Local gray level S-curve transformation – A generalized contrast enhancement technique for medical images

Prediction of esophageal fistula in radiotherapy/chemoradiotherapy for patients with advanced esophageal cancer by a clinical-deep learning radiomics model : Prediction of esophageal fistula in radiotherapy/chemoradiotherapy patients

BACKGROUND

Esophageal fistula (EF), a rare and potentially fatal complication, can be better managed with predictive models for personalized treatment plans in esophageal cancers. We aim to develop a clinical-deep learning radiomics model for effectively predicting the occurrence of EF.

METHODS

The study involved esophageal cancer patients undergoing radiotherapy or chemoradiotherapy. Arterial phase enhanced CT images were used to extract handcrafted and deep learning radiomic features. Along with clinical information, a 3-step feature selection method (statistical tests, Least Absolute Shrinkage and Selection Operator, and Recursive Feature Elimination) was used to identify five feature sets in training cohort for constructing random forest EF prediction models. Model performance was compared and validated in both retrospective and prospective test cohorts.

RESULTS

One hundred seventy five patients (122 in training and 53 in test cohort)were retrospectively collected from April 2018 to June 2022. An additional 27 patients were enrolled as a prospective test cohort from June 2022 to December 2023. Post-selection in the training cohort, five feature sets were used for model construction: clinical, handcrafted radiomic, deep learning radiomic, clinical-handcrafted radiomic, and clinical-deep learning radiomic. The clinical-deep learning radiomic model excelled with AUC of 0.89 (95% Confidence Interval: 0.83-0.95) in the training cohort, 0.81 (0.65-0.94) in the test cohort, and 0.85 (0.71-0.97) in the prospective test cohort. Brier-score and calibration curve analyses validated its predictive ability.

CONCLUSIONS

The clinical-deep learning radiomic model can effectively predict EF in patients with advanced esophageal cancer undergoing radiotherapy or chemoradiotherapy.

Comprehensive assessment of imaging quality of artificial intelligence-assisted compressed sensing-based MR images in routine clinical settings

BACKGROUND

Conventional MR acceleration techniques, such as compressed sensing, parallel imaging, and half Fourier often face limitations, including noise amplification, reduced signal-to-noise ratio (SNR) and increased susceptibility to artifacts, which can compromise image quality, especially in high-speed acquisitions. Artificial intelligence (AI)-assisted compressed sensing (ACS) has emerged as a novel approach that combines the conventional techniques with advanced AI algorithms. The objective of this study was to examine the imaging quality of the ACS approach by qualitative and quantitative analysis for brain, spine, kidney, liver, and knee MR imaging, as well as compare the performance of this method with conventional (non-ACS) MR imaging.

METHODS

This study included 50 subjects. Three radiologists independently assessed the quality of MR images based on artefacts, image sharpness, overall image quality and diagnostic efficacy. SNR, contrast-to-noise ratio (CNR), edge content (EC), enhancement measure (EME), scanning time were used for quantitative evaluation. The Cohen's kappa correlation coefficient (k) was employed to measure radiologists' inter-observer agreement, and the Mann Whitney U-test used for comparison between non-ACS and ACS.

RESULTS

The qualitative analysis of three radiologists demonstrated that ACS images showed superior clinical information than non-ACS images with a mean k of ~ 0.70. The images acquired with ACS approach showed statistically higher values (p < 0.05) for SNR, CNR, EC, and EME compared to the non-ACS images. Furthermore, the study's findings indicated that ACS-enabled images reduced scan time by more than 50% while maintaining high imaging quality.

CONCLUSION

Integrating ACS technology into routine clinical settings has the potential to speed up image acquisition, improve image quality, and enhance diagnostic procedures and patient throughput.

Enhancing mammography: a comprehensive review of computer methods for improving image quality

Mammography imaging remains the gold standard for breast cancer detection and diagnosis, but challenges in image quality can lead to misdiagnosis, increased radiation exposure, and higher healthcare costs. This comprehensive review evaluates traditional and machine learning-based techniques for improving mammography image quality, aiming to benefit clinicians and enhance diagnostic accuracy. Our literature search, spanning 2015 - 2024, identified 115 articles focusing on contrast enhancement and noise reduction methods, including histogram equalization, filtering, unsharp masking, fuzzy logic, transform-based techniques, and advanced machine learning approaches. Machine learning, particularly architectures integrating denoising autoencoders with convolutional neural networks, emerged as highly effective in enhancing image quality without compromising detail. The discussion highlights the success of these techniques in improving mammography images' visual quality. However, challenges such as high noise ratios, inconsistent evaluation metrics, and limited open-source datasets persist. Addressing these issues offers opportunities for future research to further advance mammography image enhancement methodologies.

Optimized S-Curve Transformation and Wavelets-Based Fusion for Contrast Elevation of Breast Tomograms and Mammograms

For the purpose of accuracy in detection and diagnosis, Computer-Aided Diagnosis (CAD) is preferred by radiologists for the analysis of Breast Cancer. However, the presence of noise, artifacts, and poor contrast in breast images during acquisition highlights the need for sophisticated enhancement techniques for the proper visualization of region-of-interest (ROI). In this work, contrast elevation of breast mammographic and tomographic images is performed with an improved S-Curve transform using the Particle Swarm Optimization (PSO) algorithm. The enhanced images are assessed using dedicated quality metrics such as the Enhancement Measure (EME) and Absolute Mean Brightness Error (AMBE) measurement. Although the enhancement techniques help in attaining better images, certain features relevant for diagnosis purposes are removed during the enhancement process, creating contradictions for radiological interpretation. Hence, to ensure the retention of diagnostic features from original breast tomograms and mammograms, a Discrete Wavelet Transform (DWT)-based fusion approach is incorporated, which fuses the original and contrast-enhanced images (with optimized s-curve transformation function) using the maximum fusion rule. The fusion performance is thereafter measured using the Image Quality Index (IQI), Standard Deviation (SD), and Entropy (E) as fusion metrics.

A comparative study of medical image enhancement algorithms and quality assessment metrics on COVID-19 CT images

Medical imaging can help doctors in better diagnosis of several conditions. During the present COVID-19 pandemic, timely detection of novel coronavirus is crucial, which can help in curing the disease at an early stage. Image enhancement techniques can improve the visual appearance of COVID-19 CT scans and speed-up the process of diagnosis. In this study, we analyze some state-of-the-art image enhancement techniques for their suitability in enhancing the CT scans of COVID-19 patients. Six quantitative metrics, Entropy, SSIM, AMBE, PSNR, EME, and EMEE, are used to evaluate the enhanced images. Two experienced radiologists were involved in the study to evaluate the performance of the enhancement techniques and the quantitative metrics used to assess them.

A Noise-robust and Overshoot-free Alternative to Unsharp Masking for Enhancing the Acuity of MR Images

Poor acutance of images (unsharpness) is one of the major concerns in magnetic resonance imaging (MRI). MRI-based diagnosis and clinical interventions become difficult due to the vague textural information and weak morphological margins on images. A novel image sharpening algorithm named as maximum local variation-based unsharp masking (MLVUM) to address the issue of 'unsharpness' in MRI is proposed in this paper. In the MLVUM, the sharpened image is the algebraic sum of the input image and the product of the user-defined scale and the difference between the output of a newly designed nonlinear spatial filter named maximum local variation-controlled edge smoothing Gaussian filter (MLVESGF) and the input image, weighted by the normalised MLV. The MLVESGF is a locally adaptive 2D Gaussian edge smoothing kernel whose standard deviation is directly proportional to the local value of the normalized MLV. The values of the acutance-to-noise ratio (ANR) and absolute mean brightness error (AMBE) shown by the MLVUM on 100 MRI slices are 0.6463 ± 0.1852 and 0.3323 ± 0.2200, respectively. Compared to 17 state-of-the-art image sharpening algorithms, the MLVUM exhibited a higher ANR and lower AMBE. The MLVUM selectively enhances the sharpness of edges in the MR images without amplifying the background noise without altering the mean brightness level.

A non-uniform quantization scheme for visualization of CT images

Medical science heavily depends on image acquisition and post-processing for accurate diagnosis and treatment planning. The introduction of noise degrades the visual quality of the medical images during the capturing process, which may result in false perception. Therefore, medical image enhancement is an essential topic of research for the improvement of image quality. In this paper, a clustering-based contrast enhancement technique is presented for computed tomography (CT) images. Our approach uses the recursive splitting of data into clusters targeting the maximum error reduction in each cluster. This leads to grouping similar pixels in every cluster, maximizing inter-cluster and minimizing intra-cluster similarities. A suitable number of clusters can be chosen to represent high precision data with the desired bit-depth. We use 256 clusters to convert 16-bit CT scans to 8-bit images suitable for visualization on standard low dynamic range displays. We compare our method with several existing contrast enhancement algorithms and show that the proposed technique provides better results in terms of execution efficiency and quality of enhanced images.

Can artificial intelligence distinguish between malignant and benign mediastinal lymph nodes using sonographic features on EBUS images?

AIMS

This study aimed to develop a new intelligent diagnostic approach using an artificial neural network (ANN). Moreover, we investigated whether the learning-method-guided quantitative analysis approach adequately described mediastinal lymphadenopathies on endobronchial ultrasound (EBUS) images.

METHODS

In total, 345 lymph nodes (LNs) from 345 EBUS images were used as source input datasets for the application group. The group consisted of 300 and 45 textural patterns as input and output variables, respectively. The input and output datasets were processed using MATLAB. All these datasets were utilized for the training and testing of the ANN.

RESULTS

The best diagnostic accuracy was 82% of that obtained from the textural patterns of the LNs pattern (89% sensitivity, 72% specificity, and 78.2% area under the curve). The negative predictive values were 81% compared to the corresponding positive predictive values of 83%. Due to the application group's pattern-based evaluation, the LN pattern was statistically significant (p = .002).

CONCLUSIONS

The proposed intelligent approach could be useful in making diagnoses. Further development is required to improve the diagnostic accuracy of the visual interpretation.

Medical image enhancement in F-shift transformation domain

Image enhancement technology plays an important role in the diagnosis and treatment of medical diseases. In this paper, we propose a method to automatically enhance medical images. The proposed method could be used to support clinical medical diagnosis, adjuvant therapy and curative effect diagnosis. This scheme uses contrast limited adaptive histogram equalization (CLAHE) method in F-shift transformation domain. Firstly, we adjust the overall brightness of the underexposed or overexposed image. Secondly, we perform CLAHE to enhance the low-frequency components obtained by one-level two-dimensional F-shift transformation (TDFS) on the adjusted images. At this stage, most of the coefficients in the high-frequency component can be changed to zero through properly setting the error bound. We then use inverse transformation to reconstruct image which is further enhanced with CLAHE. Compared to previous work, this approach takes into account not only the image enhancement, but also the data compression. Experimental results and comparison with state-of-the-art methods show that our proposed method has a better enhancement performance. Moreover, it has a certain data compression ability.

A novel framework for MR image segmentation and quantification by using MedGA

BACKGROUND AND OBJECTIVES

Image segmentation represents one of the most challenging issues in medical image analysis to distinguish among different adjacent tissues in a body part. In this context, appropriate image pre-processing tools can improve the result accuracy achieved by computer-assisted segmentation methods. Taking into consideration images with a bimodal intensity distribution, image binarization can be used to classify the input pictorial data into two classes, given a threshold intensity value. Unfortunately, adaptive thresholding techniques for two-class segmentation work properly only for images characterized by bimodal histograms. We aim at overcoming these limitations and automatically determining a suitable optimal threshold for bimodal Magnetic Resonance (MR) images, by designing an intelligent image analysis framework tailored to effectively assist the physicians during their decision-making tasks.

METHODS

In this work, we present a novel evolutionary framework for image enhancement, automatic global thresholding, and segmentation, which is here applied to different clinical scenarios involving bimodal MR image analysis: (i) uterine fibroid segmentation in MR guided Focused Ultrasound Surgery, and (ii) brain metastatic cancer segmentation in neuro-radiosurgery therapy. Our framework exploits MedGA as a pre-processing stage. MedGA is an image enhancement method based on Genetic Algorithms that improves the threshold selection, obtained by the efficient Iterative Optimal Threshold Selection algorithm, between the underlying sub-distributions in a nearly bimodal histogram.

RESULTS

The results achieved by the proposed evolutionary framework were quantitatively evaluated, showing that the use of MedGA as a pre-processing stage outperforms the conventional image enhancement methods (i.e., histogram equalization, bi-histogram equalization, Gamma transformation, and sigmoid transformation), in terms of both MR image enhancement and segmentation evaluation metrics.

CONCLUSIONS

Thanks to this framework, MR image segmentation accuracy is considerably increased, allowing for measurement repeatability in clinical workflows. The proposed computational solution could be well-suited for other clinical contexts requiring MR image analysis and segmentation, aiming at providing useful insights for differential diagnosis and prognosis.

Hospital evaluation mechanism based on mobile health for IoT system in social networks

The uneven distribution of medical resources is a serious problem in developing countries. Those seeking timely treatment have difficulty choosing the right hospital. To found sustainable development with medical system, this paper establishes a model of the hospital confidence evaluation index by combining national evaluation and a third-party evaluation. The model is applied to a social network. Users from any region can use the model through APP in IoT, a hospital analysis index query, which selects the best hospital for diagnosis and treatment. The model can locate different personnel characteristics by modifying the control variables. Establishing a medical system with big data provides good model characteristics. Effective data analysis through large data users in the sample is established to provide the most effective hospital recommendation, which is a good solution to the selectivity problem. The contributions in this works are: (1) Models of initial trust and hospital evaluations are established by combining national and third-party assessments; (2) the initial trust evaluation model is modified and optimized by establishing control variables; (3) the trust evaluation mechanism of users in social networks is obtained through big data sampling and model analysis, and the balanced distribution of the medical staff is realized.

A q-Extension of Sigmoid Functions and the Application for Enhancement of Ultrasound Images

This paper proposes the q-sigmoid functions, which are variations of the sigmoid expressions and an analysis of their application to the process of enhancing regions of interest in digital images. These new functions are based on the non-extensive Tsallis statistics, arising in the field of statistical mechanics through the use of q-exponential functions. The potential of q-sigmoids for image processing is demonstrated in tasks of region enhancement in ultrasound images which are highly affected by speckle noise. Before demonstrating the results in real images, we study the asymptotic behavior of these functions and the effect of the obtained expressions when processing synthetic images. In both experiments, the q-sigmoids overcame the original sigmoid functions, as well as two other well-known methods for the enhancement of regions of interest: slicing and histogram equalization. These results show that q-sigmoids can be used as a preprocessing step in pipelines including segmentation as demonstrated for the Otsu algorithm and deep learning approaches for further feature extractions and analyses.

A Hybrid Proposed Fundus Image Enhancement Framework for Diabetic Retinopathy

Diabetic retinopathy (DR) is a complication of diabetes and is known as visual impairment, and is diagnosed in various ethnicities of the working-age population worldwide. Fundus angiography is a widely applicable modality used by ophthalmologists and computerized applications to detect DR-based clinical features such as microaneurysms (MAs), hemorrhages (HEMs), and exudates (EXs) for early screening of DR. Fundus images are usually acquired using funduscopic cameras in varied light conditions and angles. Therefore, these images are prone to non-uniform illumination, poor contrast, transmission error, low brightness, and noise problems. This paper presents a novel and real-time mechanism of fundus image enhancement used for early grading of diabetic retinopathy, macular degeneration, retinal neoplasms, and choroid disruptions. The proposed system is based on two folds: (i) An RGB fundus image is initially taken and converted into a color appearance module (called lightness and denoted as J) of the CIECAM02 color space model to obtain image information in grayscale with bright light. Afterwards, in step (ii), the achieved J component is processed using a nonlinear contrast enhancement approach to improve the textural and color features of the fundus image without any further extraction steps. To test and evaluate the strength of the proposed technique, several performance and quality parameters—namely peak signal-to-noise ratio (PSNR), contrast-to-noise ratio (CNR), entropy (content information), histograms (intensity variation), and a structure similarity index measure (SSIM)—were applied to 1240 fundus images comprised of two publicly available datasets, DRIVE and MESSIDOR. It was determined from the experiments that the proposed enhancement procedure outperformed histogram-based approaches in terms of contrast, sharpness of fundus features, and brightness. This further revealed that it can be a suitable preprocessing tool for segmentation and classification of DR-related features algorithms.

X-Ray Enhancement Based on Component Attenuation, Contrast Adjustment, and Image Fusion

Inspecting X-ray images is an essential aspect of medical diagnosis. However, due to an X-ray's low contrast and low dynamic range, important aspects such as organs, bones, and nodules become difficult to identify. Hence, contrast adjustment is critical, especially because of its ability to enhance the details in both bright and dark regions. For X-ray image enhancement, we therefore propose a new concept based on component attenuation. Notably, we assumed an X-ray image could be decomposed into tissue components and important details. Since tissues may not be the major primary focus of an X-ray, we proposed enhancing the visual contrast by adaptive tissue attenuation and dynamic range stretching. Via component decomposition and tissue attenuation, a parametric adjustment model was deduced to generate many enhanced images at once. Finally, an ensemble framework was proposed for fusing these enhanced images and producing a high-contrast output in both bright and dark regions. We have used measurement metrics to evaluate our system and achieved promising scores in each. An online testing system was also built for subjective evaluation. Moreover, we applied our system to an X-ray data set provided by the Japanese Society of Radiological Technology to help with nodule detection. The experimental results of which demonstrated the effectiveness of our method.

Local Binary Patterns Descriptor Based on Sparse Curvelet Coefficients for False-Positive Reduction in Mammograms

Breast Cancer is the most prevalent cancer among women across the globe. Automatic detection of breast cancer using Computer Aided Diagnosis (CAD) system suffers from false positives (FPs). Thus, reduction of FP is one of the challenging tasks to improve the performance of the diagnosis systems. In the present work, new FP reduction technique has been proposed for breast cancer diagnosis. It is based on appropriate integration of preprocessing, Self-organizing map (SOM) clustering, region of interest (ROI) extraction, and FP reduction. In preprocessing, contrast enhancement of mammograms has been achieved using Local Entropy Maximization algorithm. The unsupervised SOM clusters an image into number of segments to identify the cancerous region and extracts tumor regions (i.e., ROIs). However, it also detects some FPs which affects the efficiency of the algorithm. Therefore, to reduce the FPs, the output of the SOM is given to the FP reduction step which is aimed to classify the extracted ROIs into normal and abnormal class. FP reduction consists of feature mining from the ROIs using proposed local sparse curvelet coefficients followed by classification using artificial neural network (ANN). The performance of proposed algorithm has been validated using the local datasets as TMCH (Tata Memorial Cancer Hospital) and publicly available MIAS (Suckling et al., 1994) and DDSM (Heath et al., 2000) database. The proposed technique results in reduction of FPs from 0.85 to 0.02 FP/image for MIAS, 4.81 to 0.16 FP/image for DDSM, and 2.32 to 0.05 FP/image for TMCH reflecting huge improvement in classification of mammograms.

Utility of the luminance standard deviation to quantify magnetic resonance imaging motion artifact induced by tongue movement

Clear magnetic resonance imaging (MRI) is required to diagnose tongue cancer. However, the absence of occlusal support may cause tongue movements which are known to introduce artifacts on the MR image. This pilot study compared the manifest of artifacts from the tongue at rest and during motion using luminance standard deviation (LSD) to quantify the artifacts, in dentulous subjects. Participants were ten dentulous participants (5 males, 5 females; age 31.50 ± 8.38 years) with occlusal support. MRI was conducted with the tongue at rest and during lateral movement. The LSD was measured in the regions of interest (ROI) in the axial and sagittal planes. Tongue movement evoked unclear MR images, compared with the images taken at rest. Statistical analysis revealed that the LSD significantly differed between the tongue at rest and in motion in the axial (P = 0.004) and sagittal planes (ROI-A: P = 0.002, ROI-P: P = 0.006). These findings suggest that tongue movement introduces motion artifact and the LSD responds quantitatively to the magnitude of artifacts. Future studies will evaluate whether a prosthetic device used to provide occlusive support can decrease these artifacts when analyzed using LSD.