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BR-122025027202-A2 - A SYSTEM FOR AUTOMATIC PERFUSION EVALUATION OF AN ANATOMICAL STRUCTURE DURING A MEDICAL PROCEDURE ON AN INDIVIDUAL AND A COMPUTER-IMPLEMENTED METHOD FOR DETECTING PERFUSION CHANGES IN AN ANATOMICAL REGION OF INTEREST IN AN INDIVIDUAL BY IMAGE PROCESSING HEMODYNAMICS IN AT LEAST A PART OF SAID ANATOMICAL REGION OF INTEREST IN VIDEO IMAGES ACQUIRED FROM THE INDIVIDUAL

BR122025027202A2BR 122025027202 A2BR122025027202 A2BR 122025027202A2BR-122025027202-A2

Abstract

The present invention relates to a method for decoding a video signal based on adaptive multiple transforms (AMT), the method comprising the steps of: obtaining an AMT index from the video signal, wherein the AMT index indicates any one of a plurality of transform combinations in a transform configuration group, and the transform configuration group includes the discrete sine transform type 7 (DST7) and the discrete cosine transform type 8 (DCT8); deriving a transform combination corresponding to the AMT index, wherein the transform combination consists of a horizontal transform and a vertical transform, and includes at least one of the DST-7 or DCT-8, performing an inverse transform on a current block based on the transform combination, and restoring the video signal using the inversely transformed current block, wherein the AMT represents a transform scheme that is performed based on a transform combination adaptively selected from a plurality of transform combinations.

Inventors

  • MORTEN TOFT LUND
  • Mads Holst Aagaard Madsen

Assignees

  • PERFUSION TECH APS

Dates

Publication Date
20260310
Application Date
20190614
Priority Date
20180614

Claims (20)

  1. 1. System for automatic perfusion assessment of an anatomical structure during a medical procedure on an individual, the system characterized in that it comprises a controllable injection pump to hold at least one primary fluorescence imaging agent, the injection pump being configured to inject a bolus corresponding to a predefined quantity of said primary fluorescence imaging agent into a vein of the individual, wherein the system is configured to receive and analyze a time series of fluorescence images of the tissue of said anatomical structure following the injection of the primary fluorescence imaging agent, and to determine at least one perfusion parameter of said anatomical structure based on said analysis.
  2. 2. System according to claim 1, characterized in that the bolus corresponds to less than 0.01 mg ICG/kg of body weight of the first fluorescence imaging agent.
  3. 3. System according to claim 1, characterized in that the bolus corresponds to less than 0.5 mg ICG of the first fluorescence imaging agent.
  4. 4. System according to claim 1, characterized in that the fluorescent agent is ICG and in that the amount of ICG in the bolus is less than 0.01 mg/kg of body weight.
  5. 5. System according to claim 1, characterized in that the fluorescence agent is ICG and in that the amount of ICG in the bolus is less than 1 mg ICG or less than 0.5 mg ICG.
  6. 6. System according to any one of claims 1 to 5, characterized in that the system is configured to inject boli at intervals between 5 and 600 seconds, such as between 15 and 300 seconds, for example between 45 and 210 seconds, such as between 90 and 120 seconds.
  7. 7. A system according to any one of claims 1 to 6, characterized in that the system is configured to determine an individual-specific minimum effective bolus of fluorescence imaging agent by: - controlling the injection pump to inject a series of boluses with varying amounts of fluorescence imaging agent with a predefined time period between each bolus, - analyzing the fluorescence emission of the anatomical structure following the injection of each bolus, and - determining the minimum bolus size that provides a quantifiable fluorescence emission of the anatomical structure.
  8. 8. System according to claim 7, characterized in that the quantifiable fluorescence emission of the anatomical structure corresponds to a fluorescence emission such that a perfusion slope can be determined.
  9. 9. System according to any one of claims 1 to 8, characterized in that the system is configured to determine an individual-specific perturbation interval defined as the period of time from the increase in a fluorescence slope until the fluorescence emission falls below a series of standard deviations, such as 20, 10 or 5 standard deviations, from a background noise.
  10. 10. System according to any one of claims 1 to 9, characterized in that the system is configured to automatically 1) control the injection pump to inject a series of predefined boluses of fluorescence imaging agent, a predefined bolus such as the minimum effective bolus, with a predefined duration between each bolus, and 2) determine at least one perfusion parameter of said anatomical structure following the injection of each bolus.
  11. 11. System according to any one of claims 1 to 10, characterized in that the system is configured to automatically 1) control the injection pump to inject a series of boluses with varying amounts of fluorescence imaging agent with a predefined time period between each bolus, and 2) determine at least one perfusion parameter of said anatomical structure following the injection of each bolus.
  12. 12. A system according to any one of claims 1 to 11, characterized in that it is configured to retain at least one second fluorescent agent that is different from the first fluorescent agent, and wherein the system is configured to inject one or more boli having a predefined quantity of said second fluorescent imaging agent into the individual's blood.
  13. 13. A system according to any one of claims 1 to 12, characterized in that the system is configured to determine said at least one perfusion parameter in one or more regions of interest located in said anatomical structure and optionally in neighboring anatomical structures, and in which said regions of interest can be optionally selected by a user of the system.
  14. 14. A system according to any one of claims 1 to 13, characterized in that it further comprises at least one light source configured to provide excitation light to induce fluorescence emission of said first and/or second fluorescent agent in said anatomical structure, and an imaging unit configured to record in said time series the fluorescence emission of the anatomical structure.
  15. 15. A system according to any one of claims 1 to 14, characterized in that it is additionally configured to track movements of at least one subsection of the anatomical structure in said time series of images, and to correlate said movements in such a way that at least said first region of interest corresponds to the same subsection of the anatomical structure in said images, and wherein the motion tracking is provided by free image tracking and/or object-based tracking.
  16. 16. A computer-implemented method for detecting perfusion changes in an anatomical region of interest in an individual by hemodynamic image processing in at least a portion of said anatomical region of interest in video images acquired from the individual, the method characterized in that it comprises the steps of: - performing image analysis of at least one video sequence acquired during and/or after a plurality of boluses comprising fluorescence imaging agent are delivered to the individual, wherein the plurality of boluses is delivered according to a predefined pattern, such as in terms of frequency and/or dose, - calculating subsequent perfusion parameters in one or more regions of interest based on the image analysis, and - monitoring the subsequent perfusion parameters to determine a change in perfusion in said region(s) of interest.
  17. 17. Method according to claim 16 characterized in that each bolus plurality corresponds to less than 0.01 mg ICG/kg body weight of the first fluorescence imaging agent.
  18. 18. Method according to claim 16 or 17, characterized in that the agent is injected by a controllable injection pump.
  19. 19. Method according to any one of claims 16 to 18, characterized in that the agent is injected as a series of boli with a predefined time between subsequent boli.
  20. 20. Method according to any one of claims 16 to 19, characterized in that the fluorescence emission of the anatomical structure is measured following the injection of each bolus.

Description

[001] The present description refers to a system and a method for automatically measuring and evaluating hemodynamics in the tissue of an anatomical structure of an individual. In particular, the present description refers to continuously measuring and evaluating hemodynamics in medical procedures using fluorescence imaging, where the administration of the fluorescent agent is controlled and automated. Fundamentals of the invention [002] The injection of fluorescence imaging agents, also known as fluorescent contrast agents, such as indocyanine green (ICG), to visualize blood flow and perfusion in anatomical structures was introduced many years ago, but the clinical use of this technology has been scarce. Today, the dose of the fluorescence agent must be large enough to ensure a strong visual signal, which can be easily detected by the surgeon. Therefore, the assessment of, for example, tissue perfusion based on fluorescence agents is based on the surgeon's visual inspection, i.e., it is largely subjective and can therefore vary between surgeons. An improved quantitative analytical approach for assessing perfusion in the gastrointestinal tract is described in the pending application PCT/EP2017/082204 entitled “System and method for assessing perfusion in an anatomical structure” and published as WO 2018/104552, by the same inventors. This application is incorporated herein by reference in its entirety. [003] Existing methods for fluorescence imaging typically rely on only a few perfusion measurements, perhaps just one, taken at critical points during the medical procedure, for example, before an intestinal resection and after the creation of an intestinal anastomosis. To create a fluorescence signal visible to the surgeon (or other medical professionals), a substantial dose of fluorescent agent is required. Such a substantial dose results in a visible burst of fluorescence emission, but also in a washout period of perhaps 20-30 minutes, during which the fluorescent agent is still in the patient's blood, giving rise to a visible background fluorescent emission signal. This visible fluorescent emission signal during the washout period, where the fluorescent agent is removed from the blood, will often prevent the medical team from initiating new fluorescence measurements during the washout period. [004] Today, measurements employing fluorescence imaging involve many manual steps, where the entire operating room is “paused” for several minutes. Typically, it is the surgeon who decides to perform a measurement involving fluorescent imaging, for example, evaluating tissue perfusion in an anatomical structure. Initially, the surgeon correctly positions the anatomical areas of interest in the video image received from a white light camera, for example, an endoscopic camera. The surgeon then switches from normal white light to another camera that can capture the fluorescent light emitted by the areas of interest, and the surgeon asks an assistant to inject the fluorescent agent into a peripheral vein. After approximately 30 seconds of waiting, the first fluorescent emission signal will appear, and the surgeon waits a few minutes until it is decided that the visual fluorescent signal has been sufficiently evaluated. Summary of the invention [005] Manual administration and evaluation of fluorescent images combined with only discrete measurements with long washout periods constitute significant practical limitations for the use of fluorescence image perfusion analysis in elective and emergency procedures. During emergency procedures, it is crucial not to perform a surgical intervention larger than necessary, as this increases surgery time and postoperative morbidity. At the same time, the surgeon cannot afford to leave an organ or part of the intestine insufficiently perfused, which can cause tissue ischemia, necrosis, infections, anastomotic leakage, and even death [Lioit et al. 2018]. An objective of the present invention is, therefore, to make fluorescence imaging more amenable to integration during emergency procedures. [006] In a first embodiment, the present description therefore refers to a system for automatic perfusion assessment of an individual's anatomical structure, for example, during medical procedures such as surgery. The system can be configured to control the injection of a predefined quantity of a fluorescence imaging agent into the individual's blood. The injection can be delivered by means of a controllable injection pump, which may be under the control of the system. The injection pump may be part of the system; the system comprises at least one controllable injection pump to contain at least one fluorescence imaging agent. That is, this injection pump can be configured to inject a predefined quantity of said fluorescence imaging agent into the individual's blood. Preferably, the system is configured so that the predefined quantity of said fluorescence imaging agent is repeatedly injected at regul