Purpose: We present a virtual model to optimize point of entry (POE) in lung biopsy planning systems. Our model allows to compute the quality of a biopsy sample taken from potential POE, taking into account the margin of error that arises from discrepancies between the orientation in the planning simulation and the actual orientation during the operation. Additionally, the study examines the impact of the characteristics of the lesion. Methods: The quality of the biopsy is given by a heatmap projected onto the skeleton of a patient-specific model of airways. The skeleton provides a 3D representation of airways structure, while the heatmap intensity represents the potential amount of tissue that it could be extracted from each POE. This amount of tissue is determined by the intersection of the lesion with a cone that represents the uncertainty area in the introduction of biopsy instruments. The cone, lesion, and skeleton are modelled as graphical objects that define a 3D scene of the intervention. Results: We have simulated different settings of the intervention scene from a single anatomy extracted from a CT scan and two lesions with regular and irregular shapes. The different scenarios are simulated by systematic rotation of each lesion placed at different distances from airways. Analysis of the heatmaps for the different settings show a strong impact of lesion orientation for irregular shape and the distance for both shapes. Conclusion: The proposed heatmaps help to visually assess the optimal POE and identify whether multiple optimal POEs exist in different zones of the bronchi. They also allow us to model the maximum allowable error in navigation systems and study which variables have the greatest influence on the success of the operation. Additionally, they help determine at what point this influence could potentially jeopardize the operation.

Accurate and complete segmentation of airways in chest CT images is essential for the quantitative assessment of lung diseases and the facilitation of pulmonary interventional procedures. Although deep learning has led to significant advancements in medical image segmentation, maintaining airway continuity remains particularly challenging. This difficulty arises primarily from the small and dispersed nature of airway structures, as well as class imbalance in CT scans. To address these challenges, we designed a Multi-scale Nested Residual U-Net (MNR-UNet), incorporating multi-scale inputs and Residual Multi-scale Modules (RMM) into a nested residual framework to enhance information flow, effectively capturing the intricate details of small airways and mitigating gradient vanishing. Building on this, we developed a three-stage segmentation pipeline to optimize the training of the MNR-UNet. The first two stages prioritize high accuracy and sensitivity, while the third stage focuses on repairing airway breakages to balance topological completeness and correctness. To further address class imbalance, we introduced a weighted Breakage-Aware Loss (wBAL) to heighten focus on challenging samples, penalizing breakages and thereby extending the length of the airway tree. Additionally, we proposed a hierarchical evaluation framework to offer more clinically meaningful analysis. Validation on both in-house and public datasets demonstrates that our approach achieves superior performance in detecting more accurate airway voxels and identifying additional branches, significantly improving airway topological completeness. The code will be released publicly following the publication of the paper.

The lack of large annotated datasets in medical imaging is an intrinsic burden for supervised Deep Learning (DL) segmentation models. Few-shot learning approaches are cost-effective solutions to transfer pre-trained models using only limited annotated data. However, such methods can be prone to overfitting due to limited data diversity especially when segmenting complex, diverse, and sparse tubular structures like airways. Furthermore, crafting informative image representations has played a crucial role in medical imaging, enabling discriminative enhancement of anatomical details. In this paper, we initially train a data-driven sparsification module to enhance airways efficiently in lung CT scans. We then incorporate these sparse representations in a standard supervised segmentation pipeline as a pretraining step to enhance the performance of the DL models. Results presented on the ATM public challenge cohort show the effectiveness of using sparse priors in pre-training, leading to segmentation Dice score increase by 1% to 10% in full-scale and few-shot learning scenarios, respectively.

In the realm of pulmonary tracheal segmentation, the scarcity of annotated data stands as a prevalent pain point in most medical segmentation endeavors. Concurrently, most Deep Learning (DL) methodologies employed in this domain invariably grapple with other dual challenges: the inherent opacity of'black box' models and the ongoing pursuit of performance enhancement. In response to these intertwined challenges, the core concept of our Human-Computer Interaction (HCI) based learning models (RS_UNet, LC_UNet, UUNet and WD_UNet) hinge on the versatile combination of diverse query strategies and an array of deep learning models. We train four HCI models based on the initial training dataset and sequentially repeat the following steps 1-4: (1) Query Strategy: Our proposed HCI models selects those samples which contribute the most additional representative information when labeled in each iteration of the query strategy (showing the names and sequence numbers of the samples to be annotated). Additionally, in this phase, the model selects the unlabeled samples with the greatest predictive disparity by calculating the Wasserstein Distance, Least Confidence, Entropy Sampling, and Random Sampling.

Bronchoscopy plays a significant role in the early diagnosis and treatment of lung diseases. This process demands physicians to maneuver the flexible endoscope for reaching distal lesions, particularly requiring substantial expertise when examining the airways of the upper lung lobe. With the development of artificial intelligence and robotics, reinforcement learning (RL) method has been applied to the manipulation of interventional surgical robots. However, unlike human physicians who utilize multimodal information, most of the current RL methods rely on a single modality, limiting their performance. In this paper, we propose BronchoCopilot, a multimodal RL agent designed to acquire manipulation skills for autonomous bronchoscopy. BronchoCopilot specifically integrates images from the bronchoscope camera and estimated robot poses, aiming for a higher success rate within challenging airway environment. We employ auxiliary reconstruction tasks to compress multimodal data and utilize attention mechanisms to achieve an efficient latent representation of this data, serving as input for the RL module. This framework adopts a stepwise training and fine-tuning approach to mitigate the challenges of training difficulty. Our evaluation in the realistic simulation environment reveals that BronchoCopilot, by effectively harnessing multimodal information, attains a success rate of approximately 90\% in fifth generation airways with consistent movements. Additionally, it demonstrates a robust capacity to adapt to diverse cases.

Pulmonary diseases rank prominently among the principal causes of death worldwide. Curing them will require, among other things, a better understanding of the many complex 3D tree-shaped structures within the pulmonary system, such as airways, arteries, and veins. In theory, they can be modeled using high-resolution image stacks. Unfortunately, standard CNN approaches operating on dense voxel grids are prohibitively expensive. To remedy this, we introduce a point-based approach that preserves graph connectivity of tree skeleton and incorporates an implicit surface representation. It delivers SOTA accuracy at a low computational cost and the resulting models have usable surfaces. Due to the scarcity of publicly accessible data, we have also curated an extensive dataset to evaluate our approach and will make it public.

Accurate segmentation of pulmonary airways and vessels is crucial for the diagnosis and treatment of pulmonary diseases. However, current deep learning approaches suffer from disconnectivity issues that hinder their clinical usefulness. To address this challenge, we propose a post-processing approach that leverages a data-driven method to repair the topology of disconnected pulmonary tubular structures. Our approach formulates the problem as a keypoint detection task, where a neural network is trained to predict keypoints that can bridge disconnected components. We use a training data synthesis pipeline that generates disconnected data from complete pulmonary structures. Moreover, the new Pulmonary Tree Repairing (PTR) dataset is publicly available, which comprises 800 complete 3D models of pulmonary airways, arteries, and veins, as well as the synthetic disconnected data.

Airway segmentation is essential for chest CT image analysis. Different from natural image segmentation, which pursues high pixel-wise accuracy, airway segmentation focuses on topology. The task is challenging not only because of its complex tree-like structure but also the severe pixel imbalance among airway branches of different generations. To tackle the problems, we present a NaviAirway method which consists of a bronchiole-sensitive loss function for airway topology preservation and an iterative training strategy for accurate model learning across different airway generations. To supplement the features of airway branches learned by the model, we distill the knowledge from numerous unlabeled chest CT images in a teacher-student manner. Experimental results show that NaviAirway outperforms existing methods, particularly in the identification of higher-generation bronchioles and robustness to new CT scans. Moreover, NaviAirway is general enough to be combined with different backbone models to significantly improve their performance. NaviAirway can generate an airway roadmap for Navigation Bronchoscopy and can also be applied to other scenarios when segmenting fine and long tubular structures in biomedical images. The code is publicly available on https://github.com/AntonotnaWang/NaviAirway.

The goal of this study is to assess the feasibility of airway geometry as a biomarker for ASD. Chest CT images of children with a documented diagnosis of ASD as well as healthy controls were identified retrospectively. 54 scans were obtained for analysis, including 31 ASD cases and 23 age and sex-matched controls. A feature selection and classification procedure using principal component analysis (PCA) and support vector machine (SVM) achieved a peak cross validation accuracy of nearly 89% using a feature set of 8 airway branching angles. Sensitivity was 94%, but specificity was only 78%. The results suggest a measurable difference in airway branchpoint angles between children with ASD and the control population. Under review at Scientific Reports

Various structures in human physiology follow a treelike morphology, which often expresses complexity at very fine scales. Examples of such structures are intrathoracic airways, retinal blood vessels, and hepatic blood vessels. Large collections of 2D and 3D images have been made available by medical imaging modalities such as magnetic resonance imaging (MRI), computed tomography (CT), Optical coherence tomography (OCT) and ultrasound in which the spatial arrangement can be observed. Segmentation of these structures in medical imaging is of great importance since the analysis of the structure provides insights into disease diagnosis, treatment planning, and prognosis. Manually labelling extensive data by radiologists is often time-consuming and error-prone. As a result, automated or semi-automated computational models have become a popular research field of medical imaging in the past two decades, and many have been developed to date. In this survey, we aim to provide a comprehensive review of currently publicly available datasets, segmentation algorithms, and evaluation metrics. In addition, current challenges and future research directions are discussed.