Concept-based Explainable Malignancy Scoring on Pulmonary Nodules in CT Images

To increase the transparency of modern computer-aided diagnosis (CAD) systems for assessing the malignancy of lung nodules, an interpretable model based on applying the generalized additive models and the concept-based learning is proposed. The model detects a set of clinically significant attributes in addition to the final malignancy regression score and learns the association between the lung nodule attributes and a final diagnosis decision as well as their contributions into the decision. The proposed concept-based learning framework provides human-readable explanations in terms of different concepts (numerical and categorical), their values, and their contribution to the final prediction. Numerical experiments with the LIDC-IDRI dataset demonstrate that the diagnosis results obtained using the proposed model, which explicitly explores internal relationships, are in line with similar patterns observed in clinical practice. Additionally, the proposed model shows the competitive classification and the nodule attribute scoring performance, highlighting its potential for effective decision-making in the lung nodule diagnosis.

VLST: Virtual Lung Screening Trial for Lung Cancer Detection Using Virtual Imaging Trial

Importance: The efficacy of lung cancer screening can be significantly impacted by the imaging modality used. This Virtual Lung Screening Trial (VLST) addresses the critical need for precision in lung cancer diagnostics and the potential for reducing unnecessary radiation exposure in clinical settings. Objectives: To establish a virtual imaging trial (VIT) platform that accurately simulates real-world lung screening trials (LSTs) to assess the diagnostic accuracy of CT and CXR modalities. Design, Setting, and Participants: Utilizing computational models and machine learning algorithms, we created a diverse virtual patient population. The cohort, designed to mirror real-world demographics, was assessed using virtual imaging techniques that reflect historical imaging technologies. Main Outcomes and Measures: The primary outcome was the difference in the Area Under the Curve (AUC) for CT and CXR modalities across lesion types and sizes. Results: The study analyzed 298 CT and 313 CXR simulated images from 313 virtual patients, with a lesion-level AUC of 0.81 (95% CI: 0.78-0.84) for CT and 0.55 (95% CI: 0.53-0.56) for CXR. At the patient level, CT demonstrated an AUC of 0.85 (95% CI: 0.80-0.89), compared to 0.53 (95% CI: 0.47-0.60) for CXR. Subgroup analyses indicated CT's superior performance in detecting homogeneous lesions (AUC of 0.97 for lesion-level) and heterogeneous lesions (AUC of 0.71 for lesion-level) as well as in identifying larger nodules (AUC of 0.98 for nodules > 8 mm). Conclusion and Relevance: The VIT platform validated the superior diagnostic accuracy of CT over CXR, especially for smaller nodules, underscoring its potential to replicate real clinical imaging trials. These findings advocate for the integration of virtual trials in the evaluation and improvement of imaging-based diagnostic tools.

Improved Focus on Hard Samples for Lung Nodule Detection

Recently, lung nodule detection methods based on deep learning have shown excellent performance in the medical image processing field. Considering that only a few public lung datasets are available and lung nodules are more difficult to detect in CT images than in natural images, the existing methods face many bottlenecks when detecting lung nodules, especially hard ones in CT images. In order to solve these problems, we plan to enhance the focus of our network. In this work, we present an improved detection network that pays more attention to hard samples and datasets to deal with lung nodules by introducing deformable convolution and self-paced learning. Experiments on the LUNA16 dataset demonstrate the effectiveness of our proposed components and show that our method has reached competitive performance.

EXACT-Net:EHR-guided lung tumor auto-segmentation for non-small cell lung cancer radiotherapy

Lung cancer is a devastating disease with the highest mortality rate among cancer types. Over 60% of non-small cell lung cancer (NSCLC) patients, which accounts for 87% of diagnoses, require radiation therapy. Rapid treatment initiation significantly increases the patient's survival rate and reduces the mortality rate. Accurate tumor segmentation is a critical step in the diagnosis and treatment of NSCLC. Manual segmentation is time and labor-consuming and causes delays in treatment initiation. Although many lung nodule detection methods, including deep learning-based models, have been proposed, there is still a long-standing problem of high false positives (FPs) with most of these methods. Here, we developed an electronic health record (EHR) guided lung tumor auto-segmentation called EXACT-Net (EHR-enhanced eXACtitude in Tumor segmentation), where the extracted information from EHRs using a pre-trained large language model (LLM), was used to remove the FPs and keep the TP nodules only. The auto-segmentation model was trained on NSCLC patients' computed tomography (CT), and the pre-trained LLM was used with the zero-shot learning approach. Our approach resulted in a 250% boost in successful nodule detection using the data from ten NSCLC patients treated in our institution.

Nodule detection and generation on chest X-rays: NODE21 Challenge

Pulmonary nodules may be an early manifestation of lung cancer, the leading cause of cancer-related deaths among both men and women. Numerous studies have established that deep learning methods can yield high-performance levels in the detection of lung nodules in chest X-rays. However, the lack of gold-standard public datasets slows down the progression of the research and prevents benchmarking of methods for this task. To address this, we organized a public research challenge, NODE21, aimed at the detection and generation of lung nodules in chest X-rays. While the detection track assesses state-of-the-art nodule detection systems, the generation track determines the utility of nodule generation algorithms to augment training data and hence improve the performance of the detection systems. This paper summarizes the results of the NODE21 challenge and performs extensive additional experiments to examine the impact of the synthetically generated nodule training images on the detection algorithm performance.

Swin-Tempo: Temporal-Aware Lung Nodule Detection in CT Scans as Video Sequences Using Swin Transformer-Enhanced UNet

Lung cancer is highly lethal, emphasizing the critical need for early detection. However, identifying lung nodules poses significant challenges for radiologists, who rely heavily on their expertise for accurate diagnosis. To address this issue, computer-aided diagnosis (CAD) systems based on machine learning techniques have emerged to assist doctors in identifying lung nodules from computed tomography (CT) scans. Unfortunately, existing networks in this domain often suffer from computational complexity, leading to high rates of false negatives and false positives, limiting their effectiveness. To address these challenges, we present an innovative model that harnesses the strengths of both convolutional neural networks and vision transformers. Inspired by object detection in videos, we treat each 3D CT image as a video, individual slices as frames, and lung nodules as objects, enabling a time-series application. The primary objective of our work is to overcome hardware limitations during model training, allowing for efficient processing of 2D data while utilizing inter-slice information for accurate identification based on 3D image context. We validated the proposed network by applying a 10-fold cross-validation technique to the publicly available Lung Nodule Analysis 2016 dataset. Our proposed architecture achieves an average sensitivity criterion of 97.84% and a competition performance metrics (CPM) of 96.0% with few parameters. Comparative analysis with state-of-the-art advancements in lung nodule identification demonstrates the significant accuracy achieved by our proposed model.

Lung Cancer Detection from CT Scan Images based on Genetic-Independent Recurrent Deep Learning

Lung cancer is one of the prevalence diseases in the world which cause many deaths. Detecting early stages of lung cancer is so necessary. So, modeling and simulating some intelligent medical systems is an essential which can help specialist to accurately determine and diagnose the disease. So this paper contributes a new lung cancer detection model in CT images which use machine learning methods. There are three steps in this model: noise reduction (pre-processing), segmentation (middle-processing) and optimize segmentation for detect exact are of nodules. This article use some filters for noise reduction and then use Independent Recurrent Neural Networks (IndRNN) as deep learning methods for segmentation which optimize and tune by Genetic Algorithm. The results represented that the proposed method can detect exact area of nodules in CT images.

INCEPTNET: Precise And Early Disease Detection Application For Medical Images Analyses

In view of the recent paradigm shift in deep AI based image processing methods, medical image processing has advanced considerably. In this study, we propose a novel deep neural network (DNN), entitled InceptNet, in the scope of medical image processing, for early disease detection and segmentation of medical images in order to enhance precision and performance. We also investigate the interaction of users with the InceptNet application to present a comprehensive application including the background processes, and foreground interactions with users. Fast InceptNet is shaped by the prominent Unet architecture, and it seizes the power of an Inception module to be fast and cost effective while aiming to approximate an optimal local sparse structure. Adding Inception modules with various parallel kernel sizes can improve the network's ability to capture the variations in the scaled regions of interest. To experiment, the model is tested on four benchmark datasets, including retina blood vessel segmentation, lung nodule segmentation, skin lesion segmentation, and breast cancer cell detection. The improvement was more significant on images with small scale structures. The proposed method improved the accuracy from 0.9531, 0.8900, 0.9872, and 0.9881 to 0.9555, 0.9510, 0.9945, and 0.9945 on the mentioned datasets, respectively, which show outperforming of the proposed method over the previous works. Furthermore, by exploring the procedure from start to end, individuals who have utilized a trial edition of InceptNet, in the form of a complete application, are presented with thirteen multiple choice questions in order to assess the proposed method. The outcomes are evaluated through the means of Human Computer Interaction.

M3Dsynth: A dataset of medical 3D images with AI-generated local manipulations

The ability to detect manipulated visual content is becoming increasingly important in many application fields, given the rapid advances in image synthesis methods. Of particular concern is the possibility of modifying the content of medical images, altering the resulting diagnoses. Despite its relevance, this issue has received limited attention from the research community. One reason is the lack of large and curated datasets to use for development and benchmarking purposes. Here, we investigate this issue and propose M3Dsynth, a large dataset of manipulated Computed Tomography (CT) lung images. We create manipulated images by injecting or removing lung cancer nodules in real CT scans, using three different methods based on Generative Adversarial Networks (GAN) or Diffusion Models (DM), for a total of 8,577 manipulated samples. Experiments show that these images easily fool automated diagnostic tools. We also tested several state-of-the-art forensic detectors and demonstrated that, once trained on the proposed dataset, they are able to accurately detect and localize manipulated synthetic content, including when training and test sets are not aligned, showing good generalization ability. Dataset and code will be publicly available at https://grip-unina.github.io/M3Dsynth/.

Improving Segmentation and Detection of Lesions in CT Scans Using Intensity Distribution Supervision

We propose a method to incorporate the intensity information of a target lesion on CT scans in training segmentation and detection networks. We first build an intensity-based lesion probability (ILP) function from an intensity histogram of the target lesion. It is used to compute the probability of being the lesion for each voxel based on its intensity. Finally, the computed ILP map of each input CT scan is provided as additional supervision for network training, which aims to inform the network about possible lesion locations in terms of intensity values at no additional labeling cost. The method was applied to improve the segmentation of three different lesion types, namely, small bowel carcinoid tumor, kidney tumor, and lung nodule. The effectiveness of the proposed method on a detection task was also investigated. We observed improvements of 41.3% -> 47.8%, 74.2% -> 76.0%, and 26.4% -> 32.7% in segmenting small bowel carcinoid tumor, kidney tumor, and lung nodule, respectively, in terms of per case Dice scores. An improvement of 64.6% -> 75.5% was achieved in detecting kidney tumors in terms of average precision. The results of different usages of the ILP map and the effect of varied amount of training data are also presented.