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Borgbjerg J, Thompson JD, Salte IM, Frøkjær JB. Towards AI-augmented radiology education: a web-based application for perception training in chest X-ray nodule detection. Br J Radiol 2023; 96:20230299. [PMID: 37750851 PMCID: PMC10646630 DOI: 10.1259/bjr.20230299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/09/2023] [Accepted: 08/15/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES Artificial intelligence (AI)-based applications for augmenting radiological education are underexplored. Prior studies have demonstrated the effectiveness of simulation in radiological perception training. This study aimed to develop and make available a pure web-based application called Perception Trainer for perception training in lung nodule detection in chest X-rays. METHODS Based on open-access data, we trained a deep-learning model for lung segmentation in chest X-rays. Subsequently, an algorithm for artificial lung nodule generation was implemented and combined with the segmentation model to allow on-the-fly procedural insertion of lung nodules in chest X-rays. This functionality was integrated into an existing zero-footprint web-based DICOM viewer, and a dynamic HTML page was created to specify case generation parameters. RESULTS The result is an easily accessible platform-agnostic web application available at: https://castlemountain.dk/mulrecon/perceptionTrainer.html.The application allows the user to specify the characteristics of lung nodules to be inserted into chest X-rays, and it produces automated feedback regarding nodule detection performance. Generated cases can be shared through a uniform resource locator. CONCLUSION We anticipate that the description and availability of our developed solution with open-sourced codes may help facilitate radiological education and stimulate the development of similar AI-augmented educational tools. ADVANCES IN KNOWLEDGE A web-based application applying AI-based techniques for radiological perception training was developed. The application demonstrates a novel approach for on-the-fly generation of cases in chest X-ray lung nodule detection employing deep-learning-based segmentation and lung nodule simulation.
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Affiliation(s)
- Jens Borgbjerg
- Department of Radiology, Akershus University Hospital, Oslo, Norway
| | - John D Thompson
- Department of Radiology, University Hospitals of Morecambe Bay NHS Foundation Trust, Morecambe, United Kingdom
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Borgbjerg J, Steinkohl E, Olesen SS, Akisik F, Bethke A, Bieliuniene E, Christensen HS, Engjom T, Haldorsen IS, Kartalis N, Lisitskaya MV, Naujokaite G, Novovic S, Ozola-Zālīte I, Phillips AE, Swensson JK, Drewes AM, Frøkjær JB. Inter- and intra-observer variability of computed tomography-based parenchymal- and ductal diameters in chronic pancreatitis: a multi-observer international study. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:306-317. [PMID: 36138242 DOI: 10.1007/s00261-022-03667-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The need for incorporation of quantitative imaging biomarkers of pancreatic parenchymal and ductal structures has been highlighted in recent proposals for new scoring systems in chronic pancreatitis (CP). To quantify inter- and intra-observer variability in CT-based measurements of ductal- and gland diameters in CP patients. MATERIALS AND METHODS Prospectively acquired pancreatic CT examinations from 50 CP patients were reviewed by 12 radiologists and four pancreatologists from 10 institutions. Assessment entailed measuring maximum diameter in the axial plane of four structures: (1) pancreatic head (PDhead), (2) pancreatic body (PDbody), (3) main pancreatic duct in the pancreatic head (MPDhead), and (4) body (MPDbody). Agreement was assessed by the 95% limits of agreement with the mean (LOAM), representing how much a single measurement for a specific subject may plausibly deviate from the mean of all measurements on the specific subject. Bland-Altman limits of agreement (LoA) were generated for intra-observer pairs. RESULTS The 16 observers completed 6400 caliper placements comprising a first and second measurement session. The widest inter-observer LOAM was seen with PDhead (± 9.1 mm), followed by PDbody (± 5.1 mm), MPDhead (± 3.2 mm), and MPDbody (± 2.6 mm), whereas the mean intra-observer LoA width was ± 7.3, ± 5.1, ± 3.7, and ± 2.4 mm, respectively. CONCLUSION Substantial intra- and inter-observer variability was observed in pancreatic two-point measurements. This was especially pronounced for parenchymal and duct diameters of the pancreatic head. These findings challenge the implementation of two-point measurements as the foundation for quantitative imaging scoring systems in CP.
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Affiliation(s)
- Jens Borgbjerg
- Department of Radiology, Akershus University Hospital, 1478, Nordbyhagen, Norway
| | - Emily Steinkohl
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark.,Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Søren S Olesen
- Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Fatih Akisik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Ste 0663, Indianapolis, IN, 46202, USA
| | - Anne Bethke
- Department of Radiology, Akershus University Hospital, 1478, Nordbyhagen, Norway
| | - Edita Bieliuniene
- Department of Radiology, Lithuanian University of Health Sciences, Eivenių g. 2, 50161, Kaunas, Lithuania
| | - Heidi S Christensen
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Trond Engjom
- Department of Medicine, University of Bergen, Jonas Lies vei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021, Bergen, Norway
| | - Ingfrid S Haldorsen
- Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021, Bergen, Norway.,Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Ulriksdal 8, 5009, Bergen, Norway
| | - Nikolaos Kartalis
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, O-huset 42, 14186, Stockholm, Sweden.,Department of Radiology Huddinge, Karolinska University Hospital, O-huset 42, 14186, Stockholm, Sweden
| | - Maria V Lisitskaya
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark.,Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark
| | - Gintare Naujokaite
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark
| | - Srdan Novovic
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Imanta Ozola-Zālīte
- Centre of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Pilsoņu iela 13, Zemgales priekšpilsēta, Riga, 1002, Latvia
| | - Anna E Phillips
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jordan K Swensson
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Ste 0663, Indianapolis, IN, 46202, USA
| | - Asbjørn M Drewes
- Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Jens B Frøkjær
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark.
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Borgbjerg J, Christensen HS, Al-Mashhadi R, Bøgsted M, Frøkjær JB, Medrud L, Larsen NE, Lindholt JS. Ultra-low-dose non-contrast CT and CT angiography can be used interchangeably for assessing maximal abdominal aortic diameter. Acta Radiol Open 2022; 11:20584601221132461. [PMID: 36246457 PMCID: PMC9561642 DOI: 10.1177/20584601221132461] [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: 05/02/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Routine CT scans may increasingly be used to document normal aortic size and to detect incidental abdominal aortic aneurysms. Purpose To determine whether ultra-low-dose non-contrast CT (ULDNC-CT) can be used instead of the gold standard CT angiography (CTA) for assessment of maximal abdominal aortic diameter. Materials and Methods This retrospective study included 50 patients who underwent CTA and a normal-dose non-contrast CT for suspected renal artery stenosis. ULDNC-CT datasets were generated from the normal-dose non-contrast CT datasets using a simulation technique. Using the centerline technique, radiology consultants (n = 4) and residents (n = 3) determined maximal abdominal aortic diameter. The limits of agreement with the mean (LOAM) was used to access observer agreement. LOAM represents how much a measurement by a single observer may plausibly deviate from the mean of all observers on the specific subject. Results Observers completed 1400 measurements encompassing repeated CTA and ULDNC-CT measurements. The mean diameter was 24.0 and 25.0 mm for CTA and ULDNC-CT, respectively, yielding a significant but minor mean difference of 1.0 mm. The 95% LOAM reproducibility was similar for CTA and ULDNC-CT (2.3 vs 2.3 mm). In addition, the 95% LOAM and mean diameters were similar for CTA and ULDNC-CT when observers were grouped as consultants and residents. Conclusions Ultra-low-dose non-contrast CT exhibited similar accuracy and reproducibility of measurements compared with CTA for assessing maximal abdominal aortic diameter supporting that ULDNC-CT can be used interchangeably with CTA in the lower range of aortic sizes.
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Affiliation(s)
- Jens Borgbjerg
- Department of Radiology, Akershus
University Hospital, Oslo, Norway,Department of Radiology, Aarhus
University Hospital, Aarhus, Denmark,Jens Borgbjerg, Department of Radiology,
Akershus University Hospital, Sykehusveien 25, 1478 Nordbyhagen, Lorenskog 1478,
Norway.
| | - Heidi S Christensen
- Department of Clinical Medicine,
Aalborg University, Aalborg, Denmark; Department of Haematology, Aalborg
University Hospital, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg
University Hospital, Aalborg, Denmark
| | - Rozh Al-Mashhadi
- Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark; Department of Radiology, Aarhus University
Hospital, Aarhus, Denmark
| | - Martin Bøgsted
- Department of Clinical Medicine,
Aalborg University, Aalborg, Denmark; Department of Haematology, Aalborg
University Hospital, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg
University Hospital, Aalborg, Denmark
| | - Jens B Frøkjær
- Mech-Sense, Department of
Radiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical
Medicine, Aalborg University, Aalborg, Denmark
| | - Lise Medrud
- Department of Radiology, Aarhus
University Hospital, Aarhus, Denmark
| | | | - Jes S Lindholt
- Department of Cardiac, Thoracic and
Vascular Surgery, Odense University Hospital, Odense, Denmark; Vascular Research
Unit, Regional Hospital Central Denmark, Viborg, Denmark; Department of Clinical
Medicine, Aarhus University, Aarhus, Denmark
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Min Q, Wang X, Huang B, Xu L. Web-Based Technology for Remote Viewing of Radiological Images: App Validation. J Med Internet Res 2020; 22:e16224. [PMID: 32975520 PMCID: PMC7547396 DOI: 10.2196/16224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 07/21/2020] [Accepted: 08/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Internet technologies can create advanced and rich web-based apps that allow radiologists to easily access teleradiology systems and remotely view medical images. However, each technology has its own drawbacks. It is difficult to balance the advantages and disadvantages of these internet technologies and identify an optimal solution for the development of medical imaging apps. OBJECTIVE This study aimed to compare different internet platform technologies for remotely viewing radiological images and analyze their advantages and disadvantages. METHODS Oracle Java, Adobe Flash, and HTML5 were each used to develop a comprehensive web-based medical imaging app that connected to a medical image server and provided several required functions for radiological interpretation (eg, navigation, magnification, windowing, and fly-through). Java-, Flash-, and HTML5-based medical imaging apps were tested on different operating systems over a local area network and a wide area network. Three computed tomography colonography data sets and 2 ordinary personal computers were used in the experiment. RESULTS The experimental results demonstrated that Java-, Flash-, and HTML5-based apps had the ability to provide real-time 2D functions. However, for 3D, performances differed between the 3 apps. The Java-based app had the highest frame rate of volume rendering. However, it required the longest time for surface rendering and failed to run surface rendering in macOS. The HTML5-based app had the fastest surface rendering and the highest speed for fly-through without platform dependence. Volume rendering, surface rendering, and fly-through performances of the Flash-based app were significantly worse than those of the other 2 apps. CONCLUSIONS Oracle Java, Adobe Flash, and HTML5 have individual strengths in the development of remote access medical imaging apps. However, HTML5 is a promising technology for remote viewing of radiological images and can provide excellent performance without requiring any plug-ins.
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Affiliation(s)
- Qiusha Min
- School of Educational Information Technology, Central China Normal University, Wuhan, Hubei, China
| | - Xin Wang
- School of Educational Information Technology, Central China Normal University, Wuhan, Hubei, China
| | - Bo Huang
- Department of Radiology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Liangzhou Xu
- Department of Radiology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, China
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