A digital mask to safeguard patient privacy

Privacy-Preserving Biometric Verification With Handwritten Random Digit String

Handwriting verification has stood as a steadfast identity authentication method for decades. However, this technique risks potential privacy breaches due to the inclusion of personal information in handwritten biometrics such as signatures. To address this concern, we propose using the Random Digit String (RDS) for privacy-preserving handwriting verification. This approach allows users to authenticate themselves by writing an arbitrary digit sequence, effectively ensuring privacy protection. To evaluate the effectiveness of RDS, we construct a new HRDS4BV dataset composed of online naturally handwritten RDS. Unlike conventional handwriting, RDS encompasses unconstrained and variable content, posing significant challenges for modeling consistent personal writing style. To surmount this, we propose the Pattern Attentive VErification Network (PAVENet), along with a Discriminative Pattern Mining (DPM) module. DPM adaptively enhances the recognition of consistent and discriminative writing patterns, thus refining handwriting style representation. Through comprehensive evaluations, we scrutinize the applicability of online RDS verification and showcase a pronounced outperformance of our model over existing methods. Furthermore, we discover a noteworthy forgery phenomenon that deviates from prior findings and discuss its positive impact in countering malicious impostor attacks. Substantially, our work underscores the feasibility of privacy-preserving biometric verification and propels the prospects of its broader acceptance and application.

Report of the Medical Image De-Identification (MIDI) Task Group -- Best Practices and Recommendations

This report addresses the technical aspects of de-identification of medical images of human subjects and biospecimens, such that re-identification risk of ethical, moral, and legal concern is sufficiently reduced to allow unrestricted public sharing for any purpose, regardless of the jurisdiction of the source and distribution sites. All medical images, regardless of the mode of acquisition, are considered, though the primary emphasis is on those with accompanying data elements, especially those encoded in formats in which the data elements are embedded, particularly Digital Imaging and Communications in Medicine (DICOM). These images include image-like objects such as Segmentations, Parametric Maps, and Radiotherapy (RT) Dose objects. The scope also includes related non-image objects, such as RT Structure Sets, Plans and Dose Volume Histograms, Structured Reports, and Presentation States. Only de-identification of publicly released data is considered, and alternative approaches to privacy preservation, such as federated learning for artificial intelligence (AI) model development, are out of scope, as are issues of privacy leakage from AI model sharing. Only technical issues of public sharing are addressed.

Publishing Identifiable Patient Photographs in the Digital Age: Focus Group Study of Patients, Doctors, and Medical Students

BACKGROUND

The publication of patient photographs in scientific journals continues to pose challenges regarding privacy and confidentiality, despite existing ethical guidelines. Recent studies indicate that key stakeholders-including health care professionals and patients-lack sufficient awareness of the ethical considerations surrounding patient photographs, particularly in the context of digital scientific publishing.

OBJECTIVE

This qualitative study aims to explore how different stakeholders-patients, medical students, and doctors-understand the challenges of patient privacy and confidentiality in scientific publications. Additionally, it sought to identify key areas for future research, particularly in the context of online, open-access articles.

METHODS

We conducted 4 online focus groups due to COVID-19 restrictions: 1 with patients, 2 with final-year medical students, and 1 with head and neck physicians and dentists who regularly handle patient photographs. Participants were invited via email, and those who accepted took part in discussions lasting approximately 1 hour. All interviews were recorded and transcribed for analysis. All 4 focus groups were asked the same set of questions, covering the following topics: (1) consent for publishing patient photographs, (2) information on guidelines and standards for consent to publish patient photographs, (3) the importance of informed consent for various purposes, (4) methods for deidentifying patient photographs, and (5) the use of patient photographs in online, open-access publishing.

RESULTS

Three key themes emerged from the focus group discussions: (1) no definitive resources or practical recommendations available, (2) online publishing of patient images makes them more open to misuse, and (3) anonymization techniques have limitations. All stakeholder groups expressed a lack of knowledge about online publishing in general and concerns about the fate of patient photographs in the digital environment after publication. They emphasized the need for increased awareness among all relevant stakeholders and more stringent procedures for obtaining informed patient consent before publishing photographs. While they recognized the usefulness of image anonymization techniques in protecting patient identity, they were also aware that current methods remain insufficient to ensure complete anonymity.

CONCLUSIONS

This qualitative study highlights that publishing patient photographs in open-access scientific journals is an important, serious, and largely unexplored issue, with all stakeholders still uncertain about the best ways to protect patient privacy. Clinicians, publishers, and journal editors should not only implement best practices to ensure fully informed patient consent for publishing identifiable photographs but also develop technical and governance safeguards. Future quantitative studies are needed to identify the most effective ways to enhance stakeholders' knowledge, policies, and procedures, ultimately guiding the development of practical recommendations for the ethical publication of patient photographs in scientific journals.

CDKD-w+: A Keyframe Recognition Method for Coronary Digital Subtraction Angiography Video Sequence Based on w+ Space Encoding

Currently, various deep learning methods can assist in medical diagnosis. Coronary Digital Subtraction Angiography (DSA) is a medical imaging technology used in cardiac interventional procedures. By employing X-ray sensors to visualize the coronary arteries, it generates two-dimensional images from any angle. However, due to the complexity of the coronary structures, the 2D images may sometimes lack sufficient information, necessitating the construction of a 3D model. Camera-level 3D modeling can be realized based on deep learning. Nevertheless, the beating of the heart results in varying degrees of arterial vasoconstriction and vasodilation, leading to substantial discrepancies between DSA sequences, which introduce errors in 3D modeling of the coronary arteries, resulting in the inability of the 3D model to reflect the coronary arteries. We propose a coronary DSA video sequence keyframe recognition method, CDKD-w+, based on w+ space encoding. The method utilizes a pSp encoder to encode the coronary DSA images, converting them into latent codes in the w+ space. Differential analysis of inter-frame latent codes is employed for heartbeat keyframe localization, aiding in coronary 3D modeling. Experimental results on a self-constructed coronary DSA heartbeat keyframe recognition dataset demonstrate an accuracy of 97%, outperforming traditional metrics such as L1, SSIM, and PSNR.

Privacy preserving technology in ophthalmology

PURPOSE OF REVIEW

Patient privacy protection is a critical focus in medical practice. Advances over the past decade in big data have led to the digitization of medical records, making medical data increasingly accessible through frequent data sharing and online communication. Periocular features, iris, and fundus images all contain biometric characteristics of patients, making privacy protection in ophthalmology particularly important. Consequently, privacy-preserving technologies have emerged, and are reviewed in this study.

RECENT FINDINGS

Recent findings indicate that general medical privacy-preserving technologies, such as federated learning and blockchain, have been gradually applied in ophthalmology. However, the exploration of privacy protection techniques of specific ophthalmic examinations, like digital mask, is still limited. Moreover, we have observed advancements in addressing ophthalmic ethical issues related to privacy protection in the era of big data, such as algorithm fairness and explainability.

SUMMARY

Future privacy protection for ophthalmic patients still faces challenges and requires improved strategies. Progress in privacy protection technology for ophthalmology will continue to promote a better healthcare environment and patient experience, as well as more effective data sharing and scientific research.

The AI revolution in glaucoma: Bridging challenges with opportunities

Recent advancements in artificial intelligence (AI) herald transformative potentials for reshaping glaucoma clinical management, improving screening efficacy, sharpening diagnosis precision, and refining the detection of disease progression. However, incorporating AI into healthcare usages faces significant hurdles in terms of developing algorithms and putting them into practice. When creating algorithms, issues arise due to the intensive effort required to label data, inconsistent diagnostic standards, and a lack of thorough testing, which often limits the algorithms' widespread applicability. Additionally, the "black box" nature of AI algorithms may cause doctors to be wary or skeptical. When it comes to using these tools, challenges include dealing with lower-quality images in real situations and the systems' limited ability to work well with diverse ethnic groups and different diagnostic equipment. Looking ahead, new developments aim to protect data privacy through federated learning paradigms, improving algorithm generalizability by diversifying input data modalities, and augmenting datasets with synthetic imagery. The integration of smartphones appears promising for using AI algorithms in both clinical and non-clinical settings. Furthermore, bringing in large language models (LLMs) to act as interactive tool in medicine may signify a significant change in how healthcare will be delivered in the future. By navigating through these challenges and leveraging on these as opportunities, the field of glaucoma AI will not only have improved algorithmic accuracy and optimized data integration but also a paradigmatic shift towards enhanced clinical acceptance and a transformative improvement in glaucoma care.

Artificial Intelligence in Facial Plastics and Reconstructive Surgery

Artificial intelligence (AI), particularly computer vision and large language models, will impact facial plastic and reconstructive surgery (FPRS) by enhancing diagnostic accuracy, refining surgical planning, and improving post-operative evaluations. These advancements can address subjective limitations of aesthetic surgery by providing objective tools for patient evaluation. Despite these advancements, AI in FPRS has yet to be fully integrated in the clinic setting and faces numerous challenges including algorithmic bias, ethical considerations, and need for validation. This article discusses current and emerging AI technologies in FPRS for the clinic setting, providing a glimpse of its future potential.

Towards regulatory generative AI in ophthalmology healthcare: a security and privacy perspective

As the healthcare community increasingly harnesses the power of generative artificial intelligence (AI), critical issues of security, privacy and regulation take centre stage. In this paper, we explore the security and privacy risks of generative AI from model-level and data-level perspectives. Moreover, we elucidate the potential consequences and case studies within the domain of ophthalmology. Model-level risks include knowledge leakage from the model and model safety under AI-specific attacks, while data-level risks involve unauthorised data collection and data accuracy concerns. Within the healthcare context, these risks can bear severe consequences, encompassing potential breaches of sensitive information, violating privacy rights and threats to patient safety. This paper not only highlights these challenges but also elucidates governance-driven solutions that adhere to AI and healthcare regulations. We advocate for preparedness against potential threats, call for transparency enhancements and underscore the necessity of clinical validation before real-world implementation. The objective of security and privacy improvement in generative AI warrants emphasising the role of ophthalmologists and other healthcare providers, and the timely introduction of comprehensive regulations.

A Practical Guide to Manual and Semi-Automated Neurosurgical Brain Lesion Segmentation

The purpose of the article is to provide a practical guide for manual and semi-automated image segmentation of common neurosurgical cranial lesions, namely meningioma, glioblastoma multiforme (GBM) and subarachnoid haemorrhage (SAH), for neurosurgical trainees and researchers.

MATERIALS AND METHODS

The medical images used were sourced from the Medical Image Computing and Computer Assisted Interventions Society (MICCAI) Multimodal Brain Tumour Segmentation Challenge (BRATS) image database and from the local Picture Archival and Communication System (PACS) record with consent. Image pre-processing was carried out using MRIcron software (v1.0.20190902). ITK-SNAP (v3.8.0) was used in this guideline due to its availability and powerful built-in segmentation tools, although others (Seg3D, Freesurfer and 3D Slicer) are available. Quality control was achieved by employing expert segmenters to review.

RESULTS

A pipeline was developed to demonstrate the pre-processing and manual and semi-automated segmentation of patient images for each cranial lesion, accompanied by image guidance and video recordings. Three sample segmentations were generated to illustrate potential challenges. Advice and solutions were provided within both text and video.

CONCLUSIONS

Semi-automated segmentation methods enhance efficiency, increase reproducibility, and are suitable to be incorporated into future clinical practise. However, manual segmentation remains a highly effective technique in specific circumstances and provides initial training sets for the development of more advanced semi- and fully automated segmentation algorithms.

Clinical translation of nanomedicine with integrated digital medicine and machine learning interventions

Nanomaterials based therapeutics transform the ways of disease prevention, diagnosis and treatment with increasing sophistications in nanotechnology at a breakneck pace, but very few could reach to the clinic due to inconsistencies in preclinical studies followed by regulatory hinderances. To tackle this, integrating the nanomedicine discovery with digital medicine provide technologies as tools of specific biological activity measurement. Hence, overcome the redundancies in nanomedicine discovery by the on-site data acquisition and analytics through integrating intelligent sensors and artificial intelligence (AI) or machine learning (ML). Integrated AI/ML wearable sensors directly gather clinically relevant biochemical information from the subject's body and process data for physicians to make right clinical decision(s) in a time and cost-effective way. This review summarizes insights and recommend the infusion of actionable big data computation enabled sensors in burgeoning field of nanomedicine at academia, research institutes, and pharmaceutical industries, with a potential of clinical translation. Furthermore, many blind spots are present in modern clinically relevant computation, one of which could prevent ML-guided low-cost new nanomedicine development from being successfully translated into the clinic was also discussed.

Global research of artificial intelligence in eyelid diseases: A bibliometric analysis

Purpose

To generate an overview of global research on artificial intelligence (AI) in eyelid diseases using a bibliometric approach.

Methods

All publications related to AI in eyelid diseases from 1900 to 2023 were retrieved from the Web of Science (WoS) Core Collection database. After manual screening, 98 publications published between 2000 and 2023 were finally included. We analyzed the annual trend of publication and citation count, productivity and co-authorship of countries/territories and institutions, research domain, source journal, co-occurrence and evolution of the keywords and co-citation and clustering of the references, using the analytic tool of the WoS, VOSviewer, Wordcloud Python package and CiteSpace.

Results

By analyzing a total of 98 relevant publications, we detected that this field had continuously developed over the past two decades and had entered a phase of rapid development in the last three years. Among these countries/territories and institutions contributing to this field, China was the most productive country and had the most institutions with high productivity, while USA was the most active in collaborating with others. The most popular research domains was Ophthalmology and the most productive journals were Ocular Surface. The co-occurrence network of keywords could be classified into 3 clusters respectively concerned about blepharoptosis, meibomian gland dysfunction and blepharospasm. The evolution of research hotspots is from clinical features to clinical scenarios and from image processing to deep learning. In the clustering analysis of co-cited reference network, cluster "0# deep learning" was the largest and latest, and cluster "#5 meibomian glands visibility assessment" existed for the longest time.

Conclusions

Although the research of AI in eyelid diseases has rapidly developed in the last three years, there are still gaps in this area. Our findings provide researchers with a better understanding of the development of the field and a reference for future research directions.

Coordinate-wise monotonic transformations enable privacy-preserving age estimation with 3D face point cloud

The human face is a valuable biomarker of aging, but the collection and use of its image raise significant privacy concerns. Here we present an approach for facial data masking that preserves age-related features using coordinate-wise monotonic transformations. We first develop a deep learning model that estimates age directly from non-registered face point clouds with high accuracy and generalizability. We show that the model learns a highly indistinguishable mapping using faces treated with coordinate-wise monotonic transformations, indicating that the relative positioning of facial information is a low-level biomarker of facial aging. Through visual perception tests and computational 3D face verification experiments, we demonstrate that transformed faces are significantly more difficult to perceive for human but not for machines, except when only the face shape information is accessible. Our study leads to a facial data protection guideline that has the potential to broaden public access to face datasets with minimized privacy risks.

A narrative review of deep learning in thyroid imaging: current progress and future prospects

Background and Objective

Deep learning (DL) has contributed substantially to the evolution of image analysis by unlocking increased data and computational power. These DL algorithms have further facilitated the growing trend of implementing precision medicine, particularly in areas of diagnosis and therapy. Thyroid imaging, as a routine means to screening for thyroid diseases on large-scale populations, is a massive data source for the development of DL models. Thyroid disease is a global health problem and involves structural and functional changes. The objective of this study was to evaluate the general rules and future directions of DL networks in thyroid medical image analysis through a review of original articles published between 2018 and 2023.

Methods

We searched for English-language articles published between April 2018 and September 2023 in the databases of PubMed, Web of Science, and Google Scholar. The keywords used in the search included artificial intelligence or DL, thyroid diseases, and thyroid nodule or thyroid carcinoma.

Key Content and Findings

The computer vision tasks of DL in thyroid imaging included classification, segmentation, and detection. The current applications of DL in clinical workflow were found to mainly include management of thyroid nodules/carcinoma, risk evaluation of thyroid cancer metastasis, and discrimination of functional thyroid diseases.

Conclusions

DL is expected to enhance the quality of thyroid images and provide greater precision in the assessment of thyroid images. Specifically, DL can increase the diagnostic accuracy of thyroid diseases and better inform clinical decision-making.

Metaverse Wearables for Immersive Digital Healthcare: A Review

The recent exponential growth of metaverse technology has been instrumental in reshaping a myriad of sectors, not least digital healthcare. This comprehensive review critically examines the landscape and future applications of metaverse wearables toward immersive digital healthcare. The key technologies and advancements that have spearheaded the metamorphosis of metaverse wearables are categorized, encapsulating all-encompassed extended reality, such as virtual reality, augmented reality, mixed reality, and other haptic feedback systems. Moreover, the fundamentals of their deployment in assistive healthcare (especially for rehabilitation), medical and nursing education, and remote patient management and treatment are investigated. The potential benefits of integrating metaverse wearables into healthcare paradigms are multifold, encompassing improved patient prognosis, enhanced accessibility to high-quality care, and high standards of practitioner instruction. Nevertheless, these technologies are not without their inherent challenges and untapped opportunities, which span privacy protection, data safeguarding, and innovation in artificial intelligence. In summary, future research trajectories and potential advancements to circumvent these hurdles are also discussed, further augmenting the incorporation of metaverse wearables within healthcare infrastructures in the post-pandemic era.

Early detection of visual impairment in young children using a smartphone-based deep learning system

Early detection of visual impairment is crucial but is frequently missed in young children, who are capable of only limited cooperation with standard vision tests. Although certain features of visually impaired children, such as facial appearance and ocular movements, can assist ophthalmic practice, applying these features to real-world screening remains challenging. Here, we present a mobile health (mHealth) system, the smartphone-based Apollo Infant Sight (AIS), which identifies visually impaired children with any of 16 ophthalmic disorders by recording and analyzing their gazing behaviors and facial features under visual stimuli. Videos from 3,652 children (≤48 months in age; 54.5% boys) were prospectively collected to develop and validate this system. For detecting visual impairment, AIS achieved an area under the receiver operating curve (AUC) of 0.940 in an internal validation set and an AUC of 0.843 in an external validation set collected in multiple ophthalmology clinics across China. In a further test of AIS for at-home implementation by untrained parents or caregivers using their smartphones, the system was able to adapt to different testing conditions and achieved an AUC of 0.859. This mHealth system has the potential to be used by healthcare professionals, parents and caregivers for identifying young children with visual impairment across a wide range of ophthalmic disorders.

Research progress and application of artificial intelligence in thyroid associated ophthalmopathy

Thyroid-associated ophthalmopathy (TAO) is a complicated orbitopathy related to dysthyroid, which severely destroys the facial appearance and life quality without medical interference. The diagnosis and management of thyroid-associated ophthalmopathy are extremely intricate, as the number of professional ophthalmologists is limited and inadequate compared with the number of patients. Nowadays, medical applications based on artificial intelligence (AI) algorithms have been developed, which have proved effective in screening many chronic eye diseases. The advanced characteristics of automated artificial intelligence devices, such as rapidity, portability, and multi-platform compatibility, have led to significant progress in the early diagnosis and elaborate evaluation of these diseases in clinic. This study aimed to provide an overview of recent artificial intelligence applications in clinical diagnosis, activity and severity grading, and prediction of therapeutic outcomes in thyroid-associated ophthalmopathy. It also discussed the current challenges and future prospects of the development of artificial intelligence applications in treating thyroid-associated ophthalmopathy.