Deep Learning-Based Algorithm for the Detection and Characterization of MRI Safety of Cardiac Implantable Electronic Devices on Chest Radiographs

Survey on Value Elements Provided by Artificial Intelligence and Their Eligibility for Insurance Coverage With an Emphasis on Patient-Centered Outcomes

OBJECTIVE

This study aims to explore the opinions on the insurance coverage of artificial intelligence (AI), as categorized based on the distinct value elements offered by AI, with a specific focus on patient-centered outcomes (PCOs). PCOs are distinguished from traditional clinical outcomes and focus on patient-reported experiences and values such as quality of life, functionality, well-being, physical or emotional status, and convenience.

MATERIALS AND METHODS

We classified the value elements provided by AI into four dimensions: clinical outcomes, economic aspects, organizational aspects, and non-clinical PCOs. The survey comprised three sections: 1) experiences with PCOs in evaluating AI, 2) opinions on the coverage of AI by the National Health Insurance of the Republic of Korea when AI demonstrated benefits across the four value elements, and 3) respondent characteristics. The opinions regarding AI insurance coverage were assessed dichotomously and semi-quantitatively: non-approval (0) vs. approval (on a 1-10 weight scale, with 10 indicating the strongest approval). The survey was conducted from July 4 to 26, 2023, using a web-based method. Responses to PCOs and other value elements were compared.

RESULTS

Among 200 respondents, 44 (22%) were patients/patient representatives, 64 (32%) were industry/developers, 60 (30%) were medical practitioners/doctors, and 32 (16%) were government health personnel. The level of experience with PCOs regarding AI was low, with only 7% (14/200) having direct experience and 10% (20/200) having any experience (either direct or indirect). The approval rate for insurance coverage for PCOs was 74% (148/200), significantly lower than the corresponding rates for other value elements (82.5%-93.5%; P ≤ 0.034). The approval strength was significantly lower for PCOs, with a mean weight ± standard deviation of 5.1 ± 3.5, compared to other value elements (P ≤ 0.036).

CONCLUSION

There is currently limited demand for insurance coverage for AI that demonstrates benefits in terms of non-clinical PCOs.

The use of low dose CT scouts for MR safety screening: A multi-reader evaluation

INTRODUCTION

Plain film radiographs are recommended to assist in MRI safety screening of patients with unknown medical histories, especially in an emergency setting where patients might be unable to answer a safety questionnaire. This study assesses the performance of CT scout images, which have low radiation dose and are faster and easier to acquire compared to plain film radiographs, in finding and naming a range of head and body implants.

METHODS

A retrospective analysis of 40 CT Head and Neck (HN) scout images and 40 CT Chest, Abdomen and Pelvis (CAP) scout images was undertaken. A subset of these were chosen to include a range of common internal implants not identifiable externally to the patient. The images were assessed by three readers with varying levels of clinical experience in MRI who were asked to find and name any implants seen.

RESULTS

Collectively, all readers reached a sensitivity of 85 % in finding internal implants, regardless of their clinical experience or experience in reviewing CT images, and a minimum specificity of 95 %. Implants were correctly named in 74 % of the images presented.

CONCLUSION

CT scout images were able to reveal most of the implants included. However, clinical experience in reviewing the images enhances a reader's ability to identify the type of implant.

IMPLICATIONS FOR PRACTICE

In an emergency setting, imaging can be critical in the management of patients presenting with acute illnesses. In the unconscious or unresponsive patient, the use of CT scouts, where this is the only option available, could provide valuable MRI safety information prior to a scan, improving access to the MRI scan in a timely manner.

Reporting Quality of Research Studies on AI Applications in Medical Images According to the CLAIM Guidelines in a Radiology Journal With a Strong Prominence in Asia

OBJECTIVE

We aimed to evaluate the reporting quality of research articles that applied deep learning to medical imaging. Using the Checklist for Artificial Intelligence in Medical Imaging (CLAIM) guidelines and a journal with prominence in Asia as a sample, we intended to provide an insight into reporting quality in the Asian region and establish a journal-specific audit.

MATERIALS AND METHODS

A total of 38 articles published in the Korean Journal of Radiology between June 2018 and January 2023 were analyzed. The analysis included calculating the percentage of studies that adhered to each CLAIM item and identifying items that were met by ≤ 50% of the studies. The article review was initially conducted independently by two reviewers, and the consensus results were used for the final analysis. We also compared adherence rates to CLAIM before and after December 2020.

RESULTS

Of the 42 items in the CLAIM guidelines, 12 items (29%) were satisfied by ≤ 50% of the included articles. None of the studies reported handling missing data (item #13). Only one study respectively presented the use of de-identification methods (#12), intended sample size (#19), robustness or sensitivity analysis (#30), and full study protocol (#41). Of the studies, 35% reported the selection of data subsets (#10), 40% reported registration information (#40), and 50% measured inter and intrarater variability (#18). No significant changes were observed in the rates of adherence to these 12 items before and after December 2020.

CONCLUSION

The reporting quality of artificial intelligence studies according to CLAIM guidelines, in our study sample, showed room for improvement. We recommend that the authors and reviewers have a solid understanding of the relevant reporting guidelines and ensure that the essential elements are adequately reported when writing and reviewing the manuscripts for publication.

Chest X-ray Foreign Objects Detection Using Artificial Intelligence

Diagnostic imaging has become an integral part of the healthcare system. In recent years, scientists around the world have been working on artificial intelligence-based tools that help in achieving better and faster diagnoses. Their accuracy is crucial for successful treatment, especially for imaging diagnostics. This study used a deep convolutional neural network to detect four categories of objects on digital chest X-ray images. The data were obtained from the publicly available National Institutes of Health (NIH) Chest X-ray (CXR) Dataset. In total, 112,120 CXRs from 30,805 patients were manually checked for foreign objects: vascular port, shoulder endoprosthesis, necklace, and implantable cardioverter-defibrillator (ICD). Then, they were annotated with the use of a computer program, and the necessary image preprocessing was performed, such as resizing, normalization, and cropping. The object detection model was trained using the You Only Look Once v8 architecture and the Ultralytics framework. The results showed not only that the obtained average precision of foreign object detection on the CXR was 0.815 but also that the model can be useful in detecting foreign objects on the CXR images. Models of this type may be used as a tool for specialists, in particular, with the growing popularity of radiology comes an increasing workload. We are optimistic that it could accelerate and facilitate the work to provide a faster diagnosis.

Detection of Pacemaker and Identification of MRI-conditional Pacemaker Based on Deep-learning Convolutional Neural Networks to Improve Patient Safety

With the increased availability of magnetic resonance imaging (MRI) and a progressive rise in the frequency of cardiac device implantation, there is an increased chance that patients with implanted cardiac devices require MRI examination during their lifetime. Though MRI is generally contraindicated in patients who have undergone pacemaker implantation with electronic circuits, the recent introduction of MR Conditional pacemaker allows physicians to take advantage of MRI to assess these patients during diagnosis and treatment. When MRI examinations of patients with pacemaker are requested, physicians must confirm whether the device is a conventional pacemaker or an MR Conditional pacemaker by reviewing chest radiographs or the electronic medical records (EMRs). The purpose of this study was to evaluate the utility of a deep convolutional neural network (DCNN) trained to detect pacemakers on chest radiographs and to determine the device's subclassification. The DCNN perfectly detected pacemakers on chest radiographs and the accuracy of the subclassification of pacemakers using the internal and external test datasets were 100.0% (n = 106/106) and 90.1% (n = 279/308). The DCNN can be applied to the radiologic workflow for double-checking purposes, thereby improving patient safety during MRI and preventing busy physicians from making errors.

Contemporary Applications of Machine Learning for Device Therapy in Heart Failure

Despite a better understanding of the underlying pathogenesis of heart failure (HF), pharmacotherapy, surgical, and percutaneous interventions do not prevent disease progression in all patients, and a significant proportion of patients end up requiring advanced therapies. Machine learning (ML) is gaining wider acceptance in cardiovascular medicine because of its ability to incorporate large, complex, and multidimensional data and to potentially facilitate the creation of predictive models not constrained by many of the limitations of traditional statistical approaches. With the coexistence of "big data" and novel advanced analytic techniques using ML, there is ever-increasing research into applying ML in the context of HF with the goal of improving patient outcomes. Through this review, the authors describe the basics of ML and summarize the existing published reports regarding contemporary applications of ML in device therapy for HF while highlighting the limitations to widespread implementation and its future promises.