MIV: A Cardiac Image Visualizer

Carlos da Silva Santos1 , Luis Roberto Pereira de Paula1 , Marco Antonio Gutierrez2 , Marina S. Rebelo2 , Roberto Hirata Jr.1
1
Institute of Mathematics and Statistics and 2 Heart Institute - University of Sao Paulo (USP) - Sao Paulo, Brazil
{csantos,luisrpp,hirata}@ime.usp.br {marco.gutierrez,marina.rebelo}@incor.usp.br

AbstractIn this paper, we present a Medical Image Visualizer (MIV) targeting cardiac SPECT images. The visualizer is
built fully on open source image processing and visualization
software. The main features of the visualizer are: a semiautomatic procedure for segmenting challenging cardiac images
and an implementation of the polar map visualization (Bulls
eye diagram) that follows recent recommendations from the
American Heart Association (AHA). The features mentioned
above and the architecture design of the software make MIV
a valuable research tool for the analysis of cardiac SPECT
studies.

SPECT studies we found in our ongoing work. Secondly,

it provides the first (to the best of our knowledge) opensource implementation of the polar map visualization to
follow the new AHA recommendations [3]. We envision
MIV as an integrated tool for the analysis of SPECT
images, eventually incorporating other image processing and
visualization techniques.

Keywords-computer vision; image processing; polar map;

I. I NTRODUCTION
Single Photon Emission Computed Tomography (SPECT)
is a nuclear imaging technique based on measuring the
spatial distribution of a radionuclide. In cardiology, SPECT
imaging is widely used to assess myocardial perfusion and
left ventricular function. Improved information about the
time dependent motion of the myocardium is achieved when
the SPECT acquisition is gated to the electrocardiogram
(ECG) signal [1]. One challenge in the application of gated
SPECT studies is the efficient presentation of information,
since one single study can generate hundreds of image slices,
whose individual examination would be too time consuming [1]. To address this issue, Garcia et al proposed the polar
map [2], also called bulls eye display. The polar map is a
representation of the 3D volume of the left ventricle as a
2D circular plate. Each point of the display, corresponding
to a specific region of the myocardium (see Figure 1 for
nomenclature on the diverse regions of the left ventricle),
receives a color according to normalized count values.
The polar map became widely used in clinical practice
in the last two decades. In 2002, the American Heart
Association (AHA) issued a recommendation [3] in order to
standardize the display of information from diverse modalities, including SPECT studies and the polar map in particular
(see Figure 2). Despite the popularity of the polar map, there
is a lack of freely available research tools implementing this
type of visualization.
In this work we present MIV (an acronym for Medical
Image Visualizer), a research tool to segment and analyze
SPECT images in cardiology. The motivation for MIV is
two-fold. Firstly, it implements a semi-automatic image segmentation procedure developed for some challenging gated

Figure 1. Definition of the planes for displaying tomographic images in

cardiology. LV: left ventricle. RV: right ventricle. Adapted from [3]

1
7
2

13

8
14
9

17
15
10

12

16
11
5

1.
2.
3.
4.
5.
6.

basal
basal
basal
basal
basal
basal

anterior
anteroseptal
inferoseptal
inferior
inferolateral
anterolateral

7. mid anterior
8. mid anteroseptal
9. mid inferoseptal
10. mid inferior
11. mid inferolateral
12. mid anterolateral

13.
14.
15.
16.
17.

apical
apical
apical
apical
apex

anterior
septal
inferior
lateral

Figure 2. Standard AHA recommendations for polar map display. The

left ventricle should be divided into 17 segments, whose names are shown
in the figure. Adapted from [3]

II. S OFTWARE D ESCRIPTION

MIV is an open-source software written in the C++. It uses
a set of open-source libraries such as the Insight Toolkit [4]
(http://www.itk.org) for image processing and input/output
operations, the Visualization Toolkit [5] (http://www.vtk.org)
for image visualization and the QT library (http://www.
qtsoftware.com) for the design of the user interface.
After loading the image into the system, the user can
apply the segmentation method to isolate the left ventricle.
The segmentation is a semi-automatic procedure based on
a mathematical morphology approach [6]. At first, we need
to set markers over the left ventricle. MIV uses the Hough
Transform [4] for finding circles on all short axis (axial)

slices. This information is used to build two different heuristics for automatic marker generation. The user can also use
the marker editor to create, delete or update markers. Once
markers are set, the Watershed Transform [6] is used to
segment the left ventricle. Figure 3 illustrates this procedure.
(a) axis editor

(b) regions editor

(c) bulls eye diagram

(a) marker editor
Figure 3.

(b) segmentation result

Figure 4.

Polar map generation.

Segmentation process.

The polar map can only be generated after the segmentation process. This process is divided into three steps:
1) Axis definition. The program suggests an axis that
should pass through the center of the myocardium.
Each frame has its own axis that will guide the
generation of the polar map. The user can check the
suggestion against the axial slices (Figure 4(a)). In
case the suggestion is not satisfactory, the user can
override it by assigning a new axis with the mouse.
2) Definition of regions. The program makes a suggestion
for dividing the slices between the regions: apex,
apical, medial and basal. The user can check this
suggestion graphically (Figure 4(b)). Optionally, the
user can override the suggestion and determine a new
start and end slices for the different regions for each
frame.
3) Polar map generation. Finally, the Bulls Eye diagram
is generated and shown in the interface (Figure 4(c)).
Each frame will have its own polar map.
III. C ONCLUSION
We presented MIV, a medical image visualizer targeting
gated SPECT studies in cardiology. Although the MIV
workflow tries to minimize the amount of user intervention necessary for segmentation, there are still cases where
segmenting a whole study might be too time consuming (a
total of 23 real cases have been used to test the software).
We are experimenting now with methods to reduce further
the amount of user interaction by taking more advantage of
the inherent redundancy between markers of adjacent slices.
We tried to keep the MIV interface fully flexible, allowing
the user to override any automatic suggestion made by the
software, recognizing that no totally automatic procedure
can be accurate in all cases.
The future steps of this work is to validate the platform;
firstly with simulated cardiac data and then with annotated

real images. The validation is an important step that must be

done to make this software tool mature enough for clinical
use. Finally, we should note that until validation MIV must
be considered of research utility only.
ACKNOWLEDGMENTS
The authors would like to thank support from FAPESP,
CNPq and FINEP.
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