The effectiveness of a cardiovascular magnetic resonance (CMR) scan depends on the ability of the operator to correctly tune the acquisition parameters to the subject being scanned and on the potential occurrence of imaging artifacts, such as cardiac and respiratory motion. In the clinical practice, a quality control step is performed by visual assessment of the acquired images; however, this procedure is strongly operator-dependent, cumbersome, and sometimes incompatible with the time constraints in clinical settings and large-scale studies. We propose a fast, fully automated, and learning-based quality control pipeline for CMR images, specifically for short-axis image stacks. Our pipeline performs three important quality checks: 1) heart coverage estimation; 2) inter-slice motion detection; 3) image contrast estimation in the cardiac region. The pipeline uses a hybrid decision forest method—integrating both regression and structured classification models—to extract landmarks and probabilistic segmentation maps from both long- and short-axis images as a basis to perform the quality checks. The technique was tested on up to 3000 cases from the UK Biobank and on 100 cases from the UK Digital Heart Project and validated against manual annotations and visual inspections performed by expert interpreters. The results show the capability of the proposed pipeline to correctly detect incomplete or corrupted scans (e.g., on UK Biobank, sensitivity and specificity, respectively, 88 and 99 for heart coverage estimation and 85 and 95 for motion detection), allowing their exclusion from the analyzed dataset or the triggering of a new acquisition.
Accurate localization of anatomical landmarks is an important step in medical imaging, as it provides useful prior information for subsequent image analysis and acquisition methods. It is particularly useful for initialization of automatic image analysis tools (e.g. segmentation and registration) and detection of scan planes for automated image acquisition. Landmark localization has been commonly performed using learning based approaches, such as classifier and or regressor models. However, trained models may not generalize well in heterogeneous datasets when the images contain large differences due to size, pose and shape variations of organs. To learn more data-adaptive and patient specific models, we propose a novel stratification based training model, and demonstrate its use in a decision forest. The proposed approach does not require any additional training information compared to the standard model training procedure and can be easily integrated into any decision tree framework. The proposed method is evaluated on 1080 3D high-resolution and 90 multi-stack 2D cardiac cine MR images. The experiments show that the proposed method achieves state-of-the-art landmark localization accuracy and outperforms standard regression and classification based approaches. Additionally, the proposed method is used in a multi-atlas segmentation to create a fully automatic segmentation pipeline, and the results show that it achieves state-of-the-art segmentation accuracy. The correct acquisition of short axis (SA) cine cardiac MR image stacks requires the imaging of the full cardiac anatomy between the apex and the mitral valve plane via multiple 2D slices. While in the clinical practice the SA stacks are usually checked qualitatively to ensure full heart coverage, visual inspection can become infeasible for large amounts of imaging data that is routinely acquired, e.g. in population studies such as the UK Biobank (UKBB). Accordingly, we propose a learning-based technique for the fully-automated estimation of the heart coverage for SA image stacks. The technique relies on the identification of cardiac landmarks (i.e. the apex and the mitral valve sides) on two chamber view long axis images and on the comparison of the landmarks’ positions to the volume covered by the SA stack. Landmark detection is performed using a hybrid random forest approach integrating both regression and structured classification models. The technique was applied on 3000 cases from the UKBB and compared to visual assessment. The obtained results (error rate = 2.3 , sens. = 73 , spec. = 90 ) indicate that the proposed technique is able to correctly detect the vast majority of the cases with insufficient coverage, suggesting that it could be used as a fully-automated quality control step for CMR SA image stacks.