The evaluation of visualization methods or designs often relies on user studies. Apart from the difficulties involved in the design of the study itself, the existing mechanisms to obtain sound conclusions are often unclear. In this work, we review and summarize some of the common statistical techniques that can be used to validate a claim in the scenarios that are commonly present in user studies in visualization, i.e., hypothesis testing. Usually, the number of participants is small and the mean and variance of the distribution are not known. Therefore, we will focus on the techniques that are adequate within these limitations. Our aim for this paper is to clarify the goals and limitations of hypothesis testing from a user study perspective, that can be interesting for the visualization community. We provide an overview of the most common mistakes made when testing a hypothesis that can lead to erroneous claims. We also present strategies to avoid those. @en

Several diagnostic and treatment procedures require the segmentation of anatomical structures from medical images. However, the automatic model-based methods that are often employed, may produce inaccurate segmentations. These, if used as input for diagnosis or treatment, can have detrimental effects for the patients. Currently, an analysis to predict which anatomic regions are more prone to inaccuracies, and to determine how to improve segmentation algorithms, cannot be performed. We propose a visual tool to enable experts, working on model-based segmentation algorithms, to explore and analyze the outcomes and errors of their methods. Our approach supports the exploration of errors in a cohort of pelvic organ segmentations, where the performance of an algorithm can be assessed. Also, it enables the detailed exploration and assessment of segmentation errors, in individual subjects. To the best of our knowledge, there is no other tool with comparable functionality. A usage scenario is employed to explore and illustrate the capabilities of our visual tool. To further assess the value of the proposed tool, we performed an evaluation with five segmentation experts. The evaluation participants confirmed the potential of the tool in providing new insight into their data and employed algorithms. They also gave feedback for future improvements.@en

The Online Anatomical Human (OAH) is a web-based viewer for studying anatomy. It is based on real human anatomy and incorporates medical image data in linked 2D and 3D views that students can freely interact with. Our application is the only to support 2D and 3D views based on real medical imaging data. The main goal of this anatomical online resource is to serve as an educational platform available to anyone with access to a modern web browser. Users can annotate regions, add comments, and provide hyperlinks to additional media. By making our work accessible to medical experts, we can ensure an increasing amount of information, leading to an ever-growing gain in educational value. The OAH will be used in an upcoming Massive Open Online Course (MOOC) to teach anatomy of the pelvis and will be made available to students worldwide via the web. @en

Accurate segmentation of brain white matter hyperintensities (WMHs) is important for prognosis and disease monitoring. To this end, classifiers are often trained – usually, using T1 and FLAIR weighted MR images. Incorporating additional features, derived from diffusion weighted MRI, could improve classification. However, the multitude of diffusion-derived features requires selecting the most adequate. For this, automated feature selection is commonly employed, which can often be sub-optimal. In this work, we propose a different approach, introducing a semi-automated pipeline to select interactively features for WMH classification. The advantage of this solution is the integration of the knowledge and skills of experts in the process. In our pipeline, a Visual Analytics (VA) system is employed, to enable user-driven feature selection. The resulting features are T1, FLAIR, Mean Diffusivity (MD), and Radial Diffusivity (RD) – and secondarily, C S  CS and Fractional Anisotropy (FA). The next step in the pipeline is to train a classifier with these features, and compare its results to a similar classifier, used in previous work with automated feature selection. Finally, VA is employed again, to analyze and understand the classifier performance and results.@en

To understand how the immune system works, one needs to have a clear picture of its cellular compositon and the cells’ corresponding properties and functionality. Mass cytometry is a novel technique to determine the properties of single-cells with unprecedented detail. This amount of detail allows for much finer differentiation but also comes at the cost of more complex analysis. In this work, we present Cytosplore, implementing an interactive workflow to analyze mass cytometry data in an integrated system, providing multiple linked views, showing different levels of detail and enabling the rapid definition of known and unknown cell types. Cytosplore handles millions of cells, each represented as a high-dimensional data point, facilitates hypothesis generation and confirmation, and provides a significant speed up of the current workflow. We show the effectiveness
of Cytosplore in a case study evaluation.@en

In recent years, dimensionality-reduction techniques have been developed and are widely used for hypothesis generation in Exploratory Data Analysis. However, these techniques are confronted with overcoming the trade-off between computation time and the quality of the provided dimensionality reduction. In this work, we address this limitation, by introducing Hierarchical Stochastic Neighbor Embedding (Hierarchical-SNE). Using a hierarchical representation of the data, we incorporate the well-known mantra of Overview-First, Details-On-Demand in non-linear dimensionality reduction. First, the analysis shows an embedding, that reveals only the dominant structures in the data (Overview). Then, by selecting structures that are visible in the overview, the user can filter the data and drill down in the hierarchy. While the user descends into the hierarchy, detailed visualizations of the high-dimensional structures will lead to new insights. In this paper, we explain how Hierarchical-SNE scales to the analysis of big datasets. In addition, we show its application potential in the visualization of Deep-Learning architectures and the analysis of hyperspectral images.
@en

Anatomical variations are naturally-occurring deviations from typical human anatomy. While these variations are considered normal and non-pathological, they are still of interest in clinical practice for medical specialists such as radiologists and transplantation surgeons. The complex variations in branching structures, for instance in arteries or nerves, are currently visualized side-by-side in illustrations or expressed using plain text in medical publications. In this work, we present a novel way of visualizing anatomical variations in complex branching structures for educational purposes: VarVis. VarVis consists of several linked views that reveal global and local similarities and differences in the variations. We propose a novel graph representation to provide an overview of the topological changes. Our solution involves a topological similarity measure, which allows the user to select variations at a global level based on their degree of similarity. After a selection is made, local topological differences can be interactively explored using illustrations and topology graphs. We also incorporate additional information regarding the probability of the various cases. Our solution has several advantages over traditional approaches, which we demonstrate in an evaluation.@en

In radiotherapy, tumors are irradiated with a high dose, while surrounding healthy tissues are spared. To quantify the probability that a tumor is effectively treated with a given dose, statistical models were built and employed in clinical research. These are called tumor control probability (TCP) models. Recently, TCP models started incorporating additional information from imaging modalities. In this way, patient-specific properties of tumor tissues are included, improving the radiobiological accuracy of models. Yet, the employed imaging modalities are subject to uncertainties with significant impact on the modeling outcome, while the models are sensitive to a number of parameter assumptions. Currently, uncertainty and parameter sensitivity are not incorporated in the analysis, due to time and resource constraints. To this end, we propose a visual tool that enables clinical researchers working on TCP modeling, to explore the information provided by their models, to discover new knowledge and to confirm or generate hypotheses within their data. Our approach incorporates the following four main components: (1) It supports the exploration of uncertainty and its effect on TCP models; (2) It facilitates parameter sensitivity analysis to common assumptions; (3) It enables the identification of inter-patient response variability; (4) It allows starting the analysis from the desired treatment outcome, to identify treatment strategies that achieve it. We conducted an evaluation with nine clinical researchers. All participants agreed that the proposed visual tool provides better understanding and new opportunities for the exploration and analysis of TCP modeling. @en

Cardiac flow is still not fully understood, and is currently an active research topic. Using phase-contrast magnetic resonance imaging (PC-MRI) blood flow can be measured. For the inspection of such flow, researchers often rely on methods that require additional scans produced by different imaging modalities to provide context. This requires labor-intensive registration and often manual segmentation before any exploration of the data is performed. This work provides a framework that allows for a quick exploration of cardiac flow without the need of additional imaging and time-consuming segmentation. To achieve this, only the 4D data from one PC-MRI scan is used. A context visualization is derived automatically from the data, and provides context for the flow. Instead of relying on segmentation to deliver an accurate context, the heart’s ventricles are approximated by half-ellipsoids that can be placed with minimal user interaction. Furthermore, seeding positions for flow visualization can be placed automatically in areas of interest defined by the user and based on derived flow features. The framework enables a user to do a fast initial exploration of cardiac flow, as is demonstrated by a use case and a user study involving cardiac blood flow researchers.@en

Progressive Visual Analytics aims at improving the interactivity in existing analytics techniques by means of visualization as well as interaction with intermediate results. One key method for data analysis is dimensionality reduction, for example, to produce 2D embeddings that can be visualized and analyzed efficiently. t-Distributed Stochastic Neighbor Embedding (tSNE) is a well-suited technique for the visualization of high-dimensional data. tSNE can create meaningful intermediate results but suffers from a slow initialization that constrains its application in Progressive Visual Analytics. We introduce a controllable tSNE approximation (A-tSNE), which trades off speed and accuracy, to enable interactive data exploration. We offer real-time visualization techniques, including a density-based solution and a Magic Lens to inspect the degree of approximation. With this feedback, the user can decide on local refinements and steer the approximation level during the analysis. We demonstrate our technique with several datasets, in a real-world research scenario and for the real-time analysis of high-dimensional streams to illustrate its effectiveness for interactive data analysis.@en

Magnetic Resonance Imaging (MRI) enables volumetric and time-varying measurements of blood-flow data. Such data have shown potential to improve diagnosis and risk assessment of various cardiovascular diseases. Hereby, a unique way of analysing patient-specific haemodynamics becomes possible. However, these measurements are susceptible to artifacts, noise and a coarse spatio-temporal resolution. Furthermore, typical flow visualization techniques rely on interpolation. For example, using pathlines requires a high quality temporal resolution. While numerical simulations, based on mathematical flow models, address some of these limitations, the involved modelling assumptions (e.g., regarding the inflow and mesh) do not provide patientspecific data to the degree actual measurements would. To overcome this issue, data assimilation techniques can be applied to use measured data in order to steer a physically-based simulation of the flow, combining the benefits of measured data and simulation. Our work builds upon such an existing solution to increase the temporal resolution of the measured data, but achieves significantly higher fidelity. We avoid the previous damping and interpolation bias towards one of the measurements, by simulating bidrectionally (forwards and backwards through time) and using sources and sinks. Our method is evaluated and compared to the, currently-used, conventional interpolation scheme and forward-only simulation using measured and analytical flow data. It reduces artifacts, noise, and interpolation error, while being closer to laminar flow, as is expected for flow in vessels.@en

Diffusion tensor imaging (DTI) is amongst the simplest mathematical models available for diffusion magnetic resonance imaging, yet still by far the most used one. Despite the success of DTI as an imaging tool for white matter fibers, its anatomical underpinnings on a microstructural basis remain unclear. In this study, we used 65 myelin-stained sections of human premotor cortex to validate modeled fiber orientations and oft used microstructure-sensitive scalar measures of DTI on the level of individual voxels. We performed this validation on high spatial resolution diffusion MRI acquisitions investigating both white and gray matter. We found a very good agreement between DTI and myelin orientations with the majority of voxels showing angular differences less than 10°. The agreement was strongest in white matter, particularly in unidirectional fiber pathways. In gray matter, the agreement was good in the deeper layers highlighting radial fiber directions even at lower fractional anisotropy (FA) compared to white matter. This result has potentially important implications for tractography algorithms applied to high resolution diffusion MRI data if the aim is to move across the gray/white matter boundary. We found strong relationships between myelin microstructure and DTI-based microstructure-sensitive measures. High FA values were linked to high myelin density and a sharply tuned histological orientation profile. Conversely, high values of mean diffusivity (MD) were linked to bimodal or diffuse orientation distributions and low myelin density. At high spatial resolution, DTI-based measures can be highly sensitive to white and gray matter microstructure despite being relatively unspecific to concrete microarchitectural aspects.@en

Parallel Coordinate Plots (PCPs) is one of the most powerful techniques for the visualization of multivariate data. However, for large datasets, the representation suffers from clutter due to overplotting. In this case, discerning the underlying data information and selecting specific interesting patterns can become difficult. We propose a new and simple technique to improve the display of PCPs by emphasizing the underlying data structure. Our Orientation-enhanced Parallel Coordinate Plots (OPCPs) improve pattern and outlier discernibility by visually enhancing parts of each PCP polyline with respect to its slope. This enhancement also allows us to introduce a novel and efficient selection method, the Orientation-enhanced Brushing (O-Brushing). Our solution is particularly useful when multiple patterns are present or when the view on certain patterns is obstructed by noise. We present the results of our approach with several synthetic and real-world datasets. Finally, we conducted a user evaluation, which verifies the advantages of the OPCPs in terms of discernibility of information in complex data. It also confirms that O-Brushing eases the selection of data patterns in PCPs and reduces the amount of necessary user interactions compared to state-of-the-art brushing techniques.@en

Diffusion Tensor Imaging (DTI) is a magnetic resonance imaging modality that enables the in-vivo reconstruction and visualization of fibrous structures. To inspect the local and individual diffusion tensors, glyph-based visualizations are commonly used since they are able to effectively convey full aspects of the diffusion tensor. For several applications it is necessary to compare tensor fields, e.g., to study the effects of acquisition parameters, or to investigate the influence of pathologies on white matter structures. This comparison is commonly done by extracting scalar information out of the tensor fields and then comparing these scalar fields, which leads to a loss of information. If the glyph representation is kept, simple juxtaposition or superposition can be used. However, neither facilitates the identification and interpretation of the differences between the tensor fields. Inspired by the checkerboard style visualization and the superquadric tensor glyph, we design a new glyph to locally visualize differences between two diffusion tensors by combining juxtaposition and explicit encoding. Because tensor scale, anisotropy type, and orientation are related to anatomical information relevant for DTI applications, we focus on visualizing tensor differences in these three aspects. As demonstrated in a user study, our new glyph design allows users to efficiently and effectively identify the tensor differences. We also apply our new glyphs to investigate the differences between DTI datasets of the human brain in two different contexts using different b-values, and to compare datasets from a healthy and HIV-infected subject.@en

We present the first visualization tool that combines pathlines from blood flow and wall thickness information. Our method uses illustrative techniques to provide occlusion-free visualization of the flow. We thus offer medical researchers an effective visual analysis tool for aneurysm treatment risk assessment. Such aneurysms bear a high risk of rupture and significant treatment-related risks. Therefore, to get a fully informed decision it is essential to both investigate the vessel morphology and the hemodynamic data. Ongoing research emphasizes the importance of analyzing the wall thickness in risk assessment. Our combination of blood flow visualization and wall thickness representation is a significant improvement for the exploration and analysis of aneurysms. As all presented information is spatially intertwined, occlusion problems occur. We solve these occlusion problems by dynamic cutaway surfaces. We combine this approach with a glyph-based blood flow representation and a visual mapping of wall thickness onto the vessel surface. We developed a GPU-based implementation of our visualizations which facilitates wall thickness analysis through real-time rendering and flexible interactive data exploration mechanisms. We designed our techniques in collaboration with domain experts, and we provide details about the evaluation of the technique and tool.@en

Modern MRI measurements deliver volumetric and time-varying blood-flow data of unprecedented quality. Visual analysis of these data potentially leads to a better diagnosis and risk assessment of various cardiovascular diseases. Recent advances have improved the speed and quality of the imaging data considerably. Nevertheless, the data remains compromised by noise and a lack of spatiotemporal resolution. Besides imaging data, also numerical simulations are employed. These are based on mathematical models of specific features of physical reality. However, these models require realistic parameters and boundary conditions based on measurements. We propose to use data assimilation to bring measured data and physically-based simulation together, and to harness the mutual benefits. The accuracy and noise robustness of the coupled approach is validated using an analytic flow field. Furthermore, we present a comparative visualization that conveys the differences between using conventional interpolation and our coupled approach.@en

Background: The surgical anatomy of the pelvis is highly complex. In case of rectal cancer the surgeon is challenged to perform a total mesorectal excision (TME) warranting complete removal of the tumor and preservation of the autonomic nerves. However, incomplete TME specimens and surgical damage to the nerves are still part of clinical reality. A highly-detailed 3D pelvic model would be an excellent tool to increase anatomical knowledge of the surgical anatomy of the pelvis. Visible Human Datasets (VHDs) are often used to create a 3D model, but they lack anatomical detail such as autonomic nerves and fasciae. Immunohistochemistry is an ideal method to study those key surgical structures at microscopic level. Recently, the Unified Anatomical Human (UAH) has been developed. UAH integrates heterogeneous anatomical data and will allow registration of patient-specific diagnostic images. In this study, we describe the development of The Virtual Surgical Pelvis (VSP) and its potential clinical value in anatomical education and surgical simulation.Material and methods: We selected 910 slices from a VHD that comprised the entire pelvis. All surgically relevant anatomical structures were manually segmented using Amira® software and three-dimensionally reconstructed using the UAH. The Online Anatomical Human (OAH), an online web-viewer, was developed as well. Paraffin embedded mega blocks of 1 female cadaveric pelvic exenteration specimen were sliced in transverse sections of 5 μm. A series was stained with Hematoxylin & Eosin and Masson’s Trichome and selected sections were immunohistochemically stained with S100, a pan-neuron marker. The autonomic nerves and fasciae were manually segmented in Amira® software, three-dimensionally reconstructed and integrated using the UAH.Results: Currently, the VSP presents most of the essential surgical anatomy of the pelvis, including the levator ani muscle and pudendal nerve, and can be interactively visualized in the UAH and OAH. Microscopic analysis of the female cadaveric specimen reveals the organization of autonomic nerves and fasciae in relation to pelvic organs.Conclusion: The VSP showing the complex pelvic anatomy is a potentially excellent tool for anatomical education. Registration of the VSP to patient-specific diagnostic images allows visualization of key surgical structures such as autonomic nerves and fasciae in relation to pelvic viscera. This makes surgical simulation a nearby future goal for all pelvic surgeons. No conflict of interest.@en