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Ross T, Tanna R, Lilaonitkul W, Mehta N. Deep Learning for Automated Image Segmentation of the Middle Ear: A Scoping Review. Otolaryngol Head Neck Surg 2024; 170:1544-1554. [PMID: 38667630 DOI: 10.1002/ohn.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Convolutional neural networks (CNNs) have revolutionized medical image segmentation in recent years. This scoping review aimed to carry out a comprehensive review of the literature describing automated image segmentation of the middle ear using CNNs from computed tomography (CT) scans. DATA SOURCES A comprehensive literature search, generated jointly with a medical librarian, was performed on Medline, Embase, Scopus, Web of Science, and Cochrane, using Medical Subject Heading terms and keywords. Databases were searched from inception to July 2023. Reference lists of included papers were also screened. REVIEW METHODS Ten studies were included for analysis, which contained a total of 866 scans which were used in model training/testing. Thirteen different architectures were described to perform automated segmentation. The best Dice similarity coefficient (DSC) for the entire ossicular chain was 0.87 using ResNet. The highest DSC for any structure was the incus using 3D-V-Net at 0.93. The most difficult structure to segment was the stapes, with the highest DSC of 0.84 using 3D-V-Net. CONCLUSIONS Numerous architectures have demonstrated good performance in segmenting the middle ear using CNNs. To overcome some of the difficulties in segmenting the stapes, we recommend the development of an architecture trained on cone beam CTs to provide improved spatial resolution to assist with delineating the smallest ossicle. IMPLICATIONS FOR PRACTICE This has clinical applications for preoperative planning, diagnosis, and simulation.
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Affiliation(s)
- Talisa Ross
- Department of Ear, Nose and Throat Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
- evidENT Team, Ear Institute, University College London, London, UK
| | - Ravina Tanna
- Department of Ear, Nose and Throat Surgery, Great Ormond Street Hospital, London, UK
| | | | - Nishchay Mehta
- evidENT Team, Ear Institute, University College London, London, UK
- Department of Ear, Nose and Throat Surgery, Royal National Ear Nose and Throat Hospital, London, UK
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Neves CA, Chemaly TE, Fu F, Blevins NH. Deep Learning Method for Rapid Simultaneous Multistructure Temporal Bone Segmentation. Otolaryngol Head Neck Surg 2024; 170:1570-1580. [PMID: 38769857 DOI: 10.1002/ohn.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/25/2024] [Accepted: 03/19/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To develop and validate a deep learning algorithm for the automated segmentation of key temporal bone structures from clinical computed tomography (CT) data sets. STUDY DESIGN Cross-sectional study. SETTING A total of 325 CT scans from a clinical database. METHOD A state-of-the-art deep learning (DL) algorithm (SwinUNETR) was used to train a prediction model for rapid segmentation of 9 key temporal bone structures in a data set of 325 clinical CTs. The data set was manually annotated by a specialist to serve as the ground truth. The data set was randomly split into training (n = 260) and testing (n = 65) sets. The model's performance was objectively assessed through external validation on the test set using metrics including Dice, Balanced accuracy, Hausdorff distances, and processing time. RESULTS The model achieved an average Dice coefficient of 0.87 for all structures, an average balanced accuracy of 0.94, an average Hausdorff distance of 0.79 mm, and an average processing time of 9.1 seconds per CT. CONCLUSION The present DL model for the automated simultaneous segmentation of multiple structures within the temporal bone from CTs achieved high accuracy according to currently commonly employed objective analysis. The results demonstrate the potential of the method to improve preoperative evaluation and intraoperative guidance in otologic surgery.
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Affiliation(s)
- Caio A Neves
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
- Faculty of Medicine, University of Brasilia UnB, Brasilia, Brazil
| | - Trishia El Chemaly
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Fanrui Fu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
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Cai Q, Zhang P, Xie F, Zhang Z, Tu B. Clinical application of high-resolution spiral CT scanning in the diagnosis of auriculotemporal and ossicle. BMC Med Imaging 2024; 24:102. [PMID: 38724896 PMCID: PMC11080198 DOI: 10.1186/s12880-024-01277-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Precision and intelligence in evaluating the complexities of middle ear structures are required to diagnose auriculotemporal and ossicle-related diseases within otolaryngology. Due to the complexity of the anatomical details and the varied etiologies of illnesses such as trauma, chronic otitis media, and congenital anomalies, traditional diagnostic procedures may not yield accurate diagnoses. This research intends to enhance the diagnosis of diseases of the auriculotemporal region and ossicles by combining High-Resolution Spiral Computed Tomography (HRSCT) scanning with Deep Learning Techniques (DLT). This study employs a deep learning method, Convolutional Neural Network-UNet (CNN-UNet), to extract sub-pixel information from medical photos. This method equips doctors and researchers with cutting-edge resources, leading to groundbreaking discoveries and better patient healthcare. The research effort is the interaction between the CNN-UNet model and high-resolution Computed Tomography (CT) scans, automating activities including ossicle segmentation, fracture detection, and disruption cause classification, accelerating the diagnostic process and increasing clinical decision-making. The suggested HRSCT-DLT model represents the integration of high-resolution spiral CT scans with the CNN-UNet model, which has been fine-tuned to address the nuances of auriculotemporal and ossicular diseases. This novel combination improves diagnostic efficiency and our overall understanding of these intricate diseases. The results of this study highlight the promise of combining high-resolution CT scanning with the CNN-UNet model in otolaryngology, paving the way for more accurate diagnosis and more individualized treatment plans for patients experiencing auriculotemporal and ossicle-related disruptions.
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Affiliation(s)
- Qinfang Cai
- Department of Otolaryngology, The First Clinical Medical College of Jinan University, Guangzhou, 510630, Guangdong, China
- Department of Otolaryngology, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, 510900, Guangdong, China
| | - Peishan Zhang
- Department of Otolaryngology, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, 510900, Guangdong, China
| | - Fengmei Xie
- Department of Otolaryngology, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, 510900, Guangdong, China
| | - Zedong Zhang
- Department of Otolaryngology, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, 510900, Guangdong, China
| | - Bo Tu
- Department of Otolaryngology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
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Walter A, Hoegen-Saßmannshausen P, Stanic G, Rodrigues JP, Adeberg S, Jäkel O, Frank M, Giske K. Segmentation of 71 Anatomical Structures Necessary for the Evaluation of Guideline-Conforming Clinical Target Volumes in Head and Neck Cancers. Cancers (Basel) 2024; 16:415. [PMID: 38254904 PMCID: PMC11154560 DOI: 10.3390/cancers16020415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/28/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
The delineation of the clinical target volumes (CTVs) for radiation therapy is time-consuming, requires intensive training and shows high inter-observer variability. Supervised deep-learning methods depend heavily on consistent training data; thus, State-of-the-Art research focuses on making CTV labels more homogeneous and strictly bounding them to current standards. International consensus expert guidelines standardize CTV delineation by conditioning the extension of the clinical target volume on the surrounding anatomical structures. Training strategies that directly follow the construction rules given in the expert guidelines or the possibility of quantifying the conformance of manually drawn contours to the guidelines are still missing. Seventy-one anatomical structures that are relevant to CTV delineation in head- and neck-cancer patients, according to the expert guidelines, were segmented on 104 computed tomography scans, to assess the possibility of automating their segmentation by State-of-the-Art deep learning methods. All 71 anatomical structures were subdivided into three subsets of non-overlapping structures, and a 3D nnU-Net model with five-fold cross-validation was trained for each subset, to automatically segment the structures on planning computed tomography scans. We report the DICE, Hausdorff distance and surface DICE for 71 + 5 anatomical structures, for most of which no previous segmentation accuracies have been reported. For those structures for which prediction values have been reported, our segmentation accuracy matched or exceeded the reported values. The predictions from our models were always better than those predicted by the TotalSegmentator. The sDICE with 2 mm margin was larger than 80% for almost all the structures. Individual structures with decreased segmentation accuracy are analyzed and discussed with respect to their impact on the CTV delineation following the expert guidelines. No deviation is expected to affect the rule-based automation of the CTV delineation.
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Affiliation(s)
- Alexandra Walter
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (G.S.); (J.P.R.); (O.J.); (K.G.)
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
- Karlsruhe Institute of Technology (KIT), Scientific Computing Center, Zirkel 2, 76131 Karlsruhe, Germany;
| | - Philipp Hoegen-Saßmannshausen
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, 69120 Heidelberg, Germany
| | - Goran Stanic
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (G.S.); (J.P.R.); (O.J.); (K.G.)
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
- Faculty of Physics and Astronomy, University of Heidelberg, 69120 Heidelberg, Germany
| | - Joao Pedro Rodrigues
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (G.S.); (J.P.R.); (O.J.); (K.G.)
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
| | - Sebastian Adeberg
- Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, 35043 Marburg, Germany;
- Marburg Ion-Beam Therapy Center (MIT), 35043 Marburg, Germany
- Universitäres Centrum für Tumorerkrankungen (UCT), 35033 Marburg, Germany
| | - Oliver Jäkel
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (G.S.); (J.P.R.); (O.J.); (K.G.)
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
| | - Martin Frank
- Karlsruhe Institute of Technology (KIT), Scientific Computing Center, Zirkel 2, 76131 Karlsruhe, Germany;
| | - Kristina Giske
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (G.S.); (J.P.R.); (O.J.); (K.G.)
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
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Tsilivigkos C, Athanasopoulos M, Micco RD, Giotakis A, Mastronikolis NS, Mulita F, Verras GI, Maroulis I, Giotakis E. Deep Learning Techniques and Imaging in Otorhinolaryngology-A State-of-the-Art Review. J Clin Med 2023; 12:6973. [PMID: 38002588 PMCID: PMC10672270 DOI: 10.3390/jcm12226973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Over the last decades, the field of medicine has witnessed significant progress in artificial intelligence (AI), the Internet of Medical Things (IoMT), and deep learning (DL) systems. Otorhinolaryngology, and imaging in its various subspecialties, has not remained untouched by this transformative trend. As the medical landscape evolves, the integration of these technologies becomes imperative in augmenting patient care, fostering innovation, and actively participating in the ever-evolving synergy between computer vision techniques in otorhinolaryngology and AI. To that end, we conducted a thorough search on MEDLINE for papers published until June 2023, utilizing the keywords 'otorhinolaryngology', 'imaging', 'computer vision', 'artificial intelligence', and 'deep learning', and at the same time conducted manual searching in the references section of the articles included in our manuscript. Our search culminated in the retrieval of 121 related articles, which were subsequently subdivided into the following categories: imaging in head and neck, otology, and rhinology. Our objective is to provide a comprehensive introduction to this burgeoning field, tailored for both experienced specialists and aspiring residents in the domain of deep learning algorithms in imaging techniques in otorhinolaryngology.
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Affiliation(s)
- Christos Tsilivigkos
- 1st Department of Otolaryngology, National and Kapodistrian University of Athens, Hippocrateion Hospital, 115 27 Athens, Greece; (A.G.); (E.G.)
| | - Michail Athanasopoulos
- Department of Otolaryngology, University Hospital of Patras, 265 04 Patras, Greece; (M.A.); (N.S.M.)
| | - Riccardo di Micco
- Department of Otolaryngology and Head and Neck Surgery, Medical School of Hannover, 30625 Hannover, Germany;
| | - Aris Giotakis
- 1st Department of Otolaryngology, National and Kapodistrian University of Athens, Hippocrateion Hospital, 115 27 Athens, Greece; (A.G.); (E.G.)
| | - Nicholas S. Mastronikolis
- Department of Otolaryngology, University Hospital of Patras, 265 04 Patras, Greece; (M.A.); (N.S.M.)
| | - Francesk Mulita
- Department of Surgery, University Hospital of Patras, 265 04 Patras, Greece; (G.-I.V.); (I.M.)
| | - Georgios-Ioannis Verras
- Department of Surgery, University Hospital of Patras, 265 04 Patras, Greece; (G.-I.V.); (I.M.)
| | - Ioannis Maroulis
- Department of Surgery, University Hospital of Patras, 265 04 Patras, Greece; (G.-I.V.); (I.M.)
| | - Evangelos Giotakis
- 1st Department of Otolaryngology, National and Kapodistrian University of Athens, Hippocrateion Hospital, 115 27 Athens, Greece; (A.G.); (E.G.)
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Petsiou DP, Martinos A, Spinos D. Applications of Artificial Intelligence in Temporal Bone Imaging: Advances and Future Challenges. Cureus 2023; 15:e44591. [PMID: 37795060 PMCID: PMC10545916 DOI: 10.7759/cureus.44591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 10/06/2023] Open
Abstract
The applications of artificial intelligence (AI) in temporal bone (TB) imaging have gained significant attention in recent years, revolutionizing the field of otolaryngology and radiology. Accurate interpretation of imaging features of TB conditions plays a crucial role in diagnosing and treating a range of ear-related pathologies, including middle and inner ear diseases, otosclerosis, and vestibular schwannomas. According to multiple clinical studies published in the literature, AI-powered algorithms have demonstrated exceptional proficiency in interpreting imaging findings, not only saving time for physicians but also enhancing diagnostic accuracy by reducing human error. Although several challenges remain in routinely relying on AI applications, the collaboration between AI and healthcare professionals holds the key to better patient outcomes and significantly improved patient care. This overview delivers a comprehensive update on the advances of AI in the field of TB imaging, summarizes recent evidence provided by clinical studies, and discusses future insights and challenges in the widespread integration of AI in clinical practice.
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Affiliation(s)
- Dioni-Pinelopi Petsiou
- Otolaryngology-Head and Neck Surgery, National and Kapodistrian University of Athens, School of Medicine, Athens, GRC
| | - Anastasios Martinos
- Otolaryngology-Head and Neck Surgery, National and Kapodistrian University of Athens, School of Medicine, Athens, GRC
| | - Dimitrios Spinos
- Otolaryngology-Head and Neck Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, GBR
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