Pulmonary Nodules In Chest Radiographs Research Articles

Detection of pulmonary nodules in chest radiographs: novel cost function for effective network training with purely synthesized datasets

PurposeMany large radiographic datasets of lung nodules are available, but the small and hard-to-detect nodules are rarely validated by computed tomography. Such difficult nodules are crucial for training nodule detection methods. This lack of difficult nodules for training can be addressed by artificial nodule synthesis algorithms, which can create artificially embedded nodules. This study aimed to develop and evaluate a novel cost function for training networks to detect such lesions. Embedding artificial lesions in healthy medical images is effective when positive cases are insufficient for network training. Although this approach provides both positive (lesion-embedded) images and the corresponding negative (lesion-free) images, no known methods effectively use these pairs for training. This paper presents a novel cost function for segmentation-based detection networks when positive–negative pairs are available.MethodsBased on the classic U-Net, new terms were added to the original Dice loss for reducing false positives and the contrastive learning of diseased regions in the image pairs. The experimental network was trained and evaluated, respectively, on 131,072 fully synthesized pairs of images simulating lung cancer and real chest X-ray images from the Japanese Society of Radiological Technology dataset.ResultsThe proposed method outperformed RetinaNet and a single-shot multibox detector. The sensitivities were 0.688 and 0.507 when the number of false positives per image was 0.2, respectively, with and without fine-tuning under the leave-one-case-out setting.ConclusionTo our knowledge, this is the first study in which a method for detecting pulmonary nodules in chest X-ray images was evaluated on a real clinical dataset after being trained on fully synthesized images. The synthesized dataset is available at https://zenodo.org/records/10648433.

Validation of a Deep Learning Algorithm for the Detection of Malignant Pulmonary Nodules in Chest Radiographs

The improvement of pulmonary nodule detection, which is a challenging task when using chest radiographs, may help to elevate the role of chest radiographs for the diagnosis of lung cancer. To assess the performance of a deep learning-based nodule detection algorithm for the detection of lung cancer on chest radiographs from participants in the National Lung Screening Trial (NLST). This diagnostic study used data from participants in the NLST ro assess the performance of a deep learning-based artificial intelligence (AI) algorithm for the detection of pulmonary nodules and lung cancer on chest radiographs using separate training (in-house) and validation (NLST) data sets. Baseline (T0) posteroanterior chest radiographs from 5485 participants (full T0 data set) were used to assess lung cancer detection performance, and a subset of 577 of these images (nodule data set) were used to assess nodule detection performance. Participants aged 55 to 74 years who currently or formerly (ie, quit within the past 15 years) smoked cigarettes for 30 pack-years or more were enrolled in the NLST at 23 US centers between August 2002 and April 2004. Information on lung cancer diagnoses was collected through December 31, 2009. Analyses were performed between August 20, 2019, and February 14, 2020. Abnormality scores produced by the AI algorithm. The performance of an AI algorithm for the detection of lung nodules and lung cancer on radiographs, with lung cancer incidence and mortality as primary end points. A total of 5485 participants (mean [SD] age, 61.7 [5.0] years; 3030 men [55.2%]) were included, with a median follow-up duration of 6.5 years (interquartile range, 6.1-6.9 years). For the nodule data set, the sensitivity and specificity of the AI algorithm for the detection of pulmonary nodules were 86.2% (95% CI, 77.8%-94.6%) and 85.0% (95% CI, 81.9%-88.1%), respectively. For the detection of all cancers, the sensitivity was 75.0% (95% CI, 62.8%-87.2%), the specificity was 83.3% (95% CI, 82.3%-84.3%), the positive predictive value was 3.8% (95% CI, 2.6%-5.0%), and the negative predictive value was 99.8% (95% CI, 99.6%-99.9%). For the detection of malignant pulmonary nodules in all images of the full T0 data set, the sensitivity was 94.1% (95% CI, 86.2%-100.0%), the specificity was 83.3% (95% CI, 82.3%-84.3%), the positive predictive value was 3.4% (95% CI, 2.2%-4.5%), and the negative predictive value was 100.0% (95% CI, 99.9%-100.0%). In digital radiographs of the nodule data set, the AI algorithm had higher sensitivity (96.0% [95% CI, 88.3%-100.0%] vs 88.0% [95% CI, 75.3%-100.0%]; P = .32) and higher specificity (93.2% [95% CI, 89.9%-96.5%] vs 82.8% [95% CI, 77.8%-87.8%]; P = .001) for nodule detection compared with the NLST radiologists. For malignant pulmonary nodule detection on digital radiographs of the full T0 data set, the sensitivity of the AI algorithm was higher (100.0% [95% CI, 100.0%-100.0%] vs 94.1% [95% CI, 82.9%-100.0%]; P = .32) compared with the NLST radiologists, and the specificity (90.9% [95% CI, 89.6%-92.1%] vs 91.0% [95% CI, 89.7%-92.2%]; P = .91), positive predictive value (8.2% [95% CI, 4.4%-11.9%] vs 7.8% [95% CI, 4.1%-11.5%]; P = .65), and negative predictive value (100.0% [95% CI, 100.0%-100.0%] vs 99.9% [95% CI, 99.8%-100.0%]; P = .32) were similar to those of NLST radiologists. In this study, the AI algorithm performed better than NLST radiologists for the detection of pulmonary nodules on digital radiographs. When used as a second reader, the AI algorithm may help to detect lung cancer.

Computer-aided Detection Fidelity of Pulmonary Nodules in Chest Radiograph.

Aim:The most ubiquitous chest diagnostic method is the chest radiograph. A common radiographic finding, quite often incidental, is the nodular pulmonary lesion. The detection of small lesions out of complex parenchymal structure is a daily clinical challenge. In this study, we investigate the efficacy of the computer-aided detection (CAD) software package SoftView™ 2.4A for bone suppression and OnGuard™ 5.2 (Riverain Technologies, Miamisburg, OH, USA) for automated detection of pulmonary nodules in chest radiographs.Subjects and Methods:We retrospectively evaluated a dataset of 100 posteroanterior chest radiographs with pulmonary nodular lesions ranging from 5 to 85 mm. All nodules were confirmed with a consecutive computed tomography scan and histologically classified as 75% malignant. The number of detected lesions by observation in unprocessed images was compared to the number and dignity of CAD-detected lesions in bone-suppressed images (BSIs).Results:SoftView™ BSI does not affect the objective lesion-to-background contrast. OnGuard™ has a stand-alone sensitivity of 62% and specificity of 58% for nodular lesion detection in chest radiographs. The false positive rate is 0.88/image and the false negative (FN) rate is 0.35/image. From the true positive lesions, 20% were proven benign and 80% were malignant. FN lesions were 47% benign and 53% malignant.Conclusion:We conclude that CAD does not qualify for a stand-alone standard of diagnosis. The use of CAD accompanied with a critical radiological assessment of the software suggested pattern appears more realistic. Accordingly, it is essential to focus on studies assessing the quality-time-cost profile of real-time (as opposed to retrospective) CAD implementation in clinical diagnostics.

Computer-aided Detection Improves Detection of Pulmonary Nodules in Chest Radiographs beyond the Support by Bone-suppressed Images

To evaluate the added value of computer-aided detection (CAD) for lung nodules on chest radiographs when radiologists have bone-suppressed images (BSIs) available. Written informed consent was waived by the institutional review board. Selection of study images and study setup was reviewed and approved by the institutional review boards. Three hundred posteroanterior (PA) and lateral chest radiographs (189 radiographs with negative findings and 111 radiographs with a solitary nodule) in 300 subjects were selected from image archives at four institutions. PA images were processed by using a commercially available CAD, and PA BSIs were generated. Five radiologists and three residents evaluated the radiographs with BSIs available, first, without CAD and, second, after inspection of the CAD marks. Readers marked locations suspicious for a nodule and provided a confidence score for that location to be a nodule. Location-based receiver operating characteristic analysis was performed by using jackknife alternative free-response receiver operating characteristic analysis. Area under the curve (AUC) functioned as figure of merit, and P values were computed with the Dorfman-Berbaum-Metz method. Average nodule size was 16.2 mm. Stand-alone CAD reached a sensitivity of 74% at 1.0 false-positive mark per image. Without CAD, average AUC for observers was 0.812. With CAD, performance significantly improved to an AUC of 0.841 (P = .0001). CAD detected 127 of 239 nodules that were missed after evaluation of the radiographs together with BSIs pooled over all observers. Only 57 of these detections were eventually marked by the observers after review of CAD candidates. CAD improved radiologists' performance for the detection of lung nodules on chest radiographs, even when baseline performance was optimized by providing lateral radiographs and BSIs. Still, most of the true-positive CAD candidates are dismissed by observers.

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.

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.

Multiscale edge-guided wavelet snake model for delineation of pulmonary nodules in chest radiographs

The <i>Journal of Electronic Imaging</i> (JEI), copublished bimonthly with the Society for Imaging Science and Technology, publishes peer-reviewed papers that cover research and applications in all areas of electronic imaging science and technology.

Computerized detection of pulmonary nodules in chest radiographs based on morphological features and wavelet snake model

We have developed a new computer-aided diagnosis scheme for automated detection of lung nodules in digital chest radiographs based on a combination of morphological features and the wavelet snake. In our scheme, two processes were applied in parallel to reduce the false-positive detections after initial nodule candidates were selected. One process consisted of adaptive filtering for enhancement of nodules and suppression of normal lung structures, followed by extraction of conventional morphological features. The other process consisted of a novel approach for elimination of false positives called the edge-guided wavelet snake model. In the latter process, multiscale edges of the candidate nodules were extracted to yield parts of the nodule boundaries. A wavelet snake was then used for fitting of these multiscale edges for approximation of the true boundaries of nodules. A boundary feature called the weighted overlap between the snake and the multiscale edges was calculated and used for elimination of false positives. Finally, the weighted overlap and the morphological features were combined by use of an artificial neural network for efficient reduction of false positives. Our scheme was applied to a publicly available database of digital chest images for pulmonary nodules. Receiver operating characteristic analysis was employed for evaluation of the performance of each process in the scheme. The combined features yielded a large reduction of false positives, and thus achieved a high performance in discriminating between true and false positives. These results show that our new method, in particular the false-positive reduction method based on the wavelet snake, is effective in improving the performance of a computerized scheme for detection of pulmonary nodules in chest radiographs.

Computer‐aided diagnostic scheme for lung nodule detection in digital chest radiographs by use of a multiple‐template matching technique

We have been developing a computer-aided diagnostic (CAD) scheme to assist radiologists in improving the detection of pulmonary nodules in chest radiographs, because radiologists can miss as many as 30% of pulmonary nodules in routine clinical practice. A key to the successful clinical application of a CAD scheme is to ensure that there are only a small number of false positives that are incorrectly reported as nodules by the scheme. In order to significantly reduce the number of false positives in our CAD scheme, we developed, in this study, a multiple-template matching technique, in which a test candidate can be identified as a false positive and thus eliminated, if its largest cross-correlation value with non-nodule templates is larger than that with nodule templates. We describe the technique for determination of cross-correlation values for test candidates with nodule templates and non-nodule templates, the technique for creation of a large number of nodule templates and non-nodule templates, and the technique for removal of nodulelike non-nodule templates and non-nodulelike nodule templates, in order to achieve a good performance. In our study, a large number of false positives (44.3%) were removed with reduction of a very small number of true positives (2.3%) by use of the multiple-template matching technique. We believe that this technique can be used to significantly improve the performance of CAD schemes for lung nodule detection in chest radiographs.

Detection of lung nodules in digital chest radiographs using artificial neural networks: A pilot study

Radiologists can fail to detect up to 30% of pulmonary nodules in chest radiographs. A back-propagation neural network was used to detect lung nodules in digital chest radiographs to assist radiologists in the diagnosis of lung cancer. Regions of interest (ROIs) that contained nodules and normal tissues in the lung were selected from digitized chest radiographs by a previously developed computer-aided diagnosis (CAD) scheme. Different preprocessing techniques were used to produce input data to the neural network. The performance of the neural network was evaluated by receiver operating characteristic (ROC) analysis. We found that subsampling of original 64- x 64-pixel ROIs to smaller 8- x 8-pixel ROIs provides the optimal preprocessing for the neural network to distinguish ROIs containing nodules from false-positive ROIs containing normal regions. The neural network was able to detect obvious nodules very well with an Az value (area under ROC curve) of 0.93, but was unable to detect subtle nodules. However, with a training method that uses different orientations of the original ROIs, we were able to improve the performance of the neural network to detect subtle nodules. Artificial neural networks have the potential to serve as a useful classifier to help to eliminate the false-positive detections of the CAD scheme.