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Ewals LJS, Heesterbeek LJJ, Yu B, van der Wulp K, Mavroeidis D, Funk M, Snijders CCP, Jacobs I, Nederend J, Pluyter JR. The Impact of Expectation Management and Model Transparency on Radiologists' Trust and Utilization of AI Recommendations for Lung Nodule Assessment on Computed Tomography: Simulated Use Study. JMIR AI 2024; 3:e52211. [PMID: 38875574 PMCID: PMC11041414 DOI: 10.2196/52211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/14/2023] [Accepted: 02/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Many promising artificial intelligence (AI) and computer-aided detection and diagnosis systems have been developed, but few have been successfully integrated into clinical practice. This is partially owing to a lack of user-centered design of AI-based computer-aided detection or diagnosis (AI-CAD) systems. OBJECTIVE We aimed to assess the impact of different onboarding tutorials and levels of AI model explainability on radiologists' trust in AI and the use of AI recommendations in lung nodule assessment on computed tomography (CT) scans. METHODS In total, 20 radiologists from 7 Dutch medical centers performed lung nodule assessment on CT scans under different conditions in a simulated use study as part of a 2×2 repeated-measures quasi-experimental design. Two types of AI onboarding tutorials (reflective vs informative) and 2 levels of AI output (black box vs explainable) were designed. The radiologists first received an onboarding tutorial that was either informative or reflective. Subsequently, each radiologist assessed 7 CT scans, first without AI recommendations. AI recommendations were shown to the radiologist, and they could adjust their initial assessment. Half of the participants received the recommendations via black box AI output and half received explainable AI output. Mental model and psychological trust were measured before onboarding, after onboarding, and after assessing the 7 CT scans. We recorded whether radiologists changed their assessment on found nodules, malignancy prediction, and follow-up advice for each CT assessment. In addition, we analyzed whether radiologists' trust in their assessments had changed based on the AI recommendations. RESULTS Both variations of onboarding tutorials resulted in a significantly improved mental model of the AI-CAD system (informative P=.01 and reflective P=.01). After using AI-CAD, psychological trust significantly decreased for the group with explainable AI output (P=.02). On the basis of the AI recommendations, radiologists changed the number of reported nodules in 27 of 140 assessments, malignancy prediction in 32 of 140 assessments, and follow-up advice in 12 of 140 assessments. The changes were mostly an increased number of reported nodules, a higher estimated probability of malignancy, and earlier follow-up. The radiologists' confidence in their found nodules changed in 82 of 140 assessments, in their estimated probability of malignancy in 50 of 140 assessments, and in their follow-up advice in 28 of 140 assessments. These changes were predominantly increases in confidence. The number of changed assessments and radiologists' confidence did not significantly differ between the groups that received different onboarding tutorials and AI outputs. CONCLUSIONS Onboarding tutorials help radiologists gain a better understanding of AI-CAD and facilitate the formation of a correct mental model. If AI explanations do not consistently substantiate the probability of malignancy across patient cases, radiologists' trust in the AI-CAD system can be impaired. Radiologists' confidence in their assessments was improved by using the AI recommendations.
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Affiliation(s)
- Lotte J S Ewals
- Catharina Cancer Institute, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | | | - Bin Yu
- Research Center for Marketing and Supply Chain Management, Nyenrode Business University, Breukelen, Netherlands
| | - Kasper van der Wulp
- Catharina Cancer Institute, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | | | - Mathias Funk
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Chris C P Snijders
- Department of Human Technology Interaction, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Igor Jacobs
- Department of Hospital Services and Informatics, Philips Research, Eindhoven, Netherlands
| | - Joost Nederend
- Catharina Cancer Institute, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Jon R Pluyter
- Department of Experience Design, Royal Philips, Eindhoven, Netherlands
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Oshima Y, Ohno Y, Takenaka D, Ito Y, Kimata H, Fujii K, Akino N, Hamabuchi N, Matsuyama T, Nagata H, Ueda T, Ikeda H, Ozawa Y, Yoshikawa T, Toyama H. Capability for dose reduction while maintaining nodule detection: Comparison of silver and copper X-ray spectrum modulation filters for chest CT using a phantom study with different reconstruction methods. Eur J Radiol 2023; 166:110969. [PMID: 37454556 DOI: 10.1016/j.ejrad.2023.110969] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To compare the capability of CTs obtained with a silver or copper x-ray beam spectral modulation filter (Ag filter and Cu filter) and reconstructed with FBP, hybrid-type IR and deep learning reconstruction (DLR) for radiation dose reduction for lung nodule detection using a chest phantom study. MATERIALS AND METHODS A chest CT phantom was scanned with a 320-detector row CT with Ag filter at 0.6, 1.6 and 2.5 mGy and Cu filters at 0.6, 1.6, 2.5 and 9.6 mGy, and reconstructed with the aforementioned methods. To compare image quality of all the CT data, SNRs and CNRs for any nodule were calculated for all protocols. To compare nodule detection capability among all protocols, the probability of detection of any nodule was assessed with a 5-point visual scoring system. Then, ROC analyses were performed to compare nodule detection capability of Ag and Cu filters for each radiation dose data with the same method and of the three methods for any radiation dose data and obtained with either filter. RESULTS At any of the doses, SNR, CNR and area under the curve for the Ag filter were significantly higher or larger than those for the Cu filter (p < 0.05). Moreover, with DLR, those values were significantly higher or larger than all the others for CTs obtained with any of the radiation doses and either filter (p < 0.05). CONCLUSION The Ag filter and DLR can significantly improve image quality and nodule detection capability compared with the Cu filter and other reconstruction methods at each of radiation doses used.
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Affiliation(s)
- Yuka Oshima
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yoshiharu Ohno
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Daisuke Takenaka
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Yuya Ito
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Hirona Kimata
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Kenji Fujii
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Naruomi Akino
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Nayu Hamabuchi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takahiro Matsuyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hirotaka Ikeda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yoshiyuki Ozawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takeshi Yoshikawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Chen Y, Hou X, Yang Y, Ge Q, Zhou Y, Nie S. A Novel Deep Learning Model Based on Multi-Scale and Multi-View for Detection of Pulmonary Nodules. J Digit Imaging 2023; 36:688-699. [PMID: 36544067 PMCID: PMC10039158 DOI: 10.1007/s10278-022-00749-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: 06/29/2022] [Revised: 11/03/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Lung cancer manifests as pulmonary nodules in the early stage. Thus, the early and accurate detection of these nodules is crucial for improving the survival rate of patients. We propose a novel two-stage model for lung nodule detection. In the candidate nodule detection stage, a deep learning model based on 3D context information roughly segments the nodules detects the preprocessed image and obtain candidate nodules. In this model, 3D image blocks are input into the constructed model, and it learns the contextual information between the various slices in the 3D image block. The parameters of our model are equivalent to those of a 2D convolutional neural network (CNN), but the model could effectively learn the 3D context information of the nodules. In the false-positive reduction stage, we propose a multi-scale shared convolutional structure model. Our lung detection model has no significant increase in parameters and computation in both stages of multi-scale and multi-view detection. The proposed model was evaluated by using 888 computed tomography (CT) scans from the LIDC-IDRI dataset and achieved a competition performance metric (CPM) score of 0.957. The average detection sensitivity per scan was 0.971/1.0 FP. Furthermore, an average detection sensitivity of 0.933/1.0 FP per scan was achieved based on data from Shanghai Pulmonary Hospital. Our model exhibited a higher detection sensitivity, a lower false-positive rate, and better generalization than current lung nodule detection methods. The method has fewer parameters and less computational complexity, which provides more possibilities for the clinical application of this method.
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Affiliation(s)
- Yang Chen
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Xuewen Hou
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Yifeng Yang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Qianqian Ge
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Yan Zhou
- Department of Radiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Shengdong Nie
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China.
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Borg M, Hilberg O, Andersen MB, Weinreich UM, Rasmussen TR. Increased use of computed tomography in Denmark: stage shift toward early stage lung cancer through incidental findings. Acta Oncol 2022; 61:1256-1262. [PMID: 36264585 DOI: 10.1080/0284186x.2022.2135134] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Computed tomography (CT) examinations are increasingly used worldwide and incidental findings are growing likewise. Lung cancer stage at diagnosis is pivotal to survival. The earliest stage of lung cancer, stage IA is in most cases asymptomatic. Potentially, increased use of clinical CTs could induce a stage shift toward earlier lung cancer diagnosis. MATERIALS AND METHODS Data on the number of CT thorax in Denmark and the stage distribution of Danish lung cancer patients 2013-2020 were acquired from, respectively, the Danish Health Data Authority and the Danish Lung Cancer Registry. Clinical auditing of stage IA lung cancer patients was performed in the period 2019-2021 in a Danish region to assess the reasons for referral. Auditing of stage IV lung cancer patients was done to see whether a CT thorax was performed in a two-year period before diagnosis. RESULTS All regions showed an increase in CTs per 1000 inhabitants. However, the number of CTs performed in 2013 differed by more than 50% among regions, and the increase per year also differed, from an increase of 1.9 to 3.4 more examinations per year. A significant correlation between CTs and fraction of stage IA lung cancers was seen in four out of the five regions. The audit of stage IA lung cancer cases revealed that 86.8% were incidental findings. Audit of stage IV lung cancer found that 4.3% had a nodule/infiltrate on a previous CT within a 2-year period prior to the diagnosis of lung cancer that was the probable origin of stage IV lung cancer. CONCLUSION The study found that the vast majority of early-stage lung cancers were incidental findings. It highlights that follow-up algorithms of incidental findings should be used in accordance with guidelines and it should be unequivocally how the CT follow-up of pulmonary infiltrates is managed.
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Affiliation(s)
- M Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Medicine, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark
| | - O Hilberg
- Department of Medicine, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark
| | - M B Andersen
- Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - U M Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - T R Rasmussen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Chen K, Lai YC, Vanniarajan B, Wang PH, Wang SC, Lin YC, Ng SH, Tran P, Lin G. Clinical impact of a deep learning system for automated detection of missed pulmonary nodules on routine body computed tomography including the chest region. Eur Radiol 2022; 32:2891-2900. [PMID: 34999920 DOI: 10.1007/s00330-021-08412-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/29/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the clinical impact of a deep learning system (DLS) for automated detection of pulmonary nodules on computed tomography (CT) images as a second reader. METHODS This single-centre retrospective study screened 21,150 consecutive body CT studies from September 2018 to February 2019. Pulmonary nodules detected by the DLS on axial CT images but not mentioned in initial radiology reports were flagged. Flagged images were scored by four board-certificated radiologists each with at least 5 years of experience. Nodules with scores of 2 (understandable miss) or 3 (should not be missed) were then categorised as unlikely to be clinically significant (2a or 3a) or likely to be clinically significant (2b or 3b) according to the 2017 Fleischner guidelines for pulmonary nodules. The miss rate was defined as the total number of studies receiving scores of 2 or 3 divided by total screened studies. RESULTS Among 172 nodules flagged by the DLS, 60 (35%) missed nodules were confirmed by the radiologists. The nodules were further categorised as 2a, 2b, 3a, and 3b in 24, 14, 10, and 12 studies, respectively, with an overall positive predictive value of 35%. Missed pulmonary nodules were identified in 0.3% of all CT images, and one-third of these lesions were considered clinically significant. CONCLUSIONS Use of DLS-assisted automated detection as a second reader can identify missed pulmonary nodules, some of which may be clinically significant. CLINICAL RELEVANCE/APPLICATION Use of DLS to help radiologists detect pulmonary lesions may improve patient care. KEY POINTS • DLS-assisted automated detection as a second reader is feasible in a large consecutive cohort. • Performance of combined radiologists and DLS was better than DLS or radiologists alone. • Pulmonary nodules were missed more frequently in abdomino-pelvis CT than the thoracic CT.
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Affiliation(s)
- Kueian Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Ying-Chieh Lai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | | | - Pieh-Hsu Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Shao-Chung Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Yu-Chun Lin
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Pelu Tran
- FerrumFerrum Health, Santa Clara, CA, USA
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan.
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan.
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Fuhsing St., Taoyuan, 33382, Guishan, Taiwan.
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6
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Gao Y, Hua M, Lv J, Ma Y, Liu Y, Ren M, Tian Y, Li X, Zhang H. Reproducibility of radiomic features of pulmonary nodules between low-dose CT and conventional-dose CT. Quant Imaging Med Surg 2022; 12:2368-2377. [PMID: 35371962 PMCID: PMC8923849 DOI: 10.21037/qims-21-609] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/30/2021] [Indexed: 09/25/2023]
Abstract
BACKGROUND The reproducibility of radiomic features is essential to lung cancer detection. This study aimed to investigate the reproducibility of radiomic features of pulmonary nodules between low-dose computed tomography (LDCT) and conventional-dose computed tomography (CDCT). METHODS A total of 105 patients with 119 pulmonary nodules [39 ground-glass nodules (GGNs) and 80 solid nodules] who underwent LDCT and CDCT were retrospectively studied between September 2019 and November 2020. Pulmonary nodules were manually segmented and 1,125 radiomic features (shape, first-order intensity, texture, wavelet, and Laplacian of the Gaussian features) were extracted from both LDCT and CDCT images. The concordance correlation coefficient (CCC) was used to evaluate the reproducibility of these radiomic features. RESULTS Of the 1,125 radiomic features considered, 35.5% (399 of 1,125) and 41.5% (467 of 1,125) were reproducible (CCC ≥0.85) for GGNs and solid nodules, respectively. The intensity, texture, and wavelet features of solid nodules were more reproducible than those of GGNs. The mean CCC values for intensity and texture features of solid nodules were of 0.85 and above, whereas the mean values for those of GGNs were of less than 0.85. After Gaussian kernel (σ =2) preprocessing, the CCC of intensity and texture features of GGNs improved from 0.77 to 0.90, and 84.9% (79 of 93) of the radiomic features were reproducible (mean CCC increase from 0.84±0.13 to 0.92±0.08 for intensity features, and from 0.75±0.15 to 0.89±0.11 for texture features). Wavelet features had the lowest CCCs for both GGNs and solid nodules. CONCLUSIONS The majority of the radiomic feature classes of solid pulmonary nodules have a high level of reproducibility between LDCT and CDCT. However, LDCT should not be used as an alternative to CDCT in the radiomic study of GGNs.
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Affiliation(s)
- Yufan Gao
- Department of Radiology, Chest Hospital, Tianjin University, Tianjin, China
| | - Minghui Hua
- Department of Radiology, Chest Hospital, Tianjin University, Tianjin, China
| | - Jun Lv
- Department of Radiology, Chest Hospital, Tianjin University, Tianjin, China
| | - Yanhe Ma
- Department of Radiology, Chest Hospital, Tianjin University, Tianjin, China
| | - Yanzhen Liu
- Department of Radiology, Chest Hospital, Tianjin University, Tianjin, China
| | - Min Ren
- Tianjin Cardiovascular Institute, Chest Hospital, Tianjin University, Tianjin, China
| | - Yaohua Tian
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ximing Li
- Department of Cardiovascular Medicine, Chest Hospital, Tianjin University, Tianjin, China
| | - Hong Zhang
- Department of Radiology, Chest Hospital, Tianjin University, Tianjin, China
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Kim YW, Jeon M, Song MJ, Kwon BS, Lim SY, Lee YJ, Park JS, Cho YJ, Yoon HI, Lee KW, Lee JH, Lee CT. Differences in detection patterns, characteristics, and outcomes of central and peripheral lung cancers in low-dose computed tomography screening. Transl Lung Cancer Res 2022; 10:4185-4199. [PMID: 35004249 PMCID: PMC8674608 DOI: 10.21037/tlcr-21-658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/09/2021] [Indexed: 12/18/2022]
Abstract
Background Although low-dose computed tomography (LDCT) screening is known to be effective for the detection of lung cancers localized in peripheral lung regions at a curable stage, limited data is available regarding the characteristics and outcomes of central lung cancers diagnosed in a screening cohort. This study aimed to determine whether LDCT screening could effectively detect central lung cancers at an early stage and offer survival benefits. Methods We analyzed 52,615 adults who underwent lung cancer screening with LDCT between May 2003 and Dec 2019 at a tertiary center in South Korea. Characteristics and outcomes of those diagnosed with lung cancer, stratified by screen-detection status and cancer location, were evaluated. Results A total of 352 individuals (281 screen-detected, 71 non-screen-detected) were diagnosed with lung cancer. Compared to screen-detected cancers, non-screen-detected cancers tended to be centrally-located (11.4% vs. 64.8%, P<0.001). Most non-screen-detected central cancers (89.1%) had a negative result on prior LDCT screening. Multivariable regression analyses revealed that for peripheral cancers, screen-detection was associated with a significantly lower probability of diagnosis at an advanced stage [III/IV, odds ratio (OR) =0.15, 95% confidence interval (CI): 0.05-0.45] and mortality [hazard ratio (HR) =0.33, 95% CI: 0.13-0.84]; however, the association was insignificant for central cancers. For screen-detected cancers, central location, compared to peripheral location, was significantly associated with a higher risk of diagnosis at an advanced stage (OR =20.83, 95% CI: 6.67-64.98) and mortality (HR =4.98, 95% CI: 2.26-10.97). Conclusions Unlike for peripheral cancers, LDCT screening did not demonstrate an improvement in outcomes of central lung cancers, indicating an important limitation of LDCT screening and the need for developing novel modalities to screen and treat central lung cancer.
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Affiliation(s)
- Yeon Wook Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Minhee Jeon
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myung Jin Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byoung Soo Kwon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Yoon Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeon Joo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Sun Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Jae Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Il Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Ho Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Choon-Taek Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Liver transplantation-associated lung cancer in smokers: Results of an early CT detection program. JOURNAL OF LIVER TRANSPLANTATION 2022. [DOI: 10.1016/j.liver.2021.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Can dynamic imaging, using 18F-FDG PET/CT and CT perfusion differentiate between benign and malignant pulmonary nodules? Radiol Oncol 2021; 55:259-267. [PMID: 34051709 PMCID: PMC8366734 DOI: 10.2478/raon-2021-0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/24/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of the study was to derive and compare metabolic parameters relating to benign and malignant pulmonary nodules using dynamic 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG) PET/CT, and nodule perfusion parameters derived through perfusion computed tomography (CT). PATIENTS AND METHODS Twenty patients with 21 pulmonary nodules incidentally detected on CT underwent a dynamic 18F-FDG PET/CT and a perfusion CT. The maximum standardized uptake value (SUVmax) was measured on conventional 18F-FDG PET/CT images. The influx constant (Ki ) was calculated from the dynamic 18F-FDG PET/CT data using Patlak model. Arterial flow (AF) using the maximum slope model and blood volume (BV) using the Patlak plot method for each nodule were calculated from the perfusion CT data. All nodules were characterized as malignant or benign based on histopathology or 2 year follow up CT. All parameters were statistically compared between the two groups using the nonparametric Mann-Whitney test. RESULTS Twelve malignant and 9 benign lung nodules were analysed (median size 20.1 mm, 9-29 mm) in 21 patients (male/female = 11/9; mean age ± SD: 65.3 ± 7.4; age range: 50-76 years). The average SUVmax values ± SD of the benign and malignant nodules were 2.2 ± 1.7 vs. 7.0 ± 4.5, respectively (p = 0.0148). Average Ki values in benign and malignant nodules were 0.0057 ± 0.0071 and 0.0230 ± 0.0155 min-1, respectively (p = 0.0311). Average BV for the benign and malignant nodules were 11.6857 ± 6.7347 and 28.3400 ± 15.9672 ml/100 ml, respectively (p = 0.0250). Average AF for the benign and malignant nodules were 74.4571 ± 89.0321 and 89.200 ± 49.8883 ml/100g/min, respectively (p = 0.1613). CONCLUSIONS Dynamic 18F-FDG PET/CT and perfusion CT derived blood volume had similar capability to differentiate benign from malignant lung nodules.
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Prospective Study of Spatial Distribution of Missed Lung Nodules by Readers in CT Lung Screening Using Computer-assisted Detection. Acad Radiol 2021; 28:647-654. [PMID: 32305166 DOI: 10.1016/j.acra.2020.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the spatial patterns of missed lung nodules in a real-life routine screening environment. MATERIALS AND METHODS In a screening institute, 4,822 consecutive adults underwent chest CT, and each image set was independently interpreted by two radiologists in three steps: (1) independently interpreted without computer-assisted detection (CAD) software, (2) independently referred to the CAD results, (3) determined by the consensus of the two radiologists. The locations of nodules and the detection performance data were semi-automatically collected using a CAD server integrated into the reporting system. Fisher's exact test was employed for evaluating findings in different lung divisions. Probability maps were drawn to illustrate the spatial distribution of radiologists' missed nodules. RESULTS Radiologists significantly tended to miss lung nodules in the bilateral hilar divisions (p < 0.01). Some radiologists had their own spatial pattern of missed lung nodules. CONCLUSION Radiologists tend to miss lung nodules present in the hilar regions significantly more often than in the rest of the lung.
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Hou H, Cao Y, Cui X, Liu Z, Xu H, Wang C, Zhang W, Zhang Y, Fang Y, Geng Y, Liang W, Cai T, Lai H. Medical image management and analysis system based on web for fungal keratitis images. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:3667-3679. [PMID: 34198405 DOI: 10.3934/mbe.2021183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The medical image management and analysis system proposed in this paper is a medical software developed by the Browser/Server (B/S) architecture after investigating the workflow of the relevant departments of the hospital, which realizes the entire process of patients from consultation to printing of reports. The computer-aided diagnosis function is added based on image management. Due to the difficulty in collecting medical image data, in the computer-aided diagnosis module, this paper only uses the common fungal keratitis collected from the hospital in the laboratory. Focused microscope images are used for experiments. First, the images were trained with three convolutional neural networks, AlexNet, ZFNet, and VGG16. These models which classify fungal keratitis were obtained and integrated was performed to obtain better classification results. Finally, the model was integrated with the system designed in this paper, which realized the automatic diagnosis of Confocal Microscopy (CM) images of fungal keratitis online and provided it to medical staff for reference. The system can improve the work efficiency of the image-related departments while reducing the workload of doctors in the department to manually read the films.
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Affiliation(s)
- Haixia Hou
- Centre of Information Security, Beijing University of Posts and Telecommunications, Beijing 100876, China
- College of Science and Information, Qingdao Agricultural University, Qingdao 266109, China
| | - Yankun Cao
- School of Information Science and Engineering, Shandong University, Qingdao 266237, China
| | - Xiaoxiao Cui
- School of Information Science and Engineering, Shandong University, Qingdao 266237, China
| | - Zhi Liu
- School of Information Science and Engineering, Shandong University, Qingdao 266237, China
| | - Hongji Xu
- School of Information Science and Engineering, Shandong University, Qingdao 266237, China
| | - Cheng Wang
- School of Information Science and Engineering, Shandong University, Qingdao 266237, China
| | - Wensheng Zhang
- School of Information Science and Engineering, Shandong University, Qingdao 266237, China
| | - Yang Zhang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | | | - Yu Geng
- School of Software Engineering, Shenzhen Institute of Information Technology, Shenzhen 518172, China
| | - Wei Liang
- School of Electrical Engineering and Automation, Qilu University of Technology, Jinan 250353, China
| | - Tie Cai
- School of Software Engineering, Shenzhen Institute of Information Technology, Shenzhen 518172, China
| | - Hong Lai
- Inspur Group Ltd, Jinan 250011, China
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Rawashdeh MA, Saade C. Radiation dose reduction considerations and imaging patterns of ground glass opacities in coronavirus: risk of over exposure in computed tomography. LA RADIOLOGIA MEDICA 2021; 126:380-387. [PMID: 32897493 PMCID: PMC7477737 DOI: 10.1007/s11547-020-01271-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/23/2020] [Indexed: 01/07/2023]
Abstract
This article aims to summarize the available data on the severe acute respiratory syndrome coronavirus 2 (SAR-CoV-2) imaging patterns as well as reducing radiation dose exposure in chest computed tomography (CT) protocols. First, the general aspects of radiation dose in CT and radiation risk are discussed, followed by the effect of changing parameters on image quality. This article attempts to highlight some of the common chest CT signs that radiologists and emergency physicians are likely to encounter. With the increasing trend of using chest CT scans as an imaging tool to diagnose and monitor SAR-CoV-2, we emphasize that pattern recognition is the key, and this pictorial essay should serve as a guide to help establish correct diagnosis coupled with correct scanner parameters to reduce radiation dose without affecting imaging quality in this tragic pandemic the world is facing.
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Affiliation(s)
- Mohammad Ahmmad Rawashdeh
- grid.37553.370000 0001 0097 5797Department of Allied Medical Sciences, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110 Jordan
| | - Charbel Saade
- grid.411654.30000 0004 0581 3406Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box 11-0236, Riad El-Solh, Beirut, 1107 2020 Lebanon
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Cho J, Kim J, Lee KJ, Nam CM, Yoon SH, Song H, Kim J, Choi YR, Lee KH, Lee KW. Incidence Lung Cancer after a Negative CT Screening in the National Lung Screening Trial: Deep Learning-Based Detection of Missed Lung Cancers. J Clin Med 2020; 9:E3908. [PMID: 33276433 PMCID: PMC7759925 DOI: 10.3390/jcm9123908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/19/2022] Open
Abstract
We aimed to analyse the CT examinations of the previous screening round (CTprev) in NLST participants with incidence lung cancer and evaluate the value of DL-CAD in detection of missed lung cancers. Thoracic radiologists reviewed CTprev in participants with incidence lung cancer, and a DL-CAD analysed CTprev according to NLST criteria and the lung CT screening reporting & data system (Lung-RADS) classification. We calculated patient-wise and lesion-wise sensitivities of the DL-CAD in detection of missed lung cancers. As per the NLST criteria, 88% (100/113) of CTprev were positive and 74 of them had missed lung cancers. The DL-CAD reported 98% (98/100) of the positive screens as positive and detected 95% (70/74) of the missed lung cancers. As per the Lung-RADS classification, 82% (93/113) of CTprev were positive and 60 of them had missed lung cancers. The DL-CAD reported 97% (90/93) of the positive screens as positive and detected 98% (59/60) of the missed lung cancers. The DL-CAD made false positive calls in 10.3% (27/263) of controls, with 0.16 false positive nodules per scan (41/263). In conclusion, the majority of CTprev in participants with incidence lung cancers had missed lung cancers, and the DL-CAD detected them with high sensitivity and a limited false positive rate.
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Affiliation(s)
- Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (K.J.L.); (S.H.Y.); (H.S.); (J.K.); (K.H.L.); (K.W.L.)
| | - Jihang Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (K.J.L.); (S.H.Y.); (H.S.); (J.K.); (K.H.L.); (K.W.L.)
| | - Kyong Joon Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (K.J.L.); (S.H.Y.); (H.S.); (J.K.); (K.H.L.); (K.W.L.)
- AI Research Group, Monitor Corporation, Seoul 06628, Korea;
| | - Chang Mo Nam
- AI Research Group, Monitor Corporation, Seoul 06628, Korea;
| | - Sung Hyun Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (K.J.L.); (S.H.Y.); (H.S.); (J.K.); (K.H.L.); (K.W.L.)
| | - Hwayoung Song
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (K.J.L.); (S.H.Y.); (H.S.); (J.K.); (K.H.L.); (K.W.L.)
| | - Junghoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (K.J.L.); (S.H.Y.); (H.S.); (J.K.); (K.H.L.); (K.W.L.)
| | - Ye Ra Choi
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Korea;
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (K.J.L.); (S.H.Y.); (H.S.); (J.K.); (K.H.L.); (K.W.L.)
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.C.); (K.J.L.); (S.H.Y.); (H.S.); (J.K.); (K.H.L.); (K.W.L.)
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Migliore M, Palmucci S, Nardini M, Basile A. Imaging patterns of early stage lung cancer for the thoracic surgeon. J Thorac Dis 2020; 12:3349-3356. [PMID: 32642259 PMCID: PMC7330749 DOI: 10.21037/jtd.2020.02.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In the modern era, thoracic surgeons are experiencing an increase interest in imaging patterns of early stage lung cancer due to the introduction of the ground glass opacity in clinical practice, and for the necessity to an accurate cancer localization to perform the appropriate type of resection. In this brief review we analyze the latest news regarding imaging patterns of early pulmonary nodules with special emphasis to ground glass opacity.
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Affiliation(s)
- Marcello Migliore
- 1Section of Thoracic Surgery, Department of General Surgery and Medical Specialities, 2Section of Radiology, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", Policlinico University Hospital, Catania, Italy
| | - Stefano Palmucci
- 1Section of Thoracic Surgery, Department of General Surgery and Medical Specialities, 2Section of Radiology, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", Policlinico University Hospital, Catania, Italy
| | - Marco Nardini
- 1Section of Thoracic Surgery, Department of General Surgery and Medical Specialities, 2Section of Radiology, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", Policlinico University Hospital, Catania, Italy
| | - Antonio Basile
- 1Section of Thoracic Surgery, Department of General Surgery and Medical Specialities, 2Section of Radiology, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", Policlinico University Hospital, Catania, Italy
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Efficiency of a computer-aided diagnosis (CAD) system with deep learning in detection of pulmonary nodules on 1-mm-thick images of computed tomography. Jpn J Radiol 2020; 38:1052-1061. [PMID: 32592003 DOI: 10.1007/s11604-020-01009-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/18/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the performance of a deep learning-based computer-aided diagnosis (CAD) system at detecting pulmonary nodules on CT by comparing radiologists' readings with and without CAD. MATERIALS AND METHODS A total of 120 chest CT images were randomly selected from patients with suspected lung cancer. The gold standard of nodules ≥ 3 mm was established by a panel of three expert radiologists. Two less experienced radiologists read the images without and afterward with CAD system. Their reading times were recorded. RESULTS The radiologists' sensitivity increased from 20.9% to 38.0% with the introduction of CAD. The positive predictive value (PPV) decreased from 70.5% to 61.8%, and the F1-score increased from 32.2% to 47.0%. The sensitivity significantly increased from 13.7% to 32.4% for small nodules (3-6 mm) and from 33.3% to 47.6% for medium nodules (6-10 mm). CAD alone showed a sensitivity of 70.3%, a PPV of 57.9%, and an F1-score of 63.5%. Reading time decreased by 11.3% with the use of CAD. CONCLUSION CAD improved the less experienced radiologists' sensitivity in detecting pulmonary nodules of all sizes, especially including a significant improvement in the detection of clinically important-sized medium nodules (6-10 mm) as well as small nodules (3-6 mm) and reduced their reading time.
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17
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Kang S, Kim TH, Shin JM, Han K, Kim JY, Min B, Park CH. Optimization of a chest computed tomography protocol for detecting pure ground glass opacity nodules: A feasibility study with a computer-assisted detection system and a lung cancer screening phantom. PLoS One 2020; 15:e0232688. [PMID: 32442174 PMCID: PMC7244125 DOI: 10.1371/journal.pone.0232688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/19/2020] [Indexed: 12/18/2022] Open
Abstract
Objective This study aimed to optimize computed tomography (CT) parameters for detecting ground glass opacity nodules (GGNs) using a computer-assisted detection (CAD) system and a lung cancer screening phantom. Methods A lung cancer screening phantom containing 15 artificial GGNs (−630 Hounsfield unit [HU], 2–10 mm) in the left lung was examined with a CT scanner. Three tube voltages of 80, 100, and 120 kVp were used in combination with five tube currents of 25, 50, 100, 200, and 400 mA; additionally, three slice thicknesses of 0.625, 1.25, and 2.5 mm and four reconstruction algorithms of adaptive statistical iterative reconstruction (ASIR-V) of 30, 60, and 90% were used. For each protocol, accuracy of the CAD system was evaluated for nine target GGNs of 6, 8, or 10 mm in size. The cut-off size was set to 5 mm to minimize false positives. Results Among the 180 combinations of tube voltage, tube current, slice thickness, and reconstruction algorithms, combination of 80 kVp, 200 mA, and 1.25-mm slice thickness with an ASIR-V of 90% had the best performance in the detection of GGNs with six true positives and no false positives. Other combinations had fewer than five true positives. In particular, any combinations with a 0.625-mm slice thickness had 0 true positive and at least one false positive result. Conclusion Low-voltage chest CT with a thin slice thickness and a high iterative reconstruction algorithm improve the detection rate of GGNs with a CAD system in a phantom model, and may have potential in lung cancer screening.
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Affiliation(s)
- Seongmin Kang
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Hoon Kim
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Min Shin
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology and the Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Young Kim
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Chul Hwan Park
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Tan M, Wu F, Yang B, Ma J, Kong D, Chen Z, Long D. Pulmonary nodule detection using hybrid two-stage 3D CNNs. Med Phys 2020; 47:3376-3388. [PMID: 32239521 DOI: 10.1002/mp.14161] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/10/2020] [Accepted: 03/19/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Early detection of pulmonary nodules is an effective way to improve patients' chances of survival. In this work, we propose a novel and efficient way to build a computer-aided detection (CAD) system for pulmonary nodules based on computed tomography (CT) scans. METHODS The system can be roughly divided into two steps: nodule candidate detection and false positive reduction. Considering the three-dimensional (3D) nature of nodules, the CAD system adopts 3D convolutional neural networks (CNNs) in both stages. Specifically, in the first stage, a segmentation-based 3D CNN with a hybrid loss is designed to segment nodules. According to the probability maps produced by the segmentation network, a threshold method and connected component analysis are applied to generate nodule candidates. In the second stage, we employ three classification-based 3D CNNs with different types of inputs to reduce false positives. In addition to simple raw data input, we also introduce hybrid inputs to make better use of the output of the previous segmentation network. In experiments, we use data augmentation and batch normalization to avoid overfitting. RESULTS We evaluate the system on 888 CT scans from the publicly available LIDC-IDRI dataset, and our method achieves the best performance by comparing with the state-of-the-art methods, which has a high detection sensitivity of 97.5% with an average of only one false positive per scan. An additional evaluation on 115 CT scans from local hospitals is also performed. CONCLUSIONS Experimental results demonstrate that our method is highly suited for the detection of pulmonary nodules.
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Affiliation(s)
- Man Tan
- The School of Mathematical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| | - Fa Wu
- The School of Mathematical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| | - Bei Yang
- The School of Mathematical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| | - Jinlian Ma
- The School of Mathematical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| | - Dexing Kong
- The School of Mathematical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| | - Zengsi Chen
- The College of Science, China Jiliang University, Hangzhou, Zhejiang, 310018, China
| | - Dan Long
- The Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China
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El-Gendy SAA, Alsafy MAM, Rutland CS, El-Khamary AN, Abu-Ahmed HM, El-Kammar MH. Morphological and Imaging Evaluation of the Metacarpophalangeal and Metatarsophalangeal Joints in Healthy and Lame Donkeys. J Equine Vet Sci 2019; 88:102904. [PMID: 32303299 DOI: 10.1016/j.jevs.2019.102904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/14/2019] [Accepted: 12/20/2019] [Indexed: 11/25/2022]
Abstract
The donkey is of socio-economic value yet imaging techniques in both healthy and abnormal limbs are a limiting factor in research and medicine. The objective was to determine anatomical features of both healthy and clinically abnormal donkey metacarpophalangeal and metatarsophalangeal joints (n = 13) using anatomical dissection, casting, X-ray and computed tomography. The joint capsule contained two palmar/plantar and two dorsal recesses. The proximal-palmar or plantar recess was larger than the distodorsal recess and potential sites of approaches to the recesses were determined. Soft tissue structures were distinguished using computed tomography at 300 mA, which was superior to 120 mA. This methodology gave better assessments of the synovial tendon sheath, joint recesses, and cruciate, collateral, and short sesamoidean ligaments. Computed tomography provided outstanding discrimination between the cortex and medulla of the third metacarpal, the proximal sesamoid bones, the proximal phalanx, and excellent details of the osseous structures. Although the joints appeared free from exostosis using X-ray; the position and extension of exostosis in pathologically affected donkeys (a novel finding) were revealed using computed tomography with 300 mA in comparison to 120 mA. The study also provided an anatomical record of the metacarpophalangeal and metatarsophalangeal joints using the latest technology, which could impact on clinical situations including anesthesia injection sites.
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Affiliation(s)
- Samir A A El-Gendy
- Faculty of Veterinary Medicine, Department of Anatomy and Embryology, Alexandria University, Alexandria, Egypt.
| | - Mohamed A M Alsafy
- Faculty of Veterinary Medicine, Department of Anatomy and Embryology, Alexandria University, Alexandria, Egypt
| | - Catrin Sian Rutland
- Faculty of Medicine, School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK.
| | - Ahmad N El-Khamary
- Faculty of Veterinary Medicine, Department of Surgery, Damanhur University, Damanhur, Egypt
| | - Howaida M Abu-Ahmed
- Faculty of Veterinary Medicine, Department of Surgery, Alexandria University, Alexandria, Egypt
| | - Mahmoud H El-Kammar
- Faculty of Veterinary Medicine, Department of Surgery, Alexandria University, Alexandria, Egypt
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Lee LIT, Kanthasamy S, Ayyalaraju RS, Ganatra R. The Current State of Artificial Intelligence in Medical Imaging and Nuclear Medicine. BJR Open 2019; 1:20190037. [PMID: 33178956 PMCID: PMC7592467 DOI: 10.1259/bjro.20190037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/08/2019] [Accepted: 09/25/2019] [Indexed: 12/31/2022] Open
Abstract
The last decade has seen a huge surge in interest surrounding artificial intelligence (AI). AI has been around since the 1950s, although technological limitations in the early days meant performance was initially inferior compared to humans.1 With rapid progression of algorithm design, growth of vast digital datasets and development of powerful computing power, AI now has the capability to outperform humans. Consequently, the integration of AI into the modern world is skyrocketing. This review article will give an overview of the use of AI in the modern world and discuss current and potential uses in healthcare, with a particular focus on its applications and likely impact in medical imaging. We will discuss the consequences and challenges of AI integration into healthcare.
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Affiliation(s)
- Louise I T Lee
- Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, England, UK
| | - Senthooran Kanthasamy
- Department of Trauma and Orthopaedics, Cambridge University Hospitals, Cambridge University Hospitals, Addenbrooke's Hospital, England, UK
| | | | - Rakesh Ganatra
- Department of Nuclear Medicine, University Hospitals of Leicester, Glenfield Hospital, England, UK
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Wood DE, Kazerooni EA, Baum SL, Eapen GA, Ettinger DS, Hou L, Jackman DM, Klippenstein D, Kumar R, Lackner RP, Leard LE, Lennes IT, Leung ANC, Makani SS, Massion PP, Mazzone P, Merritt RE, Meyers BF, Midthun DE, Pipavath S, Pratt C, Reddy C, Reid ME, Rotter AJ, Sachs PB, Schabath MB, Schiebler ML, Tong BC, Travis WD, Wei B, Yang SC, Gregory KM, Hughes M. Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 16:412-441. [PMID: 29632061 DOI: 10.6004/jnccn.2018.0020] [Citation(s) in RCA: 383] [Impact Index Per Article: 76.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.
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Gu X, Wang J, Zhao J, Li Q. Segmentation and suppression of pulmonary vessels in low-dose chest CT scans. Med Phys 2019; 46:3603-3614. [PMID: 31240721 DOI: 10.1002/mp.13648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/29/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The suppression of pulmonary vessels in chest computed tomography (CT) images can enhance the conspicuity of lung nodules, thereby improving the detection rate of early lung cancer. This study aimed to develop two key techniques in vessel suppression, that is, segmentation and removal of pulmonary vessels while preserving the nodules. METHODS Pulmonary vessel segmentation and removal methods in CT images were developed. The vessel segmentation method used a framework of two cascaded convolutional neural networks (CNNs). A bi-class segmentation network was utilized in the first step to extract high-intensity structures, including both vessels and nonvascular tissues such as nodules. A tri-class segmentation network was employed in the second step to distinguish the vessels from nonvascular tissues (mainly nodules) and the lung parenchyma. In the vessel removal method, the voxels in the segmented vessels were replaced with randomly selected voxels from the surrounding lung parenchyma. The dataset in this study comprised 50 three-dimensional (3D) low-dose chest CT images. The labels for vessel and nodule segmentation were annotated with a semi automatic approach. The two cascaded networks for pulmonary vessel segmentation were trained with CT images of 40 cases and tested with CT images of ten cases. Pulmonary vessels were removed from the ten testing scans based on the predicted segmentation results. In addition to qualitative evaluation to the effects of segmentation and removal, the segmentation results were quantitatively evaluated using Dice coefficient (DICE), Jaccard index (JAC), and volumetric similarity (VS) and the removal results were evaluated using contrast-to-noise ratio (CNR). RESULTS In the first step of vessel segmentation, the mean DICE, JAC, and VS for high-intensity tissues, including both vessels and nodules, were 0.943, 0.893, and 0.991, respectively. In the second step, all the nodules were separated from the vessels, and the mean DICE, JAC, and VS for the vessels were 0.941, 0.890, and 0.991, respectively. After vessel removal, the mean CNR for nodules was improved from 4.23 (6.26 dB) to 6.95 (8.42 dB). CONCLUSIONS Quantitative and qualitative evaluations demonstrated that the proposed method achieved a high accuracy for pulmonary vessel segmentation and a good effect on pulmonary vessel suppression.
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Affiliation(s)
- Xiaomeng Gu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.,Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China
| | - Jiyong Wang
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China
| | - Jun Zhao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Qiang Li
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China.,Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
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A Novel Computer-Aided Diagnosis Scheme on Small Annotated Set: G2C-CAD. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6425963. [PMID: 31119180 PMCID: PMC6500711 DOI: 10.1155/2019/6425963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/05/2019] [Indexed: 11/18/2022]
Abstract
Purpose Computer-aided diagnosis (CAD) can aid in improving diagnostic level; however, the main problem currently faced by CAD is that it cannot obtain sufficient labeled samples. To solve this problem, in this study, we adopt a generative adversarial network (GAN) approach and design a semisupervised learning algorithm, named G2C-CAD. Methods From the National Cancer Institute (NCI) Lung Image Database Consortium (LIDC) dataset, we extracted four types of pulmonary nodule sign images closely related to lung cancer: noncentral calcification, lobulation, spiculation, and nonsolid/ground-glass opacity (GGO) texture, obtaining a total of 3,196 samples. In addition, we randomly selected 2,000 non-lesion image blocks as negative samples. We split the data 90% for training and 10% for testing. We designed a DCGAN generative adversarial framework and trained it on the small sample set. We also trained our designed CNN-based fuzzy Co-forest on the labeled small sample set and obtained a preliminary classifier. Then, coupled with the simulated unlabeled samples generated by the trained DCGAN, we conducted iterative semisupervised learning, which continually improved the classification performance of the fuzzy Co-forest until the termination condition was reached. Finally, we tested the fuzzy Co-forest and compared its performance with that of a C4.5 random decision forest and the G2C-CAD system without the fuzzy scheme, using ROC and confusion matrix for evaluation. Results Four different types of lung cancer-related signs were used in the classification experiment: noncentral calcification, lobulation, spiculation, and nonsolid/ground-glass opacity (GGO) texture, along with negative image samples. For these five classes, the G2C-CAD system obtained AUCs of 0.946, 0.912, 0.908, 0.887, and 0.939, respectively. The average accuracy of G2C-CAD exceeded that of the C4.5 random decision tree by 14%. G2C-CAD also obtained promising test results on the LISS signs dataset; its AUCs for GGO, lobulation, spiculation, pleural indentation, and negative image samples were 0.972, 0.964, 0.941, 0.967, and 0.953, respectively. Conclusion The experimental results show that G2C-CAD is an appropriate method for addressing the problem of insufficient labeled samples in the medical image analysis field. Moreover, our system can be used to establish a training sample library for CAD classification diagnosis, which is important for future medical image analysis.
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Abstract
OBJECTIVE The purpose of this study was to evaluate the imaging characteristics of liver metastases overlooked at contrast-enhanced CT. MATERIALS AND METHODS The records of 746 patients with a diagnosis of liver metastases from colorectal, breast, gastric, or lung cancer between November 2010 and September 2017 were reviewed. Images were reviewed when liver metastases were first diagnosed, and images from prior contrast-enhanced CT examinations were checked if available. These lesions were classified into two groups: missed lesions (those missed on the prior images) and detected lesions (those correctly identified and invisible on the prior images or there were no prior images). Tumor size, contrast-to-noise ratio, location, presence of coexisting liver cysts and hepatic steatosis, and indications for examination were compared between the groups. The t test and Fisher exact test were used to analyze the imaging characteristics of previously overlooked lesions. RESULTS The final analysis included 137 lesions, of which 68 were classified as missed. In univariate analysis, contrast-to-noise ratio was significantly lower in missed lesions (95% CI, 2.65 ± 0.24 vs 3.90 ± 0.23; p < 0.001). The proportion of subcapsular lesions (odds ratio, 3.44; p < 0.001), hepatic steatosis (odds ratio, 6.35; p = 0.007), and examination indication other than survey of malignant tumors (odds ratio, 9.07; p = 0.02) were significantly higher for missed lesions. CONCLUSION Liver metastases without sufficient contrast enhancement, those in patients with hepatic steatosis, those in subcapsular locations, and those found at examinations for indications other than to assess for tumors were significantly more likely to be overlooked.
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Li L, Liu Z, Huang H, Lin M, Luo D. Evaluating the performance of a deep learning-based computer-aided diagnosis (DL-CAD) system for detecting and characterizing lung nodules: Comparison with the performance of double reading by radiologists. Thorac Cancer 2018; 10:183-192. [PMID: 30536611 PMCID: PMC6360226 DOI: 10.1111/1759-7714.12931] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/11/2018] [Accepted: 11/13/2018] [Indexed: 12/17/2022] Open
Abstract
Background The study was conducted to evaluate the performance of a state‐of‐the‐art commercial deep learning‐based computer‐aided diagnosis (DL‐CAD) system for detecting and characterizing pulmonary nodules. Methods Pulmonary nodules in 346 healthy subjects (male: female = 221:125, mean age 51 years) from a lung cancer screening program conducted from March to November 2017 were screened using a DL‐CAD system and double reading independently, and their performance in nodule detection and characterization were evaluated. An expert panel combined the results of the DL‐CAD system and double reading as the reference standard. Results The DL‐CAD system showed a higher detection rate than double reading, regardless of nodule size (86.2% vs. 79.2%; P < 0.001): nodules ≥ 5 mm (96.5% vs. 88.0%; P = 0.008); nodules < 5 mm (84.3% vs. 77.5%; P < 0.001). However, the false positive rate (per computed tomography scan) of the DL‐CAD system (1.53, 529/346) was considerably higher than that of double reading (0.13, 44/346; P < 0.001). Regarding nodule characterization, the sensitivity and specificity of the DL‐CAD system for distinguishing solid nodules > 5 mm (90.3% and 100.0%, respectively) and ground‐glass nodules (100.0% and 96.1%, respectively) were close to that of double reading, but dropped to 55.5% and 93%, respectively, when discriminating part solid nodules. Conclusion Our DL‐CAD system detected significantly more nodules than double reading. In the future, false positive findings should be further reduced and characterization accuracy improved.
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Affiliation(s)
- Li Li
- Department of Radiology, National Cancer Center/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Zhou Liu
- Department of Radiology, National Cancer Center/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Hua Huang
- Department of Radiology, National Cancer Center/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Meng Lin
- Department of Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dehong Luo
- Department of Radiology, National Cancer Center/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.,Department of Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Eun H, Kim D, Jung C, Kim C. Single-view 2D CNNs with fully automatic non-nodule categorization for false positive reduction in pulmonary nodule detection. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 165:215-224. [PMID: 30337076 DOI: 10.1016/j.cmpb.2018.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/27/2018] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE In pulmonary nodule detection, the first stage, candidate detection, aims to detect suspicious pulmonary nodules. However, detected candidates include many false positives and thus in the following stage, false positive reduction, such false positives are reliably reduced. Note that this task is challenging due to 1) the imbalance between the numbers of nodules and non-nodules and 2) the intra-class diversity of non-nodules. Although techniques using 3D convolutional neural networks (CNNs) have shown promising performance, they suffer from high computational complexity which hinders constructing deep networks. To efficiently address these problems, we propose a novel framework using the ensemble of 2D CNNs using single views, which outperforms existing 3D CNN-based methods. METHODS Our ensemble of 2D CNNs utilizes single-view 2D patches to improve both computational and memory efficiency compared to previous techniques exploiting 3D CNNs. We first categorize non-nodules on the basis of features encoded by an autoencoder. Then, all 2D CNNs are trained by using the same nodule samples, but with different types of non-nodules. By extending the learning capability, this training scheme resolves difficulties of extracting representative features from non-nodules with large appearance variations. Note that, instead of manual categorization requiring the heavy workload of radiologists, we propose to automatically categorize non-nodules based on the autoencoder and k-means clustering. RESULTS We performed extensive experiments to validate the effectiveness of our framework based on the database of the lung nodule analysis 2016 challenge. The superiority of our framework is demonstrated through comparing the performance of five frameworks trained with differently constructed training sets. Our proposed framework achieved state-of-the-art performance (0.922 of the competition performance metric score) with low computational demands (789K of parameters and 1024M of floating point operations per second). CONCLUSION We presented a novel false positive reduction framework, the ensemble of single-view 2D CNNs with fully automatic non-nodule categorization, for pulmonary nodule detection. Unlike previous 3D CNN-based frameworks, we utilized 2D CNNs using 2D single views to improve computational efficiency. Also, our training scheme using categorized non-nodules, extends the learning capability of representative features of different non-nodules. Our framework achieved state-of-the-art performance with low computational complexity.
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Affiliation(s)
- Hyunjun Eun
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Republic of Korea
| | - Daeyeong Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Republic of Korea
| | - Chanho Jung
- Department of Electrical Engineering, Hanbat National University, Republic of Korea
| | - Changick Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Republic of Korea.
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Fazal MI, Patel ME, Tye J, Gupta Y. The past, present and future role of artificial intelligence in imaging. Eur J Radiol 2018; 105:246-250. [DOI: 10.1016/j.ejrad.2018.06.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/08/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023]
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Kotwal AA, Schonberg MA. Cancer Screening in the Elderly: A Review of Breast, Colorectal, Lung, and Prostate Cancer Screening. Cancer J 2018; 23:246-253. [PMID: 28731949 PMCID: PMC5608027 DOI: 10.1097/ppo.0000000000000274] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There are relatively limited data on outcomes of screening older adults for cancer; therefore, the decision to screen older adults requires balancing the potential harms of screening and follow-up diagnostic tests with the possibility of benefit. Harms of screening can be amplified in older and frail adults and include discomfort from undergoing the test itself, anxiety, potential complications from diagnostic procedures resulting from a false-positive test, false reassurance from a false-negative test, and overdiagnosis of tumors that are of no threat and may result in overtreatment. In this paper, we review the evidence and guidelines on breast, colorectal, lung and prostate cancer as applied to older adults. We also provide a general framework for approaching cancer screening in older adults by incorporating evidence-based guidelines, patient preferences, and patient life expectancy estimates into shared screening decisions.
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Affiliation(s)
- Ashwin A. Kotwal
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Mara A. Schonberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Qian F, Yang W, Chen Q, Zhang X, Han B. Screening for early stage lung cancer and its correlation with lung nodule detection. J Thorac Dis 2018; 10:S846-S859. [PMID: 29780631 PMCID: PMC5945694 DOI: 10.21037/jtd.2017.12.123] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/20/2017] [Indexed: 12/14/2022]
Abstract
Currently, the most effective way of reducing lung cancer mortality is early diagnosis of lung cancer. The National Lung Screening Trial has proved the efficacy of lung cancer screening using low-dose computed tomography to reduce lung cancer mortality. However, many questions remain surrounding lung cancer screening implementation, among which include how to select the optimal risk population, the personalized screening interval based different levels of risk, methods to improve diagnostic discrimination between malignant and benign disease in detected lung nodules, and the roles of biomolecular markers in stratifying risk and in guiding the management of indeterminate nodules. This review concentrates on the latest developments of lung cancer screening and provides an overview of the main unanswered questions on lung nodule detection.
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Affiliation(s)
- Fangfei Qian
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wenjia Yang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Qunhui Chen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xueyan Zhang
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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A Comparative Study of Modern Machine Learning Approaches for Focal Lesion Detection and Classification in Medical Images: BoVW, CNN and MTANN. INTELLIGENT SYSTEMS REFERENCE LIBRARY 2018. [DOI: 10.1007/978-3-319-68843-5_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Del Ciello A, Franchi P, Contegiacomo A, Cicchetti G, Bonomo L, Larici AR. Missed lung cancer: when, where, and why? Diagn Interv Radiol 2017; 23:118-126. [PMID: 28206951 DOI: 10.5152/dir.2016.16187] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Missed lung cancer is a source of concern among radiologists and an important medicolegal challenge. In 90% of the cases, errors in diagnosis of lung cancer occur on chest radiographs. It may be challenging for radiologists to distinguish a lung lesion from bones, pulmonary vessels, mediastinal structures, and other complex anatomical structures on chest radiographs. Nevertheless, lung cancer can also be overlooked on computed tomography (CT) scans, regardless of the context, either if a clinical or radiologic suspect exists or for other reasons. Awareness of the possible causes of overlooking a pulmonary lesion can give radiologists a chance to reduce the occurrence of this eventuality. Various factors contribute to a misdiagnosis of lung cancer on chest radiographs and on CT, often very similar in nature to each other. Observer error is the most significant one and comprises scanning error, recognition error, decision-making error, and satisfaction of search. Tumor characteristics such as lesion size, conspicuity, and location are also crucial in this context. Even technical aspects can contribute to the probability of skipping lung cancer, including image quality and patient positioning and movement. Albeit it is hard to remove missed lung cancer completely, strategies to reduce observer error and methods to improve technique and automated detection may be valuable in reducing its likelihood.
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Affiliation(s)
- Annemilia Del Ciello
- Institute of Radiology, Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Rome, Italy.
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Liu Y, Wang H, Li Q, McGettigan MJ, Balagurunathan Y, Garcia AL, Thompson ZJ, Heine JJ, Ye Z, Gillies RJ, Schabath MB. Radiologic Features of Small Pulmonary Nodules and Lung Cancer Risk in the National Lung Screening Trial: A Nested Case-Control Study. Radiology 2017; 286:298-306. [PMID: 28837413 DOI: 10.1148/radiol.2017161458] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose To extract radiologic features from small pulmonary nodules (SPNs) that did not meet the original criteria for a positive screening test and identify features associated with lung cancer risk by using data and images from the National Lung Screening Trial (NLST). Materials and Methods Radiologic features in SPNs in baseline low-dose computed tomography (CT) screening studies that did not meet NLST criteria to be considered a positive screening examination were extracted. SPNs were identified for 73 incident case patients who were given a diagnosis of lung cancer at either the first or second follow-up screening study and for 157 control subjects who had undergone three consecutive negative screening studies. Multivariable logistic regression was used to assess the association between radiologic features and lung cancer risk. All statistical tests were two sided. Results Nine features were significantly different between case patients and control subjects. Backward elimination followed by bootstrap resampling identified a reduced model of highly informative radiologic features with an area under the receiver operating characteristic curve of 0.932 (95% confidence interval [CI]: 0.88, 0.96), a specificity of 92.38% (95% CI: 52.22%, 84.91%), and a sensitivity of 76.55% (95% CI: 87.50%, 95.35%) that included total emphysema score (odds ratio [OR] = 1.71; 95% CI: 1.39, 2.01), attachment to vessel (OR = 2.41; 95% CI: 0.99, 5.81), nodule location (OR = 3.25; 95% CI: 1.09, 8.55), border definition (OR = 7.56; 95% CI: 1.89, 30.8), and concavity (OR = 2.58; 95% CI: 0.89, 5.64). Conclusion A set of clinically relevant radiologic features were identified that that can be easily scored in the clinical setting and may be of use to determine lung cancer risk among participants with SPNs. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Ying Liu
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Hua Wang
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Qian Li
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Melissa J McGettigan
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Yoganand Balagurunathan
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Alberto L Garcia
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Zachary J Thompson
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - John J Heine
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Zhaoxiang Ye
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Robert J Gillies
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Matthew B Schabath
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
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Tirzīte M, Bukovskis M, Strazda G, Jurka N, Taivans I. Detection of lung cancer in exhaled breath with an electronic nose using support vector machine analysis. J Breath Res 2017; 11:036009. [PMID: 28585921 DOI: 10.1088/1752-7163/aa7799] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer is one of the most common malignancies and has a low 5-year survival rate. There are no cheap, simple and widely available screening methods for the early diagnostics of lung cancer. The aim of this study was to determine whether analysis of exhaled breath with an artificial olfactory sensor using support vector analysis can differentiate patients with lung cancer from healthy individuals and patients with other lung diseases, regardless of the stage of lung cancer and the most common comorbidities. Patients with histologically or cytologically verified lung cancer, healthy volunteers and patients with other lung diseases (e.g. chronic obstructive pulmonary disease (COPD), asthma, pneumonia, pulmonary embolism, benign lung tumors) were enrolled in the study. Breath sample collection and analysis with a Cyranose 320 sensor device was performed and data were further analyzed using a support vector machine (SVM). The SVM correctly differentiated between cancer patients and healthy volunteers in 98.8% of cases. The cancer versus non-cancer group patients (healthy volunteers and patients with other lung diseases) were classified correctly by SVM in 87.3% of cases. In the mixed diagnosis groups (only cancer, only COPD, cancer + COPD and control) all 79 out of 79 patients were predicted correctly in the cancer + COPD group, with the rate of correct prognosis in other patient groups being lower. Exhaled breath analysis by electronic nose using a SVM is able to discriminate patients with lung cancer from healthy subjects and mixed groups of patients with different lung diseases. It can also provide a certain level of discrimination between lung cancer patients, lung cancer patients with concomitant COPD, COPD alone and a healthy control group.
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Affiliation(s)
- Madara Tirzīte
- Faculty of Medicine, University of Latvia, Raina Blv. 19, Riga, Latvia. Riga East Clinical University Hospital 'Gailezers', 2nd Department of Pulmonology, Hipokrata Str. 2, Riga, Latvia
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Cancer Screening in the Elderly: A Review of Breast, Colorectal, Lung, and Prostate Cancer Screening. Cancer J 2017. [DOI: 10.1097/00130404-201707000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A review of lung cancer screening and the role of computer-aided detection. Clin Radiol 2017; 72:433-442. [DOI: 10.1016/j.crad.2017.01.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 12/14/2016] [Accepted: 01/04/2017] [Indexed: 12/26/2022]
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Abstract
Since the release of the US Preventive Services Task Force and Centers for Medicare and Medicaid Services recommendations for lung cancer screening, low-dose chest computed tomography screening has moved from the research arena to clinical practice. Lung cancer screening programs must reach beyond image acquisition and interpretation and engage in a multidisciplinary effort of clinical shared decision-making, standardization of imaging and nodule management, smoking cessation, and patient follow-up. Standardization of radiologic reports and nodule management will systematize patient care, provide quality assurance, further reduce harm, and contain health care costs. Although the National Lung Screening Trial results and eligibility criteria of a heavy smoking history are the foundation for the standard guidelines for low-dose chest computed tomography screening in the United States, currently only 27% of patients diagnosed with lung cancer would meet US lung cancer screening recommendations. Current and future efforts must be directed to better delineate those patients who would most benefit from screening and to ensure that the benefits of screening reach all socioeconomic strata and racial and ethnic minorities. Further optimization of lung cancer screening program design and patient eligibility will assure that lung cancer screening benefits will outweigh the potential risks to our patients.
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Ebner L, Tall M, Choudhury KR, Ly DL, Roos JE, Napel S, Rubin GD. Variations in the functional visual field for detection of lung nodules on chest computed tomography: Impact of nodule size, distance, and local lung complexity. Med Phys 2017; 44:3483-3490. [PMID: 28419484 DOI: 10.1002/mp.12277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/24/2017] [Accepted: 03/20/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To explore the characteristics that impact lung nodule detection by peripheral vision when searching for lung nodules on chest CT-scans. METHODS This study was approved by the local IRB and is HIPAA compliant. A simulated primary (1°) target mass (2 × 2 × 5 cm) was embedded into 5 cm thick subvolumes (SV) extracted from three unenhanced lung MDCT scans (64 row, 1.25 mm thickness, 0.7 mm increment). One of 30 solid, secondary nodules with either 3-4 mm and 5-8 mm diameters were embedded into 192 of 207 SVs. The secondary nodule was placed at a random depth within each SV, a transverse distance of 2.5, 5, 7.5, or 10 mm, and along one of eight rays cast every 45° from the center of the 1° mass. Video recordings of transverse paging in cranio-caudal direction were created for each SV (frame rate three sections/sec). Six radiologists observed each cine-loop once while gaze-tracking hardware assured that gaze was centered on the 1° mass. Each radiologist assigned a confidence rating (0-5) to the detection of a secondary nodule and indicated its location. Detection sensitivity was analyzed relative to secondary nodule size, transverse distance, radial orientation, and lung complexity. Lung complexity was characterized by the number of particles (connected pixels) and the sum of the area of all particles above a -500 HU threshold within regions of interest around the 1° mass and secondary nodule. RESULTS Using a proportional odds logistic regression model and eliminating redundant predictors, models fit individually to each reader resulted in the following decreasing order of association based on greatest reduction in Akaike Information Criterion: secondary nodule diameter (6/6 readers, P < 0.001), distance from central mass (6/6 readers, P < 0.001), lung complexity particle count (5/6 readers, P = 0.05), and lung complexity particle area (3/6 readers, P = 0.03). Substantial inter-reader differences in sensitivity to decreasing nodule diameter, distance, and complexity characteristics were observed. CONCLUSIONS Of the investigated parameters, secondary nodule size, distance from the gaze center and lung complexity (particle number and area) significantly impact nodule detection with peripheral vision.
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Affiliation(s)
- Lukas Ebner
- Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Martin Tall
- Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA
| | | | - Donald L Ly
- Department of Radiology, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Justus E Roos
- Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Sandy Napel
- Department of Radiology, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Geoffrey D Rubin
- Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA
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Interval lung cancer after a negative CT screening examination: CT findings and outcomes in National Lung Screening Trial participants. Eur Radiol 2017; 27:3249-3256. [PMID: 28050695 DOI: 10.1007/s00330-016-4705-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/03/2016] [Accepted: 12/15/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study retrospectively analyses the screening CT examinations and outcomes of the National Lung Screening Trial (NLST) participants who had interval lung cancer diagnosed within 1 year after a negative CT screen and before the next annual screen. METHODS The screening CTs of all 44 participants diagnosed with interval lung cancer (cases) were matched with negative CT screens of participants who did not develop lung cancer (controls). A majority consensus process was used to classify each CT screen as positive or negative according to the NLST criteria and to estimate the likelihood that any abnormalities detected retrospectively were due to lung cancer. RESULTS By retrospective review, 40/44 cases (91%) and 17/44 controls (39%) met the NLST criteria for a positive screen (P < 0.001). Cases had higher estimated likelihood of lung cancer (P < 0.001). Abnormalities included pulmonary nodules ≥4 mm (n = 16), mediastinal (n = 8) and hilar (n = 6) masses, and bronchial lesions (n = 6). Cancers were stage III or IV at diagnosis in 32/44 cases (73%); 37/44 patients (84%) died of lung cancer, compared to 225/649 (35%) for all screen-detected cancers (P < 0.0001). CONCLUSION Most cases met the NLST criteria for a positive screen. Awareness of missed abnormalities and interpretation errors may aid lung cancer identification in CT screening. KEY POINTS • Lung cancer within a year of a negative CT screen was rare. • Abnormalities likely due to lung cancer were identified retrospectively in most patients. • Awareness of error types may help identify lung cancer sooner.
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Rampinelli C, Calloni SF, Minotti M, Bellomi M. Spectrum of early lung cancer presentation in low-dose screening CT: a pictorial review. Insights Imaging 2016; 7:449-59. [PMID: 27188380 PMCID: PMC4877352 DOI: 10.1007/s13244-016-0487-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/20/2016] [Accepted: 03/18/2016] [Indexed: 12/14/2022] Open
Abstract
The typical presentation of early stage lung cancers on low-dose CT screening are non-calcified pulmonary nodules. However, there is a wide spectrum of unusual focal abnormalities that can be early presentations of lung cancer. These abnormalities include, for example, cancers associated with 'cystic airspaces' or scar-like cancers. The detection of lung cancer with low-dose CT can be affected by the absence of intravenous contrast medium. As a consequence, endobronchial and central lesions can be difficult to recognize, raising the potential for missed cancers. Focal lesions arising within pre-existing lung disease, such as lung fibrosis or apical scars, can also be early lung cancer manifestations and deserve particular consideration as recognition of these lesions may be hindered by the underlying disease. Furthermore, the unpredictable growth rate of lung cancer, which ranges from indolent to aggressive cancers, necessitates attention to the wide spectrum of progression in lung cancer appearance on serial low-dose CT scans. In this pictorial review we discuss the spectrum of early lung cancer presentation in low-dose CT screening, highlighting typical as well as unusual radiological features and the varied growth rates of early lung cancer. Teaching Points • There is a wide spectrum of early presentations of lung cancer on LDCT. • Low radiation dose and the absence of contrast medium injection can affect lung cancer detection. • Lung cancer growth shows various behaviours, ranging from indolent to aggressive cancers. • Familiarity with LDCT technique can improve CT screening effectiveness and avoid missed diagnosis.
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Affiliation(s)
- Cristiano Rampinelli
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy.
| | | | - Marta Minotti
- School of Medicine, University of Milan, Milan, Italy
| | - Massimo Bellomi
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy
- School of Medicine, University of Milan, Milan, Italy
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Liang M, Tang W, Xu DM, Jirapatnakul AC, Reeves AP, Henschke CI, Yankelevitz D. Low-Dose CT Screening for Lung Cancer: Computer-aided Detection of Missed Lung Cancers. Radiology 2016; 281:279-88. [PMID: 27019363 DOI: 10.1148/radiol.2016150063] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To update information regarding the usefulness of computer-aided detection (CAD) systems with a focus on the most critical category, that of missed cancers at earlier imaging, for cancers that manifest as a solid nodule. Materials and Methods By using a HIPAA-compliant institutional review board-approved protocol where informed consent was obtained, 50 lung cancers that manifested as a solid nodule on computed tomographic (CT) scans in annual rounds of screening (time 1) were retrospectively identified that could, in retrospect, be identified on the previous CT scans (time 0). Four CAD systems were compared, which were referred to as CAD 1, CAD 2, CAD 3, and CAD 4. The total number of accepted CAD-system-detected nodules at time 0 was determined by consensus of two radiologists and the number of CAD-system-detected nodules that were rejected by the radiologists was also documented. Results At time 0 when all the cancers had been missed, CAD system detection rates for the cancers were 56%, 70%, 68%, and 60% (κ = 0.45) for CAD systems 1, 2, 3, and 4, respectively. At time 1, the rates were 74%, 82%, 82%, and 78% (κ = 0.32), respectively. The average diameter of the 50 cancers at time 0 and time 1 was 4.8 mm and 11.4 mm, respectively. The number of CAD-system-detected nodules that were rejected per CT scan for CAD systems 1-4 at time 0 was 7.4, 1.7, 0.6, and 4.5 respectively. Conclusion CAD systems detected up to 70% of lung cancers that were not detected by the radiologist but failed to detect about 20% of the lung cancers when they were identified by the radiologist, which suggests that CAD may be useful in the role of second reader. (©) RSNA, 2016.
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Affiliation(s)
- Mingzhu Liang
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029 (M.L., W.T., D.M.X., A.C.J., C.I.H., D.Y.); and School of Electrical and Computer Engineering, Cornell University, Ithaca, NY (A.P.R.)
| | - Wei Tang
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029 (M.L., W.T., D.M.X., A.C.J., C.I.H., D.Y.); and School of Electrical and Computer Engineering, Cornell University, Ithaca, NY (A.P.R.)
| | - Dong Ming Xu
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029 (M.L., W.T., D.M.X., A.C.J., C.I.H., D.Y.); and School of Electrical and Computer Engineering, Cornell University, Ithaca, NY (A.P.R.)
| | - Artit C Jirapatnakul
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029 (M.L., W.T., D.M.X., A.C.J., C.I.H., D.Y.); and School of Electrical and Computer Engineering, Cornell University, Ithaca, NY (A.P.R.)
| | - Anthony P Reeves
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029 (M.L., W.T., D.M.X., A.C.J., C.I.H., D.Y.); and School of Electrical and Computer Engineering, Cornell University, Ithaca, NY (A.P.R.)
| | - Claudia I Henschke
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029 (M.L., W.T., D.M.X., A.C.J., C.I.H., D.Y.); and School of Electrical and Computer Engineering, Cornell University, Ithaca, NY (A.P.R.)
| | - David Yankelevitz
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029 (M.L., W.T., D.M.X., A.C.J., C.I.H., D.Y.); and School of Electrical and Computer Engineering, Cornell University, Ithaca, NY (A.P.R.)
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Owens EJ, Taylor NR, Howlett DC. Perceptual type error in everyday practice. Clin Radiol 2016; 71:593-601. [PMID: 26973044 DOI: 10.1016/j.crad.2015.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/23/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Abstract
Discrepancy or quality improvement meetings are good practice and are now commonplace in most Radiology Departments, with the aim of improving diagnostic accuracy, preventing recurrent and common mistakes, improving the radiological report and thereby improving patient care. A total of 122 cases were assessed from a two-year period. This review highlights some of the more common, recurrent and important issues encountered within a general hospital with an emphasis on learning points and review areas.
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Affiliation(s)
- E J Owens
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex BN21 2UD, UK.
| | - N R Taylor
- Medical Illustration, Eastbourne District General Hospital, Eastbourne, East Sussex BN21 2UD, UK
| | - D C Howlett
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex BN21 2UD, UK
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Valente IRS, Cortez PC, Neto EC, Soares JM, de Albuquerque VHC, Tavares JMRS. Automatic 3D pulmonary nodule detection in CT images: A survey. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 124:91-107. [PMID: 26652979 DOI: 10.1016/j.cmpb.2015.10.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/01/2015] [Accepted: 10/03/2015] [Indexed: 06/05/2023]
Abstract
This work presents a systematic review of techniques for the 3D automatic detection of pulmonary nodules in computerized-tomography (CT) images. Its main goals are to analyze the latest technology being used for the development of computational diagnostic tools to assist in the acquisition, storage and, mainly, processing and analysis of the biomedical data. Also, this work identifies the progress made, so far, evaluates the challenges to be overcome and provides an analysis of future prospects. As far as the authors know, this is the first time that a review is devoted exclusively to automated 3D techniques for the detection of pulmonary nodules from lung CT images, which makes this work of noteworthy value. The research covered the published works in the Web of Science, PubMed, Science Direct and IEEEXplore up to December 2014. Each work found that referred to automated 3D segmentation of the lungs was individually analyzed to identify its objective, methodology and results. Based on the analysis of the selected works, several studies were seen to be useful for the construction of medical diagnostic aid tools. However, there are certain aspects that still require attention such as increasing algorithm sensitivity, reducing the number of false positives, improving and optimizing the algorithm detection of different kinds of nodules with different sizes and shapes and, finally, the ability to integrate with the Electronic Medical Record Systems and Picture Archiving and Communication Systems. Based on this analysis, we can say that further research is needed to develop current techniques and that new algorithms are needed to overcome the identified drawbacks.
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Affiliation(s)
- Igor Rafael S Valente
- Instituto Federal do Ceará, Campus Maracanaú, Av. Parque Central, S/N, Distrito Industrial I, 61939-140 Maracanaú, Ceará, Brazil; Universidade Federal do Ceará, Departamento de Engenharia de Teleinformática, Av. Mister Hull, S/N, Campus do Pici, 6005, 60455-760 Fortaleza, Ceará, Brazil
| | - Paulo César Cortez
- Universidade Federal do Ceará, Departamento de Engenharia de Teleinformática, Av. Mister Hull, S/N, Campus do Pici, 6005, 60455-760 Fortaleza, Ceará, Brazil
| | - Edson Cavalcanti Neto
- Universidade Federal do Ceará, Departamento de Engenharia de Teleinformática, Av. Mister Hull, S/N, Campus do Pici, 6005, 60455-760 Fortaleza, Ceará, Brazil
| | - José Marques Soares
- Universidade Federal do Ceará, Departamento de Engenharia de Teleinformática, Av. Mister Hull, S/N, Campus do Pici, 6005, 60455-760 Fortaleza, Ceará, Brazil
| | - Victor Hugo C de Albuquerque
- Programa de Pós-Graduacão em Informática Aplicada, Universidade de Fortaleza, Av. Washington Soares, 1321, Edson Queiroz, 60811341, CEP 608113-41 Fortaleza, Ceará, Brazil
| | - João Manuel R S Tavares
- Instituto de Ciência e Inovacão em Engenharia Mecânica e Engenharia Industrial, Departamento de Engenharia Mecânica, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, S/N, 4200-465 Porto, Portugal.
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Ichikawa K, Kobayashi T, Sagawa M, Katagiri A, Uno Y, Nishioka R, Matsuyama J. A phantom study investigating the relationship between ground-glass opacity visibility and physical detectability index in low-dose chest computed tomography. J Appl Clin Med Phys 2015; 16:202–215. [PMID: 26218991 PMCID: PMC5690005 DOI: 10.1120/jacmp.v16i4.5001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 03/19/2015] [Accepted: 03/16/2015] [Indexed: 12/02/2022] Open
Abstract
In this study, the relationship between ground-glass opacity (GGO) visibility and physical detectability index in low-dose computed tomography (LDCT) for lung cancer screening was investigated. An anthropomorphic chest phantom that included synthetic GGOs with CT numbers of -630 Hounsfield units (HU; high attenuation GGO: HGGO) and -800 HU (low attenuation GGO: LGGO), and three phantoms for physical measurements were employed. The phantoms were scanned using 12 CT systems located in 11 screening centers in Japan. The slice thicknesses and CT dose indices (CTDI(vol)) varied over 1.0-5.0 mm and 0.85-3.30 mGy, respectively, and several reconstruction kernels were used. Physical detectability index values were calculated from measurements of resolution, noise, and slice thickness properties for all image sets. Five radiologists and one thoracic surgeon, blind to one another's observations, evaluated GGO visibility using a five-point scoring system. The physical detectability index correlated reasonably well with the GGO visibility (R² = 0.709, p < 0.01 for 6 mm HGGO and R² = 0.646, p < 0.01 for 10 mm LGGO), and was nearly proportional to the CTDI(vol). Consequently, the CTDI(vol) also correlated reasonably well with the GGO visibility (R² = 0.701, p < 0.01 for 6 mm HGGO and R² = 0.680, p < 0.01 for 10 mm LGGO). As a result, the CTDI(vol) was nearly dominant in the GGO visibility for image sets with different reconstruction kernels and slice thicknesses, used in this study.
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44
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Li F. Potential clinical impact of advanced imaging and computer-aided diagnosis in chest radiology: importance of radiologist's role and successful observer study. Radiol Phys Technol 2015; 8:161-73. [PMID: 25981309 DOI: 10.1007/s12194-015-0319-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/06/2015] [Indexed: 11/29/2022]
Abstract
This review paper is based on our research experience in the past 30 years. The importance of radiologists' role is discussed in the development or evaluation of new medical images and of computer-aided detection (CAD) schemes in chest radiology. The four main topics include (1) introducing what diseases can be included in a research database for different imaging techniques or CAD systems and what imaging database can be built by radiologists, (2) understanding how radiologists' subjective judgment can be combined with technical objective features to improve CAD performance, (3) sharing our experience in the design of successful observer performance studies, and (4) finally, discussing whether the new images and CAD systems can improve radiologists' diagnostic ability in chest radiology. In conclusion, advanced imaging techniques and detection/classification of CAD systems have a potential clinical impact on improvement of radiologists' diagnostic ability, for both the detection and the differential diagnosis of various lung diseases, in chest radiology.
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Affiliation(s)
- Feng Li
- Department of Radiology, MC 2026, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA,
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Akashita S, Tachibana Y, Sakamaki K, Sogawa K, Inoue T. Detection of pure ground-glass nodules in the lung by low-dose multi-detector computed tomography, with use of an iterative reconstruction method: a comparison with conventional image reconstruction by the filtered back-projection method. Jpn J Radiol 2015; 33:113-21. [PMID: 25552203 DOI: 10.1007/s11604-014-0384-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/10/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the feasibility of the iterative reconstruction (IR) method with low-dose multi-detector computed tomography (MDCT) for lung cancer screening. MATERIALS AND METHODS A chest CT phantom containing simulated ground-glass nodules (GGNs) of 5 different sizes was scanned by use of 16-row and 64-row MDCT. Tube currents of 10, 20, and 30 mA were used for the low-dose CT. To assess the detectability of pure GGNs, a radiologist-performance test was conducted. Mean visual scores for simulated GGNs were compared for reconstructed images from filtered back-projection (FBP) and the IR method. RESULTS When 64-row MDCT was used, visual scores for simulated GGNs were significantly higher for the IR method than for the FBP method under any conditions; scores were also significantly higher for 16-row MDCT under some conditions. CONCLUSIONS The results of this experimental chest phantom study showed that use of the IR method improved the detectability of simulated pure GGNs.
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Affiliation(s)
- Shiho Akashita
- Department of Radiology, Yokohama City Medical College, 3-9, Hukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan,
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Retrospective Review of Lung Cancers Diagnosed in Annual Rounds of CT Screening. AJR Am J Roentgenol 2014; 203:965-72. [DOI: 10.2214/ajr.13.12115] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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47
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Scholten ET, Horeweg N, de Koning HJ, Vliegenthart R, Oudkerk M, Mali WPTM, de Jong PA. Computed tomographic characteristics of interval and post screen carcinomas in lung cancer screening. Eur Radiol 2014; 25:81-8. [DOI: 10.1007/s00330-014-3394-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 08/02/2014] [Accepted: 08/11/2014] [Indexed: 12/14/2022]
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48
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Wang YXJ, Gong JS, Suzuki K, Morcos SK. Evidence based imaging strategies for solitary pulmonary nodule. J Thorac Dis 2014; 6:872-87. [PMID: 25093083 DOI: 10.3978/j.issn.2072-1439.2014.07.26] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/29/2014] [Indexed: 12/21/2022]
Abstract
Solitary pulmonary nodule (SPN) is defined as a rounded opacity ≤3 cm in diameter surrounded by lung parenchyma. The majority of smokers who undergo thin-section CT have SPNs, most of which are smaller than 7 mm. In the past, multiple follow-up examinations over a two-year period, including CT follow-up at 3, 6, 12, 18, and 24 months, were recommended when such nodules are detected incidentally. This policy increases radiation burden for the affected population. Nodule features such as shape, edge characteristics, cavitation, and location have not yet been found to be accurate for distinguishing benign from malignant nodules. When SPN is considered to be indeterminate in the initial exam, the risk factor of the patients should be evaluated, which includes patients' age and smoking history. The 2005 Fleischner Society guideline stated that at least 99% of all nodules 4 mm or smaller are benign; when nodule is 5-9 mm in diameter, the best strategy is surveillance. The timing of these control examinations varies according to the nodule size (4-6, or 6-8 mm) and the type of patients, specifically at low or high risk of malignancy concerned. Noncalcified nodules larger than 8 mm diameter bear a substantial risk of malignancy, additional options such as contrast material-enhanced CT, positron emission tomography (PET), percutaneous needle biopsy, and thoracoscopic resection or videoassisted thoracoscopic resection should be considered.
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Affiliation(s)
- Yi-Xiang J Wang
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Jing-Shan Gong
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Kenji Suzuki
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Sameh K Morcos
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
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Pixel-based Machine Learning in Computer-Aided Diagnosis of Lung and Colon Cancer. INTELLIGENT SYSTEMS REFERENCE LIBRARY 2014. [DOI: 10.1007/978-3-642-40017-9_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Common Blind Spots on Chest CT: Where Are They All Hiding? Part 1—Airways, Lungs, and Pleura. AJR Am J Roentgenol 2013; 201:W533-8. [DOI: 10.2214/ajr.12.9354] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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