DIMACS Center, Rutgers University, Piscataway, NJ

**Organizers:****Danny Chen**, University of Notre Dame, dchen@cse.nd.edu**Jean-Claude Latombe**, Stanford University, latombe@cs.stanford.edu

**Abstracts:**

**Helmut Alt**, Freie Universitat Berlin

Medical Applications of Geometric Pattern Matching

Gel-electrophoresis is a technique to produce from a probe of human or animal tissue a two-dimensional diagram consisting of numerous spots each of which corresponds to a protein present in the tissue. We developed techniques based on computational geometry to compare several diagrams of this kind and to match corresponding spot patterns. In fact, our technique is based on constructing the Delaunay triangulation of the spots and compare Delaunay edges of approximately the same length and orientation.

In a second project we developed techniques used in brain surgery. Here, before surgery metal markers are fixed to the patient's head. The brain together with the markers is scanned by CT or MR and these data are stored. During surgery the surgical instrument is equipped with a radio transmitter and from its position among the current position of the markers our program, by calculating the correct matching (rigid motion) between the markers and their images is able to show on screen the current location of the instrument within the brain.

**Reneta P. Barneva** and **Valentin E. Brimkov**, Department of Mathematics
and Computer Science, SUNY Fredonia

Methods for obtaining very thin tunnel-free discretizations of polyhedral surfaces

Having advanced algorithms for discretizing polyhedral surfaces (usually triangulations) is of significant practical importance, since for various applications it is sufficient to work with a polyhedral approximation of a given surface rather than with the surface itself. Often this is the only possibility since the surface may not be available in an explicit form. On the other hand, sometimes it is quite desirable that the obtained discretization be as thin as possible. Such a requirement may appear in medical imaging or terrain modeling, especially when very precise representation is needed under certain memory limitations. However, it has been very early recognized as a difficult task to obtain a tunnel-free discretization of a polyhedral surface, provided that every polygonal patch is approximated by a portion of the thinnest possible tunnel-free discrete plane. The difficulty is rooted in the discrete nature of the discrete plane primitives, which may cause appearance of tunnels at the discrete ``edges'' shared by two discrete polygons. The intersection of two discrete planes may indeed be too far from the intuitive idea of an edge and, in fact, may be a disconnected set of voxels. Moreover, under the above mentioned circumstances, it is usually hard to prove that a given algorithm produces tunnel-free discretization of a surface, even if it performs well in practice.

In this talk we will review three different methods for obtaining very thin discretizations of arbitrary polyhedral surfaces.

The methods rest on different approaches. The first one is based on reducing the 3D problem to a 2D one by projecting the surface polygons on suitable coordinate planes, next discretizing the obtained 2D polygons, and then restoring the 3D discrete polygons [1]. The generated discrete polygons are portions of the thinnest possible discrete planes associated with the facets of the surface. The second method approximates directly every space polygon by a discrete one, which is again the thinnest possible, while the polygons' edges are approximated by the thinnest possible 3D straight lines [2]. The obtained discretization appears to be optimally thin, in a sense that removing an arbitrary voxels from the discrete surface leads to occurrence of a tunnel in it. The third method is based on introducing new fundamental classes of 3D lines and planes (called graceful) which are used to approximate the surface polygons and their edges, respectively [3].

All algorithms run in time that is linear in the number of the generated voxels, which are stored in a 2D array. Thus the algorithms are optimal regarding their time and space complexity. Another advantage of the proposed algorithms is that the generated 3D discrete polygons admit analytical description. The algorithms are simple and easy to implement.

The different algorithms have different advantages over each other, so that one may choose to apply a particular algorithm in accordance with the specific application. In the talk we will compare the algorithms' performance and discuss on related matters. Reminiscent work of other authors will be commented as well.

Finally, we will briefly consider an approach for discretizing higher dimensional surfaces [4]. We believe that this is interesting not only from theoretical perspective, but also regarding certain practical applications, such as 4D imaging related to PET scans and other dynamic medical images.

References

- [1] Barneva, R.P., V.E. Brimkov, Ph. Nehlig, Thin discrete triangular meshes, Theoretical Computer Science, Elsevier, 246 (1-2) (2000) 73-105
- [2] Brimkov, V.E., R.P. Barneva, Ph. Nehlig, Minimally thin discrete triangulations, In: Volume Graphics, A. Kaufman, R. Yagel, M. Chen (Eds.), Springer Verlag (2000) Chapter 3, pp. 51-70
- [3] Brimkov, V.E., R.P. Barneva, Graceful planes and lines, Theoretical Computer Science, Elsevier, 283 (2002) 151-170
- [4] Brimkov, V.E., E. Andres, R.P. Barneva, Object discretizations in higher dimensions, Pattern Recognition Letters, Elsevier, 23 (6) (2002) 623-636

**Valentin E. Brimkov** and ** Reneta P. Barneva**, Department of Mathematics
and Computer Science, SUNY Fredonia

Analytical properties of discrete planes

Some classes of medical images can be represented by meshes of discrete polygons that are portions of discrete planes, while the polygon edges are segments of discrete lines. Classically, the discrete planes and lines are defined algorithmically. While being quite satisfactory regarding various practical purposes, these definitions are not always easy to use for obtaining deep structural results. Moreover, storing big volumetric images might be problematic. This may happen, for instance, if a 3D object is represented ``slicewisely'' (similar to the ``Visible Human'' representation). Furthermore, sometimes it may be non-trivial to perform certain elementary image processing operations, such as verifying if a voxel (or a set of voxels) belong to a discrete plane, or to the intersection or the union of several discrete planes, etc.

A promising approach which may help overcome some of the above mentioned difficulties
is the one based on the analytical description of an object. In 1991 Reveilles proposed an
analytical definition of a discrete straight line [1], which extends to a discrete plane. According
to it, a discrete line *L*(*a*, *b*, , ) is the set of
integer points satisfying a double linear Diophantine
inequality of the form 0 __<__ *ax* + *by* + < .
Here **Z** is an internal translation constant
measuring the shift of the line with respect to the origin, while
**N** is the arithmetic thickness
of the line. Respectively, a discrete plane *P*(*a*, *b*, *c*, , )
is a set of integer points with 0 __<__
*ax*+*by*+*cz*+ < , where the parameters
*Z* and **N** have similar meaning. *L*(*a*, *b*, ,
)
and *P*(*a*, *b*, *c*, , ) can be regarded as a discretization of a line (resp. plane) with coefficients *a*,
*b* (resp. *a*, *b*, *c*).
It can be shown that if = max(|*a*|, |*b*|) (resp. =
max(|*a*|, |*b*|, |*c*|), the above
definitions are equivalent to other well-known classical de.nitions of lines and planes (see [2] for
getting acquainted with di.erent approaches to defining digital straightness, and [3] for a study
on digital flatness).

The main advantage of an analytical definition seems to lie in the fact that one can study
an object in terms of a few parameters that define it. Along with ensuring a very compact
object encoding, this may significantly facilitate the geometric and analytic reasoning and help
describe theoretical results in a more rigorous and elegant form. For example, one can easily
show that a discrete plane *P*(*a*, *b*, *c*, , )
has tunnels if and only if < max(|*a*|, |*b*|, |*c*|).
Analytic definitions may also help raise new theoretical questions, whose rigorous formulation
would be difficult by other means. For instance, given three integers (plane coefficients) *a*,
*b*, and *c*, one can look for the maximal value for which the discrete plane
*P*(*a*, *b*, *c*, , )
is disconnected, i.e., one can define plane connectivity number as (*a*, *b*, *c*) = max{
:
the discrete plane *P*(*a*, *b*, *c*, ,
) is disconnected }. Thus the notion of discrete plane connectivity
can be properly formalized and studied. This problem is important since, on the one
hand, discrete plane is a very fundamental primitive in volume modeling (in particular, in medical
imaging) and properties of digital flatness are of a wide interest from theoretical perspective.
On the other hand, connectivity is a principal topological characteristic, crucial for the deeper
understanding the properties of a given class of objects and, possibly, for designing new more
powerful visualization techniques.

Discrete plane connectivity, however, cannot be characterized by a condition as simple as the one above characterizing tunnel-freedom. To our knowledge of the available literature and according to our personal communications, this problem is still open, although within the last ten years or more, several researchers (including Reveilles, among others) have attempted to resolve it. So it becomes a challenge to achieve certain progress towards its solution.

With this talk we will present a solution to the discrete plane connectivity problem in terms
of the analytical discrete plane de.nition. In some cases the problem admits an explicit answer.
Thus, for example, we show that if the plane coe.cient satisfy the inequality *c* > *a* + 2*b*, then
(*a*, *b*, *c*) = *c*-*a*-*b*+*gcd*(*a*, *b*)-1. One can also determine other classes of instances admitting
equally simple answer. In other cases the solution may be more complicated.

Our approach is based on study of various properties of discrete planes, some of which may be of interest in their own. We believe that some of these properties may not only serve as a theoretical background for constructing new discretization algorithms, but might also have direct application to designing sophisticated methods that will allow one to simultaneously visualize and study the surface of a given human organ and its interior.

References:

- [1] Reveilles, J.-P., ``Geometrie discrete, calcul en nombres entiers et algorithmique,'' These d'Etat, Universite Louis Pasteur, Strasbourg, France, 1991
- [2] Rosenfeld, A., R. Klette, Digital straightness, Electronic Notes in Theoretical Computer Science 46 (2001) URL: http://www.elsevier.nl/locate/entcs/volume46.html
- [3] Brimkov, V.E., Notes on digital .atness. TR 2002-01, Laboratory on Signal, Image and Communications, UFR SFA, University of Poitiers, France, 2002, 52 pages

**Joel Brown**, Computer Science Department, Stanford University

Soft-tissue and Suturing Simulation

We present several algorithms to deform objects realistically, and interact with these deformable objects, in the context of a general purpose surgery simu-lator. Our system renders a 3-D graphical virtual environment, which consists of an arbitrary number of tools, such as forceps and laparoscopes, and anatomical structures, such as organs and vessels. These tools are controlled by a user of the system via a variety of tracking devices, and used to manipulate the structures (e-g- grasp, move, cut and suture). A mass-spring model is used to describe 3-D soft tissues, and external forces (usually exerted by the tools) drive the defor-mation of these tissues. An assumption of quasi-static behavior increases the efficiency of the deformation algorithm, and a method of localizing the defor-mation allows us to scale up to large objects. Our simulation also introduces a novel method of suture motion, which looks natural, and obeys the physical constraints caused by both self-collisions in the suture, and collisions between the suture and other objects. We are able to tie knots in the suture, and identify them. Interactions between the tools, suture, soft tissues, and other objects rely heavily on collision detection and collision management. Focusing our process-ing power on certain of these interactions allows for the creation of specialized applications (e.g., a microsurgery application involves forceps, blood vessels, and a suture, each interacting with the others). A description of the soft-tissue sim-ulation and collision detection can be found in [1, 2], a more detailed description of the system architecture is discussed in [3], while much of the suture simulation is unpublished. References:

- 1. J. Brown, S. Sorkin, J.-C. Latombe, K. Montgomery, M. Stephanides, Algorithmic tools for real-time microsurgery simulation, Medical Image Analysis 6 (3) (2002) 289-300.
- 2. J. Brown, S. Sorkin, C. Bruyns, J.-C. Latombe, K. Montgomery, M. Stephanides, Real-time simulation of deformable objects: Tools and application, in: Computer Animation 2001, 2001, pp. 228-236.
- 3. K. Montgomery, C. Bruyns, J. Brown, G. Thonier, A. Tellier, J.-C. Latombe, Spring: A general framework for collaborative, real-time surgical simulation, in: Medicine Meets Virtual Reality, 2002, pp. 296-303.

Digital Morse Theory for Biomedical Images

We present a mathematical analysis that we call Digital Morse Theory, that has applications to volume data set image visualization and understanding, with applications to Biomedical imaging. Volume data sets arise in many applications areas including CT data, MRI data, and X-ray crystallography. Isosurfaces and volume rendering are two important techniques for viewing the data and also for segmenting areas of interest in the data, for example for identifying anatomical features and tumors in medical image data.

Using our techniques we develop a method for preprocessing and organizing discrete scalar volume data of any dimension. The preprocessing algorithm constructs a criticality tree (independently developed) that is related to the contour tree of the literature, and computes regions of space called topological zones. The criticality tree and the zones hierarchically organize the data, and have a number of useful properties. We also present a simple algorithm that constructs provably correct isosurfaces in any dimension. We describe the implementation of a visual navigation system using our techniques. Typically researchers applying Morse theoretic ideas to scalar volume data have had to reorganize regularly gridded data onto a tetrahedral mesh and have had to perturb identical values. This is done to insure that the discrete data can be extended by a sufficiently well behaved interpolation function, so that a direct application of Morse theory could then be made.

In our approach, we first identify the properties satisfied by some of the more popular isosurface extraction methods. We then demonstrate that the class of interpolating functions that satisfy these properties produces topologically equivalent isosurfaces. We further show that the topological changes in these isosurfaces (changes to topological type, in the sense of homotopy), as the isovalue is varied, are uniquely defined and can be computed from combinatorial properties of the discrete data. Thus one does not need to consider the analytic properties of the interpolating function and one does not need to make a direct application of Morse theory. Consequently, our DMT analysis shows that our methods work on both irregularly and regularly gridded data, and on data with nonunique values, so that perturbation or resampling of the data set is not required.

We use our DMT analysis to define topological zones and we show how to efficiently compute the zones. We prove some interesting properties of the zones and show how these properties may be used in visualization. We discuss the use of the topological zone organization in fast isosurface construction. We show how the zone organization facillitates identifying all topologically distinct isosurface bounded objects in the dataset. We discuss our use of DMT in surface and data simplification, and managing the level of detail of a 3D rendering of a medical image.

Finally we will discuss future extensions of our DMT organizing technology. In particular we discuss our idea of segmentation surfaces, non-isovalued surfaces for anatomical segmentation for distinguishing features in regions of low image gradient. This provides a nice compromise betweem surface and volume-based techniques.

**H. Delingette**, EPIDAURE Research Project, INRIA Sophia Antipolis, France

Electro-mechanical modeling of the Right and Left Ventricles for Cardiac Image Analysis

I will present the latest developments of a ``beating heart model'', developed at INRIA, which is suitable for the quantitative analysis of cardiac images (gated MRI, echocardiography,..). This model describes three distinct physical phenomena: the propagation of the electrical wave from the apex to the base, the application of contractile stress depending on the action potential level and the mechanical deformation of the ventricles. More information regarding the three models axe provided below.

The current implementation is based on a generic finite element mesh consisting of linear tetrahedra. Our ultimate goal is to adapt this generic model to the anatomy and physiology of a given patient and to recover key physical parameters (stress, aortic pressure, ....) that cannot be measured directly from the images. I will illustrate the presentation with results concerning the generic model and its adaptation to medical images. Readers may refer to [1, 4, 3) for more details.

**Electrical Model**

There exists several mathematical model of the propagation of electric
wave across the heart ventricles. We have chosen to implement the
macroscopic model of Fitzhugh Nagumo [2] which links the evolution of
the transmembrane potential (directly related to the parameter) and
an auxiliary variable *z*.

We solve this paxtial differential equation using a standard *P*1
Lagrange finite element procedure (with mass lumping and first order
numerical integration at vertices), on the given tetrahedral
anatomical mesh. The Euler explicit time integration is performed to
advance computations. We have introduced an anisotropic behavior by
making the diffusion matrix *D* depending on the local fiber
orientation.

One residual and crucial problem (of great issues) is that some boundary conditions must be imposed at the junctions between the special conduction system (Purkinje fibers) and the myocardium, which is not well known so far. We have followed an approach which consists in assuming that the junctions region is located near the apex, below a plane that cuts the main heart axis.

**Electrical-Mechanical Coupling**

During one heart beat cycle, depolaxization wave propagates along the
my-ocardium during about 10% of the total cardiac cycle. It induces a
contraction of the whole myocardium, which produces a stress tensor _{f}
= *f* *f*, where
is the activation rate, and *f* is the fiber
direction. Therefore, when a fiber is activated, its contraction is
modeled as a pressure applied to the surface of the tetrahedron in the
fiber direction.

Furthermore, in addition to the stress along the fiber direction, the electrical activation of the myocaxdium modifies its elastic properties.

**Mechanical Model**

The heart myocaxdium is a nonlineax viscoelastic anisotropic material. It is composed of fiber bundles spiraling around the two ventricles. Obviously, the physical model has to be simple enough for computational purposes. To sim-plify the model, we propose to approximate the non-linear behavior of the my-ocardium by a series of linear models that are only valid during a small part of the cardiac cycle. References:

- [1] N. Ayache, D. Chapelle, F. Clement, Y. Coudiere,
H. Delingette, J.A. Desideri, M. Sermesant, M. Sorine, and
J. Urquiza. Towards model-based estimation of the cardiac
electro-mechanical activity from ECG signals and ultrasound images. In
T. Katila, 1. Magnin, P. Clarysse, J. Montagnat, and J. Nenonen,
editors, Functional Imaging and Modeling of the Heart (FIMH'01),
number 2230 in Lecture Notes in Computer Science (LNCS), pages
120-127. Springer, 2001.
- [2] A. L. Baxdou, P. M. Auger, P. J. Birkui, and
J.-L. Chasse. Modeling of cardiac electrophysiological mechanisms:
From action potential genesis to its propagation in
myocaxdium. Critical Reviews in Biomedical Engineering, 24:141-221,
1996.
- [3] M. Sermesant, Y. Coudiere, H. Delingette, and
N. Ayache. Progress towards an electro-mechanical model of the heart
for cardiac image analysis. In IEEE Inter-national Symposium on
Biomedical Imaging (ISBI'02), pages 10-14, 2002.
- [4] Maxime Sermesant, Clement Forest, Xavier Pennec, Herve
Delingette, and Nicholas Ayache. Biomechanical model construction from
different modalities: Application to cardiac images. In Takeyoshi Dohi
and Ron Kikinis, editors, Medi-cal Image Computing and
Computer-Assisted Intervention (MICCAI'02), volume 2488 of LNCS, pages
714-721, Tokyo, September 2002. Springer.
- [5] J. Smoller. Shock Waves and Reaction-Diffusion Equations. Springer-Verlag (Grundlehren der mathematischen Wissenschaften 258), 1983.

**Michael C. Ferris** and **Meta M. Voelker**, University of Wisconsin

Neuro-Dynamic Programming for Radiation Treatment Planning

In many cases a radiotherapy treatment is delivered as a series of smaller dosages over a period of time. Currently, it is difficult to determine the actual dose that has been delivered at each stage, precluding the use of adaptive treatment plans. However, new generations of machines will give more accurate information of actual dose delivered, allowing a planner to compensate for errors in delivery. We formulate a model of the day-to-day planning problem as a stochastic linear program and exhibit the gains that can be achieved by incorporating uncertainty about errors during treatment into the planning process. Due to size and time restrictions, the model becomes intractable for realistic instances. We show how neuro-dynamic programming can be used to approximate the stochastic solution, and derive results from our models for realistic time periods. These results allow us to generate practical rules of thumb that can be immediately implemented in current planning technologies.

**Edgar Garduno**, University of California, San Diego

Boundary Tracking for Both the Simple Cubic and the Face-Centered Cubic Grids

**Leo Joskowicz**, School of Computer Science and Engineering, The
Hebrew University of Jerusalem, Israel

Computer-Aided Navigation and Positioning in Orthopaedic Surgery

The past ten years have witnessed the development and deployment of a variety of computer-aided system for orthopaedic surgery. The goals of these systems are to enhance the surgeon's dexterity, visual feedback, and information integration before and during surgery. Computer-aided orthopaedic surgery (CAOS) systems aim at improving the accuracy and steadiness of the surgical gestures, reduce complications due to tool and implant misplacement, reduce cumulative exposure to X-ray radiation, and reduce surgery time and patient morbidity. CAOS surgeries, such joint, trauma and ligament surgeries, are beginning to have an impact on routine clinical practice.

In this talk, we survey the clinical results and technical state of the art in computer-aided orthopaedic surgery (CAOS). After a brief overview of the most common orthopaedic surgeries, we identify their common characteristics and the desirable system goals in terms of accuracy, resolution, robustness, repeatability, and computation and reaction time. We then describe the technical characteristics of existing imaging (X-ray, ultrasound, CT, and MRI), tracking (optical, electromagnetic, and gyroscopic), and robotic systems. We classify navigation systems into four categories: 1. CT-based; 2. Fluoroscopic X-ray based; 3. CT+Fluoroscopic X-ray based; and 4. CT-less spatial navigation, and robotic systems into two categories: 1. positioning and guiding aids, and; 2. active execution systems. For each, we describe the state of the art, its current clinical applications, and its pros and cons. We identify key technical challenges and propose possible solutions. We conclude with perspectives for the emerging field of medical CAD/CAM and its expected impact on orthopaedic surgery.

**D. B. Karron**, Computer Aided Surgery, Inc.

Early experience using Digital Morse Theory for Medical Image Segmentation at Computer Aided Surgery, Inc.

Extracting precise and accurate objective measurements from image data has been an enduring problem in biomedical engineering. We are in the midst of an explosion of mega pixels from imaging technology. Imaging, from reflected, structured, and transmitted visible light, infrared, ionizing radiation, ultrasound, planar images, tomography, and the admixture of these, has vast application for in image guidance in many applications from image guided surgery to surgical simulation and education. The explosion of pixels from these technologies has motivated our efforts to understand these images in terms of well-defined objects. Further we wish to understand the interrelationship amongst these objects. We are meeting this challenge by the development by the extension of basic mathematical theory from Morse Theory into the pixilated digital domain wit Digital Morse Theory.

Digital Morse Theory is an extension of traditional Morse Theory developed by Marsdon Morse in the 1930's and 1940's at the Princeton Institute for Advanced Studies. The essential idea of Morse Theory is to describe the topology of a function as opposed to the geometry of a function in terms of Morse Criticalities. Traditionally, Morse theory required an analytic description of a function that was twice differentiable and continuous. Digital Morse Theory, as being developed by Cox and Karron with recent work by Jack Snoyink et al, attempts to adapt Morse’s concept of criticalities to discrete image data measurements. This has many practical applications in multidimensional image segmentation in that we can describe all of the objectively segmentable objects in terms of their parent, progeny, and peer criticalities in what we are terming a Morsian organization. A Reeb graph describes the relationship of objects to one another; we are programming a demonstration of the application of Digital Morse Theory for medical image segmentation that shows a catalog of all of the segmentable objects and permits the user to organize component objects into desired ensembles of anatomic objects quickly, precisely, and accurately.

Sample medical images from the CT and MRI images of the Visible Human Project and their associated DMT graph will be presented. We will demonstrate the relationship between the DMT graph and image components and how we can build a 3d scene of segmented objects with important projects for anatomic surgical modeling. Specifically, we desire anatomic dimensional fidelity and accuracy, as we will use these models to make critical care decision. Since models derived from DMT based segmentation have the Jordan and Manifold surfaces, this means that disparate segmented objects do not have interpenetrating surfaces or other geometric pathologies.

Our goal is to have semi-automatic to fully automatic segmentation and fusion of disparate medical images.

**A. Kuba**, Dept. of Applied Informatics, University of Szeged, Hungary

Discrete Tomography from Absorbed Projections

Consider a set of points in the space where all of the points emit the same intensity of radioactivity. Suppose that the space is filled with some homogeneous material having known absorption coefficient. There are detectors measuring the so-called absorbed projections, that is, the sums of the partially absorbed activities along lines between the point sources and the detectors. The problem is to reconstruct the point set from its absorbed projections. This model is similar to the acquisition technique used, for example, in the nuclear medicine, where the radioactivity emitted from the administered radiopharmacon is partially absorbed in the human body before detection.

This new direction of discrete tomography has a few interesting uniqueness results and reconstruction algorithms in special cases. For example, the reconstruction of discrete sets from two absorbed projections is studied if the absorption coefficient is log((1+sqrt(5))/2). A necessary and sufficient condition is given for the uniqueness and a reconstruction algorithm is suggested in this special case. It is proved that the reconstruction of so-called hv-convex discrete sets from such projections can be done in polynomial time. In this presentation we are going to generalize these results for different absorption values and for more than two projections.

**Eva K. Lee**^{1,2,3}, **Tim Fox**^{2} and **Ian Crocker**^{2}

Beam Geometry and Intensity Map Optimization in Intensity- Modulated Radiation Therapy via Combinatorial Optimization

In this talk, we describe the use of mixed integer programming for
simultaneously determining optimal beamlet fluence weights and beam
angles in intensity-modulated-radiation-therapy treat-ment
planning. In particular, binary variables are used to capture
use/non-use of each beam, and continuous variables capture intensity
values for each beamlet. For the tumor, explicit constraints include
coverage with tumor underdose specified, conformity, and homogeneity;
while DVH re-strictions for critical structures and normal tissues are
imposed. Our algorithmic design thus fax has been motivated by
clinical cases. To set up the model, 16-24 coplanar candidate fields
of size 20*x*2O *cm*^{2} are generated, each consisting of 1600
5mm-beamlets. The maximum number of fields in the final plan will be
constrained. Numerical tests are performed and analyzed on three tumor
sites: 1)head-and-neck tonsil, 2)posterior-fossa-boost, and
3)prostate. In all cases, homogeneity is kept below 1.25, while
requiring 95% tumor-volume coverage by the 100% isodose-curve and 100%
tumor-coverage by the 95% isodose-curve. Optimal plans are obtained
when maximum number of fields are restricted from 6-24
fields. Sensitivity of quality of plans versus various objective
functions are compared and analyzed. For a practical 8-field practical
plan, optimal results in the quality of plans for the head-and-neck
tonsil case and the posterior fossa boost occur when the conformity is
minimized in the objective function. In the prostate cancer case,
there are overlapping boundary points in the rectal wall and the
prostate, and the best quality plan (for 8-fields) results from an
objective which minimizes the total weighted dose to the rectum and
bladder, together with a tight ring of 5mm-thick normal tissue drawn
around the prostate-PTV. The deviation in best objective choice use
may result from the closeness of the rectal wall (and the bladder) to
the prostate with overlapping boundary points.

^{1} School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia.
^{2}Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.
^{3}Corresponding author, evakylee@isye.gatech.edu

**Ming C. Lin**, Department of Computer Science, University of North Carolina at Chapel Hill

Geometric Algorithms for Modeling Deformable Bodies

Modeling deformation is a key component for many technology assisted medical procedures, such as image-guided surgery, multi-modal image registration, surgical planning and training, instructional medical illustration. In this talk, we discuss geometric issues involved in simulating interaction between flexible bodies and present efficient algorithms for a subset of these problems.

Some of the challenging research issues include rapid detection of contacts, efficient enforcement of non-penetration constraints, and fast contact resolution. We describe two classes of geometric algorithms for computing "deformed distance fields" dynamically using fast-marching level-set methods and modern graphics hardware. We introduce the concept of "multi-level simulation acceleration" techniques for enhancing the performance of simulators used in modeling deformation. We demonstrate the effectiveness of our approaches on moderately complex animated scenes and medical simulations.

**Danny Z. Chen, Xiaobo S. Hu, Shuang Luan and Chao Wang**,
Department of Computer Science and Engineering,
University of Notre Dame

**Charles E. Lee, Shahid A. Naqvi and Cedric X. Yu**, Department of Radiation Oncology
University of Maryland Medical School

**Xiaodong Wu**, Department of Computer Science,
The University of Texas - Pan American

Geometric Algorithms and Experiments for Static Leaf Sequencing Problems in Radiation Therapy

Radiation therapy uses radiation beams to eradicate tumors while
sparing surrounding vital organs and healthy tissues. A good shape
matching between the tumor volume and radiation beams is critical to
the quality of treatments. In general, tumors have vaxious sizes and
shapes, while the radiation beams generated by the linear accelerators
(LINAC) (machines that are used to generate and deliver radiation) are
cylindrical. One way to overcome the poor shape matching problem with
LINAC is to use a device called * multileaf collimator* (MLC), which uses
a set of opposing tungsten leaves to vary the cylindrical beam shape
in order to obtain the needed discrete dose distributions. However,
one of the challenging issues of using a collimator is its potentially
prolonged treatment time. The *static leaf sequencing* (SLS) problem
axises in radiation therapy for cancer treatments, aiming to
accomplish the delivery of a radiation prescription to a taxget tumor
using an MLC in the minimum amount of delivery time.

Geometrically, the SLS problem can be formulated as a 3-dimensional
partition problem for which the 2-dimensional problem of partitioning
a polygonal domain (possibly with holes) into a minimum set of
monotone polygons is a special case. In this talk, we present new
geometric algorithms for a basic case of the 3-D SLS problem (which is
also of clinical value) and for the general 3-D SLS problem. Our basic
3-D SLS algorithm, based on new geometric observations, produces
guaxanteed optimal quality solutions using Steiner points in
polynomial time; the previously best known basic 3-D SLS algorithm
gives optimal outputs only for the case without using Steiner points,
and its time bound involves a multiplicative factor of a factorial
function of the input. Our general 3-D SLS algorithm is based on our
basic 3-D SLS algorithm and a polynomial time algorithm for
partitioning a polygonal domain (possibly with holes) into a minimum
set of *x*-monotone polygons, and has a fast running time.

Experiments and compaxisons using real medical data and on a real
radiotherapy machine have shown that our 3-D SLS algorithms and
software produce treatment plans that use significantly shorter
delivery time and give better treatment quality than the current most
popular commercial treatment planning system and the most well-known
SLS algorithm. Some of our techniques and geometric procedures (e.g.,
for the problem of partitioning a polygonal domain into a minimum set
of *x*-monotone polygons) axe interesting in their own right.

**Dimitris Metaxas**, Rutgers University

Segmentation, Modeling and Estimation Techniques for Internal Organs

3D segmentation and modeling for improved medical diagnosis of disease promises to revolutionize the way medical practice is done currently which is inherently 2D. In this talk we will first present our 3D hybrid segmentation framework which consists of integrating low level image processing and higher level deformable models. We will show semgentations of a variety of organs including brains, the heart and the colon. In the second part we will present our 3D stress-strain estimation framework of the heart's shape, motion and material properties from MRI-SPAMM.

**Neil Molino**, Stanford University

Deformable Bodies: Mesh Generation and Simulation

The generation of meshes for deformable bodies and the subsequent simulation of their motion are used in a number of areas including fracture, haptics, solid modeling, surgical simulations, and the modeling of biological tissue including the brain, the knee and even fatty tissue. Robust methods for generating these meshes are in high demand. Of particular interest to us are simulations of highly deformable bodies such as cloth (skin) and the muscle and fatty tissues commonly encountered in graphics, biomechanics, or virtual surgery. We propose a new mesh generation paradigm that gives particular consideration to conditioning the mesh for high deformation. We further discuss innovations for the simulation of deformable objects including a finite volume method for volumetric simulation, collision resolution, and internal dynamics modeling for cloth.

Our new mesh generation algorithm produces both high quality elements and a mesh that is well conditioned for subsequent large deformations. We primarily focus on tetrahedral meshes, but use this algorithm for surface meshing as well. We use a signed distance function defined on a grid in order to represent the object geometry. In the volumetric case, after tiling space with a uniform lattice based on crystallography, we identify a subset of these tetrahedra that adequately fill the space occupied by the object. Then we use the signed distance function or other user defined criteria to guide a red green mesh subdivision algorithm that results in a candidate mesh with the appropriate levels of detail. After this, both the signed distance function and topological considerations are used to prune the mesh as close to the desired shape as possible while keeping the mesh flexible for large deformations. Finally, we compress the mesh to tightly fit the object boundary using either masses and springs, the finite element method, or an optimization approach to relax the positions of both the interior and boundary nodes. The resulting mesh is well-suited for simulation since it is highly structured, has robust connectivity in the face of deformation, and is readily refined if deemed necessary during a subsequent simulation.

Mesh generation is not only a broad field, but is in some sense many fields each concerned with the creation of meshes that conform to quality measures specific to the application at hand. The requirements for fluid flow and heat transfer, where the mesh is not deformed, and for small deformation solids where the mesh is barely deformed, can be quite different from those for simulating soft biological tissue that may undergo large deformations. For example, while an optimal mesh for a fluid flow simulation should include anisotropically compressed elements in boundary layers, these highly stretched cells tend to be ill-conditioned when a mesh deforms significantly as is typical for soft bodies. Either the mesh is softer in the thin direction and the cell has a tendency to invert, or the mesh is stiffer in the thin direction and the simulation becomes very costly as the time step shrinks with higher stiffness and smaller element cross-section. Thus, although our method has been designed to provide a high degree of adaptivity both to resolve the geometry and to guarantee quality simulation results, we neither consider nor desire anisotropically stretched elements. Also, since highly deformable bodies tend to be devoid of sharp features such as edges and corners, we do not consider boundary feature preservation here. However, we believe that our algorithm can be extended to treat this case and plan to pursue it as future work.

Our main concern is to generate a mesh that will be robust when subsequently subject to large deformations. For example, although we obviously want an adaptive mesh with smaller elements in areas where more detail is desired, it is even more important to have a mesh that can be adapted during the simulation since these regions will change. Motivated by crystallography, we use a body-centered cubic (BCC) mesh that is highly structured and produces similar (in the precise geometric sense) tetrahedra under regular refinement. This allows us to adaptively refine both while generating the mesh and during the subsequent simulation.

Beginning with a uniform tiling of space, we then use a signed distance function representation of the geometry to guide the creation of the adaptive mesh, the deletion of elements that are not needed to represent the object of interest, and the compression of the mesh necessary to match the object boundaries. This compression stage can be carried out using either a mass spring system, a finite element method, or an optimization based approach. One advantage of using a physically based compression algorithm is that it gives some indication of how a mesh is likely to respond to the deformations it will experience during simulation. This is in contrast to many traditional methods that may produce an initial mesh with good quality measures, but also with hidden deficiencies that can be revealed during simulation leading to poor accuracy or element collapse.

In addition to testing the mesh with the physics based compression algorithm, we identify and guarantee several topological properties that ensure the mesh is sufficient for high deformation, for example a tetrahedron with all four of its edges on the boundary or an internal edge with both nodes on the boundary can limit the accuracy of the simulation, or worse, allow collapse.

We have generated tetrahedral meshes with this algorithm and used them in the simulation of highly deformable objects with a variety of constitutive models using several simulation techniques. The meshes retained their quality throughout all of these simulations. One new simulation technique that we tried is the finite volume method (FVM), which is more intuitive than the finite element method (FEM), since it relies on a geometrical rather than variational framework. We show that FVM allows one to interpret the stress inside a tetrahedron as a simple ``multidimensional force'' pushing on each face. Moreover, this interpretation leads to a heuristic method for calculating the force on each node, which is as simple to implement and comprehend as masses and springs. In the finite volume spirit, we also present a geometric rather than interpolating function definition of strain. We illustrate that FVM places no restrictions on the simulation of volumetric objects subject to large deformations, in particular using a quasi-incompressible, transversely isotropic, hyperelastic constitutive model for simulating contracting muscle tissue. B-spline solids are used to model fiber directions, and the muscle activation levels are derived from key frame animations.

Significant effort has been placed into accelerating FEM calculations including recent approaches that precompute and cache various quantities, modal analysis, and approximations to local rotations. In spite of significant effort into alternative (and related) methods for the robust simulation of deformable bodies, FVM has been largely ignored. Two aspects of FVM make it extremely attractive. First, it has a firm basis in geometry as opposed to the FEM variational setting. This not only increases the level of intuition and the simplicity of implementation, but also increases the likelihood that aggressive but robust optimizations might be found. Second, there is a large community of researchers using these methods to model solid materials subject to very high deformations. For example, it has been used with subcell pressures to eliminate the artificial hour-glass type motions that can arise in materials with strongly diagonally dominant stress tensors, such as incompressible biological materials.

We are particularly interested in the simulation of both active and passive muscle tissue. Biological tissues typically undergo rather large nonlinear deformations, and thus they create a stringent test for any simulation method. Moreover, they tend to have complex material models with quasi-incompressibility, transverse anisotropy, hyperelasticity, and both active and passive components. In this paper, we use a state of the art constitutive model, B-spline solids to represent fiber directions, and derive muscle activations from key frame animation.

The general theme of our mesh generation algorithm---tile ambient space as regularly as possible, select a subset of elements that are nicely connected and roughly conform to the object, then deform them to match the boundary---is applicable in any dimension and on general manifolds. We have used this idea to triangulate two-dimensional manifolds with boundary. We begin with a complete quality mesh of the object (actually created as the boundary of a tetrahedral mesh from our method, with additional edge-swapping and smoothing), and a level set indicating areas of the surface to trim. We keep a subset of the surface triangles inside the trimming level set and compress to the trimming boundary, making sure to stay on the surface. This can also be done for parametric surfaces with a triangulation in parameter space and a trimming level set defined either in three-dimensional space or in the parameter space. Quality two-dimensional surface meshes with boundary are especially important for cloth simulation. We, therefore, used cloth modeling as a testbed for our surface meshes. Two of the significant concerns in cloth simulation are collision resolution and internal dynamics modeling. A quality mesh free of slivers is important for well-conditioned numerical algorithms for both of these issues, particularly internal dynamics.

Collisions are a major bottleneck in cloth simulation. Since all points are on the surface, all points (and there will be many thousands for reasonably resolved simulations) may potentially collide with each other and the environment in any given time step. We argue that it is essential to maintain the constraint that the cloth mesh can never intersect itself. This can be efficiently achieved by a novel combination of fast and numerically well-conditioned penalty forces with a fail-safe geometric method. For dealing with collisions with large volumetric objects in the environment we demonstrate a technique for pushing the cloth to the surface of the objects while still preserving wrinkles and other features. Motivated by Newmark central schemes we demonstrate a time integration algorithm that decouples the collision dynamics from the interior cloth dynamics.

Cloth internal dynamics can be broken up into in-plane deformations (stretching and shearing) and bending. Bending is visually the most fundamental characteristic of cloth, yet it is not well understood. Working from basic principles we derive the only reasonable family of bending spring models that operate on triangle meshes, and show results with the simplest and most efficient member of this family. Our model easily permits non-flat rest poses, which allow the simulation of non-flat manifolds (e.g. skin) as well as pre-sculpted wrinkles and folds in cloth to maintain the desired artistic look of a garment during motion.

When simulating highly deformable objects, using a mesh designed for that purpose is obviously very important. Our new meshing algorithm produces such a mesh and has been tested in various simulations. As future work, we plan to explore the interplay between the mesh generation phase and the simulation phase for deformable bodes, for example allowing the mesh to slip during the simulation.

**Dinesh K. Pai**, Rutgers University

Geometric Problems in Ultrasound Imaging

Ultrasound imaging is widely used in medicine because it is safe and interactive. However, raw ultrasound images have significant noise and artifacts relative to other imaging techniques such as CT and MRI, and present interesting algorithmic challenges for extracting useful geometric information. In this talk I will describe the fundamentals of ultrasound imaging, and some of our recent work in extracting 3D geometry from free-hand ultrasound images and for improving ultrasound image quality. (Joint work with Rohling, Salcudean, Wei, and Zhang).

**P. M. Pardalos**^{1}, **J. C. Sackellares**^{2}, **D. S. Shiau**^{2}, and **V. A.
Yatsenko**^{2}

- (1) Center for Applied Optimization and ISE Department University of Florida, Gainesville, FL
- (2) Departments of Neurology and Neuroscience, University of Florida, Gainesville, FL

The existence of complex chaotic, unstable, noisy and nonlinear dynamics in brain electrical activity requires new approaches to the study of brain dynamics. One approach is the combination of combining certain geometric concepts, control approach, and optimization. In this paper we discuss the use of a differential geometric approach to the control of Lyapunov exponents and the characterization of statistical information to predict and ``correct'' brain dynamics. This approach assumes that information about the physiological state (in this case the electrocencephalogram) comes in the form of a nonlinear time series with noise. The approach involves a geometric description of Lyapunov exponents for the purpose of correcting of the nonlinear process that provides adaptive dynamic control. We separate the Lyapunov exponents into tangent space (fiber bundle) and its functional space. Control involves signal processing, calculation of an information characteristic, measurement of Lyapunov exponents, and feed-back to the system. With more information, we can reduce uncertainty by a certain degree. We demonstrate the computational aspects of the proposed geometric approach on the base of different mathematical models in the presence of noise of various origins. We review the EEG signal, and outline a typical application of the geometrical representation: three dimensional reconstruction of Lyapunov exponents and correlation dimension obtained from EEG data. The novelty in this paper is in the representation of dynamical and information characteristics in three dimensional vector space in a way that permits practical applications. We discuss an application of this approach to the development novel devices for seizure control though electromagnetic feed-back.

**Achim Schweikard**, Informatik, Universtat Luebeck, Germany

Planning and Navigation for Robotic Radiosurgery

Stereotactic radiosurgery uses focused beams of radiation from multiple spatial directions to ablate brain tumors. To plan the treatment, spatial directions of the beams must be determined in a first step. The set of such beam directions should be chosen such that the dose to surrounding healthy tissue remains minimal, and the tumor absorbs a homogeneous dose throughout its volume. In addition to choosing the beam directions, one must find the weight for each such beam direction, i.e. the activation duration for the beam.

Earlier systems for stereotactic radiosurgery are inherently limited to treat lesions in the brain. The first goal of robotic radiosurgery is to improve conventional stereotactic radiosurgery with respect to accuracy. A second, more important goal is to allow for treating lesions anywhere in the body.

In the first part of this talk, we present planning methods for robotic radiosurgery. Our methods are based on linear programming. Linear programming gives a fast and globally convergent optimisation strategy. It has been proposed as a planning technique in radiation therapy applications by several authors. In robotic radiosurgery, up to 1500 beam directions are used for a single treatment, and the beam can be moved in space with full kinematic flexibility. We show that the general approach of linear programming is practical for robotic radiosurgery, where a very large number of beam directions is used. An implementation of our methods has been incorporated into the Cyberknife robotic radiosurgery system. Several thousand patients with tumors of the brain, the spine and the lung have been treated with the described linear programming based planning system.

The second part of this talk addresses the problem of navigation for robotic radiosurgery. Conventional stereotactic radiosurgery is limited to the brain. Tumors in the chest and the abdomen move during respiration. The ability of conventional radiation therapy systems to compensate for respiratory motion by moving the radiation source is inherently limited. Since safety margins currently used in radiation therapy increase the radiation dose by a very large amount, an accurate tracking method for following the motion of the tumor is of utmost clinical relevance. We investigate methods to compensate for respiratory motion using robotic radiosurgery. Thus, the therapeutic beam is moved by a robotic arm, and follows the moving target tumor. To determine the precise position of the moving target we combine infrared tracking with synchronized X-ray imaging. Infrared emitters are used to record the motion of the patient's skin surface. A stereo X-ray imaging system provides information about the location of internal markers. During an initialisation phase (prior to treatment), the correlation between the motions observed by the two sensors (X-ray imaging and infrared tracking) is computed. This model is also continuously updated during treatment to compensate for other, non-respiratory motion. Experiments and clinical trials suggest that robot-based methods can substantially reduce the safety margins currently needed in radiation therapy. Our correlation based navigation method has since been incorporated into the Cyberknife robotic radiosurgery system. Our new module is in routine clinical use at a growing number of sites worldwide.

References:

- Schweikard, A., Glosser, G., Bodduluri, M., Adler, J. R., Robotic Motion Compensation for
Respiratory Motion during Radiosurgery Journal of Computer-Aided Surgery, vol. 5, no
4., 263-277, Sept. 2000.
- Schweikard, A., Bodduluri, M., Adler, J. R.: Planning for Camera-Guided Radiosurgery, IEEE Transactions on Robotics and Automation, 13, 6, 951-962, 1998.

**Marcelo Siqueira**^{1}, **Tessa Sundaram**^{2}, **Suneeta Ramaswami**^{3},
**Jean Gallier**^{1}, **James Gee**^{4}

Quadrilateral Meshes for the Registration of Human Brain Images

- (1) Department of Computer and Information Science, University of Pennsylvania
- (2) School of Medicine and Department of Bioengineering, University of Pennsylvania
- (3) Department of Computer Science, Rutgers University
- (4) Department of Radiology, University of Pennsylvania

**Frederic F. Leymarie** and **Benjamin B. Kimia**, Brown University

Shock Scaffolds for 3D Shapes in Medical Applications

**Demetri Terzopoulos**, Courant Institute, New York University

Deformable Models for Medical Image Analysis

The modeling of biological structures and the model-based interpretation of medical images present many challenging problems. I will describe a powerful modeling paradigm, known as deformable models, which combines computational geometry, computational physics, and estimation theory. Deformable models evolve in response to simulated forces as dictated by the continuum mechanical principles of flexible materials expressed via variational principles and PDEs. The talk will review several biomedical applications currently under development, including image segmentation using dynamic finite element and topologically adaptive deformable models, as well as our recent work on ``deformable organisms''. The latter aims to automate the segmentation process by augmenting deformable models with behavioral and cognitive control mechanisms from our work on artificial life.

**Jayaram K. Udupa**, University of Pennsylvania

Fuzzy Connectedness and Image Segmentation

Image segmentation - the process of defining objects in images - remains the most challenging problem in image processing despite decades of research. Many general methodologies have been proposed to date to tackle this problem. An emerging framework that has shown considerable promise recently is that of fuzzy connectedness. Images are by nature fuzzy. Object regions manifest themselves in images with a heterogeneity of image intensities owing to the inherent object material heterogeneity, and artifacts such as blurring, noise and background variation introduced by the imaging device. In spite of this gradation of intensities, knowledgeable observers can perceive object regions as a gestalt. The fuzzy connectedness framework aims at capturing this notion via a fuzzy topological notion called fuzzy connectedness which defines how the image elements hang together spatially in spite of their gradation of intensities. In defining objects in a given image, the strength of connectedness between every pair of image elements is considered, which in turn is determined by considering all possible connecting paths between the pair. In spite of a high combinatorial complexity, theoretical advances in fuzzy connectedness have made it possible to delineate objects via dynamic programming at close to interactive speeds on modern PCs. This paper gives a tutorial review of the fuzzy connectedness framework delineating the various advances that have been made. These are illustrated with several medical applications in the areas of Multiple Sclerosis of the brain, MR and CT angiography, brain tumor, mammography, upper airway disorders in children, and colonography.

**A. Frank van der Stappen**, Universiteit Utrecht

(joint work with Han-Wen Nienhuys)

Simulating cuts in triangulated objects

The motivation of our work on simulating cuts is formed by interactive surgery simulations. Such simulations combine interactive deformation of virtual tissue with simulations of surgical procedures. The Finite Element Method (FEM) seems suited for computing deformation since it is physically accurate. Meshes form the basis of this technique: the domain of the problem is subdivided in geometric primitives (`elements') such as tetrahedra or triangles. With this subdivision the governing partial differential equation (PDE) can be transformed in a system of numerical equations. For the rest of the discussion, we will assume that the PDE is linear and derives from an elasticity problem. The equations can then be discretized into a linear system, where the matrix is called stiffness matrix.

Finding a solution is a two step process: first, the stiffness matrix is constructed, then the unknowns (a set of deformations) are computed from the stiffness matrix and given loads. The characteristics of a mesh influence both steps. The accuracy of the discretization process is determined by element shapes. For triangular/tetrahedral meshes, large elements and large angles decrease the accuracy of the FEM discretisation. The accuracy of the solution process in finite precision arithmetic is determined by the condition number of the stiffness matrix, where a lower condition number is better. The convergence speed of iterative solution methods also depends on the condition number. This holds for both the conjugate gradient algorithm (a static approach), and for damped dynamic relaxations using explicit time integration. The condition number of a complete stiffness matrix can be bounded by the condition numbers for separate elements. In contrast to the FEM discretisation error, high condition numbers are caused by elements with small sizes and small angles. So, the requirements for optimal accuracy in the discretisation and for optimal speed and accuracy in the numerical process are contradictory. However, it is safe to say that a mesh with `round' (non-flat) elements and bounded element sizes is a good general purpose mesh.

Iterative algorithms seem well suited as numerical solution strategies for surgery simulations, since they allow on-line meshchanges. If such an iterative approach is used, then mesh quality becomes an issue of vital importance: the maximum size of simulations is largely determined by mesh characterics: better meshes yield faster convergence, enabling larger and more accurate simulations. It follows that simulated surgical manipulations (such as needle insertions, cuts, and cauterizations) should be designed to keep mesh quality high. Secondly, the manipulations should also keep the complexity of the mesh low, since the cost of a single iteration step is proportional to the size of the mesh.

We state the general mesh cutting problem as follows: given a starting mesh, and positions of a user-controlled scalpel, modify the mesh at every moment to show an incision that represents the past trajectory of the scalpel, and ends exactly at the scalpel. The challenge is to do so while maintaining the quality and size of the mesh.

Simulation of cuts in surgery simulation is related to simulation of other destructive surgical procedures. The first operation to have been simulated on volumetric meshes is cauterization. This was done by removing elements in contact with a virtual cauterization tool. A disadvantage when applied to cutting is that it produces a jagged surface on the virtual tissue.

For cutting, subdivision methods have been the norm: elements that are in contact with the scalpel are subdivided to produce a cut conforming to the scalpel position. Subdivision methods always increase the size of the mesh. Moreover, these methods tend to produce degeneracies: mesh modification is done only within a fixed region of the mesh, and if the scalpel moves close to the boundary of that region, poorly-shaped elements are inevitable. Research has been done to counter the the degeneracies---caused by subdivision cutting---by collapsing short edges of the mesh. This approach does improve the quality of the mesh, but this solution does not repair all inconsistencies: not all edges may be contracted, and flat triangles and tetrahedrons, which do not contain short edges but are still degenerate, are not dealt with.

Our first approach to cutting in tetrahedralized objects keeps the mesh size at the initial level by performing cuts only along faces of the mesh, which are selected according to a heuristic. Nodes of the mesh are relocated to align these faces with the trajectory of the virtual scalpel. We have implemented this approach and the results confirm that the mesh size remains small. In addition, the method also creates only few short edges. There are, however, also some disadvantages. Since no new nodes are created, the resolution of the cut is bounded by the mesh resolution, which results in a less accurate representation of the cut in the unlikely case of sharp turns in the scalpel path. A more serious problem is that snapping can result in degenerate elements in the mesh. Such degeneracies are dealt with by subdividing flat elements, and collapsing the resulting short edges, effectively removing the flat element. Unfortunately, not all edges can be collapsed. Using only existing mesh features as a basis for mesh modification is problematic: when the scalpel is not especially close to a mesh feature, it may not be possible to match the mesh topology to the scalpel path without introducing degeneracies.

Our second approach applies to triangulated surfaces. The technique could be applied to surgery simulation for membrane-like structures, such as skin or intestine. The method keeps the mesh size and quality at the initial level through a careful scheme of edge flips, node deletions, and node insertions. When cutting, a node of the mesh is attached to the virtual scalpel. Roughly speaking, our method deletes nodes that are to close to this (moving) active node to prevent degeneracies, it flips edges around the active node to increase the mesh quality, and inserts nodes behind the active node to adequately approximate the past trajectory of the scalpel. We have implemented our approach and it turns out that it maintains the mesh quality and keeps the mesh size low, without introducing degeneracies.

Finally, we report some initial results on our approach to needle insertion.

**Simon K. Warfield, Kelly H. Zou and William M. Wells**, Harvard University

STAPLE (Simultaneous Truth and Performance Level Estimation) : A New Validation Algorithm for Judging Image Segmentations

The extraction of geometry from medical images depends upon accurate image segmentation to appropriately identify the structures of interest. Characterizing the performance of image segmentation approaches has been a persistent challenge. Performance analysis is important since segmentation algorithms often have limited accuracy and precision.

Interactive drawing of the desired segmentation by domain experts has often been the only acceptable approach, and yet suffers from intra-expert and inter-expert variability. Automated algorithms have been sought in order to remove the variability introduced by experts, but automated algorithms must be assessed to ensure they are suitable for the task.

The accuracy of segmentations of medical images has been difficult to quantify in the absence of a known true segmentation for clinical data. Although physical and digital phantoms can be constructed for which ``ground truth'' is known or readily estimated, such phantoms don't fully reflect clinical images in that it is difficult to construct phantoms which reproduce the full range of imaging characteristics and normal and pathological anatomical variability observed in clinical data. Comparison to a collection of segmentations by experts is an attractive alternative since it can be carried out directly on the clinical imaging data for which the validation of the segmentation is desired, but the most appropriate measure or measures with which to compare such segmentations has not been clarified and several measures are used in practice.

We present here an Expectation-Maximization algorithm we call STAPLE (Simultaneous Truth and Performance Level Estimation). The algorithm takes a collection of segmentations and computes a probabilistic estimate of the true segmentation and a measure of the performance level represented by each segmentation. The source of each segmentation in the collection may be an appropriately trained human expert or experts, or it may be an automated segmentation algorithm. STAPLE is straightforward to apply to clinical imaging data, it readily enables the validation of an automated image segmentation algorithm, and allows direct comparison of expert and algorithm performance.

Illustrative results are presented on digital phantoms for which the true segmentation is known, and for several clinical applications that require validation of image segmentations.

**Cedric Yu**, University of Maryland School of Medicine

Mathematical and Algorithmic Challenges in Radiotherapy

In the talk, I will review the current topics and discuss what we are doing at the University of Maryland School of Medicine. These include IMRT optimization, brachytherapy optimization, deformable image registration using an optimization setting and a clinical trial related to it, and IGS/CAS/CAD (computer aided diagnosis). I will introduce the problems and the current status. I will also talk about dose calculation, which has been always a compromise between accuracy and computational speed. There could also be an algorithmic solution for the dose calculation problem. In the second part of my talk, I would like to touch some new areas that are not on our current screen. These include genomics and proteomics, biological modeling, and simulation of radiation induced DNA damage and repair. I will illustrate that the new possibilities are much broader than in the traditional areas.

**Eva Lee**, Georgia Institute of Technology and Emory University School of Medicine

(joint work with Tim Fox and Ian Crocker, Emory University School of Medicine)

Beam Geometry and Intensity Map Optimization in Intensity-Modulated Radiation Therapy via Combinatorial Optimization

In this talk, we describe the use of mixed integer programming for simultaneously determining
optimal beamlet .uence weights and beam angles in intensity-modulated-radiation-therapy treatment
planning. In particular, binary variables are used to capture use/non-use of each beam, and
continuous variables capture intensity values for each beamlet. For the tumor, explicit constraints
include coverage with tumor underdose speci.ed, conformity, and homogeneity;while DVH restrictions
for critical structures and normal tissues are imposed. Our algorithmic design thus far
has been motivated by clinical cases. To set up the model, 16-24 coplanar candidate .elds of size
20x20 cm^{2} are generated, each consisting of 1600 5mm-beamlets. The maximum number of .elds
in the .nal plan will be constrained. Numerical tests are performed and analyzed on three tumor
sites: 1)head-and-neck tonsil, 2)posterior-fossa-boost, and 3)prostate. In all cases, homogeneity is
kept below 1.25, while requiring 95% tumor-volume coverage by the 100% isodose-curve and 100%
tumor-coverage by the 95% isodose-curve. Optimal plans are obtained when maximum number of
.elds are restricted from 6-24 .elds. Sensitivity of quality of plans versus various objective functions
are compared and analyzed. For a practical 8-.eld practical plan, optimal results in the quality of
plans for the head-and-neck tonsil case and the posterior fossa boost occur when the conformity is
minimized in the objective function. In the prostate cancer case, there are overlapping boundary
points in the rectal wall and the prostate, and the best quality plan (for 8-.elds) results from an
objective which minimizes the total weighted dose to the rectum and bladder, together with a tight
ring of 5mm-thick normal tissue drawn around the prostate-PTV. The deviation in best objective
choice use may result from the closeness of the rectal wall (and the bladder) to the prostate with
overlapping boundary points.

**Jinhui Xu, Guang Xu, Zhenming Chen** and **Kenneth R. Hoffmann**, SUNY Buffalo

Determining Bi-Plane Imaging Geometry for Reconstructing 3-D Vascular Structures

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Document last modified on March 24, 2003.