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

A Thorough Review of the Clinical Applications of Artificial Intelligence in Lung Cancer

According to data from the World Health Organization (WHO), lung cancer is becoming a global epidemic. It is particularly high in the list of the leading causes of death not only in developed countries, but also worldwide; furthermore, it holds the leading place in terms of cancer-related mortality. Nevertheless, many breakthroughs have been made the last two decades regarding its management, with one of the most prominent being the implementation of artificial intelligence (AI) in various aspects of disease management. We included 473 papers in this thorough review, most of which have been published during the last 5-10 years, in order to describe these breakthroughs. In screening programs, AI is capable of not only detecting suspicious lung nodules in different imaging modalities-such as chest X-rays, computed tomography (CT), and positron emission tomography (PET) scans-but also discriminating between benign and malignant nodules as well, with success rates comparable to or even better than those of experienced radiologists. Furthermore, AI seems to be able to recognize biomarkers that appear in patients who may develop lung cancer, even years before this event. Moreover, it can also assist pathologists and cytologists in recognizing the type of lung tumor, as well as specific histologic or genetic markers that play a key role in treating the disease. Finally, in the treatment field, AI can guide in the development of personalized options for lung cancer patients, possibly improving their prognosis.

Transforming Healthcare in Low-Resource Settings With Artificial Intelligence: Recent Developments and Outcomes

BACKGROUND

Artificial intelligence now encompasses technologies like machine learning, natural language processing, and robotics, allowing machines to undertake complex tasks traditionally done by humans. AI's application in healthcare has led to advancements in diagnostic tools, predictive analytics, and surgical precision.

AIM

This comprehensive review aims to explore the transformative impact of AI across diverse healthcare domains, highlighting its applications, advancements, challenges, and contributions to enhancing patient care.

METHODOLOGY

A comprehensive literature search was conducted across multiple databases, covering publications from 2014 to 2024. Keywords related to AI applications in healthcare were used to gather data, focusing on studies exploring AI's role in medical specialties.

RESULTS

AI has demonstrated substantial benefits across various fields of medicine. In cardiology, it aids in automated image interpretation, risk prediction, and the management of cardiovascular diseases. In oncology, AI enhances cancer detection, treatment planning, and personalized drug selection. Radiology benefits from improved image analysis and diagnostic accuracy, while critical care sees advancements in patient triage and resource optimization. AI's integration into pediatrics, surgery, public health, neurology, pathology, and mental health has similarly shown significant improvements in diagnostic precision, personalized treatment, and overall patient care. The implementation of AI in low-resource settings has been particularly impactful, enhancing access to advanced diagnostic tools and treatments.

CONCLUSION

AI is rapidly changing the healthcare industry by greatly increasing the accuracy of diagnoses, streamlining treatment plans, and improving patient outcomes across a variety of medical specializations. This review underscores AI's transformative potential, from early disease detection to personalized treatment plans, and its ability to augment healthcare delivery, particularly in resource-limited settings.

A Systematic Review: The Role of Artificial Intelligence in Lung Cancer Screening in Detecting Lung Nodules on Chest X-Rays

Background: Lung cancer remains one of the leading causes of cancer-related deaths worldwide. Artificial intelligence (AI) holds significant potential roles in enhancing the detection of lung nodules through chest X-ray (CXR), enabling earlier diagnosis and improved outcomes. Methods: Papers were identified through a comprehensive search of the Web of Science (WOS), Scopus, and Ovid Medline databases for publications dated between 2020 and 2024. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 34 studies that met the inclusion criteria were selected for quality assessment and data extraction. Results: AI demonstrated sensitivity rates of 56.4-95.7% and specificities of 71.9-97.5%, with the area under the receiver operating characteristic (AUROC) values between 0.89 and 0.99, compared to radiologists' mean area under the curve (AUC) of 0.81. AI performed better with larger nodules (>2 cm) and solid nodules, showing higher AUC values for calcified (0.71) compared to non-calcified nodules (0.55). Performance was lower in hilar areas (30%) and lower lung fields (43.8%). A combined AI-radiologist approach improved overall detection rates, particularly benefiting less experienced readers; however, AI showed limitations in detecting ground-glass opacities (GGOs). Conclusions: AI shows promise as a supplementary tool for radiologists in lung nodule detection. However, the variability in AI results across studies highlights the need for standardized assessment methods and diverse datasets for model training. Future studies should focus on developing more precise and applicable algorithms while evaluating the effectiveness and cost-efficiency of AI in lung cancer screening interventions.

Better performance of deep learning pulmonary nodule detection using chest radiography with pixel level labels in reference to computed tomography: data quality matters

Labeling errors can significantly impact the performance of deep learning models used for screening chest radiographs. The deep learning model for detecting pulmonary nodules is particularly vulnerable to such errors, mainly because normal chest radiographs and those with nodules obscured by ribs appear similar. Thus, high-quality datasets referred to chest computed tomography (CT) are required to prevent the misclassification of nodular chest radiographs as normal. From this perspective, a deep learning strategy employing chest radiography data with pixel-level annotations referencing chest CT scans may improve nodule detection and localization compared to image-level labels. We trained models using a National Institute of Health chest radiograph-based labeling dataset and an AI-HUB CT-based labeling dataset, employing DenseNet architecture with squeeze-and-excitation blocks. We developed four models to assess whether CT versus chest radiography and pixel-level versus image-level labeling would improve the deep learning model's performance to detect nodules. The models' performance was evaluated using two external validation datasets. The AI-HUB dataset with image-level labeling outperformed the NIH dataset (AUC 0.88 vs 0.71 and 0.78 vs. 0.73 in two external datasets, respectively; both p < 0.001). However, the AI-HUB data annotated at the pixel level produced the best model (AUC 0.91 and 0.86 in external datasets), and in terms of nodule localization, it significantly outperformed models trained with image-level annotation data, with a Dice coefficient ranging from 0.36 to 0.58. Our findings underscore the importance of accurately labeled data in developing reliable deep learning algorithms for nodule detection in chest radiography.

Can Artificial Intelligence Replace Humans for Detecting Lung Tumors on Radiographs? An Examination of Resected Malignant Lung Tumors

OBJECTIVE

Although lung cancer screening trials have showed the efficacy of computed tomography to decrease mortality compared with chest radiography, the two are widely taken as different kinds of clinical practices. Artificial intelligence can improve outcomes by detecting lung tumors in chest radiographs. Currently, artificial intelligence is used as an aid for physicians to interpret radiograms, but with the future evolution of artificial intelligence, it may become a modality that replaces physicians. Therefore, in this study, we investigated the current situation of lung cancer diagnosis by artificial intelligence.

METHODS

In total, we recruited 174 consecutive patients with malignant pulmonary tumors who underwent surgery after chest radiography that was checked by artificial intelligence before surgery. Artificial intelligence diagnoses were performed using the medical image analysis software EIRL X-ray Lung Nodule version 1.12, (LPIXEL Inc., Tokyo, Japan).

RESULTS

The artificial intelligence determined pulmonary tumors in 90 cases (51.7% for all patients and 57.7% excluding 18 patients with adenocarcinoma in situ). There was no significant difference in the detection rate by the artificial intelligence among histological types. All eighteen cases of adenocarcinoma in situ were not detected by either the artificial intelligence or the physicians. In a univariate analysis, the artificial intelligence could detect cases with larger histopathological tumor size (p < 0.0001), larger histopathological invasion size (p < 0.0001), and higher maximum standardized uptake values of positron emission tomography-computed tomography (p < 0.0001). In a multivariate analysis, detection by AI was significantly higher in cases with a large histopathological invasive size (p = 0.006). In 156 cases excluding adenocarcinoma in situ, we examined the rate of artificial intelligence detection based on the tumor site. Tumors in the lower lung field area were less frequently detected (p = 0.019) and tumors in the middle lung field area were more frequently detected (p = 0.014) compared with tumors in the upper lung field area.

CONCLUSIONS

Our study showed that using artificial intelligence, the diagnosis of tumor-associated findings and the diagnosis of areas that overlap with anatomical structures is not satisfactory. While the current standing of artificial intelligence diagnostics is to assist physicians in making diagnoses, there is the possibility that artificial intelligence can substitute for humans in the future. However, artificial intelligence should be used in the future as an enhancement, to aid physicians in the role of a radiologist in the workflow.

Exploring the efficacy of artificial neural networks in predicting lung cancer recurrence: a retrospective study based on patient records

Background

Lung cancer remains a significant public health concern, accounting for a considerable number of cancer-related deaths worldwide. Neural networks have emerged as a promising tool that can aid in the diagnosis and treatment of various cancers. Consequently, there has been a growing interest in exploring the potential of artificial intelligence (AI) methods in medicine. The present study aimed to evaluate the effectiveness of a neural network in predicting lung cancer recurrence.

Methods

The study employed retrospective data from 2,296 medical records of patients diagnosed with lung cancer and admitted to the Warmińsko-Mazurskie Center for Lung Diseases in Olsztyn, Poland. The statistical software STATISTICA 7.1, equipped with the Neural Networks module (StatSoft Inc., Tulsa, USA), was utilized to analyze the data. The neural network model was trained using patient information regarding gender, treatment, smoking status, family history, and symptoms of cancer.

Results

The study employed a multilayer perceptron neural network with a two-phase learning process. The network demonstrated high predictive ability, as indicated by the percentage of correct classifications, which amounted to 87.5%, 89.1%, and 89.9% for the training, validation, and test sets, respectively.

Conclusions

The findings of this study support the potential usefulness of a neural network-based predictive model in assessing the risk of lung cancer recurrence. Further research is warranted to validate these findings and to explore AI's broader implications in cancer diagnosis and treatment.

MSF-Net: A Lightweight Multi-Scale Feature Fusion Network for Skin Lesion Segmentation

Segmentation of skin lesion images facilitates the early diagnosis of melanoma. However, this remains a challenging task due to the diversity of target scales, irregular segmentation shapes, low contrast, and blurred boundaries of dermatological graphics. This paper proposes a multi-scale feature fusion network (MSF-Net) based on comprehensive attention convolutional neural network (CA-Net). We introduce the spatial attention mechanism in the convolution block through the residual connection to focus on the key regions. Meanwhile, Multi-scale Dilated Convolution Modules (MDC) and Multi-scale Feature Fusion Modules (MFF) are introduced to extract context information across scales and adaptively adjust the receptive field size of the feature map. We conducted many experiments on the public data set ISIC2018 to verify the validity of MSF-Net. The ablation experiment demonstrated the effectiveness of our three modules. The comparison experiment with the existing advanced network confirms that MSF-Net can achieve better segmentation under fewer parameters.

Usefulness of copper filters in digital chest radiography based on the relationship between effective detective quantum efficiency and deep learning-based segmentation accuracy of the tumor area

This study aimed to determine the optimal radiographic conditions for detecting lesions on digital chest radiographs using an indirect conversion flat-panel detector with a copper (Cu) filter. First, we calculated the effective detective quantum efficiency (DQE) by considering clinical conditions to evaluate the image quality. We then measured the segmentation accuracy using a U-net convolutional network to verify the effectiveness of the Cu filter. We obtained images of simulated lung tumors using 10-mm acrylic spheres positioned at the right lung apex and left middle lung of an adult chest phantom. The Dice coefficient was calculated as the similarity between the output and learning images to evaluate the accuracy of tumor area segmentation using U-net. Our results showed that effective DQE was higher in the following order up to the spatial frequency of 2 cycles/mm: 120 kV + no Cu, 120 kV + Cu 0.1 mm, and 120 kV + Cu 0.2 mm. The segmented region was similar to the true region for mass-area extraction in the left middle lobe. The lesion segmentation in the upper right lobe with 120 kV + no Cu and 120 kV + Cu 0.1 mm was less successful. However, adding a Cu filter yielded reproducible images with high Dice coefficients, regardless of the tumor location. We confirmed that adding a Cu filter decreases the X-ray absorption efficiency while improving the signal-to-noise ratio (SNR). Furthermore, artificial intelligence accurately segments low-contrast lesions.