Conventional Visual Examination Research Articles

Diagnosis of Pressure Ulcer Stage Using On-Device AI

Pressure ulcers are serious healthcare concerns, especially for the elderly with reduced mobility. Severe pressure ulcers are accompanied by pain, degrading patients’ quality of life. Thus, speedy and accurate detection and classification of pressure ulcers are vital for timely treatment. The conventional visual examination method requires professional expertise for diagnosing pressure ulcer severity but it is difficult for the lay carer in domiciliary settings. In this study, we present a mobile healthcare platform incorporated with a light-weight deep learning model to exactly detect pressure ulcer regions and classify pressure ulcers into six severities such as stage 1–4, deep tissue pressure injury, and unstageable. YOLOv8 models were trained and tested using 2800 annotated pressure ulcer images. Among the five tested YOLOv8 models, the YOLOv8m model exhibited promising detection performance with overall classification accuracy of 84.6% and a mAP@50 value of 90.8%. The mobile application (app) was also developed applying the trained YOLOv8m model. The mobile app returned the diagnostic result within a short time (≒3 s). Accordingly, the proposed on-device AI app can contribute to early diagnosis and systematic management of pressure ulcers.

Utilizing a Pathomics Biomarker to Predict the Effectiveness of Bevacizumab in Ovarian Cancer Treatment.

The purpose of this investigation is to develop and initially assess a quantitative image analysis scheme that utilizes histopathological images to predict the treatment effectiveness of bevacizumab therapy in ovarian cancer patients. As a widely accessible diagnostic tool, histopathological slides contain copious information regarding underlying tumor progression that is associated with tumor prognosis. However, this information cannot be readily identified by conventional visual examination. This study utilizes novel pathomics technology to quantify this meaningful information for treatment effectiveness prediction. Accordingly, a total of 9828 features were extracted from segmented tumor tissue, cell nuclei, and cell cytoplasm, which were categorized into geometric, intensity, texture, and subcellular structure features. Next, the best performing features were selected as the input for SVM (support vector machine)-based prediction models. These models were evaluated on an open dataset containing a total of 78 patients and 288 whole slides images. The results indicated that the sufficiently optimized, best-performing model yielded an area under the receiver operating characteristic (ROC) curve of 0.8312. When examining the best model's confusion matrix, 37 and 25 cases were correctly predicted as responders and non-responders, respectively, achieving an overall accuracy of 0.7848. This investigation initially validated the feasibility of utilizing pathomics techniques to predict tumor responses to chemotherapy at an early stage.

Inter-observer agreement among specialists in the diagnosis of oral potentially malignant disorders and oral cancer using store-and-forward technology.

Oral cancer is a leading cause of morbidity and mortality. Screening and mobile Health (mHealth)-based approach facilitates early detection remotely in a resource-limited settings. Recent advances in eHealth technology have enabled remote monitoring and triage to detect oral cancer in its early stages. Although studies have been conducted to evaluate the diagnostic efficacy of remote specialists, to our knowledge, no studies have been conducted to evaluate the consistency of remote specialists. The aim of this study was to evaluate interobserver agreement between specialists through telemedicine systems in real-world settings using store-and-forward technology. The two remote specialists independently diagnosed clinical images (n=822) from image archives. The onsite specialist diagnosed the same participants using conventional visual examination, which was tabulated. The diagnostic accuracy of two remote specialists was compared with that of the onsite specialist. Images that were confirmed histopathologically were compared with the onsite diagnoses and the two remote specialists. There was moderate agreement (k= 0.682) between two remote specialists and (k= 0.629) between the onsite specialist and two remote specialists in the diagnosis of oral lesions. The sensitivity and specificity of remote specialist 1 were 92.7% and 83.3%, respectively, and those of remote specialist 2 were 95.8% and 60%, respectively, each compared with histopathology. The diagnostic accuracy of the two remote specialists was optimal, suggesting that "store and forward" technology and telehealth can be an effective tool for triage and monitoring of patients. Telemedicine is a good tool for triage and enables faster patient care in real-world settings.

Improving the Diagnostic Performance by Adding Methylation Marker to Conventional Visual Examination in Identifying Oral Cancer.

Background: Visual oral examination (VOE) is a conventional oral cancer screening method. This study aimed to evaluate the value of methylation marker to assist VOE in identifying oral epithelial dysplasia and oral squamous cell carcinoma (OED/OSCC) from non-cancerous lesions in a real-world situation. Methods: 201 patients with high-risk personal habits who self-perceived oral anomaly were VOE examined, ZNF582 methylation (ZNF582m) tested, and histologically diagnosed. Results: Among them, 132 patients (65.7%) were histologically diagnosed OED/OSCC. Using VOE, 56.1% OED/OSCC patients had possible oral cancer, whereas 37.7% non-OED/OSCC patients had leukoplakia. ZNF582m-positive was detected in 90.2% OED/OSCC patients and 44.9% non-OED/OSCC patients. Various logistic regression models were postulated to evaluate the diagnostic performance of conventional VOE and new strategies using ZNF582m. ROC analysis and its corresponding C-index demonstrated that either triage or co-testing models of VOE and ZNF582m could improve diagnostic performance and discriminative abilities compared with the VOE only approach. Conclusions: In conclusion, methylation marker test shows equivalent performance to an experienced judgment by oral maxillofacial surgeons and plays a significantly supplementary role in increasing the efficacy in identifying oral malignant lesions. ZNF582m may be an especially important tool for family physicians or general dentists to properly diagnose suspicious oral lesions.

A non-invasive imaging approach for improved assessments on the construction and the condition of historical knotted-pile carpets

The appraisal of the design and the weaving structure of Islamic knotted-pile carpets can tell plenty about the context in which they were produced, and the identification of signs of deterioration can help to establish their condition. These are often somewhat imprecise and laborious examinations, especially when considering carpets of large dimensions. Analytical methods that support these disciplines urge further exploration so that improved interpretations can be obtained. An interdisciplinary combination of art history, analytical science and textile conservation aimed, on the one hand, to improve the weaving examination of these complex textile objects – by considering the spin of threads and the ply of yarns; the knot count and density; and the weaving structure of warps, wefts and piles – and on the other, to help their condition assessment – by mapping of damaged areas, old repairs and contaminations. For this purpose, the possibilities and limitations of several non-invasive imaging techniques, namely transmitted, raking or incident visible, ultraviolet (UV) and infrared (IR) illumination through Visual Spectral Comparator (VSC), as well as conventional X-radiography, mammography and (micro) CT scanning, were assessed to support the conventional visual examination of the weaving details and present condition of two 17th-century Safavid knotted-pile carpet fragments. Observation with NUV and NIR imaging with VSC, as well as CT techniques, offered enriching overviews about weaving characteristics, damaged areas or contaminations that were not easily discernible with the naked eye, thus supporting the conventional visual examination. As a result, detailed digital mappings about the technological structure and the condition of the fragments could be obtained in a relatively efficient and accessible way. Moreover, combining art historical identification of the design with the analysis of the weaving structure confirmed that both carpet fragments are border corners that originally belonged to much larger carpets made in the so-called “Indo-Persian” style. The outcome of this interdisciplinary research brings very useful contributions for future art historical and conservation assessments of historical carpets, and it encourages further exploration of imaging techniques in the examination of other textile objects in museums and private collections.

Comparative efficacy of chemiluminescence and toluidine blue in the detection of potentially malignant and malignant disorders of the oral cavity.

Context:Early detection of oral cancer is of paramount importance in determining the prognosis of oral cancer. Literature suggests that several diagnostic modalities have been proposed to aid a clinician in early detection of oral cancer without much conclusive evidence.Aims:The present study aims to compare toluidine blue and chemiluminescence screening methods in early detection of carcinoma in North Indian population and also to evaluate these methods with histopathological diagnosis.Methods:In this prospective study, 42 patients with clinically visible premalignant lesions were included. Demographic data were collected, and suspicious lesions were examined by chemiluminescence light (Vizilite) and followed by local application of toluidine blue (Mashberg's recommendation). Findings were recorded for each lesion under standard incandescent light as positive or negative. Biopsy and histopathological analysis of the tissues were performed.Statistical Analysis:Sensitivity, specificity and positive and negative predictive values for the chemiluminescence technique and toluidine blue were calculated for diagnostic tests.Results and Conclusions:In the present study, toluidine blue test was found to be moderately sensitive (63.33%) whereas chemiluminescence test (Vizilite) was found to be highly sensitive (90%); however, the test has limited specificity (50%). Thus, the study concluded that both toluidine blue and Vizilite can be used as an adjunct to simple, conventional visual examination and in screening procedure for oral potentially malignant disorders.

Current Practice and Emerging Molecular Imaging Technologies in Oral Cancer Screening.

Oral cancer is one of the most common cancers globally. Survival rates for patients are directly correlated with stage of diagnosis; despite this knowledge, 60% of individuals are presenting with late-stage disease. Currently, the initial evaluation of a questionable lesion is performed by a conventional visual examination with white light. If a lesion is deemed suspicious, a biopsy is taken for diagnosis. However, not all lesions present suspicious under visual white light examination, and there is limited specificity in differentiating between benign and malignant transformations. Several vital dyes, light-based detection systems, and cytology evaluation methods have been formulated to aid in the visualization process, but their lack of specific biomarkers resulted in high false-positive rates and thus limits their reliability as screening and guidance tools. In this review, we will analyze the current methodologies and demonstrate the need for specific intraoral imaging agents to aid in screening and diagnosis to identify patients earlier. Several novel molecular imaging agents will be presented as, by result of their molecular targeting, they aim to have high specificity for tumor pathways and can support in identifying dysplastic/cancerous lesions and guiding visualization of biopsy sites. Imaging agents that are easy to use, inexpensive, noninvasive, and specific can be utilized to increase the number of patients who are screened and monitored in a variety of different environments, with the ultimate goal of increasing early detection.

Ex vivo assessment of the potency of optical coherence tomography for the detection of early occlusal caries

This study aimed to evaluate the potency of optical coherence tomography (OCT) to detect early occlusal caries compared with clinical visual examination. Approximately 97 sites of occlusal fissures on 77 extracted accessional human teeth were scored by three examiners using conventional visual examination and OCT. Results of histological examination on these sites obtained by polarimicroscope served as a gold standard to analyze the sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV). Results of the area under receiver operating characteristic (ROC) curve (AUC) by visual examination and OCT were also analyzed. The Spearman's rank correlation coefficient with histology and the inter-examiner reliability were compared. For sites of enamel demineralization limited to the outer 1/2 of the enamel layer, the detection rate of OCT (14/25) was obviously higher than that of the clinical and visual examination (3/25). SE, SP, PPV and NPV of OCT during diagnosis of the early occlusal caries (0.83, 0.64, 0.87 and 0.57) were higher than that of the visual examination (0.79, 0.60, 0.85 and 0.50). AUC (95%CI) of OCT and the visual examination were 0.737 (0.569-0.822) and 0.696 (0.614-0.859), respectively. No statistically significant difference was observed between the results. Results of OCT correlated well with histology (r=0.559, P<0.05). The inter-examiner reliability of OCT was medium. OCT can accurately detect early occlusal lesions atraumatically with high sensitivity and effectiveness. OCT exhibits the potential of auxiliary clinical diagnosis enhancing detection rate and finally implementing early diagnosis and early intervention of early occlusal lesions in clinical practice.

Efficacy of light based detection systems for early detection of oral cancer and oral potentially malignant disorders: Systematic review.

BackgroundEarlier detection of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) is essential for dental professionals to improve patient survival rates. The aim of this systematic review is to to evaluate the effectiveness of devices that utilise the principles of chemiluminescence and tissue autofluorescence as adjuncts in the detection of OSCC and OPMD.Material and MethodsThe electronic retrieval systems and databases searched for relevant articles were PubMed [MEDLINE] and Science direct. The search was for limited articles published in English or with an English abstract and articles published during the period from January 2005 to April 2014. Clinical trials utilized ViziLite, Microlux TM/DL and Visual Enhanced Light scope (VELscope) for early detection of OPMD and OSCC.ResultsTwenty primary studies published satisfied our criteria for selection - 10 utilised chemiluminescence and 10 tissue autofluorescence. Senstivity of Vizilite for detecting OSCC nad OPMD ranged from 77.1 % to 100% and specificity was low that ranged from 0% to 27.8%.Most have shown that chemiluminescence increases the brightness and margins of oral mucosal white lesions and thus assist in identification of mucosal lesions not considered under Conventional visual examination. However, it preferentially detects leukoplakia and may fail to spot red patches. Clinical trials demonstrated that sensitivity of VELscope in detecting malignancy and OPMD ranged from 22 % to 100 % and specificity ranged from 16 % to 100%. Most studies concluded that VELscope can help the experienced clinician to find oral precursor malignant lesions. But it couldnot differentiate between dysplasia and benign inflammatory conditions.ConclusionsBoth devices are simple, non-invasive test of the oral mucosa but are suited for clinicians with sufficient experience and training. More clinical trials in future should be conducted to establish optical imaging as an efficacious adjunct tool in early diagnosis of OSCC and OPMD. Key words:Oral cancer, early diagnosis, potentially malignant disorders, chemiluminescence, tissue autofluorescence, VELscope, ViziLite plus.

Analysis of oral lesion biopsies identified and evaluated by visual examination, chemiluminescence and toluidine blue

Conventional visual examination and palpation remains the gold-standard for the identification of oral mucosal lesions. The purpose of this study was to investigate the adjunctive value of a chemiluminescent light source (ViziLite, Zila Pharmaceuticals, Phoenix, Arizona) and application of pharmaceutical grade toluidine blue (TBlue(630), Zila Pharmaceuticals, Phoenix, Arizona) to further assess lesions identified during the conventional oral soft tissue examination. Lesions deemed clinically suspicious by visual examination under incandescent light were further assessed under chemiluminescence and then application of toluidine blue stain. Differences between the conventional visual examination and chemiluminescent examination were noted on four characteristics which may aid in lesion identification. Tissue retention of toluidine blue stain was documented. Each suspicious lesion was biopsied and diagnosed based upon routine histopathology. Both adjunctive exams were evaluated by comparing the histologic diagnosis. The additive value of toluidine blue stain retention was assessed in lesions diagnosed as "serious pathology" defined as severe dysplasia, carcinoma in situ and squamous cell carcinoma. Ninety-seven clinically suspicious lesions in 84 patients were identified. The chemiluminescent exam improved the brightness and/or sharpness of margin in 61.8% of identified lesions. Biopsied lesions with toluidine blue stain retention reduced the false positive rate by 55.26% while maintaining a 100% negative predictive value (NPV). Chemiluminescence was shown to increase the brightness and margins of mucosal lesions in a majority of cases and therefore may assist in identification of mucosal lesions not considered under traditional visual examination. Toluidine blue stain retention was associated with a large reduction in biopsies showing benign histology (false positive biopsy results), while maintaining a 100% NPV for the presence of severe dysplasia or cancer. Practitioners may consider use of these adjuncts in practice, however the results presented are based upon experienced providers in referral centers for mucosal disease or cancer centers and therefore positive findings may be an indication for referral to experienced providers.

The present and future use of technology to detect plant pathogens to guide disease control in sustainable farming systems

As the control of any disease is most effective and economical if addressed at its onset, there is a need to detect potential epidemics before they decrease yields in sustainable farming systems. Diagnostic tests to detect plant pathogens are now based on a number of diverse technologies, yet to be effective a procedure must be simple, accurate, rapid and safe to perform, and be sensitive enough to avoid ‘false positives’. These technologies have developed as considerable skill is required to identify, quantify or even detect the presence of pathogens at the start of an outbreak even when the final symptoms of a disease are frequently conspicuous. Although highly sensitive methods of diagnosis may not be as fast or simple as the conventional visual examination of crop plants for disease symptoms, little training is required to generate routinely reliable results. Since no method of identifying pathogens or diseases is unrivalled in both reliability and simplicity, many diagnostic methods will probably continue to co-exist in some form in the future. In practice, different methods of diagnosing plant disease are often used in a complementary way rather than as alternatives. It is uncertain how much the traditional methods, such as identification by visual inspection of pathogens in situ or in vitro in pure cultures by microscopic examination, will decline as methods based on the molecular biology of pathogens become more prevalent. Electronic communication and retrieval systems are also likely to become useful.

Automatic detection of spike-and-wave bursts in ambulatory EEG recordings

The spike-and-wave detection scheme described in this report is based on the recognition of groups of spikes and sharp waves with loosely defined temporal and inter-channel relationships; presence of a slow wave is required only with spikes of low amplitude. Particular attention is paid to artefacts. This method allows the detection of classical 3/sec spike-and-wave activity as well as irregular patterns. The analysis produces a standard EEG tracing containing only the detected bursts, allowing conventional visual examination by an electroencephalographer. After interactive editing of false detections, a quantitative display of burst distribution can be obtained. The rate of false detections due to artefacts or non-epileptiform patterns was evaluated on eight 20 h cassette recordings; an average of 2.4–10 false detections were made per hour. When tested against hand-scoring by two EEGers of eight 2 h recordings which included very irregular spike-and-wave patterns, the computer detected 70% of the spike-and-wave activity identified by both readers (i.e., 30% false negatives), while 12% of the computer detections were not identified by either reader (false positives). The context in which such a computer method with imperfect performance can be clinically useful is discussed.

Optimal speed as a function of system performance for continuous flow analyzers

The limitation to high rates of sample throughput with continuous flow automated analyzers is unacceptably high sample-to-sample carry-over. Previous programs for carry-over correction have involved relatively large computer capacities. Here, the simple expression derived for carry-over can be easily programmed in BASIC for a Commodore PET operating in real time. The program includes peak picking and calculation of the calibration graph and sample concentrations. At 240 samples per hour, the results obtained for total protein (linear calibration graph) and haptoglobin (non-linear calibration plot) showed acceptable precision and recovery and correlated well with the same determination conducted at normal operating speeds. Standard Auto Analyzer equipment was used througout. A parameter which monitors the instrument function is also calculated; this replaces the conventional visual examination of the curve for function monitoring. At high sample rates with degraded curves, visual curve examination is not effective.