Computer-aided Detection System Research Articles

Prior tuberculosis, radiographic lung abnormalities and prevalent diabetes in rural South Africa

BackgroundGrowing evidence suggests that chronic inflammation caused by tuberculosis (TB) may increase the incidence of diabetes. However, the relationship between post-TB pulmonary abnormalities and diabetes has not been well characterized.MethodsWe analyzed data from a cross-sectional study in KwaZulu-Natal, South Africa, of people 15 years and older who underwent chest X-ray and diabetes screening with hemoglobin A1c testing. The analytic sample was restricted to persons with prior TB, defined by either (1) a self-reported history of TB treatment, (2) radiologist-confirmed prior TB on chest radiography, and (3) a negative sputum culture and GeneXpert. Chest X-rays of all participants were evaluated by the study radiologist to determine the presence of TB lung abnormalities. To assess the relationships between our outcome of interest, prevalent diabetes (HBA1c ≥6.5%), and our exposure of interest, chest X-ray abnormalities, we fitted logistic regression models adjusted for potential clinical and demographic confounders. In secondary analyses, we used the computer-aided detection system CAD4TB, which scores X-rays from 10 to 100 for detection of TB disease, as our exposure interest, and repeated analyses with a comparator group that had no history of TB disease.ResultsIn the analytic cohort of people with prior TB (n = 3,276), approximately two-thirds (64.9%) were women, and the average age was 50.8 years (SD 17.4). The prevalence of diabetes was 10.9%, and 53.0% of people were living with HIV. In univariate analyses, there was no association between diabetes prevalence and radiologist chest X-ray abnormalities (OR 1.23, 95%CI 0.95–1.58). In multivariate analyses, the presence of pulmonary abnormalities was associated with an 29% reduction in the odds of prevalent diabetes (aOR 0.71, 95%CI 0.53–0.97, p = 0.030). A similar inverse relationship was observed for diabetes with each 10-unit increase in the CAD4TB chest X-ray scores among people with prior TB (aOR 0.92, 95%CI 0.87–0.97; p = 0.002), but this relationship was less pronounced in the no TB comparator group (aOR 0.96, 95%CI 0.94–0.99).ConclusionsAmong people with prior TB, pulmonary abnormalities on digital chest X-ray are inversely associated with prevalent diabetes. The severity of radiographic post-TB lung disease does not appear to be a determinant of diabetes in this South African population.

Deep Learning-Based Localization and Detection of Malpositioned Nasogastric Tubes on Portable Supine Chest X-Rays in Intensive Care and Emergency Medicine: A Multi-center Retrospective Study.

Malposition of a nasogastric tube (NGT) can lead to severe complications. We aimed to develop a computer-aided detection (CAD) system to localize NGTs and detect NGT malposition on portable chest X-rays (CXRs). A total of 7378 portable CXRs were retrospectively retrieved from two hospitals between 2015 and 2020. All CXRs were annotated with pixel-level labels for NGT localization and image-level labels for NGT presence and malposition. In the CAD system, DeepLabv3 + with backbone ResNeSt50 and DenseNet121 served as the model architecture for segmentation and classification models, respectively. The CAD system was tested on images from chronologically different datasets (National Taiwan University Hospital (National Taiwan University Hospital)-20), geographically different datasets (National Taiwan University Hospital-Yunlin Branch (YB)), and the public CLiP dataset. For the segmentation model, the Dice coefficients indicated accurate delineation of the NGT course (National Taiwan University Hospital-20: 0.665, 95% confidence interval (CI) 0.630-0.696; National Taiwan University Hospital-Yunlin Branch: 0.646, 95% CI 0.614-0.678). The distance between the predicted and ground-truth NGT tips suggested accurate tip localization (National Taiwan University Hospital-20: 1.64 cm, 95% CI 0.99-2.41; National Taiwan University Hospital-Yunlin Branch: 2.83 cm, 95% CI 1.94-3.76). For the classification model, NGT presence was detected with high accuracy (area under the receiver operating characteristic curve (AUC): National Taiwan University Hospital-20: 0.998, 95% CI 0.995-1.000; National Taiwan University Hospital-Yunlin Branch: 0.998, 95% CI 0.995-1.000; CLiP dataset: 0.991, 95% CI 0.990-0.992). The CAD system also detected NGT malposition with high accuracy (AUC: National Taiwan University Hospital-20: 0.964, 95% CI 0.917-1.000; National Taiwan University Hospital-Yunlin Branch: 0.991, 95% CI 0.970-1.000) and detected abnormal nasoenteric tube positions with favorable performance (AUC: 0.839, 95% CI 0.807-0.869). The CAD system accurately localized NGTs and detected NGT malposition, demonstrating excellent potential for external generalizability.

Greater benefits of deep learning-based computer-aided detection systems for finding small signals in 3D volumetric medical images.

Radiologists are tasked with visually scrutinizing large amounts of data produced by 3D volumetric imaging modalities. Small signals can go unnoticed during the 3D search because they are hard to detect in the visual periphery. Recent advances in machine learning and computer vision have led to effective computer-aided detection (CADe) support systems with the potential to mitigate perceptual errors. Sixteen nonexpert observers searched through digital breast tomosynthesis (DBT) phantoms and single cross-sectional slices of the DBT phantoms. The 3D/2D searches occurred with and without a convolutional neural network (CNN)-based CADe support system. The model provided observers with bounding boxes superimposed on the image stimuli while they looked for a small microcalcification signal and a large mass signal. Eye gaze positions were recorded and correlated with changes in the area under the ROC curve (AUC). The CNN-CADe improved the 3D search for the small microcalcification signal ( , ) and the 2D search for the large mass signal ( , ). The CNN-CADe benefit in 3D for the small signal was markedly greater than in 2D ( , ). Analysis of individual differences suggests that those who explored the least with eye movements benefited the most from the CNN-CADe ( , ). However, for the large signal, the 2D benefit was not significantly greater than the 3D benefit ( , ). The CNN-CADe brings unique performance benefits to the 3D (versus 2D) search of small signals by reducing errors caused by the underexploration of the volumetric data.

Greater benefits of deep learning-based computer-aided detection systems for finding small signals in 3D volumetric medical images.

Radiologists are tasked with visually scrutinizing large amounts of data produced by 3D volumetric imaging modalities. Small signals can go unnoticed during the 3D search because they are hard to detect in the visual periphery. Recent advances in machine learning and computer vision have led to effective computer-aided detection (CADe) support systems with the potential to mitigate perceptual errors. Sixteen nonexpert observers searched through digital breast tomosynthesis (DBT) phantoms and single cross-sectional slices of the DBT phantoms. The 3D/2D searches occurred with and without a convolutional neural network (CNN)-based CADe support system. The model provided observers with bounding boxes superimposed on the image stimuli while they looked for a small microcalcification signal and a large mass signal. Eye gaze positions were recorded and correlated with changes in the area under the ROC curve (AUC). The CNN-CADe improved the 3D search for the small microcalcification signal ( , ) and the 2D search for the large mass signal ( , ). The CNN-CADe benefit in 3D for the small signal was markedly greater than in 2D ( , ). Analysis of individual differences suggests that those who explored the least with eye movements benefited the most from the CNN-CADe ( , ). However, for the large signal, the 2D benefit was not significantly greater than the 3D benefit ( , ). The CNN-CADe brings unique performance benefits to the 3D (versus 2D) search of small signals by reducing errors caused by the underexploration of the volumetric data.

Pneumonia prediction using deep learning in chest X-ray Images

Pneumonia, a potentially fatal lung disease caused by viral or bacterial infection, poses challenges in diagnosis from chest X-ray images due to similarities with other lung infections. This research aims to develop a computer-aided system for pneumonia detection in children, enhancing diagnostic accuracy. In this paper, five established deep learning models such as VGG-16, VGG-19, ResNet-50, Inception-V3, Xception pre-trained on ImageNet have been used. These models have been applied on the chest X-ray dataset to optimize performance. Xception provides recall, specificity, accuracy and AUC of 97.43%, 91.02%, 95.06% and 94.23%, respectively.

REAL-Colon: A dataset for developing real-world AI applications in colonoscopy

Detection and diagnosis of colon polyps are key to preventing colorectal cancer. Recent evidence suggests that AI-based computer-aided detection (CADe) and computer-aided diagnosis (CADx) systems can enhance endoscopists' performance and boost colonoscopy effectiveness. However, most available public datasets primarily consist of still images or video clips, often at a down-sampled resolution, and do not accurately represent real-world colonoscopy procedures. We introduce the REAL-Colon (Real-world multi-center Endoscopy Annotated video Library) dataset: a compilation of 2.7 M native video frames from sixty full-resolution, real-world colonoscopy recordings across multiple centers. The dataset contains 350k bounding-box annotations, each created under the supervision of expert gastroenterologists. Comprehensive patient clinical data, colonoscopy acquisition information, and polyp histopathological information are also included in each video. With its unprecedented size, quality, and heterogeneity, the REAL-Colon dataset is a unique resource for researchers and developers aiming to advance AI research in colonoscopy. Its openness and transparency facilitate rigorous and reproducible research, fostering the development and benchmarking of more accurate and reliable colonoscopy-related algorithms and models.

VER-Net: a hybrid transfer learning model for lung cancer detection using CT scan images

BackgroundLung cancer is the second most common cancer worldwide, with over two million new cases per year. Early identification would allow healthcare practitioners to handle it more effectively. The advancement of computer-aided detection systems significantly impacted clinical analysis and decision-making on human disease. Towards this, machine learning and deep learning techniques are successfully being applied. Due to several advantages, transfer learning has become popular for disease detection based on image data.MethodsIn this work, we build a novel transfer learning model (VER-Net) by stacking three different transfer learning models to detect lung cancer using lung CT scan images. The model is trained to map the CT scan images with four lung cancer classes. Various measures, such as image preprocessing, data augmentation, and hyperparameter tuning, are taken to improve the efficacy of VER-Net. All the models are trained and evaluated using multiclass classifications chest CT images.ResultsThe experimental results confirm that VER-Net outperformed the other eight transfer learning models compared with. VER-Net scored 91%, 92%, 91%, and 91.3% when tested for accuracy, precision, recall, and F1-score, respectively. Compared to the state-of-the-art, VER-Net has better accuracy.ConclusionVER-Net is not only effectively used for lung cancer detection but may also be useful for other diseases for which CT scan images are available.

Optical diagnosis in still images of colorectal polyps: comparison between expert endoscopists and PolyDeep, a Computer-Aided Diagnosis system

BackgroundPolyDeep is a computer-aided detection and classification (CADe/x) system trained to detect and classify polyps. During colonoscopy, CADe/x systems help endoscopists to predict the histology of colonic lesions.ObjectiveTo compare the diagnostic performance of PolyDeep and expert endoscopists for the optical diagnosis of colorectal polyps on still images.MethodsPolyDeep Image Classification (PIC) is an in vitro diagnostic test study. The PIC database contains NBI images of 491 colorectal polyps with histological diagnosis. We evaluated the diagnostic performance of PolyDeep and four expert endoscopists for neoplasia (adenoma, sessile serrated lesion, traditional serrated adenoma) and adenoma characterization and compared them with the McNemar test. Receiver operating characteristic curves were constructed to assess the overall discriminatory ability, comparing the area under the curve of endoscopists and PolyDeep with the chi- square homogeneity areas test.ResultsThe diagnostic performance of the endoscopists and PolyDeep in the characterization of neoplasia is similar in terms of sensitivity (PolyDeep: 89.05%; E1: 91.23%, p=0.5; E2: 96.11%, p<0.001; E3: 86.65%, p=0.3; E4: 91.26% p=0.3) and specificity (PolyDeep: 35.53%; E1: 33.80%, p=0.8; E2: 34.72%, p=1; E3: 39.24%, p=0.8; E4: 46.84%, p=0.2). The overall discriminative ability also showed no statistically significant differences (PolyDeep: 0.623; E1: 0.625, p=0.8; E2: 0.654, p=0.2; E3: 0.629, p=0.9; E4: 0.690, p=0.09). In the optical diagnosis of adenomatous polyps, we found that PolyDeep had a significantly higher sensitivity and a significantly lower specificity. The overall discriminative ability of adenomatous lesions by expert endoscopists is significantly higher than PolyDeep (PolyDeep: 0.582; E1: 0.685, p < 0.001; E2: 0.677, p < 0.0001; E3: 0.658, p < 0.01; E4: 0.694, p < 0.0001).ConclusionPolyDeep and endoscopists have similar diagnostic performance in the optical diagnosis of neoplastic lesions. However, endoscopists have a better global discriminatory ability than PolyDeep in the optical diagnosis of adenomatous polyps.

Assessment of the role of false-positive alerts in computer-aided polyp detection for assistance capabilities.

False positives (FPs) pose a significant challenge in the application of artificial intelligence (AI) for polyp detection during colonoscopy. The study aimed to quantitatively evaluate the impact of computer-aided polyp detection (CADe) systems' FPs on endoscopists. The model's FPs were categorized into four gradients: 0-5, 5-10, 10-15, and 15-20 FPs per minute (FPPM). Fifty-six colonoscopy videos were collected for a crossover study involving 10 endoscopists. Polyp missed rate (PMR) was set as primary outcome. Subsequently, to further verify the impact of FPPM on the assistance capability of AI in clinical environments, a secondary analysis was conducted on a prospective randomized controlled trial (RCT) from Renmin Hospital of Wuhan University in China from July 1 to October 15, 2020, with the adenoma detection rate (ADR) as primary outcome. Compared with routine group, CADe reduced PMR when FPPM was less than 5. However, with the continuous increase of FPPM, the beneficial effect of CADe gradually weakens. For secondary analysis of RCT, a total of 956 patients were enrolled. In AI-assisted group, ADR is higher when FPPM≤5 compared with FPPM>5 (CADe group: 27.78% vs 11.90%; P=0.014; odds ratio [OR], 0.351; 95% confidence interval [CI], 0.152-0.812; COMBO group: 38.40% vs 23.46%, P=0.029; OR, 0.427; 95% CI, 0.199-0.916). After AI intervention, ADR increased when FPPM≤5 (27.78% vs 14.76%; P=0.001; OR, 0.399; 95% CI, 0.231-0.690), but no statistically significant difference was found when FPPM>5 (11.90% vs 14.76%, P=0.788; OR, 1.111; 95% CI, 0.514-2.403). The level of FPs of CADe does affect its effectiveness as an aid to endoscopists, with its best effect when FPPM is less than 5.

Medical image Classification using Transfer Learning: Convolutional Neural Network Models approach

A relatively low life expectancy in their greatest grade is caused by more debilitating diseases in the medical sector. Any kind of misdiagnosis may lead to improper medical intervention and lower the likelihood that a patient will survive. Making an appropriate treatment plan to cure and enhance the quality of life for patients suffering from any kind of illness starts with an accurate diagnosis. Convolutional neural networks and computer-aided disease detection systems have produced success stories and advanced the science of machine learning significantly. Compared to more conventional neural network layers, the deep convolutional layers automatically extract significant and reliable characteristics from the input space. Within the suggested structure, we use two convolutional neural network architectures (VGG16 and VGG19) to perform two types of medical imaging (x-ray and MRI) investigations in order to categorize brain tumors as normal and up normal as well as classify x-ray pneumonia or normal. The transfer learning strategies by VGG16 and vgg19 models that is, using MRI and x-ray to fine-tune and freeze are then examined in each investigation. In order to increase dataset samples and decrease the likelihood of over-fitting, data augmentation techniques are performed to MRI slices and x-rays for results that can be more broadly utilized. In the proposed studies, the fine-tune VGG19, VGG16 architecture attained highest accuracy up to 0.95with x-ray and 0.80 respectively. The accuracy0.98 used MRI in terms of classification and detection with VGG19.

Artificial intelligence for dysplasia detection during surveillance colonoscopy in patients with ulcerative colitis: A cross-sectional, non-inferiority, diagnostic test comparison study

Background and study aimHigh-definition virtual chromoendoscopy, along with targeted biopsies, is recommended for dysplasia surveillance in ulcerative colitis patients at risk for colorectal cancer. Computer-aided detection (CADe) systems aim to improve colonic adenoma detection, however their efficacy in detecting polyps and adenomas in this context remains unclear. This study evaluates the CADe Discovery™ system's effectiveness in detecting colonic dysplasia in ulcerative colitis patients at risk for colorectal cancer. Patients and methodsA prospective cross-sectional, non-inferiority, diagnostic test comparison study was conducted on ulcerative colitis patients undergoing colorectal cancer surveillance colonoscopy between January 2021 and April 2021. Patients underwent virtual chromoendoscopy (VCE) with iSCAN 1 and 3 with optical enhancement. One endoscopist, blinded to CADe Discovery™ system results, examined colon sections, while a second endoscopist concurrently reviewed CADe images. Suspicious areas detected by both techniques underwent resection. Proportions of dysplastic lesions and patients with dysplasia detected by VCE or CADe were calculated. ResultsFifty-two patients were included, and 48 lesions analyzed. VCE and CADe each detected 9 cases of dysplasia (21.4% and 20.0%, respectively; p=0.629) in 8 patients and 7 patients (15.4% vs. 13.5%, respectively; p=0.713). Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for dysplasia detection using VCE or CADe were 90% and 90%, 13% and 5%, 21% and 2%, 83% and 67%, and 29.2% and 22.9%, respectively. ConclusionsThe CADe Discovery™ system shows similar diagnostic performance to VCE with iSCAN in detecting colonic dysplasia in ulcerative colitis patients at risk for colorectal cancer.

Deep learning-based computer-aided diagnosis system for the automatic detection and classification of lateral cervical lymph nodes on original ultrasound images of papillary thyroid carcinoma: a prospective diagnostic study.

This study aims to develop a deep learning-based computer-aided diagnosis (CAD) system for the automatic detection and classification of lateral cervical lymph nodes (LNs) on original ultrasound images of papillary thyroid carcinoma (PTC) patients. A retrospective data set of 1801 cervical LN ultrasound images from 1675 patients with PTC and a prospective test set including 185 images from 160 patients were collected. Four different deep leaning models were trained and validated in the retrospective data set. The best model was selected for CAD system development and compared with three sonographers in the retrospective and prospective test sets. The Deformable Detection Transformer (DETR) model showed the highest diagnostic efficacy, with a mean average precision score of 86.3% in the retrospective test set, and was therefore used in constructing the CAD system. The detection performance of the CAD system was superior to the junior sonographer and intermediate sonographer with accuracies of 86.3% and 92.4% in the retrospective and prospective test sets, respectively. The classification performance of the CAD system was better than all sonographers with the areas under the curve (AUCs) of 94.4% and 95.2% in the retrospective and prospective test sets, respectively. This study developed a Deformable DETR model-based CAD system for automatically detecting and classifying lateral cervical LNs on original ultrasound images, which showed excellent diagnostic efficacy and clinical utility. It can be an important tool for assisting sonographers in the diagnosis process.

The use of a real-time computer-aided detection system for visible lesions in the Barrett’s esophagus during live endoscopic procedures, a pilot study

In this pilot study we evaluated performance of a recently developed computer-aided detection (CADe) system for Barrett's neoplasia during live endoscopic procedures. 15 patients with and 15 without a visible lesion were included in this study. A CAD assisted workflow was employed that included: a slow pullback video recording of the entire Barrett's segment with live CADe assistance, followed by CADe assisted level-based video recordings every 2cm of the Barrett's segment. Outcomes were per patient and per level diagnostic accuracy of the CAD assisted workflow, where the primary outcome was per patient in-vivo CADe sensitivity. In the per patient analyses, the CADe system detected all visible lesions (sensitivity 100%). Per patient CADe specificity was 53%. Per-level sensitivity and specificity of the CADe assisted workflow were 100% and 73%, respectively. In this pilot study, the CADe system detected all potentially neoplastic lesions in Barrett's esophagus comparable to an expert endoscopist. Continued refinement of the system may improve specificity. External validation in larger multicenter studies is planned.

The application of mammography imaging in the diagnosis and prediction of breast diseases

Breast diseases pose a significant threat to women’s health, so early detection and treatment are extremely important. In this context, early disease identification has become crucial in the diagnosis and treatment of breast diseases. This paper begins by outlining the pivotal role of mammography in the early diagnosis of breast cancer, comparing the structural similarities and differences between normal and diseased breast tissues. This comparison underscores the primary role of mammography in the diagnosis and treatment of breast diseases. Additionally, our paper provides an overview of fundamental concepts related to breast cancer detection, diagnosis, and prediction systems. It delves into the latest research developments in auxiliary diagnostic detection, examination, and risk prediction systems associated with breast cancer. Our objective is to offer a comprehensive understanding of the role of computer-aided detection, diagnosis, and prediction systems in breast diseases, fostering further development and application. This work aims to explore and drive innovation in the field, enhance early detection rates of breast diseases, and guide readers towards novel directions, thus contributing to female healthcare management.

Robustness evaluation of deep neural networks for endoscopic image analysis: Insights and strategies

Computer-aided detection and diagnosis systems (CADe/CADx) in endoscopy are commonly trained using high-quality imagery, which is not representative for the heterogeneous input typically encountered in clinical practice. In endoscopy, the image quality heavily relies on both the skills and experience of the endoscopist and the specifications of the system used for screening. Factors such as poor illumination, motion blur, and specific post-processing settings can significantly alter the quality and general appearance of these images. This so-called domain gap between the data used for developing the system and the data it encounters after deployment, and the impact it has on the performance of deep neural networks (DNNs) supportive endoscopic CAD systems remains largely unexplored. As many of such systems, for e.g. polyp detection, are already being rolled out in clinical practice, this poses severe patient risks in particularly community hospitals, where both the imaging equipment and experience are subject to considerable variation. Therefore, this study aims to evaluate the impact of this domain gap on the clinical performance of CADe/CADx for various endoscopic applications. For this, we leverage two publicly available data sets (KVASIR-SEG and GIANA) and two in-house data sets. We investigate the performance of commonly-used DNN architectures under synthetic, clinically calibrated image degradations and on a prospectively collected dataset including 342 endoscopic images of lower subjective quality. Additionally, we assess the influence of DNN architecture and complexity, data augmentation, and pretraining techniques for improved robustness. The results reveal a considerable decline in performance of 11.6% (±1.5) as compared to the reference, within the clinically calibrated boundaries of image degradations. Nevertheless, employing more advanced DNN architectures and self-supervised in-domain pre-training effectively mitigate this drop to 7.7% (±2.03). Additionally, these enhancements yield the highest performance on the manually collected test set including images with lower subjective quality. By comprehensively assessing the robustness of popular DNN architectures and training strategies across multiple datasets, this study provides valuable insights into their performance and limitations for endoscopic applications. The findings highlight the importance of including robustness evaluation when developing DNNs for endoscopy applications and propose strategies to mitigate performance loss.

FCCS-Net: Breast cancer classification using Multi-Level fully Convolutional-Channel and spatial attention-based transfer learning approach

Breast cancer ranks among one of the most lethal cancer varieties among the many types that exist. Timely detection is paramount, as late diagnosis can exacerbate its severity. Computer-aided detection systems can complement the clinician in early decision-making. Therefore, in this study, a multi-level, complete convolution-driven attention-based transfer learning approach named ‘FCCS-Net’ has been proposed, for breast cancer classification. In contrast to the shared multi-layer perceptron (MLP)-based attention mechanism, the proposed approach employs a fully convolutional attention mechanism to focus the important cellular features in inter-channel and intra-channel feature space. This proposed attention is applied across multiple levels of a pre-trained ResNet18 model, supplemented with additional residual connections. The performance of the proposed FCCS-Net is tested on publicly available datasets such as ‘BreakHis’,‘IDC’ and ‘BACH’, containing breast cancer histopathology images. On the BreakHis dataset, the proposed method achieves accuracy rates of 99.25%, 98.32%, 99.50%, and 96.98% at 40X, 100X, 200X, and 400X optical zoom levels, respectively. In the case of the IDC dataset, a classification accuracy of 90.58% is attained at 40X magnifications, whereas with BACH dataset 91.25% average classification accuracy has been obtained. These findings establish the robustness and efficacy of the FCCS-Net in detecting breast cancer through histopathology images. The area focused by each attention layer has also been visually explained. The integration of multi-level, fully convolutional attention with supplementary residual connections holds the potential to advance breast cancer detection methodologies. The relevant PyTorch code for implementing the FCCS-Net model can be accessed at https://github.com/maurya123ritesh47/FCCS-Net.

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

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.

Revolutionizing gastric cancer diagnosis through advanced machine learning approaches

<p class="Keywords">Early detection of gastric cancer through a Computer-Aided Detection (CAD) system has the potential to significantly reduce the mortality rate associated with this disease. This study aims to investigate the effects of class imbalance on the performance of machine learning classifiers in this context. Using a dataset of 145,787 screening records from NHS Liverpool Hospital, we employed stratified sampling to create balanced and unbalanced datasets and evaluated the performance of four machine learning algorithms—Logistic Regression, Support Vector Machine, Naive Bayes, and Multilayer Perceptron—under five different test conditions. The study’s novelty lies in its detailed examination of class imbalance in gastric cancer diagnosis, emphasizing the crucial role of balanced datasets in machine learning-based early detection systems. For the MLP model under 10-fold cross-validation, the Class 0 sensitivity (non-cancer cases) of the unbalanced dataset was 0.968, higher than the balanced dataset’s 0.902. However, the Class 1 sensitivity (cancer cases) and Positive Predictive Value (PPV) of the unbalanced dataset were much lower (0.383 and 0.527) than those of the balanced dataset (0.959 and 0.907), indicating a significant improvement in identifying true positive cases when using a balanced dataset. These findings highlight the negative effect of class imbalance on prediction accuracy for positive cancer cases and underscore the importance of addressing this imbalance for more reliable and accurate predictions in medical diagnosis and screening. This approach has the potential to improve patient outcomes and may contribute to strategies aimed at reducing the mortality rate associated with gastric cancer.</p>

A computer-aided polyp detection system in screening and surveillance colonoscopy: an international, multicentre, randomised, tandem trial

Studies on the effect of computer-aided detection (CAD) in a daily clinical screening and surveillance colonoscopy population practice are scarce. The aim of this study was to evaluate a novel CAD system in a screening and surveillance colonoscopy population. This multicentre, randomised, controlled trial was done in ten hospitals in Europe, the USA, and Israel by 31 endoscopists. Patients referred for non-immunochemical faecal occult blood test (iFOBT) screening or surveillance colonoscopy were included. Patients were randomomly assigned to CAD-assisted colonoscopy or conventional colonoscopy; a subset was further randomly assigned to undergo tandem colonoscopy: CAD followed by conventional colonoscopy or conventional colonoscopy followed by CAD. Primary objectives included adenoma per colonoscopy (APC) and adenoma per extraction (APE). Secondary objectives included adenoma miss rate (AMR) in the tandem colonoscopies. The study was registered at ClinicalTrials.gov, NCT04640792. A total of 916 patients were included in the modified intention-to-treat analysis: 449 in the CAD group and 467 in the conventional colonoscopy group. APC was higher with CAD compared with conventional colonoscopy (0·70 vs 0·51, p=0·015; 314 adenomas per 449 colonoscopies vs 238 adenomas per 467 colonoscopies; poisson effect ratio 1·372 [95% CI 1·068-1·769]), while showing non-inferiority of APE compared with conventional colonoscopy (0·59 vs 0·66; p<0·001 for non-inferiority; 314 of 536 extractions vs 238 of 360 extractions). AMR in the 127 (61 with CAD first, 66 with conventional colonoscopy first) patients completing tandem colonoscopy was 19% (11 of 59 detected during the second pass) in the CAD first group and 36% (16 of 45 detected during the second pass) in the conventional colonoscopy first group (p=0·024). CAD increased adenoma detection in non-iFOBT screening and surveillance colonoscopies and reduced adenoma miss rates compared with conventional colonoscopy, without an increase in the resection of non-adenomatous lesions. Magentiq Eye.

Deep learning-based lung nodule detection: a review

CT scan acquisition is fast and cost-effective and has become the main lung imaging tool. However, the increase in large numbers of CT scans has placed a heavy burden on radiologists; therefore, automated lung nodule detection techniques are needed to reduce the workload of radiologists and computer-aided detection systems are proposed for further accurate diagnosis of the condition. This review provides a comprehensive overview of recent automated lung nodule detection techniques and challenges, etc., as well as a detailed overview and discussion of current research gaps, future developments, and research trends. Relevant articles published in databases such as IEEE Xplore, Science Direct, PubMed, and Web of Science cover research algorithms published from 2014 to 2023, mainly discussing deep learning-based techniques. The schemes presented in these articles, the databases used, the experimental results, and the performance of the algorithms are compared and discussed. This work aims to introduce researchers and readers to the latest techniques and their advances in the detection of lung nodules in the last decade, which will help researchers and radiologists to further understand the latest techniques in this field.