The general objective of the project: Identification and prevention of cutaneous hemangiomas by developing an automatic software for image processing and statistic prediction. This general objective shall be reached by accomplishing the following specific objectives:
- Elaboration of a database with cases documented both clinically and imagistically
For the start of the research project, the first and very important objective of the study shall be accomplishing, by creating a database of photographic, ultrasound and thermographic images, video recording, clinical and anamnestic data obtained as result of a careful examination and surveillance. The acquisition of such items shall continue during the entire duration of the project and shall permanently centralize data that shall be sent for processing. For the collection of the necessary data we shall relay upon the help of neonatologists and family physicians who represent the first categories of doctors that enter into contact with the patients. Both categories shall be informed about the necessity of collecting the data and shall be encouraged to send towards the specialist pediatric surgeon all the patients that present at birth or in the first months of life a vascular anomaly. One of the scientific challenges that may occur consists in the lack of adequate information of the doctors regarding the pathology that shall be studied. In order to solve this issue, the providing of documentary materials for the correct information of the doctors shall be necessary. Centralizing all information received from the parents (case history), co-related with the results of the clinical and imagistic investigation, a database of the patients shall be created. The UMFB medical staff will conceive a standard consent form and present it to the kin in order to complete. Among the technical challenges that may occur, the most important is represented by the poor quality of the digital images or of the video recordings. This problem may occur especially because of the patients. We reiterate that the study has as subject infants and small children who have a diminished capacity to comply with the logistic requirements for the recordings. The agitation of the patient during the clinical examination and the imagistic investigation may lead to unclear photos, inadequate video recordings and inexact thermographic and ultrasound recordings. As a measure of diminishing this impediment, a close co-operation with the family of the patients is required, a permanent exchange of information. The challenge shall be solved by centralizing a sufficient number of medical cases and associate images. The number of images collected for each studied period must be sufficiently high in order to choose the most relevant data that shall be sent for processing. The number of patients that we shall tray to make part of the study is of approximately 100. The registration of all data shall be made initially at the moment of the first examination and of the diagnosis, followed by new data collected with the occasion of each doctor appointment.
Extension of the portfolio of therapeutical and diagnosis methods
The medical team, who shall coordinate the centralizing of clinical and imagistic data, relies at present for the establishing of a diagnosis upon a Doppler ultrasound of an average performance from the point of view of tissue penetration. Besides ultrasound recordings, photo and video, thermographical images shall be used and the modality of collecting and saving must be well understood by all the participants to the study. A new therapeutical method, innovative and universally used at international level resides in more sessions of Long pulsed Nd: YAG Laser 1064nm that we also wish to add to the current portfolio of therapeutical methods. The technical problems that may occur in fulfilling this objective are mostly of financial nature and related to the logistic of the acquisition of new equipment for the project, the modality of settlement being a good co-operation between the CO members and P3, on one hand, and the management of UMFB, on the other hand.
Elaboration of Analysis Methods and Processing of the specific images of hemangiomas and of the Methods of Prediction and Evolution
Temporal sequences of photographic, thermographic and ultrasound images for each patient shall be taken, at equal intervals in time. (The RMI images shall not be subject of our research in view of the above mentioned obstacles). Pre-processing and geometrical registration of the images shall be performed. One will design specific algorithms for segmentation, alignment and extraction of characteristic features for each type of image. One will elaborate a specific procedure for feature fusion. Prediction algorithms will be developed using the features extracted and fused, correlated with the associated clinical observations. A challenge in reaching this objective is represented by the establishing of the main guidelines based upon which the software system for the prediction of the evolution of the hemangioma shall be achieved. This challenge shall be mitigated by a close co-operation between the medical partner and the researchers in the field of technology information and by a rigorous analysis of the diagnosis associated to each image analyzed for the correct identification of the specific features for each identified case.
The specific objectives represented by the projection of algorithms represent the essential steps in order to achieve the general objective of the project and represent at the same time challenges from a scientific point of view, taking into consideration the prior approaches practically absent. The overcoming of these scientific challenges resides in projecting innovative algorithms for images processing adapted to the specific cases represented by the hemangiomas.
The Transfer and Dissemination of the Results in the Current Practice
This objective is important in achieving the general objective of the project due to the necessity of exposing the results for a further applicability. The results of the research project shall be present to the specialized public in order to improve the quality of the medical act and to the patients and their families in order to better understand the methods of treatment available to them. Using the medical software system, even the doctor who is not initiated in the study of this pathology shall be able to orientate both in terms of diagnosis and in terms of the recommended methods of treatment. This software shall be provided to the medical personnel for a 4 week free trial. Related to this matter, no technical or scientific challenges are foreseen. Moreover, while attending congresses and workshops, during the two years of duration of the project, presentation of the results of the study shall be held, in special sessions. One of the challenges that may occur could be a lack of receptivity of the organizers of the congresses that may lead to a limitation of the presentation of the new information accumulated within the project. In such a case, the challenge shall be mitigated by dissemination of the information by open access on-line journals.
- The main result of the project is creating an automatic image processing and prediction software to identify cutaneous hemangiomas and establish their evolution trends. This final outcome summarizes all the objectives and results of the project. The purpose of this software is to streamline the diagnosis of vascular anomalies and to establish as soon as possible a treatment strategy relaying on previous observations.
- The database gathers clinical information, anamnestic or obtained by way of direct observation, photographic digital images, ultrasound, thermographic and video sequences. The database has to be well organized and the selection of the images and clinical features representative. This result is also a first time achievement. Until present it was never accomplished a triple association of imagistic procedures for each studied lesion.
- Based on the information gathered in the database, at the end of the project we will elaborate a digital atlas that presents in parallel photographic, thermographic and ultrasound frames. All this images will be presented in evolution sequences in order to exemplify the specific modifications that appear after using each type of therapeutic procedure. Also, this atlas is an innovative achievement, following the details of the former paragraph.
- The data can be used even after the conclusion of the research study for the purpose of initiating multiple clinical studies in order to deepen the therapeutic methods.
- Publishing articles resulted from the collaboration between the medical and engineering team. This important method of dissemination can lead to national and international recognition of the produced software.
- Presentation of the results during specialized conferences and workshops. These events will be organized under the patronage of one of the surgical or orthopedics existing societies during important national events.
- Brochures created for patients and family information. This contains all available treatment methods, each one’s feasibility and the contact data of the researchers presented in the study.
- Also as a direct result of the project is the employment of 17 researchers, 1 post doctorate researcher and 3 PhD researchers, on a period between 4 to 24 months. Their contribution to the project is essential and critical, the results and achievements of the research depending entirely on their distribution and competence.