Towards 3D facial morphometry: facial image analysis applications in anesthesiology and 3D spectral nonrigid registration

In anesthesiology, the detection and anticipation of difficult tracheal intubation is crucial for patient safety. When undergoing general anesthesia, a patient who is unexpectedly difficult to intubate risks potential life-threatening complications with poor clinical outcomes, ranging from severe harm to brain damage or death. Conversely, in cases of suspected difficulty, specific equipment and personnel will be called upon to increase safety and the chances of successful intubation. Research in anesthesiology has associated a certain number of morphological features of the face and neck with higher risk of difficult intubation. Detecting and analyzing these and other potential features, thus allowing the prediction of difficulty of tracheal intubation in a robust, objective, and automatic way, may therefore improve the patients'€™ safety. In this thesis, we first present a method to automatically classify images of the mouth cavity according to the visibility of certain oropharyngeal structures. This method is then integrated into a novel and completely automatic method, based on frontal and profile images of the patient'€™s face, to predict the difficulty of intubation. We also provide a new database of three dimensional (3D) facial scans and present the initial steps towards a complete 3D model of the face suitable for facial morphometry applications, which include difficult tracheal intubation prediction. In order to develop and test our proposed method, we collected a large database of multimodal recordings of over 2700 patients undergoing general anesthesia. In the first part of this thesis, using two dimensional (2D) facial image analysis methods, we automatically extract morphological and appearance-based features from these images. These are used to train a classifier, which learns to discriminate between patients as being easy or difficult to intubate. We validate our approach on two different scenarios, one of them being close to a real-world clinical scenario, using 966 patients, and demonstrate that the proposed method achieves performance comparable to medical diagnosis-based predictions by experienced anesthesiologists. In the second part of this thesis, we focus on the development of a new 3D statistical model of the face to overcome some of the limitations of 2D methods. We first present EPFL3DFace, a new database of 3D facial expression scans, containing 120 subjects, performing 35 different facial expressions. Then, we develop a nonrigid alignment method to register the scans and allow for statistical analysis. Our proposed method is based on spectral geometry processing and makes use of an implicit representation of the scans in order to be robust to noise or holes in the surfaces. It presents the significant advantage of reducing the number of free parameters to optimize for in the alignment process by two orders of magnitude. We apply our proposed method on the data collected and discuss qualitative results. At its current level of performance, our fully automatic method to predict difficult intubation already has the potential to reduce the cost, and increase the availability of such predictions, by not relying on qualified anesthesiologists with years of medical training. Further data collection, in order to increase the number of patients who are difficult to intubate, as well as extracting morphological features from a 3D representation of the face are key elements to further improve the performance.

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