Lung Nodules In Chest Radiographs Research Articles

Development and Validation of a Deep Learning–Based Synthetic Bone-Suppressed Model for Pulmonary Nodule Detection in Chest Radiographs

Dual-energy chest radiography exhibits better sensitivity than single-energy chest radiography, partly due to its ability to remove overlying anatomical structures. To develop and validate a deep learning-based synthetic bone-suppressed (DLBS) nodule-detection algorithm for pulmonary nodule detection on chest radiographs. This decision analytical modeling study used data from 3 centers between November 2015 and July 2019 from 1449 patients. The DLBS nodule-detection algorithm was trained using single-center data (institute 1) of 998 chest radiographs. The DLBS algorithm was validated using 2 external data sets (institute 2, 246 patients; and institute 3, 205 patients). Statistical analysis was performed from March to December 2021. DLBS nodule-detection algorithm. The nodule-detection performance of DLBS model was compared with the convolution neural network nodule-detection algorithm (original model). Reader performance testing was conducted by 3 thoracic radiologists assisted by the DLBS algorithm or not. Sensitivity and false-positive markings per image (FPPI) were compared. Training data consisted of 998 patients (539 men [54.0%]; mean [SD] age, 54.2 [9.82] years), and 2 external validation data sets consisted of 246 patients (133 men [54.1%]; mean [SD] age, 55.3 [8.7] years) and 205 patients (105 men [51.2%]; mean [SD] age, 51.8 [9.1] years). Using the external validation data set of institute 2, the bone-suppressed model showed higher sensitivity compared with that of the original model for nodule detection (91.5% [109 of 119] vs 79.8% [95 of 119]; P < .001). The overall mean of FPPI with the bone-suppressed model was reduced compared with the original model (0.07 [17 of 246] vs 0.09 [23 of 246]; P < .001). For the observer performance testing with the data of institute 3, the mean sensitivity of 3 radiologists was 77.5% (95% [CI], 69.9%-85.2%), whereas that of radiologists assisted by DLBS modeling was 92.1% (95% CI, 86.3%-97.3%; P < .001). The 3 radiologists had a reduced number of FPPI when assisted by the DLBS model (0.071 [95% CI, 0.041-0.111] vs 0.151 [95% CI, 0.111-0.210]; P < .001). This decision analytical modeling study found that the DLBS model was more sensitive to detecting pulmonary nodules on chest radiographs compared with the original model. These findings suggest that the DLBS model could be beneficial to radiologists in the detection of lung nodules in chest radiographs without need of the specialized equipment or increase of radiation dose.

A narrative review of deep learning applications in lung cancer research: from screening to prognostication.

Background and ObjectiveDeep learning (DL) algorithms have been developed for various tasks, including lung nodule detection on chest radiographs or lung cancer computed tomography screening, potential candidate selection in lung cancer screening, malignancy prediction for indeterminate pulmonary nodules, lung cancer staging, treatment response prediction, prognostication, and prediction of genetic mutations in lung cancer. Furthermore, these DL algorithms have been applied in various clinical settings in order for them to be generalized in real-world clinical practice. Multiple DL algorithms have been corroborated to be on par with experts or current clinical prediction models for several specific tasks. However, no article has yet comprehensively reviewed DL algorithms dedicated to lung cancer research. This narrative review presents an overview of the literature dealing with DL techniques applied in lung cancer research and briefly summarizes the results according to the DL algorithms’ clinical use cases.Methodswe performed a narrative review by searching the Embase and OVID-MEDLINE databases for articles published in English from October, 2016 until September, 2021 and reviewing the bibliographies of key references to identify important literature related to DL in lung cancer research. The background, development, results, and clinical implications of each DL algorithm are briefly discussed. Lastly, we end this review article by highlighting future directions in lung cancer research using DL techniques.Key Content and FindingsDL algorithms have been introduced to show comparable or higher performance than human experts in various clinical settings. Specifically, they have been actively applied to detect lung nodules in chest radiographs or computed tomography (CT) examinations, optimize candidate selection for lung cancer screening (LCS), predict the malignancy of lung nodules, stage lung cancer, and predict treatment response, patients’ prognoses, and genetic mutations in lung cancers.ConclusionsDL algorithms have corroborated their potential value for various tasks, ranging from lung cancer screening to prognostication of lung cancer patients. Future research is warranted for the clinical application of these algorithms in daily clinical practice and verification of their real-world clinical usefulness.

Separation of bones from soft tissue in chest radiographs: Anatomy-specific orientation-frequency-specific deep neural network convolution.

Lung nodules that are missed by radiologists as well as by computer-aided detection (CAD) systems mostly overlap with ribs and clavicles. Removing the bony structures would result in better visualization of undetectable lesions. Our purpose in this study was to develop a virtual dual-energy imaging system to separate ribs and clavicles from soft tissue in chest radiographs. We developed a mixture of anatomy-specific, orientation-frequency-specific (ASOFS) deep neural network convolution (NNC) experts. Anatomy-specific (AS) NNC was designed to separate the bony structures from soft tissue in different lung segments. While an AS design was proposed previously under our massive-training artificial neural networks (MTANN) framework, in this work, we newly mathematically defined an AS experts model as well as its learning and inference strategies in a probabilistic deep-learning framework. In addition, in combination with our AS experts design, we newly proposed the orientation-frequency-specific (OFS) NNC models to decompose bone and soft-tissue structures into specific orientation-frequency components of different scales using a multi-resolution decomposition technique. We trained multiple NNC models, each of which is an expert for a specific orientation-frequency component in a particular anatomic segment. Perfect reconstruction discrete wavelet transform was used for OFS decomposition/reconstruction, while we introduced a soft-gating layer to merge the predictions of AS NNC experts. To train our model, we used the bone images obtained from a dual-energy system as the target (or teaching) images while the standard chest radiographs were used as the input to our model. The training, validation, and test were performed in a nested two-fold cross-validation manner. We used a database of 118 chest radiographs with pulmonary nodules to evaluate our NNC scheme. In order to evaluate our scheme, we performed quantitative and qualitative evaluation of the predicted bone and soft-tissue images from our model as well as the ones of a state-of-the-art technique where the "gold-standard" dual-energy bone and soft-tissue images were used as the reference images. Both quantitative and qualitative evaluations demonstrated that our ASOFS NNC was superior to the state-of-the-art bone-suppression technique. Particularly, our scheme was better able to maintain the conspicuity of nodules and lung vessels, comparing to the reference technique, while it separated ribs and clavicles from soft tissue. Comparing to a state-of-the-art bone suppression technique, our bone images had substantially higher (t-test; P<0.01) similarity, in terms of structural similarity index (SSIM) and peak signal-to-noise ratio (PSNR), to the "gold-standard" dual-energy bone images. Our deep ASOFS NNC scheme can decompose chest radiographs into their bone and soft-tissue images accurately, offering the improved conspicuity of lung nodules and vessels, and therefore would be useful for radiologists as well as CAD systems in detecting lung nodules in chest radiographs.

Learning to detect chest radiographs containing pulmonary lesions using visual attention networks.

Machine learning approaches hold great potential for the automated detection of lung nodules on chest radiographs, but training algorithms requires very large amounts of manually annotated radiographs, which are difficult to obtain. The increasing availability of PACS (Picture Archiving and Communication System), is laying the technological foundations needed to make available large volumes of clinical data and images from hospital archives. Binary labels indicating whether a radiograph contains a pulmonary lesion can be extracted at scale, using natural language processing algorithms. In this study, we propose two novel neural networks for the detection of chest radiographs containing pulmonary lesions. Both architectures make use of a large number of weakly-labelled images combined with a smaller number of manually annotated x-rays. The annotated lesions are used during training to deliver a type of visual attention feedback informing the networks about their lesion localisation performance. The first architecture extracts saliency maps from high-level convolutional layers and compares the inferred position of a lesion against the true position when this information is available; a localisation error is then back-propagated along with the softmax classification error. The second approach consists of a recurrent attention model that learns to observe a short sequence of smaller image portions through reinforcement learning; the reward function penalises the exploration of areas, within an image, that are unlikely to contain nodules. Using a repository of over 430,000 historical chest radiographs, we present and discuss the proposed methods over related architectures that use either weakly-labelled or annotated images only.

Performance Evaluation of Super-Resolution Methods Using Deep-Learning and Sparse-Coding for Improving the Image Quality of Magnified Images in Chest Radiographs

Purpose: To detect small diagnostic signals such as lung nodules in chest radiographs, radiologists magnify a region-of-interest using linear interpolation methods. However, such methods tend to generate over-smoothed images with artifacts that can make interpretation difficult. The purpose of this study was to investigate the effectiveness of super-resolution methods for improving the image quality of magnified chest radiographs. Materials and Methods: A total of 247 chest X-rays were sampled from the JSRT database, then divided into 93 training cases with non-nodules and 154 test cases with lung nodules. We first trained two types of super-resolution methods, sparse-coding super-resolution (ScSR) and super-resolution convolutional neural network (SRCNN). With the trained super-resolution methods, the high-resolution image was then reconstructed using the super-resolution methods from a low-resolution image that was down-sampled from the original test image. We compared the image quality of the super-resolution methods and the linear interpolations (nearest neighbor and bilinear interpolations). For quantitative evaluation, we measured two image quality metrics: peak signal-to-noise ratio (PSNR) and structural similarity (SSIM). For comparative evaluation of the super-resolution methods, we measured the computation time per image. Results: The PSNRs and SSIMs for the ScSR and the SRCNN schemes were significantly higher than those of the linear interpolation methods (p < 0.001 or p < 0.05). The image quality differences between the super-resolution methods were not statistically significant. However, the SRCNN computation time was significantly faster than that of ScSR (p < 0.001). Conclusion: Super-resolution methods provide significantly better image quality than linear interpolation methods for magnified chest radiograph images. Of the two tested schemes, the SRCNN scheme processed the images fastest; thus, SRCNN could be clinically superior for processing radiographs in terms of both image quality and processing speed.

A parameterized logarithmic image processing method with Laplacian of Gaussian filtering for lung nodule enhancement in chest radiographs.

The enhancement of lung nodules in chest radiographs (CXRs) plays an important role in the manual as well as computer-aided detection (CADe) lung cancer. In this paper, we proposed a parameterized logarithmic image processing (PLIP) method combined with the Laplacian of a Gaussian (LoG) filter to enhance lung nodules in CXRs. We first applied several LoG filters with varying parameters to an original CXR to enhance the nodule-like structures as well as the edges in the image. We then applied the PLIP model, which can enhance lung nodule images with high contrast and was beneficial in extracting effective features for nodule detection in the CADe scheme. Our method combined the advantages of both the PLIP algorithm and the LoG algorithm, which can enhance lung nodules in chest radiographs with high contrast. To test our nodule enhancement method, we tested a CADe scheme, with a relatively high performance in nodule detection, using a publically available database containing 140 nodules in 140 CXRs enhanced through our nodule enhancement method. The CADe scheme attained a sensitivity of 81 and 70% with an average of 5.0 frame rate (FP) and 2.0 FP, respectively, in a leave-one-out cross-validation test. By contrast, the CADe scheme based on the original image recorded a sensitivity of 77 and 63% at 5.0 FP and 2.0 FP, respectively. We introduced the measurement of enhancement by entropy evaluation to objectively assess our method. Experimental results show that the proposed method obtains an effective enhancement of lung nodules in CXRs for both radiologists and CADe schemes.

Bone suppressed images improve radiologists’ detection performance for pulmonary nodules in chest radiographs

ObjectivesTo assess the effect of bone suppression imaging on observer performance in detecting lung nodules in chest radiographs. Materials and methodsPosteroanterior (PA) and lateral digital chest radiographs of 111 (average age 65) patients with a CT proven solitary nodule (median diameter 15mm), and 189 (average age 63) controls were read by 5 radiologists and 3 residents. Conspicuity of nodules on the radiographs was classified in obvious (n=32), moderate (n=32), subtle (n=29) and very subtle (n=18). Observers read the PA and lateral chest radiographs without and with an additional PA bone suppressed image (BSI) (ClearRead Bone Suppression 2.4, Riverain Technologies, Ohio) within one reading session. Multi reader multi case (MRMC) receiver operating characteristics (ROC) were used for statistical analysis. ResultsROC analysis showed improved detection with use of BSI compared to chest radiographs alone (AUC=0.883 versus 0.855; p=0.004). Performance also increased at high specificities exceeding 80% (pAUC=0.136 versus 0.124; p=0.0007). Operating at a specificity of 90%, sensitivity increased with BSI from 66% to 71% (p=0.0004). Increase of detection performance was highest for nodules with moderate and subtle conspicuity (p=0.02; p=0.03). ConclusionBone suppressed images improve radiologists’ detection performance for pulmonary nodules, especially for those of moderate and subtle conspicuity.

A nonparametric-based rib suppression method for chest radiographs

This paper presents an automated and comprehensive system for eliminating rib shadows in chest radiographs, which integrates lung field identification, rib segmentation, rib intensity estimation, and suppression. We designed a region of interest (ROI)-based method to estimate a suitable initial lung boundary for active shape model (ASM) deformation by determining the translation and scaling parameters from the lung ROI. By considering the anatomical structure of the rib cage, we developed a locale sampling scheme to achieve nonparametric rib modeling. This scheme integrates knowledge-based generalized Hough transform (GHT) for accurate rib segmentation. We subsequently estimated rib intensity using the real-coded genetic algorithm (RCGA). Experimental results indicate that the relative conspicuity of the nodules increased after rib suppression, compared to the original image. Additionally, the proposed system uses only one standard chest radiograph, and the dual-energy subtraction technique is not required. Thus, this system is suitable for radiologists and computer-aided diagnosis (CAD) schemes for detecting lung nodules in chest radiographs.

Biplane Correlation Imaging: A Feasibility Study Based on Phantom and Human Data

The objective of this study was to implement and evaluate the performance of a biplane correlation imaging (BCI) technique aimed to reduce the effect of anatomic noise and improve the detection of lung nodules in chest radiographs. Seventy-one low-dose posterior-anterior images were acquired from an anthropomorphic chest phantom with 0.28° angular separations over a range of ±10° along the vertical axis within an 11 s interval. Similar data were acquired from 19 human subjects with institutional review board approval and informed consent. The data were incorporated into a computer-aided detection (CAD) algorithm in which suspect lesions were identified by examining the geometrical correlation of the detected signals that remained relatively constant against variable anatomic backgrounds. The data were analyzed to determine the effect of angular separation, and the overall sensitivity and false-positives for lung nodule detection. The best performance was achieved for angular separations of the projection pairs greater than 5°. Within that range, the technique provided an order of magnitude decrease in the number of false-positive reports when compared with CAD analysis of single-view images. Overall, the technique yielded ~1.1 false-positive per patient with an average sensitivity of 75%. The results indicated that the incorporation of angular information can offer a reduction in the number of false-positives without a notable reduction in sensitivity. The findings suggest that the BCI technique has the potential for clinical implementation as a cost-effective technique to improve the detection of subtle lung nodules with lowered rate of false-positives.

A computer-aided diagnosis system for detection of lung nodules in chest radiographs with an evaluation on a public database

A computer algorithm for nodule detection in chest radiographs is presented. The algorithm consists of four main steps: (i) image preprocessing; (ii) nodule candidate detection; (iii) feature extraction; (iv) candidate classification. Two optional extensions to this scheme are tested: candidate selection and candidate segmentation. The output of step (ii) is a list of circles, which can be transformed into more detailed contours by the extra candidate segmentation step. In addition, the candidate selection step (which is a classification step using a small number of features) can be used to reduce the list of nodule candidates before step (iii). The algorithm uses multi-scale techniques in several stages of the scheme: Candidates are found by looking for local intensity maxima in Gaussian scale space; nodule boundaries are detected by tracing edge points found at large scales down to pixel scale; some of the features used for classification are taken from a multi-scale Gaussian filterbank. Experiments with this scheme (with and without the segmentation and selection steps) are carried out on a previously characterized, publicly available database, that contains a large number of very subtle nodules. For this database, counting as detections only those nodules that were indicated with a confidence level of 50% or more, radiologists previously detected 70% of the nodules. For our algorithm, it turns out that the selection step does have an added value for the system, while segmentation does not lead to a clear improvement. With the scheme with the best performance, accepting on average two false positives per image results in the identification of 51% of all nodules. For four false positives, this increases to 67%. This is close to the previously reported 70% detection rate of the radiologists.

Effect of high sensitivity in a computerized scheme for detecting extremely subtle solitary pulmonary nodules in chest radiographs: observer performance study 1

Rationales and Objectives. This study investigated the effect of a high sensitivity in computer-aided diagnosis (CAD) for detecting lung nodules in chest radiographs when extremely subtle cases were presented to radiologists. Material and Methods. The chest radiographs used in this study consisted of 36 normal images and 54 abnormals containing solitary lung nodules, of which 25 were extremely subtle and 29 were very subtle. Receiver operating characteristic analysis for detecting lung nodules was performed without and with CAD. The levels of CAD output were simulated with a hypothetical ideal performance of 100% sensitivity, but with three or four false positives per image. Six radiologists participated in an observer study in which cases were interpreted first without and then with the use of CAD. Results. The average A Z values for radiologists without and with CAD were 0.682 and 0.808, respectively. The performance of radiologists was improved significantly when high sensitivity was used ( P = .0003). However, the radiologists were not able to recognize some extremely subtle nodules (5 of 54 nodules by all radiologists), even with the correct CAD output; these nodules were then considered as non-actionable. None of 306 computer-false positives was incorrectly regarded as a nodule by all radiologists, but 63 false positives were incorrectly identified by one or more radiologists. Conclusion. The accuracy of radiologists in the detection of some extremely subtle solitary pulmonary nodules can be improved significantly when the sensitivity of a CAD scheme can be made to be at an extremely high level. However, all of the six radiologists failed to identify some nodules (about 10%), even with the correct output of the CAD.

Computerized analysis for automated detection of lung nodules in digital chest radiographs

The objective of this study was to develop a computer‐aided diagnosis(CAD) scheme for automated detection of lung nodules in digital chest images in order to help radiologists to improve their performance in detecting lung nodules. Lung nodules in chest radiographs are the important sign of lungcancer which is the leading cause of cancer death in men and women in the United States, with the 5‐year survival rate only about 13%. Early detection and treatment are crucial for the improvement of this survival rate for patients with lungcancer. This dissertation included the following four topics: (1) accurate determination of ribcage boundary in digital chest radiographs; (2) detection of right and left hemidiaphragm edges and delineation of lung fields in digital chest radiographs; (3) development of a CAD scheme for automated detection of lung nodules in digital chest radiographs; and (4) ROC studies of effects of CAD output on radiologists’ performance for detection of lung nodules on chest radiographs. Our CAD scheme for automated detection of lung nodules in digital chest images was based on the segmentation of lung fields, the difference image technique, image feature analysis, and an artificial neural network. The performance of the CAD scheme was evaluated by the FROC methodology. The CAD scheme achieved an improved performance of 70% sensitivity with 1.7 false positives per image, on average. The ROC analysis results indicated that radiologists increased their performance significantly in detecting lung nodules by use of the CAD output as a ‘‘second opinion.’’ Radiologists did not increase their reading time when the CAD output was used. [Thesis copies are available upon request from the author.]

Detection of lung nodules in chest radiographs using artificial networks : Coppini G, Legittimo R, De Dominicis R, Valli G (Department of Electronic Engineering, University of Florence, Via Santa Marta 3, I-50139 Firenze, Italy). Radiol Diagnostica 1994;35:5–8

Detection of lung nodules in chest radiographs using artificial networks : Coppini G, Legittimo R, De Dominicis R, Valli G (Department of Electronic Engineering, University of Florence, Via Santa Marta 3, I-50139 Firenze, Italy). Radiol Diagnostica 1994;35:5–8

A visual dwell algorithm can aid search and recognition of missed lung nodules in chest radiographs : Nodine, C.F., and Kundel, H.L. In: D. Brogan (Ed). Visual search, Taylor & Francis, London, 1990, pp 399–406, 5 refs

A visual dwell algorithm can aid search and recognition of missed lung nodules in chest radiographs : Nodine, C.F., and Kundel, H.L. In: D. Brogan (Ed). Visual search, Taylor & Francis, London, 1990, pp 399–406, 5 refs