Lung Computed Tomography Images Research Articles

An integrated method for detecting lung cancer via CT scanning via optimization, deep learning, and IoT data transmission

With its increasing global prevalence, lung cancer remains a critical health concern. Despite the advancement of screening programs, patient selection and risk stratification pose significant challenges. This study addresses the pressing need for early detection through a novel diagnostic approach that leverages innovative image processing techniques. The urgency of early lung cancer detection is emphasized by its alarming growth worldwide. While computed tomography (CT) surpasses traditional X-ray methods, a comprehensive diagnosis requires a combination of imaging techniques. This research introduces an advanced diagnostic tool implemented through image processing methodologies. The methodology commences with histogram equalization, a crucial step in artifact removal from CT images sourced from a medical database. Accurate lung CT image segmentation, which is vital for cancer diagnosis, follows. The Otsu thresholding method and optimization, employing Colliding Bodies Optimization (CBO), enhance the precision of the segmentation process. A local binary pattern (LBP) is deployed for feature extraction, enabling the identification of nodule sizes and precise locations. The resulting image underwent classification using the densely connected CNN (DenseNet) deep learning algorithm, which effectively distinguished between benign and malignant tumors. The proposed CBO+DenseNet CNN exhibits remarkable performance improvements over traditional methods. Notable enhancements in accuracy (98.17%), specificity (97.32%), precision (97.46%), and recall (97.89%) are observed, as evidenced by the results from the fractional randomized voting model (FRVM). These findings highlight the potential of the proposed model as an advanced diagnostic tool. Its improved metrics promise heightened accuracy in tumor classification and localization. The proposed model uniquely combines Colliding Bodies Optimization (CBO) with DenseNet CNN, enhancing segmentation and classification accuracy for lung cancer detection, setting it apart from traditional methods with superior performance metrics.

Lung disease prediction based on CT images using REInf-net and world cup optimization based BI-LSTM classification

ABSTRACT A major global source of disability as well as mortality is respiratory illness. Though visual evaluation of computed tomography (CT) images and chest radiographs are a primary diagnostic for respiratory illnesses, it is limited in its ability to assess severity and predict patient outcomes due to low specificity and fundamental infectious organisms. In order to address these problems, world cup optimization-based Bi-LSTM classification and lung disease prediction on CT images using REINF-net were employed. To enhance the image quality, the gathered lung CT images are pre-processed using Lucy Richardson and CLAHE algorithms. For the purpose of lung infection segmentation, the pre-processed images are segmented using the REInf-net. The GLRLM method is used to extract features from the segmented images. In order to predict lung disease in CT images, the extracted features are trained using the Bi-LSTM based on world cup optimization. Accuracy, Precision, recall, Error and Specificity for the proposed model are 97.8%, 96.7%, 96.7%, 2.2% and 98.3%. These evaluated values are contrasted with the results of existing methods like WCO-BiLSTM, MLP, CNN and LSTM. Finally, the Lung disease prediction based on CT images using REINF-Net and world cup optimization based BI-LSTM classification performs better than the existing model.

Longitudinal registration of thoracic CT images with radiation-induced lung diseases: A divide-and-conquer approach based on component structure wise registration using coherent point drift

Background and ObjectiveRegistration of pulmonary computed tomography (CT) images with radiation-induced lung diseases (RILD) was essential to investigate the voxel-wise relationship between the formation of RILD and the radiation dose received by different tissues. Although various approaches had been developed for the registration of lung CTs, their performances remained clinically unsatisfactory for registration of lung CT images with RILD. The main difficulties arose from the longitudinal change in lung parenchyma, including RILD and volumetric change of lung cancers, after radiation therapy, leading to inaccurate registration and artifacts caused by erroneous matching of the RILD tissues. MethodsTo overcome the influence of the parenchymal changes, a divide-and-conquer approach rooted in the coherent point drift (CPD) paradigm was proposed. The proposed method was based on two kernel ideas. One was the idea of component structure wise registration. Specifically, the proposed method relaxed the intrinsic assumption of equal isotropic covariances in CPD by decomposing a lung and its surrounding tissues into component structures and independently registering the component structures pairwise by CPD. The other was the idea of defining a vascular subtree centered at a matched branch point as a component structure. This idea could not only provide a sufficient number of matched feature points within a parenchyma, but avoid being corrupted by the false feature points resided in the RILD tissues due to globally and indiscriminately sampling using mathematical operators. The overall deformation model was built by using the Thin Plate Spline based on all matched points. ResultsThis study recruited 30 pairs of lung CT images with RILD, 15 of which were used for internal validation (leave-one-out cross-validation) and the other 15 for external validation. The experimental results showed that the proposed algorithm achieved a mean and a mean of maximum 1 % of average surface distances <2 and 8 mm, respectively, and a mean and a maximum target registration error <2 mm and 5 mm on both internal and external validation datasets. The paired two-sample t-tests corroborated that the proposed algorithm outperformed a recent method, the Stavropoulou's method, on the external validation dataset (p < 0.05). ConclusionsThe proposed algorithm effectively reduced the influence of parenchymal changes, resulting in a reasonably accurate and artifact-free registration.

A 3D boundary-guided hybrid network with convolutions and Transformers for lung tumor segmentation in CT images

—Accurate lung tumor segmentation from Computed Tomography (CT) scans is crucial for lung cancer diagnosis. Since the 2D methods lack the volumetric information of lung CT images, 3D convolution-based and Transformer-based methods have recently been applied in lung tumor segmentation tasks using CT imaging. However, most existing 3D methods cannot effectively collaborate the local patterns learned by convolutions with the global dependencies captured by Transformers, and widely ignore the important boundary information of lung tumors. To tackle these problems, we propose a 3D boundary-guided hybrid network using convolutions and Transformers for lung tumor segmentation, named BGHNet. In BGHNet, we first propose the Hybrid Local-Global Context Aggregation (HLGCA) module with parallel convolution and Transformer branches in the encoding phase. To aggregate local and global contexts in each branch of the HLGCA module, we not only design the Volumetric Cross-Stripe Window Transformer (VCSwin-Transformer) to build the Transformer branch with local inductive biases and large receptive fields, but also design the Volumetric Pyramid Convolution with transformer-based extensions (VPConvNeXt) to build the convolution branch with multi-scale global information. Then, we present a Boundary-Guided Feature Refinement (BGFR) module in the decoding phase, which explicitly leverages the boundary information to refine multi-stage decoding features for better performance. Extensive experiments were conducted on two lung tumor segmentation datasets, including a private dataset (HUST-Lung) and a public benchmark dataset (MSD-Lung). Results show that BGHNet outperforms other state-of-the-art 2D or 3D methods in our experiments, and it exhibits superior generalization performance in both non-contrast and contrast-enhanced CT scans.

Phenotyping COVID-19 respiratory failure in spontaneously breathing patients with AI on lung CT-scan

BackgroundAutomated analysis of lung computed tomography (CT) scans may help characterize subphenotypes of acute respiratory illness. We integrated lung CT features measured via deep learning with clinical and laboratory data in spontaneously breathing subjects to enhance the identification of COVID-19 subphenotypes.MethodsThis is a multicenter observational cohort study in spontaneously breathing patients with COVID-19 respiratory failure exposed to early lung CT within 7 days of admission. We explored lung CT images using deep learning approaches to quantitative and qualitative analyses; latent class analysis (LCA) by using clinical, laboratory and lung CT variables; regional differences between subphenotypes following 3D spatial trajectories.ResultsComplete datasets were available in 559 patients. LCA identified two subphenotypes (subphenotype 1 and 2). As compared with subphenotype 2 (n = 403), subphenotype 1 patients (n = 156) were older, had higher inflammatory biomarkers, and were more hypoxemic. Lungs in subphenotype 1 had a higher density gravitational gradient with a greater proportion of consolidated lungs as compared with subphenotype 2. In contrast, subphenotype 2 had a higher density submantellar–hilar gradient with a greater proportion of ground glass opacities as compared with subphenotype 1. Subphenotype 1 showed higher prevalence of comorbidities associated with endothelial dysfunction and higher 90-day mortality than subphenotype 2, even after adjustment for clinically meaningful variables.ConclusionsIntegrating lung-CT data in a LCA allowed us to identify two subphenotypes of COVID-19, with different clinical trajectories. These exploratory findings suggest a role of automated imaging characterization guided by machine learning in subphenotyping patients with respiratory failure.Trial registration: ClinicalTrials.gov Identifier: NCT04395482. Registration date: 19/05/2020.

The Nonlinear Relationship Between High-Density Lipoprotein and Changes in Pulmonary Structure Function and Pulmonary Function in COPD Patients in China.

The previous findings on the correlation between spirometry and high-density lipoprotein (HDL) cholesterol are intriguing yet conflicting. The aim of this research is to evaluate the relationship between HDL levels and spirometry as well as imaging parameters in patients with chronic obstructive pulmonary disease (COPD) in China. This study encompasses a total of 907 COPD patients. Participants with complete data from questionnaire interviews, lipid profile examinations, spirometry testing, and computed tomography (CT) scans were included in the analysis. A generalized additive model was employed to identify the non-linear relationship between HDL levels and both spirometry and imaging parameters. In the presence of non-linear correlations, segmented linear regression model was applied to ascertain threshold effects. After adjusting for various factors, we found a non-linear correlation between HDL levels and spirometry/imaging parameters, with an inflection point at 4.2 (66 mg/dL). When Ln (HDL) was below 4.2, each unit increase correlated significantly with reduced post-bronchodilator FEV1 (0.32L, 95% CI: 0.09-0.55), decreased predicted FEV1% (11.0%, 95% CI: 2.7-19.3), and lowered FEV1/FVC (8.0%, 95% CI: 4.0-12.0), along with notable increases in Ln (LAA-950) by 1.20 (95% CI: 0.60-1.79) and Ln (LAA-856) by 0.77 (95% CI: 0.37-1.17). However, no significant associations were observed when Ln (HDL) was greater than or equal to 4.2. A non-linear correlation existed between HDL levels with lung function and CT imaging in COPD patients. Prior to reaching 66 mg/dL, an elevation in HDL was significantly associated with impaired lung function, more severe gas trapping and emphysema.

Image Findings and Radiation Dose in Lung CT Scan of Patients With COVID-19 in Hamadan

Background: Computed tomography (CT) scan plays an important role in the diagnosis of the COVID-19. Lung involvement appears in different forms on CT images. Absorbed dose to the patients may exceed diagnostic reference levels. This study aimed to investigate clinical symptoms, findings of lung CT scan, and absorbed dose to the patients. Methods: This cross-sectional descriptive study was conducted in two CT scan centers in Hamadan: Besat and Sina. CT images of 163 patients with positive real-time polymerase chain reaction (PCR) tests were interpreted by six experienced radiologists. Volume CT dose index (CTDIvol), dose length product (DLP), and effective dose were calculated in both centers and compared using the Mann-Whitney statistical test. Results: The most common findings in the CT images were ground-glass opacification (GGO), consolidation, and the combination of GGO and consolidation. CTDIvol, DLP, and effective dose to the patients were respectively 1.64±5.24 mGy, 177.12±59.03 mGy.cm, and 3.01±1.00 mSv in Sina hospital and 4.58±1.91 mGy, and 2.60±1.02 mSv in Besat hospital. The difference between quantities in the two centers was statistically significant (P&gt;0.05). Conclusion: The most common findings in lung CT images of patients with positive polymerase chain reaction (PCR) tests were GGO and consolidation. Furthermore, there were differences in radiation dose to patients between hospitals, indicating the need for optimization.

An Advanced Lung Carcinoma Prediction and Risk Screening Model Using Transfer Learning.

Lung cancer, also known as lung carcinoma, has a high death rate, but an early diagnosis can substantially reduce this risk. In the current era, prediction models face challenges such as low accuracy, excessive noise, and low contrast. To resolve these problems, an advanced lung carcinoma prediction and risk screening model using transfer learning is proposed. Our proposed model initially preprocesses lung computed tomography images for noise removal, contrast stretching, convex hull lung region extraction, and edge enhancement. The next phase segments the preprocessed images using the modified Bates distribution coati optimization (B-RGS) algorithm to extract key features. The PResNet classifier then categorizes the cancer as normal or abnormal. For abnormal cases, further risk screening determines whether the risk is low or high. Experimental results depict that our proposed model performs at levels similar to other state-of-the-art models, achieving enhanced accuracy, precision, and recall rates of 98.21%, 98.71%, and 97.46%, respectively. These results validate the efficiency and effectiveness of our suggested methodology in early lung carcinoma prediction and risk assessment.

Detection of Covid‐19 disease by using privacy‐aware artificial intelligence system

AbstractCovid‐19 is a highly infectious respiratory disease that spreads quickly between individuals and has been recognized as a pandemic by the World Health Organization (WHO). Chest x‐ray images, lung computed tomography images, and polymerase chain reaction tests are generally used to diagnose this disease by the doctors. Nevertheless, manual diagnosis of Covid‐19 disease is laborious and requires highly experienced professionals. Therefore, automated systems are always needed to assist doctors in their diagnostic decisions. In the field of medicine and healthcare, artificial intelligence and deep learning currently offer incredibly effective and rapid automatic decision‐support systems. Since sensitive data is used to diagnose Covid‐19, privacy has become a major concern in research that uses artificial intelligence and deep learning. In order to eliminate these issues, this paper proposes a novel deep learning model that privately detects Covid‐19 disease. The proposed model utilizes differential privacy technique to provide data privacy and convolutional neural network to diagnose Covid‐19 disease. The performance of the proposed model was evaluated through experiments conducted on five different datasets, resulting a maximum accuracy rate of 97%.

Hybrid Artificial Intelligence Approach to COVID-19 Diagnosis from CT Images: Deep Networks and Classification Analysis

Using lung images obtained by computed tomography (CT), this study aims to detect coronavirus (Covid-19) disease with deep learning (DL) techniques. The study included 751 lung CT images from 118 Covid-19 patients and 628 lung CT images from 100 healthy individuals. In total, 70% of the 1379 images were used for training and 30% for testing. In the study, two different methods were proposed on the same dataset. In the first method, the images were trained on AlexNet, VGG-16, VGG-19, GoogleNet and a proposed network. The performance metrics obtained from the five networks were compared and it was observed that the proposed network achieved the highest accuracy value with 95.61%. In the second method, the images were trained on VGG-16, VGG-19, DenseNet-121, ResNet-50 and MobileNet networks. Among the image features obtained from each of these networks, the best 1000 features were selected by Principal Component Analysis (PCA). The best 1000 features were classified with Random Forest (RF) and Support Vector Machines (SVM). According to the classification results, the best 1000 features selected from the features extracted by the VGG-16 and MobileNet networks were obtained with the highest accuracy rate of 93.94% using SVM. It is thought that this study can be a helpful tool in the diagnosis of Covid-19 disease while reducing time and labor costs with the use of artificial intelligence (AI).

Predominance of A2063G mutant strains in the Mycoplasma pneumoniae epidemic in children: A clinical and epidemiological study in 2023 in Wuhan, China

ObjectivesThe prevalence of respiratory infectious diseases has changed in the post-COVID-19 epidemic era, and mycoplasma pneumoniae (MP) infection in children has attracted wide attention. MethodsChildren hospitalized for pneumonia in Wuhan, China, in 2023 were enrolled. Respiratory secretions were obtained for the targeted next-generation sequencing (tNGS) including mutation of MP. Pulmonary inflammation was divided into bronchopneumonia and pulmonary consolidation/atelectasis according to lung computed tomography imaging. ResultsOf the 667 pediatric pneumonia, 478 were MP positive (72%). The positive rate of MP detected by tNGS increased from April, and MP had become the primary pathogen of pneumonia in children in 2023. The 23S rRNA mutations were all A2063G, accounting for 85% of detected MP. The clinical symptoms of the mutant and wild-type strains were similar, with half of them experiencing atelectasis and lung consolidation. Early bronchoscopic lavage combined with azithromycin in pediatric pulmonary consolidation was an effective therapy strategy, which could be an alternative selection to MP pneumonia treatment. ConclusionsA2063G mutant strain MP was the primary pathogen of mycoplasma pneumoniae in children recently, which was often complicated by extra-pulmonary symptoms and complications.

SM-GRSNet: sparse mapping-based graph representation segmentation network for honeycomb lung lesion

Objective. Honeycomb lung is a rare but severe disease characterized by honeycomb-like imaging features and distinct radiological characteristics. Therefore, this study aims to develop a deep-learning model capable of segmenting honeycomb lung lesions from Computed Tomography (CT) scans to address the efficacy issue of honeycomb lung segmentation. Methods. This study proposes a sparse mapping-based graph representation segmentation network (SM-GRSNet). SM-GRSNet integrates an attention affinity mechanism to effectively filter redundant features at a coarse-grained region level. The attention encoder generated by this mechanism specifically focuses on the lesion area. Additionally, we introduce a graph representation module based on sparse links in SM-GRSNet. Subsequently, graph representation operations are performed on the sparse graph, yielding detailed lesion segmentation results. Finally, we construct a pyramid-structured cascaded decoder in SM-GRSNet, which combines features from the sparse link-based graph representation modules and attention encoders to generate the final segmentation mask. Results. Experimental results demonstrate that the proposed SM-GRSNet achieves state-of-the-art performance on a dataset comprising 7170 honeycomb lung CT images. Our model attains the highest IOU (87.62%), Dice(93.41%). Furthermore, our model also achieves the lowest HD95 (6.95) and ASD (2.47). Significance. The SM-GRSNet method proposed in this paper can be used for automatic segmentation of honeycomb lung CT images, which enhances the segmentation performance of Honeycomb lung lesions under small sample datasets. It will help doctors with early screening, accurate diagnosis, and customized treatment. This method maintains a high correlation and consistency between the automatic segmentation results and the expert manual segmentation results. Accurate automatic segmentation of the honeycomb lung lesion area is clinically important.

Lung computed tomography image enhancement using U‐Net segmentation

AbstractThe goal of image enhancement methods is to improve image's quality. The efficacy of U‐net is evident through its extensive utilization across various significant image modalities, involving computed tomography (CT) scans, magnetic resonance imaging, X‐rays, and microscopy. In this study, we provided a novel and efficient strategy to improve lung CT images based on segmentation using U‐Net architecture. Subsequently, contrast enhancement was performed using adaptive histogram equalization and dark channel prior methods. Finally, the lightness of the lung CT image was enhanced using nonlinear mapping. The contrast enhancement performance of the suggested method is quantified by various measures like the average gradient, mean of the local standard deviation, contrast enhancement measure, and structural similarity index. The performance of the suggested method is compared against other methods, and the results indicate that the suggested method achieves better quality measures of 23.4907, 55.20341, 0.961674, and 0.4143 for the four performance metrics.

Bi-level Analysis of Computed Tomography Images of Malignant Pleural Mesothelioma: Deep Learning-Based Classification and Subsequent Three-Dimensional Reconstruction

Abstract A bi-level analysis of computed tomography (CT) images of malignant pleural mesothelioma (MPM) is presented in this paper, starting with a deep learning-based system for classification, followed by a three-dimensional (3D) reconstruction method. MPM is a highly aggressive cancer caused by asbestos exposure, and accurate diagnosis and determination of the tumor’s volume are crucial for effective treatment. The proposed system employs a bi-level approach, utilizing machine learning and deep learning techniques to classify CT lung images and subsequently calculate the tumor’s volume. The study addresses challenges related to deep neural networks, such as the requirement for large and diverse datasets, hyperparameter optimization, and potential data bias. To evaluate performance, two convolutional neural network (CNN) architectures, Inception-v3 and ResNet-50, were compared in terms of their features and performance. Based on CT images, the second stage incorporates 3D volume reconstruction. The process is carried out by cropping, registering, filtering, and segmenting images. This study demonstrated the efficacy of the developed system by combining CNN optimizations with 3D image reconstruction. It is intended to improve the accuracy of MPM diagnosis and to assist in the determination of chemotherapy doses, both of which may result in improved outcomes for patients.

Segmentation and classification of lungs CT-scan for detecting COVID-19 abnormalities by deep learning technique: U-Net model.

Artificial intelligence (AI) techniques have been ascertained useful in the analysis and description of infectious areas in radiological images promptly. Our aim in this study was to design a web-based application for detecting and labeling infected tissues on CT (computed tomography) lung images of patients based on the deep learning (DL) method as a type of AI. The U-Net architecture, one of the DL networks, is used as a hybrid model with pre-trained densely connected convolutional network 121 (DenseNet121) architecture for the segmentation process. The proposed model was constructed on 1031 persons' CT-scan images from Ibn Sina Hospital of Iran in 2021 and some publicly available datasets. The network was trained using 6000 slices, validated on 1000 slices images, and tested against the 150 slices. Accuracy, sensitivity, specificity, and area under the receiver operating characteristics (ROC) curve (AUC) were calculated to evaluate model performance. The results indicate the acceptable ability of the U-Net-DenseNet121 model in detecting COVID-19 abnormality (accuracy = 0.88 and AUC = 0.96 for thresholds of 0.13 and accuracy = 0.88 and AUC = 0.90 for thresholds of 0.2). Based on this model, we developed the "Imaging-Tech" web-based application for use at hospitals and clinics to make our project's output more practical and attractive in the market. We designed a DL-based model for the segmentation of COVID-19 CT scan images and, based on this model, constructed a web-based application that, according to the results, is a reliable detector for infected tissue in lung CT-scans. The availability of such tools would aid in automating, prioritizing, fastening, and broadening the treatment of COVID-19 patients globally.

Deep-Learning Reconstruction of High-Resolution CT Improves Interobserver Agreement for the Evaluation of Pulmonary Fibrosis.

Objective: This study aimed to investigate whether deep-learning reconstruction (DLR) improves interobserver agreement in the evaluation of honeycombing for patients with interstitial lung disease (ILD) who underwent high-resolution computed tomography (CT) compared with hybrid iterative reconstruction (HIR). Methods: In this retrospective study, 35 consecutive patients suspected of ILD who underwent CT including the chest region were included. High-resolution CT images of the unilateral lung with DLR and HIR were reconstructed for the right and left lungs. A radiologist placed regions of interest on the lung and measured standard deviation of CT attenuation (i.e., quantitative image noise). In the qualitative image analyses, 5 blinded readers assessed the presence of honeycombing and reticulation, qualitative image noise, artifacts, and overall image quality using a 5-point scale (except for artifacts which was evaluated using a 3-point scale). Results: The quantitative and qualitative image noise in DLR was remarkably reduced compared to that in HIR (P < .001). Artifacts and overall DLR quality were significantly improved compared to those of HIR (P < .001 for 4 out of 5 readers). Interobserver agreement in the evaluations of honeycombing and reticulation for DLR (0.557 [0.450-0.693] and 0.525 [0.470-0.541], respectively) were higher than those for HIR (0.321 [0.211-0.520] and 0.470 [0.354-0.533], respectively). A statistically significant difference was found for honeycombing (P = .014). Conclusions: DLR improved interobserver agreement in the evaluation of honeycombing in patients with ILD on CT compared to HIR.

CHDNet: A lightweight weakly supervised segmentation network for lung CT image

Deep learning methods have ushered in an unprecedented transformation in medical image segmentation by automating the segmentation of computed tomography (CT) slices. However, challenges persist in the application of these deep learning methods, including models with a high number of training parameters which hinder their clinical deployment and practical use. Furthermore, acquiring a large volume of high-quality labels from radiologists for training is prohibitively expensive. In light of these challenges, this paper introduces a weakly supervised method aimed at addressing the scarcity of high-quality labels by annotating only a small subset of pixels within regions of interest. This strategy expedites the labeling process, requiring just a few seconds to complete. Additionally, we present a lightweight segmentation model designed to minimize computational complexity. By incorporating parallel dilated convolutions and depthwise separable convolutions, this model consists of 11.03M parameters and can segment lesions in lung CT slices in just 0.05 s, showcasing high segmentation efficiency. To capture shape and size information from point labels, we propose a Convex-Hull-based Segmentation (CHS) loss function. This loss function empowers our weakly supervised model to approximate the performance of a fully supervised model when evaluated against point labels. We conduct a comprehensive evaluation, comparing our proposed method with other state-of-the-art methods using multiple metrics on public datasets. The experimental results demonstrate a significant improvement in performance compared to current state-of-the-art (SOTA) point label segmentation methods, with an increase of 19.08% in Intersection over Union (IoU), 20.54% in Dice Similarity Coefficient (DSC), 2.60% in sensitivity, and 1.33% in specificity. In comparison to the SOTA fully supervised methods, our approach exhibits a minimal IoU difference of just 2.1%. Further ablation experiments validate the effectiveness of the key methodologies introduced in this work.

Feasibility of high-frequency percussions in people with severe acquired brain injury and tracheostomy: an observational study.

People with severe acquired brain injury (pwSABI) frequently experience pulmonary complications. Among these, atelectasis can occur as a result of pneumonia, thus increasing the chance of developing acute respiratory failure. Respiratory physiotherapy contribution to the management of atelectasis in pwSABI is yet poorly understood. We conducted a retrospective analysis on 15 non-cooperative pwSABI with tracheostomy and spontaneously breathing, hospitalized and treated with high-frequency percussion physiotherapy between September 2018 and February 2021 at the Neurological Rehabilitation Unit of the IRCCS "S.Maria Nascente - Fondazione Don Gnocchi", Milan. Our primary aim was to investigate the feasibility of such a physiotherapy intervention method. Then, we assessed changes in respiratory measures (arterial blood gas analysis and peripheral night-time oxygen saturation) and high-resolution computed tomography lung images, evaluated before and after the physiotherapy treatment. The radiological measures were a modified radiological atelectasis score (mRAS) assigned by two radiologists, and an opacity score automatically provided by the software CT Pneumonia Analysis® that identifies the regions of abnormal lung patterns. Treatment diaries showed that all treatments were completed, and no adverse events during treatment were registered. Among the 15 pwSABI analyzed, 8 were treated with IPV® and 7 with MetaNeb®. After a median of 14 (I-III quartile=12.5-14.5) days of treatment, we observed a statistical improvement in various arterial blood gas measures and peripheral night-time oxygen saturation measures. We also found radiological improvement or stability in more than 80% of pwSABI. In conclusion, our physiotherapy approach was feasible, and we observed respiratory parameters and radiological improvements. Using technology to assess abnormal tomographic patterns could be of interest to disentangle the short-term effects of respiratory physiotherapy on non-collaborating people.

Enhancing brain metastasis prediction in non-small cell lung cancer: a deep learning-based segmentation and CT radiomics-based ensemble learning model

BackgroundBrain metastasis (BM) is most common in non-small cell lung cancer (NSCLC) patients. This study aims to enhance BM risk prediction within three years for advanced NSCLC patients by using a deep learning-based segmentation and computed tomography (CT) radiomics-based ensemble learning model.MethodsThis retrospective study included 602 stage IIIA-IVB NSCLC patients, 309 BM patients and 293 non-BM patients, from two centers. Patients were divided into a training cohort (N = 376), an internal validation cohort (N = 161) and an external validation cohort (N = 65). Lung tumors were first segmented by using a three-dimensional (3D) deep residual U-Net network. Then, a total of 1106 radiomics features were computed by using pretreatment lung CT images to decode the imaging phenotypes of primary lung cancer. To reduce the dimensionality of the radiomics features, recursive feature elimination configured with the least absolute shrinkage and selection operator (LASSO) regularization method was applied to select the optimal image features after removing the low-variance features. An ensemble learning algorithm of the extreme gradient boosting (XGBoost) classifier was used to train and build a prediction model by fusing radiomics features and clinical features. Finally, Kaplan‒Meier (KM) survival analysis was used to evaluate the prognostic value of the prediction score generated by the radiomics–clinical model.ResultsThe fused model achieved area under the receiver operating characteristic curve values of 0.91 ± 0.01, 0.89 ± 0.02 and 0.85 ± 0.05 on the training and two validation cohorts, respectively. Through KM survival analysis, the risk score generated by our model achieved a significant prognostic value for BM-free survival (BMFS) and overall survival (OS) in the two cohorts (P < 0.05).ConclusionsOur results demonstrated that (1) the fusion of radiomics and clinical features can improve the prediction performance in predicting BM risk, (2) the radiomics model generates higher performance than the clinical model, and (3) the radiomics-clinical fusion model has prognostic value in predicting the BMFS and OS of NSCLC patients.

End-to-end Prediction of EGFR Mutation Status with Denseformer.

Accurate genotyping of the epidermal growth factor receptor (EGFR) is critical for the treatment planning of lung adenocarcinoma. Currently, clinical identification of EGFR genotyping highly relies on biopsy and sequence testing which is invasive and complicated. Recent advancements in the integration of computed tomography (CT) imagery with deep learning techniques have yielded a non-invasive and straightforward way for identifying EGFR profiles. However, there are still many limitations for further exploration: 1) most of these methods still require physicians to annotate tumor boundaries, which are time-consuming and prone to subjective errors; 2) most of the existing methods are simply borrowed from computer vision field which does not sufficiently exploit the multi-level features for final prediction. To solve these problems, we propose a Denseformer framework to identify EGFR mutation status in a real end-to-end fashion directly from 3D lung CT images. Specifically, we take the 3D whole-lung CT images as the input of the neural network model without manually labeling the lung nodules. This is inspired by the medical report that the mutational status of EGFR is associated not only with the local tumor nodules but also with the microenvironment surrounded by the whole lung. Besides, we design a novel Denseformer network to fully explore the distinctive information across the different level features. The Denseformer is a novel network architecture that combines the advantages of both convolutional neural network (CNN) and Transformer. Denseformer directly learns from the 3D whole-lung CT images, which preserves the spatial location information in the CT images. To further improve the model performance, we designed a combined Transformer module. This module employs the Transformer Encoder to globally integrate the information of different levels and layers and use them as the basis for the final prediction. The proposed model has been tested on a lung adenocarcinoma dataset collected at the Affiliated Hospital of Zunyi Medical University. Extensive experiments demonstrated the proposed method can effectively extract meaningful features from 3D CT images to make accurate predictions. Compared with other state-of-the-art methods, Denseformer achieves the best performance among current methods using deep learning to predict EGFR mutation status based on a single modality of CT images.