Alison Pouch

Research Associate

I am a member of the Penn Image Computing and Science Laboratory in the Department of Radiology and the Gorman Cardiovascular Research Group in the Department of Surgery. My general research interests include 3D echocardiographic (3DE) imaging, cardiovascular physiology, and quantitative medical image analysis, especially image segmentation and shape theory. Within this broad scope, my research goals focus on developing quantitative methods for 4D morphological assessment of heart valves in real-time 3DE images. The motivation for these goals is to maximize the potential of cardiac ultrasound for image-based guidance of surgical treatment for heart valve disease.

Projects

Education

University of Pennsylvania, 2007 – 2013

  • Ph.D. in Bioengineering
  • HHMI-NIBIB Interfaces Program in Biomedical Imaging and Informational Sciences

The College of William and Mary, 2003 – 2007

  • B.S. in Physics with a dual concentration in Anthropology

Links

Research Gate | PubMed | Google Scholar

Peer-reviewed journal and conference publications

  • [DOI] A. S. Jassar, M. M. Levack, R. Solorzano, A. M. Pouch, G. Ferrari, A. Cheung, V. A. Ferrari, J. H. Gorman 3rd, R. Gorman, and B. M. Jackson, “Feasibility of In Vivo Human Aortic Valve Modeling Using Real-Time Three-Dimensional Echocardiography.,” Ann Thorac Surg, 2014.
    [Bibtex]
    @ARTICLE{Jassar2014ATS,
    author = {Jassar, Arminder S. and Levack, Melissa M. and Solorzano, Ricardo
    D. and Pouch, Alison M. and Ferrari, Giovanni and Cheung, Albert
    T. and Ferrari, Victor A. and Gorman, 3rd, Joseph H and Gorman, Robert
    C. and Jackson, Benjamin M.},
    title = {{F}easibility of {I}n {V}ivo {H}uman {A}ortic {V}alve {M}odeling
    {U}sing {R}eal-{T}ime {T}hree-{D}imensional {E}chocardiography.},
    journal = {{A}nn {T}horac {S}urg},
    year = {2014},
    month = {Feb},
    abstract = {Surgical techniques for aortic valve (AV) repair are directed toward
    restoring normal structural relationships in the aortic root and
    rely on detailed assessment of root and valve anatomy. Noninvasive
    three-dimensional (3D) imaging and modeling may assist in patient
    selection and operative planning.Transesophageal real-time 3D echocardiographic
    images of 5 patients with normal AV were acquired. The aortic root
    and the annulus were manually segmented at end diastole using a 36-point
    rotational template. The AV leaflets and the coaptation zone were
    manually segmented in parallel 1-mm cross sections. Quantitative
    3D models of the AV and root were generated and used to measure standard
    anatomic parameters and were compared to conventional two-dimensional
    echocardiographic measurements. All measurements are given as mean
    ± SD.Annular, sinus, and sinotubular junction areas were 4.1 ± 0.6
    cm(2), 7.5 ± 1.2 cm(2), and 3.9 ± 1.0 cm(2), respectively. Root diameters
    (measured in three locations) by 3D model inspection and two-dimensional
    echocardiography measurement correlated (R(2) = 0.75). Noncoapted
    areas of the left, right, and noncoronary leaflets were 1.9 ± 0.2
    cm(2), 1.6 ± 0.3 cm(2), and 1.6 ± 0.3 cm(2), respectively. Mean coaptation
    areas for the left-right, left-noncoronary, and right-noncoronary
    coaptation zones were 87.7 ± 36.9 mm(2), 69.9 ± 20.7 mm(2), and 114.2
    ± 23.0 mm(2), respectively. The mean ratio of noncoapted leaflet
    area to annular area was 1.3 ± 0.2.High-resolution 3D models of the
    in vivo normal human aortic root and valve were generated using 3D
    echocardiography. Quantitative 3D models and analysis may assist
    in characterization of pathology and decision making for AV repair.},
    doi = {10.1016/j.athoracsur.2013.12.017},
    institution = {{D}epartment of {S}urgery, {U}niversity of {P}ennsylvania, {P}hiladelphia,
    {P}ennsylvania. {E}lectronic address: benjamin.jackson@uphs.upenn.edu.},
    language = {eng},
    medline-pst = {aheadofprint},
    owner = {alison},
    pii = {S0003-4975(13)02852-X},
    pmid = {24518577},
    timestamp = {2014.02.27},
    url = {http://dx.doi.org/10.1016/j.athoracsur.2013.12.017}
    }
  • [DOI] E. K. Shang, E. Lai, A. M. Pouch, R. Hinmon, R. C. Gorman, J. H. Gorman 3rd, C. Sehgal, G. Ferrari, J. E. Bavaria, and B. Jackson, “Validation of semiautomated and locally resolved aortic wall thickness measurements from computed tomography.,” J Vasc Surg, 2014.
    [Bibtex]
    @ARTICLE{Shang2014JVS,
    author = {Shang, Eric K. and Lai, Eric and Pouch, Alison M. and Hinmon, Robin
    and Gorman, Robert C. and Gorman, 3rd, Joseph H and Sehgal, Chandra
    M. and Ferrari, Giovanni and Bavaria, Joseph E. and Jackson, Benjamin
    M.},
    title = {{V}alidation of semiautomated and locally resolved aortic wall thickness
    measurements from computed tomography.},
    journal = {{J} {V}asc {S}urg},
    year = {2014},
    month = {Jan},
    abstract = {Aortic wall thickness (AWT) is important for anatomic description
    and biomechanical modeling of aneurysmal disease. However, no validated,
    noninvasive method for measuring AWT exists. We hypothesized that
    semiautomated image segmentation algorithms applied to computed tomography
    angiography (CTA) can accurately measure AWT.Aortic samples from
    10 patients undergoing open thoracoabdominal aneurysm repair were
    taken from sites of the proximal or distal anastomosis, or both,
    yielding 13 samples. Aortic specimens were fixed in formalin, embedded
    in paraffin, and sectioned. After staining with hematoxylin and eosin
    and Masson's trichrome, sections were digitally scanned and measured.
    Patients' preoperative CTA Digital Imaging and Communications in
    Medicine (DICOM; National Electrical Manufacturers Association, Rosslyn,
    Va) images were segmented into luminal, inner arterial, and outer
    arterial surfaces with custom algorithms using active contours, isoline
    contour detection, and texture analysis. AWT values derived from
    image data were compared with measurements of corresponding pathologic
    specimens.AWT determined by CTA averaged 2.33 ± 0.66 mm (range, 1.52-3.55 mm),
    and the AWT of pathologic specimens averaged 2.36 ± 0.75 mm (range,
    1.51-4.16 mm). The percentage difference between pathologic specimens
    and CTA-determined AWT was 9.5\% ± 4.1\% (range, 1.8\%-16.7\%). The
    correlation between image-based measurements and pathologic measurements
    was high (R = 0.935). The 95\% limits of agreement computed by Bland-Altman
    analysis fell within the range of -0.42 and 0.42 mm.Semiautomated
    analysis of CTA images can be used to accurately measure regional
    and patient-specific AWT, as validated using pathologic ex vivo human
    aortic specimens. Descriptions and reconstructions of aortic aneurysms
    that incorporate locally resolved wall thickness are feasible and
    may improve future attempts at biomechanical analyses.},
    doi = {10.1016/j.jvs.2013.11.065},
    institution = {{D}epartment of {S}urgery, {U}niversity of {P}ennsylvania, {P}hiladelphia,
    {P}a; {D}ivision of {V}ascular {S}urgery and {E}ndovascular {T}herapy,
    {U}niversity of {P}ennsylvania, {P}hiladelphia, {P}a. {E}lectronic
    address: benjamin.jackson@uphs.upenn.edu.},
    language = {eng},
    medline-pst = {aheadofprint},
    owner = {alison},
    pii = {S0741-5214(13)02160-5},
    pmid = {24388698},
    timestamp = {2014.02.27},
    url = {http://dx.doi.org/10.1016/j.jvs.2013.11.065}
    }
  • [DOI] A. M. Pouch, M. Vergnat, J. R. McGarvey, G. Ferrari, B. M. Jackson, C. M. Sehgal, P. A. Yushkevich, R. C. Gorman, and J. Gorman 3rd, “Statistical assessment of normal mitral annular geometry using automated three-dimensional echocardiographic analysis.,” Ann Thorac Surg, vol. 97, iss. 1, pp. 71-77, 2014.
    [Bibtex]
    @ARTICLE{Pouch2014ATS,
    author = {Pouch, Alison M. and Vergnat, Mathieu and McGarvey, Jeremy R. and
    Ferrari, Giovanni and Jackson, Benjamin M. and Sehgal, Chandra M.
    and Yushkevich, Paul A. and Gorman, Robert C. and Gorman, 3rd, Joseph
    H},
    title = {{S}tatistical assessment of normal mitral annular geometry using
    automated three-dimensional echocardiographic analysis.},
    journal = {{A}nn {T}horac {S}urg},
    year = {2014},
    volume = {97},
    pages = {71--77},
    number = {1},
    month = {Jan},
    abstract = {The basis of mitral annuloplasty ring design has progressed from qualitative
    surgical intuition to experimental and theoretical analysis of annular
    geometry with quantitative imaging techniques. In this work, we present
    an automated three-dimensional (3D) echocardiographic image analysis
    method that can be used to statistically assess variability in normal
    mitral annular geometry to support advancement in annuloplasty ring
    design.Three-dimensional patient-specific models of the mitral annulus
    were automatically generated from 3D echocardiographic images acquired
    from subjects with normal mitral valve structure and function. Geometric annular
    measurements including annular circumference, annular height, septolateral
    diameter, intercommissural width, and the annular height to intercommissural
    width ratio were automatically calculated. A mean 3D annular contour
    was computed, and principal component analysis was used to evaluate
    variability in normal annular shape.The following mean ± standard
    deviations were obtained from 3D echocardiographic image analysis:
    annular circumference, 107.0 ± 14.6 mm; annular height, 7.6 ± 2.8
    mm; septolateral diameter, 28.5 ± 3.7 mm; intercommissural width,
    33.0 ± 5.3 mm; and annular height to intercommissural width ratio,
    22.7\% ± 6.9\%. Principal component analysis indicated that shape
    variability was primarily related to overall annular size, with more
    subtle variation in the skewness and height of the anterior annular
    peak, independent of annular diameter.Patient-specific 3D echocardiographic-based
    modeling of the human mitral valve enables statistical analysis of
    physiologically normal mitral annular geometry. The tool can potentially
    lead to the development of a new generation of annuloplasty rings
    that restore the diseased mitral valve annulus back to a truly normal
    geometry.},
    doi = {10.1016/j.athoracsur.2013.07.096},
    institution = {{G}orman {C}ardiovascular {R}esearch {G}roup, {U}niversity of {P}ennsylvania,
    {P}hiladelphia, {P}ennsylvania; {D}epartment of {S}urgery, {U}niversity
    of {P}ennsylvania, {P}hiladelphia, {P}ennsylvania. {E}lectronic address:
    gormanj@uphs.upenn.edu.},
    language = {eng},
    medline-pst = {ppublish},
    owner = {alison},
    pii = {S0003-4975(13)01709-8},
    pmid = {24090576},
    timestamp = {2014.02.27},
    url = {http://dx.doi.org/10.1016/j.athoracsur.2013.07.096}
    }
  • [DOI] A. M. Pouch, H. Wang, M. Takabe, B. M. Jackson, J. Gorman 3rd, R. C. Gorman, P. A. Yushkevich, and C. M. Sehgal, “Fully automatic segmentation of the mitral leaflets in 3D transesophageal echocardiographic images using multi-atlas joint label fusion and deformable medial modeling.,” Med Image Anal, vol. 18, iss. 1, pp. 118-129, 2014.
    [Bibtex]
    @ARTICLE{Pouch2014MIA,
    author = {Pouch, A. M. and Wang, H. and Takabe, M. and Jackson, B. M. and Gorman,
    3rd, JH and Gorman, R. C. and Yushkevich, P. A. and Sehgal, C. M.},
    title = {{F}ully automatic segmentation of the mitral leaflets in 3{D} transesophageal
    echocardiographic images using multi-atlas joint label fusion and
    deformable medial modeling.},
    journal = {{M}ed {I}mage {A}nal},
    year = {2014},
    volume = {18},
    pages = {118--129},
    number = {1},
    month = {Jan},
    abstract = {Comprehensive visual and quantitative analysis of in vivo human mitral
    valve morphology is central to the diagnosis and surgical treatment
    of mitral valve disease. Real-time 3D transesophageal echocardiography
    (3D TEE) is a practical, highly informative imaging modality for
    examining the mitral valve in a clinical setting. To facilitate visual
    and quantitative 3D TEE image analysis, we describe a fully automated
    method for segmenting the mitral leaflets in 3D TEE image data. The
    algorithm integrates complementary probabilistic segmentation and
    shape modeling techniques (multi-atlas joint label fusion and deformable
    modeling with continuous medial representation) to automatically
    generate 3D geometric models of the mitral leaflets from 3D TEE image
    data. These models are unique in that they establish a shape-based
    coordinate system on the valves of different subjects and represent
    the leaflets volumetrically, as structures with locally varying thickness.
    In this work, expert image analysis is the gold standard for evaluating
    automatic segmentation. Without any user interaction, we demonstrate
    that the automatic segmentation method accurately captures patient-specific
    leaflet geometry at both systole and diastole in 3D TEE data acquired
    from a mixed population of subjects with normal valve morphology
    and mitral valve disease.},
    doi = {10.1016/j.media.2013.10.001},
    institution = {{D}epartment of {B}ioengineering, {U}niversity of {P}ennsylvania,
    {P}hiladelphia, {PA}, {U}nited {S}tates; {G}orman {C}ardiovascular
    {R}esearch {G}roup, {U}niversity of {P}ennsylvania, {P}hiladelphia,
    {PA}, {U}nited {S}tates. {E}lectronic address: pouch@seas.upenn.edu.},
    language = {eng},
    medline-pst = {ppublish},
    owner = {alison},
    pii = {S1361-8415(13)00142-4},
    pmid = {24184435},
    timestamp = {2014.02.27},
    url = {http://dx.doi.org/10.1016/j.media.2013.10.001}
    }
  • A. M. Pouch, H. Wang, M. Takabe, B. M. Jackson, C. M. Sehgal, J. H. Gorman 3rd, R. C. Gorman, and P. A. Yushkevich, “Automated segmentation and geometrical modeling of the tricuspid aortic valve in 3D echocardiographic images.,” Med Image Comput Comput Assist Interv, vol. 16, iss. Pt 1, pp. 485-492, 2013.
    [Bibtex]
    @ARTICLE{Pouch2013MICCAI,
    author = {Pouch, Alison M. and Wang, Hongzhi and Takabe, Manabu and Jackson,
    Benjamin M. and Sehgal, Chandra M. and Gorman, 3rd, Joseph H and
    Gorman, Robert C. and Yushkevich, Paul A.},
    title = {{A}utomated segmentation and geometrical modeling of the tricuspid
    aortic valve in 3{D} echocardiographic images.},
    journal = {{M}ed {I}mage {C}omput {C}omput {A}ssist {I}nterv},
    year = {2013},
    volume = {16},
    pages = {485--492},
    number = {Pt 1},
    abstract = {The aortic valve has been described with variable anatomical definitions,
    and the consistency of 2D manual measurement of valve dimensions
    in medical image data has been questionable. Given the importance
    of image-based morphological assessment in the diagnosis and surgical
    treatment of aortic valve disease, there is considerable need to
    develop a standardized framework for 3D valve segmentation and shape
    representation. Towards this goal, this work integrates template-based
    medial modeling and multi-atlas label fusion techniques to automatically
    delineate and quantitatively describe aortic leaflet geometry in
    3D echocardiographic (3DE) images, a challenging task that has been
    explored only to a limited extent. The method makes use of expert
    knowledge of aortic leaflet image appearance, generates segmentations
    with consistent topology, and establishes a shape-based coordinate
    system on the aortic leaflets that enables standardized automated
    measurements. In this study, the algorithm is evaluated on 11 3DE
    images of normal human aortic leaflets acquired at mid systole. The
    clinical relevance of the method is its ability to capture leaflet
    geometry in 3DE image data with minimal user interaction while producing
    consistent measurements of 3D aortic leaflet geometry.},
    institution = {{D}epartment of {R}adiology, {U}niversity of {P}ennsylvania, {P}hiladelphia,
    {PA}, {USA}.},
    language = {eng},
    medline-pst = {ppublish},
    owner = {alison},
    pmid = {24505702},
    timestamp = {2014.02.27}
    }
  • [DOI] A. M. Pouch, C. Xu, P. A. Yushkevich, A. S. Jassar, M. Vergnat, J. H. Gorman 3rd, R. C. Gorman, C. M. Sehgal, and B. M. Jackson, “Semi-automated mitral valve morphometry and computational stress analysis using 3D ultrasound.,” J Biomech, vol. 45, iss. 5, pp. 903-907, 2012.
    [Bibtex]
    @ARTICLE{Pouch2012JB,
    author = {Pouch, Alison M. and Xu, Chun and Yushkevich, Paul A. and Jassar,
    Arminder S. and Vergnat, Mathieu and Gorman, 3rd, Joseph H and Gorman,
    Robert C. and Sehgal, Chandra M. and Jackson, Benjamin M.},
    title = {{S}emi-automated mitral valve morphometry and computational stress
    analysis using 3{D} ultrasound.},
    journal = {{J} {B}iomech},
    year = {2012},
    volume = {45},
    pages = {903--907},
    number = {5},
    month = {Mar},
    abstract = {In vivo human mitral valves (MV) were imaged using real-time 3D transesophageal
    echocardiography (rt-3DTEE), and volumetric images of the MV at mid-systole
    were analyzed by user-initialized segmentation and 3D deformable
    modeling with continuous medial representation, a compact representation
    of shape. The resulting MV models were loaded with physiologic pressures
    using finite element analysis (FEA). We present the regional leaflet
    stress distributions predicted in normal and diseased (regurgitant)
    MVs. Rt-3DTEE, semi-automated leaflet segmentation, 3D deformable
    modeling, and FEA modeling of the in vivo human MV is tenable and
    useful for evaluation of MV pathology.},
    doi = {10.1016/j.jbiomech.2011.11.033},
    institution = {{D}epartment of {B}ioengineering, {U}niversity of {P}ennsylvania,
    {P}hiladelphia, {PA}, {USA}.},
    keywords = {Echocardiography, Three-Dimensional, methods; Echocardiography, Transesophageal,
    methods; Finite Element Analysis; Heart Valve Diseases, pathology/ultrasonography;
    Humans; Image Interpretation, Computer-Assisted, methods; Mitral
    Valve, pathology/ultrasonography; Models, Cardiovascular; Ultrasonics,
    methods},
    language = {eng},
    medline-pst = {ppublish},
    owner = {alison},
    pii = {S0021-9290(11)00715-9},
    pmid = {22281408},
    timestamp = {2014.02.27},
    url = {http://dx.doi.org/10.1016/j.jbiomech.2011.11.033}
    }
  • [DOI] A. M. Pouch, P. A. Yushkevich, B. M. Jackson, A. S. Jassar, M. Vergnat, J. H. Gorman, R. C. Gorman, and C. M. Sehgal, “Development of a semi-automated method for mitral valve modeling with medial axis representation using 3D ultrasound.,” Med Phys, vol. 39, iss. 2, pp. 933-950, 2012.
    [Bibtex]
    @ARTICLE{Pouch2012MP,
    author = {Pouch, Alison M. and Yushkevich, Paul A. and Jackson, Benjamin M.
    and Jassar, Arminder S. and Vergnat, Mathieu and Gorman, Joseph H.
    and Gorman, Robert C. and Sehgal, Chandra M.},
    title = {{D}evelopment of a semi-automated method for mitral valve modeling
    with medial axis representation using 3{D} ultrasound.},
    journal = {{M}ed {P}hys},
    year = {2012},
    volume = {39},
    pages = {933--950},
    number = {2},
    month = {Feb},
    abstract = {Precise 3D modeling of the mitral valve has the potential to improve
    our understanding of valve morphology, particularly in the setting
    of mitral regurgitation (MR). Toward this goal, the authors have
    developed a user-initialized algorithm for reconstructing valve geometry
    from transesophageal 3D ultrasound (3D US) image data.Semi-automated
    image analysis was performed on transesophageal 3D US images obtained
    from 14 subjects with MR ranging from trace to severe. Image analysis
    of the mitral valve at midsystole had two stages: user-initialized
    segmentation and 3D deformable modeling with continuous medial representation
    (cm-rep). Semi-automated segmentation began with user-identification
    of valve location in 2D projection images generated from 3D US data.
    The mitral leaflets were then automatically segmented in 3D using
    the level set method. Second, a bileaflet deformable medial model
    was fitted to the binary valve segmentation by Bayesian optimization.
    The resulting cm-rep provided a visual reconstruction of the mitral
    valve, from which localized measurements of valve morphology were
    automatically derived. The features extracted from the fitted cm-rep
    included annular area, annular circumference, annular height, intercommissural
    width, septolateral length, total tenting volume, and percent anterior
    tenting volume. These measurements were compared to those obtained
    by expert manual tracing. Regurgitant orifice area (ROA) measurements
    were compared to qualitative assessments of MR severity. The accuracy
    of valve shape representation with cm-rep was evaluated in terms
    of the Dice overlap between the fitted cm-rep and its target segmentation.The
    morphological features and anatomic ROA derived from semi-automated
    image analysis were consistent with manual tracing of 3D US image
    data and with qualitative assessments of MR severity made on clinical
    radiology. The fitted cm-reps accurately captured valve shape and
    demonstrated patient-specific differences in valve morphology among
    subjects with varying degrees of MR severity. Minimal variation in
    the Dice overlap and morphological measurements was observed when
    different cm-rep templates were used to initialize model fitting.This
    study demonstrates the use of deformable medial modeling for semi-automated
    3D reconstruction of mitral valve geometry using transesophageal
    3D US. The proposed algorithm provides a parametric geometrical representation
    of the mitral leaflets, which can be used to evaluate valve morphology
    in clinical ultrasound images.},
    doi = {10.1118/1.3673773},
    institution = {{D}epartment of {B}ioengineering, {U}niversity of {P}ennsylvania,
    {P}hiladelphia, {PA} 19104, {USA}. pouch@seas.upenn.edu},
    keywords = {Algorithms; Computer Simulation; Echocardiography, Three-Dimensional,
    methods; Humans; Image Enhancement, methods; Image Interpretation,
    Computer-Assisted, methods; Mitral Valve, anatomy /&/ histology/ultrasonography;
    Models, Anatomic; Models, Cardiovascular; Pattern Recognition, Automated,
    methods; Reproducibility of Results; Sensitivity and Specificity},
    language = {eng},
    medline-pst = {ppublish},
    owner = {alison},
    pmid = {22320803},
    timestamp = {2014.02.27},
    url = {http://dx.doi.org/10.1118/1.3673773}
    }
  • [DOI] A. M. Pouch, H. Wang, P. A. Yushkevich, M. Takabe, B. M. Jackson, J. H. Gorman 3rd, R. C. Gorman, and C. M. Sehgal, Fully automatic segmentation of the open mitral leaflets in 3D transesophageal echocardiographic images using multi-atlas label fusion and deformable medial modeling, 2012.
    [Bibtex]
    @PROCEEDINGS{2012,
    title = {{F}ully automatic segmentation of the open mitral leaflets in {3D}
    transesophageal echocardiographic images using multi-atlas label
    fusion and deformable medial modeling},
    year = {2012},
    author = {Pouch, Alison M. and Wang, Hongzhi and Yushkevich, Paul A. and Takabe,
    Manabu and Jackson, Benjamin M. and Gorman, 3rd, Joseph H. and Gorman,
    Robert C. and Sehgal, Chandra M.},
    booktitle = {{U}ltrasonics {S}ymposium ({IUS}), 2012 {IEEE} {I}nternational},
    doi = {10.1109/ULTSYM.2012.0055},
    owner = {alison},
    pages = {220--223},
    timestamp = {2014.02.27},
    url = {http://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=6562275}
    }
  • [DOI] D. P. Nathan, C. Xu, A. M. Pouch, K. B. Chandran, B. Desjardins, J. H. Gorman 3rd, R. M. Fairman, R. C. Gorman, and B. M. Jackson, “Increased wall stress of saccular versus fusiform aneurysms of the descending thoracic aorta.,” Ann Vasc Surg, vol. 25, iss. 8, pp. 1129-1137, 2011.
    [Bibtex]
    @ARTICLE{Nathan2011AVS,
    author = {Nathan, Derek P. and Xu, Chun and Pouch, Alison M. and Chandran,
    Krishnan B. and Desjardins, Benoit and Gorman, 3rd, Joseph H and
    Fairman, Ron M. and Gorman, Robert C. and Jackson, Benjamin M.},
    title = {{I}ncreased wall stress of saccular versus fusiform aneurysms of
    the descending thoracic aorta.},
    journal = {{A}nn {V}asc {S}urg},
    year = {2011},
    volume = {25},
    pages = {1129--1137},
    number = {8},
    month = {Nov},
    abstract = {Repair of fusiform descending thoracic aortic aneurysms (DTAs) is
    indicated when aneurysmal diameter exceeds a certain threshold; however,
    diameter-related indications for repair of saccular DTA are less
    well established.Human subjects with fusiform (n = 17) and saccular
    (n = 17) DTAs who underwent computed tomographic angiography were
    identified. Patients with aneurysms related to connective tissue
    disease were excluded. The thoracic aorta was segmented, reconstructed,
    and triangulated to create a mesh. Finite element analysis was performed
    using a pressure load of 120 mm Hg and a uniform aortic wall thickness
    of 3.2 mm to compare the pressure-induced wall stress of fusiform
    and saccular DTAs.The mean maximum diameter of the fusiform DTAs
    (6.0 ± 1.5 cm) was significantly greater (p = 0.006) than that of
    the saccular DTAs (4.4 ± 1.8 cm). However, mean peak wall stress
    of the fusiform DTAs (0.33 ± 0.15 MPa) was equivalent to that of
    the saccular DTAs (0.30 ± 0.14 MPa), as found by using an equivalence
    threshold of 0.15 MPa. The mean normalized wall stress (peak wall
    stress divided by maximum aneurysm radius) of the saccular DTAs was
    greater than that of the fusiform DTAs (0.16 ± 0.09 MPa/cm vs. 0.11
    ± 0.03 MPa/cm, p = 0.035).The normalized wall stress for saccular
    DTA is greater than that for fusiform DTA, indicating that geometric
    factors such as aneurysm shape influence wall stress. These results
    suggest that saccular aneurysms may be more prone to rupture than
    fusiform aneurysms of similar diameter, provide a theoretical rationale
    for the repair of saccular DTAs at a smaller diameter, and suggest
    investigation of the role of biomechanical modeling in surgical decision
    making is warranted.},
    doi = {10.1016/j.avsg.2011.07.008},
    institution = {{D}epartment of {G}eneral {S}urgery, {H}ospital of the {U}niversity
    of {P}ennsylvania, {P}hiladelphia, {PA} 19104, {USA}.},
    keywords = {Aged; Aged, 80 and over; Aorta, Thoracic, physiopathology/radiography;
    Aortic Aneurysm, Thoracic, physiopathology/radiography; Aortography,
    methods; Biomechanical Phenomena; Blood Pressure; Chi-Square Distribution;
    Computer Simulation; Female; Finite Element Analysis; Hemodynamics;
    Humans; Male; Middle Aged; Models, Cardiovascular; Philadelphia;
    Prognosis; Retrospective Studies; Stress, Mechanical; Tomography,
    X-Ray Computed},
    language = {eng},
    medline-pst = {ppublish},
    owner = {alison},
    pii = {S0890-5096(11)00359-1},
    pmid = {22023944},
    timestamp = {2014.02.27},
    url = {http://dx.doi.org/10.1016/j.avsg.2011.07.008}
    }
  • [DOI] A. S. Jassar, C. J. Brinster, M. Vergnat, D. J. Robb, T. J. Eperjesi, A. M. Pouch, A. T. Cheung, S. J. Weiss, M. A. Acker, J. H. Gorman 3rd, R. C. Gorman, and B. Jackson, “Quantitative mitral valve modeling using real-time three-dimensional echocardiography: technique and repeatability.,” Ann Thorac Surg, vol. 91, iss. 1, pp. 165-171, 2011.
    [Bibtex]
    @ARTICLE{Jassar2011ATS,
    author = {Jassar, Arminder Singh and Brinster, Clayton J. and Vergnat, Mathieu
    and Robb, J Daniel and Eperjesi, Thomas J. and Pouch, Alison M. and
    Cheung, Albert T. and Weiss, Stuart J. and Acker, Michael A. and
    Gorman, 3rd, Joseph H and Gorman, Robert C. and Jackson, Benjamin
    M.},
    title = {{Q}uantitative mitral valve modeling using real-time three-dimensional
    echocardiography: technique and repeatability.},
    journal = {{A}nn {T}horac {S}urg},
    year = {2011},
    volume = {91},
    pages = {165--171},
    number = {1},
    month = {Jan},
    abstract = {Real-time three-dimensional (3D) echocardiography has the ability
    to construct quantitative models of the mitral valve (MV). Imaging
    and modeling algorithms rely on operator interpretation of raw images
    and may be subject to observer-dependent variability. We describe
    a comprehensive analysis technique to generate high-resolution 3D
    MV models and examine interoperator and intraoperator repeatability
    in humans.Patients with normal MVs were imaged using intraoperative
    transesophageal real-time 3D echocardiography. The annulus and leaflets
    were manually segmented using a TomTec Echo-View workstation. The
    resultant annular and leaflet point cloud was used to generate fully
    quantitative 3D MV models using custom Matlab algorithms. Eight images
    were subjected to analysis by two independent observers. Two sequential
    images were acquired for 6 patients and analyzed by the same observer.
    Each pair of annular tracings was compared with respect to conventional
    variables and by calculating the mean absolute distance between paired
    renderings. To compare leaflets, MV models were aligned so as to
    minimize their sum of squares difference, and their mean absolute
    difference was measured.Mean absolute annular and leaflet distance
    was 2.4±0.8 and 0.6±0.2 mm for the interobserver and 1.5±0.6 and
    0.5±0.2 mm for the intraobserver comparisons, respectively. There
    was less than 10\% variation in annular variables between comparisons.These
    techniques generate high-resolution, quantitative 3D models of the
    MV and can be used consistently to image the human MV with very small
    interoperator and intraoperator variability. These data lay the framework
    for reliable and comprehensive noninvasive modeling of the normal
    and diseased MV.},
    doi = {10.1016/j.athoracsur.2010.10.034},
    institution = {{D}epartment of {S}urgery, {H}ospital of the {U}niversity of {P}ennsylvania,
    {P}hiladelphia, {P}ennsylvania 19104, {USA}.},
    keywords = {Echocardiography, Three-Dimensional; Echocardiography, Transesophageal;
    Heart Valve Diseases, pathology/ultrasonography; Humans; Image Processing,
    Computer-Assisted, methods; Mitral Valve; Models, Cardiovascular;
    Monitoring, Intraoperative; Observer Variation; Predictive Value
    of Tests; Reproducibility of Results},
    language = {eng},
    medline-pst = {ppublish},
    owner = {alison},
    pii = {S0003-4975(10)02379-9},
    pmid = {21172507},
    timestamp = {2014.02.27},
    url = {http://dx.doi.org/10.1016/j.athoracsur.2010.10.034}
    }
  • [DOI] M. Vergnat, A. S. Jassar, B. M. Jackson, L. P. Ryan, T. J. Eperjesi, A. M. Pouch, S. J. Weiss, A. T. Cheung, M. A. Acker, J. H. Gorman 3rd, and R. C. Gorman, “Ischemic mitral regurgitation: a quantitative three-dimensional echocardiographic analysis.,” Ann Thorac Surg, vol. 91, iss. 1, pp. 157-164, 2011.
    [Bibtex]
    @ARTICLE{Vergnat2011ATS,
    author = {Vergnat, Mathieu and Jassar, Arminder S. and Jackson, Benjamin M.
    and Ryan, Liam P. and Eperjesi, Thomas J. and Pouch, Alison M. and
    Weiss, Stuart J. and Cheung, Albert T. and Acker, Michael A. and
    Gorman, 3rd, Joseph H and Gorman, Robert C.},
    title = {{I}schemic mitral regurgitation: a quantitative three-dimensional
    echocardiographic analysis.},
    journal = {{A}nn {T}horac {S}urg},
    year = {2011},
    volume = {91},
    pages = {157--164},
    number = {1},
    month = {Jan},
    abstract = {A comprehensive three-dimensional echocardiography based approach
    is applied to preoperative mitral valve (MV) analysis in patients
    with ischemic mitral regurgitation (IMR). This method is used to
    characterize the heterogeneous nature of the pathologic anatomy associated
    with IMR.Intraoperative real-time three-dimensional transesophageal
    echocardiograms of 18 patients with IMR (10 with anterior, 8 with
    inferior infarcts) and 17 patients with normal MV were analyzed.
    A customized image analysis protocol was used to assess global and
    regional determinants of annular size and shape, leaflet tethering
    and curvature, relative papillary muscle anatomy, and anatomic regurgitant
    orifice area.Both mitral annular area and MV tenting volume were
    increased in the IMR group as compared with patients with normal
    MV (mitral annular area=1,065±59 mm2 versus 779±44 mm2, p=0.001;
    and MV tenting volume=3,413±403 mm3 versus 1,696±200 mm3, p=0.001,
    respectively). Within the IMR group, patients with anterior infarct
    had larger annuli (1,168±99 mm2) and greater tenting volumes (4,260±779
    mm3 versus 2,735±245 mm3, p=0.06) than the inferior infarct subgroup.
    Papillary-annular distance was increased in the IMR group relative
    to normal; these distances were largest in patients with anterior
    infarcts. Whereas patients with normal MV had very consistent anatomic
    determinants, annular shape and leaflet tenting distribution in the
    IMR group were exceedingly variable. Mean anatomic regurgitant orifice
    area was 25.8±3.0 mm2, and the number of discrete regurgitant orifices
    varied from 1 to 4.Application of custom analysis techniques to three-dimensional
    echocardiography images allows a quantitative and systematic analysis
    of the MV, and demonstrates the extreme variability in pathologic
    anatomy that occurs in patients with severe IMR.},
    doi = {10.1016/j.athoracsur.2010.09.078},
    institution = {{D}epartment of {S}urgery, {U}niversity of {P}ennsylvania, {P}hiladelphia,
    {P}ennsylvania, {USA}.},
    keywords = {Aged; Aged, 80 and over; Echocardiography, Three-Dimensional; Female;
    Humans; Male; Middle Aged; Mitral Valve Insufficiency, etiology/surgery/ultrasonography;
    Myocardial Ischemia, complications/surgery/ultrasonography; Predictive
    Value of Tests; Reproducibility of Results; sisted},
    language = {eng},
    medline-pst = {ppublish},
    owner = {alison},
    pii = {S0003-4975(10)02217-4},
    pmid = {21172506},
    timestamp = {2014.02.27},
    url = {http://dx.doi.org/10.1016/j.athoracsur.2010.09.078}
    }
  • A. M. Pouch, T. W. Cary, S. M. Schultz, and C. M. Sehgal, “In vivo noninvasive temperature measurement by B-mode ultrasound imaging.,” J Ultrasound Med, vol. 29, iss. 11, pp. 1595-1606, 2010.
    [Bibtex]
    @ARTICLE{Pouch2010JUM,
    author = {Pouch, Alison M. and Cary, Theodore W. and Schultz, Susan M. and
    Sehgal, Chandra M.},
    title = {{I}n vivo noninvasive temperature measurement by {B}-mode ultrasound
    imaging.},
    journal = {{J} {U}ltrasound {M}ed},
    year = {2010},
    volume = {29},
    pages = {1595--1606},
    number = {11},
    month = {Nov},
    abstract = {This study investigated the use of ultrasound image analysis in quantifying
    temperature changes in tissue, both ex vivo and in vivo, undergoing
    local hyperthermia.Temperature estimation is based on the thermal
    dependence of the acoustic speed in a heated medium. Because standard
    beam-forming algorithms on clinical ultrasound scanners assume a
    constant acoustic speed, temperature-induced changes in acoustic
    speed produce apparent scatterer displacements in B-mode images.
    A cross-correlation algorithm computes axial speckle pattern displacement
    in B-mode images of heated tissue, and a theoretically derived temperature-displacement
    relationship is used to generate maps of temperature changes within
    the tissue. Validation experiments were performed on excised tissue
    and in murine subjects, wherein low-intensity ultrasound was used
    to thermally treat tissue for several minutes. Diagnostic temperature
    estimation was performed using a linear array ultrasound transducer,
    while a fine-wire thermocouple invasively measured the temperature
    change.Pearson correlations ± SDs between the image-derived and thermocouple-measured
    temperature changes were R² = 0.923 ± 0.066 for 4 thermal treatments
    of excised bovine muscle tissue and R² = 0.917 ± 0.036 for 4 treatments
    of in vivo murine tumor tissue. The average differences between the
    two temperature measurements were 0.87°C ± 0.72°C for ex vivo studies
    and 0.97°C ± 0.55°C for in vivo studies. Maps of the temperature
    change distribution in tissue were generated for each experiment.This
    study demonstrates that velocimetric measurement on B-mode images
    has potential to assess temperature changes noninvasively in clinical
    applications.},
    institution = {{D}epartment of {R}adiology, {U}niversity of {P}ennsylvania, 3400
    {S}pruce {S}treet, {P}hiladelphia, {PA} 19104 {USA}. pouch@seas.upenn.edu},
    keywords = {Algorithms; Animals; Cattle; Female; Hyperthermia, Induced, instrumentation/methods;
    Image Processing, Computer-Assisted; Lung Neoplasms, therapy/ultrasonography;
    Mice; Mice, Nude; Temperature; Transducers; Ultrasonography, methods},
    language = {eng},
    medline-pst = {ppublish},
    owner = {alison},
    pii = {29/11/1595},
    pmid = {20966471},
    timestamp = {2014.02.27}
    }
  • [DOI] J. E. Lynch, A. Pouch, R. Sanders, M. Hinders, K. Rudd, and J. Sevick, “Gaseous microemboli sizing in extracorporeal circuits using ultrasound backscatter.,” Ultrasound Med Biol, vol. 33, iss. 10, pp. 1661-1675, 2007.
    [Bibtex]
    @ARTICLE{Lynch2007UMB,
    author = {Lynch, John E. and Pouch, Alison and Sanders, Randi and Hinders,
    Mark and Rudd, Kevin and Sevick, John},
    title = {{G}aseous microemboli sizing in extracorporeal circuits using ultrasound
    backscatter.},
    journal = {{U}ltrasound {M}ed {B}iol},
    year = {2007},
    volume = {33},
    pages = {1661--1675},
    number = {10},
    month = {Oct},
    abstract = {This paper describes efforts to estimate the size of gaseous microemboli
    (GME) in extracorporeal blood circuits based on the amplitude of
    backscattered ultrasound, starting with analytic modeling of the
    scattering behavior of GME in blood. After neglecting resonance effects,
    this model predicts a linear relationship between the amplitude of
    backscattered echoes and the diameter of GME. Computer simulations
    based on the cylindrical acoustic finite integration technique were
    performed to test some of the simplifying assumptions of the analytical
    model, with the simulations predicting small deviations from the
    linear approximation that could be treated as random scatter. Ultrasonic
    and microscopic measurements of injected GME were then performed
    on a test circuit to determine the linear correlation coefficient
    between echo amplitude and GME diameter in conditions like those
    employed in real cardiopulmonary bypass (CPB) circuits. The correlation
    coefficient determined through this study was further validated in
    a closed-loop CPB circuit using canine blood. This study shows that
    the amplitude of ultrasonic backscattered echoes can be used to accurately
    estimate the size distribution of a population of detected GME when
    the spacing of emboli is great enough to minimize interference and
    other multi-path scattering effects. With the high flow rates found
    in CPB circuits, typically ranging from 2 to 6 L per minute (equivalent
    to a flow velocity of 0.3 to 1 m/s through the circuit tubing), this
    assumption will be valid even when hundreds of emboli per second
    pass through the circuit. Therefore, sizing of GME using the ultrasonic
    backscatter models described in this paper is a viable method for
    estimating embolic load delivered to a patient during a CPB procedure.},
    doi = {10.1016/j.ultrasmedbio.2007.04.008},
    institution = {{L}una {I}nnovations {I}ncorporated, {H}ampton, {VA} 23185, {USA}.
    lyncht@lunainnovations.com},
    keywords = {Algorithms; Animals; Cardiopulmonary Bypass, adverse effects; Computer
    Simulation; Dogs; Embolism, Air, ultrasonography; Extracorporeal
    Circulation, adverse effects; Humans; Image Interpretation, Computer-Assisted;
    Models, Animal; Scattering, Radiation; Ultrasonics},
    language = {eng},
    medline-pst = {ppublish},
    owner = {alison},
    pii = {S0301-5629(07)00204-9},
    pmid = {17570578},
    timestamp = {2014.02.27},
    url = {http://dx.doi.org/10.1016/j.ultrasmedbio.2007.04.008}
    }

Short conference papers and abstracts

  • [DOI] A. M. Pouch, H. Wang, P. A. Yushkevich, M. Takabe, B. M. Jackson, J. H. Gorman 3rd, R. C. Gorman, and C. M. Sehgal, Fully automatic segmentation of the open mitral leaflets in 3D transesophageal echocardiographic images using multi-atlas label fusion and deformable medial modeling, 2012.
    [Bibtex]
    @PROCEEDINGS{2012,
    title = {{F}ully automatic segmentation of the open mitral leaflets in {3D}
    transesophageal echocardiographic images using multi-atlas label
    fusion and deformable medial modeling},
    year = {2012},
    author = {Pouch, Alison M. and Wang, Hongzhi and Yushkevich, Paul A. and Takabe,
    Manabu and Jackson, Benjamin M. and Gorman, 3rd, Joseph H. and Gorman,
    Robert C. and Sehgal, Chandra M.},
    booktitle = {{U}ltrasonics {S}ymposium ({IUS}), 2012 {IEEE} {I}nternational},
    doi = {10.1109/ULTSYM.2012.0055},
    owner = {alison},
    pages = {220--223},
    timestamp = {2014.02.27},
    url = {http://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=6562275}
    }