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Verfaillie G, Rutten J, D'Asseler Y, Bacher K. Accuracy of patient-specific CT organ doses from Monte Carlo simulations: influence of CT-based voxel models. Phys Eng Sci Med 2024:10.1007/s13246-024-01422-z. [PMID: 38634980 DOI: 10.1007/s13246-024-01422-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/01/2024] [Indexed: 04/19/2024]
Abstract
Monte Carlo simulations using patient CT images as input are the gold standard to perform patient-specific dosimetry. However, in standard clinical practice patient's CT images are limited to the reconstructed CT scan range. In this study, organ dose calculations were performed with ImpactMC for chest and cardiac CT using whole-body and anatomy-specific voxel models to estimate the accuracy of CT organ doses based on the latter model. When the 3D patient model is limited to the CT scan range, CT organ doses from Monte Carlo simulations are the most accurate for organs entirely in the field of view. For these organs only the radiation dose related to scatter from the rest of the body is not incorporated. For organs lying partially outside the field of view organ doses are overestimated by not accounting for the non-irradiated tissue mass. This overestimation depends strongly on the amount of the organ volume located outside the field of view. To get a more accurate estimation of the radiation dose to these organs, the ICRP reference organ masses and densities could form a solution. Except for the breast, good agreement in dose was found for most organs. Voxel models generated from clinical CT examinations do not include the overscan in the z-direction. The availability of whole-body voxel models allowed to study this influence as well. As expected, overscan induces slightly higher organ doses.
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Affiliation(s)
- Gwenny Verfaillie
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
| | - Jeff Rutten
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Yves D'Asseler
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Klaus Bacher
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Koetzier LR, Mastrodicasa D, Szczykutowicz TP, van der Werf NR, Wang AS, Sandfort V, van der Molen AJ, Fleischmann D, Willemink MJ. Deep Learning Image Reconstruction for CT: Technical Principles and Clinical Prospects. Radiology 2023; 306:e221257. [PMID: 36719287 PMCID: PMC9968777 DOI: 10.1148/radiol.221257] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 02/01/2023]
Abstract
Filtered back projection (FBP) has been the standard CT image reconstruction method for 4 decades. A simple, fast, and reliable technique, FBP has delivered high-quality images in several clinical applications. However, with faster and more advanced CT scanners, FBP has become increasingly obsolete. Higher image noise and more artifacts are especially noticeable in lower-dose CT imaging using FBP. This performance gap was partly addressed by model-based iterative reconstruction (MBIR). Yet, its "plastic" image appearance and long reconstruction times have limited widespread application. Hybrid iterative reconstruction partially addressed these limitations by blending FBP with MBIR and is currently the state-of-the-art reconstruction technique. In the past 5 years, deep learning reconstruction (DLR) techniques have become increasingly popular. DLR uses artificial intelligence to reconstruct high-quality images from lower-dose CT faster than MBIR. However, the performance of DLR algorithms relies on the quality of data used for model training. Higher-quality training data will become available with photon-counting CT scanners. At the same time, spectral data would greatly benefit from the computational abilities of DLR. This review presents an overview of the principles, technical approaches, and clinical applications of DLR, including metal artifact reduction algorithms. In addition, emerging applications and prospects are discussed.
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Affiliation(s)
| | | | - Timothy P. Szczykutowicz
- From the Department of Radiology (L.R.K., D.M., A.S.W., V.S., D.F.,
M.J.W.) and Stanford Cardiovascular Institute (D.M., D.F., M.J.W.), Stanford
University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5105;
Department of Radiology, University of Wisconsin–Madison, School of
Medicine and Public Health, Madison, Wis (T.P.S.); Department of Radiology,
Erasmus Medical Center, Rotterdam, the Netherlands (N.R.v.d.W.); Clinical
Science Western Europe, Philips Healthcare, Best, the Netherlands (N.R.v.d.W.);
and Department of Radiology, Leiden University Medical Center, Leiden, the
Netherlands (A.J.v.d.M.)
| | - Niels R. van der Werf
- From the Department of Radiology (L.R.K., D.M., A.S.W., V.S., D.F.,
M.J.W.) and Stanford Cardiovascular Institute (D.M., D.F., M.J.W.), Stanford
University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5105;
Department of Radiology, University of Wisconsin–Madison, School of
Medicine and Public Health, Madison, Wis (T.P.S.); Department of Radiology,
Erasmus Medical Center, Rotterdam, the Netherlands (N.R.v.d.W.); Clinical
Science Western Europe, Philips Healthcare, Best, the Netherlands (N.R.v.d.W.);
and Department of Radiology, Leiden University Medical Center, Leiden, the
Netherlands (A.J.v.d.M.)
| | - Adam S. Wang
- From the Department of Radiology (L.R.K., D.M., A.S.W., V.S., D.F.,
M.J.W.) and Stanford Cardiovascular Institute (D.M., D.F., M.J.W.), Stanford
University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5105;
Department of Radiology, University of Wisconsin–Madison, School of
Medicine and Public Health, Madison, Wis (T.P.S.); Department of Radiology,
Erasmus Medical Center, Rotterdam, the Netherlands (N.R.v.d.W.); Clinical
Science Western Europe, Philips Healthcare, Best, the Netherlands (N.R.v.d.W.);
and Department of Radiology, Leiden University Medical Center, Leiden, the
Netherlands (A.J.v.d.M.)
| | - Veit Sandfort
- From the Department of Radiology (L.R.K., D.M., A.S.W., V.S., D.F.,
M.J.W.) and Stanford Cardiovascular Institute (D.M., D.F., M.J.W.), Stanford
University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5105;
Department of Radiology, University of Wisconsin–Madison, School of
Medicine and Public Health, Madison, Wis (T.P.S.); Department of Radiology,
Erasmus Medical Center, Rotterdam, the Netherlands (N.R.v.d.W.); Clinical
Science Western Europe, Philips Healthcare, Best, the Netherlands (N.R.v.d.W.);
and Department of Radiology, Leiden University Medical Center, Leiden, the
Netherlands (A.J.v.d.M.)
| | - Aart J. van der Molen
- From the Department of Radiology (L.R.K., D.M., A.S.W., V.S., D.F.,
M.J.W.) and Stanford Cardiovascular Institute (D.M., D.F., M.J.W.), Stanford
University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5105;
Department of Radiology, University of Wisconsin–Madison, School of
Medicine and Public Health, Madison, Wis (T.P.S.); Department of Radiology,
Erasmus Medical Center, Rotterdam, the Netherlands (N.R.v.d.W.); Clinical
Science Western Europe, Philips Healthcare, Best, the Netherlands (N.R.v.d.W.);
and Department of Radiology, Leiden University Medical Center, Leiden, the
Netherlands (A.J.v.d.M.)
| | - Dominik Fleischmann
- From the Department of Radiology (L.R.K., D.M., A.S.W., V.S., D.F.,
M.J.W.) and Stanford Cardiovascular Institute (D.M., D.F., M.J.W.), Stanford
University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5105;
Department of Radiology, University of Wisconsin–Madison, School of
Medicine and Public Health, Madison, Wis (T.P.S.); Department of Radiology,
Erasmus Medical Center, Rotterdam, the Netherlands (N.R.v.d.W.); Clinical
Science Western Europe, Philips Healthcare, Best, the Netherlands (N.R.v.d.W.);
and Department of Radiology, Leiden University Medical Center, Leiden, the
Netherlands (A.J.v.d.M.)
| | - Martin J. Willemink
- From the Department of Radiology (L.R.K., D.M., A.S.W., V.S., D.F.,
M.J.W.) and Stanford Cardiovascular Institute (D.M., D.F., M.J.W.), Stanford
University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5105;
Department of Radiology, University of Wisconsin–Madison, School of
Medicine and Public Health, Madison, Wis (T.P.S.); Department of Radiology,
Erasmus Medical Center, Rotterdam, the Netherlands (N.R.v.d.W.); Clinical
Science Western Europe, Philips Healthcare, Best, the Netherlands (N.R.v.d.W.);
and Department of Radiology, Leiden University Medical Center, Leiden, the
Netherlands (A.J.v.d.M.)
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Cancer risk in healthy patients who underwent chest tomography comparing three different technologies. Appl Radiat Isot 2023; 193:110625. [PMID: 36680979 DOI: 10.1016/j.apradiso.2022.110625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
This research aimed to estimate the risk of cancer associated with patients without previous disease undergoing chest tomography. Siemens CT scanners have 6, 64, and 128 detectors. The Biologic Effects of Ionizing Radiation Reports - BEIR VII methodology was used. The study presented a sample of 64 patients aged between 18 and 80 years, in the city of Belo Horizonte, Minas Gerais - Brazil. The IMPACT CT software and CalDose X CT Online were used to calculate the absorbed and equivalent dose from the Volumetric Computed Tomography Dose Index - CTDIvol (mGy) and Dose Length Product - DLP values provided by the equipment. CT-Expo Software was also used to estimate Specific Dose Estimates (SSDEs) values. The CTDvol results for the MG1, MG,2 and MG3 Diagnostic Centers in mGy were respectively 4.369 ± 1.352, 6.99 4 ± 1.53,3 and 9.984 ± 2.282 and the SSDE values were 3.800, 6.40,0 and 9,.500. The values for the equivalent dose, at the MG2 Diagnostic Center, by IMPACT CT, in (mSv) for the breasts, esophagus, heart, thyroid, lung and thymus were respectively 3.9, 5.7, 4.7, 1.0, 4.8 and 5.7. The CalDose Software, for the same equipment and the same organs, in mSv, estimated the values 7.4, 9.4, 11.1, 5.3, 10.8 and 11.3 for women and 7.1, 9.3, 11.0, 5.3, 10.2 and 10.9 for men. The estimated risk of cancer decreased according to the patient's age, but with a higher incidence for females. The use of each software must be carefully analyzed to avoid undue values due to the particularities of each one. The results also showed that the risk of developing cancer due to radiation decreases with patient age and is higher in females.
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Enger K, Tonnar X, Kotter E, Bertz H. Sequential low-dose CT thorax scans to determine invasive pulmonary fungal infection incidence after allogeneic hematopoietic cell transplantation. Ann Hematol 2023; 102:413-420. [PMID: 36460795 PMCID: PMC9889523 DOI: 10.1007/s00277-022-05062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Invasive fungal disease (IFD) during neutropenia goes along with a high mortality for patients after allogeneic hematopoietic cell transplantation (alloHCT). Low-dose computed tomography (CT) thorax shows good sensitivity for the diagnosis of IFD with low radiation exposure. The aim of our study was to evaluate sequential CT thorax scans at two time points as a new reliable method to detect IFD during neutropenia after alloHCT. We performed a retrospective single-center observational study in 265/354 screened patients admitted for alloHCT from June 2015 to August 2019. All were examined by a low-dose CT thorax scan at admission (CT t0) and after stable neutrophil recovery (CT t1) to determine the incidences of IFD. Furthermore, antifungal prophylaxis medications were recorded and cohorts were analyzed for statistical differences in IFD incidence using the sequential CT scans. In addition, IFD cases were classified according to EORTC 2008. At CT t0 in 9.6% of the patients, an IFD was detected and antifungal therapy initiated. The cumulative incidence of IFD in CT t1 in our department was 14%. The use of Aspergillus-effective prophylaxis through voriconazole or posaconazole decreased CT thorax t1 suggesting IFD is statistically significant compared to prophylaxis with fluconazole (5.6% asp-azol group vs 16.3% fluconazole group, p = 0.048). In 86%, CT t1 was negative for IFD. Low-dose sequential CT thorax scans are a valuable tool to detect pulmonary IFDs and guide antifungal prophylaxis and therapies. Furthermore, a negative CT t1 scan shows a benefit by allowing discontinuation of antifungal medication sparing patients from drug interactions and side effects.
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Affiliation(s)
- K. Enger
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Freiburg University Medical Center, Freiburg, Germany
| | - X. Tonnar
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Freiburg University Medical Center, Freiburg, Germany
| | - E. Kotter
- Department of Diagnostic and Interventional Radiology, Freiburg University Medical Center, Freiburg, Germany
| | - H. Bertz
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Freiburg University Medical Center, Freiburg, Germany
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Rao M. Postoperative lung cancer surveillance: the highs and lows of computerized tomographic scanning. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6967038. [PMID: 36592038 DOI: 10.1093/ejcts/ezac593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Madhuri Rao
- Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, MN, USA
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Gunawan R, Tran Y, Zheng J, Nguyen H, Chai R. Image Recovery from Synthetic Noise Artifacts in CT Scans Using Modified U-Net. SENSORS (BASEL, SWITZERLAND) 2022; 22:7031. [PMID: 36146380 PMCID: PMC9505882 DOI: 10.3390/s22187031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/11/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
Computed Tomography (CT) is commonly used for cancer screening as it utilizes low radiation for the scan. One problem with low-dose scans is the noise artifacts associated with low photon count that can lead to a reduced success rate of cancer detection during radiologist assessment. The noise had to be removed to restore detail clarity. We propose a noise removal method using a new model Convolutional Neural Network (CNN). Even though the network training time is long, the result is better than other CNN models in quality score and visual observation. The proposed CNN model uses a stacked modified U-Net with a specific number of feature maps per layer to improve the image quality, observable on an average PSNR quality score improvement out of 174 images. The next best model has 0.54 points lower in the average score. The score difference is less than 1 point, but the image result is closer to the full-dose scan image. We used separate testing data to clarify that the model can handle different noise densities. Besides comparing the CNN configuration, we discuss the denoising quality of CNN compared to classical denoising in which the noise characteristics affect quality.
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Affiliation(s)
- Rudy Gunawan
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Yvonne Tran
- Macquarie University Hearing (MU Hearing), Centre for Healthcare Resilience and Implementation Science, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Jinchuan Zheng
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Hung Nguyen
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Rifai Chai
- School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
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Kerpel-Fronius A, Monostori Z, Kovacs G, Ostoros G, Horvath I, Solymosi D, Pipek O, Szatmari F, Kovacs A, Markoczy Z, Rojko L, Renyi-Vamos F, Hoetzenecker K, Bogos K, Megyesfalvi Z, Dome B. Nationwide lung cancer screening with low-dose computed tomography: implementation and first results of the HUNCHEST screening program. Eur Radiol 2022; 32:4457-4467. [PMID: 35247089 DOI: 10.1007/s00330-022-08589-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/20/2021] [Accepted: 01/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Lung cancer (LC) kills more people than any other cancer in Hungary. Hence, there is a clear rationale for considering a national screening program. The HUNCHEST pilot program primarily aimed to investigate the feasibility of a population-based LC screening in Hungary, and determine the incidence and LC probability of solitary pulmonary nodules. METHODS A total of 1890 participants were assigned to undergo low-dose CT (LDCT) screening, with intervals of 1 year between procedures. Depending on the volume, growth, and volume doubling time (VDT), screenings were defined as negative, indeterminate, or positive. Non-calcified lung nodules with a volume > 500 mm3 and/or a VDT < 400 days were considered positive. LC diagnosis was based on histology. RESULTS At baseline, the percentage of negative, indeterminate, and positive tests was 81.2%, 15.1%, and 3.7%, respectively. The frequency of positive and indeterminate LDCT results was significantly higher in current smokers (vs. non-smokers or former smokers; p < 0.0001) and in individuals with COPD (vs. those without COPD, p < 0.001). In the first screening round, 1.2% (n = 23) of the participants had a malignant lesion, whereas altogether 1.5% (n = 29) of the individuals were diagnosed with LC. The overall positive predictive value of the positive tests was 31.6%. Most lung malignancies were diagnosed at an early stage (86.2% of all cases). CONCLUSIONS In terms of key characteristics, our prospective cohort study appears consistent to that of comparable studies. Altogether, the results of the HUNCHEST pilot program suggest that LDCT screening may facilitate early diagnosis and thus curative-intent treatment in LC. KEY POINTS • The HUNCHEST pilot study is the first nationwide low-dose CT screening program in Hungary. • In the first screening round, 1.2% of the participants had a malignant lesion, whereas altogether 1.5% of the individuals were diagnosed with lung cancer. • The overall positive predictive value of the positive tests in the HUNCHEST screening program was 31.6%.
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Affiliation(s)
- Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Zsuzsanna Monostori
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Gabor Kovacs
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Gyula Ostoros
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Istvan Horvath
- Affidea Diagnostics Hungary, Szent Margit and Nyiro Gyula Hospitals, Budapest, Hungary
| | - Diana Solymosi
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Orsolya Pipek
- Department of Physics of Complex Systems, Eotvos Lorand University, Budapest, Hungary
| | - Ferenc Szatmari
- Affidea Diagnostics Hungary, Petz Aladar Hospital, Gyor, Hungary
| | - Anita Kovacs
- Department of Radiology, Albert Szent-Gyorgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsolt Markoczy
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Livia Rojko
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary
| | - Ferenc Renyi-Vamos
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary.,Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Krisztina Bogos
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary.
| | - Zsolt Megyesfalvi
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary.,Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Balazs Dome
- National Koranyi Institute of Pulmonology, Korányi Frigyes út 1, Budapest, 1121, Hungary. .,Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary. .,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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A segmentation tool for pulmonary nodules in lung cancer screening: Testing and clinical usage. Phys Med 2021; 90:23-29. [PMID: 34530212 DOI: 10.1016/j.ejmp.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/28/2021] [Accepted: 08/21/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE With the future goal of defining a large dataset based on low-dose CT with labelled pulmonary lesions for lung cancer screening (LCS) research, the aim of this work is to propose and evaluate into a clinical context a tool for semi-automatic segmentation able to facilitate the process of labels collection from a LCS study (COSMOS, Continuous Observation of SMOking Subjects). METHODS Considering a preliminary set of manual annotations, a segmentation model based on a 2D-Unet was trained from scratch. Contour quality of the final 2D-Unet was assessed on an internal test set of manual annotations and on a subset of the public available LIDC dataset used as external test set. The tool for semi-automatic segmentation was then designed integrating the tested model into a Graphical User Interface. According to the opinion of two clinical users, the percentage of lesions properly contoured through the tool was quantified (Acceptance Rate, AR). The variability between segmentations derived by the two readers was estimated as mean percentage of difference (MPD) between the two sets of volumes and comparing the likelihood of malignancy derived from Volume Doubling Time (VDT). RESULTS Performance in test sets were found similar (DICE ~ 0.75(0.15)). Accordingly, a good mean AR (80.1%) resulted from the two readers. Variability in terms of MPD was equal to 23.6% while 2.7% was the VDTs percentage of disagreement. CONCLUSIONS A semi-automatic segmentation tool was developed and its applicability evaluated into a clinical context demonstrating the efficacy of the tool in facilitating the collection of labelled data.
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The use of deep learning towards dose optimization in low-dose computed tomography: A scoping review. Radiography (Lond) 2021; 28:208-214. [PMID: 34325998 DOI: 10.1016/j.radi.2021.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/10/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Low-dose computed tomography tends to produce lower image quality than normal dose computed tomography (CT) although it can help to reduce radiation hazards of CT scanning. Research has shown that Artificial Intelligence (AI) technologies, especially deep learning can help enhance the image quality of low-dose CT by denoising images. This scoping review aims to create an overview on how AI technologies, especially deep learning, can be used in dose optimisation for low-dose CT. METHODS Literature searches of ProQuest, PubMed, Cinahl, ScienceDirect, EbscoHost Ebook Collection and Ovid were carried out to find research articles published between the years 2015 and 2020. In addition, manual search was conducted in SweMed+, SwePub, NORA, Taylor & Francis Online and Medic. RESULTS Following a systematic search process, the review comprised of 16 articles. Articles were organised according to the effects of the deep learning networks, e.g. image noise reduction, image restoration. Deep learning can be used in multiple ways to facilitate dose optimisation in low-dose CT. Most articles discuss image noise reduction in low-dose CT. CONCLUSION Deep learning can be used in the optimisation of patients' radiation dose. Nevertheless, the image quality is normally lower in low-dose CT (LDCT) than in regular-dose CT scans because of smaller radiation doses. With the help of deep learning, the image quality can be improved to equate the regular-dose computed tomography image quality. IMPLICATIONS TO PRACTICE Lower dose may decrease patients' radiation risk but may affect the image quality of CT scans. Artificial intelligence technologies can be used to improve image quality in low-dose CT scans. Radiologists and radiographers should have proper education and knowledge about the techniques used.
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DNA methylation of PTGER4 in peripheral blood plasma helps to distinguish between lung cancer, benign pulmonary nodules and chronic obstructive pulmonary disease patients. Eur J Cancer 2021; 147:142-150. [PMID: 33662689 DOI: 10.1016/j.ejca.2021.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND/INTRODUCTION In contrast to patients who present with advanced stage lung cancer and associated poor prognosis, patients with early-stage lung cancer may be candidates for curative treatments. The results of the NELSON lung cancer screening trial are expected to stimulate the development and implementation of a lung cancer screening strategy in most countries. Widespread use of chest computed tomography scans will also result in the detection of solitary pulmonary nodules. Because reliable biomarkers to distinguish between malignant and benign lesions are lacking, tissue-based histopathological diagnostics remain the gold standard. In this study, we aimed to establish a test to assess the predictive ability of DNA hypermethylation of SHOX2 and PTGER4 in plasma to discriminate between patients with 1.) lung cancer, 2.) benign lesions, and 3.) patients with chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS We retrospectively analysed SHOX2 and PTGER4 methylation in 121 prospectively collected plasma samples of patients with lung cancer (group 1A), benign lesions (group 1B), and COPD without nodules (group 2). RESULTS PTGER4 DNA hypermethylation was more frequently observed in patients with lung cancer than in controls (p = 0.0004). Results remained significant after correction for tumour volume, smoking status, age, and eligibility for the NELSON trial. CONCLUSIONS Detection of methylated PTGER4 in plasma DNA may serve as a biomarker to support clinical decision-making in patients with pulmonary lesions at lung cancer screening in high-risk populations. Further exploration in prospective studies is warranted.
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Tækker M, Kristjánsdóttir B, Graumann O, Laursen CB, Pietersen PI. Diagnostic accuracy of low-dose and ultra-low-dose CT in detection of chest pathology: a systematic review. Clin Imaging 2021; 74:139-148. [PMID: 33517021 DOI: 10.1016/j.clinimag.2020.12.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/12/2020] [Accepted: 12/31/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Studies have evaluated imaging modalities with a lower radiation dose than standard-dose CT (SD-CT) for chest examination. This systematic review aimed to summarize evidence on diagnostic accuracy of these modalities - low-dose and ultra-low-dose CT (LD- and ULD-CT) - for chest pathology. METHOD Ovid-MEDLINE, Ovid-EMBASE and the Cochrane Library were systematically searched April 29th-30th, 2019 and screened by two reviewers. Studies on diagnostic accuracy were included if they defined their index tests as 'LD-CT', 'Reduced-dose CT' or 'ULD-CT' and had SD-CT as reference standard. Risk of bias was evaluated on study level using the Quality Assessment of Diagnostic Accuracy Studies-2. A narrative synthesis was conducted to compare the diagnostic accuracy measurements. RESULTS Of the 4257 studies identified, 18 were eligible for inclusion. SD-CT (3.17 ± 1.47 mSv) was used as reference standard in all studies to evaluate diagnostic accuracy of LD- (1.22 ± 0.34 mSv) and ULD-CT (0.22 ± 0.05 mSv), respectively. LD-CT had high sensitivities for detection of bronchiectasis (82-96%), honeycomb (75-100%), and varying sensitivities for nodules (63-99%) and ground glass opacities (GGO) (77-91%). ULD-CT had high sensitivities for GGO (93-100%), pneumothorax (100%), consolidations (90-100%), and varying sensitivities for nodules (60-100%) and emphysema (65-90%). CONCLUSION The included studies found LD-CT to have high diagnostic accuracy in detection of honeycombing and bronchiectasis and ULD-CT to have high diagnostic accuracy for pneumothorax, consolidations and GGO. Summarizing evidence on diagnostic accuracy of LD- and ULD-CT for other chest pathology was not possible due to varying outcome measures, lack of precision estimates and heterogeneous study design and methodology.
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Affiliation(s)
- Maria Tækker
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, entrance 112, 2nd floor, 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, Kloevervaenget 47, 5000 Odense C, Denmark.
| | - Björg Kristjánsdóttir
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, entrance 112, 2nd floor, 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, Kloevervaenget 47, 5000 Odense C, Denmark.
| | - Ole Graumann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, entrance 112, 2nd floor, 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, Kloevervaenget 47, 5000 Odense C, Denmark.
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Kloevervaenget 2, entrance 87-88, 5000 Odense C, Denmark; Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
| | - Pia I Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Kloevervaenget 2, entrance 87-88, 5000 Odense C, Denmark; Regional Center for Technical Simulation, Odense University Hospital, Region of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
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12
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Validation of low-dose lung cancer PET-CT protocol and PET image improvement using machine learning. Phys Med 2020; 81:285-294. [PMID: 33341375 DOI: 10.1016/j.ejmp.2020.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To conduct a simplified lesion-detection task of a low-dose (LD) PET-CT protocol for frequent lung screening using 30% of the effective PETCT dose and to investigate the feasibility of increasing clinical value of low-statistics scans using machine learning. METHODS We acquired 33 SD PET images, of which 13 had actual LD (ALD) PET, and simulated LD (SLD) PET images at seven different count levels from the SD PET scans. We employed image quality transfer (IQT), a machine learning algorithm that performs patch-regression to map parameters from low-quality to high-quality images. At each count level, patches extracted from 23 pairs of SD/SLD PET images were used to train three IQT models - global linear, single tree, and random forest regressions with cubic patch sizes of 3 and 5 voxels. The models were then used to estimate SD images from LD images at each count level for 10 unseen subjects. Lesion-detection task was carried out on matched lesion-present and lesion-absent images. RESULTS LD PET-CT protocol yielded lesion detectability with sensitivity of 0.98 and specificity of 1. Random forest algorithm with cubic patch size of 5 allowed further 11.7% reduction in the effective PETCT dose without compromising lesion detectability, but underestimated SUV by 30%. CONCLUSION LD PET-CT protocol was validated for lesion detection using ALD PET scans. Substantial image quality improvement or additional dose reduction while preserving clinical values can be achieved using machine learning methods though SUV quantification may be biased and adjustment of our research protocol is required for clinical use.
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13
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Stemler J, Bruns C, Mellinghoff SC, Alakel N, Akan H, Ananda-Rajah M, Auberger J, Bojko P, Chandrasekar PH, Chayakulkeeree M, Cozzi JA, de Kort EA, Groll AH, Heath CH, Henze L, Hernandez Jimenez M, Kanj SS, Khanna N, Koldehoff M, Lee DG, Mager A, Marchesi F, Martino-Bufarull R, Nucci M, Oksi J, Pagano L, Phillips B, Prattes J, Pyrpasopoulou A, Rabitsch W, Schalk E, Schmidt-Hieber M, Sidharthan N, Soler-Palacín P, Stern A, Weinbergerová B, El Zakhem A, Cornely OA, Koehler P. Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients. J Fungi (Basel) 2020; 6:jof6010036. [PMID: 32183235 PMCID: PMC7151030 DOI: 10.3390/jof6010036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 12/21/2022] Open
Abstract
Baseline chest computed tomography (BCT) in high-risk hematology patients allows for the early diagnosis of invasive pulmonary aspergillosis (IPA). The distribution of BCT implementation in hematology departments and impact on outcome is unknown. A web-based questionnaire was designed. International scientific bodies were invited. The estimated numbers of annually treated hematology patients, chest imaging timepoints and techniques, IPA rates, and follow-up imaging were assessed. In total, 142 physicians from 43 countries participated. The specialties included infectious diseases (n = 69; 49%), hematology (n = 68; 48%), and others (n = 41; 29%). BCT was performed in 57% (n = 54) of 92 hospitals. Upon the diagnosis of malignancy or admission, 48% and 24% performed BCT, respectively, and X-ray was performed in 48% and 69%, respectively. BCT was more often used in hematopoietic cell transplantation and in relapsed acute leukemia. European centers performed BCT in 59% and non-European centers in 53%. Median estimated IPA rate was 8% and did not differ between BCT (9%; IQR 5–15%) and non-BCT centers (7%; IQR 5–10%) (p = 0.69). Follow-up computed tomography (CT) for IPA was performed in 98% (n = 90) of centers. In high-risk hematology patients, baseline CT is becoming a standard-of-care. Chest X-ray, while inferior, is still widely used. Randomized, controlled trials are needed to investigate the impact of BCT on patient outcome.
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Affiliation(s)
- Jannik Stemler
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; (C.B.); (S.C.M.); (O.A.C.); (P.K.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, 50937 Cologne, Germany
- Correspondence: ; Tel.: +49(0)-221-478-32884
| | - Caroline Bruns
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; (C.B.); (S.C.M.); (O.A.C.); (P.K.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Sibylle C. Mellinghoff
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; (C.B.); (S.C.M.); (O.A.C.); (P.K.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Nael Alakel
- Department of Internal Medicine I, University Hospital of Dresden, 01307 Dresden, Germany;
| | - Hamdi Akan
- Hematology Clinical Research Unit, Cebeci Hospital, Ankara University Faculty of Medicine, 06100 Ankara, Turkey;
| | - Michelle Ananda-Rajah
- Dept of Infectious Diseases and General Medical Unit, Alfred Health & Central Clinical School, Monash University, Melbourne 3004, Australia;
| | - Jutta Auberger
- Onkologische Schwerpunktpraxis Freilassing, 83395 Freilassing, Germany;
| | - Peter Bojko
- Department of Hematology and Oncology, Red Cross Hospital Munich, 80634 Munich, Germany;
| | - Pranatharthi H. Chandrasekar
- Division of Infectious Diseases, Wayne State University School of Medicine, Karmanos Cancer Center, Detroit, MI 48201, USA;
| | - Methee Chayakulkeeree
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - José A. Cozzi
- Hematology Department, Hospital Provincial Del Centenario, Rosario 2000, Argentina;
| | - Elizabeth A. de Kort
- Department of Hematology, Radboud University Medical Center, 6500 Nijmegen, The Netherlands;
| | - Andreas H. Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and, Department of Pediatric Hematology and Oncology, University Children’s Hospital, 48149 Münster, Germany;
| | - Christopher H. Heath
- Department of Microbiology (PathWest Laboratory Medicine, WA, FSH Network), Perth 6000, Australia;
- Depts. of Infectious Diseases, Fiona Stanley Hospital & Royal Perth Hospital, Perth 6000, Australia
- Faculty of Health & Medical Sciences, University of Western Australia, Murdoch/Perth, Murdoch 6150, Australia
| | - Larissa Henze
- Department of Medicine, Clinic III – Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany;
| | - Marcos Hernandez Jimenez
- Head of the bone marrow unit, Hospital City Dr. Enrique Tejera, 2001 Valencia, Venezuela;
- Departament of Medicine, Facultad de Ciencias de la Salud, University of Carabobo, 2001 Valencia, Venezuela
| | - Souha S. Kanj
- Division of Infectious Diseases, Infection Control Program, Antimicrobial Stewardship Program, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
| | - Nina Khanna
- Division of Infection Diseases and Hospital Epidemiology, University and University Hospital of Basel, 4031 Basel, Switzerland;
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Dong-Gun Lee
- Division of infectious Diseases, Department of Internal Medicine, Catholic Hematology Hospital & Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 06591 Seoul, Korea;
| | - Alina Mager
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany;
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 00144 Rome, Italy;
| | | | - Marcio Nucci
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil;
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, 20521 Turku, Finland;
| | - Livio Pagano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli -IRCCS, 00169 Rome, Italy;
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Bob Phillips
- Leeds Children’s Hospital, Leeds General Infirmary, Leeds Teaching Hospitals, NHS Trust, Leeds LS1 3EX, UK;
- Centre for Reviews and Dissemination, Alcuin College, University of York, York YO10 5DD, UK
| | - Juergen Prattes
- Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, 8036 Graz, Austria;
| | | | - Werner Rabitsch
- Department of Internal Medicine I, Bone Marrow Transplant-Unit, Medical University of Vienna, 1090 Vienna, Austria;
| | - Enrico Schalk
- Department of Hematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Center, 39120 Magdeburg, Germany;
| | | | - Neeraj Sidharthan
- Department of Clinical Haematology, Amrita Institute of Medical Sciences, Kochi 682041, India;
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit. Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain;
| | - Anat Stern
- Infectious Diseases institute, Rambam Health Care Campus, 3109601 Haifa, Israel;
| | - Barbora Weinbergerová
- Department of Internal Medicine–Hematology and Oncology, Masaryk University and University Hospital Brno, 62500 Brno, Czech Republic;
| | - Aline El Zakhem
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
| | - Oliver A. Cornely
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; (C.B.); (S.C.M.); (O.A.C.); (P.K.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, 50937 Cologne, Germany
- Clinical Trials Centre Cologne, ZKS Köln, 50935 Cologne, Germany
| | - Philipp Koehler
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; (C.B.); (S.C.M.); (O.A.C.); (P.K.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
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Gao Y, Liang Z, Zhang H, Yang J, Ferretti J, Bilfinger T, Yaddanapudi K, Schweitzer M, Bhattacharji P, Moore W. A Task-dependent Investigation on Dose and Texture in CT Image Reconstruction. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2019; 4:441-449. [PMID: 33907724 DOI: 10.1109/trpms.2019.2957459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Localizing and characterizing clinically-significant lung nodules, a potential precursor to lung cancer, at the lowest achievable radiation dose is demanded to minimize the stochastic radiation effects from x-ray computed tomography (CT). A minimal dose level is heavily dependent on the image reconstruction algorithms and clinical task, in which the tissue texture always plays an important role. This study aims to investigate the dependence through a task-based evaluation at multiple dose levels and variable textures in reconstructions with prospective patient studies. 133 patients with a suspicious pulmonary nodule scheduled for biopsy were recruited and the data was acquired at120kVp with three different dose levels of 100, 40 and 20mAs. Three reconstruction algorithms were implemented: analytical filtered back-projection (FBP) with optimal noise filtering; statistical Markov random field (MRF) model with optimal Huber weighting (MRF-H) for piecewise smooth reconstruction; and tissue-specific texture model (MRF-T) for texture preserved statistical reconstruction. Experienced thoracic radiologists reviewed and scored all images at random, blind to the CT dose and reconstruction algorithms. The radiologists identified the nodules in each image including the 133 biopsy target nodules and 66 other non-target nodules. For target nodule characterization, only MRF-T at 40mAs showed no statistically significant difference from FBP at 100mAs. For localizing both the target nodules and the non-target nodules, some as small as 3mm, MRF-T at 40 and 20mAs levels showed no statistically significant difference from FBP at 100mAs, respectively. MRF-H and FBP at 40 and 20mAs levels performed statistically differently from FBP at 100mAs. This investigation concluded that (1) the textures in the MRF-T reconstructions improves both the tasks of localizing and characterizing nodules at low dose CT and (2) the task of characterizing nodules is more challenging than the task of localizing nodules and needs more dose or enhanced textures from reconstruction.
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Affiliation(s)
- Yongfeng Gao
- Department of Radiology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Zhengrong Liang
- Departments of Radiology, Biomedical Engineering, Computer Science, and Electrical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Hao Zhang
- Departments of Radiology and Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA and now with the Department of Radiation Oncology, Stanford University, Stanford, CA 94035, USA
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - John Ferretti
- Department of Radiology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Thomas Bilfinger
- Department of Surgery, Stony Brook University, Stony Brook, NY 11794, USA)
| | | | - Mark Schweitzer
- Department of Radiology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Priya Bhattacharji
- Department of Radiology, Stony Brook University, Stony Brook, NY 11794, USA, and now with the Department of Radiology, New York University, New York, NY 10016, USA
| | - William Moore
- Department of Radiology, Stony Brook University, Stony Brook, NY 11794, USA, and now with the Department of Radiology, New York University, New York, NY 10016, USA
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15
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Ma H, Wang J, Ma X, Zheng S, Ma H, Ge J. Video-assisted thoracoscopic surgery for invasive pulmonary fungal infection in haematology patients. J Thorac Dis 2019; 11:2839-2845. [PMID: 31463113 DOI: 10.21037/jtd.2019.07.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Invasive pulmonary fungal infection in haematological patients sometimes was a difficult problem in diagnosis and treatments. This retrospective study was intended to assess the outcomes of video-assisted thoracoscopic surgery (VATS) in the treatments of this problem. Methods From January 2011 to December 2017, a total of 51 haematological patients underwent VATS for invasive pulmonary fungal infection. We collected and then analyzed potential factors including general conditions, types of haematological diseases, preoperative clinical symptoms, surgical procedures, length of postoperative hospital stay, incidence of postoperative complications and postoperative follow-ups. Results Of the 51 patients, 32 patients underwent video-assisted thoracoscopic wedge resection (62.7%), 6 patients underwent video-assisted thoracoscopic segmentectomy (11.8%) and 13 patients underwent video-assisted thoracoscopic lobectomy (25.5%). The mean operative time was 110.24±38.12 min. The average intraoperative blood loss was 112.35±87.85 mL. The mean postoperative hospital stay was 7.75±3.27 days. Prolonged air leak was found in 6 patients (11.8%), followed by excessive effusion which was found in 4 patients (7.8%). No life-threatening complications or resurgence of fungal infection occurred after surgery. Twenty-seven patients (52.9%) received postoperative antifungal therapies. No 30-day mortality and pulmonary fungal infection recurrence occurred in 6 to 24 months follow-ups. Conclusions VATS is an effective and safe option in management of invasive pulmonary fungal infection among patients with haematological diseases.
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Affiliation(s)
- Han Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jun Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xiao Ma
- Department of Haematology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Shiying Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Haitao Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jinfeng Ge
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Gao Y, Liang Z, Moore WH, Zhang H, Pomeroy MJ, Ferretti JA, Bilfinger TV, Ma J, Lu H. A Feasibility Study of Extracting Tissue Textures From a Previous Full-Dose CT Database as Prior Knowledge for Bayesian Reconstruction of Current Low-Dose CT Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:1981-1992. [PMID: 30605098 PMCID: PMC6610633 DOI: 10.1109/tmi.2018.2890788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Markov random field (MRF) has been widely used to incorporate a priori knowledge as penalty or regularizer to preserve edge sharpness while smoothing the region enclosed by the edge for pieces-wise smooth image reconstruction. In our earlier study, we proposed a type of MRF reconstruction method for low-dose CT (LdCT) scans using tissue-specific textures extracted from the same patient's previous full-dose CT (FdCT) scans as prior knowledge. It showed advantages in clinical applications. This paper aims to remove the constraint of using previous data of the same patient. We investigated the feasibility of extracting the tissue-specific MRF textures from an FdCT database to reconstruct a LdCT image of another patient. This feasibility study was carried out by experiments designed as follows. We constructed a tissue-specific MRF-texture database from 3990 FdCT scan slices of 133 patients who were scheduled for lung nodule biopsy. Each patient had one FdCT scan (120 kVp/100 mAs) and one LdCT scan (120 kVp/20 mAs) prior to biopsy procedure. When reconstructing the LdCT image of one patient among the 133 patients, we ranked the closeness of the MRF-textures from the other 132 patients saved in the database and used them as the a prior knowledge. Then, we evaluated the reconstructed image quality using Haralick texture measures. For any patient within our database, we found more than eighteen patients' FdCT MRF texures can be used without noticeably changing the Haralick texture measures on the lung nodules (to be biopsied). These experimental outcomes indicate it is promising that a sizable FdCT texture database could be used to enhance Bayesian reconstructions of any incoming LdCT scans.
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Affiliation(s)
- Yongfeng Gao
- Department of Radiology, State University of New York at Stony Brook, Stony Brook, NY 11974 USA
| | - Zhengrong Liang
- Departments of Radiology, Electrical and Computer Engineering, Computer Science and Biomedical Engineering, State University of New York at Stony Brook, Stony Brook, NY 11794, USA ()
| | - William H. Moore
- Department of Radiology, State University of New York at Stony Brook, Stony Brook, NY 11794, USA, and now is with the Department of Radiology, New York University, New York, NY 10016, USA
| | - Hao Zhang
- Department of Radiation Oncology, Stanford University, Stanford, CA 94035, USA
| | - Marc J. Pomeroy
- Departments of Radiology and Biomedical Engineering, State University of New York at Stony Brook, Stony Brook, NY 11794, USA
| | - John A. Ferretti
- Department of Radiology, State University of New York at Stony Brook, Stony Brook, NY 11794, USA
| | - Thomas V. Bilfinger
- Department of Surgery, State University of New York at Stony Brook, Stony Brook, NY 11794, USA
| | - Jianhua Ma
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Hongbing Lu
- Department of Biomedical Engineering, Fourth Military Medical University, Xi’an 710032, China
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Heinz WJ, Vehreschild JJ, Buchheidt D. Diagnostic work up to assess early response indicators in invasive pulmonary aspergillosis in adult patients with haematologic malignancies. Mycoses 2019; 62:486-493. [PMID: 30329192 DOI: 10.1111/myc.12860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/03/2018] [Accepted: 10/07/2018] [Indexed: 12/20/2022]
Abstract
In immunocompromised patients with acute leukaemia as well as in allogeneic hematopoietic stem cell transplant patients, pulmonary lesions are commonly seen. Existing guidelines provide useful algorithms for diagnostic procedures and treatment options, but they do not give recommendations on how to evaluate early success or failure and if or when it is best to change therapy. Here, we review the diagnostic techniques currently used in association with clinical findings and propose an approach using a combination of computer tomography, clinical and all available biomarkers and inflammation parameters, especially those positive at baseline, to assess early response in invasive pulmonary aspergillosis. Computed tomography scans should be carried out at regular intervals during early and long-term follow-up. Imaging on day seven, or even earlier in clinically unstable patients, combined with an additional testing of biomarkers and inflammatory markers in between, is needed for a reliable assessment at day 14. If no improvement is seen after 2 weeks of therapy or the clinical condition is deteriorating, a change of antifungal therapy should be considered. Alleged breakthrough infections or treatment failure should undergo early diagnostic workup, including tissue biopsies when possible, to retrieve fungal cultures for resistance testing.
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Affiliation(s)
- Werner J Heinz
- Klinikum Weiden, Weiden, Würzburg university medical center, Würzburg, Germany
| | - Jörg J Vehreschild
- Department for Internal Medicine, German Centre for Infection Research, University Hospital of Cologne, Partner Site Bonn-Cologne, University of Cologne, Köln, Germany
| | - Dieter Buchheidt
- Department of Internal Medicine-Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
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Comparison of the 18F-FDG avidity at PET of benign and malignant pure ground-glass opacities: a paradox? Clin Radiol 2019; 74:187-195. [DOI: 10.1016/j.crad.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/13/2018] [Indexed: 11/24/2022]
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Ohno Y, Koyama H, Seki S, Kishida Y, Yoshikawa T. Radiation dose reduction techniques for chest CT: Principles and clinical results. Eur J Radiol 2018; 111:93-103. [PMID: 30691672 DOI: 10.1016/j.ejrad.2018.12.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/06/2018] [Accepted: 12/16/2018] [Indexed: 11/19/2022]
Abstract
Computer tomography plays a major role in the evaluation of thoracic diseases, especially since the advent of the multidetector-row CT (MDCT) technology. However, the increase use of this technique has raised some concerns about the resulting radiation dose. In this review, we will present the various methods allowing limiting the radiation dose exposure resulting from chest CT acquisitions, including the options of image filtering and iterative reconstruction (IR) algorithms. The clinical applications of reduced dose protocols will be reviewed, especially for lung nodule detection and diagnosis of pulmonary thromboembolism. The performance of reduced dose protocols for infiltrative lung disease assessment will also be discussed. Lastly, the influence of using IR algorithms on computer-aided detection and volumetry of lung nodules, as well as on quantitative and functional assessment of chest diseases will be presented and discussed.
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Affiliation(s)
- Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Japan.
| | | | - Shinichiro Seki
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Japan
| | - Yuji Kishida
- Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Japan
| | - Takeshi Yoshikawa
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Japan
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Momcilovic M, Shackelford DB. Imaging Cancer Metabolism. Biomol Ther (Seoul) 2018; 26:81-92. [PMID: 29212309 PMCID: PMC5746040 DOI: 10.4062/biomolther.2017.220] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 12/23/2022] Open
Abstract
It is widely accepted that altered metabolism contributes to cancer growth and has been described as a hallmark of cancer. Our view and understanding of cancer metabolism has expanded at a rapid pace, however, there remains a need to study metabolic dependencies of human cancer in vivo. Recent studies have sought to utilize multi-modality imaging (MMI) techniques in order to build a more detailed and comprehensive understanding of cancer metabolism. MMI combines several in vivo techniques that can provide complementary information related to cancer metabolism. We describe several non-invasive imaging techniques that provide both anatomical and functional information related to tumor metabolism. These imaging modalities include: positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS) that uses hyperpolarized probes and optical imaging utilizing bioluminescence and quantification of light emitted. We describe how these imaging modalities can be combined with mass spectrometry and quantitative immunochemistry to obtain more complete picture of cancer metabolism. In vivo studies of tumor metabolism are emerging in the field and represent an important component to our understanding of how metabolism shapes and defines cancer initiation, progression and response to treatment. In this review we describe in vivo based studies of cancer metabolism that have taken advantage of MMI in both pre-clinical and clinical studies. MMI promises to advance our understanding of cancer metabolism in both basic research and clinical settings with the ultimate goal of improving detection, diagnosis and treatment of cancer patients.
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Affiliation(s)
- Milica Momcilovic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, Los Angeles, CA, 90095, USA
| | - David B Shackelford
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, Los Angeles, CA, 90095, USA
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Kubo T, Ohno Y, Seo JB, Yamashiro T, Kalender WA, Lee CH, Lynch DA, Kauczor HU, Hatabu H. Securing safe and informative thoracic CT examinations—Progress of radiation dose reduction techniques. Eur J Radiol 2017; 86:313-319. [DOI: 10.1016/j.ejrad.2016.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 12/16/2022]
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