Covering all clinically significant areas of the colon surface in virtual colonoscopy

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Abstract
We have developed a method that automatically displays, places in sized order and allows viewing of the areas of the colon surface not visualized during initial endoscopic navigational viewing. While complete surface visualization is possible, we demonstrate that all of these missed patches do not have to be reviewed to detect clinically significant colon polyps. CT scans are performed on 147 patients and volunteers after bowel preparation and colon distention with CO2. After automatic segmentation and electronic cleansing of the colon lumen, the medial axis (centerline) is extracted. Volume rendering fly-through along the centerline is performed and visualized surfaces are marked. To simulate optical colonoscopy, the virtual camera is passed in the antegrade direction. For virtual colonoscopy, the camera is passed both antegrade and retrograde, and the combined visible surface voxel count is recorded. After both fly-throughs, the total visualized surface is recorded and all 'patches' of connected surface area not yet seen are identified, measured, sorted by size, and counted. Clinically significant patches, defined as smallest diameter being > 5mm, are sequentially visualized by stepping through the sorted list until reaching the patch diameter of 5 mm.. for each. By enabling endoscopic navigation in both antegrade and retrograde directions, virtual colonoscopy is able to evaluate behind haustral folds and around sharp bends, thereby visualizing significantly more surface area than optical colonoscopy. Furthermore, automatic marking of the visualized surface area and identifying and viewing unseen patches allows examination of all clinically significant surfaces of the colon.

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