Computer Vision Aided Image Analysis and Volumetric Reconstruction of The Kidney to Improve Detection of Obstruction in the Urinary Tract Dr. Pramod Reddy

Problem Statement The Heart, Central Nervous System and Urinary tract make up the top three organ systems involved with congenital malformations. One of the more common diagnoses that involves the Kidneys is – Hydronephrosis (urine being retained in the Kidney). This is found to some extent in 1in 500 live births. During scans of a kidney there is a need to distinguish Hydronephrosis that is physiological and does not need any further intervention compared to clinically significant obstruction that will cause loss of renal function if untreated.

Title Problem Statement (2) The current clinical practice involves a series of tests over time to follow the Hydronephrotic kidney with the goal of distinguishing with high sensitivity and specificity the obstructed kidneys. Once a obstructed kidney has been identified – surgical correction is then undertaken and the obstruction is removed and the kidney is reconstructed The likelihood of the obstruction recurring is about 1-2% over the lifetime of the patient – so long term follow-up is needed.

Problem Statement (3) Current imaging tests to detect clinically significant obstruction are invasive, not very specific with borderline cases and can require the patient to be sedated for the test to be conducted. The current diagnostic tests to detect obstruction include – Nuclear Scans, MRI and Contrast Studies.

Title Problem Statement (4) Most of these require an IV in the patient to administer the contrast or nuclide tracer and also involve radiation exposure. Also due to the nature of the equipment required – not all hospitals have this equipment. Having a Ultrasound based imaging strategy to reliably detect clinically significant obstruction would be a ‘Game Changer’ and benefit the patients and the healthcare systems by providing better value – Pt experience, reducing cost of care and be safer (no radiation exposure) as well as making the test ubiquitous – available around the world.

Goals Goals The goal is to create image analysis algorithms that can take advantage of advances in ‘Computer Vision’ and train the Ultrasound machines or an AI platform to create a volumetric image reconstruction of the kidney as it is being scanned. Multiple image planes of the kidney are taken using Ultrasound scans and reconstructed to provide a calculation of the kidney volume. This can either be done in real-time or post-image acquisition analysis The volumetric ratio of the parenchyma and the collecting system (urine) is used to provide a proxy calculation of the volume of the kidneys. We would then create Clinical Nomograms that would be used to indicate if a particular renal parenchyma to collecting system ratio was indicative of a clinically significant obstruction

Success Outcomes Automated image analysis (either in real-time or post-image acquisition) calculation and reconstruction of the kidney volume. Development of Clinical Nomograms that will indicate clinically significant obstruction with a high reliability and with high degree of sensitivity and specificity

Constraints Constraints Easy to use and set up Quantitative and reproducible results Non-Ionizing radiation Minimal manual intervention – the algorithms will automate this process No hardware needed - it performs post-acquisition image analysis of U/S images of the kidneys Can be licensed to any and all U/S manufacturers to be included in their Kidney suite of software Is not restricted to Pediatric cases - even adults have these issues We here at CCHMC have a large cohort of these Pts - so we can be intimately involved in validating/calibrating the sensitivity and specificity of the algorithms with clinical cases (including before and after surgical interventions).

Summary The breadth of the market is vast This is not limited to any geographic regions and can be used through out the world  This has the potential to be a ‘Game Changer’ in the diagnosis of renal obstruction – can be used in prenatal diagnoses also The absence of the need for an IV or Radiation is huge – there will be reduced harm from the radiation and no patient that I have ever met has told me that he is happy to have an IV. The introduction of Computer Vision into Medicine will be a landmark event and can be spread to other organ systems and can be scaled up as needed

Summary Such a tool will serve a large patient population that have abnormal upper urinary tracts. Will permit early diagnosis of obstructed kidneys and prevent injury to the kidney Prevent unnecessary surgery on kidneys that are not REALLY obstructed It is a scalable technology that will have wide spread implementation in any Radiology/Imaging Dept