InterNet: Detection of Active Abdominal Arterial Bleeding Using Emergency Digital Subtraction Angiography Imaging With Two-Stage Deep Learning

Objective

Active abdominal arterial bleeding is an emergency medical condition. Herein, we present our use of this two-stage InterNet model for detection of active abdominal arterial bleeding using emergency DSA imaging.

Methods

Firstly, 450 patients who underwent abdominal DSA procedures were randomly selected for development of the region localization stage (RLS). Secondly, 160 consecutive patients with active abdominal arterial bleeding were included for development of the bleeding site detection stage (BSDS) and InterNet (cascade network of RLS and BSDS). Another 50 patients that ruled out active abdominal arterial bleeding were used as negative samples to evaluate InterNet performance. We evaluated the mode's efficacy using the precision-recall (PR) curve. The classification performance of a doctor with and without InterNet was evaluated using a receiver operating characteristic (ROC) curve analysis.

Results

The AP, precision, and recall of the RLS were 0.99, 0.95, and 0.99 in the validation dataset, respectively. Our InterNet reached a recall of 0.7, the precision for detection of bleeding sites was 53% in the evaluation set. The AUCs of doctors with and without InterNet were 0.803 and 0.759, respectively. In addition, the doctor with InterNet assistant could significantly reduce the elapsed time for the interpretation of each DSA sequence from 84.88 to 43.78 s.

Conclusion

Our InterNet system could assist interventional radiologists in identifying bleeding foci quickly and may improve the workflow of the DSA operation to a more real-time procedure.

Radiation dose and excess risk of cancer in children undergoing neuroangiography

OBJECTIVE

The primary goal of this study was to determine the radiation dose received during diagnostic and interventional neuroangiographic procedures in a group of pediatric patients. A second goal was to approximate the total average radiation dose from all angiographic and CT studies that pediatric patients underwent during the study period and to estimate the increased risk of cancer incidence in this patient group.

MATERIALS AND METHODS

The study subjects were pediatric patients who had undergone one or more neuroangiographic procedures at Harborview Medical Center between December 1, 2004, and April 30, 2008. Recorded radiation doses were converted to entrance skin dose (ESD) and effective dose (ED) to indicate deterministic and stochastic damage, respectively. The Biologic Effects of Ionizing Radiation (BEIR) VII, phase 2, report was used to estimate the expected increased risk of cancer in the study population.

RESULTS

For diagnostic and therapeutic procedures, a mean ED of 10.4 and 34.0 mSv per procedure was calculated, respectively. The ESD values proved too low to cause deterministic harm. The estimated number of excess cases of malignancy projected from the total average radiation exposure was 890.6 per 100,000 exposed male children and 1,222.5 per 100,000 exposed females, an overall increase of approximately 1% to the lifetime attributable risk of cancer.

CONCLUSION

Although both angiography and CT have revolutionized the practice of medicine and confer benefits to patients, it is important that we continue to investigate the possible adverse effects of these technologies. Protocols that minimize radiation dose without compromising a study should be implemented.