We aimed to develop and validate a deep learning system for fully automated segmentation of abdominal muscle and fat areas on computed tomography (CT) images.
A fully convolutional network-based ...segmentation system was developed using a training dataset of 883 CT scans from 467 subjects. Axial CT images obtained at the inferior endplate level of the 3rd lumbar vertebra were used for the analysis. Manually drawn segmentation maps of the skeletal muscle, visceral fat, and subcutaneous fat were created to serve as ground truth data. The performance of the fully convolutional network-based segmentation system was evaluated using the Dice similarity coefficient and cross-sectional area error, for both a separate internal validation dataset (426 CT scans from 308 subjects) and an external validation dataset (171 CT scans from 171 subjects from two outside hospitals).
The mean Dice similarity coefficients for muscle, subcutaneous fat, and visceral fat were high for both the internal (0.96, 0.97, and 0.97, respectively) and external (0.97, 0.97, and 0.97, respectively) validation datasets, while the mean cross-sectional area errors for muscle, subcutaneous fat, and visceral fat were low for both internal (2.1%, 3.8%, and 1.8%, respectively) and external (2.7%, 4.6%, and 2.3%, respectively) validation datasets.
The fully convolutional network-based segmentation system exhibited high performance and accuracy in the automatic segmentation of abdominal muscle and fat on CT images.
•Integration of a point-based detection method and fixed 32-point regression in a cascaded fashion.•The proposed method does not require any additional classification methods for tooth ...identification.•Introduction of a novel distance regularization loss between neighboring teeth to improve the regression.•Multitask training of box parameters and the marginal offset vector of the center point to improve the accuracy of detection.
Dental panoramic X-ray imaging is a popular diagnostic method owing to its very small dose of radiation. For an automated computer-aided diagnosis system in dental clinics, automatic detection and identification of individual teeth from panoramic X-ray images are critical prerequisites. In this study, we propose a point-wise tooth localization neural network by introducing a spatial distance regularization loss. The proposed network initially performs center point regression for all the anatomical teeth (i.e., 32 points), which automatically identifies each tooth. A novel distance regularization penalty is employed on the 32 points by considering L2 regularization loss of Laplacian on spatial distances. Subsequently, teeth boxes are individually localized using a multitask neural network on a patch basis. A multitask offset training is employed on the final output to improve the localization accuracy. Our method successfully localizes not only the existing teeth but also missing teeth; consequently, highly accurate detection and identification are achieved. The experimental results demonstrate that the proposed algorithm outperforms state-of-the-art approaches by increasing the average precision of teeth detection by 15.71 % compared to the best performing method. The accuracy of identification achieved a precision of 0.997 and recall value of 0.972. Moreover, the proposed network does not require any additional identification algorithm owing to the preceding regression of the fixed 32 points regardless of the existence of the teeth.
The conventional chemotherapeutic agents, used for cancer chemotherapy, have major limitations including non-specificity, ubiquitous biodistribution, low concentration in tumor tissue, and systemic ...toxicity. In recent years, owing to their unique features, polymeric nanoparticles have been widely used for the target-specific delivery of drugs in the body. Although polymeric nanoparticles have addressed a number of important issues, the bioavailability of drugs at the disease site, and especially upon cellular internalization, remains a challenge. A polymer nanocarrier system with a stimuli-responsive property (e.g., pH, temperature, or redox potential), for example, would be amenable to address the intracellular delivery barriers by taking advantage of pH, temperature, or redox potentials. With a greater understanding of the difference between normal and pathological tissues, there is a highly promising role of stimuli-responsive nanocarriers for drug delivery in the future. In this review, we highlighted the recent advances in different types of stimuli-responsive polymers for drug delivery.
This research paper presents the Buckley-James Q-learning (BJ-Q) algorithm, a cutting-edge method designed to optimize personalized treatment strategies, especially in the presence of right ...censoring. We critically assess the algorithm’s effectiveness in improving patient outcomes and its resilience across various scenarios. Central to our approach is the innovative use of the survival time to impute the reward in Q-learning, employing the Buckley-James method for enhanced accuracy and reliability. Our findings highlight the significant potential of personalized treatment regimens and introduce the BJ-Q learning algorithm as a viable and promising approach. This work marks a substantial advancement in our comprehension of treatment dynamics and offers valuable insights for augmenting patient care in the ever-evolving clinical landscape.
In environmental studies, it is important to assess how regulatory standards for air pollutants affect public health. High ozone levels contribute to harmful air pollutants. The EPA regulates ozone ...levels by setting ozone standards to protect public health. It is thus crucial to assess how various regulatory ozone standards affect non-accidental mortality related to respiratory deaths during the ozone season. The original rollback approach provides an adjusted ozone process under a new regulation scenario in a deterministic fashion. Herein, we consider a statistical rollback approach to allow for uncertainty in the rollback procedure by adopting the quantile matching method so that it provides flexible rollback sets. Hierarchical Bayesian models are used to predict the potential effects of different ozone standards on human health. We apply the method to epidemiologic data.
As sarcopenia research has been gaining emphasis, the need for quantification of abdominal muscle on computed tomography (CT) is increasing. Thus, a fully automated system to select L3 slice and ...segment muscle in an end-to-end manner is demanded. We aimed to develop a deep learning model (DLM) to select the L3 slice with consideration of anatomic variations and to segment cross-sectional areas (CSAs) of abdominal muscle and fat. Our DLM, named L3SEG-net, was composed of a YOLOv3-based algorithm for selecting the L3 slice and a fully convolutional network (FCN)-based algorithm for segmentation. The YOLOv3-based algorithm was developed via supervised learning using a training dataset (n = 922), and the FCN-based algorithm was transferred from prior work. Our L3SEG-net was validated with internal (n = 496) and external validation (n = 586) datasets. Ground truth L3 level CT slice and anatomic variation were identified by a board-certified radiologist. L3 slice selection accuracy was evaluated by the distance difference between ground truths and DLM-derived results. Technical success for L3 slice selection was defined when the distance difference was < 10 mm. Overall segmentation accuracy was evaluated by CSA error and DSC value. The influence of anatomic variations on DLM performance was evaluated. In the internal and external validation datasets, the accuracy of automatic L3 slice selection was high, with mean distance differences of 3.7 ± 8.4 mm and 4.1 ± 8.3 mm, respectively, and with technical success rates of 93.1% and 92.3%, respectively. However, in the subgroup analysis of anatomic variations, the L3 slice selection accuracy decreased, with distance differences of 12.4 ± 15.4 mm and 12.1 ± 14.6 mm, respectively, and with technical success rates of 67.2% and 67.9%, respectively. The overall segmentation accuracy of abdominal muscle areas was excellent regardless of anatomic variation, with CSA errors of 1.38-3.10 cm
. A fully automatic system was developed for the selection of an exact axial CT slice at the L3 vertebral level and the segmentation of abdominal muscle areas.
Although CT radiomics has shown promising results in the evaluation of vertebral fractures, the need for manual segmentation of fractured vertebrae limited the routine clinical implementation of ...radiomics. Therefore, automated segmentation of fractured vertebrae is needed for successful clinical use of radiomics. In this study, we aimed to develop and validate an automated algorithm for segmentation of fractured vertebral bodies on CT, and to evaluate the applicability of the algorithm in a radiomics prediction model to differentiate benign and malignant fractures. A convolutional neural network was trained to perform automated segmentation of fractured vertebral bodies using 341 vertebrae with benign or malignant fractures from 158 patients, and was validated on independent test sets (internal test, 86 vertebrae 59 patients; external test, 102 vertebrae 59 patients). Then, a radiomics model predicting fracture malignancy on CT was constructed, and the prediction performance was compared between automated and human expert segmentations. The algorithm achieved good agreement with human expert segmentation at testing (Dice similarity coefficient, 0.93-0.94; cross-sectional area error, 2.66-2.97%; average surface distance, 0.40-0.54 mm). The radiomics model demonstrated good performance in the training set (AUC, 0.93). In the test sets, automated and human expert segmentations showed comparable prediction performances (AUC, internal test, 0.80 vs 0.87, p = 0.044; external test, 0.83 vs 0.80, p = 0.37). In summary, we developed and validated an automated segmentation algorithm that showed comparable performance to human expert segmentation in a CT radiomics model to predict fracture malignancy, which may enable more practical clinical utilization of radiomics.
We present an interactive visual analytics framework, GazeDx (abbr. of GazeDiagnosis), for the comparative analysis of gaze data from multiple readers examining volumetric images while integrating ...important contextual information with the gaze data. Gaze pattern comparison is essential to understanding how radiologists examine medical images, and to identifying factors influencing the examination. Most prior work depended upon comparisons with manually juxtaposed static images of gaze tracking results. Comparative gaze analysis with volumetric images is more challenging due to the additional cognitive load on 3D perception. A recent study proposed a visualization design based on direct volume rendering (DVR) for visualizing gaze patterns in volumetric images; however, effective and comprehensive gaze pattern comparison is still challenging due to a lack of interactive visualization tools for comparative gaze analysis. We take the challenge with GazeDx while integrating crucial contextual information such as pupil size and windowing into the analysis process for more in-depth and ecologically valid findings. Among the interactive visualization components in GazeDx, a context-embedded interactive scatterplot is especially designed to help users examine abstract gaze data in diverse contexts by embedding medical imaging representations well known to radiologists in it. We present the results from two case studies with two experienced radiologists, where they compared the gaze patterns of 14 radiologists reading two patients' volumetric CT images.
Objective: The clinical relevance of myosteatosis has not been well evaluated in patients with pancreatic ductal adenocarcinoma (PDAC), although sarcopenia has been extensively researched. Therefore, ...we evaluated the prognostic value of muscle quality, including myosteatosis, in patients with resectable PDAC treated surgically. Materials and Methods: We retrospectively evaluated 347 patients with resectable PDAC who underwent curative surgery (mean age ± standard deviation, 63.6 ± 9.6 years; 202 male). Automatic muscle segmentation was performed on preoperative computed tomography (CT) images using an artificial intelligence program. A single axial image of the portal phase at the inferior endplate level of the L3 vertebra was used for analysis in each patient. Sarcopenia was evaluated using the skeletal muscle index, calculated as the skeletal muscle area (SMA) divided by the height squared. The mean SMA attenuation was used to evaluate myosteatosis. Diagnostic cutoff values for sarcopenia and myosteatosis were devised using the Contal and O'Quigley methods, and patients were classified according to normal (nMT), sarcopenic (sMT), myosteatotic (mMT), or combined (cMT) muscle quality types. Multivariable Cox regression analyses were conducted to assess the effects of muscle type on the overall survival (OS) and recurrence-free survival (RFS) after surgery. Results: Eighty-four (24.2%), 73 (21.0%), 75 (21.6%), and 115 (33.1%) patients were classified as having nMT, sMT, mMT, and cMT, respectively. Compared to nMT, mMT and cMT were significantly associated with poorer OS, with hazard ratios (HRs) of 1.49 (95% confidence interval, 1.00-2.22) and 1.68 (1.16-2.43), respectively, while sMT was not (HR of 1.40 0.94-2.10). Only mMT was significantly associated with poorer RFS, with an HR of 1.59 (1.07-2.35), while sMT and cMT were not. Conclusion: Myosteatosis was associated with poor OS and RFS in patients with resectable PDAC who underwent curative surgery.
PDF
