ISLE: An Intelligent Streaming Framework for High-Throughput AI Inference in Medical Imaging.

As the adoption of artificial intelligence (AI) systems in radiology grows, the increase in demand for greater bandwidth and computational resources can lead to greater infrastructural costs for healthcare providers and AI vendors. To that end, we developed ISLE, an intelligent streaming framework to address inefficiencies in current imaging infrastructures. Our framework draws inspiration from video-on-demand platforms to intelligently stream medical images to AI vendors at an optimal resolution for inference from a single high-resolution copy using progressive encoding. We hypothesize that ISLE can dramatically reduce the bandwidth and computational requirements for AI inference, while increasing throughput (i.e., the number of scans processed by the AI system per second). We evaluate our framework by streaming chest X-rays for classification and abdomen CT scans for liver and spleen segmentation and comparing them with the original versions of each dataset. For classification, our results show that ISLE reduced data transmission and decoding time by at least 92% and 88%, respectively, while increasing throughput by more than 3.72 × . For both segmentation tasks, ISLE reduced data transmission and decoding time by at least 82% and 88%, respectively, while increasing throughput by more than 2.9 × . In all three tasks, the ISLE streamed data had no impact on the AI system's diagnostic performance (all P > 0.05). Therefore, our results indicate that our framework can address inefficiencies in current imaging infrastructures by improving data and computational efficiency of AI deployments in the clinical environment without impacting clinical decision-making using AI systems.

Improving the Safety of Computed Tomography Through Automated Quality Measurement: A Radiologist Reader Study of Radiation Dose, Image Noise, and Image Quality.

OBJECTIVES: The Centers for Medicare and Medicaid Services funded the development of a computed tomography (CT) quality measure for use in pay-for-performance programs, which balances automated assessments of radiation dose with image quality to incentivize dose reduction without compromising the diagnostic utility of the tests. However, no existing quantitative method for assessing CT image quality has been validated against radiologists' image quality assessments on a large number of CT examinations. Thus to develop an automated measure of image quality, we tested the relationship between radiologists' subjective ratings of image quality with measurements of radiation dose and image noise. MATERIALS AND METHODS: Board-certified, posttraining, clinically active radiologists rated the image quality of 200 diagnostic CT examinations from a set of 734, representing 14 CT categories. Examinations with significant distractions, motion, or artifact were excluded. Radiologists rated diagnostic image quality as excellent, adequate, marginally acceptable, or poor; the latter 2 were considered unacceptable for rendering diagnoses. We quantified the relationship between ratings and image noise and radiation dose, by category, by analyzing the odds of an acceptable rating per standard deviation (SD) increase in noise or geometric SD (gSD) in dose. RESULTS: One hundred twenty-five radiologists contributed 24,800 ratings. Most (89%) were acceptable. The odds of an examination being rated acceptable statistically significantly increased per gSD increase in dose and decreased per SD increase in noise for most categories, including routine dose head, chest, and abdomen-pelvis, which together comprise 60% of examinations performed in routine practice. For routine dose abdomen-pelvis, the most common category, each gSD increase in dose raised the odds of an acceptable rating (2.33; 95% confidence interval, 1.98-3.24), whereas each SD increase in noise decreased the odds (0.90; 0.79-0.99). For only 2 CT categories, high-dose head and neck/cervical spine, neither dose nor noise was associated with ratings. CONCLUSIONS: Radiation dose and image noise correlate with radiologists' image quality assessments for most CT categories, making them suitable as automated metrics in quality programs incentivizing reduction of excessive radiation doses.