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

A Novel Deep Learning-Based (3D U-Net Model) Automated Pulmonary Nodule Detection Tool for CT Imaging

BACKGROUND

Precise detection and characterization of pulmonary nodules on computed tomography (CT) is crucial for early diagnosis and management.

OBJECTIVES

In this study, we propose the use of a deep learning-based algorithm to automatically detect pulmonary nodules in computed tomography (CT) scans. We evaluated the performance of the algorithm against the interpretation of radiologists to analyze the effectiveness of the algorithm.

MATERIALS AND METHODS

The study was conducted in collaboration with a tertiary cancer center. We used a collection of public (LUNA) and private (tertiary cancer center) datasets to train our deep learning models. The sensitivity, the number of false positives per scan, and the FROC curve along with the CPM score were used to assess the performance of the deep learning algorithm by comparing the deep learning algorithm and the radiology predictions.

RESULTS

We evaluated 491 scans consisting of 5669 pulmonary nodules annotated by a radiologist from our hospital; our algorithm showed a sensitivity of 90% and with only 0.3 false positives per scan with a CPM score of 0.85. Apart from the nodule-wise performance, we also assessed the algorithm for the detection of patients containing true nodules where it achieved a sensitivity of 0.95 and specificity of 1.0 over 491 scans in the test cohort.

CONCLUSIONS

Our multi-institutional validated deep learning-based algorithm can aid radiologists in confirming the detection of pulmonary nodules through computed tomography (CT) scans and identifying further abnormalities and can be used as an assistive tool. This will be helpful in national lung screening programs guiding early diagnosis and appropriate management.

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

PURPOSE

Many 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.

METHODS

Based 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.

RESULTS

The 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.

CONCLUSION

To 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 .

Limited Additional Value of a Chest CT in Whole-Body Staging with PET-MRI: A Retrospective Cohort Study

Hybrid PET-MRI systems are being used more frequently. One of the drawbacks of PET-MRI imaging is its inferiority in detecting lung nodules, so it is often combined with a computed tomography (CT) of the chest. However, chest CT often detects additional, indeterminate lung nodules. The objective of this study was to assess the sensitivity of detecting metastatic versus indeterminate nodules with PET-MRI compared to chest CT. A total of 328 patients were included. All patients had a PET/MRI whole-body scan for (re)staging of cancer combined with an unenhanced chest CT performed at our center between 2014 and 2020. Patients had at least a two-year follow-up. Six percent of the patients had lung metastases at initial staging. The sensitivity and specificity of PET-MRI for detecting lung metastases were 85% and 100%, respectively. The incidence of indeterminate lung nodules on chest CT was 30%. The sensitivity of PET-MRI to detect indeterminate lung nodules was poor (23.0%). The average size of the indeterminate lung nodules detected on PET-MRI was 7 ± 4 mm, and the missed indeterminate nodules on PET-MRI were 4 ± 1 mm (p < 0.001). The detection of metastatic lung nodules is fairly good with PET-MRI, whereas the sensitivity of PET-MRI for detecting indeterminate lung nodules is size-dependent. This may be an advantage, limiting unnecessary follow-up of small, indeterminate lung nodules while adequately detecting metastases.

Artificial intelligence-based model for predicting pulmonary arterial hypertension on chest x-ray images

BACKGROUND

Pulmonary arterial hypertension is a serious medical condition. However, the condition is often misdiagnosed or a rather long delay occurs from symptom onset to diagnosis, associated with decreased 5-year survival. In this study, we developed and tested a deep-learning algorithm to detect pulmonary arterial hypertension using chest X-ray (CXR) images.

METHODS

From the image archive of Chiba University Hospital, 259 CXR images from 145 patients with pulmonary arterial hypertension and 260 CXR images from 260 control patients were identified; of which 418 were used for training and 101 were used for testing. Using the testing dataset for each image, the algorithm outputted a numerical value from 0 to 1 (the probability of the pulmonary arterial hypertension score). The training process employed a binary cross-entropy loss function with stochastic gradient descent optimization (learning rate parameter, α = 0.01). In addition, using the same testing dataset, the algorithm's ability to identify pulmonary arterial hypertension was compared with that of experienced doctors.

RESULTS

The area under the curve (AUC) of the receiver operating characteristic curve for the detection ability of the algorithm was 0.988. Using an AUC threshold of 0.69, the sensitivity and specificity of the algorithm were 0.933 and 0.982, respectively. The AUC of the algorithm's detection ability was superior to that of the doctors.

CONCLUSION

The CXR image-derived deep-learning algorithm had superior pulmonary arterial hypertension detection capability compared with that of experienced doctors.

Exploration and Enhancement of Classifiers in the Detection of Lung Cancer from Histopathological Images

Lung cancer is a prevalent malignancy that impacts individuals of all genders and is often diagnosed late due to delayed symptoms. To catch it early, researchers are developing algorithms to study lung cancer images. The primary objective of this work is to propose a novel approach for the detection of lung cancer using histopathological images. In this work, the histopathological images underwent preprocessing, followed by segmentation using a modified approach of KFCM-based segmentation and the segmented image intensity values were dimensionally reduced using Particle Swarm Optimization (PSO) and Grey Wolf Optimization (GWO). Algorithms such as KL Divergence and Invasive Weed Optimization (IWO) are used for feature selection. Seven different classifiers such as SVM, KNN, Random Forest, Decision Tree, Softmax Discriminant, Multilayer Perceptron, and BLDC were used to analyze and classify the images as benign or malignant. Results were compared using standard metrics, and kappa analysis assessed classifier agreement. The Decision Tree Classifier with GWO feature extraction achieved good accuracy of 85.01% without feature selection and hyperparameter tuning approaches. Furthermore, we present a methodology to enhance the accuracy of the classifiers by employing hyperparameter tuning algorithms based on Adam and RAdam. By combining features from GWO and IWO, and using the RAdam algorithm, the Decision Tree classifier achieves the commendable accuracy of 91.57%.

Development of Debiasing Technique for Lung Nodule Chest X-ray Datasets to Generalize Deep Learning Models

Screening programs for early lung cancer diagnosis are uncommon, primarily due to the challenge of reaching at-risk patients located in rural areas far from medical facilities. To overcome this obstacle, a comprehensive approach is needed that combines mobility, low cost, speed, accuracy, and privacy. One potential solution lies in combining the chest X-ray imaging mode with federated deep learning, ensuring that no single data source can bias the model adversely. This study presents a pre-processing pipeline designed to debias chest X-ray images, thereby enhancing internal classification and external generalization. The pipeline employs a pruning mechanism to train a deep learning model for nodule detection, utilizing the most informative images from a publicly available lung nodule X-ray dataset. Histogram equalization is used to remove systematic differences in image brightness and contrast. Model training is then performed using combinations of lung field segmentation, close cropping, and rib/bone suppression. The resulting deep learning models, generated through this pre-processing pipeline, demonstrate successful generalization on an independent lung nodule dataset. By eliminating confounding variables in chest X-ray images and suppressing signal noise from the bone structures, the proposed deep learning lung nodule detection algorithm achieves an external generalization accuracy of 89%. This approach paves the way for the development of a low-cost and accessible deep learning-based clinical system for lung cancer screening.

A systematic approach to deep learning-based nodule detection in chest radiographs

Lung cancer is a serious disease responsible for millions of deaths every year. Early stages of lung cancer can be manifested in pulmonary lung nodules. To assist radiologists in reducing the number of overseen nodules and to increase the detection accuracy in general, automatic detection algorithms have been proposed. Particularly, deep learning methods are promising. However, obtaining clinically relevant results remains challenging. While a variety of approaches have been proposed for general purpose object detection, these are typically evaluated on benchmark data sets. Achieving competitive performance for specific real-world problems like lung nodule detection typically requires careful analysis of the problem at hand and the selection and tuning of suitable deep learning models. We present a systematic comparison of state-of-the-art object detection algorithms for the task of lung nodule detection. In this regard, we address the critical aspect of class imbalance and and demonstrate a data augmentation approach as well as transfer learning to boost performance. We illustrate how this analysis and a combination of multiple architectures results in state-of-the-art performance for lung nodule detection, which is demonstrated by the proposed model winning the detection track of the Node21 competition. The code for our approach is available at https://github.com/FinnBehrendt/node21-submit.

Computer-assisted diagnosis for an early identification of lung cancer in chest X rays

Computer-assisted diagnosis (CAD) algorithms have shown its usefulness for the identification of pulmonary nodules in chest x-rays, but its capability to diagnose lung cancer (LC) is unknown. A CAD algorithm for the identification of pulmonary nodules was created and used on a retrospective cohort of patients with x-rays performed in 2008 and not examined by a radiologist when obtained. X-rays were sorted according to the probability of pulmonary nodule, read by a radiologist and the evolution for the following three years was assessed. The CAD algorithm sorted 20,303 x-rays and defined four subgroups with 250 images each (percentiles ≥ 98, 66, 33 and 0). Fifty-eight pulmonary nodules were identified in the ≥ 98 percentile (23,2%), while only 64 were found in lower percentiles (8,5%) (p < 0.001). A pulmonary nodule was confirmed by the radiologist in 39 out of 173 patients in the high-probability group who had follow-up information (22.5%), and in 5 of them a LC was diagnosed with a delay of 11 months (12.8%). In one quarter of the chest x-rays considered as high-probability for pulmonary nodule by a CAD algorithm, the finding is confirmed and corresponds to an undiagnosed LC in one tenth of the cases.

Deep-learning algorithm to detect fibrosing interstitial lung disease on chest radiographs

BACKGROUND

Antifibrotic therapies are available to treat chronic fibrosing interstitial lung diseases (CF-ILDs), including idiopathic pulmonary fibrosis. Early use of these treatments is recommended to slow deterioration of respiratory function and to prevent acute exacerbation. However, identifying patients in the early stages of CF-ILD using chest radiographs is challenging. In this study, we developed and tested a deep-learning algorithm to detect CF-ILD using chest radiograph images.

METHOD

From the image archive of Sapporo Medical University Hospital, 653 chest radiographs from 263 patients with CF-ILDs and 506 from 506 patients without CF-ILD were identified; 921 were used for deep learning and 238 were used for algorithm testing. The algorithm was designed to output a numerical score ranging from 0 to 1, representing the probability of CF-ILD. Using the testing dataset, the algorithm's capability to identify CF-ILD was compared with that of doctors. A second dataset, in which CF-ILD was confirmed using computed tomography images, was used to further evaluate the algorithm's performance.

RESULTS

The area under the receiver operating characteristic curve, which indicates the algorithm's detection capability, was 0.979. Using a score cut-off of 0.267, the sensitivity and specificity of detection were 0.896 and 1.000, respectively. These data showed that the algorithm's performance was noninferior to that of doctors, including pulmonologists and radiologists; performance was verified using the second dataset.

CONCLUSIONS

We developed a deep-learning algorithm to detect CF-ILDs using chest radiograph images. The algorithm's detection capability was noninferior to that of doctors.

Artificial intelligence: A critical review of applications for lung nodule and lung cancer

Artificial intelligence (AI) is a broad concept that usually refers to computer programs that can learn from data and perform certain specific tasks. In the recent years, the growth of deep learning, a successful technique for computer vision tasks that does not require explicit programming, coupled with the availability of large imaging databases fostered the development of multiple applications in the medical imaging field, especially for lung nodules and lung cancer, mostly through convolutional neural networks (CNN). Some of the first applications of AI is this field were dedicated to automated detection of lung nodules on X-ray and computed tomography (CT) examinations, with performances now reaching or exceeding those of radiologists. For lung nodule segmentation, CNN-based algorithms applied to CT images show excellent spatial overlap index with manual segmentation, even for irregular and ground glass nodules. A third application of AI is the classification of lung nodules between malignant and benign, which could limit the number of follow-up CT examinations for less suspicious lesions. Several algorithms have demonstrated excellent capabilities for the prediction of the malignancy risk when a nodule is discovered. These different applications of AI for lung nodules are particularly appealing in the context of lung cancer screening. In the field of lung cancer, AI tools applied to lung imaging have been investigated for distinct aims. First, they could play a role for the non-invasive characterization of tumors, especially for histological subtype and somatic mutation predictions, with a potential therapeutic impact. Additionally, they could help predict the patient prognosis, in combination to clinical data. Despite these encouraging perspectives, clinical implementation of AI tools is only beginning because of the lack of generalizability of published studies, of an inner obscure working and because of limited data about the impact of such tools on the radiologists' decision and on the patient outcome. Radiologists must be active participants in the process of evaluating AI tools, as such tools could support their daily work and offer them more time for high added value tasks.

Artificial Intelligence for Early Detection of Chest Nodules in X-ray Images

Early detection increases overall survival among patients with lung cancer. This study formulated a machine learning method that processes chest X-rays (CXRs) to detect lung cancer early. After we preprocessed our dataset using monochrome and brightness correction, we used different kinds of preprocessing methods to enhance image contrast and then used U-net to perform lung segmentation. We used 559 CXRs with a single lung nodule labeled by experts to train a You Only Look Once version 4 (YOLOv4) deep-learning architecture to detect lung nodules. In a testing dataset of 100 CXRs from patients at Taipei Veterans General Hospital and 154 CXRs from the Japanese Society of Radiological Technology dataset, the sensitivity of the AI model using a combination of different preprocessing methods performed the best at 79%, with 3.04 false positives per image. We then tested the AI by using 383 sets of CXRs obtained in the past 5 years prior to lung cancer diagnoses. The median time from detection to diagnosis for radiologists assisted with AI was 46 (3-523) days, longer than that for radiologists (8 (0-263) days). The AI model can assist radiologists in the early detection of lung nodules.

Utilizing Synthetic Nodules for Improving Nodule Detection in Chest Radiographs

Algorithms that automatically identify nodular patterns in chest X-ray (CXR) images could benefit radiologists by reducing reading time and improving accuracy. A promising approach is to use deep learning, where a deep neural network (DNN) is trained to classify and localize nodular patterns (including mass) in CXR images. Such algorithms, however, require enough abnormal cases to learn representations of nodular patterns arising in practical clinical settings. Obtaining large amounts of high-quality data is impractical in medical imaging where (1) acquiring labeled images is extremely expensive, (2) annotations are subject to inaccuracies due to the inherent difficulty in interpreting images, and (3) normal cases occur far more frequently than abnormal cases. In this work, we devise a framework to generate realistic nodules and demonstrate how they can be used to train a DNN identify and localize nodular patterns in CXR images. While most previous research applying generative models to medical imaging are limited to generating visually plausible abnormalities and using these patterns for augmentation, we go a step further to show how the training algorithm can be adjusted accordingly to maximally benefit from synthetic abnormal patterns. A high-precision detection model was first developed and tested on internal and external datasets, and the proposed method was shown to enhance the model's recall while retaining the low level of false positives.

The value of AI in the Diagnosis, Treatment, and Prognosis of Malignant Lung Cancer

Malignant tumors is a serious public health threat. Among them, lung cancer, which has the highest fatality rate globally, has significantly endangered human health. With the development of artificial intelligence (AI) and its integration with medicine, AI research in malignant lung tumors has become critical. This article reviews the value of CAD, computer neural network deep learning, radiomics, molecular biomarkers, and digital pathology for the diagnosis, treatment, and prognosis of malignant lung tumors.

Segmentation and classification on chest radiography: a systematic survey

Chest radiography (X-ray) is the most common diagnostic method for pulmonary disorders. A trained radiologist is required for interpreting the radiographs. But sometimes, even experienced radiologists can misinterpret the findings. This leads to the need for computer-aided detection diagnosis. For decades, researchers were automatically detecting pulmonary disorders using the traditional computer vision (CV) methods. Now the availability of large annotated datasets and computing hardware has made it possible for deep learning to dominate the area. It is now the modus operandi for feature extraction, segmentation, detection, and classification tasks in medical imaging analysis. This paper focuses on the research conducted using chest X-rays for the lung segmentation and detection/classification of pulmonary disorders on publicly available datasets. The studies performed using the Generative Adversarial Network (GAN) models for segmentation and classification on chest X-rays are also included in this study. GAN has gained the interest of the CV community as it can help with medical data scarcity. In this study, we have also included the research conducted before the popularity of deep learning models to have a clear picture of the field. Many surveys have been published, but none of them is dedicated to chest X-rays. This study will help the readers to know about the existing techniques, approaches, and their significance.

Lung Segmentation using Active Shape Model to Detect the Disease from Chest Radiography

Background:

Some parametric models are used to diagnose problems of lung segmentation more easily and effectively.

Objective:

The present study aims to detect lung diseases (nodules and tuberculosis) better using an active shape model (ASM) from chest radiographs.

Material and Methods:

In this analytical study, six grouping methods, including three primary methods such as physicians, Dice similarity, and correlation coefficients) and also three secondary methods using SVM (Support Vector Machine) were used to classify the chest radiographs regarding diaphragm congestion and heart reshaping. The most effective method, based on the evaluation of the results by a radiologist, was found and used as input data for segmenting the images by active shape model (ASM). Several segmentation parameters were evaluated to calculate the accuracy of segmentation. This work was conducted on JSRT (Japanese Society of Radiological Technology) database images and tuberculosis database images were used for validation.

Results:

The results indicated that the ASM can detect 94.12 ± 2.34 % and 94.38 ± 3.74 % (mean± standard deviation) of pulmonary nodules in left and right lungs, respectively, from the JRST radiology datasets. Furthermore, the ASM model detected 88.33 ± 6.72 % and 90.37 ± 5.48 % of tuberculosis in left and right lungs, respectively.

Conclusion:

The ASM segmentation method combined with pre-segmentation grouping can be used as a preliminary step to identify areas with tuberculosis or pulmonary nodules. In addition, this presented approach can be used to measure the size and dimensions of the heart in future studies.

Deep learning applied to automatic disease detection using chest X-rays

Deep learning (DL) has shown rapid advancement and considerable promise when applied to the automatic detection of diseases using CXRs. This is important given the widespread use of CXRs across the world in diagnosing significant pathologies, and the lack of trained radiologists to report them. This review article introduces the basic concepts of DL as applied to CXR image analysis including basic deep neural network (DNN) structure, the use of transfer learning and the application of data augmentation. It then reviews the current literature on how DNN models have been applied to the detection of common CXR abnormalities (e.g. lung nodules, pneumonia, tuberculosis and pneumothorax) over the last few years. This includes DL approaches employed for the classification of multiple different diseases (multi-class classification). Performance of different techniques and models and their comparison with human observers are presented. Some of the challenges facing DNN models, including their future implementation and relationships to radiologists, are also discussed.

Automatic Lung Segmentation Algorithm on Chest X-ray Images Based on Fusion Variational Auto-Encoder and Three-Terminal Attention Mechanism

Automatic segmentation of the lungs in Chest X-ray images (CXRs) is a key step in the screening and diagnosis of related diseases. There are many opacities in the lungs in the CXRs of patients, which makes the lungs difficult to segment. In order to solve this problem, this paper proposes a segmentation algorithm based on U-Net. This article introduces variational auto-encoder (VAE) in each layer of the decoder-encoder. VAE can extract high-level semantic information, such as the symmetrical relationship between the left and right thoraxes in most cases. The fusion of the features of VAE and the features of convolution can improve the ability of the network to extract features. This paper proposes a three-terminal attention mechanism. The attention mechanism uses the channel and spatial attention module to automatically highlight the target area and improve the performance of lung segmentation. At the same time, the three-terminal attention mechanism uses the advanced semantics of high-scale features to improve the positioning and recognition capabilities of the attention mechanism, suppress background noise, and highlight target features. Experimental results on two different datasets show that the accuracy (ACC), recall (R), F1-Score and Jaccard values of the algorithm proposed in this paper are the highest on the two datasets, indicating that the algorithm in this paper is better than other state-of-the-art algorithms.

On the performance of lung nodule detection, segmentation and classification

Computed tomography (CT) screening is an effective way for early detection of lung cancer in order to improve the survival rate of such a deadly disease. For more than two decades, image processing techniques such as nodule detection, segmentation, and classification have been extensively studied to assist physicians in identifying nodules from hundreds of CT slices to measure shapes and HU distributions of nodules automatically and to distinguish their malignancy. Thanks to new parallel computation, multi-layer convolution, nonlinear pooling operation, and the big data learning strategy, recent development of deep-learning algorithms has shown great progress in lung nodule screening and computer-assisted diagnosis (CADx) applications due to their high sensitivity and low false positive rates. This paper presents a survey of state-of-the-art deep-learning-based lung nodule screening and analysis techniques focusing on their performance and clinical applications, aiming to help better understand the current performance, the limitation, and the future trends of lung nodule analysis.

Medical Image Classification Algorithm Based on Visual Attention Mechanism-MCNN

Due to the complexity of medical images, traditional medical image classification methods have been unable to meet the actual application needs. In recent years, the rapid development of deep learning theory has provided a technical approach for solving medical image classification. However, deep learning has the following problems in the application of medical image classification. First, it is impossible to construct a deep learning model with excellent performance according to the characteristics of medical images. Second, the current deep learning network structure and training strategies are less adaptable to medical images. Therefore, this paper first introduces the visual attention mechanism into the deep learning model so that the information can be extracted more effectively according to the problem of medical images, and the reasoning is realized at a finer granularity. It can increase the interpretability of the model. Additionally, to solve the problem of matching the deep learning network structure and training strategy to medical images, this paper will construct a novel multiscale convolutional neural network model that can automatically extract high-level discriminative appearance features from the original image, and the loss function uses the Mahalanobis distance optimization model to obtain a better training strategy, which can improve the robust performance of the network model. The medical image classification task is completed by the above method. Based on the above ideas, this paper proposes a medical classification algorithm based on a visual attention mechanism-multiscale convolutional neural network. The lung nodules and breast cancer images were classified by the method in this paper. The experimental results show that the accuracy of medical image classification in this paper is not only higher than that of traditional machine learning methods but also improved compared with other deep learning methods, and the method has good stability and robustness.

Transfer-to-Transfer Learning Approach for Computer Aided Detection of COVID-19 in Chest Radiographs

The coronavirus disease 2019 (COVID-19) global pandemic has severely impacted lives across the globe. Respiratory disorders in COVID-19 patients are caused by lung opacities similar to viral pneumonia. A Computer-Aided Detection (CAD) system for the detection of COVID-19 using chest radiographs would provide a second opinion for radiologists. For this research, we utilize publicly available datasets that have been marked by radiologists into two-classes (COVID-19 and non-COVID-19). We address the class imbalance problem associated with the training dataset by proposing a novel transfer-to-transfer learning approach, where we break a highly imbalanced training dataset into a group of balanced mini-sets and apply transfer learning between these. We demonstrate the efficacy of the method using well-established deep convolutional neural networks. Our proposed training mechanism is more robust to limited training data and class imbalance. We study the performance of our algorithm(s) based on 10-fold cross validation and two hold-out validation experiments to demonstrate its efficacy. We achieved an overall sensitivity of 0.94 for the hold-out validation experiments containing 2265 and 2139 marked as COVID-19 chest radiographs, respectively. For the 10-fold cross validation experiment, we achieve an overall Area under the Receiver Operating Characteristic curve (AUC) value of 0.996 for COVID-19 detection. This paper serves as a proof-of-concept that an automated detection approach can be developed with a limited set of COVID-19 images, and in areas with scarcity of trained radiologists.

The detection of lung cancer using massive artificial neural network based on soft tissue technique

BACKGROUND

A proposed computer aided detection (CAD) scheme faces major issues during subtle nodule recognition. However, radiologists have not noticed subtle nodules in beginning stage of lung cancer while a proposed CAD scheme recognizes non subtle nodules using x-ray images.

METHOD

Such an issue has been resolved by creating MANN (Massive Artificial Neural Network) based soft tissue technique from the lung segmented x-ray image. A soft tissue image recognizes nodule candidate for feature extortion and classification. X-ray images are downloaded using Japanese society of radiological technology (JSRT) image set. This image set includes 233 images (140 nodule x-ray images and 93 normal x-ray images). A mean size for a nodule is 17.8 mm and it is validated with computed tomography (CT) image. Thirty percent (42/140) abnormal represents subtle nodules and it is split into five stages (tremendously subtle, very subtle, subtle, observable, relatively observable) by radiologists.

RESULT

A proposed CAD scheme without soft tissue technique attained 66.42% (93/140) sensitivity and 66.76% accuracy having 2.5 false positives per image. Utilizing soft tissue technique, many nodules superimposed by ribs as well as clavicles have identified (sensitivity is 72.85% (102/140) and accuracy is 72.96% at one false positive rate).

CONCLUSION

In particular, a proposed CAD system determine sensitivity and accuracy in support of subtle nodules (sensitivity is 14/42 = 33.33% and accuracy is 33.66%) is statistically higher than CAD (sensitivity is 13/42 = 30.95% and accuracy is 30.97%) scheme without soft tissue technique. A proposed CAD scheme attained tremendously minimum false positive rate and it is a promising technique in support of cancerous recognition due to improved sensitivity and specificity.

The investigation of multiresolution approaches for chest X-ray image based COVID-19 detection

COVID-19 is a novel virus, which has a fast spreading rate, and now it is seen all around the world. The case and death numbers are increasing day by day. Some tests have been used to determine the COVID-19. Chest X-ray and chest computerized tomography (CT) are two important imaging tools for determination and monitoring of COVID-19. And new methods have been searching for determination of the COVID-19. In this paper, the investigation of various multiresolution approaches in detection of COVID-19 is carried out. Chest X-ray images are used as input to the proposed approach. As recent trend in machine learning shifts toward the deep learning, we would like to show that the traditional methods such as multiresolution approaches are still effective. To this end, the well-known multiresolution approaches namely Wavelet, Shearlet and Contourlet transforms are used to decompose the chest X-ray images and the entropy and the normalized energy approaches are employed for feature extraction from the decomposed chest X-ray images. Entropy and energy features are generally accompanied with the multiresolution approaches in texture recognition applications. The extreme learning machines (ELM) classifier is considered in the classification stage of the proposed study. A dataset containing 361 different COVID-19 chest X-ray images and 200 normal (healthy) chest X-ray images are used in the experimental works. The performance evaluation is carried out by employing various metric namely accuracy, sensitivity, specificity and precision. As deep learning is mentioned, a comparison between proposed multiresolution approaches and deep learning approaches is also carried out. To this end, deep feature extraction and fine-tuning of pretrained convolutional neural networks (CNNs) are considered. For deep feature extraction, pretrained, ResNet50 model is employed. For classification of the deep features, the Support Vector Machines (SVM) classifier is used. The ResNet50 model is also used in the fine-tuning. The experimental works show that multiresolution approaches produced better performance than the deep learning approaches. Especially, Shearlet transform outperformed at all. 99.29% accuracy score is obtained by using Shearlet transform.

Multi-resolution convolutional networks for chest X-ray radiograph based lung nodule detection

Lung cancer is the leading cause of cancer death worldwide. Early detection of lung cancer is helpful to provide the best possible clinical treatment for patients. Due to the limited number of radiologist and the huge number of chest x-ray radiographs (CXR) available for observation, a computer-aided detection scheme should be developed to assist radiologists in decision-making. While deep learning showed state-of-the-art performance in several computer vision applications, it has not been used for lung nodule detection on CXR. In this paper, a deep learning-based lung nodule detection method was proposed. We employed patch-based multi-resolution convolutional networks to extract the features and employed four different fusion methods for classification. The proposed method shows much better performance and is much more robust than those previously reported researches. For publicly available Japanese Society of Radiological Technology (JSRT) database, more than 99% of lung nodules can be detected when the false positives per image (FPs/image) was 0.2. The FAUC and R-CPM of the proposed method were 0.982 and 0.987, respectively. The proposed approach has the potential of applications in clinical practice.

A Computer-Aided Pipeline for Automatic Lung Cancer Classification on Computed Tomography Scans

Lung cancer is one of the most common cancer types. For the survival of the patient, early detection of lung cancer with the best treatment method is crucial. In this study, we propose a novel computer-aided pipeline on computed tomography (CT) scans for early diagnosis of lung cancer thanks to the classification of benign and malignant nodules. The proposed pipeline is composed of four stages. In preprocessing steps, CT images are enhanced, and lung volumes are extracted from the image with the help of a novel method called lung volume extraction method (LUVEM). The significance of the proposed pipeline is using LUVEM for extracting lung region. In nodule detection stage, candidate nodules are determined according to the circular Hough transform- (CHT-) based method. Then, lung nodules are segmented with self-organizing maps (SOM). In feature computation stage, intensity, shape, texture, energy, and combined features are used for feature extraction, and principal component analysis (PCA) is used for feature reduction step. In the final stage, probabilistic neural network (PNN) classifies benign and malign nodules. According to the experiments performed on our dataset, the proposed pipeline system can classify benign and malign nodules with 95.91% accuracy, 97.42% sensitivity, and 94.24% specificity. Even in cases of small-sized nodules (3-10 mm), the proposed system can determine the nodule type with 94.68% accuracy.

Computer-aided detection in chest radiography based on artificial intelligence: a survey

As the most common examination tool in medical practice, chest radiography has important clinical value in the diagnosis of disease. Thus, the automatic detection of chest disease based on chest radiography has become one of the hot topics in medical imaging research. Based on the clinical applications, the study conducts a comprehensive survey on computer-aided detection (CAD) systems, and especially focuses on the artificial intelligence technology applied in chest radiography. The paper presents several common chest X-ray datasets and briefly introduces general image preprocessing procedures, such as contrast enhancement and segmentation, and bone suppression techniques that are applied to chest radiography. Then, the CAD system in the detection of specific disease (pulmonary nodules, tuberculosis, and interstitial lung diseases) and multiple diseases is described, focusing on the basic principles of the algorithm, the data used in the study, the evaluation measures, and the results. Finally, the paper summarizes the CAD system in chest radiography based on artificial intelligence and discusses the existing problems and trends.

Performance analysis of a computer-aided detection system for lung nodules in CT at different slice thicknesses

We study the performance of a computer-aided detection (CAD) system for lung nodules in computed tomography (CT) as a function of slice thickness. In addition, we propose and compare three different training methodologies for utilizing nonhomogeneous thickness training data (i.e., composed of cases with different slice thicknesses). These methods are (1) aggregate training using the entire suite of data at their native thickness, (2) homogeneous subset training that uses only the subset of training data that matches each testing case, and (3) resampling all training and testing cases to a common thickness. We believe this study has important implications for how CT is acquired, processed, and stored. We make use of 192 CT cases acquired at a thickness of 1.25 mm and 283 cases at 2.5 mm. These data are from the publicly available Lung Nodule Analysis 2016 dataset. In our study, CAD performance at 2.5 mm is comparable with that at 1.25 mm and is much better than at higher thicknesses. Also, resampling all training and testing cases to 2.5 mm provides the best performance among the three training methods compared in terms of accuracy, memory consumption, and computational time.

Lung Field Segmentation in Chest Radiographs From Boundary Maps by a Structured Edge Detector

Lung field segmentation in chest radiographs (CXRs) is an essential preprocessing step in automatically analyzing such images. We present a method for lung field segmentation that is built on a high-quality boundary map detected by an efficient modern boundary detector, namely a structured edge detector (SED). A SED is trained beforehand to detect lung boundaries in CXRs with manually outlined lung fields. Then, an ultrametric contour map (UCM) is transformed from the masked and marked boundary map. Finally, the contours with the highest confidence level in the UCM are extracted as lung contours. Our method is evaluated using the public Japanese Society of Radiological Technology database of scanned films. The average Jaccard index of our method is 95.2%, which is comparable with those of other state-of-the-art methods (95.4%). The computation time of our method is less than 0.1 s for a CXR when executed on an ordinary laptop. Our method is also validated on CXRs acquired with different digital radiography units. The results demonstrate the generalization of the trained SED model and the usefulness of our method.

Computer-Aided Diagnosis for Chest Radiographs in Intensive Care

The chest radiograph is an essential tool for the diagnosis of several lung diseases in intensive care units (ICU). However, several factors make the interpretation of the chest radiograph difficult including the number of X-rays done daily in ICU, the quality of the chest radiograph, and the lack of a standardized interpretation. To overcome these limitations in the interpretation of chest radiographs, researchers have developed computer-aided diagnosis (CAD) systems. In this review, the authors report the methodology used to develop CAD systems including identification of the region of interest, analysis of these regions, and classification. Currently, only a few CAD systems for chest X-ray interpretation are commercially available. Some promising research is ongoing, but the involvement of the pediatric research community is needed for the development and validation of such CAD systems dedicated to pediatric intensive care.

Directional fractal signature methods for trabecular bone texture in hand radiographs: data from the Osteoarthritis Initiative

PURPOSE

To develop directional fractal signature methods for the analysis of trabecular bone (TB) texture in hand radiographs. Problems associated with the small size of hand bones and the orientation of fingers were addressed.

METHODS

An augmented variance orientation transform (AVOT) and a quadrant rotating grid (QRG) methods were developed. The methods calculate fractal signatures (FSs) in different directions. Unlike other methods they have the search region adjusted according to the size of bone region of interest (ROI) to be analyzed and they produce FSs defined with respect to any chosen reference direction, i.e., they work for arbitrary orientation of fingers. Five parameters at scales ranging from 2 to 14 pixels (depending on image size and method) were derived from rose plots of Hurst coefficients, i.e., FS in dominating roughness (FSSta), vertical (FSV) and horizontal (FSH) directions, aspect ratio (StrS), and direction signatures (StdS), respectively. The accuracy in measuring surface roughness and isotropy/anisotropy was evaluated using 3600 isotropic and 800 anisotropic fractal surface images of sizes between 20 × 20 and 64 × 64 pixels. The isotropic surfaces had FDs ranging from 2.1 to 2.9 in steps of 0.1, and the anisotropic surfaces had two dominating directions of 30° and 120°. The methods were used to find differences in hand TB textures between 20 matched pairs of subjects with (cases: approximate Kellgren-Lawrence (KL) grade ≥ 2) and without (controls: approximate KL grade <2) radiographic hand osteoarthritis (OA). The OA Initiative public database was used and 20 × 20 pixel bone ROIs were selected on 5th distal and middle phalanges. The performance of the AVOT and QRG methods was compared against a variance orientation transform (VOT) method developed earlier [M. Wolski, P. Podsiadlo, and G. W. Stachowiak, "Directional fractal signature analysis of trabecular bone: evaluation of different methods to detect early osteoarthritis in knee radiographs," Proc. Inst. Mech. Eng., Part H 223, 211-236 (2009)].

RESULTS

The AVOT method correctly quantified the isotropic and anisotropic surfaces for all image sizes and scales. Values of FSSta were significantly different (P < 0.05) between the isotropic surfaces. Using the VOT and QRG methods no differences were found at large scales for the isotropic surfaces that are smaller than 64 × 64 and 48 × 48 pixels, respectively, and at some scales for the anisotropic surfaces with size 48 × 48 pixels. Compared to controls, using the AVOT and QRG methods the authors found that OA TB textures were less rough (P < 0.05) in the dominating and horizontal directions (i.e., lower FSSta and FSH), rougher in the vertical direction (i.e., higher FSV) and less anisotropic (i.e., higher StrS) than controls. No differences were found using the VOT method.

CONCLUSIONS

The AVOT method is well suited for the analysis of bone texture in hand radiographs and it could be potentially useful for early detection and prediction of hand OA.

Robust and Reproducible Quantification of the Extent of Chest Radiographic Abnormalities (And It's Free!)

Rationale

Objective, reproducible quantification of the extent of abnormalities seen on a chest radiograph would improve the user-friendliness of a previously proposed severity scoring system for pulmonary tuberculosis and could be helpful in monitoring response to therapy, including in clinical trials.

Methods

In this study we report the development and evaluation of a simple tool using free image editing software (GIMP) to accurately and reproducibly quantify the area of affected lung on the chest radiograph of tuberculosis patients. As part of a pharmacokinetic study in Lima, Peru, a chest radiograph was performed on patients with pulmonary tuberculosis and this was subsequently photographed using a digital camera. The GIMP software was used by two independent and trained readers to estimate the extent of affected lung (expressed as a percentage of total lung area) in each radiograph and the resulting radiographic SCORE.

Results

56 chest radiographs were included in the reading analysis. The Intraclass correlation coefficient (ICC) between the 2 observers was 0.977 (p<0.001) for the area of lung affected and was 0.955 (p<0.001) for the final score; and the kappa coefficient of Interobserver agreement for both the area of lung affected and the score were 0.9 (p<0.001) and 0.86 (p<0.001) respectively.

Conclusions

This high level of between-observer agreement suggests that this freely available software could constitute a simple and useful tool for robust evaluation of individual and serial chest radiographs.

Data analysis of the Lung Imaging Database Consortium and Image Database Resource Initiative

RATIONALE AND OBJECTIVES

The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI) is the largest publicly available computed tomography (CT) image reference data set of lung nodules. In this article, a comprehensive data analysis of the data set and a uniform data model are presented with the purpose of facilitating potential researchers to have an in-depth understanding to and efficient use of the data set in their lung cancer-related investigations.

MATERIALS AND METHODS

A uniform data model was designed for representation and organization of various types of information contained in different source data files. A software tool was developed for the processing and analysis of the database, which 1) automatically aligns and graphically displays the nodule outlines marked manually by radiologists onto the corresponding CT images; 2) extracts diagnostic nodule characteristics annotated by radiologists; 3) calculates a variety of nodule image features based on the outlines of nodules, including diameter, volume, and degree of roundness, and so forth; 4) integrates all the extracted nodule information into the uniform data model and stores it in a common and easy-to-access data format; and 5) analyzes and summarizes various feature distributions of nodules in several different categories. Using this data processing and analysis tool, all 1018 CT scans from the data set were processed and analyzed for their statistical distribution.

RESULTS

The information contained in different source data files with different formats was extracted and integrated into a new and uniform data model. Based on the new data model, the statistical distributions of nodules in terms of nodule geometric features and diagnostic characteristics were summarized. In the LIDC/IDRI data set, 2655 nodules ≥3 mm, 5875 nodules <3 mm, and 7411 non-nodules are identified, respectively. Among the 2655 nodules, 1) 775, 488, 481, and 911 were marked by one, two, three, or four radiologists, respectively; 2) most of nodules ≥3 mm (85.7%) have a diameter <10.0 mm with the mean value of 6.72 mm; and 3) 10.87%, 31.4%, 38.8%, 16.4%, and 2.6% of nodules were assessed with a malignancy score of 1, 2, 3, 4, and 5, respectively.

CONCLUSIONS

This study demonstrates the usefulness of the proposed software tool to the potential users for an in-depth understanding of the LIDC/IDRI data set, therefore likely to be beneficial to their future investigations. The analysis results also demonstrate the distribution diversity of nodules characteristics, therefore being useful as a reference resource for assessing the performance of a new and existing nodule detection and/or segmentation schemes.

Application of phase congruency for discriminating some lung diseases using chest radiograph

A novel procedure using phase congruency is proposed for discriminating some lung disease using chest radiograph. Phase congruency provides information about transitions between adjacent pixels. Abrupt changes of phase congruency values between pixels may suggest a possible boundary or another feature that may be used for discrimination. This property of phase congruency may have potential for deciding between disease present and disease absent where the regions of infection on the images have no obvious shape, size, or configuration. Five texture measures calculated from phase congruency and Gabor were shown to be normally distributed. This gave good indicators of discrimination errors in the form of the probability of Type I Error (δ) and the probability of Type II Error (β). However, since 1 -  δ is the true positive fraction (TPF) and β is the false positive fraction (FPF), an ROC analysis was used to decide on the choice of texture measures. Given that features are normally distributed, for the discrimination between disease present and disease absent, energy, contrast, and homogeneity from phase congruency gave better results compared to those using Gabor. Similarly, for the more difficult problem of discriminating lobar pneumonia and lung cancer, entropy and homogeneity from phase congruency gave better results relative to Gabor.

Development of a personalized training system using the Lung Image Database Consortium and Image Database resource Initiative Database

RATIONALE AND OBJECTIVES

The aim of this study was to develop a personalized training system using the Lung Image Database Consortium (LIDC) and Image Database resource Initiative (IDRI) Database, because collecting, annotating, and marking a large number of appropriate computed tomography (CT) scans, and providing the capability of dynamically selecting suitable training cases based on the performance levels of trainees and the characteristics of cases are critical for developing a efficient training system.

MATERIALS AND METHODS

A novel approach is proposed to develop a personalized radiology training system for the interpretation of lung nodules in CT scans using the Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI) database, which provides a Content-Boosted Collaborative Filtering (CBCF) algorithm for predicting the difficulty level of each case of each trainee when selecting suitable cases to meet individual needs, and a diagnostic simulation tool to enable trainees to analyze and diagnose lung nodules with the help of an image processing tool and a nodule retrieval tool.

RESULTS

Preliminary evaluation of the system shows that developing a personalized training system for interpretation of lung nodules is needed and useful to enhance the professional skills of trainees.

CONCLUSIONS

The approach of developing personalized training systems using the LIDC/IDRL database is a feasible solution to the challenges of constructing specific training program in terms of cost and training efficiency.

Feasibility study of dual energy radiographic imaging for target localization in radiotherapy for lung tumors

Purpose

Dual-energy (DE) radiographic imaging improves tissue discrimination by separating soft from hard tissues in the acquired images. This study was to establish a mathematic model of DE imaging based on intrinsic properties of tissues and quantitatively evaluate the feasibility of applying the DE imaging technique to tumor localization in radiotherapy.

Methods

We investigated the dependence of DE image quality on the radiological equivalent path length (EPL) of tissues with two phantoms using a stereoscopic x-ray imaging unit. 10 lung cancer patients who underwent radiotherapy each with gold markers implanted in the tumor were enrolled in the study approved by the hospital's Ethics Committee. The displacements of the centroids of the delineated gross tumor volumes (GTVs) in the digitally reconstructed radiograph (DRR) and in the bone-canceled DE image were compared with the averaged displacements of the centroids of gold markers to evaluate the feasibility of using DE imaging for tumor localization.

Results

The results of the phantom study indicated that the contrast-to-noise ratio (CNR) was linearly dependent on the difference of EPL and a mathematical model was established. The objects and backgrounds corresponding to ΔEPL less than 0.08 are visually indistinguishable in the bone-canceled DE image. The analysis of patient data showed that the tumor contrast in the bone-canceled images was improved significantly as compared with that in the original radiographic images and the accuracy of tumor localization using the DE imaging technique was comparable with that of using fiducial makers.

Conclusion

It is feasible to apply the technique for tumor localization in radiotherapy.

Evaluation of computer-aided detection and diagnosis systems

Computer-aided detection and diagnosis (CAD) systems are increasingly being used as an aid by clinicians for detection and interpretation of diseases. Computer-aided detection systems mark regions of an image that may reveal specific abnormalities and are used to alert clinicians to these regions during image interpretation. Computer-aided diagnosis systems provide an assessment of a disease using image-based information alone or in combination with other relevant diagnostic data and are used by clinicians as a decision support in developing their diagnoses. While CAD systems are commercially available, standardized approaches for evaluating and reporting their performance have not yet been fully formalized in the literature or in a standardization effort. This deficiency has led to difficulty in the comparison of CAD devices and in understanding how the reported performance might translate into clinical practice. To address these important issues, the American Association of Physicists in Medicine (AAPM) formed the Computer Aided Detection in Diagnostic Imaging Subcommittee (CADSC), in part, to develop recommendations on approaches for assessing CAD system performance. The purpose of this paper is to convey the opinions of the AAPM CADSC members and to stimulate the development of consensus approaches and "best practices" for evaluating CAD systems. Both the assessment of a standalone CAD system and the evaluation of the impact of CAD on end-users are discussed. It is hoped that awareness of these important evaluation elements and the CADSC recommendations will lead to further development of structured guidelines for CAD performance assessment. Proper assessment of CAD system performance is expected to increase the understanding of a CAD system's effectiveness and limitations, which is expected to stimulate further research and development efforts on CAD technologies, reduce problems due to improper use, and eventually improve the utility and efficacy of CAD in clinical practice.

Individual nodule tracking in micro-CT images of a longitudinal lung cancer mouse model

We present and evaluate an automatic and quantitative method for the complex task of characterizing individual nodule volumetric progression in a longitudinal mouse model of lung cancer. Fourteen A/J mice received an intraperitoneal injection of urethane. Respiratory-gated micro-CT images of the lungs were acquired at 8, 22, and 37 weeks after injection. A radiologist identified a total of 196, 585 and 636 nodules, respectively. The three micro-CT image volumes from every animal were then registered and the nodules automatically matched with an average accuracy of 99.5%. All nodules detected at week 8 were tracked all the way to week 37, and volumetrically segmented to measure their growth and doubling rates. 92.5% of all nodules were correctly segmented, ranging from the earliest stage to advanced stage, where nodule segmentation becomes more challenging due to complex anatomy and nodule overlap. Volume segmentation was validated using a foam lung phantom with embedded polyethylene microspheres. We also correlated growth rates with nodule phenotypes based on histology, to conclude that the growth rate of malignant tumors is significantly higher than that of benign lesions. In conclusion, we present a turnkey solution that combines longitudinal imaging with nodule matching and volumetric nodule segmentation resulting in a powerful tool for preclinical research.

Foreign object detection and removal to improve automated analysis of chest radiographs

PURPOSE

Chest radiographs commonly contain projections of foreign objects, such as buttons, brassier clips, jewellery, or pacemakers and wires. The presence of these structures can substantially affect the output of computer analysis of these images. An automated method is presented to detect, segment, and remove foreign objects from chest radiographs.

METHODS

Detection is performed using supervised pixel classification with a kNN classifier, resulting in a probability estimate per pixel to belong to a projected foreign object. Segmentation is performed by grouping and post-processing pixels with a probability above a certain threshold. Next, the objects are replaced by texture inpainting.

RESULTS

The method is evaluated in experiments on 257 chest radiographs. The detection at pixel level is evaluated with receiver operating characteristic analysis on pixels within the unobscured lung fields and an Az value of 0.949 is achieved. Free response operator characteristic analysis is performed at the object level, and 95.6% of objects are detected with on average 0.25 false positive detections per image. To investigate the effect of removing the detected objects through inpainting, a texture analysis system for tuberculosis detection is applied to images with and without pathology and with and without foreign object removal. Unprocessed, the texture analysis abnormality score of normal images with foreign objects is comparable to those with pathology. After removing foreign objects, the texture score of normal images with and without foreign objects is similar, while abnormal images, whether they contain foreign objects or not, achieve on average higher scores.

CONCLUSIONS

The authors conclude that removal of foreign objects from chest radiographs is feasible and beneficial for automated image analysis.