75 Nice challenge that is difficult to meet? Sritharan, Vasanth; Sallam, Mohammed; Islam, Mohammad ...
Heart (British Cardiac Society),
06/2021, Volume:
107, Issue:
Suppl 1
Journal Article
Peer reviewed
Open access
IntroductionCurrent NICE guidelines recommend early invasive strategy with coronary angiography within 72 hours of first presentation of NSTEMI to those who have an intermediate or higher risk of ...adverse cardiovascular events, defined as a GRACE 2.0 risk greater than 3.0%. The aim of this audit is to explore NICE guideline adherence, patient characteristics and clinical outcomes.MethodsRetrospective data from patients with a final diagnosis of NSTEMI in the months of October 2018 and January 2019 was gathered from clinical coding. Patients were stratified by their GRACE 2.0 score, which was retrospectively calculated using their clinical notes and investigations on the Integrated Clinical Environment.ResultsThere were 116 patients of which 90 (77.6%) had an intermediate to high risk. Data was analysed for all the 90 patients (table 1) with further analysis for those who underwent early or late inpatient coronary angiography with fisher’s exact test (table 2).From the 90 patients 44 (48.9%) underwent coronary angiography, while 46 patients (51.1%) were not suitable for invasive intervention hence treated with standard medical therapy. 18 patients (40.9%) had coronary angiography within 72 hours and 26 waited more than 72 hours. 13 (72.2%) of those who had early coronary angiography went on to have percutaneous coronary intervention compared to the 10 (38.5%) patients who had delayed coronary angiography (p=0.0018).Abstract 75 Table 1Summary table of patients with intermediate to high risk of cardiovascular event Clinical characteristic (N=90) Coronary angiography >72hrs (N=18) Coronary angiography >72hrs (N=26) Medical management (N=46) Demographic Age (mean)70.974.782.1Female8 (44.4%)10 (38.5%)27 (58.7%) Secondary prevention DAPT or antiplatelet +anticoagulation17 (94.4%)24 (92.3%)37 (80.4%)ACEi17 (94.4%)23 (88.5%)27 (58.7%)Statin18 (100%)25 (96.2%)33 (71.7%) Intervention PCI13 (72.2%)10 (38.5%)0 (0%)CABG0 (0%)3 (11.5%)0 (0%) Outcome Dead at 6 months0 (0%)1 (3.8%)13 (21.7%)Re-admitted with adverse cardiac event at 1 year5 (27.8%)7 (26.9%)10 (21.7%)Abstract 75 Table 2Comparison of adverse cardiovascular events when coronary angiography is delayed Coronary angiography >72hrs (N=18) Coronary angiography >72hrs (N=26) p value Death at 6 months0 (0%)1 (3.8%)1.0000Re-admitted with adverse cardiac event at 1 year5 (27.8%)7 (26.9%)1.0000ConclusionDespite expectations there was only 40.9% adherence to NICE guideline. In contrast to expectations intermediate to high-risk patients are less likely to have early invasive strategy. However, there is no difference in outcome between an early versus late invasive strategy for inpatients. Standard medical treatment is still practiced at higher number of patients with multiple comorbidities, higher age and intermediate to high risk. This shows that meeting NICE recommendations can be challenging for numerous factors beyond a clinician’s control. Further data from medium sized district general hospitals with catheterization laboratory facility is needed to assess the overall ability of these centres to meet NICE recommendations.Conflict of InterestNone
What has happened in machine learning lately, and what does it mean for the future of medical image analysis? Machine learning has witnessed a tremendous amount of attention over the last few years. ...The current boom started around 2009 when so-called deep artificial neural networks began outperforming other established models on a number of important benchmarks. Deep neural networks are now the state-of-the-art machine learning models across a variety of areas, from image analysis to natural language processing, and widely deployed in academia and industry. These developments have a huge potential for medical imaging technology, medical data analysis, medical diagnostics and healthcare in general, slowly being realized. We provide a short overview of recent advances and some associated challenges in machine learning applied to medical image processing and image analysis. As this has become a very broad and fast expanding field we will not survey the entire landscape of applications, but put particular focus on deep learning in MRI.
Our aim is threefold: (i) give a brief introduction to deep learning with pointers to core references; (ii) indicate how deep learning has been applied to the entire MRI processing chain, from acquisition to image retrieval, from segmentation to disease prediction; (iii) provide a starting point for people interested in experimenting and perhaps contributing to the field of deep learning for medical imaging by pointing out good educational resources, state-of-the-art open-source code, and interesting sources of data and problems related medical imaging.
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.
Remarkable progress has been made in image recognition, primarily due to the availability of large-scale annotated datasets and deep convolutional neural networks (CNNs). CNNs enable learning ...data-driven, highly representative, hierarchical image features from sufficient training data. However, obtaining datasets as comprehensively annotated as ImageNet in the medical imaging domain remains a challenge. There are currently three major techniques that successfully employ CNNs to medical image classification: training the CNN from scratch, using off-the-shelf pre-trained CNN features, and conducting unsupervised CNN pre-training with supervised fine-tuning. Another effective method is transfer learning, i.e., fine-tuning CNN models pre-trained from natural image dataset to medical image tasks. In this paper, we exploit three important, but previously understudied factors of employing deep convolutional neural networks to computer-aided detection problems. We first explore and evaluate different CNN architectures. The studied models contain 5 thousand to 160 million parameters, and vary in numbers of layers. We then evaluate the influence of dataset scale and spatial image context on performance. Finally, we examine when and why transfer learning from pre-trained ImageNet (via fine-tuning) can be useful. We study two specific computer-aided detection (CADe) problems, namely thoraco-abdominal lymph node (LN) detection and interstitial lung disease (ILD) classification. We achieve the state-of-the-art performance on the mediastinal LN detection, and report the first five-fold cross-validation classification results on predicting axial CT slices with ILD categories. Our extensive empirical evaluation, CNN model analysis and valuable insights can be extended to the design of high performance CAD systems for other medical imaging tasks.
Convolutional neural networks (CNNs) have achieved state-of-the-art performance for automatic medical image segmentation. However, they have not demonstrated sufficiently accurate and robust results ...for clinical use. In addition, they are limited by the lack of image-specific adaptation and the lack of generalizability to previously unseen object classes (a.k.a. zero-shot learning). To address these problems, we propose a novel deep learning-based interactive segmentation framework by incorporating CNNs into a bounding box and scribble-based segmentation pipeline. We propose image-specific fine tuning to make a CNN model adaptive to a specific test image, which can be either unsupervised (without additional user interactions) or supervised (with additional scribbles). We also propose a weighted loss function considering network and interaction-based uncertainty for the fine tuning. We applied this framework to two applications: 2-D segmentation of multiple organs from fetal magnetic resonance (MR) slices, where only two types of these organs were annotated for training and 3-D segmentation of brain tumor core (excluding edema) and whole brain tumor (including edema) from different MR sequences, where only the tumor core in one MR sequence was annotated for training. Experimental results show that: 1) our model is more robust to segment previously unseen objects than state-of-the-art CNNs; 2) image-specific fine tuning with the proposed weighted loss function significantly improves segmentation accuracy; and 3) our method leads to accurate results with fewer user interactions and less user time than traditional interactive segmentation methods.
Training a deep convolutional neural network (CNN) from scratch is difficult because it requires a large amount of labeled training data and a great deal of expertise to ensure proper convergence. A ...promising alternative is to fine-tune a CNN that has been pre-trained using, for instance, a large set of labeled natural images. However, the substantial differences between natural and medical images may advise against such knowledge transfer. In this paper, we seek to answer the following central question in the context of medical image analysis: Can the use of pre-trained deep CNNs with sufficient fine-tuning eliminate the need for training a deep CNN from scratch? To address this question, we considered four distinct medical imaging applications in three specialties (radiology, cardiology, and gastroenterology) involving classification, detection, and segmentation from three different imaging modalities, and investigated how the performance of deep CNNs trained from scratch compared with the pre-trained CNNs fine-tuned in a layer-wise manner. Our experiments consistently demonstrated that 1) the use of a pre-trained CNN with adequate fine-tuning outperformed or, in the worst case, performed as well as a CNN trained from scratch; 2) fine-tuned CNNs were more robust to the size of training sets than CNNs trained from scratch; 3) neither shallow tuning nor deep tuning was the optimal choice for a particular application; and 4) our layer-wise fine-tuning scheme could offer a practical way to reach the best performance for the application at hand based on the amount of available data.
Deformable image registration is a fundamental task in medical image processing. Among its most important applications, one may cite: 1) multi-modality fusion, where information acquired by different ...imaging devices or protocols is fused to facilitate diagnosis and treatment planning; 2) longitudinal studies, where temporal structural or anatomical changes are investigated; and 3) population modeling and statistical atlases used to study normal anatomical variability. In this paper, we attempt to give an overview of deformable registration methods, putting emphasis on the most recent advances in the domain. Additional emphasis has been given to techniques applied to medical images. In order to study image registration methods in depth, their main components are identified and studied independently. The most recent techniques are presented in a systematic fashion. The contribution of this paper is to provide an extensive account of registration techniques in a systematic manner.
Automated detection of cancer metastases in lymph nodes has the potential to improve the assessment of prognosis for patients. To enable fair comparison between the algorithms for this purpose, we ...set up the CAMELYON17 challenge in conjunction with the IEEE International Symposium on Biomedical Imaging 2017 Conference in Melbourne. Over 300 participants registered on the challenge website, of which 23 teams submitted a total of 37 algorithms before the initial deadline. Participants were provided with 899 whole-slide images (WSIs) for developing their algorithms. The developed algorithms were evaluated based on the test set encompassing 100 patients and 500 WSIs. The evaluation metric used was a quadratic weighted Cohen's kappa. We discuss the algorithmic details of the 10 best pre-conference and two post-conference submissions. All these participants used convolutional neural networks in combination with pre- and postprocessing steps. Algorithms differed mostly in neural network architecture, training strategy, and pre- and postprocessing methodology. Overall, the kappa metric ranged from 0.89 to −0.13 across all submissions. The best results were obtained with pre-trained architectures such as ResNet. Confusion matrix analysis revealed that all participants struggled with reliably identifying isolated tumor cells, the smallest type of metastasis, with detection rates below 40%. Qualitative inspection of the results of the top participants showed categories of false positives, such as nerves or contamination, which could be targeted for further optimization. Last, we show that simple combinations of the top algorithms result in higher kappa metric values than any algorithm individually, with 0.93 for the best combination.
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