Segmented Images Research Articles

Aqueous Humor Angiography.

Aqueous humor angiography, or aqueous angiography, is an anterior segment imaging technique capable of visualizing the conventional/trabecular aqueous humor outflow pathways. As a translational technique, it is applicable for in vivo imaging in living subjects and ex vivo imaging using whole-globe preparations or anterior segment perfusion setups. Excellent spatial and temporal resolution has enabled insights into the segmental distribution of aqueous humor outflow in physiological conditions as well as after trabecular bypass surgery. In this chapter, we thoroughly describe aqueous humor angiography in various experimental setups. The necessary materials for different settings and their application for in vivo and ex vivo experiments as well as notes on dye choice, dye sequences, and special considerations on performing aqueous humor angiography during surgery are presented.

Two-Stage Multimodal Method for Predicting Intramuscular Fat in Pigs

Intramuscular fat (IMF) content significantly influences pork tenderness, flavor, and juiciness. Maintaining an optimal IMF range not only enhances nutritional value but also improves the taste of pork products. However, traditional IMF measurement methods are often invasive and time-consuming. Ultrasound imaging technology offers a non-destructive solution capable of predicting IMF content and assessing backfat thickness as well as longissimus dorsi muscle area size. A two-stage multimodal network model was developed in this study. First, using B-mode ultrasound images, we employed the UNetPlus segmentation network to accurately delineate the longissimus dorsi muscle area. Subsequently, we integrated data on backfat thickness and longissimus dorsi muscle area to create a multimodal input for IMF content prediction using our model. The results indicate that UNetPlus achieves a 94.17% mean Intersection over Union (mIoU) for precise longissimus dorsi muscle area segmentation. The multimodal network achieves an R2 of 0.9503 for IMF content prediction, with Spearman and Pearson correlation coefficients of 0.9683 and 0.9756, respectively, all within a compact model size of 4.96 MB. This study underscores the efficacy of combining segmented longissimus dorsi muscle images with data on backfat thickness and muscle area in a two-stage multimodal approach for predicting IMF content.

A method for measuring hairline length and discriminating hairline recession grades based on the BiSeNet model

Abstract Hair plays an important role in a person’s appearance. According to a survey by the World Health Organization, approximately 70% of adults have scalp and hair prob lems. Doctors currently make hairline recession diagnoses based on hair loss criteria, but this approach is subjective. This paper proposes a novel method for objectively assessing hairline recession grades. First, the Bilateral Segmentation Network model (BiSeNet) is utilized to obtain a facial segmentation image. Second, this paper utilizes the connected components method to improve the facial segmentation results. Next, the labeling key points method is used to extract part of the features of the eyebrow and facial region and calculate the related values. Finally, the judgment of hairline length and hairline recession grade is realized by combining these features with camera calibration. In this paper, front-face images of 50 volunteers were collected for hair line recession grade determination. The judgment results of expert doctors on hairline length and hairline recession grade were compared with the judgment results of this method. The results showed a 1.3 cm difference in the average length of the hairline and about 80% similarity in hairline recession grade judgments. In conclusion, using machine vision methods to measure the height of the hairline provides objective and repeatable results.

Research on Improved Image Segmentation Algorithm Based on GrabCut

The classic interactive image segmentation algorithm GrabCut achieves segmentation through iterative optimization. However, GrabCut requires multiple iterations, resulting in slower performance. Moreover, relying solely on a rectangular bounding box can sometimes lead to inaccuracies, especially when dealing with complex shapes or intricate object boundaries. To address these issues in GrabCut, an improvement is introduced by incorporating appearance overlap terms to optimize segmentation energy function, thereby achieving optimal segmentation results in a single iteration. This enhancement significantly reduces computational costs while improving the overall segmentation speed without compromising accuracy. Additionally, users can directly provide seed points on the image to more accurately indicate foreground and background regions, rather than relying solely on a bounding box. This interactive approach not only enhances the algorithm’s ability to accurately segment complex objects but also simplifies the user experience. We evaluate the experimental results through qualitative and quantitative analysis. In qualitative analysis, improvements in segmentation accuracy are visibly demonstrated through segmented images and residual segmentation results. In quantitative analysis, the improved algorithm outperforms GrabCut and min_cut algorithms in processing speed. When dealing with scenes where complex objects or foreground objects are very similar to the background, the improved algorithm will display more stable segmentation results.

Sorghum segmentation and leaf counting using in silico trained deep neural model

AbstractThis paper introduces a novel deep neural model for segmenting and tracking the number of leaves in sorghum plants in phenotyping facilities. Our algorithm inputs a sequence of images of a sorghum plant and outputs the segmented images and the number of leaves. The key novelty of our approach is in training the deep neural model. Manual annotations are tedious, and we have developed a procedural three‐dimensional (3D) sorghum model that provides detailed geometry and texture to generate photorealistic 3D models. The overall shape of the sorghum leaf geometry is determined by its skeleton, and it is detailed by a procedural model that varies its curvature, width, length, and overall shape. The color is determined by using a Monte Carlo path tracer. We mimic the illumination of the phenotyping facility and use reflectance and transmittance on sorghum surfaces to determine the color of the leaves. The 3D procedural model allows us to generate photorealistic and segmented images that we use to train a deep neural model. Our segmentation provides a mean intersection over union score of 0.51, resulting in leaf counting accuracy within the 90% confidence interval for the human counts.

Mechanical properties of stromal striae, and their impact on corneal tissue behavior

Cornea is an essential element of our eye. The refractive power of the cornea is closely related to its shape, which depends on the balance between its mechanical properties and the intraocular pressure. However, in keratoconus, the shape of the cornea is altered, and the mechanical properties (i.e., elastic modulus and viscosity) are reduced. These alterations have been associated with the development of striae within the cornea. Recently, such striae have been observed in healthy corneas as well, but with slightly different shapes. Our study investigated the mechanical role of these striae. To this end, we performed an inflation test under Optical Coherence Tomography: tomographic volumes were acquired in the central zone of eleven human corneas during an inflation test. Striae planes were extracted from the segmented images, and principal deformation maps were obtained by Digital Volume Correlation (DVC). We observe that the pattern of the striae does not change with pressure, even far above physiological pressure. Maximum principal strains are co-localized with the striae and are oriented perpendicular to the striae. We also observe that principal deformations on the striae increase with depth in the cornea. Our results show that striae lead to greater deformability in the direction perpendicular to the striae, especially in the posterior part of the cornea where they are the most visible. This supports the idea that the striae are undulations in the cornea collagenous microstructure, which are progressively unfolded under loading. They decrease the global stiffness of the cornea, in particular in the posterior part, and thus may help in accommodating deformations.

A Deep Learning Biomimetic Milky Way Compass.

Moving in straight lines is a behaviour that enables organisms to search for food, move away from threats, and ultimately seek suitable environments in which to survive and reproduce. This study explores a vision-based technique for detecting a change in heading direction using the Milky Way (MW), one of the navigational cues that are known to be used by night-active insects. An algorithm is proposed that combines the YOLOv8m-seg model and normalised second central moments to calculate the MW orientation angle. This method addresses many likely scenarios where segmentation of the MW from the background by image thresholding or edge detection is not applicable, such as when the moon is substantial or when anthropogenic light is present. The proposed YOLOv8m-seg model achieves a segment mAP@0.5 of 84.7% on the validation dataset using our own training dataset of MW images. To explore its potential role in autonomous system applications, we compare night sky imagery and GPS heading data from a field trial in rural South Australia. The comparison results show that for short-term navigation, the segmented MW image can be used as a reliable orientation cue. There is a difference of roughly 5-10° between the proposed method and GT as the path involves left or right 90° turns at certain locations.

Image-Based Peridynamic Modeling-Based Micro-CT for Failure Simulation of Composites

By utilizing computed tomography (CT) technology, we can gain a comprehensive understanding of the specific details within the material. When combined with computational mechanics, this approach allows us to predict the structural response through numerical simulation, thereby avoiding the high experimental costs. In this study, the tensile cracking behavior of carbon–silicon carbide (C/SiC) composites is numerically simulated using the bond-based peridynamics model (BB-PD), which is based on geometric models derived from segmented images of three-dimensional (3D) CT data. To obtain results efficiently and accurately, we adopted a deep learning-based image recognition model to identify the kinds of material and then the pixel type that corresponds to the material point, which can be modeled by BB-PD for failure simulation. The numerical simulations of the composites indicate that the proposed image-based peridynamics (IB-PD) model can accurately reconstruct the actual composite microstructure. It can effectively simulate various fracture phenomena such as interfacial debonding, crack propagation affected by defects, and damage to the matrix.

Advanced artificial intelligence framework for T classification of TNM lung cancer in 18FDG-PET/CT imaging

The integration of artificial intelligence (AI) into lung cancer management offers immense potential to revolutionize diagnostic and treatment strategies. The aim is to develop a resilient AI framework capable of two critical tasks: firstly, achieving accurate and automated segmentation of lung tumors and secondly, facilitating the T classification of lung cancer according to the ninth edition of TNM staging 2024 based on PET/CT imaging. This study presents a robust AI framework for the automated segmentation of lung tumors and T classification of lung cancer using PET/CT imaging. The database includes axial DICOM CT and18FDG-PET/CT images. A modified ResNet-50 model was employed for segmentation, achieving high precision and specificity. Reconstructed 3D models of segmented slices enhance tumor boundary visualization, which is essential for treatment planning. The Pulmonary Toolkit facilitated lobe segmentation, providing critical diagnostic insights. Additionally, the segmented images were used as input for the T classification using a CNN ResNet-50 model. Our classification model demonstrated excellent performance, particularly for T1a, T2a, T2b, T3 and T4 tumors, with high precision, F1 scores, and specificity. The T stage is particularly relevant in lung cancer as it determines treatment approaches (surgery, chemotherapy and radiation therapy or supportive care) and prognosis assessment. In fact, for Tis-T2, each increase of one centimeter in tumor size results in a worse prognosis. For locally advanced tumors (T3-T4) and regardless of size, the prognosis is poorer. This AI framework marks a significant advancement in the automation of lung cancer diagnosis and staging, promising improved patient outcomes.

Hierarchical convolution neural network models for classifying the segmented OCT and OCTA images using U-Net model

Hierarchical convolution neural network models for classifying the segmented OCT and OCTA images using U-Net model

A Flexible Artificial Spiking Photoreceptor Enabled by a Single VO2 Mott Memristor for the Spike-Based Electronic Retina.

The neuromorphic vision system that utilizes spikes as information carriers is crucial for the formation of spiking neural networks. Here, we present a bioinspired flexible artificial spiking photoreceptor (ASP), which is realized by using a single VO2 Mott memristor that can simultaneously sense and encode the stimulus light into spikes. The ASP has high spike-encoded photosensitivity and ultrawide photosensing range (405-808 nm) with good endurance (>7 × 107) and high flexibility (bending radius ∼5 mm). Then, we put forward an all-spike electronic retina architecture that comprises one layer of ASPs and one layer of artificial optical nerves (AONs) to process the spike information. Each AON consists of a single Mott memristor connected in series with a neuro-transistor that is a multiple-input floating-gate MOS transistor. Simulation results demonstrate that the all-spike electronic retina can successfully segment images with high Shannon entropy, thus laying the foundation for the development of a spike-based neuromorphic vision system.

Solid–liquid separation state control system for shale shaker based on computer vision

Shale shakers are crucial in drilling operations, separating solid–liquid mixtures, protecting equipment, improving efficiency, and supporting environmental protection and resource recovery. Typically, the solid–liquid separation status on shaker screens is assessed through manual inspection and experiential judgment, with the screen tilt angle adjusted manually. This method has inherent delays, failing to promptly detect and address screen surface abnormalities. To overcome this, a computer vision-driven intelligent control system has been proposed, enhancing drilling sieving operations’ efficiency. The system uses computer vision and servo motors to monitor and adjust the sieving state. Twin industrial cameras capture images, which undergo preprocessing like perspective correction, grayscale conversion, noise reduction, and illumination equalization. Local threshold segmentation and morphological analysis distinguish between liquid and solid states. The segmented images’ contours and area analysis precisely determine the separation state. Results are transmitted to motors via an industrial computer to adjust the sieve net angle. Servo motors on both sides manipulate the sliding block lifting mechanism for precise tilt adjustment. Experiments demonstrate that the method achieves an average accuracy of 93.635% in identifying mud edges. The system’s high efficiency and reliability ensure accurate identification and adjustment of the solid–liquid separation state, thereby optimizing drilling sieving workflows.

Using 2D U-Net convolutional neural networks for automatic acetabular and proximal femur segmentation of hip MRI images and morphological quantification: a preliminary study in DDH

BackgroundDevelopmental dysplasia of the hip (DDH) is a common pediatric orthopedic condition characterized by varying degrees of acetabular dysplasia and hip dislocation. Current 2D imaging methods often fail to provide sufficient anatomical detail for effective treatment planning, leading to higher rates of misdiagnosis and missed diagnoses. MRI, with its advantages of being radiation-free, multi-planar, and containing more anatomical information, can provide the crucial morphological and volumetric data needed to evaluate DDH. However, manual techniques for measuring parameters like the center–edge angle (CEA) and acetabular index (AI) are time-consuming. Automating these processes is essential for accurate clinical assessments and personalized treatment strategies.MethodsThis study employed a U-Net-based CNN model to automate the segmentation of hip MRI images in children. The segmentation process was validated using a leave-one-out method during training. Subsequently, the segmented hip joint images were utilized in clinical settings to perform automated measurements of key angles: AI, femoral neck angle (FNA), and CEA. This automated approach aimed to replace manual measurements and provide an objective reference for clinical assessments.ResultsThe U-Net-based network demonstrates high effectiveness in hip segmentation compared to manual radiologist segmentations. In test data, it achieves average DSC values of 0.9109 (acetabulum) and 0.9244 (proximal femur), with a 91.76% segmentation success rate. The average ASD values are 0.3160 mm (acetabulum) and 0.6395 mm (proximal femur) in test data, with Ground Truth (GT) edge points and predicted segmentation maps having a mean distance of less than 1 mm. Using automated segmentation models for clinical hip angle measurements (CEA, AI, FNA) shows no statistical difference compared to manual measurements (p > 0.05).ConclusionUtilizing U-Net-based image segmentation and automated measurement of morphological parameters significantly enhances the accuracy and efficiency of DDH assessment. These methods improve precision in automatic measurements and provide an objective basis for clinical diagnosis and treatment of DDH.

Evaluation of a fully automated computed tomography image segmentation method for fast and accurate body composition measurements

IntroductionBody composition evaluation can be used to assess patients’ nutritional status to predict clinical outcomes. To facilitate reliable and time-efficient body composition measurements eligible for clinical practice, fully automated computed tomography segmentation methods were developed. The aim of this study was to evaluate automated segmentation by Data Analysis Facilitation Suite in an independent dataset. Materials and methodsPreoperative computed tomography images were used of 165 patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy from 2014 to 2019. Manual and automated measurements of skeletal muscle mass (SMM), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intramuscular adipose tissue (IMAT) were performed at the third lumbar vertebra. Segmentation accuracy of automated measurements was assessed using the Jaccard index and intra-class correlation coefficients. ResultsAutomatic segmentation provided accurate measurements compared to manual analysis, resulting in Jaccard score coefficients of 94.9 for SMM, 98.4 for VAT, 99.1 for SAT, and 79.4 for IMAT. Intra-class correlation coefficients ranged from 0.98 to 1.00. Automated measurements on average overestimated SMM and SAT areas compared to manual analysis, with mean differences (±2 standard deviations) of 1.10 (–1.91 to 4.11) and 1.61 (–2.26 to 5.48) respectively. For VAT and IMAT, automated measurements on average underestimated the areas with mean differences of –1.24 (–3.35 to 0.87) and –0.93 (–5.20 to 3.35), respectively. ConclusionsCommercially available Data Analysis Facilitation Suite provides similar results compared to manual measurements of body composition at the level of third lumbar vertebra. This software provides accurate and time-efficient body composition measurements, which is necessary for implementation in clinical practice.

Diagnosing skin cancer using social spider optimization (SSO) and error correcting output codes (ECOC) with weighted hamming distance

Skin cancer is a common disease resulting from genetic defects, and early detection is critical to improve treatment outcomes. Diagnostic programs that use computer aid especially those that use supervised learning are very useful in early diagnosis of skin cancer. This research therefore presents a new approach that integrates optimization methods with supervised learning to improve skin cancer diagnosis using machine vision approach. The presented method is initiated by data pre-processing that involves the removal of unnecessary data. Then, to segment the images, a combination of K-means clustering and social spider optimization technique is employed. The region of interest is then extracted from the segmented image and from this region a convolutional neural network extracts the significant features. To enhance the classification performance as compared with the standard classifiers, this research introduces a new concept of error correcting output codes coupled with a weighted Hamming distance in the group of gamma classifiers. The ability of the proposed approach in segmentation of skin lesions and classifying them was tested using samples from the ISIC-2017 and ISIC-2016 databases. The introduced method obtained state-of-the-art accuracy on both datasets (ISIC-2016: 97.10%, ISIC-2017: 95.17%). In particularly, the accuracy of the introduced approach for both these databases is at least 1.17% higher than the compared methods. This proves the high performance of the suggested method based on the usage of the convolutional neural networks for feature extraction and gamma classifiers with error correcting output codes for classification in skin cancer detection.

A NOVEL HYBRID DEEP LEARNING APPROACH FOR 3D OBJECT DETECTION AND TRACKING IN AUTONOMOUS DRIVING

Recently Object detection and tracking using fusion of LiDAR and RGB camera for the autonomous vehicle environment is a challenging task. The existingworks initiates several object detection and tracking frameworks using ArtificialIntelligence (AI) algorithms. However, they were limited with high false positives and computation time issues thus lacking the performance of autonomousdriving environment. The existing issues are resolved by proposing HybridDeep Learning based Multi Object Detection and Tracking (HDL-MODT) using sensor fusion methods. The proposed work performs fusion of solid stateLiDAR, Pseudo LiDAR, and RGB camera for improving detection and trackingquality. At first, the multi-stage preprocessing is done in which noise removal isperformed using Adaptive Fuzzy Filter (A-Fuzzy). The pre-processed fused image is then provided for instance segmentation to reduce the classification andtracking complexity. For that, the proposed work adopts Lightweight GeneralAdversarial Networks (LGAN). The segmented image is provided for objectdetection and tracking using HDL. For reducing the complexity, the proposedwork utilized VGG-16 for feature extraction which forms the feature vectors.The features vectors are then provided for object detection using YOLOv4.Finally, the detected objects were tracked using Improved Unscented KalmanFilter (IUKF) and mapping the vehicles using time based mapping by considering their RFID, velocity, location, dimension and unique ID. The simulation ofthe proposed work is carried out using MATLAB R2020a simulation tool andperformance of the proposed work is compared with several metrics that showthat the proposed work outperforms than the existing works.

Annotated Dataset for Training Cloud Segmentation Neural Networks Using High-Resolution Satellite Remote Sensing Imagery

The integration of satellite data with deep learning has revolutionized various tasks in remote sensing, including classification, object detection, and semantic segmentation. Cloud segmentation in high-resolution satellite imagery is a critical application within this domain, yet progress in developing advanced algorithms for this task has been hindered by the scarcity of specialized datasets and annotation tools. This study addresses this challenge by introducing CloudLabel, a semi-automatic annotation technique leveraging region growing and morphological algorithms including flood fill, connected components, and guided filter. CloudLabel v1.0 streamlines the annotation process for high-resolution satellite images, thereby addressing the limitations of existing annotation platforms which are not specifically adapted to cloud segmentation, and enabling the efficient creation of high-quality cloud segmentation datasets. Notably, we have curated the Annotated Dataset for Training Cloud Segmentation (ADTCS) comprising 32,065 images (512 × 512) for cloud segmentation based on CloudLabel. The ADTCS dataset facilitates algorithmic advancement in cloud segmentation, characterized by uniform cloud coverage distribution and high image entropy (mainly 5–7). These features enable deep learning models to capture comprehensive cloud characteristics, enhancing recognition accuracy and reducing ground object misclassification. This contribution significantly advances remote sensing applications and cloud segmentation algorithms.

Machine/deep learning-assisted hemoglobin level prediction using palpebral conjunctival images.

Palpebral conjunctival hue alteration is used in non-invasive screening for anaemia, whereas it is a qualitative measure. This study constructed machine/deep learning models for predicting haemoglobin values using 150 palpebral conjunctival images taken by a smartphone. The median haemoglobin value was 13.1 g/dL, including 10 patients with <11 g/dL. A segmentation model using U-net was successfully constructed. The segmented images were subjected to non-convolutional neural network (CNN)-based and CNN-based regression models for predicting haemoglobin values. The correlation coefficients between the actual and predicted haemoglobin values were 0.38 and 0.44 in the non-CNN-based and CNN-based models, respectively. The sensitivity and specificity for anaemia detection were 13% and 98% for the non-CNN-based model and 20% and 99% for the CNN-based model. The performance of the CNN-based model did not improve with a mask layer guiding the model's attention towards the conjunctival regions, however, slightly improved with correction by the aspect ratio and exposure time of input images. The gradient-weighted class activation mapping heatmap indicated that the lower half area of the conjunctiva was crucial for haemoglobin value prediction. In conclusion, the CNN-based model had better results than the non-CNN-based model. The prediction accuracy would improve by using more input data with anaemia.

Increasing the space–bandwidth product of holographic displays by segmenting and combining phase masks

This paper presents a method for enlarging holographic images under the constraints of spatial light modulators. The proposed method involves using a modified Gerchberg–Saxton algorithm and spatial multiplexing to segment images and projection surfaces. Segmented element images are processed to create multiple phase masks, which are then stitched for image reconstruction. Experimental results indicated that the proposed method enabled effective magnification under different segmentation methods. This method allows the enlargement of holographic images without using additional lenses, thus enabling effective magnification to be achieved with a limited setup. Reconstruction results indicate that the proposed method can produce a magnification of up to 16 × .

Impact of an institutional process change adopting end-systolic coronary CTA acquisition and automated dose selection on patient throughput and image quality

IntroductionGuidelines recommend prospective ECG-triggered mid-diastolic coronary computed tomographic angiography (CCTA) acquisition after achieving optimal heart rate (HR) control in order to optimize scan image quality. With dual-source CCTA, prospective end-systolic acquisition has been shown to be less prone to motion artifacts at higher heart rates and may improve scan and CT laboratory efficiency by allowing CCTA without routine pre-scan beta-blocker (BB) administration. MethodsWe implemented an institutional process change in CCTA performance effective January 2023, comprising a transition from prospective ECG-triggered mid-diastolic acquisitions individually supervised by a physician at the scanner to an algorithmic approach predominately utilizing prospective end-systolic acquisition (200–400 ​ms after R peak), employing an automated dose selection algorithm, without BB administration. All scans were performed on a third-generation 192-slice dual-source scanner. We reviewed 300 consecutive CCTAs done pre- and post-process change in Jan 2022 (phase 0), Jan 2023 (phase 1), and in May 2023 (phase 2) after implementation of a process improvement involving more selective utilization of automated tube potential/current algorithms (CARE kV) to optimize image quality. Coronary segmental image quality was assessed by two experienced CCTA readers by consensus using an 18-segment SCCT model on a 5-point Likert scale (1 ​= ​non-interpretable; 2 ​= ​poor; 3 ​= ​acceptable; 4 ​= ​good; 5 ​= ​excellent). Measures of radiation dose, medication administration, and time required for patient scanning were compared. Logistic regression was used to determine factors associated with patient-level reduction in image quality (IQ) and with repeat scans. ResultsPost-process change, there was a significant reduction in the median overall patient appointment [phase 0: 95 (75–125) min vs. phase 1: 68 (52–88) min and phase 2: 72 (59–90) min; P ​< ​0.001] and scan times [phase 0: 13 (10–16) min vs. phase 1: 8 (6–13) min and phase 2: 9 (7–13) min; P ​< ​0.001]. Median IQ score in both post-process change phases was 4 (4–5) compared to a median score of 5 (4–5) pre-process change (P for comparison <0.001). The majority of segments post-process change had “good” IQ (Phase 1 segmental IQ scores: 5 ​= ​36.7 ​%, 4 ​= ​46.8 ​%, 3 ​= ​13 ​%, 2 ​= ​2.6 ​%, 1 ​= ​0.9 ​%; Phase 2 segmental IQ scores: 5 ​= ​26 ​%, 4 ​= ​49.7 ​%, 3 ​= ​16.3 ​%, 2 ​= ​6.1 ​%, 1 ​= ​1.9 ​%), whereas pre-process change, the majority of segments had “excellent” IQ (Phase 0 segmental IQ scores: 5 ​= ​56 ​%, 4 ​= ​34.3 ​%, 3 ​= ​7.5 ​%, 2 ​= ​1.8 ​%, 1 ​= ​0.4 ​%) There was no significant increase in non-interpretable scans at the patient level. The 22 ​% re-scan rate in phase 1 (vs. 6 ​% in phase 0, P ​= ​.002) improved to 15 ​% in phase 2. While patient related factors of body mass index [adjusted OR obese 2.64, 95 ​% CI 1.12–6.51, P ​= ​0.03; aOR morbidly obese 6.94, 95 ​% CI 2.21–23.52, P ​= ​0.001] and average HR [aOR (per 10 bpm increase) 1.51, 95 ​% CI 1.21–1.9, P ​< ​0.001] were associated with the scoring of any segment as ​≤ ​3 ​at the patient level in a fully adjusted model, the improved phase 2 of the process change was not [aOR 1.61, 95 ​% CI 0.78–3.32]. ConclusionImplementation of an institutional process change utilizing prospective ECG-triggered dual-source end-systolic acquisition avoided the use of beta-blockers, significantly reduced patient appointment and scan times with acceptable diagnostic performance.