Radiomics-based decision support tool assists radiologists in small lung nodule classification and improves lung cancer early diagnosis

BACKGROUND

Methods to improve stratification of small (≤15 mm) lung nodules are needed. We aimed to develop a radiomics model to assist lung cancer diagnosis.

METHODS

Patients were retrospectively identified using health records from January 2007 to December 2018. The external test set was obtained from the national LIBRA study and a prospective Lung Cancer Screening programme. Radiomics features were extracted from multi-region CT segmentations using TexLab2.0. LASSO regression generated the 5-feature small nodule radiomics-predictive-vector (SN-RPV). K-means clustering was used to split patients into risk groups according to SN-RPV. Model performance was compared to 6 thoracic radiologists. SN-RPV and radiologist risk groups were combined to generate "Safety-Net" and "Early Diagnosis" decision-support tools.

RESULTS

In total, 810 patients with 990 nodules were included. The AUC for malignancy prediction was 0.85 (95% CI: 0.82-0.87), 0.78 (95% CI: 0.70-0.85) and 0.78 (95% CI: 0.59-0.92) for the training, test and external test datasets, respectively. The test set accuracy was 73% (95% CI: 65-81%) and resulted in 66.67% improvements in potentially missed [8/12] or delayed [6/9] cancers, compared to the radiologist with performance closest to the mean of six readers.

CONCLUSIONS

SN-RPV may provide net-benefit in terms of earlier cancer diagnosis.

COVID-19: using chest CT of major trauma patients to monitor and evaluate the second wave in London and the development of routine monitoring in practice

AIM

To follow-up previous work evaluating incidental findings of COVID-19 signs on computed tomography (CT) images of major trauma patients to include the second wave prior to any major effects from vaccines.

MATERIALS AND METHODS

The study population included all patients admitted following major trauma between 1 January 2020 and 28 February 2021 with CT including the lungs (n=1776). Major trauma patients admitted pre-COVID-19 from alternate months from January 2019 to November 2019 comprised a control group (n=837). The assessing radiologists were blinded to the time period and used double reading in consensus to determine if the patient had signs of COVID-19. Lung appearances were classified as no evidence of COVID-19, minor signs, or major signs.

RESULTS

The method successfully tracked the second wave of the COVID-19 pandemic in London. The estimated population affected by the disease based on those with major signs was similar to estimates of the proportion of the population in London with antibodies (around 30% by end February 2021) and the total of major and minor signs produced a much higher figure of 68%, which may include all those with both antibody and just T-cell responses.

CONCLUSIONS

Incidental findings on CT from major trauma patients may provide a novel and sensitive way of tracking the virus. It is recommended that all major trauma units include a simple question on signs of COVID-19 to provide an early warning system for further waves.

Temporal non-linearities of the cochlear amplifier revealed by maximum length sequence stimulation

OBJECTIVES

The objective of this study was to examine whether temporal non-linearities of the cochlear amplifier, as reflected by otoacoustic emissions (OAEs), exist and are distinct from any recording system non-linearities.

METHODS

Maximum length sequence stimulation, at various stimulus rates, was used to evoke OAEs from normally hearing subjects. Recordings from a 2cc cavity were also made. The data were analyzed to obtain the linear response and estimates of the slices of the 2nd and 3rd order Volterra kernels. This provided a measure of two and 3 click non-linear temporal interactions, respectively.

RESULTS

The results showed that temporal non-linearities of OAEs do exist, are stable and repeatable within individuals and have properties that differ from those shown by the conventional linear response. Whilst some of the non-linear response properties conformed to the expected pattern, of increasing amplitude with increase in stimulus rate, there are some areas in which they show an unpredicted complexity.

CONCLUSIONS

Whilst system non-linearities could be found, there was no difficulty in distinguishing between the physiological and system non-linear components. New areas of research and application may result from the use of these new OAE responses.

Provision of counselling for the dying patient

The majority of doctors and nurses clearly recognise their responsibility to provide palliative care to the dying patient, and also the need for effective communication, counselling and support for this group of patients. This paper explores some of the issues preventing patient and significant others from being referred to the counselling service at this stage, and demonstrates that the nursing staff feel both inadequate and ill prepared to deliver quality care to the dying patient and use avoidance as a coping mechanism.

Standards of palliative care in a renal care setting

Palliative care has been described as the active total care of patients whose disease is not responsive to curative treatment. The principles of palliative care are applicable to patients living with non-malignant disease such as end stage renal failure. This paper describes the development of standards of palliative care in a renal care setting. It emphasises the need for a multidisciplinary basis for palliative care and specifies standards of practice in six core areas: Assessment and Referral, Pain and Symptom Control, Communication and giving information, Sexuality, Spirituality and Bereavement.

Out-patient dietary management in the Prader-Willi syndrome

Dietary adherence of eight children with the Prader-Willi syndrome was studied in the home environment. Weight changes were recorded at two-week intervals, and measured two-week dietary records were completed twice during the study by the parents of seven of the children. An eighth child was similarly followed for three months, and one dietary record was obtained. Calories, protein, fat, and carbohydrate contents were calculated, and related to recorded weight changes to determine which diets were most practical in controlling weight gain. Caloric requirements of children with the Prader-Willi syndrome appear to be much lower than those of healthy, active children of comparable ages. Age, degree of obesity, familial relationships, and probably, composition of the diet influenced the effectiveness of a given diet. Each family designed a diet which took into consideration the family's eating habits, as well as the needs of the Prader-Willi child. Frequent contact with the dietitian enabled each family to try new food preparation ideas. The effectiveness and acceptability of a low caloric, very low-carbohydrate diet should be tested over long periods in Prader-Willi children whose obesity is being managed in a non-institution setting.