Low-dose computed tomography (LDCT) has attracted major attention in the medical imaging field, since CT-associated X-ray radiation carries health risks for patients. The reduction of the CT ...radiation dose, however, compromises the signal-to-noise ratio, which affects image quality and diagnostic performance. Recently, deep-learning-based algorithms have achieved promising results in LDCT denoising, especially convolutional neural network (CNN) and generative adversarial network (GAN) architectures. This paper introduces a conveying path-based convolutional encoder-decoder (CPCE) network in 2-D and 3-D configurations within the GAN framework for LDCT denoising. A novel feature of this approach is that an initial 3-D CPCE denoising model can be directly obtained by extending a trained 2-D CNN, which is then fine-tuned to incorporate 3-D spatial information from adjacent slices. Based on the transfer learning from 2-D to 3-D, the 3-D network converges faster and achieves a better denoising performance when compared with a training from scratch. By comparing the CPCE network with recently published work based on the simulated Mayo data set and the real MGH data set, we demonstrate that the 3-D CPCE denoising model has a better performance in that it suppresses image noise and preserves subtle structures.
The continuous development and extensive use of computed tomography (CT) in medical practice has raised a public concern over the associated radiation dose to the patient. Reducing the radiation dose ...may lead to increased noise and artifacts, which can adversely affect the radiologists' judgment and confidence. Hence, advanced image reconstruction from low-dose CT data is needed to improve the diagnostic performance, which is a challenging problem due to its ill-posed nature. Over the past years, various low-dose CT methods have produced impressive results. However, most of the algorithms developed for this application, including the recently popularized deep learning techniques, aim for minimizing the mean-squared error (MSE) between a denoised CT image and the ground truth under generic penalties. Although the peak signal-to-noise ratio is improved, MSE- or weighted-MSE-based methods can compromise the visibility of important structural details after aggressive denoising. This paper introduces a new CT image denoising method based on the generative adversarial network (GAN) with Wasserstein distance and perceptual similarity. The Wasserstein distance is a key concept of the optimal transport theory and promises to improve the performance of GAN. The perceptual loss suppresses noise by comparing the perceptual features of a denoised output against those of the ground truth in an established feature space, while the GAN focuses more on migrating the data noise distribution from strong to weak statistically. Therefore, our proposed method transfers our knowledge of visual perception to the image denoising task and is capable of not only reducing the image noise level but also trying to keep the critical information at the same time. Promising results have been obtained in our experiments with clinical CT images.
Given the potential risk of X-ray radiation to the patient, low-dose CT has attracted a considerable interest in the medical imaging field. Currently, the main stream low-dose CT methods include ...vendor-specific sinogram domain filtration and iterative reconstruction algorithms, but they need to access raw data, whose formats are not transparent to most users. Due to the difficulty of modeling the statistical characteristics in the image domain, the existing methods for directly processing reconstructed images cannot eliminate image noise very well while keeping structural details. Inspired by the idea of deep learning, here we combine the autoencoder, deconvolution network, and shortcut connections into the residual encoder-decoder convolutional neural network (RED-CNN) for low-dose CT imaging. After patch-based training, the proposed RED-CNN achieves a competitive performance relative to the-state-of-art methods in both simulated and clinical cases. Especially, our method has been favorably evaluated in terms of noise suppression, structural preservation, and lesion detection.
Deep learning (DL) based solutions have been proposed for interpretation of several imaging modalities including radiography, CT, and MR. For chest radiographs, DL algorithms have found success in ...the evaluation of abnormalities such as lung nodules, pulmonary tuberculosis, cystic fibrosis, pneumoconiosis, and location of peripherally inserted central catheters. Chest radiography represents the most commonly performed radiological test for a multitude of non-emergent and emergent clinical indications. This study aims to assess accuracy of deep learning (DL) algorithm for detection of abnormalities on routine frontal chest radiographs (CXR), and assessment of stability or change in findings over serial radiographs.
We processed 874 de-identified frontal CXR from 724 adult patients (> 18 years) with DL (Qure AI). Scores and prediction statistics from DL were generated and recorded for the presence of pulmonary opacities, pleural effusions, hilar prominence, and enlarged cardiac silhouette. To establish a standard of reference (SOR), two thoracic radiologists assessed all CXR for these abnormalities. Four other radiologists (test radiologists), unaware of SOR and DL findings, independently assessed the presence of radiographic abnormalities. A total 724 radiographs were assessed for detection of findings. A subset of 150 radiographs with follow up examinations was used to asses change over time. Data were analyzed with receiver operating characteristics analyses and post-hoc power analysis.
About 42% (305/ 724) CXR had no findings according to SOR; single and multiple abnormalities were seen in 23% (168/724) and 35% (251/724) of CXR. There was no statistical difference between DL and SOR for all abnormalities (p = 0.2-0.8). The area under the curve (AUC) for DL and test radiologists ranged between 0.837-0.929 and 0.693-0.923, respectively. DL had lowest AUC (0.758) for assessing changes in pulmonary opacities over follow up CXR. Presence of chest wall implanted devices negatively affected the accuracy of DL algorithm for evaluation of pulmonary and hilar abnormalities.
DL algorithm can aid in interpretation of CXR findings and their stability over follow up CXR. However, in its present version, it is unlikely to replace radiologists due to its limited specificity for categorizing specific findings.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The objective of this study was to compare image quality and clinically significant lesion detection on deep learning reconstruction (DLR) and iterative reconstruction (IR) images of submillisievert ...chest and abdominopelvic CT.
Our prospective multiinstitutional study included 59 adult patients (33 women, 26 men; mean age ± SD, 65 ± 12 years old; mean body mass index weight in kilograms divided by the square of height in meters = 27 ± 5) who underwent routine chest (
= 22; 16 women, six men) and abdominopelvic (
= 37; 17 women, 20 men) CT on a 640-MDCT scanner (Aquilion ONE, Canon Medical Systems). All patients gave written informed consent for the acquisition of low-dose (LD) CT (LDCT) after a clinically indicated standard-dose (SD) CT (SDCT). The SDCT series (120 kVp, 164-644 mA) were reconstructed with interactive reconstruction (IR) (adaptive iterative dose reduction AIDR 3D, Canon Medical Systems), and the LDCT (100 kVp, 120 kVp; 30-50 mA) were reconstructed with filtered back-projection (FBP), IR (AIDR 3D and forward-projected model-based iterative reconstruction solution FIRST, Canon Medical Systems), and deep learning reconstruction (DLR) (Advanced Intelligent Clear-IQ Engine AiCE, Canon Medical Systems). Four subspecialty-trained radiologists first read all LD image sets and then compared them side-by-side with SD AIDR 3D images in an independent, randomized, and blinded fashion. Subspecialty radiologists assessed image quality of LDCT images on a 3-point scale (1 = unacceptable, 2 = suboptimal, 3 = optimal). Descriptive statistics were obtained, and the Wilcoxon sign rank test was performed.
Mean volume CT dose index and dose-length product for LDCT (2.1 ± 0.8 mGy, 49 ± 13mGy·cm) were lower than those for SDCT (13 ± 4.4 mGy, 567 ± 249 mGy·cm) (
< 0.0001). All 31 clinically significant abdominal lesions were seen on SD AIDR 3D and LD DLR images. Twenty-five, 18, and seven lesions were detected on LD AIDR 3D, LD FIRST, and LD FBP images, respectively. All 39 pulmonary nodules detected on SD AIDR 3D images were also noted on LD DLR images. LD DLR images were deemed acceptable for interpretation in 97% (35/37) of abdominal and 95-100% (21-22/22) of chest LDCT studies (
= 0.2-0.99). The LD FIRST, LD AIDR 3D, and LD FBP images had inferior image quality compared with SD AIDR 3D images (
< 0.0001).
At submillisievert chest and abdominopelvic CT doses, DLR enables image quality and lesion detection superior to commercial IR and FBP images.
To assess the relationship between intravenous iodinated contrast media (ICM) administration usage and radiation doses for contrast-enhanced (CE) CT of head, chest, and abdomen-pelvis (AP) in ...international, multicenter settings.OBJECTIVETo assess the relationship between intravenous iodinated contrast media (ICM) administration usage and radiation doses for contrast-enhanced (CE) CT of head, chest, and abdomen-pelvis (AP) in international, multicenter settings.Our international (n = 16 countries), multicenter (n = 43 sites), and cross-sectional (ConRad) study had two parts. Part 1: Redcap survey with questions on information related to CT and ICM manufacturer/brand and respective protocols. Part 2: Information on 3,258 patients (18-96 years; M:F 1654:1604) who underwent CECT for a routine head (n = 456), chest (n = 528), AP (n = 599), head CT angiography (n = 539), pulmonary embolism (n = 599), and liver CT examinations (n = 537) at 43 sites across five continents. The following information was recorded: hospital name, patient age, gender, body mass index BMI, clinical indications, scan parameters (number of scan phases, kV), IV-contrast information (concentration, volume, flow rate, and delay), and dose indices (CTDIvol and DLP).METHODSOur international (n = 16 countries), multicenter (n = 43 sites), and cross-sectional (ConRad) study had two parts. Part 1: Redcap survey with questions on information related to CT and ICM manufacturer/brand and respective protocols. Part 2: Information on 3,258 patients (18-96 years; M:F 1654:1604) who underwent CECT for a routine head (n = 456), chest (n = 528), AP (n = 599), head CT angiography (n = 539), pulmonary embolism (n = 599), and liver CT examinations (n = 537) at 43 sites across five continents. The following information was recorded: hospital name, patient age, gender, body mass index BMI, clinical indications, scan parameters (number of scan phases, kV), IV-contrast information (concentration, volume, flow rate, and delay), and dose indices (CTDIvol and DLP).Most routine chest (58.4%) and AP (68.7%) CECT exams were performed with 2-4 scan phases with fixed scan delay (chest 71.4%; AP 79.8%, liver CECT 50.7%) following ICM administration. Most sites did not change kV across different patients and scan phases; most CECT protocols were performed at 120-140 kV (83%, 1979/2685). There were no significant differences between radiation doses for non-contrast (CTDIvol 24 16-30 mGy; DLP 633 414-702 mGy·cm) and post-contrast phases (22 19-27 mGy; 648 392-694 mGy·cm) (p = 0.142). Sites that used bolus tracking for chest and AP CECT had lower CTDIvol than sites with fixed scan delays (p < 0.001). There was no correlation between BMI and CTDIvol (r2 ≤ - 0.1 to 0.1, p = 0.931).RESULTSMost routine chest (58.4%) and AP (68.7%) CECT exams were performed with 2-4 scan phases with fixed scan delay (chest 71.4%; AP 79.8%, liver CECT 50.7%) following ICM administration. Most sites did not change kV across different patients and scan phases; most CECT protocols were performed at 120-140 kV (83%, 1979/2685). There were no significant differences between radiation doses for non-contrast (CTDIvol 24 16-30 mGy; DLP 633 414-702 mGy·cm) and post-contrast phases (22 19-27 mGy; 648 392-694 mGy·cm) (p = 0.142). Sites that used bolus tracking for chest and AP CECT had lower CTDIvol than sites with fixed scan delays (p < 0.001). There was no correlation between BMI and CTDIvol (r2 ≤ - 0.1 to 0.1, p = 0.931).Our study demonstrates up to ten-fold variability in ICM injection protocols and radiation doses across different CT protocols. The study emphasizes the need for optimizing CT scanning and contrast protocols to reduce unnecessary contrast and radiation exposure to patients.CONCLUSIONOur study demonstrates up to ten-fold variability in ICM injection protocols and radiation doses across different CT protocols. The study emphasizes the need for optimizing CT scanning and contrast protocols to reduce unnecessary contrast and radiation exposure to patients.The wide variability and lack of standardization of ICM media and radiation doses in CT protocols suggest the need for education and optimization of contrast usage and scan factors for optimizing image quality in CECT.CLINICAL RELEVANCE STATEMENTThe wide variability and lack of standardization of ICM media and radiation doses in CT protocols suggest the need for education and optimization of contrast usage and scan factors for optimizing image quality in CECT.There is a lack of patient-centric CT protocol optimization taking into consideration mainly patients' size. There is a lack of correlation between ICM volume and CT radiation dose across CT protocol. A ten-fold variation in iodine-load for the same CT protocol in sites suggests a lack of standardization.KEY POINTSThere is a lack of patient-centric CT protocol optimization taking into consideration mainly patients' size. There is a lack of correlation between ICM volume and CT radiation dose across CT protocol. A ten-fold variation in iodine-load for the same CT protocol in sites suggests a lack of standardization.
The global pandemic of coronavirus disease 2019 (COVID-19) has upended the world with over 6.6 million infections and over 391,000 deaths worldwide. Reverse-transcription polymerase chain reaction ...(RT-PCR) assay is the preferred method of diagnosis of COVID-19 infection. Yet, chest CT is often used in patients with known or suspected COVID-19 due to regional preferences, lack of availability of PCR assays, and false-negative PCR assays, as well as for monitoring of disease progression, complications, and treatment response. The International Atomic Energy Agency (IAEA) organized a webinar to discuss CT practice and protocol optimization from a radiation protection perspective on April 9, 2020, and surveyed participants from five continents. We review important aspects of CT in COVID-19 infection from the justification of its use to specific scan protocols for optimizing radiation dose and diagnostic information.
Key Points
• Chest CT provides useful information in patients with moderate to severe COVID-19 pneumonia.
• When indicated, chest CT in most patients with COVID-19 pneumonia must be performed with non-contrast, low-dose protocol.
• Although chest CT has high sensitivity for diagnosis of COVID-19 pneumonia, CT findings are non-specific and overlap with other viral infections including influenza and H1N1.
1. CT radiation dose optimization is one of the major concerns for the scientific community. 2. CT image quality is dependent on the selected image reconstruction algorithm. 3. Iterative ...reconstruction algorithms have reemerged with the potential of radiation dose optimization by lowering image noise. 4. Tube current is the most common parameter used to reduce radiation dose along with iterative reconstruction. 5. Tube potential (kV) is also used for dose optimization with iterative reconstruction in CT angiography protocols and small patients.
The new coronavirus disease 2019 (COVID-19) pandemic has challenged many healthcare systems around the world. While most of the current understanding of the clinical features of COVID-19 is derived ...from Chinese studies, there is a relative paucity of reports from the remaining global health community. In this study, we analyze the clinical and radiologic factors that correlate with mortality odds in COVID-19 positive patients from a tertiary care center in Tehran, Iran. A retrospective cohort study of 90 patients with reverse transcriptase-polymerase chain reaction (RT-PCR) positive COVID-19 infection was conducted, analyzing demographics, co-morbidities, presenting symptoms, vital signs, laboratory values, chest radiograph findings, and chest CT features based on mortality. Chest radiograph was assessed using the Radiographic Assessment of Lung Edema (RALE) scoring system. Chest CTs were assessed according to the opacification pattern, distribution, and standardized severity score. Initial and follow-up Chest CTs were compared if available. Multiple logistic regression was used to generate a prediction model for mortality. The 90 patients included 59 men and 31 women (59.4 ± 16.6 years), including 21 deceased and 69 surviving patients. Among clinical features, advanced age (p = 0.02), low oxygenation saturation (p<0.001), leukocytosis (p = 0.02), low lymphocyte fraction (p = 0.03), and low platelet count (p = 0.048) were associated with increased mortality. High RALE score on initial chest radiograph (p = 0.002), presence of pleural effusions on initial CT chest (p = 0.005), development of pleural effusions on follow-up CT chest (p = 0.04), and worsening lung severity score on follow-up CT Chest (p = 0.03) were associated with mortality. A two-factor logistic model using patient age and oxygen saturation was created, which demonstrates 89% accuracy and area under the ROC curve of 0.86 (p<0.0001). Specific demographic, clinical, and imaging features are associated with increased mortality in COVID-19 infections. Attention to these features can help optimize patient management.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•We develop a soft activation mapping (SAM) method to enable fine-grained lung nodule shape and margin (LNSM) features analysis with a CNN. However, existing methods CAM and Grad-CAM have no such ...advantage.•The further proposed high-level feature enhanced SAM (HESAM) integrates the features at the median location of encode-decode structure, and this allows LNSM features visualization relates to nodule shape. Our implementation using HESAM achieves the state-of-the-art lung nodule classification performance.•The conducted visually matching experiment verifies that HESAM explanations match the pathological LNSM correctly with features the radiologists care about. This provides strong evidence of clinical application for our methods.
Display omitted
A number of studies on lung nodule classification lack clinical/biological interpretations of the features extracted by convolutional neural network (CNN). The methods like class activation mapping (CAM) and gradient-based CAM (Grad-CAM) are tailored for interpreting localization and classification tasks while they ignored fine-grained features. Therefore, CAM and Grad-CAM cannot provide optimal interpretation for lung nodule categorization task in low-dose CT images, in that fine-grained pathological clues like discrete and irregular shape and margins of nodules are capable of enhancing sensitivity and specificity of nodule classification with regards to CNN. In this paper, we first develop a soft activation mapping (SAM) to enable fine-grained lung nodule shape & margin (LNSM) feature analysis with a CNN so that it can access rich discrete features. Secondly, by combining high-level convolutional features with SAM, we further propose a high-level feature enhancement scheme (HESAM) to localize LNSM features. Experiments on the LIDC-IDRI dataset indicate that 1) SAM captures more fine-grained and discrete attention regions than existing methods, 2) HESAM localizes more accurately on LNSM features and obtains the state-of-the-art predictive performance, reducing the false positive rate, and 3) we design and conduct a visually matching experiment which incorporates radiologists study to increase the confidence level of applying our method to clinical diagnosis.
PDF
