Thank you very much for your question and feedback after having tried out the Clara COVID-19 pipeline. Thank you also for your patience on getting a response from us, as we had been doing some internal investigation before responding.
Please advise us what software was used in your rendering, and confirm both the segmentation and original images used in the rendering are in DICOM format.
Before diving into the details, please let me clarify that for the COVID-19 pipeline, the lung segmentation AI inference result (shown in your test correctly aligned) is fed into the COVID-19 classification model to arrive at the final predictions and hence classification result, which is not affected by the lesion segmentation orientation misalignment. Besides, the lesion to lung volume ratio is not affected. So, both DICOM Reports for classification and volume ratio are correct, and the issue is isolated to the lesion segmentation orientation.
So, here are the observations:
- The seg image (in MHD) out of the Lesion operator in the COVID-19 pipeline is overlaid correctly on the DICOM Series, using Slicer 4.11. Please see attached screenshot. and
- The DICOM Seg instance that is generated from the above image is shown diagonally inverted, (-1, -1) transformed, when viewed in MicroDICOM. Please see attached screenshot, and
- In screenshot provided by you, both the original and seg images are inverted (R/L) compared to the above DICOM Viewer display.
So, the lesion segmentation is diagonally inverted. A bug has been logged and the fix will be scheduled. Below are a few points that may lead to the possible root cause of the issue:
- In this particular Lesion operator, the input image is loaded as closest canonical (the lung seg does not do this) , so special processing was required for writing out the resultant seg image into MetaIO format.
- When loaded into 3D Slicer, the orientation was correctly processed and seg image shown correctly even with the somewhat different TranformMatrix (note the associated AnatomicalOrientation = LPI".
- In the DICOM segmentation writer, the seg image is loaded back using Simple ITK, and the image slices are used to generate the DICOM Seg IOD referencing the original DICOM instances.
- During this loading phase, the image orientation may not have been handled correctly.
Hope this helps explain the issue, and we’ll work to confirm and address the root cause.