The Image Biomarker Standardization Initiative: Standardized Convolutional Filters for Reproducible Radiomics and Enhanced Clinical Insights.

Filters are commonly used to enhance specific structures and patterns in images, such as vessels or peritumoral regions, to enable clinical insights beyond the visible image using radiomics. However, their lack of standardization restricts reproducibility and clinical translation of radiomics decision support tools. In this special report, teams of researchers who developed radiomics software participated in a three-phase study (September 2020 to December 2022) to establish a standardized set of filters. The first two phases focused on finding reference filtered images and reference feature values for commonly used convolutional filters: mean, Laplacian of Gaussian, Laws and Gabor kernels, separable and nonseparable wavelets (including decomposed forms), and Riesz transformations. In the first phase, 15 teams used digital phantoms to establish 33 reference filtered images of 36 filter configurations. In phase 2, 11 teams used a chest CT image to derive reference values for 323 of 396 features computed from filtered images using 22 filter and image processing configurations. Reference filtered images and feature values for Riesz transformations were not established. Reproducibility of standardized convolutional filters was validated on a public data set of multimodal imaging (CT, fluorodeoxyglucose PET, and T1-weighted MRI) in 51 patients with soft-tissue sarcoma. At validation, reproducibility of 486 features computed from filtered images using nine configurations × three imaging modalities was assessed using the lower bounds of 95% CIs of intraclass correlation coefficients. Out of 486 features, 458 were found to be reproducible across nine teams with lower bounds of 95% CIs of intraclass correlation coefficients greater than 0.75. In conclusion, eight filter types were standardized with reference filtered images and reference feature values for verifying and calibrating radiomics software packages. A web-based tool is available for compliance checking.

3D-printed iodine-ink CT phantom for radiomics feature extraction - advantages and challenges.

BACKGROUND: To test and validate novel CT techniques, such as texture analysis in radiomics, repeat measurements are required. Current anthropomorphic phantoms lack fine texture and true anatomic representation. 3D-printing of iodinated ink on paper is a promising phantom manufacturing technique. Previously acquired or artificially created CT data can be used to generate realistic phantoms. PURPOSE: To present the design process of an anthropomorphic 3D-printed iodine ink phantom, highlighting the different advantages and pitfalls in its use. To analyze the phantom's X-ray attenuation properties, and the influences of the printing process on the imaging characteristics, by comparing it to the original input dataset. METHODS: Two patient CT scans and artificially generated test patterns were combined in a single dataset for phantom printing and cropped to a size of 26 × 19 × 30 cm3 . This DICOM dataset was printed on paper using iodinated ink. The phantom was CT-scanned and compared to the original image dataset used for printing the phantom. The water-equivalent diameter of the phantom was compared to that of a patient cohort (N = 104). Iodine concentrations in the phantom were measured using dual-energy CT. 86 radiomics features were extracted from 10 repeat phantom scans and the input dataset. Features were compared using a histogram analysis and a PCA individually and overall, respectively. The frequency content was compared using the normalized spectrum modulus. RESULTS: Low density structures are depicted incorrectly, while soft tissue structures show excellent visual accordance with the input dataset. Maximum deviations of around 30 HU between the original dataset and phantom HU values were observed. The phantom has X-ray attenuation properties comparable to a lightweight adult patient (∼54 kg, BMI 19 kg/m2 ). Iodine concentrations in the phantom varied between 0 and 50 mg/ml. PCA of radiomics features shows different tissue types separate in similar areas of PCA representation in the phantom scans as in the input dataset. Individual feature analysis revealed systematic shift of first order radiomics features compared to the original dataset, while some higher order radiomics features did not. The normalized frequency modulus |f(ω)| of the phantom data agrees well with the original data. However, all frequencies systematically occur more frequently in the phantom compared to the maximum of the spectrum modulus than in the original data set, especially for mid-frequencies (e.g., for ω = 0.3942 mm-1 , |f(ω)|original  = 0.09 * |fmax |original and |f(ω)|phantom  = 0.12 * |fmax |phantom ). CONCLUSIONS: 3D-iodine-ink-printing technology can be used to print anthropomorphic phantoms with a water-equivalent diameter of a lightweight adult patient. Challenges include small residual air enclosures and the fidelity of HU values. For soft tissue, there is a good agreement between the HU values of the phantom and input data set. Radiomics texture features of the phantom scans are similar to the input data set, but systematic shifts of radiomics features in first order features, due to differences in HU values, need to be considered. The paper substrate influences the spatial frequency distribution of the phantom scans. This phantom type is of very limited use for dual-energy CT analyses.

QuantImage v2: a comprehensive and integrated physician-centered cloud platform for radiomics and machine learning research.

BACKGROUND: Radiomics, the field of image-based computational medical biomarker research, has experienced rapid growth over the past decade due to its potential to revolutionize the development of personalized decision support models. However, despite its research momentum and important advances toward methodological standardization, the translation of radiomics prediction models into clinical practice only progresses slowly. The lack of physicians leading the development of radiomics models and insufficient integration of radiomics tools in the clinical workflow contributes to this slow uptake. METHODS: We propose a physician-centered vision of radiomics research and derive minimal functional requirements for radiomics research software to support this vision. Free-to-access radiomics tools and frameworks were reviewed to identify best practices and reveal the shortcomings of existing software solutions to optimally support physician-driven radiomics research in a clinical environment. RESULTS: Support for user-friendly development and evaluation of radiomics prediction models via machine learning was found to be missing in most tools. QuantImage v2 (QI2) was designed and implemented to address these shortcomings. QI2 relies on well-established existing tools and open-source libraries to realize and concretely demonstrate the potential of a one-stop tool for physician-driven radiomics research. It provides web-based access to cohort management, feature extraction, and visualization and supports "no-code" development and evaluation of machine learning models against patient-specific outcome data. CONCLUSIONS: QI2 fills a gap in the radiomics software landscape by enabling "no-code" radiomics research, including model validation, in a clinical environment. Further information about QI2, a public instance of the system, and its source code is available at https://medgift.github.io/quantimage-v2-info/ . Key points As domain experts, physicians play a key role in the development of radiomics models. Existing software solutions do not support physician-driven research optimally. QuantImage v2 implements a physician-centered vision for radiomics research. QuantImage v2 is a web-based, "no-code" radiomics research platform.

Assessing radiomics feature stability with simulated CT acquisitions.

Medical imaging quantitative features had once disputable usefulness in clinical studies. Nowadays, advancements in analysis techniques, for instance through machine learning, have enabled quantitative features to be progressively useful in diagnosis and research. Tissue characterisation is improved via the "radiomics" features, whose extraction can be automated. Despite the advances, stability of quantitative features remains an important open problem. As features can be highly sensitive to variations of acquisition details, it is not trivial to quantify stability and efficiently select stable features. In this work, we develop and validate a Computed Tomography (CT) simulator environment based on the publicly available ASTRA toolbox ( www.astra-toolbox.com ). We show that the variability, stability and discriminative power of the radiomics features extracted from the virtual phantom images generated by the simulator are similar to those observed in a tandem phantom study. Additionally, we show that the variability is matched between a multi-center phantom study and simulated results. Consequently, we demonstrate that the simulator can be utilised to assess radiomics features' stability and discriminative power.

The Discriminative Power and Stability of Radiomics Features With Computed Tomography Variations: Task-Based Analysis in an Anthropomorphic 3D-Printed CT Phantom.

OBJECTIVES: The aims of this study were to determine the stability of radiomics features against computed tomography (CT) parameter variations and to study their discriminative power concerning tissue classification using a 3D-printed CT phantom based on real patient data. MATERIALS AND METHODS: A radiopaque 3D phantom was developed using real patient data and a potassium iodide solution paper-printing technique. Normal liver tissue and 3 lesion types (benign cyst, hemangioma, and metastasis) were manually annotated in the phantom. The stability and discriminative power of 86 radiomics features were assessed in measurements taken from 240 CT series with 8 parameter variations of reconstruction algorithms, reconstruction kernels, slice thickness, and slice spacing. Pairwise parameter group and pairwise tissue class comparisons were performed using Wilcoxon signed rank tests. RESULTS: In total, 19,264 feature stability tests and 8256 discriminative power tests were performed. The 8 CT parameter variation pairwise group comparisons had statistically significant differences on average in 78/86 radiomics features. On the other hand, 84% of the univariate radiomics feature tests had a successful and statistically significant differentiation of the 4 classes of liver tissue. The 86 radiomics features were ranked according to the cumulative sum of successful stability and discriminative power tests. CONCLUSIONS: The differences in radiomics feature values obtained from different types of liver tissue are generally greater than the intraclass differences resulting from CT parameter variations.

Machine Learning Assisted Citation Screening for Systematic Reviews.

Evidence-based practice is highly dependent upon up-to-date systematic reviews (SR) for decision making. However, conducting and updating systematic reviews, especially the citation screening for identification of relevant studies, requires much human work and is therefore expensive. Automating citation screening using machine learning (ML) based approaches can reduce cost and labor. Machine learning has been applied to automate citation screening but not for the SRs with very narrow research questions. This paper reports the results and observations for an ongoing research that aims to automate citation screening for SRs with narrow research questions using machine learning. The research also sheds light on the problem of class imbalance and class overlap on the performance of ML classifiers when applied to SRs with narrow research questions.

Deep Learning-Based Retrieval System for Gigapixel Histopathology Cases and the Open Access Literature.

BACKGROUND: The introduction of digital pathology into clinical practice has led to the development of clinical workflows with digital images, in connection with pathology reports. Still, most of the current work is time-consuming manual analysis of image areas at different scales. Links with data in the biomedical literature are rare, and a need for search based on visual similarity within whole slide images (WSIs) exists. OBJECTIVES: The main objective of the work presented is to integrate content-based visual retrieval with a WSI viewer in a prototype. Another objective is to connect cases analyzed in the viewer with cases or images from the biomedical literature, including the search through visual similarity and text. METHODS: An innovative retrieval system for digital pathology is integrated with a WSI viewer, allowing to define regions of interest (ROIs) in images as queries for finding visually similar areas in the same or other images and to zoom in/out to find structures at varying magnification levels. The algorithms are based on a multimodal approach, exploiting both text information and content-based image features. RESULTS: The retrieval system allows viewing WSIs and searching for regions that are visually similar to manually defined ROIs in various data sources (proprietary and public datasets, e.g., scientific literature). The system was tested by pathologists, highlighting its capabilities and suggesting ways to improve it and make it more usable in clinical practice. CONCLUSIONS: The developed system can enhance the practice of pathologists by enabling them to use their experience and knowledge to control artificial intelligence tools for navigating repositories of images for clinical decision support and teaching, where the comparison with visually similar cases can help to avoid misinterpretations. The system is available as open source, allowing the scientific community to test, ideate and develop similar systems for research and clinical practice.

Cloud-Based Evaluation of Anatomical Structure Segmentation and Landmark Detection Algorithms: VISCERAL Anatomy Benchmarks.

Variations in the shape and appearance of anatomical structures in medical images are often relevant radiological signs of disease. Automatic tools can help automate parts of this manual process. A cloud-based evaluation framework is presented in this paper including results of benchmarking current state-of-the-art medical imaging algorithms for anatomical structure segmentation and landmark detection: the VISCERAL Anatomy benchmarks. The algorithms are implemented in virtual machines in the cloud where participants can only access the training data and can be run privately by the benchmark administrators to objectively compare their performance in an unseen common test set. Overall, 120 computed tomography and magnetic resonance patient volumes were manually annotated to create a standard Gold Corpus containing a total of 1295 structures and 1760 landmarks. Ten participants contributed with automatic algorithms for the organ segmentation task, and three for the landmark localization task. Different algorithms obtained the best scores in the four available imaging modalities and for subsets of anatomical structures. The annotation framework, resulting data set, evaluation setup, results and performance analysis from the three VISCERAL Anatomy benchmarks are presented in this article. Both the VISCERAL data set and Silver Corpus generated with the fusion of the participant algorithms on a larger set of non-manually-annotated medical images are available to the research community.

Comparing fusion techniques for the ImageCLEF 2013 medical case retrieval task.

Retrieval systems can supply similar cases with a proven diagnosis to a new example case under observation to help clinicians during their work. The ImageCLEFmed evaluation campaign proposes a framework where research groups can compare case-based retrieval approaches. This paper focuses on the case-based task and adds results of the compound figure separation and modality classification tasks. Several fusion approaches are compared to identify the approaches best adapted to the heterogeneous data of the task. Fusion of visual and textual features is analyzed, demonstrating that the selection of the fusion strategy can improve the best performance on the case-based retrieval task.

Live ECG readings using Google Glass in emergency situations.

Most sudden cardiac problems require rapid treatment to preserve life. In this regard, electrocardiograms (ECG) shown on vital parameter monitoring systems help medical staff to detect problems. In some situations, such monitoring systems may display information in a less than convenient way for medical staff. For example, vital parameters are displayed on large screens outside the field of view of a surgeon during cardiac surgery. This may lead to losing time and to mistakes when problems occur during cardiac operations. In this paper we present a novel approach to display vital parameters such as the second derivative of the ECG rhythm and heart rate close to the field of view of a surgeon using Google Glass. As a preliminary assessment, we run an experimental study to verify the possibility for medical staff to identify abnormal ECG rhythms from Google Glass. This study compares 6 ECG rhythms readings from a 13.3 inch laptop screen and from the prism of Google Glass. Seven medical residents in internal medicine participated in the study. The preliminary results show that there is no difference between identifying these 6 ECG rhythms from the laptop screen versus Google Glass. Both allow close to perfect identification of the 6 common ECG rhythms. This shows the potential of connected glasses such as Google Glass to be useful in selected medical applications.

Facilitating medical information search using Google Glass connected to a content-based medical image retrieval system.

Wearable computing devices are starting to change the way users interact with computers and the Internet. Among them, Google Glass includes a small screen located in front of the right eye, a camera filming in front of the user and a small computing unit. Google Glass has the advantage to provide online services while allowing the user to perform tasks with his/her hands. These augmented glasses uncover many useful applications, also in the medical domain. For example, Google Glass can easily provide video conference between medical doctors to discuss a live case. Using these glasses can also facilitate medical information search by allowing the access of a large amount of annotated medical cases during a consultation in a non-disruptive fashion for medical staff. In this paper, we developed a Google Glass application able to take a photo and send it to a medical image retrieval system along with keywords in order to retrieve similar cases. As a preliminary assessment of the usability of the application, we tested the application under three conditions (images of the skin; printed CT scans and MRI images; and CT and MRI images acquired directly from an LCD screen) to explore whether using Google Glass affects the accuracy of the results returned by the medical image retrieval system. The preliminary results show that despite minor problems due to the relative stability of the Google Glass, images can be sent to and processed by the medical image retrieval system and similar images are returned to the user, potentially helping in the decision making process.