Special Issue on The International Conference on Information and Communication Systems (ICICS 2011)

Quantification of Corneal Neovascularization via

Contourlet Transform based Segmentation of Blood Vessels
Nesreen.A.Otoum, Eran.A.Edirisinghe
Department of Computer Science, Loughborough University, Loughborough, LE11 3TU, UK
N.otoum@lboro.ac.uk, E.A.Edirisinghe@lboro.ac.uk

ABSTRACT
The quantification of blood vessels provides the means for assessing the severity of
corneal neovascularization and the impact of any treatment process being followed.
In this paper we propose a Contourlet Transform based approach to the detection,
enhancement and quantification of blood vessels in corneal images. Initially a semiautomated approach is used to identify the boundary of the cornea and to segment
the corneal region of interest (ROI). This is followed by the application of
Contourlet Transforms to the difference of red and green colour planes of the ROI,
an image that produces fewer artefacts due to reflections and highlights. The blood
vessel regions are subsequently enhanced in the Countourlet domain before being
inverse transformed to obtain a corneal ROI with enhanced contrast. The enhanced
image is finally thresholded to form a binary image which undergoes thinning to
produce the final binary image. The quantification of the blood vessels is carried out
by calculating the ratio between pixels belonging to the blood vessels and
background areas. Experimental results on four practical data sets obtained from
patients suffering from different levels of corneal neovascularization are provided.
Keywords:Contourlet Transform, corneal neovascularization,segmentation of blood vessels

INTRODUCTION

The normal cornea is devoid of both blood and

lymphatic vessels (lymphatic vessels refer to the
capillaries, collecting vessels, and trunks that collect
lymph from the tissues and carry it to the blood
stream). This avascularity (also termed the angiogenic
privilege of the cornea) is highly conserved
evolutionarily to maintain transparency and visual
acuity. Nonetheless, because of a variety of severe
inflammatory diseases, the cornea can become
invaded by pathologic blood and lymphatic vessels.
Pathologic corneal neovascularization (the excessive
ingrowth of blood vessels from the limbal vascular
plexus into the cornea, i.e., angiogenesis) not only
reduces the quality of being able to see objects
through the cornea (also called corneal transparency)
but also is a major risk factor for corneal
transplantation.
In
addition,
host
corneal
neovascularization both before as well as after
surgeryis one of the most significant risk factors for
subsequent immune rejections after replacing the
damaged cornea with a clear cornea (corneal grafting).
Thus timely and effective treatment of corneal
neovascularization is important.
Quantification of corneal neovascularization
provides means to monitor the effectiveness of any

UbiCC Journal

treatment process. To this affect many corneal

imaging devices are capable of providing medical
experts with high quality images that may be manually
inspected and quantified. However, in severe cases of
corneal neovascularization, manual inspection and
quantification becomes an extremely tedious, time
consuming task prone to human error (figure 1
Illustrates the difference between severe and minor
cases in terms of number of the blood vessels growing
within the cornea). Automated or semi-automated
computer aided inspection and measurement provides
a valuable and more accurate alternative approach.

(a)

(b)

Figure 1: Corneal Neovascularization (a) a severe

case (b) a minor case.

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Special Issue on The International Conference on Information and Communication Systems (ICICS 2011)

Literature on the quantification of Corneal

Neovascularization focuses more on the clinical
analysis aspects and uses basic image processing tools
that are implemented within standard imaging
applications [1-7]. These include the separation of
colour planes, noise removal, contrast adjustment,
thresholding based image segmentation etc. The use of
these tools requires considerable human intervention
and trial and error testing for determining the best
threshold values. Further, the segmentation accuracy
will depend heavily on the image capture device and
varying noise levels. On the other hand some
promising approaches have been developed for the
enhancement of blood vessels in retinal (i.e. back of
the eye) imaging [8-13]. Our detailed study of using
some of the key techniques adopted in retinal blood
vessel (blood vessels that are present on the retina of
the eye) enhancement in corneal blood vessel
enhancement revealed that the differences of noise
levels and the presence of bright reflections and acute
variations in background illumination in the latter
warrants new approaches to be developed and tested.
In this paper we use an approach based on Contourlet
Transform [14] which results in a local, flexible multiresolution and directional image decomposition using
contour segments. The directional nature of
Countourlet Transforms allows for more accurate
representation of contours, allowing their subsequent
processing/enhancement to be done more efficiently.
Given the fact that corneal blood vessels are of
random shapes and orientations and are of varying
scale and resolution, the use of Countourlet
Transforms in their representation is further justified.
For clarity of presentation this paper is divided
into four sections. Apart from section 1 that
introduced the reader to the problem domain and gives
an insight to existing solutions, section 2 presents the
proposed approach. Section 3 provides experimental
results and an analysis. Finally section 4 concludes
with an insight to further possible directions of
research.
2

with the boundary of the cornea. Although this step

requires manual intervention the process is easy and is
worth the effort due to the difficulty of automatically
detecting the accurate shape of a corneal boundary
using any existing image processing approach.

(a)

(b)

Figure 2: Semi-automated Segmentation of the

Cornea (a) initial ellipse automatically drawn within
the cornea (b) manually adjusted ellipse to coincide
with the corneal boundary.
Figure 2 illustrates the steps that are followed in the
semi-automated segmentation of the cornea. In the
initial stage an ellipse is drawn which has dimensions
along the minor and major axes, approximately equal
to half of the radius of circular edge (determined by a
Canny edge detector with appropriate threshold
settings) of the cornea. The system then allows the
user to move the boundary and the entire elliptical
shape, to enable its boundarys best alignment with
that of the corneal boundary.
Once the corneal image is segmented as described
above it undergoes a number of stages of processing
as illustrated by the high level block diagram of figure
3.

Proposed Approach

2.1

An Overview
The quantification of corneal neovascularization
requires the determination of the ratio between the
total area occupied by the blood vessels and the total
area of the cornea. This requires both the
determination of the boundary of the cornea and the
segmentation of all blood vessels.
Although a number of automated corneal area
segmentation algorithms have been proposed in
literature under the present context of our research
which focuses more on the accuracy of segmentation
of blood vessels [15], we decided to use a semiautomated, accurate, corneal boundary segmentation
approach. In this approach an initial elliptically shaped
countour is adjusted manually by the user to register

UbiCC Journal

Figure 3: Proposed approach to corneal

neovascularization.
The contrast enhancement and noise removal are
both done within a Countourlet Transform domain
processing procedure described in section 2.2. As a
result of this stage the contrast of the blood vessels of
the corneal image is enhanced. Further noise and nonuniform background illumination is minimized. This
allows the simple thresholding based blood vessel
extraction algorithm to perform accurately. The final
quantification stage quantifies the total area occupied
by the blood vessels.

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2.2

Contrast Enhancement and Noise Removal

Figure 4 illustrates a detailed block diagram of the
stages involved within this phase of the proposed
approach to the quantification of corneal
neovascularization. The subsequent sections provide
more details of each important sub-stage.

Subsequent to the formation of the difference

image contrast stretching can be used to improve the
contrast further. This involves the determination of the
highest pixel value and re-mapping it to 255 and the
determination of the lowest pixel value and remapping it to 0.
2) Contourlet transform: In general the application of
Contourlet Transform to an image involves two stages.
A Laplacian pyramid is first used to capture point
discontinuities followed by the application of a
directional filter bank to link point discontinuities into a
linear structure (see equation (2) and (3), point 4,
and section 2.2).

Pre-processing

Figure 6 illustrates the use of filters in forming a

Laplacian pyramid. Note the generation of a down
sampled lowpass version of the original image and the
difference between the original and the prediction.
Figure 4: Corneal image enhancement.
1) Pre-processing - Removal of non-uniform
illumination: The first phase of this stage is the
determination of the different images between the
red and green colour planes of the original
corneal colour image. Our investigations with the
three colour planes revealed that either the
difference between the red and green plane or the
difference between the red and blue planes
enables the removal of non-uniform background
illumination, which is a major obstacle for the
subsequent blood vessel segmentation stages.
(see figure 5) Figure 5 (d) illustrates that the
highlighted areas have been removed in the
difference image between the red and green
component images.

(a)

(b)

(c)

(d)

Figure 5: Removal of non-uniform illumination (a)

original colour image (b) red component image (c)
green component (d) red-green component image.

UbiCC Journal

Figure 6: Laplacian pyramid. (a) One level of

decomposition. The
outputs
are
a
coarse
approximation a[n] and a difference b[n] between the
original signal and the prediction. (b) The new
reconstruction scheme for the Laplacian pyramid [16].
The overall result is thus an image expansion using
basic elements such as contour segments and is hence
named a Contourlet.
Figure 7 illustrates the Contourlet decomposition [14]
of a typical corneal image with neovascularization.
The specific decomposition illustrated represents a
two level decomposition with the first level illustrating
four directions and the second level illustrating eight
directions. It is noted that blood vessels are
represented in their parts within the various sub-bands
of decomposition.
3) Contourlet based image enhancement: A closer
look at the difference image between the red and the
green colour plains reveals blood vessels of different
luminosity. The vessels having high contrast to the
background (bright) are easy to detect but the vessels
having low contrast to the background will be more
difficult to segment. The approach proposed attempts
soften the stronger edges and amplify the faint edges
so that the slim vessels will become visible. This is
done as follows:
After the decomposition of the image into contourlet
coefficients (i.e. the values that result from the
transformation of pixel values, when a Contourlet
Transform is applied to the corneal image) they are
modified via a non-linearity function y defined below.

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Special Issue on The International Conference on Information and Communication Systems (ICICS 2011)

Figure 7: Two level, 8 band Contourlet decomposition of a corneal image.

Note that taking noise into consideration we have

adopted a noise standard deviation in the equation
(see point 4 in section 2.2).
ya ( x, ) = 1

Km

=10, all coefficients can be amplified

between 3 and 30.

if x < a

x a m p 2a x
(
) +
a
a
a
m p
if 2a x < m
y a ( x, ) = ( )
x
m
y a ( x, ) = ( ) s
if x m
x
y a ( x, ) =

m = lM a , which m is derived from the

Ma

of the
maximum Contourlet coefficient
relative sub-band. l must be less than 1. In this
case, choosing for instance a=3 l=0.5, we
amplify all coefficients with an absolute value
between 3 and half the maximum absolute
value of the sub-band.

if a x < 2a

(1)
In the above equations, m determines the degree of
nonlinearity. s introduces dynamic range compression.
Using a nonzero s will enhance the weaker edges and
soften the stronger edges. a is a normalization
parameter. Parameter m is the value under which
coefficients are amplified. It is obviously dependent
on the values of pixels. There are two possible options
to derive the value of m,
m = K m

, which m is derived from the noise

The first option allows the user to define the

coefficients to be amplified as a function of their
signal to noise ratio, while the second choice gives a
general and easy way to fix the parameter m
independently of the range of the pixel values.

4) Estimation of noise standard deviation

Estimation of the amount of noise is crucial in many
algorithms for digital image analysis. This enables
algorithm to adapt to the noise instead of following
fixed thresholds. There are a number of standard
K K
standard deviation by using parameter m . m approaches one can use to estimate the noise variance.
Since image structures like edges have strong second
is independent of the Contourlet coefficient
order differential components, a noise estimator
values and quite easy for users to set. When a=3,
should be insensitive to the Laplacian of an image.

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One of the estimation methods is to suppress the

image structure by Laplace masks [17].
The Laplacian of an image f can be defined as follows:
2

2 f =

f
f
+
x 2
y 2

Then,

(2)

|t |

1
2

exp(

t 2
2 2

(9)

n , which is the
2
standarddeviation of noise from the variance n

2 f = f (x +1, y) + f (x 1, y) + f (x, y +1) + f (x, y 1) 4 f (x, y) (3)

From above, we can obtain

Immerker in [18] suggests using the difference

between two templates L1 and L2, approximating the
Laplacian of an image in discrete format. The two
masks are as follows:

n =

0 1 0
L1 = 1 -4 1
0 1 0

)dt

1
| f ( x, y) * M |
2 6(W 2)( H 2) image f
(10)

5) Inverse Contourlet transform: Once the coefficients

have been modified following the above procedure the
inverse contourlet transform is used to obtain the
enhanced image. Figure 8 illustrates a typical example.

1 0 1
1
=
L2 = 0 -4 0

2
1 0 1
(4)

The noise estimation operator M is represented by the

difference between the two masks above:

1 -2 1

M = 2(L2 L1 ) = -2 4 -2
1 -2 1

(5)
(a)

which has zero mean and variance

(4 + 4 (2) + 4 1 )
2

2
n

= 36 n

(b)

Figure 8: The difference between the red and green

component images (a) before application (b) after
application, of countourlet based enhancement.

(6)

assuming that the noise at each pixel has a standard

6) Contrast enhancement filter: The following 2-D

deviation n . Assume f(x, y) * M denotes the value filter was applied on the output of the previous step
of applying the mask M at position (x, y) in the image f. (Inverse contourlet transform)
Computing the variance of the output of the M
operator applied to the image f, will give an estimate

36 2

n at each pixel, which can be averaged over

of
the image f or local neighbourhoods to give an

estimate of the noise variance

noise in f can be obtained as,
n2 =

1
36(W 2)(H 2)

n2 . The variance of the

2
( f ( x, y) * M )

(7)

image f

Where W and H represent the width and height of

image f, * is the time domain convolution.
To obtain the absolute deviation from the variance
above, assuming Gaussian distribution with zero mean
and variance , the deviation is
2

|t |

1
2

UbiCC Journal

exp(

t 2
)dt =
2 2

(11)

2.3 Segmentation
After the images have been enhanced following the
procedure described in 2.2 we use a simple
threholding based approach to segment the blood
vessels (Note experimental selection of threshold
that results in the best perceptual results). In doing so
we create a binary image with 0 (black) representing
pixel values outside the blood vessels and 255 (white)
representing pixel values belonging to the blood
vessels.
Figure 9 illustrates the resulting blood vessel
segmentation obtained by following the contrast
enhancement procedure described in 2.2

(8)

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Condition G3:
(16)
Condition G3:
(17)

(a)

(b)

Figure 9: The segmentation result (a) before

application (b) after application, of Contrast
enhancement filter.
2.4

Thinning
We applied a standard Thinning approach [19] to
make the blood vessels more analogous to the ones on
the original image. The algorithm can be described as
follows:
In the thinning approach used the deletion or retention
of a (white) pixel p depends on a number of conditions
(G1, G2 and G2 defined below) and iterations.
After dividing the image into two distinct subfields, in
the first sub-iteration, if and only if conditions G1, G2
and G3 are all satisfied pixel p would be deleted from
the first subfield.
In the second sub-iteration, if and only if conditions
G1, G2 and G3 are all satisfied pixel p would be
deleted from the second subfield. [19]
Condition G1:

(12)

(a)

(b)

Figure 10: The segmentation result (a) before

application (b) after application, of the Thinning
algorithm.
2.5 Quantification
For each image the total amount of pixels belonging
to the entire corneal area and the total amount of
pixels belonging to the blood vessels are calculated.
The first figure is calculated by adding up the number
of pixels within the corneal boundary, regardless of its
colour and the second figure is calculated by totalling
up the white pixels within the boundary of the image.
The percentage ratio between the total number of
pixels located within the corneal blood vessels and the
cornea is finally calculated.
3

Experimental Results & Analysis

Where

(13)
Condition G2:
(14)

Experiments were performed on a set of forty

images
with
various
degrees
of
corneal
neovascularization. All algorithms were implemented
with Maltab. The results for six test images are
illustrated in Figure 11. The images in figure 11 have
been arranged in descending order of the degree of
corneal neovascularization. The results illustrate the
capability of the proposed approach to enhance the
blood vessels before segmentation, making the
quantifications more accurate.
Table-1 tabulates the quantification results for the
selected set of six test images.

Where

Table 1: Quantification results

Threshold

(15)

UbiCC Journal

Image 1
Image 2

35
39

Cornea
area
196022
190582

Image 3
Image 4
Image 5
Image 6

40
35
70
135

195034
197199
186190
157139

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Vessel
area
72491
60734

Ratio
%
36.9
31.9

55448
51138
42728
13374

28.4
25.9
22.9
8.5

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Special Issue on The International Conference on Information and Communication Systems (ICICS 2011)

Image 1

(a)

(b)

(e)

(f)

(c)

(d)

(g)

(h)

(c)

(d)

(g)

(h)

(c)

(d)

Image 2

(a)

(b)

(e)

(f)
Image 3

(a)

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(b)

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(e)

(f)

(g)

(h)

Image 4

(a)

(b)

(e)

(f)

(c)

(d)

(g)

(h)

Image 5

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

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Image 6

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

Figure 11: Experimental Results (a) original colour images (b) red component images (c) green component
images (d) The difference between the red and green component image, before enhancement (e) The difference
between the red and green component image after countoulet based enhancement (f) result after applying the
contrast enhancement filter (g) binary images after segmentation that was used in the quantification. (h) Result
after the Thinning algorithm is applied.

To investigate the practical usefulness of the proposed

quantification approach, further experiments were
performed on corneal images of two patients, one who
had undergone corneal grafting and another who has
been undergoing medical treatment, over a period of
time. For the initial case the data was recorded over a
three year period and for the latter case the data
recording took over a period of seven months. Figure
12 illustrates sequential images for the patient who
A closer investigation of the test image (2) and (4) of
figure 11 illustrates that the proposed approach is also
able to remove the consideration of suture marks that
are present in the original image due to surgical
intervention. Further, the approach has been able to
perform remarkably well in the presence of significant
effects of non-uniform illumination and reflections.
In general the experimental results indicate that the
directional nature of Countourlet Transforms allows
for more accurate representation of the blood vessels,
allowing their subsequent processing/enhancement to
be done more efficiently. Given the fact that corneal
blood vessels are of random shapes and orientations
and are of varying scale and resolution, the use of
Countourlet Transforms in their representation is thus
justified.
4

had undergone corneal grafting and figure 13

illustrates sequential images for the patient who has
been undergoing medical treatment. Charts 1 and 2
illustrate graphs demonstrating the healing progression
for the patients. The progression of healing is well
demonstrated by the graphs. This information will be
vital to medical experts in monitoring patient care and
evaluating the effect of different ways of treating
corneal neovascularization.
approach to the quantification of corneal
neovascularization. The approach is based on the use
of Contourlet Transforms to enhance the blood vessels
before their segmentation is carried out. A special
feature of the approach is that it is robust to different
levels of noise that may be present in corneal images.
We have shown that the proposed approach is capable
of performing effectively in the presence of noise,
non-uniform
illumination
and
reflections.
Quantifications experiments were done on four
corneal images and the performance of the algorithms
were analysed at various stages.
At present we are working on making the proposed
approach fully automated by introducing an efficient
and robust approach to the determination of corneal
boundary and the determination of thresholding values
used in the final stage of segmentation.

Conclusions
We have proposed an efficient computer aided

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2007

2009

2010

(a)

(b)
Figure 12: Results for a patient who has undergone corneal drafting. [Note: each column indicates the year of
data capture] (a) Original Images. (b) Binary images after segmentation

Chart 1: The healing progression of the cornea of the patient who had undergone corneal grafting.

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May 2010

June 2010

December 2010

(a)

(b)
Figure 13: Results for the patient who has been undergoing medical treatment. [Note: each column indicates the
month and year of data capture. Only three out of the seven samples are illustrated above] (a) Original Images
(b) binary images after segmentation

Chart 2: The healing progression of the cornea of the patient who had been undergoing medical treatment.

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[10] L. Espona, M. Carreira, M. Penedo, et.

Retinal Vessel Tree Segmentation using a
Deformable Contour Model , IEEE 2008
978-1-4244-2175-6/08.
[11] P.Feng, Y.Pan, B.Wei,et. Enhancing retinal
image by the Contourlet transform , Pattern
Recognition Letters 28 (2007) 516522 .
[12] A.C Shore Capillaroscopy and the
pressure.
measurement
of
capillary
Blackwell Science 2000, 50(6), 501513.
[13] Hern S, Mortimer PS. Visualization of
dermal blood vessels--capillaroscopy., Clin
Exp Dermatol. 1999 Nov;24(6):473-8.
[14] M.N.Do,
M.Vetterli,
The
Contourlet
transform:
an
efficient
directional
multiresolution image representation, IEEE
Trans. On Image Processing, 14(12), pp
2091-2106, 2005.

Acknowledgment
The authors would like to extend their gratitude to
Prof. H. Dua and Ms L.Faraj, Queens Medical Centre,
Nottingham University, UK for their support and
advice.
5

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Nesreen Otoum received her

BSc degree in Management
Information
Science
from
Philadelphia University, Jordan
in August 2007. In December
2008 she obtained her MSc
degree in Internet Computing
and Network security from
Loughborough University. Her
MSc project was titled "Error
Concealment for H.264/AVC" video coding. Her PhD
work is focused on developing novel algorithm for
medical image processing and analysis. Her research
interests include medical image analysis, image preprocessing,
object
recognition,
classification
techniques and visual effects. She is a member of the

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Special Issue on The International Conference on Information and Communication Systems (ICICS 2011)

Digital
Imaging
Research
Loughborough University, UK.

Group

(DIRG),

Eran A Edirisinghe received

his B.Sc.Eng degree from
University of Moratuwa, Sri
Lanka in 1995, his MSc and PhD
degrees from Loughborough
University UK in 1996 and 1999.
He joined as a lecturer of the
Department
of
Computer
Science,
Loughborough
University and was promoted to
the Reader in Digital Imaging in 2008. He is at present
the Director of Research of the Department of
Computer Science, Loughborough University and the
Head of the Digital Imaging Research Group. He is
currently supervising a team of 18 PhD students and
post-doctoral research students working in the areas of
image processing, coding and mobile application
development. His research has been substantially
funded by the UK industry, government and the
research council, EPSRC.

UbiCC Journal

Page 43

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