Prostatic urinary tract visualization with super-resolution deep learning models.

In urethra-sparing radiation therapy, prostatic urinary tract visualization is important in decreasing the urinary side effect. A methodology has been developed to visualize the prostatic urinary tract using post-urination magnetic resonance imaging (PU-MRI) without a urethral catheter. This study investigated whether the combination of PU-MRI and super-resolution (SR) deep learning models improves the visibility of the prostatic urinary tract. We enrolled 30 patients who had previously undergone real-time-image-gated spot scanning proton therapy by insertion of fiducial markers. PU-MRI was performed using a non-contrast high-resolution two-dimensional T2-weighted turbo spin-echo imaging sequence. Four different SR deep learning models were used: the enhanced deep SR network (EDSR), widely activated SR network (WDSR), SR generative adversarial network (SRGAN), and residual dense network (RDN). The complex wavelet structural similarity index measure (CW-SSIM) was used to quantitatively assess the performance of the proposed SR images compared to PU-MRI. Two radiation oncologists used a 1-to-5 scale to subjectively evaluate the visibility of the prostatic urinary tract. Cohen's weighted kappa (k) was used as a measure of agreement of inter-operator reliability. The mean CW-SSIM in EDSR, WDSR, SRGAN, and RDN was 99.86%, 99.89%, 99.30%, and 99.67%, respectively. The mean prostatic urinary tract visibility scores of the radiation oncologists were 3.70 and 3.53 for PU-MRI (k = 0.93), 3.67 and 2.70 for EDSR (k = 0.89), 3.70 and 2.73 for WDSR (k = 0.88), 3.67 and 2.73 for SRGAN (k = 0.88), and 4.37 and 3.73 for RDN (k = 0.93), respectively. The results suggest that SR images using RDN are similar to the original images, and the SR deep learning models subjectively improve the visibility of the prostatic urinary tract.

Acceptance of the Use of Artificial Intelligence in Medicine Among Japan's Doctors and the Public: A Questionnaire Survey.

BACKGROUND: The use of artificial intelligence (AI) in the medical industry promises many benefits, so AI has been introduced to medical practice primarily in developed countries. In Japan, the government is preparing for the rollout of AI in the medical industry. This rollout depends on doctors and the public accepting the technology. Therefore it is necessary to consider acceptance among doctors and among the public. However, little is known about the acceptance of AI in medicine in Japan. OBJECTIVE: This study aimed to obtain detailed data on the acceptance of AI in medicine by comparing the acceptance among Japanese doctors with that among the Japanese public. METHODS: We conducted an online survey, and the responses of doctors and members of the public were compared. AI in medicine was defined as the use of AI to determine diagnosis and treatment without requiring a doctor. A questionnaire was prepared referred to as the unified theory of acceptance and use of technology, a model of behavior toward new technologies. It comprises 20 items, and each item was rated on a five-point scale. Using this questionnaire, we conducted an online survey in 2018 among 399 doctors and 600 members of the public. The sample-wide responses were analyzed, and then the responses of the doctors were compared with those of the public using t tests. RESULTS: Regarding the sample-wide responses (N=999), 653 (65.4%) of the respondents believed, in the future, AI in medicine would be necessary, whereas only 447 (44.7%) expressed an intention to use AI-driven medicine. Additionally, 730 (73.1%) believed that regulatory legislation was necessary, and 734 (73.5%) were concerned about where accountability lies. Regarding the comparison between doctors and the public, doctors (mean 3.43, SD 1.00) were more likely than members of the public (mean 3.23, SD 0.92) to express intention to use AI-driven medicine (P<.001), suggesting that optimism about AI in medicine is greater among doctors compared to the public. CONCLUSIONS: Many of the respondents were optimistic about the role of AI in medicine. However, when asked whether they would like to use AI-driven medicine, they tended to give a negative response. This trend suggests that concerns about the lack of regulation and about accountability hindered acceptance. Additionally, the results revealed that doctors were more enthusiastic than members of the public regarding AI-driven medicine. For the successful implementation of AI in medicine, it would be necessary to inform the public and doctors about the relevant laws and to take measures to remove their concerns about them.

A Bayesian Network-Based Browsing Model for Patients Seeking Radiology-Related Information on Hospital Websites: Development and Usability Study.

BACKGROUND: An increasing number of people are visiting hospital websites to seek better services and treatments compared to the past. It is therefore important for hospitals to develop websites to meet the needs of their patients. However, few studies have investigated whether and how the current hospital websites meet the patient's needs. Above all, in radiation departments, it may be difficult for patients to obtain the desired information regarding modality and diagnosis because such information is subdivided when described on a website. OBJECTIVE: The purpose of this study is to suggest a hospital website search behavior model by analyzing the browsing behavior model using a Bayesian network from the perspective of one-to-one marketing. METHODS: First, we followed the website access log of Hokkaido University Hospital, which was collected from September 1, 2016, to August 31, 2017, and analyzed the access log using Google Analytics. Second, we specified the access records related to radiology from visitor browsing pages and keywords. Third, using these resources, we structured 3 Bayesian network models based on specific patient needs: radiotherapy, nuclear medicine examination, and radiological diagnosis. Analyzing each model, this study considered why some visitors could not reach their desired page and improvements to meet the needs of visitors seeking radiology-related information. RESULTS: The radiotherapy model showed that 74% (67/90) of the target visitors could reach their requested page, but only 2% (2/90) could reach the Center page where inspection information, one of their requested pages, is posted. By analyzing the behavior of the visitors, we clarified that connecting with the radiotherapy and radiological diagnosis pages is useful for increasing the proportion of patients reaching their requested page. CONCLUSIONS: We proposed solutions for patient web-browsing accessibility based on a Bayesian network. Further analysis is necessary to verify the accuracy of the proposed model in comparison to other models. It is expected that information provided on hospital websites will be improved using this method.

Projecting supply and demand for pharmacists in pharmacies based on the number of prescriptions and system dynamics modeling.

BACKGROUND: Pharmacists play an important role in promoting people's health in Japan, which has an aging population. Hence, it is necessary that the distribution of pharmacists meets the population's needs in each region. This study projects the future supply and demand for pharmacists in pharmacies to consider an optimal distribution of pharmacists. METHODS: The future supply of pharmacists working in pharmacies in Hokkaido is projected using system dynamics modeling, according to their career path. The demand is projected based on the number of prescriptions, sourced from publicly available sources. The analysis period is 2015-2040. The estimated demand is converted into the number of pharmacists and the sufficiency is evaluated using sufficiency ratio (supply/demand ratio). Sensitivity analyses of the sufficiency ratio were conducted to estimate the effects of changes in parameters such as national exam pass rate, enrollments, attrition rates, the number of prescriptions per pharmacist, and diffusion of newly licensed pharmacists. RESULTS: The projected supply, in 2025 and 2040, is 1.24 and 1.56 times, respectively, as that in 2015 and the demand is 1.11 and 0.98 times, respectively. In 2015, although the sufficiency ratio in Hokkaido overall is 1.19, the ratios are higher in urban medical areas and lower than 1 in rural medical areas, such as Minamihiyama, Emmon, and Nemuro. By 2040, the sufficiency ratios are greater than 1 for all areas except for Emmon and higher than 2 in some areas. The sensitivity analyses found that the sufficiency ratio was most sensitive to diffusion of newly licensed pharmacists and the number of prescriptions per pharmacist. CONCLUSION: Optimal distribution should be considered, as the results reveal a possible shortage in the number of pharmacists in rural medical areas in 2015-2025. Conversely, as the demand is projected to decrease after 2025 with a population decrease, future supply should be determined in order not to cause an oversupply after 2025. Refinements of the projection model should be conducted since the related factors such as the roles of pharmacists will change over time.

Characteristics of Type-2 Diabetics Who are Prone to High-Cost Medical Care Expenses by Bayesian Network.

Objective: This study aims to determine the characteristics of Type 2 diabetic patients who are more likely to cause high-cost medical expenses using the Bayesian network model. Methods: The 2011-2015 receipt data of Iwamizawa city, Japan were collected from the National Health Insurance Database. From the record, we identified patients with Type 2 diabetes with the following items: age, gender, area, number of days provided medical services, number of diseases, number of medical examinations, annual healthcare expenditures, and the presence or absence of hospitalization. The Bayesian network model was applied to identify the characteristics of the patients, and four observed values were changed using a model for patients who paid at least 3607 USD a year for medical expenses. The changes in the conditional probability of the annual healthcare expenditures and changes in the percentage of patients with high-cost medical expenses were analyzed. Results: After changing the observed value, the percentage of patients with high-cost medical expense reimbursement increased when the following four conditions were applied: the patient "has ever been hospitalized", "had been provided medical services at least 18 days a year", "had at least 14 diseases listed on medical insurance receipts", and "has not had specific health checkups in five years". Conclusions: To prevent an excessive rise in healthcare expenditures in Type 2 diabetic patients, measures against complications and promoting encouragement for them to undergo specific health checkups are considered as effective.

Factors associated with medication adherence among people with diabetes mellitus in poor urban areas of Cambodia: A cross-sectional study.

BACKGROUND: In Cambodia, the age-standardized prevalence of diabetes mellitus has increased in both men and women. The main objective of this study was to identify factors associated with diabetes medication adherence among people with diabetes mellitus in poor urban areas of Phnom Penh, Cambodia. METHODS: A cross-sectional study was conducted in 2017 using a structured questionnaire for face-to-face interviews by trained interviewers. The participants were people with diabetes mellitus who were the active members of a peer educator network, lived in poor urban areas of Phnom Penh, and attended weekly educational sessions during the survey period. Diabetes medication adherence was measured using four items of modified Morisky Medication Adherence Scale. Participants were classified into two groups based on their adherence score: 0 (high adherence) and from 1 to 4 (medium or low adherence). Sociodemographic characteristics; medical history; accessibility to health services; and knowledge, attitude, and practices related to diabetes mellitus were examined. A multiple logistic regression analysis was conducted adjusting for sex, age, marital status, and education levels. RESULTS: Data from 773 people with diabetes were included in the analyses. Of the total, 49.3% had a high level of diabetes medication adherence. A high level of adherence was associated with higher family income (≥50 USD per month) (adjusted odds ratio [AOR] = 5.00, 95% confidence interval [CI] = 2.25-11.08), absence of diabetes mellitus-related complications (AOR = 1.66, 95% CI = 1.19-2.32), use of health services more than once per month (AOR = 2.87, 95% CI = 1.64-5.04), following special diet for diabetes mellitus (AOR = 1.81, 95% CI = 1.17-2.81), and absence of alcohol consumption (AOR = 13.67, 95% CI = 2.86-65.34). CONCLUSIONS: High diabetes medication adherence was associated with better family economic conditions, absence of diabetes mellitus-related complications, and healthy behaviors. It would be crucial to improve affordable access to regular follow-ups including promotion of healthy behaviors through health education and control of diabetes mellitus-related complications.

Cost comparison between open radical cystectomy, laparoscopic radical cystectomy, and robot-assisted radical cystectomy for patients with bladder cancer: a systematic review of segmental costs.

BACKGROUND: Robot-assisted radical cystectomy is becoming a common treatment for bladder carcinoma. However, in comparison with open radical cystectomy, its cost-effectiveness has not been confirmed. Although few published reviews have compared total costs between the two surgical procedures, no study has compared segmental costs and explained their impact on total costs. METHODS: A systematic review was conducted based on studies on the segmental costs of open, laparoscopic, and robot-assisted radical cystectomy using PubMed, Web of Science, and Cochrane Library databases to provide insight into cost-effective management methods for radical cystectomy. The segmental costs included operating, robot-related, complication, and length of stay costs. A sensitivity analysis was conducted to determine the impact of the annual number of cases on the per-case robot-related costs. RESULTS: We identified two studies that compared open and laparoscopic surgeries and nine that compared open and robotic surgeries. Open radical cystectomy costs were higher than those of robotic surgeries in two retrospective single-institution studies, while robot-assisted radical cystectomy costs were higher in 1 retrospective single-institution study, 1 randomized controlled trial, and 4 large database studies. Operating costs were higher for robotic surgery, and accounted for 63.1-70.5% of the total robotic surgery cost. Sensitivity analysis revealed that robot-related costs were not a large proportion of total surgery costs in institutions with a large number of cases but accounted for a large proportion of total costs in centers with a small number of cases. CONCLUSIONS: The results show that robot-assisted radical cystectomy is more expensive than open radical cystectomy. The most effective methods to decrease costs associated with robotic surgery include a decrease in operating time and an increase in the number of cases. Further research is required on the cost-effectiveness of surgeries, including quality measures such as quality of life and quality-adjusted life years.

[Assessing Visual Attention of Mammography Positioning Using Eye Tracking System: A Comparison between Experts and Novices].

A common cause for image retakes in mammography is lack of proper positioning. Image retake is a potential hazard of increased radiation exposure to patient, patient discomfort and pain. Therefore, a mammographer has to provide fast exams with fewer retakes. Although evaluation of how a mammographer is effectively positioning has been studied in many ways, little research has been conducted to analyze visual attention. In this study, eye tracking system was adopted to detect eye movements and locations within a participants' visual fields during positioning. Eye tracking system has been widely used for assessing technical skills and risk awareness, and for comparing the skills between experts and novices. Two skilled mammographers and two novices were recruited. Positioning related activities were divided into two phases: patient's observation and breast positioning. Breast positioning was sub-divided into three stages to compare visual attention between experts and novices using heatmap and gaze plot. Although the expert tended to check each point, the novices tended to have a relatively short gaze of the outer breast region was observed. In the future, a comparative evaluation using clinical images is necessary; however, the eye tracking system to visualize attention contributes to medical safety during positioning.

Where Does Telemedicine Achieve a Cost Reduction Effect? Cost Minimization Analysis of Teleradiology Services in Japan.

Background: Telemedicine as a technology is expected to resolve issues such as doctor shortages and disparities in medical services. However, high costs of system installation and maintenance inhibit its widespread use.Introduction: This study involved a cost minimization analysis for installation of a teleradiology system in the Hokkaido prefecture of Japan. Conditions under which system utilization is cost-efficient and system utilization is effective for cost reduction were analyzed.Materials and Methods: A cost minimization analysis was conducted using three geospatial points of 50, 100, and 200 km from Sapporo city, the prefectural capital of Hokkaido, assuming a central imaging diagnosis center in Sapporo. The analysis was conducted from the standpoint of both patients and requesting hospitals.Results: From the patient's standpoint, a cost reduction effect was observed at all three distances from system installation. In contrast, from the hospital's standpoint, a cost reduction effect was found only when teleradiology examination was conducted from a distance of at least 100 km from Sapporo.Discussion: Results show that the cost reduction effect for patients increased as the travel distance increased. Although the teleradiology service is beneficial for a wide range of patients, the financial burden on requesting hospitals is significant.Conclusions: The following conditions were found necessary to reduce the requesting hospital's financial burden: the hospital should be far from the imaging diagnosis center, an inexpensive system is to be selected, and the system needs to be utilized continuously.

Road traffic crashes and fatalities in Japan 2000-2010 with special reference to the elderly road user.

OBJECTIVE: To investigate comparative road user crash and fatality rates in Japan between 2000 and 2010 in the elderly and young. METHODS: Data from the Japan Ministry of Health, Labor and Welfare Vital Statistics Database and the Institute for Traffic Accident Research and Data Analysis were used to calculate crash rates by age group, vehicle, and license category. RESULTS: Fatal crash rates per 100,000 licensed drivers for 4-wheeled motor vehicle drivers decreased by 53, 56, and 42 percent among the 65-69, 70-74, and ≥75 age groups between 2000 and 2010, respectively, compared to 66 and 60 percent among the 16-19 and 20-24 age groups, respectively. Fatal crash rates per 100,000 licensed riders for 2-wheeled motor vehicles decreased by 64, 23, and 33 percent in the 65-69, 70-74, and ≥75 age groups, respectively. Similarly, fatal crash rates per million population among bicyclists and pedestrians decreased in all age groups but were highest in the elderly age group in all years; the annual fatal crash rate for elderly pedestrians was 3 to 10 times higher than that for younger pedestrians. CONCLUSIONS: Despite the overall decrease in the elderly crash and fatal crash rates in all road use categories, elderly pedestrians are more susceptible to road traffic crashes and are more likely to be killed than younger persons. Further research may reduce this risk.

Knowledge, attitude and practice assessment of construction workers for HIV/AIDS in Sri Lanka.

BACKGROUND: Human immunodeficiency virus (HIV) prevalence is relatively lower in Sri Lanka than in other Asian countries; however, the number of HIV-infected persons has rapidly increased in recent years. METHODOLOGY: A baseline study on HIV, acquired immunodeficiency virus (AIDS), and sexually transmitted infections (STI) knowledge, attitude, and practice was conducted at two construction sites in Sri Lanka from January to February 2007 to design an effective intervention strategy for the construction workers. RESULTS: Among 611 respondents (mostly males, mean age 32.8 years), nearly two-thirds lived away from home. Knowledge was fairly good on AIDS prevention but poorer on STI than on HIV. Some misconceptions were also observed. A high percentage did not consider HIV/AIDS as their own personal issue, and over 50% respondents expressed discriminatory attitudes towards HIV positives. Condom access was limited due to social and cultural norms. Mobility was not significantly associated with practice of prevention of HIV and STI. CONCLUSION: This study showed that the construction workers were not specially at higher risk of HIV at that time. In order to minimize the potential risk of infection, however, it would be effective to reduce stigma and discrimination among them through the prevention program, working together with community or religious leaders in the areas. More comprehensive assessment among other population groups would also be beneficial to identify their risk of infection.

A pilot study on the usefulness of information and education campaign materials in enhancing the knowledge, attitude and practice on rabies in rural Sri Lanka.

BACKGROUND: Rabies remains endemic in Sri Lanka despite a strong government patronized anti-rabies campaign. Personal, cultural or religious beliefs have been thought to influence health practices that could render rabies prevalent in the country. METHODOLOGY: The knowledge, attitudes, and beliefs of 580 household heads/members from Nuwara Eliya District, Sri Lanka, regarding rabies were explored through a structured questionnaire. An improvement/deterioration in their knowledge and practices after the use of information and education campaign (IEC) materials was assessed through a repeat exploration at an interval of four weeks. RESULTS: Respondents showed inclination toward animal birth control (60%) rather than elimination methods (24%). There was disparity between pet owners enthusiasm to take pets for rabies inoculation (57%) and their ability to show dog vaccination cards (40%). Almost twice more pet owners than non-pet owners believed that it is their responsibility to control the population of roaming pet dogs (aOR=1.78; 95% CI: 1.14 to 2.76). The rabies leaflets were very effective in informing the people on how to deal with rabid animals, the earliest schedule for anti-rabies vaccine (ARV), and repeat vaccination. CONCLUSIONS: Awareness and proper attitude toward rabies management and canine population control are adequate among the rural Sinhalese and Buddhist populations of Sri Lanka; however, their current health practices should be improved. The rabies KAP could be further enhanced through the use of IEC materials.

Interpretive Structural Modeling for introducing of image information system at the middle-scale hospitals.

We extract and analyze the decision factors of introducing image information system by ISM (Interpretive Structural Modeling) method to determine the criteria and structure for system selection. As a result, 15 factors were extracted, and the structure and relation among factors became clear.