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Chen H, Zhang B, Huang J. Recent advances and applications of artificial intelligence in 3D bioprinting. BIOPHYSICS REVIEWS 2024; 5:031301. [PMID: 39036708 PMCID: PMC11260195 DOI: 10.1063/5.0190208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/11/2024] [Indexed: 07/23/2024]
Abstract
3D bioprinting techniques enable the precise deposition of living cells, biomaterials, and biomolecules, emerging as a promising approach for engineering functional tissues and organs. Meanwhile, recent advances in 3D bioprinting enable researchers to build in vitro models with finely controlled and complex micro-architecture for drug screening and disease modeling. Recently, artificial intelligence (AI) has been applied to different stages of 3D bioprinting, including medical image reconstruction, bioink selection, and printing process, with both classical AI and machine learning approaches. The ability of AI to handle complex datasets, make complex computations, learn from past experiences, and optimize processes dynamically makes it an invaluable tool in advancing 3D bioprinting. The review highlights the current integration of AI in 3D bioprinting and discusses future approaches to harness the synergistic capabilities of 3D bioprinting and AI for developing personalized tissues and organs.
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Affiliation(s)
| | - Bin Zhang
- Department of Mechanical and Aerospace Engineering, Brunel University London, London, United Kingdom
| | - Jie Huang
- Department of Mechanical Engineering, University College London, London, United Kingdom
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Ma M, Sun LH, Chen R, Zhu J, Zhao B. Artificial intelligence in fetal echocardiography: Recent advances and future prospects. IJC HEART & VASCULATURE 2024; 53:101380. [PMID: 39156918 PMCID: PMC11327943 DOI: 10.1016/j.ijcha.2024.101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/04/2024] [Indexed: 08/20/2024]
Abstract
In the past few decades, great progress has been made in prenatal diagnosis of congenital heart disease (CHD). Fetal echocardiography is recognized as the main prenatal screening and diagnostic tool that can accurately detect approximately 85 % of fetal cardiac abnormalities. Evaluation of the fetal heart remains a major challenge in prenatal ultrasound screening and diagnosis due to fetal position, involuntary movement, small and complex fetal cardiac anatomy, maternal abdominal wall conditions, and lack of expertise in fetal echocardiography by some physicians engaged in obstetric ultrasound. Artificial intelligence (AI) can automate and standardize the display of each diagnostic section of the fetal heart and thus contribute to accurate diagnosis, which significantly optimizes the clinical application of fetal echocardiography. In this review, we not only clarify the role of AI but also highlight its significance and future solutions in the field of fetal echocardiography.
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Affiliation(s)
- Mingming Ma
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, China
| | - Li-Hua Sun
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, China
| | - Ran Chen
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, China
| | - Jiang Zhu
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapyfor Major Gynecological Diseases, Women’s Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Bowen Zhao
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, China
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Ferreira I, Simões J, Pereira B, Correia J, Areia AL. Ensemble learning for fetal ultrasound and maternal-fetal data to predict mode of delivery after labor induction. Sci Rep 2024; 14:15275. [PMID: 38961231 PMCID: PMC11222528 DOI: 10.1038/s41598-024-65394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024] Open
Abstract
Providing adequate counseling on mode of delivery after induction of labor (IOL) is of utmost importance. Various AI algorithms have been developed for this purpose, but rely on maternal-fetal data, not including ultrasound (US) imaging. We used retrospectively collected clinical data from 808 subjects submitted to IOL, totaling 2024 US images, to train AI models to predict vaginal delivery (VD) and cesarean section (CS) outcomes after IOL. The best overall model used only clinical data (F1-score: 0.736; positive predictive value (PPV): 0.734). The imaging models employed fetal head, abdomen and femur US images, showing limited discriminative results. The best model used femur images (F1-score: 0.594; PPV: 0.580). Consequently, we constructed ensemble models to test whether US imaging could enhance the clinical data model. The best ensemble model included clinical data and US femur images (F1-score: 0.689; PPV: 0.693), presenting a false positive and false negative interesting trade-off. The model accurately predicted CS on 4 additional cases, despite misclassifying 20 additional VD, resulting in a 6.0% decrease in average accuracy compared to the clinical data model. Hence, integrating US imaging into the latter model can be a new development in assisting mode of delivery counseling.
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Affiliation(s)
- Iolanda Ferreira
- Faculty of Medicine of University of Coimbra, Obstetrics Department, University and Hospitalar Centre of Coimbra, Coimbra, Portugal.
- Maternidade Doutor Daniel de Matos, R. Miguel Torga, 3030-165, Coimbra, Portugal.
| | - Joana Simões
- Department of Informatics Engineering, Centre for Informatics and Systems of the University of Coimbra, University of Coimbra, Coimbra, Portugal
| | - Beatriz Pereira
- Department of Physics, University of Coimbra, Coimbra, Portugal
| | - João Correia
- Department of Informatics Engineering, Centre for Informatics and Systems of the University of Coimbra, University of Coimbra, Coimbra, Portugal
| | - Ana Luísa Areia
- Faculty of Medicine of University of Coimbra, Obstetrics Department, University and Hospitalar Centre of Coimbra, Coimbra, Portugal
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Khera R, Oikonomou EK, Nadkarni GN, Morley JR, Wiens J, Butte AJ, Topol EJ. Transforming Cardiovascular Care With Artificial Intelligence: From Discovery to Practice: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:97-114. [PMID: 38925729 DOI: 10.1016/j.jacc.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 06/28/2024]
Abstract
Artificial intelligence (AI) has the potential to transform every facet of cardiovascular practice and research. The exponential rise in technology powered by AI is defining new frontiers in cardiovascular care, with innovations that span novel diagnostic modalities, new digital native biomarkers of disease, and high-performing tools evaluating care quality and prognosticating clinical outcomes. These digital innovations promise expanded access to cardiovascular screening and monitoring, especially among those without access to high-quality, specialized care historically. Moreover, AI is propelling biological and clinical discoveries that will make future cardiovascular care more personalized, precise, and effective. The review brings together these diverse AI innovations, highlighting developments in multimodal cardiovascular AI across clinical practice and biomedical discovery, and envisioning this new future backed by contemporary science and emerging discoveries. Finally, we define the critical path and the safeguards essential to realizing this AI-enabled future that helps achieve optimal cardiovascular health and outcomes for all.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, USA; Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut, USA; Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA.
| | - Evangelos K Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Girish N Nadkarni
- The Samuel Bronfman Department of Medicine, Division of Data Driven and Digital Medicine (D3M), Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jessica R Morley
- Digital Ethics Center, Yale University, New Haven, Connecticut, USA
| | - Jenna Wiens
- Electrical Engineering and Computer Science, Computer Science and Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Atul J Butte
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA; Center for Data-Driven Insights and Innovation, University of California Health, Oakland, California, USA
| | - Eric J Topol
- Molecular Medicine, Scripps Research Translational Institute, Scripps Research, La Jolla, California, USA
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Patel DJ, Chaudhari K, Acharya N, Shrivastava D, Muneeba S. Artificial Intelligence in Obstetrics and Gynecology: Transforming Care and Outcomes. Cureus 2024; 16:e64725. [PMID: 39156405 PMCID: PMC11329325 DOI: 10.7759/cureus.64725] [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: 06/15/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
The integration of artificial intelligence (AI) in obstetrics and gynecology (OB/GYN) is revolutionizing the landscape of women's healthcare. This review article explores the transformative impact of AI technologies on the diagnosis, treatment, and management of obstetric and gynecological conditions. We examine key advancements in AI-driven imaging techniques, predictive analytics, and personalized medicine, highlighting their roles in enhancing prenatal care, improving maternal and fetal outcomes, and optimizing gynecological interventions. The article also addresses the challenges and ethical considerations associated with the implementation of AI in clinical practice. This paper highlights the potential of AI to greatly improve the standard of care in OB/GYN, ultimately leading to better health outcomes for women, by offering a thorough overview of present AI uses and future prospects.
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Affiliation(s)
- Dharmesh J Patel
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Kamlesh Chaudhari
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Deepti Shrivastava
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shaikh Muneeba
- Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Day TG, Matthew J, Budd SF, Venturini L, Wright R, Farruggia A, Vigneswaran TV, Zidere V, Hajnal JV, Razavi R, Simpson JM, Kainz B. Interaction between clinicians and artificial intelligence to detect fetal atrioventricular septal defects on ultrasound: how can we optimize collaborative performance? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:28-35. [PMID: 38197584 DOI: 10.1002/uog.27577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/19/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Artificial intelligence (AI) has shown promise in improving the performance of fetal ultrasound screening in detecting congenital heart disease (CHD). The effect of giving AI advice to human operators has not been studied in this context. Giving additional information about AI model workings, such as confidence scores for AI predictions, may be a way of further improving performance. Our aims were to investigate whether AI advice improved overall diagnostic accuracy (using a single CHD lesion as an exemplar), and to determine what, if any, additional information given to clinicians optimized the overall performance of the clinician-AI team. METHODS An AI model was trained to classify a single fetal CHD lesion (atrioventricular septal defect (AVSD)), using a retrospective cohort of 121 130 cardiac four-chamber images extracted from 173 ultrasound scan videos (98 with normal hearts, 75 with AVSD); a ResNet50 model architecture was used. Temperature scaling of model prediction probability was performed on a validation set, and gradient-weighted class activation maps (grad-CAMs) produced. Ten clinicians (two consultant fetal cardiologists, three trainees in pediatric cardiology and five fetal cardiac sonographers) were recruited from a center of fetal cardiology to participate. Each participant was shown 2000 fetal four-chamber images in a random order (1000 normal and 1000 AVSD). The dataset comprised 500 images, each shown in four conditions: (1) image alone without AI output; (2) image with binary AI classification; (3) image with AI model confidence; and (4) image with grad-CAM image overlays. The clinicians were asked to classify each image as normal or AVSD. RESULTS A total of 20 000 image classifications were recorded from 10 clinicians. The AI model alone achieved an accuracy of 0.798 (95% CI, 0.760-0.832), a sensitivity of 0.868 (95% CI, 0.834-0.902) and a specificity of 0.728 (95% CI, 0.702-0.754), and the clinicians without AI achieved an accuracy of 0.844 (95% CI, 0.834-0.854), a sensitivity of 0.827 (95% CI, 0.795-0.858) and a specificity of 0.861 (95% CI, 0.828-0.895). Showing a binary (normal or AVSD) AI model output resulted in significant improvement in accuracy to 0.865 (P < 0.001). This effect was seen in both experienced and less-experienced participants. Giving incorrect AI advice resulted in a significant deterioration in overall accuracy, from 0.761 to 0.693 (P < 0.001), which was driven by an increase in both Type-I and Type-II errors by the clinicians. This effect was worsened by showing model confidence (accuracy, 0.649; P < 0.001) or grad-CAM (accuracy, 0.644; P < 0.001). CONCLUSIONS AI has the potential to improve performance when used in collaboration with clinicians, even if the model performance does not reach expert level. Giving additional information about model workings such as model confidence and class activation map image overlays did not improve overall performance, and actually worsened performance for images for which the AI model was incorrect. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T G Day
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Matthew
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - S F Budd
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - L Venturini
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - R Wright
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A Farruggia
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - T V Vigneswaran
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - V Zidere
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Harris Birthright Research Centre, King's College London NHS Foundation Trust, London, UK
| | - J V Hajnal
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - R Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J M Simpson
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - B Kainz
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
- Department of Computing, Faculty of Engineering, Imperial College London, London, UK
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Taksøe-Vester CA, Mikolaj K, Petersen OBB, Vejlstrup NG, Christensen AN, Feragen A, Nielsen M, Svendsen MBS, Tolsgaard MG. Role of artificial-intelligence-assisted automated cardiac biometrics in prenatal screening for coarctation of aorta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:36-43. [PMID: 38339776 DOI: 10.1002/uog.27608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Although remarkable strides have been made in fetal medicine and the prenatal diagnosis of congenital heart disease, around 60% of newborns with isolated coarctation of the aorta (CoA) are not identified prior to birth. The prenatal detection of CoA has been shown to have a notable impact on survival rates of affected infants. To this end, implementation of artificial intelligence (AI) in fetal ultrasound may represent a groundbreaking advance. We aimed to investigate whether the use of automated cardiac biometric measurements with AI during the 18-22-week anomaly scan would enhance the identification of fetuses that are at risk of developing CoA. METHODS We developed an AI model capable of identifying standard cardiac planes and conducting automated cardiac biometric measurements. Our data consisted of pregnancy ultrasound image and outcome data spanning from 2008 to 2018 and collected from four distinct regions in Denmark. Cases with a postnatal diagnosis of CoA were paired with healthy controls in a ratio of 1:100 and matched for gestational age within 2 days. Cardiac biometrics obtained from the four-chamber and three-vessel views were included in a logistic regression-based prediction model. To assess its predictive capabilities, we assessed sensitivity and specificity on receiver-operating-characteristics (ROC) curves. RESULTS At the 18-22-week scan, the right ventricle (RV) area and length, left ventricle (LV) diameter and the ratios of RV/LV areas and main pulmonary artery/ascending aorta diameters showed significant differences, with Z-scores above 0.7, when comparing subjects with a postnatal diagnosis of CoA (n = 73) and healthy controls (n = 7300). Using logistic regression and backward feature selection, our prediction model had an area under the ROC curve of 0.96 and a specificity of 88.9% at a sensitivity of 90.4%. CONCLUSIONS The integration of AI technology with automated cardiac biometric measurements obtained during the 18-22-week anomaly scan has the potential to enhance substantially the performance of screening for fetal CoA and subsequently the detection rate of CoA. Future research should clarify how AI technology can be used to aid in the screening and detection of congenital heart anomalies to improve neonatal outcomes. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C A Taksøe-Vester
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Fetal Medicine, Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Academy of Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - K Mikolaj
- Technical University of Denmark, Lyngby, Denmark
| | - O B B Petersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Fetal Medicine, Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - N G Vejlstrup
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - A Feragen
- Technical University of Denmark, Lyngby, Denmark
| | - M Nielsen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - M B S Svendsen
- Copenhagen Academy of Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - M G Tolsgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Fetal Medicine, Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Academy of Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
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Jia J, Fan X, Zhang W, Xu Z, Wu M, Zhan Y, Fan B. Predictive model for totally implanted venous access ports‑related long‑term complications in patients with lung cancer. Oncol Lett 2024; 28:326. [PMID: 38807672 PMCID: PMC11130750 DOI: 10.3892/ol.2024.14459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/30/2024] Open
Abstract
Totally implanted venous access ports (TIVAPs), which are typically used in oncological chemotherapy and parenteral nutritional support, are convenient and safe, and thus offer patients a higher quality of life. However, insertion or removal of the device requires a minor surgical operation. Long-term complications (>30 days post insertion), such as catheter migration, catheter-related thrombosis and infection, are major reasons for TIVAP removal and are associated with a number of factors such as body mass index and hemoglobin count. Since management of complications is typically time-consuming and costly, a predictive model of such events may be of great value. Therefore, in the present study, a predictive model for long-term complications following TIVAP implantation in patients with lung cancer was developed. After excluding patients with a large amount of missing data, 902 patients admitted to The First Affiliated Hospital with Nanjing Medical University (Nanjing, China) were ultimately included in the present study. Of the included patients, 28 had complications, indicating an incidence rate of 3.1%. Patients were randomly divided into training and test cohorts (7:3), and three machine learning-based anomaly detection algorithms, namely, the Isolation Forest, one-class Support Vector Machines (one-class SVM) and Local Outlier Factor, were used to construct a model. The performance of the model was initially evaluated by the Matthew's correlation coefficient (MCC), area under curve (AUC) and accuracy. The one-class SVM model demonstrated the highest performance in classifying the risk of complications associated with the use of the intracavitary electrocardiogram method for TIVAP implantation in patients with lung cancer (MCC, 0.078; AUC, 0.62; accuracy, 66.0%). In conclusion, the predictive model developed in the present study may be used to improve the early detection of TIVAP-related complications in patients with lung cancer, which could lead to the conservation of medical resources and the promotion of medical advances.
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Affiliation(s)
- Jian Jia
- Department of General Practice, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
- School of Business, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
| | - Xutong Fan
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wenhong Zhang
- School of Business, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
| | - Zhiyang Xu
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Mian Wu
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yiyang Zhan
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Boqiang Fan
- Department of Oncology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Shahryari Fard S, Perkins TJ, Wells PS. A deep-learning approach to predict bleeding risk over time in patients on extended anticoagulation therapy. J Thromb Haemost 2024; 22:1997-2008. [PMID: 38642704 DOI: 10.1016/j.jtha.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/22/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Thus far, all the clinical models developed to predict major bleeding in patients on extended anticoagulation therapy use the baseline predictors to stratify patients into different risk groups. Therefore, these models do not account for the clinical changes and events that occur after the baseline visit, which can modify risk of bleeding. However, it is difficult to develop predictive models from the routine follow-up clinical interviews, which are irregular sequences of multivariate time series data. OBJECTIVES To demonstrate that deep learning can incorporate patient time series follow-up data to improve prediction of major bleeding. METHODS We used the baseline and follow-up data that were collected over 8 years in a longitudinal cohort study of 2542 patients, of whom 118 had major bleeding. Four supervised neural network-based machine-learning models were trained on the baseline, follow-up, or both datasets using 70% of the data. The performance of these models was evaluated, along with modified versions of 6 previously developed clinical models, on the remaining 30% of the data. RESULTS An ensemble of feedforward and recurrent neural networks that used the baseline and follow-up data was the best-performing model, achieving a sensitivity and a specificity of 61% and 82%, respectively, in identifying major bleeding, and it outperformed the previously developed clinical models in terms of area under the receiver operating characteristic curve (82%) and area under the precision-recall curve (14%). CONCLUSION Time series follow-up data can improve major bleeding prediction in patients on extended anticoagulation therapy.
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Affiliation(s)
- Soroush Shahryari Fard
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Theodore J Perkins
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Philip S Wells
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Oikonomou EK, Vaid A, Holste G, Coppi A, McNamara RL, Baloescu C, Krumholz HM, Wang Z, Apakama DJ, Nadkarni GN, Khera R. Artificial intelligence-guided detection of under-recognized cardiomyopathies on point-of-care cardiac ultrasound: a multi-center study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.10.24304044. [PMID: 38559021 PMCID: PMC10980112 DOI: 10.1101/2024.03.10.24304044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Point-of-care ultrasonography (POCUS) enables cardiac imaging at the bedside and in communities but is limited by abbreviated protocols and variation in quality. We developed and tested artificial intelligence (AI) models to automate the detection of underdiagnosed cardiomyopathies from cardiac POCUS. Methods In a development set of 290,245 transthoracic echocardiographic videos across the Yale-New Haven Health System (YNHHS), we used augmentation approaches and a customized loss function weighted for view quality to derive a POCUS-adapted, multi-label, video-based convolutional neural network (CNN) that discriminates HCM (hypertrophic cardiomyopathy) and ATTR-CM (transthyretin amyloid cardiomyopathy) from controls without known disease. We evaluated the final model across independent, internal and external, retrospective cohorts of individuals who underwent cardiac POCUS across YNHHS and Mount Sinai Health System (MSHS) emergency departments (EDs) (2011-2024) to prioritize key views and validate the diagnostic and prognostic performance of single-view screening protocols. Findings We identified 33,127 patients (median age 61 [IQR: 45-75] years, n=17,276 [52·2%] female) at YNHHS and 5,624 (57 [IQR: 39-71] years, n=1,953 [34·7%] female) at MSHS with 78,054 and 13,796 eligible cardiac POCUS videos, respectively. An AI-enabled single-view screening approach successfully discriminated HCM (AUROC of 0·90 [YNHHS] & 0·89 [MSHS]) and ATTR-CM (YNHHS: AUROC of 0·92 [YNHHS] & 0·99 [MSHS]). In YNHHS, 40 (58·0%) HCM and 23 (47·9%) ATTR-CM cases had a positive screen at median of 2·1 [IQR: 0·9-4·5] and 1·9 [IQR: 1·0-3·4] years before clinical diagnosis. Moreover, among 24,448 participants without known cardiomyopathy followed over 2·2 [IQR: 1·1-5·8] years, AI-POCUS probabilities in the highest (vs lowest) quintile for HCM and ATTR-CM conferred a 15% (adj.HR 1·15 [95%CI: 1·02-1·29]) and 39% (adj.HR 1·39 [95%CI: 1·22-1·59]) higher age- and sex-adjusted mortality risk, respectively. Interpretation We developed and validated an AI framework that enables scalable, opportunistic screening of treatable cardiomyopathies wherever POCUS is used. Funding National Heart, Lung and Blood Institute, Doris Duke Charitable Foundation, BridgeBio.
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Affiliation(s)
- Evangelos K. Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Akhil Vaid
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Division of Data Driven and Digital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gregory Holste
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Andreas Coppi
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Robert L. McNamara
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Cristiana Baloescu
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Zhangyang Wang
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Donald J. Apakama
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish N. Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Division of Data Driven and Digital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
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11
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Chambers HN, Caris E, Conwell J, Edwards LA, Hulse JE, Lewin M, Pinto NM, Wolfe E, Arya B. Suboptimal Imaging on Obstetric Ultrasound Should Prompt Early Referral for Fetal Echocardiography. Pediatr Cardiol 2024:10.1007/s00246-024-03495-9. [PMID: 38831151 DOI: 10.1007/s00246-024-03495-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/08/2024] [Indexed: 06/05/2024]
Abstract
Recent studies suggest that suboptimal cardiac imaging on routine obstetric anatomy ultrasound (OB-scan) is not associated with a higher risk for congenital heart disease (CHD) and, therefore, should not be an indication for fetal echocardiography (F-echo). We aim to determine the incidence of CHD in patients referred for suboptimal imaging in a large catchment area, including regions that are geographically distant from a tertiary care center. We conducted a retrospective chart review of patients referred to Seattle Children's Hospital (SCH) and SCH Regional Cardiology sites (SCH-RC) from 2011 to 2021 for F-echo with the indication of suboptimal cardiac imaging by OB-scan. Of 454 patients referred for suboptimal imaging, 21 (5%) of patients were diagnosed with CHD confirmed on postnatal echo. 10 patients (2%) required intervention by age one. Mean GA at F-echo was significantly later for suboptimal imaging compared to all other referral indications (27.5 ± 3.9 vs 25.2 ± 5.2 weeks, p < 0.01). Mean GA at F-echo was also significantly later at SCH-RC compared to SCH (29.2 ± 4.6 vs 24.2 ± 2.9 weeks; p < 0.01). In our experience, CHD in patients referred for suboptimal imaging is higher (5%) than previously described, suggesting that routine referral for is warranted. Furthermore, while suboptimal imaging was associated with a delayed F-echo compared to other indications, this delay was most striking for those seen at regional sites. This demonstrates a potential disparity for these patients and highlights opportunities for targeted education in cardiac assessment for primary providers in these regions.
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Affiliation(s)
- Hailey N Chambers
- Seattle Children's Hospital, University of Washington Medical Center, OC.7.830, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.
| | | | - Jeffrey Conwell
- Seattle Children's Hospital, University of Washington Medical Center, Seattle, WA, USA
| | | | - J Eddie Hulse
- Seattle Children's Hospital, University of Washington Medical Center, Seattle, WA, USA
| | - Mark Lewin
- Seattle Children's Hospital, University of Washington Medical Center, Seattle, WA, USA
| | - Nelangi M Pinto
- Seattle Children's Hospital, University of Washington Medical Center, Seattle, WA, USA
| | - Elana Wolfe
- Seattle Children's Hospital, University of Washington Medical Center, Seattle, WA, USA
| | - Bhawna Arya
- Seattle Children's Hospital, University of Washington Medical Center, Seattle, WA, USA
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12
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Eckersley L. Socioeconomic Determinants of Health: Remoteness From Care. Can J Cardiol 2024; 40:1007-1015. [PMID: 38246325 DOI: 10.1016/j.cjca.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024] Open
Abstract
Remoteness from care remains a major challenge to equitable provision of health services worldwide. Beyond the difficulties associated with geographically and climatically rugged terrain, there are also socioeconomic, cultural, and technological challenges associated with remote residence. The objective of this review is to examine the factors whereby remoteness can be associated with sociodemographic disadvantage in health care and describe some of the methodologies for measurement and analysis of remoteness, with examples from the literature, particularly focusing on Canada. As surrogates for remoteness, simple measurements of direct distance or travel time may correlate well with more complex measures and can be performed relative to specific health care services of interest (for example, tertiary obstetric service). These metrics may also be measured, as general proxies for service availability, to various sizes of population centres. More complex measures of remoteness may also incorporate modes of available transport and availability of specific services into an index such as the Canadian Index of Remoteness. As an important independent predictor of health, remoteness requires careful predictive modelling because of potential complex nonlinear relationships, edge effects created by health system zone boundaries, and covariance with other sociodemographic factors and Indigenous population proportions. To combat disadvantage caused by remoteness, innovation in health service delivery, policy, and technology is required. Health-resource allocation must be adequate, and innovative technological advances-such as remote monitoring, expert clinical support, and artificial intelligence algorithms-must be supported by development of appropriate technological infrastructure, targeting remote regions. With these, the barriers to equitable health imposed by remoteness can be overcome.
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Affiliation(s)
- Luke Eckersley
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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13
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S S, Rufus NHA. Investigation on ultrasound images for detection of fetal congenital heart defects. Biomed Phys Eng Express 2024; 10:042001. [PMID: 38781934 DOI: 10.1088/2057-1976/ad4f91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/23/2024] [Indexed: 05/25/2024]
Abstract
Congenital heart defects (CHD) are one of the serious problems that arise during pregnancy. Early CHD detection reduces death rates and morbidity but is hampered by the relatively low detection rates (i.e., 60%) of current screening technology. The detection rate could be increased by supplementing ultrasound imaging with fetal ultrasound image evaluation (FUSI) using deep learning techniques. As a result, the non-invasive foetal ultrasound image has clear potential in the diagnosis of CHD and should be considered in addition to foetal echocardiography. This review paper highlights cutting-edge technologies for detecting CHD using ultrasound images, which involve pre-processing, localization, segmentation, and classification. Existing technique of preprocessing includes spatial domain filter, non-linear mean filter, transform domain filter, and denoising methods based on Convolutional Neural Network (CNN); segmentation includes thresholding-based techniques, region growing-based techniques, edge detection techniques, Artificial Neural Network (ANN) based segmentation methods, non-deep learning approaches and deep learning approaches. The paper also suggests future research directions for improving current methodologies.
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Affiliation(s)
- Satish S
- Department of Electronics and Communication Engineering, Vel Tech Rangarajan Dr Sagunthala R&D Institute of Science and Technology, Chennai-600062, Tamil Nadu, India
| | - N Herald Anantha Rufus
- Department of Electronics and Communication Engineering, Vel Tech Rangarajan Dr Sagunthala R&D Institute of Science and Technology, Chennai-600062, Tamil Nadu, India
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14
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Liang B, Peng F, Luo D, Zeng Q, Wen H, Zheng B, Zou Z, An L, Wen H, Wen X, Liao Y, Yuan Y, Li S. Automatic segmentation of 15 critical anatomical labels and measurements of cardiac axis and cardiothoracic ratio in fetal four chambers using nnU-NetV2. BMC Med Inform Decis Mak 2024; 24:128. [PMID: 38773456 PMCID: PMC11106923 DOI: 10.1186/s12911-024-02527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/02/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Accurate segmentation of critical anatomical structures in fetal four-chamber view images is essential for the early detection of congenital heart defects. Current prenatal screening methods rely on manual measurements, which are time-consuming and prone to inter-observer variability. This study develops an AI-based model using the state-of-the-art nnU-NetV2 architecture for automatic segmentation and measurement of key anatomical structures in fetal four-chamber view images. METHODS A dataset, consisting of 1,083 high-quality fetal four-chamber view images, was annotated with 15 critical anatomical labels and divided into training/validation (867 images) and test (216 images) sets. An AI-based model using the nnU-NetV2 architecture was trained on the annotated images and evaluated using the mean Dice coefficient (mDice) and mean intersection over union (mIoU) metrics. The model's performance in automatically computing the cardiac axis (CAx) and cardiothoracic ratio (CTR) was compared with measurements from sonographers with varying levels of experience. RESULTS The AI-based model achieved a mDice coefficient of 87.11% and an mIoU of 77.68% for the segmentation of critical anatomical structures. The model's automated CAx and CTR measurements showed strong agreement with those of experienced sonographers, with respective intraclass correlation coefficients (ICCs) of 0.83 and 0.81. Bland-Altman analysis further confirmed the high agreement between the model and experienced sonographers. CONCLUSION We developed an AI-based model using the nnU-NetV2 architecture for accurate segmentation and automated measurement of critical anatomical structures in fetal four-chamber view images. Our model demonstrated high segmentation accuracy and strong agreement with experienced sonographers in computing clinically relevant parameters. This approach has the potential to improve the efficiency and reliability of prenatal cardiac screening, ultimately contributing to the early detection of congenital heart defects.
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Affiliation(s)
- Bocheng Liang
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Fengfeng Peng
- Department of Computer Science and Electronic Engineering, Hunan University, Changsha, 410082, China
| | - Dandan Luo
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Qing Zeng
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Huaxuan Wen
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Bowen Zheng
- Department of Computer Science and Electronic Engineering, Hunan University, Changsha, 410082, China
| | - Zhiying Zou
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Liting An
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Huiying Wen
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Xin Wen
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Yimei Liao
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Ying Yuan
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China
| | - Shengli Li
- Department of Ultrasound, Shenzhen Maternity&Child Healthcare Hospital, Shenzhen, 518028, China.
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15
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Pu B, Li K, Chen J, Lu Y, Zeng Q, Yang J, Li S. HFSCCD: A Hybrid Neural Network for Fetal Standard Cardiac Cycle Detection in Ultrasound Videos. IEEE J Biomed Health Inform 2024; 28:2943-2954. [PMID: 38412077 DOI: 10.1109/jbhi.2024.3370507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
In the fetal cardiac ultrasound examination, standard cardiac cycle (SCC) recognition is the essential foundation for diagnosing congenital heart disease. Previous studies have mostly focused on the detection of adult CCs, which may not be applicable to the fetus. In clinical practice, localization of SCCs needs to recognize end-systole (ES) and end-diastole (ED) frames accurately, ensuring that every frame in the cycle is a standard view. Most existing methods are not based on the detection of key anatomical structures, which may not recognize irrelevant views and background frames, results containing non-standard frames, or even it does not work in clinical practice. We propose an end-to-end hybrid neural network based on an object detector to detect SCCs from fetal ultrasound videos efficiently, which consists of 3 modules, namely Anatomical Structure Detection (ASD), Cardiac Cycle Localization (CCL), and Standard Plane Recognition (SPR). Specifically, ASD uses an object detector to identify 9 key anatomical structures, 3 cardiac motion phases, and the corresponding confidence scores from fetal ultrasound videos. On this basis, we propose a joint probability method in the CCL to learn the cardiac motion cycle based on the 3 cardiac motion phases. In SPR, to reduce the impact of structure detection errors on the accuracy of the standard plane recognition, we use XGBoost algorithm to learn the relation knowledge of the detected anatomical structures. We evaluate our method on the test fetal ultrasound video datasets and clinical examination cases and achieve remarkable results. This study may pave the way for clinical practices.
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16
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Zhang J, Xiao S, Zhu Y, Zhang Z, Cao H, Xie M, Zhang L. Advances in the Application of Artificial Intelligence in Fetal Echocardiography. J Am Soc Echocardiogr 2024; 37:550-561. [PMID: 38199332 DOI: 10.1016/j.echo.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/23/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024]
Abstract
Congenital heart disease is a severe health risk for newborns. Early detection of abnormalities in fetal cardiac structure and function during pregnancy can help patients seek timely diagnostic and therapeutic advice, and early intervention planning can significantly improve fetal survival rates. Echocardiography is one of the most accessible and widely used diagnostic tools in the diagnosis of fetal congenital heart disease. However, traditional fetal echocardiography has limitations due to fetal, maternal, and ultrasound equipment factors and is highly dependent on the skill level of the operator. Artificial intelligence (AI) technology, with its rapid development utilizing advanced computer algorithms, has great potential to empower sonographers in time-saving and accurate diagnosis and to bridge the skill gap in different regions. In recent years, AI-assisted fetal echocardiography has been successfully applied to a wide range of ultrasound diagnoses. This review systematically reviews the applications of AI in the field of fetal echocardiography over the years in terms of image processing, biometrics, and disease diagnosis and provides an outlook for future research.
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Affiliation(s)
- Junmin Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Sushan Xiao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ye Zhu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Zisang Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Haiyan Cao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
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17
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Liu X, Zhang Y, Zhu H, Jia B, Wang J, He Y, Zhang H. Applications of artificial intelligence-powered prenatal diagnosis for congenital heart disease. Front Cardiovasc Med 2024; 11:1345761. [PMID: 38720920 PMCID: PMC11076681 DOI: 10.3389/fcvm.2024.1345761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Artificial intelligence (AI) has made significant progress in the medical field in the last decade. The AI-powered analysis methods of medical images and clinical records can now match the abilities of clinical physicians. Due to the challenges posed by the unique group of fetuses and the dynamic organ of the heart, research into the application of AI in the prenatal diagnosis of congenital heart disease (CHD) is particularly active. In this review, we discuss the clinical questions and research methods involved in using AI to address prenatal diagnosis of CHD, including imaging, genetic diagnosis, and risk prediction. Representative examples are provided for each method discussed. Finally, we discuss the current limitations of AI in prenatal diagnosis of CHD, namely Volatility, Insufficiency and Independence (VII), and propose possible solutions.
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Affiliation(s)
- Xiangyu Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Key Laboratory of Data Science and Intelligent Computing, International Innovation Institute, Beihang University, Hangzhou, China
| | - Yingying Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Key Laboratory of Data Science and Intelligent Computing, International Innovation Institute, Beihang University, Hangzhou, China
| | - Haogang Zhu
- Key Laboratory of Data Science and Intelligent Computing, International Innovation Institute, Beihang University, Hangzhou, China
- State Key Laboratory of Software Development Environment, Beihang University, Beijing, China
- School of Computer Science and Engineering, Beihang University, Beijing, China
| | - Bosen Jia
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Jingyi Wang
- Echocardiography Medical Center Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
| | - Yihua He
- Echocardiography Medical Center Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
| | - Hongjia Zhang
- Key Laboratory of Data Science and Intelligent Computing, International Innovation Institute, Beihang University, Hangzhou, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
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18
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Dadon Z, Rav Acha M, Orlev A, Carasso S, Glikson M, Gottlieb S, Alpert EA. Artificial Intelligence-Based Left Ventricular Ejection Fraction by Medical Students for Mortality and Readmission Prediction. Diagnostics (Basel) 2024; 14:767. [PMID: 38611680 PMCID: PMC11011323 DOI: 10.3390/diagnostics14070767] [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: 03/11/2024] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Point-of-care ultrasound has become a universal practice, employed by physicians across various disciplines, contributing to diagnostic processes and decision-making. AIM To assess the association of reduced (<50%) left-ventricular ejection fraction (LVEF) based on prospective point-of-care ultrasound operated by medical students using an artificial intelligence (AI) tool and 1-year primary composite outcome, including mortality and readmission for cardiovascular-related causes. METHODS Eight trained medical students used a hand-held ultrasound device (HUD) equipped with an AI-based tool for automatic evaluation of the LVEF of non-selected patients hospitalized in a cardiology department from March 2019 through March 2020. RESULTS The study included 82 patients (72 males aged 58.5 ± 16.8 years), of whom 34 (41.5%) were diagnosed with AI-based reduced LVEF. The rates of the composite outcome were higher among patients with reduced systolic function compared to those with preserved LVEF (41.2% vs. 16.7%, p = 0.014). Adjusting for pertinent variables, reduced LVEF independently predicted the composite outcome (HR 2.717, 95% CI 1.083-6.817, p = 0.033). As compared to those with LVEF ≥ 50%, patients with reduced LVEF had a longer length of stay and higher rates of the secondary composite outcome, including in-hospital death, advanced ventilatory support, shock, and acute decompensated heart failure. CONCLUSION AI-based assessment of reduced systolic function in the hands of medical students, independently predicted 1-year mortality and cardiovascular-related readmission and was associated with unfavorable in-hospital outcomes. AI utilization by novice users may be an important tool for risk stratification for hospitalized patients.
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Affiliation(s)
- Ziv Dadon
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shemy Carasso
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shmuel Gottlieb
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Evan Avraham Alpert
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Department of Emergency Medicine, Hadassah Medical Center—Ein Kerem, Jerusalem 9112001, Israel
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19
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Al-Alshaikh HA, P P, Poonia RC, Saudagar AKJ, Yadav M, AlSagri HS, AlSanad AA. Comprehensive evaluation and performance analysis of machine learning in heart disease prediction. Sci Rep 2024; 14:7819. [PMID: 38570582 PMCID: PMC10991287 DOI: 10.1038/s41598-024-58489-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/29/2024] [Indexed: 04/05/2024] Open
Abstract
Heart disease is a leading cause of mortality on a global scale. Accurately predicting cardiovascular disease poses a significant challenge within clinical data analysis. The present study introduces a prediction model that utilizes various combinations of information and employs multiple established classification approaches. The proposed technique combines the genetic algorithm (GA) and the recursive feature elimination method (RFEM) to select relevant features, thus enhancing the model's robustness. Techniques like the under sampling clustering oversampling method (USCOM) address the issue of data imbalance, thereby improving the model's predictive capabilities. The classification challenge employs a multilayer deep convolutional neural network (MLDCNN), trained using the adaptive elephant herd optimization method (AEHOM). The proposed machine learning-based heart disease prediction method (ML-HDPM) demonstrates outstanding performance across various crucial evaluation parameters, as indicated by its comprehensive assessment. During the training process, the ML-HDPM model exhibits a high level of performance, achieving an accuracy rate of 95.5% and a precision rate of 94.8%. The system's sensitivity (recall) performs with a high accuracy rate of 96.2%, while the F-score highlights its well-balanced performance, measuring 91.5%. It is worth noting that the specificity of ML-HDPM is recorded at a remarkable 89.7%. The findings underscore the potential of ML-HDPM to transform the prediction of heart disease and aid healthcare practitioners in providing precise diagnoses, exerting a substantial influence on patient care outcomes.
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Affiliation(s)
- Halah A Al-Alshaikh
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), 11432, Riyadh, Saudi Arabia
| | - Prabu P
- Department of Computer Science, CHRIST University, Bangalore, 560029, India
| | | | - Abdul Khader Jilani Saudagar
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), 11432, Riyadh, Saudi Arabia
| | - Manoj Yadav
- Department of Computer Science and Engineering, Guru Jambheshwar University of Science and Technology, Hisar, India
| | - Hatoon S AlSagri
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), 11432, Riyadh, Saudi Arabia
| | - Abeer A AlSanad
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), 11432, Riyadh, Saudi Arabia
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20
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Mayourian J, La Cava WG, Vaid A, Nadkarni GN, Ghelani SJ, Mannix R, Geva T, Dionne A, Alexander ME, Duong SQ, Triedman JK. Pediatric ECG-Based Deep Learning to Predict Left Ventricular Dysfunction and Remodeling. Circulation 2024; 149:917-931. [PMID: 38314583 PMCID: PMC10948312 DOI: 10.1161/circulationaha.123.067750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Artificial intelligence-enhanced ECG analysis shows promise to detect ventricular dysfunction and remodeling in adult populations. However, its application to pediatric populations remains underexplored. METHODS A convolutional neural network was trained on paired ECG-echocardiograms (≤2 days apart) from patients ≤18 years of age without major congenital heart disease to detect human expert-classified greater than mild left ventricular (LV) dysfunction, hypertrophy, and dilation (individually and as a composite outcome). Model performance was evaluated on single ECG-echocardiogram pairs per patient at Boston Children's Hospital and externally at Mount Sinai Hospital using area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC). RESULTS The training cohort comprised 92 377 ECG-echocardiogram pairs (46 261 patients; median age, 8.2 years). Test groups included internal testing (12 631 patients; median age, 8.8 years; 4.6% composite outcomes), emergency department (2830 patients; median age, 7.7 years; 10.0% composite outcomes), and external validation (5088 patients; median age, 4.3 years; 6.1% composite outcomes) cohorts. Model performance was similar on internal test and emergency department cohorts, with model predictions of LV hypertrophy outperforming the pediatric cardiologist expert benchmark. Adding age and sex to the model added no benefit to model performance. When using quantitative outcome cutoffs, model performance was similar between internal testing (composite outcome: AUROC, 0.88, AUPRC, 0.43; LV dysfunction: AUROC, 0.92, AUPRC, 0.23; LV hypertrophy: AUROC, 0.88, AUPRC, 0.28; LV dilation: AUROC, 0.91, AUPRC, 0.47) and external validation (composite outcome: AUROC, 0.86, AUPRC, 0.39; LV dysfunction: AUROC, 0.94, AUPRC, 0.32; LV hypertrophy: AUROC, 0.84, AUPRC, 0.25; LV dilation: AUROC, 0.87, AUPRC, 0.33), with composite outcome negative predictive values of 99.0% and 99.2%, respectively. Saliency mapping highlighted ECG components that influenced model predictions (precordial QRS complexes for all outcomes; T waves for LV dysfunction). High-risk ECG features include lateral T-wave inversion (LV dysfunction), deep S waves in V1 and V2 and tall R waves in V6 (LV hypertrophy), and tall R waves in V4 through V6 (LV dilation). CONCLUSIONS This externally validated algorithm shows promise to inexpensively screen for LV dysfunction and remodeling in children, which may facilitate improved access to care by democratizing the expertise of pediatric cardiologists.
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Affiliation(s)
- Joshua Mayourian
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - William G. La Cava
- Computational Health Informatics Program, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Akhil Vaid
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Girish N. Nadkarni
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sunil J. Ghelani
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Rebekah Mannix
- Department of Medicine, Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mark E. Alexander
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Son Q. Duong
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John K. Triedman
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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21
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Taksoee-Vester CA, Mikolaj K, Bashir Z, Christensen AN, Petersen OB, Sundberg K, Feragen A, Svendsen MBS, Nielsen M, Tolsgaard MG. AI supported fetal echocardiography with quality assessment. Sci Rep 2024; 14:5809. [PMID: 38461322 PMCID: PMC10925034 DOI: 10.1038/s41598-024-56476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/06/2024] [Indexed: 03/11/2024] Open
Abstract
This study aimed to develop a deep learning model to assess the quality of fetal echocardiography and to perform prospective clinical validation. The model was trained on data from the 18-22-week anomaly scan conducted in seven hospitals from 2008 to 2018. Prospective validation involved 100 patients from two hospitals. A total of 5363 images from 2551 pregnancies were used for training and validation. The model's segmentation accuracy depended on image quality measured by a quality score (QS). It achieved an overall average accuracy of 0.91 (SD 0.09) across the test set, with images having above-average QS scoring 0.97 (SD 0.03). During prospective validation of 192 images, clinicians rated 44.8% (SD 9.8) of images as equal in quality, 18.69% (SD 5.7) favoring auto-captured images and 36.51% (SD 9.0) preferring manually captured ones. Images with above average QS showed better agreement on segmentations (p < 0.001) and QS (p < 0.001) with fetal medicine experts. Auto-capture saved additional planes beyond protocol requirements, resulting in more comprehensive echocardiographies. Low QS had adverse effect on both model performance and clinician's agreement with model feedback. The findings highlight the importance of developing and evaluating AI models based on 'noisy' real-life data rather than pursuing the highest accuracy possible with retrospective academic-grade data.
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Affiliation(s)
- Caroline A Taksoee-Vester
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Dept. 4071, 2100, Copenhagen, Denmark.
- Copenhagen Academy of Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark.
| | - Kamil Mikolaj
- DTU Compute, Technical University of Denmark (DTU), Lyngby, Denmark
| | - Zahra Bashir
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy of Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
- Center for Fetal Medicine, Department of Obstetrics, Slagelse Hospital, Slagelse, Denmark
| | | | - Olav B Petersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Dept. 4071, 2100, Copenhagen, Denmark
| | - Karin Sundberg
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Dept. 4071, 2100, Copenhagen, Denmark
| | - Aasa Feragen
- DTU Compute, Technical University of Denmark (DTU), Lyngby, Denmark
| | - Morten B S Svendsen
- Copenhagen Academy of Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Mads Nielsen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Martin G Tolsgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Dept. 4071, 2100, Copenhagen, Denmark
- Copenhagen Academy of Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
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22
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Cheng M, Wang J, Liu X, Wang Y, Wu Q, Wang F, Li P, Wang B, Zhang X, Xie W. Development and Validation of a Deep-Learning Network for Detecting Congenital Heart Disease from Multi-View Multi-Modal Transthoracic Echocardiograms. RESEARCH (WASHINGTON, D.C.) 2024; 7:0319. [PMID: 38455153 PMCID: PMC10919123 DOI: 10.34133/research.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/26/2024] [Indexed: 03/09/2024]
Abstract
Early detection and treatment of congenital heart disease (CHD) can significantly improve the prognosis of children. However, inexperienced sonographers often face difficulties in recognizing CHD through transthoracic echocardiogram (TTE) images. In this study, 2-dimensional (2D) and Doppler TTEs of children collected from 2 clinical groups from Beijing Children's Hospital between 2018 and 2022 were analyzed, including views of apical 4 chamber, subxiphoid long-axis view of 2 atria, parasternal long-axis view of the left ventricle, parasternal short-axis view of aorta, and suprasternal long-axis view. A deep learning (DL) framework was developed to identify cardiac views, integrate information from various views and modalities, visualize the high-risk region, and predict the probability of the subject being normal or having an atrial septal defect (ASD) or a ventricular septaldefect (VSD). A total of 1,932 children (1,255 healthy controls, 292 ASDs, and 385 VSDs) were collected from 2 clinical groups. For view classification, the DL model reached a mean [SD] accuracy of 0.989 [0.001]. For CHD screening, the model using both 2D and Doppler TTEs with 5 views achieved a mean [SD] area under the receiver operating characteristic curve (AUC) of 0.996 [0.000] and an accuracy of 0.994 [0.002] for within-center evaluation while reaching a mean [SD] AUC of 0.990 [0.003] and an accuracy of 0.993 [0.001] for cross-center test set. For the classification of healthy, ASD, and VSD, the model reached the mean [SD] accuracy of 0.991 [0.002] and 0.986 [0.001] for within- and cross-center evaluation, respectively. The DL models aggregating TTEs with more modalities and scanning views attained superior performance to approximate that of experienced sonographers. The incorporation of multiple views and modalities of TTEs in the model enables accurate identification of children with CHD in a noninvasive manner, suggesting the potential to enhance CHD detection performance and simplify the screening process.
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Affiliation(s)
- Mingmei Cheng
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Department of Psychology, School of Mental Health and Psychological Sciences,
Anhui Medical University, Hefei 230011, China
| | - Jing Wang
- Heart Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 10045, China
- School of Basic Medical Sciences, Capital Medical University, Beijing 10069, China
| | - Xiaofeng Liu
- Gordon Center for Medical Imaging, Harvard Medical School, and Massachusetts General Hospital, Boston, MA 02114, USA
| | - Yanzhong Wang
- School of Life Course and Population Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - Qun Wu
- Heart Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 10045, China
| | - Fangyun Wang
- Heart Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 10045, China
| | - Pei Li
- Heart Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 10045, China
| | - Binbin Wang
- Center for Genetics,
National Research Institute for Family Planning, Beijing 100730, China
- Graduated School,
Peking Union Medical College, Beijing 100730, China
| | - Xin Zhang
- Heart Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 10045, China
| | - Wanqing Xie
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Department of Psychology, School of Mental Health and Psychological Sciences,
Anhui Medical University, Hefei 230011, China
- Beth Israel Deaconess Medical Center, Harvard Medical School,
Harvard University, Boston, MA 02215, USA
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23
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Robinson J, Sahai S, Pennacchio C, Sharew B, Chen L, Karamlou T. Effects of Sociodemographic Factors on Access to and Outcomes in Congenital Heart Disease in the United States. J Cardiovasc Dev Dis 2024; 11:67. [PMID: 38392282 PMCID: PMC10889660 DOI: 10.3390/jcdd11020067] [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: 01/19/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
Congenital heart defects (CHDs) are complex conditions affecting the heart and/or great vessels that are present at birth. These defects occur in approximately 9 in every 1000 live births. From diagnosis to intervention, care has dramatically improved over the last several decades. Patients with CHDs are now living well into adulthood. However, there are factors that have been associated with poor outcomes across the lifespan of these patients. These factors include sociodemographic and socioeconomic positions. This commentary examined the disparities and solutions within the evolution of CHD care in the United States.
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Affiliation(s)
- Justin Robinson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Siddhartha Sahai
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Caroline Pennacchio
- Case Western Reserve University School of Medicine, Cleveland, OH 44195, USA
| | - Betemariam Sharew
- Cleveland Clinic Learner College of Medicine, Cleveland, OH 44195, USA
| | - Lin Chen
- Case Western Reserve University School of Medicine, Cleveland, OH 44195, USA
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Division of Pediatric Cardiac Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, 9500 Euclid Avenue, Desk M41, Cleveland, OH 44195, USA
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24
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Peng Y, Tang Y, Luan P, Zhang Z, Tu H. MAFE-Net: retinal vessel segmentation based on a multiple attention-guided fusion mechanism and ensemble learning network. BIOMEDICAL OPTICS EXPRESS 2024; 15:843-862. [PMID: 38404318 PMCID: PMC10890843 DOI: 10.1364/boe.510251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/27/2024]
Abstract
The precise and automatic recognition of retinal vessels is of utmost importance in the prevention, diagnosis and assessment of certain eye diseases, yet it brings a nontrivial uncertainty for this challenging detection mission due to the presence of intricate factors, such as uneven and indistinct curvilinear shapes, unpredictable pathological deformations, and non-uniform contrast. Therefore, we propose a unique and practical approach based on a multiple attention-guided fusion mechanism and ensemble learning network (MAFE-Net) for retinal vessel segmentation. In conventional UNet-based models, long-distance dependencies are explicitly modeled, which may cause partial scene information loss. To compensate for the deficiency, various blood vessel features can be extracted from retinal images by using an attention-guided fusion module. In the skip connection part, a unique spatial attention module is applied to remove redundant and irrelevant information; this structure helps to better integrate low-level and high-level features. The final step involves a DropOut layer that removes some neurons randomly to prevent overfitting and improve generalization. Moreover, an ensemble learning framework is designed to detect retinal vessels by combining different deep learning models. To demonstrate the effectiveness of the proposed model, experimental results were verified in public datasets STARE, DRIVE, and CHASEDB1, which achieved F1 scores of 0.842, 0.825, and 0.814, and Accuracy values of 0.975, 0.969, and 0.975, respectively. Compared with eight state-of-the-art models, the designed model produces satisfactory results both visually and quantitatively.
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Affiliation(s)
- Yuanyuan Peng
- School of Electrical and Automation Engineering, East China Jiaotong University, Nanchang 330000, China
| | - Yingjie Tang
- School of Electrical and Automation Engineering, East China Jiaotong University, Nanchang 330000, China
| | - Pengpeng Luan
- School of Electrical and Automation Engineering, East China Jiaotong University, Nanchang 330000, China
| | - Zixu Zhang
- School of Electrical and Automation Engineering, East China Jiaotong University, Nanchang 330000, China
| | - Hongbin Tu
- School of Electrical and Automation Engineering, East China Jiaotong University, Nanchang 330000, China
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25
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Enache IA, Iovoaica-Rămescu C, Ciobanu ȘG, Berbecaru EIA, Vochin A, Băluță ID, Istrate-Ofițeru AM, Comănescu CM, Nagy RD, Iliescu DG. Artificial Intelligence in Obstetric Anomaly Scan: Heart and Brain. Life (Basel) 2024; 14:166. [PMID: 38398675 PMCID: PMC10890185 DOI: 10.3390/life14020166] [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: 10/24/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The ultrasound scan represents the first tool that obstetricians use in fetal evaluation, but sometimes, it can be limited by mobility or fetal position, excessive thickness of the maternal abdominal wall, or the presence of post-surgical scars on the maternal abdominal wall. Artificial intelligence (AI) has already been effectively used to measure biometric parameters, automatically recognize standard planes of fetal ultrasound evaluation, and for disease diagnosis, which helps conventional imaging methods. The usage of information, ultrasound scan images, and a machine learning program create an algorithm capable of assisting healthcare providers by reducing the workload, reducing the duration of the examination, and increasing the correct diagnosis capability. The recent remarkable expansion in the use of electronic medical records and diagnostic imaging coincides with the enormous success of machine learning algorithms in image identification tasks. OBJECTIVES We aim to review the most relevant studies based on deep learning in ultrasound anomaly scan evaluation of the most complex fetal systems (heart and brain), which enclose the most frequent anomalies.
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Affiliation(s)
- Iuliana-Alina Enache
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.-A.E.); (C.I.-R.); (E.I.A.B.)
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (A.V.); (I.D.B.); (A.M.I.-O.); (C.M.C.); (R.D.N.); (D.G.I.)
| | - Cătălina Iovoaica-Rămescu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.-A.E.); (C.I.-R.); (E.I.A.B.)
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (A.V.); (I.D.B.); (A.M.I.-O.); (C.M.C.); (R.D.N.); (D.G.I.)
| | - Ștefan Gabriel Ciobanu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.-A.E.); (C.I.-R.); (E.I.A.B.)
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (A.V.); (I.D.B.); (A.M.I.-O.); (C.M.C.); (R.D.N.); (D.G.I.)
| | - Elena Iuliana Anamaria Berbecaru
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.-A.E.); (C.I.-R.); (E.I.A.B.)
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (A.V.); (I.D.B.); (A.M.I.-O.); (C.M.C.); (R.D.N.); (D.G.I.)
| | - Andreea Vochin
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (A.V.); (I.D.B.); (A.M.I.-O.); (C.M.C.); (R.D.N.); (D.G.I.)
| | - Ionuț Daniel Băluță
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (A.V.); (I.D.B.); (A.M.I.-O.); (C.M.C.); (R.D.N.); (D.G.I.)
| | - Anca Maria Istrate-Ofițeru
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (A.V.); (I.D.B.); (A.M.I.-O.); (C.M.C.); (R.D.N.); (D.G.I.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
- Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
| | - Cristina Maria Comănescu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (A.V.); (I.D.B.); (A.M.I.-O.); (C.M.C.); (R.D.N.); (D.G.I.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Rodica Daniela Nagy
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (A.V.); (I.D.B.); (A.M.I.-O.); (C.M.C.); (R.D.N.); (D.G.I.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
| | - Dominic Gabriel Iliescu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (A.V.); (I.D.B.); (A.M.I.-O.); (C.M.C.); (R.D.N.); (D.G.I.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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26
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Cinteza E, Vasile CM, Busnatu S, Armat I, Spinu AD, Vatasescu R, Duica G, Nicolescu A. Can Artificial Intelligence Revolutionize the Diagnosis and Management of the Atrial Septal Defect in Children? Diagnostics (Basel) 2024; 14:132. [PMID: 38248009 PMCID: PMC10814919 DOI: 10.3390/diagnostics14020132] [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: 12/04/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Atrial septal defects (ASDs) present a significant healthcare challenge, demanding accurate and timely diagnosis and precise management to ensure optimal patient outcomes. Artificial intelligence (AI) applications in healthcare are rapidly evolving, offering promise for enhanced medical decision-making and patient care. In the context of cardiology, the integration of AI promises to provide more efficient and accurate diagnosis and personalized treatment strategies for ASD patients. In interventional cardiology, sometimes the lack of precise measurement of the cardiac rims evaluated by transthoracic echocardiography combined with the floppy aspect of the rims can mislead and result in complications. AI software can be created to generate responses for difficult tasks, like which device is the most suitable for different shapes and dimensions to prevent embolization or erosion. This paper reviews the current state of AI in healthcare and its applications in cardiology, emphasizing the specific opportunities and challenges in applying AI to ASD diagnosis and management. By exploring the capabilities and limitations of AI in ASD diagnosis and management. This paper highlights the evolution of medical practice towards a more AI-augmented future, demonstrating the capacity of AI to unlock new possibilities for healthcare professionals and patients alike.
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Affiliation(s)
- Eliza Cinteza
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.)
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, F-33600 Bordeaux, France;
| | - Stefan Busnatu
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Cardiology Department, “Prof. Dr. Bagdasar Arseni” Clinical Hospital, 041915 Bucharest, Romania
| | - Ionel Armat
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Arsenie Dan Spinu
- “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania;
- Department 3, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu Vatasescu
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Emergency Clinical Hospital, 014461 Bucharest, Romania
| | - Gabriela Duica
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.)
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Alin Nicolescu
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
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27
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Kaur I, Ahmad T. A cluster-based ensemble approach for congenital heart disease prediction. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107922. [PMID: 37984098 DOI: 10.1016/j.cmpb.2023.107922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND One of the most prevalent birth disorders is congenital heart diseases (CHD). Although CHD risk factors have been the subject of numerous studies, their propensity to cause CHD has not been tested. Particularly few research has attempted to forecast CHD risk using population-based cross-sectional data, which is inherently imbalanced. OBJECTIVE The main goals of this study are to create a reliable data analysis model that can help with (i) a better understanding of congenital heart disease prediction in the presence of missing and unbalanced data and (ii) creating cohorts of expectant mothers with similar lifestyle characteristics. METHODS Clusters of patient cohorts are produced using the unsupervised data mining technique density-based spatial clustering of applications with noise (DBSCAN). For more accurate CHD prediction, a random forest model was trained using these clusters and their corresponding patterns. This study uses a dataset of 33,831 expectant mothers to make its prediction. Missing data were handled using the k-NN imputation approach, while extremely unbalanced data were balanced using SMOTE. These techniques are all data-driven and need little to no user or expert involvement. RESULTS AND CONCLUSION Using DBSCAN, three cohorts were found. The cluster information enhanced the random forest-based CHD prediction and revealed intricate factors that influence prediction accuracy. The proposed approach gave the highest results with 99 % accuracy and 0.91 AUC and performed better than the state-of-the-art methodologies. Hence, the suggested method using unsupervised learning can provide intricate information to the classifier and further enhance the performance of the classification.
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Affiliation(s)
- Ishleen Kaur
- Sri Guru Tegh Bahadur Khalsa College, University of Delhi, Delhi, India.
| | - Tanvir Ahmad
- Department of Computer Engineering, Jamia Millia Islamia, New Delhi, India
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Zhang J, Chao H, Dasegowda G, Wang G, Kalra MK, Yan P. Revisiting the Trustworthiness of Saliency Methods in Radiology AI. Radiol Artif Intell 2024; 6:e220221. [PMID: 38166328 PMCID: PMC10831523 DOI: 10.1148/ryai.220221] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 01/04/2024]
Abstract
Purpose To determine whether saliency maps in radiology artificial intelligence (AI) are vulnerable to subtle perturbations of the input, which could lead to misleading interpretations, using prediction-saliency correlation (PSC) for evaluating the sensitivity and robustness of saliency methods. Materials and Methods In this retrospective study, locally trained deep learning models and a research prototype provided by a commercial vendor were systematically evaluated on 191 229 chest radiographs from the CheXpert dataset and 7022 MR images from a human brain tumor classification dataset. Two radiologists performed a reader study on 270 chest radiograph pairs. A model-agnostic approach for computing the PSC coefficient was used to evaluate the sensitivity and robustness of seven commonly used saliency methods. Results The saliency methods had low sensitivity (maximum PSC, 0.25; 95% CI: 0.12, 0.38) and weak robustness (maximum PSC, 0.12; 95% CI: 0.0, 0.25) on the CheXpert dataset, as demonstrated by leveraging locally trained model parameters. Further evaluation showed that the saliency maps generated from a commercial prototype could be irrelevant to the model output, without knowledge of the model specifics (area under the receiver operating characteristic curve decreased by 8.6% without affecting the saliency map). The human observer studies confirmed that it is difficult for experts to identify the perturbed images; the experts had less than 44.8% correctness. Conclusion Popular saliency methods scored low PSC values on the two datasets of perturbed chest radiographs, indicating weak sensitivity and robustness. The proposed PSC metric provides a valuable quantification tool for validating the trustworthiness of medical AI explainability. Keywords: Saliency Maps, AI Trustworthiness, Dynamic Consistency, Sensitivity, Robustness Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Yanagawa and Sato in this issue.
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Affiliation(s)
- Jiajin Zhang
- From the Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th St, Biotech 4231, Troy, NY 12180 (J.Z., H.C., G.W., P.Y.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (G.D., M.K.K.)
| | - Hanqing Chao
- From the Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th St, Biotech 4231, Troy, NY 12180 (J.Z., H.C., G.W., P.Y.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (G.D., M.K.K.)
| | - Giridhar Dasegowda
- From the Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th St, Biotech 4231, Troy, NY 12180 (J.Z., H.C., G.W., P.Y.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (G.D., M.K.K.)
| | - Ge Wang
- From the Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th St, Biotech 4231, Troy, NY 12180 (J.Z., H.C., G.W., P.Y.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (G.D., M.K.K.)
| | - Mannudeep K. Kalra
- From the Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th St, Biotech 4231, Troy, NY 12180 (J.Z., H.C., G.W., P.Y.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (G.D., M.K.K.)
| | - Pingkun Yan
- From the Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th St, Biotech 4231, Troy, NY 12180 (J.Z., H.C., G.W., P.Y.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (G.D., M.K.K.)
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Athalye C, van Nisselrooij A, Rizvi S, Haak MC, Moon-Grady AJ, Arnaout R. Deep-learning model for prenatal congenital heart disease screening generalizes to community setting and outperforms clinical detection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:44-52. [PMID: 37774040 PMCID: PMC10841849 DOI: 10.1002/uog.27503] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES Despite nearly universal prenatal ultrasound screening programs, congenital heart defects (CHD) are still missed, which may result in severe morbidity or even death. Deep machine learning (DL) can automate image recognition from ultrasound. The main aim of this study was to assess the performance of a previously developed DL model, trained on images from a tertiary center, using fetal ultrasound images obtained during the second-trimester standard anomaly scan in a low-risk population. A secondary aim was to compare initial screening diagnosis, which made use of live imaging at the point-of-care, with diagnosis by clinicians evaluating only stored images. METHODS All pregnancies with isolated severe CHD in the Northwestern region of The Netherlands between 2015 and 2016 with available stored images were evaluated, as well as a sample of normal fetuses' examinations from the same region and time period. We compared the accuracy of the initial clinical diagnosis (made in real time with access to live imaging) with that of the model (which had only stored imaging available) and with the performance of three blinded human experts who had access only to the stored images (like the model). We analyzed performance according to ultrasound study characteristics, such as duration and quality (scored independently by investigators), number of stored images and availability of screening views. RESULTS A total of 42 normal fetuses and 66 cases of isolated CHD at birth were analyzed. Of the abnormal cases, 31 were missed and 35 were detected at the time of the clinical anatomy scan (sensitivity, 53%). Model sensitivity and specificity were 91% and 78%, respectively. Blinded human experts (n = 3) achieved mean ± SD sensitivity and specificity of 55 ± 10% (range, 47-67%) and 71 ± 13% (range, 57-83%), respectively. There was a statistically significant difference in model correctness according to expert-graded image quality (P = 0.03). The abnormal cases included 19 lesions that the model had not encountered during its training; the model's performance in these cases (16/19 correct) was not statistically significantly different from that for previously encountered lesions (P = 0.41). CONCLUSIONS A previously trained DL algorithm had higher sensitivity than initial clinical assessment in detecting CHD in a cohort in which over 50% of CHD cases were initially missed clinically. Notably, the DL algorithm performed well on community-acquired images in a low-risk population, including lesions to which it had not been exposed previously. Furthermore, when both the model and blinded human experts had access to only stored images and not the full range of images available to a clinician during a live scan, the model outperformed the human experts. Together, these findings support the proposition that use of DL models can improve prenatal detection of CHD. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Athalye
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - A van Nisselrooij
- Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - S Rizvi
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - M C Haak
- Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - A J Moon-Grady
- Department of Pediatrics, Division of Cardiology, University of California, San Francisco, San Francisco, CA, USA
| | - R Arnaout
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, Division of Cardiology, University of California, San Francisco, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute; Department of Radiology; UCSF Berkeley Joint Program in Computational Precision Health; Center for Intelligent Imaging; Biological and Medical Informatics, University of California, San Francisco, San Francisco, CA, USA
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Yu X, Ma L, Wang H, Zhang Y, Du H, Xu K, Wang L. Deep learning-based differentiation of ventricular septal defect from tetralogy of Fallot in fetal echocardiography images. Technol Health Care 2024; 32:457-464. [PMID: 38759068 PMCID: PMC11191497 DOI: 10.3233/thc-248040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
BACKGROUND Congenital heart disease (CHD) seriously affects children's health and quality of life, and early detection of CHD can reduce its impact on children's health. Tetralogy of Fallot (TOF) and ventricular septal defect (VSD) are two types of CHD that have similarities in echocardiography. However, TOF has worse diagnosis and higher morality than VSD. Accurate differentiation between VSD and TOF is highly important for administrative property treatment and improving affected factors' diagnoses. OBJECTIVE TOF and VSD were differentiated using convolutional neural network (CNN) models that classified fetal echocardiography images. METHODS We collected 105 fetal echocardiography images of TOF and 96 images of VSD. Four CNN models, namely, VGG19, ResNet50, NTS-Net, and the weakly supervised data augmentation network (WSDAN), were used to differentiate the two congenital heart diseases. The performance of these four models was compared based on sensitivity, accuracy, specificity, and AUC. RESULTS VGG19 and ResNet50 performed similarly, with AUCs of 0.799 and 0.802, respectively. A superior performance was observed with NTS-Net and WSDAN specific for fine-grained image categorization tasks, with AUCs of 0.823 and 0.873, respectively. WSDAN had the best performance among all models tested. CONCLUSIONS WSDAN exhibited the best performance in differentiating between TOF and VSD and is worthy of further clinical popularization.
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Affiliation(s)
- Xia Yu
- Weihai Maternal and Children Health Hospital, Weihai, Shandong, China
- Weihai Key Laboratory of Precision Medical Technology, Weihai, Shandong, China
| | - Liyong Ma
- Weihai Key Laboratory of Precision Medical Technology, Weihai, Shandong, China
- School of Information Science and Engineering, Harbin Institute of Technology, Weihai, Shandong, China
| | - Hongjie Wang
- Weihai Maternal and Children Health Hospital, Weihai, Shandong, China
- Weihai Key Laboratory of Precision Medical Technology, Weihai, Shandong, China
| | - Yong Zhang
- School of Ocean Engineering, Harbin Institute of Technology, Weihai, Shandong, China
| | - Hai Du
- School of Information Science and Engineering, Harbin Institute of Technology, Weihai, Shandong, China
| | - Kaiyuan Xu
- School of Information Science and Engineering, Harbin Institute of Technology, Weihai, Shandong, China
| | - Lianfang Wang
- School of Information Science and Engineering, Harbin Institute of Technology, Weihai, Shandong, China
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31
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Jacquemyn X, Kutty S, Manlhiot C. The Lifelong Impact of Artificial Intelligence and Clinical Prediction Models on Patients With Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:440-452. [PMID: 38161675 PMCID: PMC10755786 DOI: 10.1016/j.cjcpc.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/24/2023] [Indexed: 01/03/2024]
Abstract
Medical advancements in the diagnosis, surgical techniques, perioperative care, and continued care throughout childhood have transformed the outlook for individuals with tetralogy of Fallot (TOF), improving survival and shifting the perspective towards lifelong care. However, with a growing population of survivors, longstanding challenges have been accentuated, and new challenges have surfaced, necessitating a re-evaluation of TOF care. Availability of prenatal diagnostics, insufficient information from traditional imaging techniques, previously unforeseen medical complications, and debates surrounding optimal timing and indications for reintervention are among the emerging issues. To address these challenges, the integration of artificial intelligence and machine learning holds great promise as they have the potential to revolutionize patient management and positively impact lifelong outcomes for individuals with TOF. Innovative applications of artificial intelligence and machine learning have spanned across multiple domains of TOF care, including screening and diagnosis, automated image processing and interpretation, clinical risk stratification, and planning and performing cardiac interventions. By embracing these advancements and incorporating them into routine clinical practice, personalized medicine could be delivered, leading to the best possible outcomes for patients. In this review, we provide an overview of these evolving applications and emphasize the challenges, limitations, and future potential for integrating them into clinical care.
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Affiliation(s)
- Xander Jacquemyn
- Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Shelby Kutty
- Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Holste G, Oikonomou EK, Mortazavi BJ, Coppi A, Faridi KF, Miller EJ, Forrest JK, McNamara RL, Ohno-Machado L, Yuan N, Gupta A, Ouyang D, Krumholz HM, Wang Z, Khera R. Severe aortic stenosis detection by deep learning applied to echocardiography. Eur Heart J 2023; 44:4592-4604. [PMID: 37611002 PMCID: PMC11004929 DOI: 10.1093/eurheartj/ehad456] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND AND AIMS Early diagnosis of aortic stenosis (AS) is critical to prevent morbidity and mortality but requires skilled examination with Doppler imaging. This study reports the development and validation of a novel deep learning model that relies on two-dimensional (2D) parasternal long axis videos from transthoracic echocardiography without Doppler imaging to identify severe AS, suitable for point-of-care ultrasonography. METHODS AND RESULTS In a training set of 5257 studies (17 570 videos) from 2016 to 2020 [Yale-New Haven Hospital (YNHH), Connecticut], an ensemble of three-dimensional convolutional neural networks was developed to detect severe AS, leveraging self-supervised contrastive pretraining for label-efficient model development. This deep learning model was validated in a temporally distinct set of 2040 consecutive studies from 2021 from YNHH as well as two geographically distinct cohorts of 4226 and 3072 studies, from California and other hospitals in New England, respectively. The deep learning model achieved an area under the receiver operating characteristic curve (AUROC) of 0.978 (95% CI: 0.966, 0.988) for detecting severe AS in the temporally distinct test set, maintaining its diagnostic performance in geographically distinct cohorts [0.952 AUROC (95% CI: 0.941, 0.963) in California and 0.942 AUROC (95% CI: 0.909, 0.966) in New England]. The model was interpretable with saliency maps identifying the aortic valve, mitral annulus, and left atrium as the predictive regions. Among non-severe AS cases, predicted probabilities were associated with worse quantitative metrics of AS suggesting an association with various stages of AS severity. CONCLUSION This study developed and externally validated an automated approach for severe AS detection using single-view 2D echocardiography, with potential utility for point-of-care screening.
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Affiliation(s)
- Gregory Holste
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8056, USA
| | - Evangelos K Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8056, USA
| | - Bobak J Mortazavi
- Department of Computer Science & Engineering, Texas A&M University, College Station, TX, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church St 5th Floor, New Haven, CT, USA
| | - Andreas Coppi
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8056, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church St 5th Floor, New Haven, CT, USA
| | - Kamil F Faridi
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8056, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8056, USA
| | - John K Forrest
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8056, USA
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8056, USA
| | - Lucila Ohno-Machado
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
| | - Neal Yuan
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Aakriti Gupta
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Ouyang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8056, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church St 5th Floor, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Zhangyang Wang
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8056, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church St 5th Floor, New Haven, CT, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, 60 College St, New Haven, CT, USA
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Yousefpour Shahrivar R, Karami F, Karami E. Enhancing Fetal Anomaly Detection in Ultrasonography Images: A Review of Machine Learning-Based Approaches. Biomimetics (Basel) 2023; 8:519. [PMID: 37999160 PMCID: PMC10669151 DOI: 10.3390/biomimetics8070519] [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: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Fetal development is a critical phase in prenatal care, demanding the timely identification of anomalies in ultrasound images to safeguard the well-being of both the unborn child and the mother. Medical imaging has played a pivotal role in detecting fetal abnormalities and malformations. However, despite significant advances in ultrasound technology, the accurate identification of irregularities in prenatal images continues to pose considerable challenges, often necessitating substantial time and expertise from medical professionals. In this review, we go through recent developments in machine learning (ML) methods applied to fetal ultrasound images. Specifically, we focus on a range of ML algorithms employed in the context of fetal ultrasound, encompassing tasks such as image classification, object recognition, and segmentation. We highlight how these innovative approaches can enhance ultrasound-based fetal anomaly detection and provide insights for future research and clinical implementations. Furthermore, we emphasize the need for further research in this domain where future investigations can contribute to more effective ultrasound-based fetal anomaly detection.
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Affiliation(s)
- Ramin Yousefpour Shahrivar
- Department of Biology, College of Convergent Sciences and Technologies, Science and Research Branch, Islamic Azad University, Tehran, 14515-775, Iran
| | - Fatemeh Karami
- Department of Medical Genetics, Applied Biophotonics Research Center, Science and Research Branch, Islamic Azad University, Tehran, 14515-775, Iran
| | - Ebrahim Karami
- Department of Engineering and Applied Sciences, Memorial University of Newfoundland, St. John’s, NL A1B 3X5, Canada
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Padovani P, Singh Y, Pass RH, Vasile CM, Nield LE, Baruteau AE. E-Health: A Game Changer in Fetal and Neonatal Cardiology? J Clin Med 2023; 12:6865. [PMID: 37959330 PMCID: PMC10650296 DOI: 10.3390/jcm12216865] [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: 10/05/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Technological advancements have greatly impacted the healthcare industry, including the integration of e-health in pediatric cardiology. The use of telemedicine, mobile health applications, and electronic health records have demonstrated a significant potential to improve patient outcomes, reduce healthcare costs, and enhance the quality of care. Telemedicine provides a useful tool for remote clinics, follow-up visits, and monitoring for infants with congenital heart disease, while mobile health applications enhance patient and parents' education, medication compliance, and in some instances, remote monitoring of vital signs. Despite the benefits of e-health, there are potential limitations and challenges, such as issues related to availability, cost-effectiveness, data privacy and security, and the potential ethical, legal, and social implications of e-health interventions. In this review, we aim to highlight the current application and perspectives of e-health in the field of fetal and neonatal cardiology, including expert parents' opinions.
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Affiliation(s)
- Paul Padovani
- CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, 44000 Nantes, France;
- CHU Nantes, INSERM, CIC FEA 1413, Nantes Université, 44000 Nantes, France
| | - Yogen Singh
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Robert H. Pass
- Department of Pediatric Cardiology, Mount Sinai Kravis Children’s Hospital, New York, NY 10029, USA;
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France;
| | - Lynne E. Nield
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON M5S 1A1, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alban-Elouen Baruteau
- CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, 44000 Nantes, France;
- CHU Nantes, INSERM, CIC FEA 1413, Nantes Université, 44000 Nantes, France
- CHU Nantes, CNRS, INSERM, L’Institut du Thorax, Nantes Université, 44000 Nantes, France
- INRAE, UMR 1280, PhAN, Nantes Université, 44000 Nantes, France
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Jost E, Kosian P, Jimenez Cruz J, Albarqouni S, Gembruch U, Strizek B, Recker F. Evolving the Era of 5D Ultrasound? A Systematic Literature Review on the Applications for Artificial Intelligence Ultrasound Imaging in Obstetrics and Gynecology. J Clin Med 2023; 12:6833. [PMID: 37959298 PMCID: PMC10649694 DOI: 10.3390/jcm12216833] [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: 09/21/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Artificial intelligence (AI) has gained prominence in medical imaging, particularly in obstetrics and gynecology (OB/GYN), where ultrasound (US) is the preferred method. It is considered cost effective and easily accessible but is time consuming and hindered by the need for specialized training. To overcome these limitations, AI models have been proposed for automated plane acquisition, anatomical measurements, and pathology detection. This study aims to overview recent literature on AI applications in OB/GYN US imaging, highlighting their benefits and limitations. For the methodology, a systematic literature search was performed in the PubMed and Cochrane Library databases. Matching abstracts were screened based on the PICOS (Participants, Intervention or Exposure, Comparison, Outcome, Study type) scheme. Articles with full text copies were distributed to the sections of OB/GYN and their research topics. As a result, this review includes 189 articles published from 1994 to 2023. Among these, 148 focus on obstetrics and 41 on gynecology. AI-assisted US applications span fetal biometry, echocardiography, or neurosonography, as well as the identification of adnexal and breast masses, and assessment of the endometrium and pelvic floor. To conclude, the applications for AI-assisted US in OB/GYN are abundant, especially in the subspecialty of obstetrics. However, while most studies focus on common application fields such as fetal biometry, this review outlines emerging and still experimental fields to promote further research.
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Affiliation(s)
- Elena Jost
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Philipp Kosian
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Jorge Jimenez Cruz
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Shadi Albarqouni
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
- Helmholtz AI, Helmholtz Munich, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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Arnaout R. ChatGPT Helped Me Write This Talk Title, but Can It Read an Echocardiogram? J Am Soc Echocardiogr 2023; 36:1021-1026. [PMID: 37499771 PMCID: PMC10914544 DOI: 10.1016/j.echo.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023]
Abstract
While multidisciplinary collaboration in echocardiography is not new, machine learning has the potential to further improve it. In this transcript of the ASE 2023 Annual Feigenbaum lecture, advancements in foundation models are discussed, including their advantages, current disadvantages, and future potential for echocardiography.
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Affiliation(s)
- Rima Arnaout
- Department of Medicine, Department of Radiology, and Department of Pediatrics, Bakar Computational Health Sciences Institute, UCSF UC Berkeley Joint Program in Computational Precision Health, University of California, San Francisco, San Francisco, California.
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Paul EA, Cohen J, Geiger MK. Cardiac problems in the fetus: a review for pediatric providers. Curr Opin Pediatr 2023; 35:523-530. [PMID: 37466056 DOI: 10.1097/mop.0000000000001274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to provide pediatric providers with a review of the diagnosis and management of fetal cardiac disease in the current era. RECENT FINDINGS Prenatal detection of congenital heart disease (CHD) has improved but is still imperfect. In experienced hands, fetal echocardiography can detect severe CHD as early as the first trimester and a majority of more subtle conditions in the second and third trimesters. Beyond detection, a prenatal diagnosis allows for lesion-specific counseling for families as well as for development of a multidisciplinary perinatal management plan, which may involve in-utero treatment. Given the diversity of cardiac diagnoses and the rarity of some, collaborative multicenter fetal cardiac research has gained momentum in recent years. SUMMARY Accurate diagnosis of fetal cardiac disease allows for appropriate counseling, pregnancy and delivery planning, and optimization of immediate neonatal care. There is potential for improving fetal CHD detection rates. Fetal interventions are available for certain conditions, and fetal and pediatric cardiac centers have developed management plans specific to the expected postnatal physiology.
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Affiliation(s)
- Erin A Paul
- Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Regouin M, Mancini J, Lafouge A, Mace P, Fontaine N, Roussin S, Guichard J, Dumont C, Quarello E. The Left Outflow Tract in Fetal Cardiac Screening Examination: Introduction of Quality Criteria Is Not Always Associated With an Improvement of Practice When Supervised by Humans. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2095-2105. [PMID: 37163223 DOI: 10.1002/jum.16231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/11/2023] [Accepted: 04/01/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Since 2016, the French CNEOF included the left ventricular outflow tract (LVOT) in the second and third trimester of pregnancy in addition to the four-chamber view and the parasagittal view of the right outflow tract. The objective of this study was to define quality criteria for fetal LVOT assessment and to perform a human audit of past and current practices, before and after the implementation of those quality criteria at a large scale. METHODS Seven quality criteria were investigated and rated from 0 to 1 during three periods of interest. Files were randomly selected from three centers, and average total and specific scores were calculated. RESULTS LVOT pictures were present in more than 94.3% of reports. The average quality score was 5.49/7 (95% confidence interval [CI]: 5.36-5.62), 5.91/7 (95% CI: 5.80-6.03), and 5.70/7 (95% CI: 5.58-5.82) for the three centers in the three periods of interest. There was no significant difference following the introduction of the quality criteria, 2017 versus 2020, P = .054. CONCLUSION Fetal LVOT images were present in most of ultrasound reports but the introduction of the proposed quality criteria under human supervision seems not associated with a significant change in practice.
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Affiliation(s)
- Maud Regouin
- Département de Gynécologie Obstétrique, Hôpital Sud de la Réunion, Réunion, France
| | - Julien Mancini
- APHM, INSERM, IRD, SESSTIM, Hop Timone, Public Health Department (BIOSTIC), Aix Marseille University, Marseille, France
| | | | - Pierre Mace
- Institut Méditerranéen d'Imagerie Médicale Appliquée à la Gynécologie, la Grossesse et l'Enfance IMAGE2, Marseille, France
- Hôpital Beauregard, Marseille, France
| | - Nathalie Fontaine
- Département de Gynécologie Obstétrique, Hôpital Sud de la Réunion, Réunion, France
| | | | - Jimmy Guichard
- Cabinet d'Echographie Gynécologique et Obstétricale-Espace 9 Mois, Montreuil, France
| | - Coralie Dumont
- Département de Gynécologie Obstétrique, Hôpital Sud de la Réunion, Réunion, France
| | - Edwin Quarello
- Institut Méditerranéen d'Imagerie Médicale Appliquée à la Gynécologie, la Grossesse et l'Enfance IMAGE2, Marseille, France
- Unité de Dépistage et de Diagnostic Prénatal, Hôpital Saint-Joseph, Marseille, France
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Ling W, Wu Q, Guo S, Li S, Ma H, Huang B, Zeng L, Dang T, Liu M, Qiu X, Weng Z. Four-section approach of fetal congenital heart disease at 11-13 +6 weeks. Front Cardiovasc Med 2023; 10:1206042. [PMID: 37692039 PMCID: PMC10483229 DOI: 10.3389/fcvm.2023.1206042] [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: 04/14/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Objective The objective of the study is to explore the value of the four-section approach in detecting fetal heart defects in the first trimester (11-13+6 weeks), analyze the reasons for the inconsistency between the results of ultrasound examination in the first trimester and subsequent verification, and describe the most common abnormal flow patterns of four sections. Materials and methods Between June 2019 and June 2021, a prenatal four-section approach (upper abdominal transverse section, four-chamber section, three vessel-trachea section, and bilateral subclavian artery section) with verification results in early pregnancy was analyzed. Results In total, 9,533 fetuses were included. Finally, 176 fetuses with congenital heart disease (CHD), containing 34 types, were identified. The total detection rate of cardiac abnormalities was 1.85%. 102 cases were accurately diagnosed by ultrasonography during early pregnancy. A total of 74 fetuses who had inconsistent results between fetal cardiac ultrasound and verification in early pregnancy were reported, of which the cases of 22 fetuses were inconsistent due to disease evolution and progression and the cases of 52 fetuses were inconsistent due to missed diagnosis and misdiagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of the four-section approach were 67.05%, 99.96%, 96.58%, and 99.33%, respectively. In this study, a total of 30 abnormal ultrasonic imaging patterns in four sections were summarized. Conclusion We confirmed that the four-section approach in early pregnancy has a good diagnostic efficacy for fetal CHD. Intrauterine evolution of the fetal heart, missed diagnosis, and misdiagnosis are the reasons for the inconsistency between the results of early pregnancy ultrasound and subsequent verification. This study also presents the abnormal imaging patterns of four scan sections of CHD in early pregnancy, which are instructive for the rapid identification and diagnosis of CHD in the first trimester.
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Affiliation(s)
- Wen Ling
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiumei Wu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shan Guo
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shangqing Li
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hong Ma
- Department of Pathology, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Biying Huang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Liqin Zeng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Tingting Dang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Min Liu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiuqing Qiu
- Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Care Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Gembicki M, Welp A, Scharf JL, Dracopoulos C, Weichert J. A Clinical Approach to Semiautomated Three-Dimensional Fetal Brain Biometry-Comparing the Strengths and Weaknesses of Two Diagnostic Tools: 5DCNS+ TM and SonoCNS TM. J Clin Med 2023; 12:5334. [PMID: 37629375 PMCID: PMC10455237 DOI: 10.3390/jcm12165334] [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: 07/30/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Objective: We aimed to evaluate the accuracy and efficacy of AI-assisted biometric measurements of the fetal central nervous system (CNS) by comparing two semiautomatic postprocessing tools. We further aimed to discuss the additional value of semiautomatically generated sagittal and coronal planes of the CNS. (2) Methods: Three-dimensional (3D) volumes were analyzed with two semiautomatic software tools, 5DCNS+™ and SonoCNS™. The application of 5DCNS+™ results in nine planes (axial, coronal and sagittal) displayed in a single template; SonoCNS™ depicts three axial cutting sections. The tools were compared regarding automatic biometric measurement accuracy. (3) Results: A total of 129 fetuses were included for final analysis. Our data indicate that, in terms of the biometric quantification of head circumference (HC), biparietal diameter (BPD), transcerebellar diameter (TCD) and cisterna magna (CM), the accuracy of SonoCNS™ was higher with respect to the manual measurement of an experienced examiner compared to 5DCNS+™, whereas it was the other way around regarding the diameter of the posterior horn of the lateral ventricle (Vp). The inclusion of four orthogonal coronal views in 5DCNS+™ gives valuable information regarding spatial arrangements, particularly of midline structures. (4) Conclusions: Both tools were able to ease assessment of the intracranial anatomy, highlighting the additional value of automated algorithms in clinical use. SonoCNS™ showed a superior accuracy of plane reconstruction and biometry, but volume reconstruction using 5DCNS+™ provided more detailed information, which is needed for an entire neurosonogram as suggested by international guidelines.
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Tang J, Liang Y, Jiang Y, Liu J, Zhang R, Huang D, Pang C, Huang C, Luo D, Zhou X, Li R, Zhang K, Xie B, Hu L, Zhu F, Xia H, Lu L, Wang H. A multicenter study on two-stage transfer learning model for duct-dependent CHDs screening in fetal echocardiography. NPJ Digit Med 2023; 6:143. [PMID: 37573426 PMCID: PMC10423245 DOI: 10.1038/s41746-023-00883-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/21/2023] [Indexed: 08/14/2023] Open
Abstract
Duct-dependent congenital heart diseases (CHDs) are a serious form of CHD with a low detection rate, especially in underdeveloped countries and areas. Although existing studies have developed models for fetal heart structure identification, there is a lack of comprehensive evaluation of the long axis of the aorta. In this study, a total of 6698 images and 48 videos are collected to develop and test a two-stage deep transfer learning model named DDCHD-DenseNet for screening critical duct-dependent CHDs. The model achieves a sensitivity of 0.973, 0.843, 0.769, and 0.759, and a specificity of 0.985, 0.967, 0.956, and 0.759, respectively, on the four multicenter test sets. It is expected to be employed as a potential automatic screening tool for hierarchical care and computer-aided diagnosis. Our two-stage strategy effectively improves the robustness of the model and can be extended to screen for other fetal heart development defects.
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Affiliation(s)
- Jiajie Tang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Information Management, Wuhan University, Wuhan, China
| | - Yongen Liang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuxuan Jiang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Information Management, Wuhan University, Wuhan, China
| | - Jinrong Liu
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rui Zhang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Danping Huang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chengcheng Pang
- Cardiovascular Pediatrics/Guangdong Cardiovascular Institute/Medical Big Data Center, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Chen Huang
- Department of Medical Ultrasonics/Shenzhen Longgang Maternal and Child Health Hospital, Shenzhen, China
| | - Dongni Luo
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xue Zhou
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ruizhuo Li
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Medicine, Southern China University of Technology, Guangzhou, China
| | - Kanghui Zhang
- School of Information Management, Wuhan University, Wuhan, China
| | - Bingbing Xie
- School of Information Management, Wuhan University, Wuhan, China
| | - Lianting Hu
- Cardiovascular Pediatrics/Guangdong Cardiovascular Institute/Medical Big Data Center, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Fanfan Zhu
- School of Information Management, Wuhan University, Wuhan, China
| | - Huimin Xia
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Long Lu
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
- School of Information Management, Wuhan University, Wuhan, China.
- Center for Healthcare Big Data Research, The Big Data Institute, Wuhan University, Wuhan, China.
- School of Public Health, Wuhan University, Wuhan, China.
| | - Hongying Wang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Sunthankar SD, Zhao J, Wei WQ, Hill GD, Parra DA, Kohl K, McCoy A, Jayaram NM, Godown J. Machine Learning to Predict Interstage Mortality Following Single Ventricle Palliation: A NPC-QIC Database Analysis. Pediatr Cardiol 2023; 44:1242-1250. [PMID: 36820914 PMCID: PMC10627450 DOI: 10.1007/s00246-023-03130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
There is high risk of mortality between stage I and stage II palliation of single ventricle heart disease. This study aimed to leverage advanced machine learning algorithms to optimize risk-prediction models and identify features most predictive of interstage mortality. This study utilized retrospective data from the National Pediatric Cardiology Quality Improvement Collaborative and included all patients who underwent stage I palliation and survived to hospital discharge (2008-2019). Multiple machine learning models were evaluated, including logistic regression, random forest, gradient boosting trees, extreme gradient boost trees, and light gradient boosting machines. A total of 3267 patients were included with 208 (6.4%) interstage deaths. Machine learning models were trained on 180 clinical features. Digoxin use at discharge was the most influential factor resulting in a lower risk of interstage mortality (p < 0.0001). Stage I surgery with Blalock-Taussig-Thomas shunt portended higher risk than Sano conduit (7.8% vs 4.4%, p = 0.0002). Non-modifiable risk factors identified with increased risk of interstage mortality included female sex, lower gestational age, and lower birth weight. Post-operative risk factors included the requirement of unplanned catheterization and more severe atrioventricular valve insufficiency at discharge. Light gradient boosting machines demonstrated the best performance with an area under the receiver operative characteristic curve of 0.642. Advanced machine learning algorithms highlight a number of modifiable and non-modifiable risk factors for interstage mortality following stage I palliation. However, model performance remains modest, suggesting the presence of unmeasured confounders that contribute to interstage risk.
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Affiliation(s)
- Sudeep D Sunthankar
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Thomas P. Graham Jr Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, 2220 Children's Way, Suite 5230, Nashville, TN, 37232, USA.
| | - Juan Zhao
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Garick D Hill
- Division of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David A Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Karen Kohl
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Allison McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natalie M Jayaram
- Division of Pediatric Cardiology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Justin Godown
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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Ramirez Zegarra R, Ghi T. Use of artificial intelligence and deep learning in fetal ultrasound imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:185-194. [PMID: 36436205 DOI: 10.1002/uog.26130] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/06/2022] [Accepted: 11/21/2022] [Indexed: 06/16/2023]
Abstract
Deep learning is considered the leading artificial intelligence tool in image analysis in general. Deep-learning algorithms excel at image recognition, which makes them valuable in medical imaging. Obstetric ultrasound has become the gold standard imaging modality for detection and diagnosis of fetal malformations. However, ultrasound relies heavily on the operator's experience, making it unreliable in inexperienced hands. Several studies have proposed the use of deep-learning models as a tool to support sonographers, in an attempt to overcome these problems inherent to ultrasound. Deep learning has many clinical applications in the field of fetal imaging, including identification of normal and abnormal fetal anatomy and measurement of fetal biometry. In this Review, we provide a comprehensive explanation of the fundamentals of deep learning in fetal imaging, with particular focus on its clinical applicability. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - T Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
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Day TG, Matthew J, Budd S, Hajnal JV, Simpson JM, Razavi R, Kainz B. Sonographer interaction with artificial intelligence: collaboration or conflict? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:167-174. [PMID: 37523514 DOI: 10.1002/uog.26238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 08/02/2023]
Affiliation(s)
- T G Day
- Department of Congenital Cardiology, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - J Matthew
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - S Budd
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - J V Hajnal
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - J M Simpson
- Department of Congenital Cardiology, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - R Razavi
- Department of Congenital Cardiology, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - B Kainz
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Computing, Faculty of Engineering, Imperial College London, London, UK
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Sun X, Yin Y, Yang Q, Huo T. Artificial intelligence in cardiovascular diseases: diagnostic and therapeutic perspectives. Eur J Med Res 2023; 28:242. [PMID: 37475050 PMCID: PMC10360247 DOI: 10.1186/s40001-023-01065-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 07/22/2023] Open
Abstract
Artificial intelligence (AI), the technique of extracting information from complex database using sophisticated computer algorithms, has incorporated itself in medical field. AI techniques have shown the potential to accelerate the progression of diagnosis and treatment of cardiovascular diseases (CVDs), including heart failure, atrial fibrillation, valvular heart disease, hypertrophic cardiomyopathy, congenital heart disease and so on. In clinical scenario, AI have been proved to apply well in CVD diagnosis, enhance effectiveness of auxiliary tools, disease stratification and typing, and outcome prediction. Deeply developed to capture subtle connections from massive amounts of healthcare data, recent AI algorithms are expected to handle even more complex tasks than traditional methods. The aim of this review is to introduce current applications of AI in CVDs, which may allow clinicians who have limited expertise of computer science to better understand the frontier of the subject and put AI algorithms into clinical practice.
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Affiliation(s)
- Xiaoyu Sun
- National Institute of Hospital Administration, National Health Commission, Beijing, China
| | - Yuzhe Yin
- The Sixth Clinical Medical School, Capital Medical University, Beijing, China
| | - Qiwei Yang
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tianqi Huo
- National Institute of Hospital Administration, National Health Commission, Beijing, China.
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Chen H, Liu Y, Balabani S, Hirayama R, Huang J. Machine Learning in Predicting Printable Biomaterial Formulations for Direct Ink Writing. RESEARCH (WASHINGTON, D.C.) 2023; 6:0197. [PMID: 37469394 PMCID: PMC10353544 DOI: 10.34133/research.0197] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/29/2023] [Indexed: 07/21/2023]
Abstract
Three-dimensional (3D) printing is emerging as a transformative technology for biomedical engineering. The 3D printed product can be patient-specific by allowing customizability and direct control of the architecture. The trial-and-error approach currently used for developing the composition of printable inks is time- and resource-consuming due to the increasing number of variables requiring expert knowledge. Artificial intelligence has the potential to reshape the ink development process by forming a predictive model for printability from experimental data. In this paper, we constructed machine learning (ML) algorithms including decision tree, random forest (RF), and deep learning (DL) to predict the printability of biomaterials. A total of 210 formulations including 16 different bioactive and smart materials and 4 solvents were 3D printed, and their printability was assessed. All ML methods were able to learn and predict the printability of a variety of inks based on their biomaterial formulations. In particular, the RF algorithm has achieved the highest accuracy (88.1%), precision (90.6%), and F1 score (87.0%), indicating the best overall performance out of the 3 algorithms, while DL has the highest recall (87.3%). Furthermore, the ML algorithms have predicted the printability window of biomaterials to guide the ink development. The printability map generated with DL has finer granularity than other algorithms. ML has proven to be an effective and novel strategy for developing biomaterial formulations with desired 3D printability for biomedical engineering applications.
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Affiliation(s)
- Hongyi Chen
- Department of Mechanical Engineering,
University College London, London, UK
- Department of Computer Science,
University College London, London, UK
| | - Yuanchang Liu
- Department of Mechanical Engineering,
University College London, London, UK
| | - Stavroula Balabani
- Department of Mechanical Engineering,
University College London, London, UK
- Wellcome-EPSRC Centre for Interventional Surgical Sciences (WEISS),
University College London, London, UK
| | - Ryuji Hirayama
- Department of Computer Science,
University College London, London, UK
| | - Jie Huang
- Department of Mechanical Engineering,
University College London, London, UK
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Tang J, Han J, Xue J, Zhen L, Yang X, Pan M, Hu L, Li R, Jiang Y, Zhang Y, Jing X, Li F, Chen G, Zhang K, Zhu F, Liao C, Lu L. A Deep-Learning-Based Method Can Detect Both Common and Rare Genetic Disorders in Fetal Ultrasound. Biomedicines 2023; 11:1756. [PMID: 37371851 DOI: 10.3390/biomedicines11061756] [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: 05/09/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
A global survey indicates that genetic syndromes affect approximately 8% of the population, but most genetic diagnoses can only be performed after babies are born. Abnormal facial characteristics have been identified in various genetic diseases; however, current facial identification technologies cannot be applied to prenatal diagnosis. We developed Pgds-ResNet, a fully automated prenatal screening algorithm based on deep neural networks, to detect high-risk fetuses affected by a variety of genetic diseases. In screening for Trisomy 21, Trisomy 18, Trisomy 13, and rare genetic diseases, Pgds-ResNet achieved sensitivities of 0.83, 0.92, 0.75, and 0.96, and specificities of 0.94, 0.93, 0.95, and 0.92, respectively. As shown in heatmaps, the abnormalities detected by Pgds-ResNet are consistent with clinical reports. In a comparative experiment, the performance of Pgds-ResNet is comparable to that of experienced sonographers. This fetal genetic screening technology offers an opportunity for early risk assessment and presents a non-invasive, affordable, and complementary method to identify high-risk fetuses affected by genetic diseases. Additionally, it has the capability to screen for certain rare genetic conditions, thereby enhancing the clinic's detection rate.
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Affiliation(s)
- Jiajie Tang
- School of Information Management, Wuhan University, Wuhan 430072, China
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
- Obstetrics and Gynecology Medical Center, Dongguan Kanghua Hospital, Dongguan 523080, China
- Center for Healthcare Big Data Research, The Big Data Institute, Wuhan University, Wuhan 430072, China
| | - Jin Han
- School of Information Management, Wuhan University, Wuhan 430072, China
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
- Obstetrics and Gynecology Medical Center, Dongguan Kanghua Hospital, Dongguan 523080, China
| | - Jiaxin Xue
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Li Zhen
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Xin Yang
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Min Pan
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Lianting Hu
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangzhou 510317, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou 510317, China
| | - Ru Li
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Yuxuan Jiang
- School of Information Management, Wuhan University, Wuhan 430072, China
| | - Yongling Zhang
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Xiangyi Jing
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Fucheng Li
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Guilian Chen
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Kanghui Zhang
- School of Information Management, Wuhan University, Wuhan 430072, China
| | - Fanfan Zhu
- School of Information Management, Wuhan University, Wuhan 430072, China
| | - Can Liao
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Long Lu
- School of Information Management, Wuhan University, Wuhan 430072, China
- Prenatal Diagnosis Center/Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
- Center for Healthcare Big Data Research, The Big Data Institute, Wuhan University, Wuhan 430072, China
- School of Public Health, Wuhan University, Wuhan 430072, China
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48
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Jiang X, Yu J, Ye J, Jia W, Xu W, Shu Q. A deep learning-based method for pediatric congenital heart disease detection with seven standard views in echocardiography. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000580. [PMID: 37303480 PMCID: PMC10255206 DOI: 10.1136/wjps-2023-000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/26/2023] [Indexed: 06/13/2023] Open
Abstract
Background With the aggregation of clinical data and the evolution of computational resources, artificial intelligence-based methods have become possible to facilitate clinical diagnosis. For congenital heart disease (CHD) detection, recent deep learning-based methods tend to achieve classification with few views or even a single view. Due to the complexity of CHD, the input images for the deep learning model should cover as many anatomical structures of the heart as possible to enhance the accuracy and robustness of the algorithm. In this paper, we first propose a deep learning method based on seven views for CHD classification and then validate it with clinical data, the results of which show the competitiveness of our approach. Methods A total of 1411 children admitted to the Children's Hospital of Zhejiang University School of Medicine were selected, and their echocardiographic videos were obtained. Then, seven standard views were selected from each video, which were used as the input to the deep learning model to obtain the final result after training, validation and testing. Results In the test set, when a reasonable type of image was input, the area under the curve (AUC) value could reach 0.91, and the accuracy could reach 92.3%. During the experiment, shear transformation was used as interference to test the infection resistance of our method. As long as appropriate data were input, the above experimental results would not fluctuate obviously even if artificial interference was applied. Conclusions These results indicate that the deep learning model based on the seven standard echocardiographic views can effectively detect CHD in children, and this approach has considerable value in practical application.
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Affiliation(s)
- Xusheng Jiang
- Department of Cardiac Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jin Yu
- Department of Ultrasound Diagnosis, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingjing Ye
- Department of Ultrasound Diagnosis, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Weijie Jia
- Innovation Center for Child Health, Binjiang Institute of Zhejiang University, Hangzhou, China
| | - Weize Xu
- Department of Cardiac Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiang Shu
- Department of Cardiac Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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49
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Arain Z, Iliodromiti S, Slabaugh G, David AL, Chowdhury TT. Machine learning and disease prediction in obstetrics. Curr Res Physiol 2023; 6:100099. [PMID: 37324652 PMCID: PMC10265477 DOI: 10.1016/j.crphys.2023.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Machine learning technologies and translation of artificial intelligence tools to enhance the patient experience are changing obstetric and maternity care. An increasing number of predictive tools have been developed with data sourced from electronic health records, diagnostic imaging and digital devices. In this review, we explore the latest tools of machine learning, the algorithms to establish prediction models and the challenges to assess fetal well-being, predict and diagnose obstetric diseases such as gestational diabetes, pre-eclampsia, preterm birth and fetal growth restriction. We discuss the rapid growth of machine learning approaches and intelligent tools for automated diagnostic imaging of fetal anomalies and to asses fetoplacental and cervix function using ultrasound and magnetic resonance imaging. In prenatal diagnosis, we discuss intelligent tools for magnetic resonance imaging sequencing of the fetus, placenta and cervix to reduce the risk of preterm birth. Finally, the use of machine learning to improve safety standards in intrapartum care and early detection of complications will be discussed. The demand for technologies to enhance diagnosis and treatment in obstetrics and maternity should improve frameworks for patient safety and enhance clinical practice.
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Affiliation(s)
- Zara Arain
- Centre for Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London, E1 4NS, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - Gregory Slabaugh
- Digital Environment Research Institute, School of Electronic Engineering and Computer Science, Queen Mary University of London, London, E1 1HH, UK
| | - Anna L. David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, Medical School Building, Huntley Street, London, WC1E 6AU, UK
| | - Tina T. Chowdhury
- Centre for Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London, E1 4NS, UK
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50
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Xiao S, Zhang J, Zhu Y, Zhang Z, Cao H, Xie M, Zhang L. Application and Progress of Artificial Intelligence in Fetal Ultrasound. J Clin Med 2023; 12:jcm12093298. [PMID: 37176738 PMCID: PMC10179567 DOI: 10.3390/jcm12093298] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/01/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Prenatal ultrasonography is the most crucial imaging modality during pregnancy. However, problems such as high fetal mobility, excessive maternal abdominal wall thickness, and inter-observer variability limit the development of traditional ultrasound in clinical applications. The combination of artificial intelligence (AI) and obstetric ultrasound may help optimize fetal ultrasound examination by shortening the examination time, reducing the physician's workload, and improving diagnostic accuracy. AI has been successfully applied to automatic fetal ultrasound standard plane detection, biometric parameter measurement, and disease diagnosis to facilitate conventional imaging approaches. In this review, we attempt to thoroughly review the applications and advantages of AI in prenatal fetal ultrasound and discuss the challenges and promises of this new field.
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Affiliation(s)
- Sushan Xiao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Junmin Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Ye Zhu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Zisang Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Haiyan Cao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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