Pedro Miguel Vieira

Background: Video capsule endoscopy (VCE) revolutionized the diagnosis and management of obscure gastrointestinal bleeding, though the rate of detection of small bowel lesions by the physician is still disappointing. Our group developed a novel algorithm (CMEMS-Uminho) to automatically detect angioectasias which display greater accuracy in VCE static frames than other methods previously published. We aimed to evaluate the algorithm overall performance and assess its diagnostic yield and usability in clinical practice. Methods: Algorithm overall performance was determined using 54 full-length VCE recordings. To assess its diagnostic yield and usability in clinical practice, 38 VCE examinations with the clinical diagnosis of angioectasias consecutively performed (2017–2018) were evaluated by three physicians with different experiences. The CMEMS-Uminho algorithm was also applied. The performance of the CMEMS-Uminho algorithm was defined by a positive concordance between a frame automatically selected by the software and a study independent capsule endoscopist. Results: Overall performance in complete VCE recordings was 77.7%, and diagnostic yield was 94.7%. There were significant differences between physicians in regard to global detection rate (p < 0.001), detection rate per capsule (p < 0.001), diagnostic yield (p = 0.007), true positive rate (p < 0.001), time (p < 0.001), and speed viewing (p < 0.001). The application of CMEMS-Uminho algorithm significantly enhanced all readers’ global detection rate (p < 0.001) and the differences between them were no longer observed. Conclusion: The CMEMS-Uminho algorithm detained a good overall performance and was able to enhance physicians’ performance, suggesting a potential usability of this tool in clinical practice.

Purpose: Wireless Capsule Endoscopy (WCE) is a minimally invasive diagnosis tool for lesion detection in the gastrointestinal tract, reaching places where conventional endoscopy is unable to. However, the significant amount of acquired data leads to difficulties in the diagnosis by the physicians; which can be eased with computer assistance. This paper addresses a method for the automatic detection of tumors in WCE by using a two‐step based procedure: region of interest selection and classification.Methods: The first step aims to separate abnormal from normal tissue by using automatic segmentation based on a Gaussian Mixture Model (GMM). A modified version of the Anderson method for convergence acceleration of the expectation–maximization (EM) algorithm is proposed. The proposed features for both segmentation and classification are based on the CIELab color space, as a way of bypassing lightness variations, where theLcomponent is discarded. Tissue variability among subjects, light inhomogeneities and even intensity differences among different devices can be overcome by using simultaneously features from both regions. In the second step, an ensemble system with partition of the training data with a new training scheme is proposed. At this stage, the gating network is trained after the experts have been trained decoupling the joint maximization of both modules. The partition module is also used at the test step, leading the incoming data to the most likely expert allowing incremental adaptation by preserving data diversity.Results: This algorithm outperforms others based on texture features selected from Wavelets and Curvelets transforms, classified by a regular support vector machine (SVM) in more than 5%.Conclusions: This work shows that simpler features can outperform more elaborate ones if appropriately designed. In the current case, luminance was discarded to cope with saturated tissue, facilitating the color perception. Ensemble systems remain an open research field. In the current case, changes in both topology and training strategy have led to significant performance improvements. A system with this level of performance can be used in current clinical practice.

Angioectasias are lesions that occur in the blood vessels of the bowel and are the cause of more than 8% of all gastrointestinal bleeding episodes. They are usually classified as bleeding related lesions, however current state-of-the-art bleeding detection algorithms present low sensitivity in the detection of these lesions. This paper proposes a methodology for the automatic detection of angioectasias in wireless capsule endoscopy (WCE) videos. This method relies on the automatic selection of a region of interest, selected by using an image segmentation module based on the Maximum a Posteriori (MAP) approach where a new accelerated version of the Expectation-Maximization (EM) algorithm is also proposed. Spatial context information is modeled in the prior probability density function by using Markov Random Fields with the inclusion of a weighted boundary function. Higher order statistics computed in the CIELab color space with the luminance component removed and intensity normalization of high reflectance regions, showed to be effective features regarding angioectasia detection. The proposed method outperforms some current state of the art algorithms, achieving sensitivity and specificity values of more than 96% in a database containing 800 WCE frames labeled by two gastroenterologists.

Correct classification of cystoscopy images depends on the interpreter’s experience. Bladder cancer is a common lesion that can only be confirmed by biopsying the tissue, therefore, the automatic identification of tumors plays a significant role in early stage diagnosis and its accuracy. To our best knowledge, the use of white light cystoscopy images for bladder tumor diagnosis has not been reported so far. In this paper, a texture analysis based approach is proposed for bladder tumor diagnosis presuming that tumors change in tissue texture. As is well accepted by the scientific community, texture information is more present in the medium to high frequency range which can be selected by using a discrete wavelet transform (DWT). Tumor enhancement can be improved by using automatic segmentation, since a mixing with normal tissue is avoided under ideal conditions. The segmentation module proposed in this paper takes advantage of the wavelet decomposition tree to discard poor texture information in such a way that both steps of the proposed algorithm segmentation and classification share the same focus on texture. Multilayer perceptron and a support vector machine with a stratified ten-fold cross-validation procedure were used for classification purposes by using the hue-saturation-value (HSV), red-green-blue, and CIELab color spaces. Performances of 91% in sensitivity and 92.9% in specificity were obtained regarding HSV color by using both preprocessing and classification steps based on the DWT. The proposed method can achieve good performance on identifying bladder tumor frames. These promising results open the path towards a deeper study regarding the applicability of this algorithm in computer aided diagnosis.

Nowadays the diagnosis of bladder lesions relies upon cystoscopy examination and depends on the interpreter's experience. State of the art of bladder tumor identification are based on 3D reconstruction, using CT images (Virtual Cystoscopy) or images where the structures are exalted with the use of pigmentation, but none uses white light cystoscopy images. An initial attempt to automatically identify tumoral tissue was already developed by the authors and this paper will develop this idea. Traditional cystoscopy images processing has a huge potential to improve early tumor detection and allows a more effective treatment. In this paper is described a multivariate approach to do segmentation of bladder cystoscopy images, that will be used to automatically detect and improve physician diagnose. Each region can be assumed as a normal distribution with specific parameters, leading to the assumption that the distribution of intensities is a Gaussian Mixture Model (GMM). Region of high grade and low grade tumors, usually appears with higher intensity than normal regions. This paper proposes a Maximum a Posteriori (MAP) approach based on pixel intensities read simultaneously in different color channels from RGB, HSV and CIELab color spaces. The Expectation-Maximization (EM) algorithm is used to estimate the best multivariate GMM parameters. Experimental results show that the proposed method does bladder tumor segmentation into two classes in a more efficient way in RGB even in cases where the tumor shape is not well defined. Results also show that the elimination of component L from CIELab color space does not allow definition of the tumor shape.

Nowadays the diagnosis of bladder lesions relies upon cystoscopic examination and depend on the interpreter's experience. State of the art of bladder tumor identification are based on 3D reconstruction, using CT images (Virtual Cystoscopy) or images where the structures are exalted with the use of pigmentations, but none uses white light cystoscopy images. Traditional cystoscopic images processing has a huge potential to improve early tumor detection and allow a more effective treatment. In this paper is described an initial approach to do segmentation of bladder cystoscopic images. This approach will be used in the future to automatically detect these types of lesions. It can be assumed that each region has a normal distribution with specific parameters, leading to the assumption that the distribution of intensities is a Gaussian Mixture Model (GMM). The most common bladder tumor type, with a cauliflower shape, appears with higher intensity than normal regions. The segmentation of these images is based on a Maximum A Posteriori (MAP) approach depending on pixel intensities of each three RGB and HSV channels, using the Expectation-Maximization (EM) algorithm to estimate the best GMM parameters. Experimental results show that the proposed method does bladder tumor segmentation in a more efficient way in RGB color space than in HSV, even in cases where the tumor shape is not well defined. Results also show that the channels with best results are the R component from RGB and the V component from HSV.