1. ©2005 Surgical Planning Laboratory, ARR Slide 1 COPD: Phenotypes from CT analysis Raul San Jose Estepar, Ph.D.

2. ©2005 Surgical Planning Laboratory, ARR Slide 2 Clinical relevance COPD is characterized by: Airway narrowing/remodeling. Parenchymal destruction. Hypothesis: Improve diagnosis and therapeutic strategies by better understanding the mechanisms leading to airflow obstruction. This means that we can provide the therapy that is best suited for a given phenotype. Goal: Development of robust automated tool for analysis of CT chest scans. Definition of COPD phenotypes.

3. ©2005 Surgical Planning Laboratory, ARR Slide 3 Challenges for the Phenotype quest Definition of lung mask Airway analysis: Lumen segmentation Wall segmentation Quantitative analysis

4. ©2005 Surgical Planning Laboratory, ARR Slide 4 Lung mask Lung mask extraction for a High Resolution CT scan Definition of a lung mask is the first step of the processing pipeline. Mask extraction allows lung mask density analysis.

5. ©2005 Surgical Planning Laboratory, ARR Slide 5 Migration of methods originally developed for brain segmentation and vascular segmentation Vessel segmentation: Lorigo et al., 2001. Brain segmentation: Pichon et al, 2003 Airways: From the brain to the lungs Sponsored by NAC

6. ©2005 Surgical Planning Laboratory, ARR Slide 6 Airway centerlines Segmented airway and extracted centerline. Airway centerlines serve as a tree representation of the airway structure

7. ©2005 Surgical Planning Laboratory, ARR Slide 7 Airway inspection Focusing on the airway wall by traveling along the airway. New CT view in planes orthogonal to the airway.

8. ©2005 Surgical Planning Laboratory, ARR Slide 8 Airway wall Development of new methods for the segmentation of airway wall. Challenge: wall not always visible due to occlusion with pulmonary vessels.

9. ©2005 Surgical Planning Laboratory, ARR Slide 9 Quantitative analysis Lung mask density. Wall thickness. Percentage of wall area. Geometric measures: curvature of airway lumen. Rate of change across airway generations.

10. ©2005 Surgical Planning Laboratory, ARR Slide 10 Collaborators SPL: S. Haker, Ph.D. C-F. Westin, Ph.D. Channing Lab: E. Silverman, M.D. Pulmonary division: G. Washko, M.D. J.J. Reilly, M.D.