Deep reinforcement learning for guidewire navigation in coronary artery phantom

In percutaneous intervention for treatment of coronary plaques, guidewire navigation is a primary procedure for stent delivery. Steering a flexible guidewire within coronary arteries requires considerable training, and the non-linearity between the control operation and the movement of the guidewire makes precise manipulation difficult. Here, we introduce a deep reinforcement learning(RL) framework for autonomous guidewire navigation in a robot-assisted coronary intervention. Using Rainbow, a segment-wise learning approach is applied to determine how best to accelerate training using human demonstrations with deep Q-learning from demonstrations (DQfD), transfer learning, and weight initialization. `State' for RL is customized as a focus window near the guidewire tip, and subgoals are placed to mitigate a sparse reward problem. The RL agent improves performance, eventually enabling the guidewire to reach all valid targets in `stable' phase. Our framework opens anew direction in the automation of robot-assisted intervention, providing guidance on RL in physical spaces involving mechanical fatigue.

T-Net: Encoder-Decoder in Encoder-Decoder architecture for the main vessel segmentation in coronary angiography

In this paper, we proposed T-Net containing a small encoder-decoder inside the encoder-decoder structure (EDiED). T-Net overcomes the limitation that U-Net can only have a single set of the concatenate layer between encoder and decoder block. To be more precise, the U-Net symmetrically forms the concatenate layers, so the low-level feature of the encoder is connected to the latter part of the decoder, and the high-level feature is connected to the beginning of the decoder. T-Net arranges the pooling and up-sampling appropriately during the encoder process, and likewise during the decoding process so that feature-maps of various sizes are obtained in a single block. As a result, all features from the low-level to the high-level extracted from the encoder are delivered from the beginning of the decoder to predict a more accurate mask. We evaluated T-Net for the problem of segmenting three main vessels in coronary angiography images. The experiment consisted of a comparison of U-Net and T-Nets under the same conditions, and an optimized T-Net for the main vessel segmentation. As a result, T-Net recorded a Dice Similarity Coefficient score (DSC) of 0.815, 0.095 higher than that of U-Net, and the optimized T-Net recorded a DSC of 0.890 which was 0.170 higher than that of U-Net. In addition, we visualized the weight activation of the convolutional layer of T-Net and U-Net to show that T-Net actually predicts the mask from earlier decoders. Therefore, we expect that T-Net can be effectively applied to other similar medical image segmentation problems.

Automated detection of vulnerable plaque in intravascular ultrasound images

Acute Coronary Syndrome (ACS) is a syndrome caused by a decrease in blood flow in the coronary arteries. The ACS is usually related to coronary thrombosis and is primarily caused by plaque rupture followed by plaque erosion and calcified nodule. Thin-cap fibroatheroma (TCFA) is known to be the most similar lesion morphologically to a plaque rupture. In this paper, we propose methods to classify TCFA using various machine learning classifiers including Feed-forward Neural Network (FNN), K-Nearest Neighbor (KNN), Random Forest (RF) and Convolutional Neural Network (CNN) to figure out a classifier that shows optimal TCFA classification accuracy. In addition, we suggest pixel range based feature extraction method to extract the ratio of pixels in the different region of interests to reflect the physician's TCFA discrimination criteria. A total of 12,325 IVUS images were labeled with corresponding OCT images to train and evaluate the classifiers. We achieved 0.884, 0.890, 0.878 and 0.933 Area Under the ROC Curve (AUC) in the order of using FNN, KNN, RF and CNN classifier. As a result, the CNN classifier performed best and the top 10 features of the feature-based classifiers (FNN, KNN, RF) were found to be similar to the physician's TCFA diagnostic criteria.