the classifier. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
         [0003]      FIGS. 1A-C  depict exemplary normal left ventricle shapes. 
           [0004]      FIGS. 1D-F  depict exemplary abnormal left ventricle shapes caused by disease. 
           [0005]      FIGS. 2A-E  depict exemplary shapes of a distorted ellipse model according to embodiments of the present disclosure. 
           [0006]      FIGS. 3A-I  illustrate localization and matching of the left ventricle bounding contour with parametric distorted ellipses according to embodiments of the present disclosure. 
           [0007]      FIG. 4A-G  illustrate parametric fits to the left ventricle in both normal and abnormal cases according to embodiments of the present disclosure. 
           [0008]      FIGS. 5A-F  illustrate ground truth generation for left ventricle extraction according to embodiments of the present disclosure. 
           [0009]      FIG. 6  depicts a plurality of exemplary left ventricle images, the corresponding ground truth, the results of Otsu thresholding, and the results of Atlas-based segmentation. 
           [0010]      FIG. 7  illustrates spread in the estimate of the left ventricle centroid by active shape models according to embodiments of the present disclosure. 
           [0011]      FIG. 8  depicts a computing node according to an embodiment of the present invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0012]    The study of left ventricular shape and function is important in 2D echocardiography. Impairment to left ventricular shape and structure affects cardiac function and is often seen in several cardiac diseases such as aneurysms, cardiomyopathies and infarctions.  FIG. 1  illustrates the difference in the appearance of the left ventricle (LV) in normal and diseased cases, with  FIGS. 1A-C  showing normal LV shapes and  FIGS. 1D-F  showing distorted LV shapes due to diseases such as cardiomyopathies ( FIG. 1D ) and aneurysms ( FIGS. 1E-F ). While even normal ventricular shape is influenced by many factors including the patient&#39;s physiognomy and the chest configuration, a grossly abnormal geometry of a ventricle may indicate the presence of a pathology. While a patient with normally appearing left ventricle (LV) could still have cardiac disease (e.g.,  FIG. 1E ), it is still worthwhile to examine the shape of this prominent chamber to develop an understanding of many cardiac diseases and to build automated clinical decision support systems. 
         [0013]    According to various embodiments of the present disclosure, systems, methods and computer program products are provided for discriminating between normal and abnormal left ventricles. Deviations are captured from the normal appearance through a parametric distorted elliptic shape model. The parameters of the distortion as well as the overall fit of the distorted ellipse to a given left ventricular bounding contour are used to form feature vectors to classify between normal and abnormal LV shapes using a support vector machine. Since the accuracy of discrimination depends on the accuracy of localization of the left ventricular bounding contour in images, an automatic method is provided for extracting such contours from 4-chamber view echocardiographic sequences. To enable robust classification due to the changing shape of the left ventricle within a heart cycle, the temporal information in the sequence is incorporated using parametric features from all images of the sequence per study. Applying the present subject matter to a large database of echocardiographic sequences indicates that the features derived from parametric fits of these distorted ellipses allows discrimination between normal and abnormal left ventricular shapes. 
         [0014]    Various embodiments of the present disclosure use the parametric distorted elliptic shape model described further below. However, various alternative embodiments use other descriptions of the left ventricular shape. In some such embodiments, measurements may be used such as area-length from prolate ellipsoidal representations using ellipsoids manually isolated by echocardiographers. In other such embodiments, the left ventricular (LV) shape is modeled using a variety of techniques including active shape and appearance models, snakes and active contours, parametric shape descriptors of endocardial contours, deformable models and templates, and level set techniques. 
         [0015]    Some model-based approaches such as active shape models may be difficult to learn from a class of shapes, as they require manual marker identification as well as prior registration of shapes during model training Such models, when used to both localize and recognize the left ventricle, may have localization errors. Therefore, in some embodiments, the bounding contours of the left ventricle are first localized in a bottom-up fashion before fitting the distorted ellipsoidal model. A similar process may be used for active contour and active snakes model fitting. However, models allow greater flexibility in warping of shapes. This unconstrained flexibility can be a barrier in estimating the extent to which shapes deviate from expected normal appearance. 
         [0016]    The normal shape of the left ventricle may be described as a bullet or a prolate ellipsoid in three dimensions. However, as seen in  FIG. 1 , cardiac diseases result in considerable deviations from this shape. According to embodiments of the present disclosure, these distortions are formulated as deviations from the prolate ellipsoidal shape. Specifically, by restricting to 4-chamber views in B-mode 2D echocardiography, a new parametric description is formulated for a 2D projection of the LV as a distorted ellipse C a,b,p (x,y) given by Equation 1. 
         [0000]    
       
         
           
             
               
                 
                   
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         [0017]    In Equation 1, 
         [0000]    
       
         
           
               
             
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         [0000]    is the rotation matrix capturing the global orientation of the left ventricular shape φ, s is the scale factor, and 
         [0000]    
       
         
           
             T 
             = 
             
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         [0000]    is the global translation to position the shape on the centroid of the left ventricle. Here the core shape of the left ventricle is described by the parameters (a,b,p) where a and b are axes of the ellipse, the parameter p controls the distortion, and θ generated the points along the elliptical contour. Because the left ventricle is independently located in a prior region selection step, the similarity transform parameters (s,R,T) themselves are recovered from the orientation and centroid of the detected left ventricle. The scale is recovered from the calibration information in images as described further below. 
         [0018]    Referring now to  FIGS. 2A-E , a variety of plausible left ventricular shapes are shown. Each shape is produced by varying the parameters (a,b,p). As set forth further below, normal hearts are well-modeled through distinct parameter settings of (a,b,p). Abnormal left ventricles are modeled by other parameter ranges of (a,b,p) when they fit well (as in the case of dilated cardiomyopathy) or have large fit errors for even the best-fitting ellipses (as in the case of aneurysms). 
         [0019]    Given a left ventricular bounding contour b (x′,y′) detected in an image, features are extracted for discriminating between normal and abnormal LV shapes as follows. Using the values of (R,T) from the LV region localization, the parametric distorted ellipse model is centered. Several candidate parametric shape C a,b,p (x,y) are generated by varying (a,b,p). For each such generated distorted ellipse contour, the alignment error is determined with the underlying LV bounding contour according to Equation 2. 
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         [0020]    In Equation 2, |x m −x m ′|&lt;δ and |y m −y m ′|&lt;δ are the nearest matched pair of points on the respective binary contours, with δ ranging from 1 to 3 pixels. The length of the parametric curve |C a,b,p (x,y)| in pixel coordinates is a function of (a,b,p) and (R,T) and can be measured at the time of synthesis within the image of projection. 
         [0021]    By applying this parametric fit to every image in the echocardiographic sequence, a set of feature vectors is obtained per sequence S as F(S)={f i (S)} as shown in Equation 3. 
         [0000]        f   i ( S )=           a   i   ,b   i   ,p   i   ,E   mi ( C   a     i     ,b     i     ,p     i     ,B   i )           Equation 3
 
         [0022]    In Equation 3,          a i ,b i ,p i           =arg min (E i (C a     i     ,b     i     ,p     i   ,B i )) and E mi (C a     i     ,b     i     ,p     i   ,B i ) is the minimum alignment error. Using the ground truth normal/abnormal labels provided for the underlying echocardiographic sequences during training, a support vector machine (SVM) is used to separate the feature vectors of the normal from abnormal data. Given a new image, its feature vector is then classified using the learned SVM model. To enable robust classification due to the changing shape of the left ventricle within a heart cycle, the temporal information is incorporated in the sequence using parametric features from all images of the sequence per study. The majority vote from the feature vectors is then used to classify the left ventricle in a sequence as being normal or abnormal. 
         [0023]    The search for the parametric fit can be kept contained by pre-analyzing the ranges of values of the fit in the training data. In one exemplary embodiment, the ranges of these values were analyzed in a training set of 800 echocardiogram images that showed shape variations of the left ventricle across patients and diseases. Let the size of the bounding box for the LV bounding contour be denoted by N x ×N y , where N x  and N y  are derived from the eigenvalues of the shape. The search ranges of the parameters are chosen as αε[0.3N x ,0.4N x ], bε[0.15N y , 0.25N y ], and p=[1.7,2.7]. 
         [0024]    Alternative LV segmentation methods such as region-based approaches may over- or under-segment the left ventricle, particularly in diseased cases. This results in inaccurate boundaries for initiating shape matching. Active shape model approaches to localize LV may have poor performance, locating the left ventricle accurately in only about 35% of the cases of 4-chamber views. Accordingly, a bottom-up approach to LV detection is provided that selects the nearest region to the intersection point of the region of interest (ROI) sector lines in apical 4-chamber views as follows. 
         [0025]    Referring now to  FIG. 3 , ROI detection according to various embodiments of the present disclosure is illustrated. The ultrasound scan sector in the image ( FIG. 3A ) is usually bounded by dominant lines  301  as shown by the edge image of  FIG. 3B . Using a Hough transform in polar coordinates (r,t) on the edge image, the dominant orientation is determined with maximum hits in the Hough transform. The intersecting lines bounding the sector are then found as pairs of high intensity spots  302 ,  303  in the Hough transform image as shown in  FIG. 3C . The intersecting lines have the same r separated by at (horizontal axis) corresponding to the sector angle. 
         [0026]    The scale is estimated from the calibration markers and number units often present along the sector lines  101 . The numbers are recognized through an optical character recognition (OCR) algorithm. Using the recognized units, the distance between markers is then converted to mm from pixel coordinates. 
         [0027]    Referring to FIG. 3D, region thresholding is next performed. In some embodiments, the intensity gradients in the sector region are thresholded using adaptive Otsu thresholding. FIG. 3D shows the resulting image where the heart structure  304  is clearly highlighted. 
         [0028]    According to various embodiments, LV localization is performed by clustering. To obtain a rough region containing the left ventricle, the triangular region defined by the intersecting sector lines and image borders is partitioned into regions using K-means clustering on the pixel locations in the thresholded binary image. Since four main chambers are usually seen in apical 4-chamber views, a value of K=4 is sufficient to separate the LV region from other regions included in the sector triangle. The region closest to the point of intersection of the sector lines is then taken as a rough indication of the location of the left ventricle as shown in  FIG. 3F . 
         [0029]    According to various embodiments, contour tracing is performed. By tracing the boundary pixels as curvilinear structures, sufficiently accurate contours  305  of the heart muscle and hence the LV bounding contours are obtained, as shown in  FIG. 3E . The bounding contours that overlap the indicated LV region  306  from clustering, are then retained as shown in  FIG. 3G . To avoid false matches to contours that are parallel to the (inner) LV contour such as the myocardium, the contours in the LV region are further limited by only retaining the nearest contours surrounding the region centroid as shown in  FIG. 3I . Since the parametric fit is initiated from the distorted ellipse model, small fragmentation from such retention can be tolerated during the matching. When the LV contour is not fully visible, as can be seen in  FIG. 3A , it poses a challenge. To provide robustness to such changes in the contour within the heart cycle, the best parametric fit is considered for every frame of the sequence forming the set of feature vectors for use in normal/abnormal classification. 
         [0030]    Referring now to  FIG. 3H , the results of parametric fitting to left ventricles are illustrated. Using the centroid and orientation of the region, the best matching parametric fit for the left ventricle in  FIG. 3A  is shown in  FIG. 3H . In this case, the patient has dilated cardiomyopathy and the LV resembles a bullet but the ellipsoidal parameters are significantly different from ranges for normal LV, which can also be seen from the large aspect ratio. 
         [0031]    Referring to  FIGS. 4A-G , exemplary results of matching of distorted ellipses to normal and abnormal left ventricles are provided. 
         [0032]    Exemplary results of discrimination between normal and abnormal left ventricular shapes in 4-chamber views of echocardiographic sequences are provided below. This exemplary dataset consists of a total of 340 patients and 2158 echocardiographic sequences depicting a variety of cardiac diseases in patients ranging from aneurysms (89), dilated cardiomyopathy (76), hypertrophies (78) and normal LV size and function (448). Of these, 503 sequences are 4-chamber views including about 138 sequences labeled as normal LV size and function from their corresponding reports. 
         [0033]    To discriminate between normal and abnormal LV, 40% of the normal and abnormal LV cases were used for training and the remaining for testing. A total of 25020 feature vectors were generated from these sequences as they were of variable length in heart cycles and averaged about 64 images per sequence. Different kernels for learning with support vector machines were applied, and the best classification performance was obtained with radial basis functions as kernels. The class was decided at the level of the echocardiographic sequence by taking the majority vote from the classification of parametric features of individual images of the sequence within cardiac cycles. The results are summarized in Table 1, which shows the accuracy of normal/abnormal discrimination of left ventricular shapes. 
         [0000]    
       
         
               
               
               
             
           
               
                   
                 TABLE 1 
               
               
                   
                   
               
               
                   
                 Classifier 
                 Accuracy (%) 
               
               
                   
                   
               
             
             
               
                   
                 Fisher LDA 
                 68.92 
               
               
                   
                 Linear SVM 
                 74.26 
               
               
                   
                 RBF kernel SVM 
                 82.67 
               
               
                   
                 kNN, k = 1 
                 64.12 
               
               
                   
                 kNN, k = 2 
                 69.07 
               
               
                   
                 kNN, k = 3 
                 68.21 
               
               
                   
                   
               
             
          
         
       
     
         [0034]    Since the feature vectors and hence the accuracy of the classification is dependent on the isolation of the correct LV contour for parametric fitting, the performance of LV contour identification was compared to alternative methods. To evaluate different segmentation methods, a clinical expert manually annotated the left ventricle from a dataset of 99 B-Mode Apical 4 Chamber view echo images ( FIGS. 5A-F ). The performance was compared to three techniques, namely, (a) Otsu thresholding alone without K-means clustering, (b) atlas-based segmentation, and (c), active shape models. The mean and standard deviation of Dice similarity 
         [0000]    
       
         
           
             coefficient 
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         [0000]    as well as sensitivity and specificity as defined in Equations 4 and 5 below were used. 
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         [0035]    Here A and B represent the bounding contours of the ground truth and extracted contours, and |A∩B| is the number of matched points between contours. Results are given in Table 2, and depicted in  FIG. 6 . From these results, it may be seen that the LV bounding contour extraction according to the present disclosure gives the best overlap with the ground truth contours. Since the contours were unavailable from active shape model method, the performance was compared by measuring the deviation in the estimation of the LV centroid. Of the 503 sequences, the LV localization could be found for 189 cases using active shape models with an average spread in the localization over 200 pixels. The detailed localization spread is shown in  FIG. 7 . In comparison, the approaches described herein missed the LV localization in only 7 failure cases which were mostly due to early sector identification errors. 
         [0000]    
       
         
               
               
               
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                   
                 TABLE 2 
               
             
             
               
                   
                   
               
               
                   
                   
                 Sensitivity 
                   
               
               
                   
                 DSC (%) 
                 (%) 
                 Specificity (%) 
               
             
          
           
               
                 Method 
                 Mean 
                 Std. 
                 Mean 
                 Std. 
                 Mean 
                 Std. 
               
               
                   
               
             
          
           
               
                 Otsu thresholding 
                 53.72 
                 11.60 
                 98.34 
                 3.31 
                 94.50 
                 1.39 
               
               
                 without Kmeans 
               
               
                 Atlas-based segmentation 
                 69.90 
                 18.70 
                 68.65 
                 21.10 
                 99.25 
                 0.71 
               
               
                 LV extraction, described 
                 89.12 
                 10.2 
                 82.9 
                 12.4 
                 97.02 
                 0.1 
               
               
                 herein 
               
               
                   
               
             
          
         
       
     
         [0036]    In this paper we have presented a novel approach to discriminating between normal and abnormal left ventricular shapes by deriving feature vectors from the deviations in the parametric fits of distorted ellipses to left ventricular contours. Future work will address disease-specific segmentation of feature spaces. 
         [0037]    Referring now to  FIG. 1 , a schematic of an example of a computing node is shown. Computing node  10  is only one example of a suitable computing node and is not intended to suggest any limitation as to the scope of use or functionality of embodiments of the invention described herein. Regardless, computing node  10  is capable of being implemented and/or performing any of the functionality set forth hereinabove. 
         [0038]    In computing node  10  there is a computer system/server  12 , which is operational with numerous other general purpose or special purpose computing system environments or configurations. Examples of well-known computing systems, environments, and/or configurations that may be suitable for use with computer system/server  12  include, but are not limited to, personal computer systems, server computer systems, thin clients, thick clients, handheld or laptop devices, multiprocessor systems, microprocessor-based systems, set top boxes, programmable consumer electronics, network PCs, minicomputer systems, mainframe computer systems, and distributed cloud computing environments that include any of the above systems or devices, and the like. 
         [0039]    Computer system/server  12  may be described in the general context of computer system-executable instructions, such as program modules, being executed by a computer system. Generally, program modules may include routines, programs, objects, components, logic, data structures, and so on that perform particular tasks or implement particular abstract data types. Computer system/server  12  may be practiced in distributed cloud computing environments where tasks are performed by remote processing devices that are linked through a communications network. In a distributed cloud computing environment, program modules may be located in both local and remote computer system storage media including memory storage devices. 
         [0040]    As shown in  FIG. 1 , computer system/server  12  in computing node  10  is shown in the form of a general-purpose computing device. The components of computer system/server  12  may include, but are not limited to, one or more processors or processing units  16 , a system memory  28 , and a bus  18  that couples various system components including system memory  28  to processor  16 . 
         [0041]    Bus  18  represents one or more of any of several types of bus structures, including a memory bus or memory controller, a peripheral bus, an accelerated graphics port, and a processor or local bus using any of a variety of bus architectures. By way of example, and not limitation, such architectures include Industry Standard Architecture (ISA) bus, Micro Channel Architecture (MCA) bus, Enhanced ISA (EISA) bus, Video Electronics Standards Association (VESA) local bus, and Peripheral Component Interconnect (PCI) bus. 
         [0042]    Computer system/server  12  typically includes a variety of computer system readable media. Such media may be any available media that is accessible by computer system/server  12 , and it includes both volatile and non-volatile media, removable and non-removable media. 
         [0043]    System memory  28  can include computer system readable media in the form of volatile memory, such as random access memory (RAM)  30  and/or cache memory  32 . Computer system/server  12  may further include other removable/non-removable, volatile/non-volatile computer system storage media. By way of example only, storage system  34  can be provided for reading from and writing to a non-removable, non-volatile magnetic media (not shown and typically called a “hard drive”). Although not shown, a magnetic disk drive for reading from and writing to a removable, non-volatile magnetic disk (e.g., a “floppy disk”), and an optical disk drive for reading from or writing to a removable, non-volatile optical disk such as a CD-ROM, DVD-ROM or other optical media can be provided. In such instances, each can be connected to bus  18  by one or more data media interfaces. As will be further depicted and described below, memory  28  may include at least one program product having a set (e.g., at least one) of program modules that are configured to carry out the functions of embodiments of the invention. 
         [0044]    Program/utility  40 , having a set (at least one) of program modules  42 , may be stored in memory  28  by way of example, and not limitation, as well as an operating system, one or more application programs, other program modules, and program data. Each of the operating system, one or more application programs, other program modules, and program data or some combination thereof, may include an implementation of a networking environment. Program modules  42  generally carry out the functions and/or methodologies of embodiments of the invention as described herein. 
         [0045]    Computer system/server  12  may also communicate with one or more external devices  14  such as a keyboard, a pointing device, a display  24 , etc.; one or more devices that enable a user to interact with computer system/server  12 ; and/or any devices (e.g., network card, modem, etc.) that enable computer system/server  12  to communicate with one or more other computing devices. Such communication can occur via Input/Output (I/O) interfaces  22 . Still yet, computer system/server  12  can communicate with one or more networks such as a local area network (LAN), a general wide area network (WAN), and/or a public network (e.g., the Internet) via network adapter  20 . As depicted, network adapter  20  communicates with the other components of computer system/server  12  via bus  18 . It should be understood that although not shown, other hardware and/or software components could be used in conjunction with computer system/server  12 . Examples, include, but are not limited to: microcode, device drivers, redundant processing units, external disk drive arrays, RAID systems, tape drives, and data archival storage systems, etc. 
         [0046]    The present invention may be a system, a method, and/or a computer program product. The computer program product may include a computer readable storage medium (or media) having computer readable program instructions thereon for causing a processor to carry out aspects of the present invention. 
         [0047]    The computer readable storage medium can be a tangible device that can retain and store instructions for use by an instruction execution device. The computer readable storage medium may be, for example, but is not limited to, an electronic storage device, a magnetic storage device, an optical storage device, an electromagnetic storage device, a semiconductor storage device, or any suitable combination of the foregoing. A non-exhaustive list of more specific examples of the computer readable storage medium includes the following: a portable computer diskette, a hard disk, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or Flash memory), a static random access memory (SRAM), a portable compact disc read-only memory (CD-ROM), a digital versatile disk (DVD), a memory stick, a floppy disk, a mechanically encoded device such as punch-cards or raised structures in a groove having instructions recorded thereon, and any suitable combination of the foregoing. A computer readable storage medium, as used herein, is not to be construed as being transitory signals per se, such as radio waves or other freely propagating electromagnetic waves, electromagnetic waves propagating through a waveguide or other transmission media (e.g., light pulses passing through a fiber-optic cable), or electrical signals transmitted through a wire. 
         [0048]    Computer readable program instructions described herein can be downloaded to respective computing/processing devices from a computer readable storage medium or to an external computer or external storage device via a network, for example, the Internet, a local area network, a wide area network and/or a wireless network. The network may comprise copper transmission cables, optical transmission fibers, wireless transmission, routers, firewalls, switches, gateway computers and/or edge servers. A network adapter card or network interface in each computing/processing device receives computer readable program instructions from the network and forwards the computer readable program instructions for storage in a computer readable storage medium within the respective computing/processing device. 
         [0049]    Computer readable program instructions for carrying out operations of the present invention may be assembler instructions, instruction-set-architecture (ISA) instructions, machine instructions, machine dependent instructions, microcode, firmware instructions, state-setting data, or either source code or object code written in any combination of one or more programming languages, including an object oriented programming language such as Smalltalk, C++ or the like, and conventional procedural programming languages, such as the “C” programming language or similar programming languages. The computer readable program instructions may execute entirely on the user&#39;s computer, partly on the user&#39;s computer, as a stand-alone software package, partly on the user&#39;s computer and partly on a remote computer or entirely on the remote computer or server. In the latter scenario, the remote computer may be connected to the user&#39;s computer through any type of network, including a local area network (LAN) or a wide area network (WAN), or the connection may be made to an external computer (for example, through the Internet using an Internet Service Provider). In some embodiments, electronic circuitry including, for example, programmable logic circuitry, field-programmable gate arrays (FPGA), or programmable logic arrays (PLA) may execute the computer readable program instructions by utilizing state information of the computer readable program instructions to personalize the electronic circuitry, in order to perform aspects of the present invention. 
         [0050]    Aspects of the present invention are described herein with reference to flowchart illustrations and/or block diagrams of methods, apparatus (systems), and computer program products according to embodiments of the invention. It will be understood that each block of the flowchart illustrations and/or block diagrams, and combinations of blocks in the flowchart illustrations and/or block diagrams, can be implemented by computer readable program instructions. 
         [0051]    These computer readable program instructions may be provided to a processor of a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions/acts specified in the flowchart and/or block diagram block or blocks. These computer readable program instructions may also be stored in a computer readable storage medium that can direct a computer, a programmable data processing apparatus, and/or other devices to function in a particular manner, such that the computer readable storage medium having instructions stored therein comprises an article of manufacture including instructions which implement aspects of the function/act specified in the flowchart and/or block diagram block or blocks. 
         [0052]    The computer readable program instructions may also be loaded onto a computer, other programmable data processing apparatus, or other device to cause a series of operational steps to be performed on the computer, other programmable apparatus or other device to produce a computer implemented process, such that the instructions which execute on the computer, other programmable apparatus, or other device implement the functions/acts specified in the flowchart and/or block diagram block or blocks. 
         [0053]    The flowchart and block diagrams in the Figures illustrate the architecture, functionality, and operation of possible implementations of systems, methods, and computer program products according to various embodiments of the present invention. In this regard, each block in the flowchart or block diagrams may represent a module, segment, or portion of instructions, which comprises one or more executable instructions for implementing the specified logical function(s). In some alternative implementations, the functions noted in the block may occur out of the order noted in the figures. For example, two blocks shown in succession may, in fact, be executed substantially concurrently, or the blocks may sometimes be executed in the reverse order, depending upon the functionality involved. It will also be noted that each block of the block diagrams and/or flowchart illustration, and combinations of blocks in the block diagrams and/or flowchart illustration, can be implemented by special purpose hardware-based systems that perform the specified functions or acts or carry out combinations of special purpose hardware and computer instructions. 
         [0054]    The descriptions of the various embodiments of the present invention have been presented for purposes of illustration, but are not intended to be exhaustive or limited to the embodiments disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art without departing from the scope and spirit of the described embodiments. The terminology used herein was chosen to best explain the principles of the embodiments, the practical application or technical improvement over technologies found in the marketplace, or to enable others of ordinary skill in the art to understand the embodiments disclosed herein.