Low-dose CT screening among never-smokers with or without a family history of lung cancer in Taiwan: a prospective cohort study.

BACKGROUND: In Taiwan, lung cancers occur predominantly in never-smokers, of whom nearly 60% have stage IV disease at diagnosis. We aimed to assess the efficacy of low-dose CT (LDCT) screening among never-smokers, who had other risk factors for lung cancer. METHODS: The Taiwan Lung Cancer Screening in Never-Smoker Trial (TALENT) was a nationwide, multicentre, prospective cohort study done at 17 tertiary medical centres in Taiwan. Eligible individuals had negative chest radiography, were aged 55-75 years, had never smoked or had smoked fewer than 10 pack-years and stopped smoking for more than 15 years (self-report), and had one of the following risk factors: a family history of lung cancer; passive smoke exposure; a history of pulmonary tuberculosis or chronic obstructive pulmonary disorders; a cooking index of 110 or higher; or cooking without using ventilation. Eligible participants underwent LDCT at baseline, then annually for 2 years, and then every 2 years up to 6 years thereafter, with follow-up assessments at each LDCT scan (ie, total follow-up of 8 years). A positive scan was defined as a solid or part-solid nodule larger than 6 mm in mean diameter or a pure ground-glass nodule larger than 5 mm in mean diameter. Lung cancer was diagnosed through invasive procedures, such as image-guided aspiration or biopsy or surgery. Here, we report the results of 1-year follow-up after LDCT screening at baseline. The primary outcome was lung cancer detection rate. The p value for detection rates was estimated by the χ2 test. Univariate and multivariable logistic regression analyses were used to assess the association between lung cancer incidence and each risk factor. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of LDCT screening were also assessed. This study is registered with ClinicalTrials.gov, NCT02611570, and is ongoing. FINDINGS: Between Dec 1, 2015, and July 31, 2019, 12 011 participants (8868 females) were enrolled, of whom 6009 had a family history of lung cancer. Among 12 011 LDCT scans done at baseline, 2094 (17·4%) were positive. Lung cancer was diagnosed in 318 (2·6%) of 12 011 participants (257 [2·1%] participants had invasive lung cancer and 61 [0·5%] had adenocarcinomas in situ). 317 of 318 participants had adenocarcinoma and 246 (77·4%) of 318 had stage I disease. The prevalence of invasive lung cancer was higher among participants with a family history of lung cancer (161 [2·7%] of 6009 participants) than in those without (96 [1·6%] of 6002 participants). In participants with a family history of lung cancer, the detection rate of invasive lung cancer increased significantly with age, whereas the detection rate of adenocarcinoma in situ remained stable. In multivariable analysis, female sex, a family history of lung cancer, and age older than 60 years were associated with an increased risk of lung cancer and invasive lung cancer; passive smoke exposure, cumulative exposure to cooking, cooking without ventilation, and a previous history of chronic lung diseases were not associated with lung cancer, even after stratification by family history of lung cancer. In participants with a family history of lung cancer, the higher the number of first-degree relatives affected, the higher the risk of lung cancer; participants whose mother or sibling had lung cancer were also at an increased risk. A positive LDCT scan had 92·1% sensitivity, 84·6% specificity, a PPV of 14·0%, and a NPV of 99·7% for lung cancer diagnosis. INTERPRETATION: TALENT had a high invasive lung cancer detection rate at 1 year after baseline LDCT scan. Overdiagnosis could have occurred, especially in participants diagnosed with adenocarcinoma in situ. In individuals who do not smoke, our findings suggest that a family history of lung cancer among first-degree relatives significantly increases the risk of lung cancer as well as the rate of invasive lung cancer with increasing age. Further research on risk factors for lung cancer in this population is needed, particularly for those without a family history of lung cancer. FUNDING: Ministry of Health and Welfare of Taiwan.

Combined Radiomic and Visual Assessment for Improved Detection of Lung Adenocarcinoma Invasiveness on Computed Tomography Scans: A Multi-Institutional Study.

Objective: The timing and nature of surgical intervention for semisolid abnormalities are dependent upon distinguishing between adenocarcinoma-in-situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (INV). We sought to develop and evaluate a quantitative imaging method to determine invasiveness of small, ground-glass lesions on computed tomography (CT) chest scans. Methods: The study comprised 268 patients from 4 institutions with resected (<=3 cm) semisolid lesions with confirmed histopathological diagnosis of MIA/AIS or INV. A total of 248 radiomic texture features from within the tumor nodule (intratumoral) and adjacent to the nodule (peritumoral) were extracted from manually annotated lung nodules of chest CT scans. The datasets were randomly divided, with 40% of patients used for training and 60% used for testing the machine classifier (Training DTrain, N=106; Testing, DTest, N=162). Results: The top five radiomic stable features included four intratumoral (Laws and Haralick feature families) and one peritumoral feature within 3 to 6 mm of the nodule (CoLlAGe feature family), which successfully differentiated INV from MIA/AIS nodules with an AUC of 0.917 [0.867-0.967] on DTrain and 0.863 [0.79-0.931] on DTest. The radiomics model successfully differentiated INV from MIA cases (<1 cm AUC: 0.76 [0.53-0.98], 1-2 cm AUC: 0.92 [0.85-0.98], 2-3 cm AUC: 0.95 [0.88-1]). The final integrated model combining the classifier with the radiologists' score gave the best AUC on DTest (AUC=0.909, p<0.001). Conclusions: Addition of advanced image analysis via radiomics to the routine visual assessment of CT scans help better differentiate adenocarcinoma subtypes and can aid in clinical decision making. Further prospective validation in this direction is warranted.

Serial quantitative chest computed tomography imaging as prognosticators of coronavirus disease 2019 pneumonia.

In 2019, a large outbreak of a novel coronavirus disease (COVID-19) occurred in China. The purpose of this study is to quantitatively analyze the evolution of chest computed tomography (CT) imaging features in COVID-19. Nine patients with positive real-time reverse-transcriptase polymerase chain reaction results were included in this study. Totally 19 CT scans were analyzed. Lesion density, lesion volume, and lesion load were higher in the severe group than in the mild group. A significantly positive correlation was noted between major laboratory prognosticators with lesion volume and load. Lesion load at the first week of disease was significantly higher in severe group (p = 0.03). Our study revealed that several CT features were significantly different between severely and mildly infected forms of COVID-19 pneumonia. The CT lesion load value at the first week of infection may be applied as an outcome predictor of the disease.

Young adult cardiovascular diseases: a single center coronary computed tomography angiography study.

PURPOSE AND BACKGROUND: Cardiovascular disease (CVD) is one of the leading causes of death. However, the prevalence of CVD in young adults (<40 years of age) has not been well documented. We conducted this study to determine the proportion of CVD in both symptomatic and asymptomatic young adults. MATERIALS AND METHODS: Coronary CT angiography images obtained from April 2015 to July 2017 in our institution was retrospectively reviewed. Young adults were separated into two groups according to whether they had experienced chest discomfort. The diagnosis was classified as normal, coronary artery disease (CAD), myocardial bridging (MB), congenital coronary anomaly, congenital cardiac anomaly, cardiomyopathy, and aortic anomaly. The proportion of different diagnoses in two groups and cardiovascular risk factors were analyzed. RESULTS: Totally 107 patients (mean age, 35.6 ±â€¯3.55 years) were grouped into 36 cases of symptomatic group and 71 patients of asymptomatic group. Cardiovascular anomalies were found in 61 cases (41%). No significant difference in the occurrence rates of CAD (14% vs 11%, p = 0.53), MB (31% vs 42%, p = 0.51), and congenital coronary anomaly (7% vs 3%, p = 0.26) between groups. Mild arterial stenosis was implied in most CAD cases. Hypertension was the only risk factor significantly correlated with CAD. CONCLUSIONS: Although young adults are conventionally identified as low-risk, more than 60% of the cases in our cohort were proved to present cardiovascular anomalies, with no significant relation to cardiac symptoms. Early interventions should be conducted for aggressive CVD subtypes to prevent future acute events.

Characterizing an absent right coronary artery through 3-dimensional coronary computed tomography angiography.

A 43-year-old man presented with exertional dyspnea and chest tightness for two months. He received coronary computed tomography angiography and the result revealed a single coronary artery, a rare congenital coronary artery anomaly.

Study of Repetitive Movements Induced Oscillatory Activities in Healthy Subjects and Chronic Stroke Patients.

Repetitive movements at a constant rate require the integration of internal time counting and motor neural networks. Previous studies have proved that humans can follow short durations automatically (automatic timing) but require more cognitive efforts to track or estimate long durations. In this study, we studied sensorimotor oscillatory activities in healthy subjects and chronic stroke patients when subjects were performing repetitive finger movements. We found the movement-modulated changes in alpha and beta oscillatory activities were decreased with the increase of movement rates in finger lifting of healthy subjects and the non-paretic hands in stroke patients, whereas no difference was found in the paretic-hand movements at different movement rates in stroke patients. The significant difference in oscillatory activities between movements of non-paretic hands and paretic hands could imply the requirement of higher cognitive efforts to perform fast repetitive movements in paretic hands. The sensorimotor oscillatory response in fast repetitive movements could be a possible indicator to probe the recovery of motor function in stroke patients.

Callosal degeneration topographically correlated with cognitive function in amnestic mild cognitive impairment and Alzheimer's disease dementia.

Degeneration of the corpus callosum (CC) is evident in the pathogenesis of Alzheimer's disease (AD). However, the correlation of microstructural damage in the CC on the cognitive performance of patients with amnestic mild cognitive impairment (aMCI) and AD dementia is undetermined. We enrolled 26 normal controls, 24 patients with AD dementia, and 40 single-domain aMCI patients with at least grade 1 hippocampal atrophy and isolated memory impairment. Diffusion tensor imaging (DTI) with fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (DA), and radial diffusivity (DR) were measured. The entire CC was parcellated based on fiber trajectories to specific cortical Brodmann areas using a probabilistic tractography method. The relationship between the DTI measures in the subregions of the CC and cognitive performance was examined. Although the callosal degeneration in the patients with aMCI was less extended than in the patients with AD dementia, degeneration was already exhibited in several subregions of the CC at the aMCI stage. Scores of various neuropsychological tests were correlated to the severity of microstructural changes in the subregional CC connecting to functionally corresponding cortical regions. Our results confirm that CC degeneration is noticeable as early as the aMCI stage of AD and the disconnection of the CC subregional fibers to the corresponding Brodmann areas has an apparent impact on the related cognitive performance.

Classification of oscillometric envelope shape using frequent sequence mining.

The shape of the oscillometric envelope is known to affect the accuracy of automatic noninvasive blood pressure (NIBP) measurement devices that use the oscillometric principle to determine systolic and diastolic blood pressures. This study proposes a novel shape classification method that uses data mining techniques to determine the characteristic sequences for different envelope shapes. The results indicate that the proposed method effectively determines the characteristic sequences for different subject groups. Subjects in the high- score group and in the low- score group tend to have an envelope with a broader plateau and are bell-shaped, respectively. This information about shape can be used for future determination of the correct algorithm for systolic and diastolic blood pressures determination in NIBP devices.

Improvement of classification accuracy in a phase-tagged steady-state visual evoked potential-based brain computer interface using multiclass support vector machine.

BACKGROUND: Brain computer interface (BCI) is an emerging technology for paralyzed patients to communicate with external environments. Among current BCIs, the steady-state visual evoked potential (SSVEP)-based BCI has drawn great attention due to its characteristics of easy preparation, high information transfer rate (ITR), high accuracy, and low cost. However, electroencephalogram (EEG) signals are electrophysiological responses reflecting the underlying neural activities which are dependent upon subject's physiological states (e.g., emotion, attention, etc.) and usually variant among different individuals. The development of classification approaches to account for each individual's difference in SSVEP is needed but was seldom reported. METHODS: This paper presents a multiclass support vector machine (SVM)-based classification approach for gaze-target detections in a phase-tagged SSVEP-based BCI. In the training steps, the amplitude and phase features of SSVEP from off-line recordings were used to train a multiclass SVM for each subject. In the on-line application study, effective epochs which contained sufficient SSVEP information of gaze targets were first determined using Kolmogorov-Smirnov (K-S) test, and the amplitude and phase features of effective epochs were subsequently inputted to the multiclass SVM to recognize user's gaze targets. RESULTS: The on-line performance using the proposed approach has achieved high accuracy (89.88 ± 4.76%), fast responding time (effective epoch length = 1.13 ± 0.02 s), and the information transfer rate (ITR) was 50.91 ± 8.70 bits/min. CONCLUSIONS: The multiclass SVM-based classification approach has been successfully implemented to improve the classification accuracy in a phase-tagged SSVEP-based BCI. The present study has shown the multiclass SVM can be effectively adapted to each subject's SSVEPs to discriminate SSVEP phase information from gazing at different gazed targets.

Inter-trial analysis of post-movement Beta activities in EEG signals using multivariate empirical mode decomposition.

Event-related desynchronization/synchronization (ERD/ERS) is a technique to quantify subject's nonphase-locked neural activities underlying specific frequency bands, reactive to external/internal stimulus. However, conventional ERD/ERS studies usually utilize fixed frequency band determined from one or few channels to filter whole-head EEG/MEG data, which may inevitably include task-unrelated signals and result in underestimation of reactive oscillatory activities in multichannel studies. In this study, we adopted multivariate empirical mode decomposition (MEMD) to extract beta-related oscillatory activities in performing self-paced right and left index-finger lifting tasks. The MEMD extracts common modes from all channels in same-index intrinsic mode functions (IMFs) which allows the temporal-frequency features among different channels can be compared in each subband. The beta-band oscillatory activities were further bandpass filtered within trial-specific beta bands determined from sensorimotor-related channels (C3 and C4), and then rectified using amplitude modulation method to detect trial-by-trial beta rebound (BR) values in ERS time courses. The validity of the MEMD approach in BR values extraction has been demonstrated in multichannel EEG study which showed larger BR values than conventional ERS technique. The MEMD-based method enables the trial-by-trial extraction of sensorimotor oscillatory activities which might allow the exploration of subtle brain dynamics in future studies.

Determination of equivalent breast phantoms for different age groups of Taiwanese women: an experimental approach.

PURPOSE: Polymethylmethacrylate (PMMA) slab is one of the mostly used phantoms for studying breast dosimetry in mammography. The purpose of this study was to evaluate the equivalence between exposure factors acquired from PMMA slabs and patient cases of different age groups of Taiwanese women in mammography. METHODS: This study included 3910 craniocaudal screen/film mammograms on Taiwanese women acquired on one mammographic unit. The tube loading, compressed breast thickness (CBT), compression force, tube voltage, and target/filter combination for each mammogram were collected for all patients. The glandularity and the equivalent thickness of PMMA were determined for each breast using the exposure factors of the breast in combination with experimental measurements from breast-tissue-equivalent attenuation slabs. Equivalent thicknesses of PMMA to the breasts of Taiwanese women were then estimated. RESULTS: The average +/- standard deviation CBT and breast glandularity in this study were 4.2 +/- 1.0 cm and 54% +/- 23%, respectively. The average equivalent PMMA thickness was 4.0 +/- 0.7 cm. PMMA slabs producing equivalent exposure factors as in the breasts of Taiwanese women were determined for the age groups 30-49 yr and 50-69 yr. For the 4-cm PMMA slab, the CBT and glandularity values of the equivalent breast were 4.1 cm and 65%, respectively, for the age group 30-49 yr and 4.4 cm and 44%, respectively, for the age group 50-69 yr. CONCLUSIONS: The average thickness of PMMA slabs producing the same exposure factors as observed in a large group of Taiwanese women is less than that reported for American women. The results from this study can provide useful information for determining a suitable thickness of PMMA for mammographic dose survey in Taiwan. The equivalence of PMMA slabs and the breasts of Taiwanese women is provided to allow average glandular dose assessment in clinical practice.

An SSVEP-based BCI using high duty-cycle visual flicker.

Steady-state visual-evoked potential (SSVEP)-based brain-computer interfaces (BCIs) have generated significant interest due to their high information transfer rate (ITR). Due to the amplitude-frequency characteristic of the SSVEP, the flickering frequency of an SSVEP-based BCI is typically lower than 20 Hz to achieve a high SNR. However, a visual flicker with a flashing frequency below the critical flicker-fusion frequency often makes subjects feel flicker jerky and causes visual discomfort. This study presents a novel technique using high duty-cycle visual flicker to decrease user's visual discomfort. The proposed design uses LEDs flashing at 13.16 Hz, driven by flickering sequences consisting of repetitive stimulus cycles with a duration T (T = 76 ms). Each stimulus cycle included an ON state with a duration T(ON) and an OFF state with a duration T(OFF) (T = T(ON) + T(OFF)), and the duty cycle, defined as T(ON)/T, varied from 10.5% to 89.5%. This study also includes a questionnaire survey and analyzes the SSVEPs induced by different duty-cycle flickers. An 89.5% duty-cycle flicker, reported as a comfortable flicker, was adopted in a phase-tagged SSVEP system. Six subjects were asked to sequentially input a sequence of cursor commands with the 25.08-bits/min ITR.

Development of an adjustable model breast for mammographic dosimetry assessment in Taiwanese women.

OBJECTIVE: The currently used model breast for mammographic dosimetry assessment lacks the flexibility to change dimensions. The aim of this study was to develop an adjustable model breast for mammographic dosimetry assessment of Taiwanese women. MATERIALS AND METHODS: A retrospective review of 4226 craniocaudal (CC) views was conducted. The geometry of the model breast was defined as a semielliptical cylinder. Breast parameters, including compressed breast thickness, chest wall-to-nipple distance, compressed breast width, and percentage glandular content, were measured and analyzed. To validate the adjustable model breast, 44 mammograms were obtained. The expected values from the adjustable model breast were compared with the measured values. RESULTS: The average values of compressed breast thickness, chest wall-to-nipple distance, compressed breast width, and percentage glandular content of the women studied were 4.1 cm, 6.9 cm, 16.9 cm, and 54%, respectively. Variations of chest wall-to-nipple distance, compressed breast width, and percentage glandular content can be expressed as functions of compressed breast thickness, and the adjustable model breast developed was based on compressed breast thickness. The average area of the CC view obtained is a factor of 0.81 lower than that defined by the American College of Radiology protocol. For validation, the difference in average values between the expected and measured did not exceed 0.5 cm in breast dimensions and 6% in percentage glandular content. CONCLUSION: Compressed breast thickness is useful for quantifying dimensions and percentage glandular content of a model breast. The adjustable model breast developed in this study can offer greater flexibility in the determination of breast dimensions for mammographic dosimetry assessment of Taiwanese women.

Live/real time three-dimensional transthoracic echocardiographic assessment of left ventricular volumes, ejection fraction, and mass compared with magnetic resonance imaging.

Due to reliance upon geometric assumptions and foreshortening issues, the traditionally utilized transthoracic two-dimensional echocardiography (2DTTE) has shown limitations in assessing left ventricular (LV) volume, mass, and function. Cardiac magnetic resonance imaging (MRI) has shown potential in accurately defining these LV characteristics. Recently, the emergence of live/real time three-dimensional (3D) TTE has demonstrated incremental value over 2DTTE and comparable value with MRI in assessing LV parameters. Here we report 58 consecutive patients with diverse cardiac disorders and clinical characteristics, referred for clinical MRI studies, who were evaluated by cardiac MRI and 3DTTE. Our results show good correlation between the two modalities.