Vertebral HU value and the pectoral muscle index based on chest CT can be used to opportunistically screen for osteoporosis.

BACKGROUND: Existing studies have shown that computed tomography (CT) attenuation and skeletal muscle tissue are strongly associated with osteoporosis; however, few studies have examined whether vertebral HU values and the pectoral muscle index (PMI) measured at the level of the 4th thoracic vertebra (T4) are strongly associated with bone mineral density (BMD). In this study, we demonstrate that vertebral HU values and the PMI based on chest CT can be used to opportunistically screen for osteoporosis and reduce fracture risk through prompt treatment. METHODS: We retrospectively evaluated 1000 patients who underwent chest CT and DXA scans from August 2020-2022. The T4 HU value and PMI were obtained using manual chest CT measurements. The participants were classified into normal, osteopenia, and osteoporosis groups based on the results of dual-energy X-ray (DXA) absorptiometry. We compared the clinical baseline data, T4 HU value, and PMI between the three groups of patients and analyzed the correlation between the T4 HU value, PMI, and BMD to further evaluate the diagnostic efficacy of the T4 HU value and PMI for patients with low BMD and osteoporosis. RESULTS: The study ultimately enrolled 469 participants. The T4 HU value and PMI had a high screening capacity for both low BMD and osteoporosis. The combined diagnostic model-incorporating sex, age, BMI, T4 HU value, and PMI-demonstrated the best diagnostic efficacy, with areas under the receiver operating characteristic curve (AUC) of 0.887 and 0.892 for identifying low BMD and osteoporosis, respectively. CONCLUSIONS: The measurement of T4 HU value and PMI on chest CT can be used as an opportunistic screening tool for osteoporosis with excellent diagnostic efficacy. This approach allows the early prevention of osteoporotic fractures via the timely screening of individuals at high risk of osteoporosis without requiring additional radiation.

Quantitative analysis of lung lesions using unenhanced chest computed tomography images.

INTRODUCTION: Chest radiograph and computed tomography (CT) scans can accidentally reveal pulmonary nodules. Malignant and benign pulmonary nodules can be difficult to distinguish without specific imaging features, such as calcification, necrosis, and contrast enhancement. However, these lesions may exhibit different image texture characteristics which cannot be assessed visually. Thus, a computer-assisted quantitative method like histogram analysis (HA) of Hounsfield unit (HU) values can improve diagnostic accuracy, reducing the need for invasive biopsy. METHODS: In this exploratory control study, nonenhanced chest CT images of 20 patients with benign (10) and cancerous (10) lesion were selected retrospectively. The appearances of benign and malignant lesions were very similar in chest CT images, and only pathology report was used to discriminate them. Free hand region of interest (ROI) was inserted inside the lesion for all slices of each lesion. Mean, minimum, maximum, and standard deviations of HU values were recorded and used to make HA. RESULTS: HA showed that the most malignant lesions have a mean HU value between 30 and 50, a maximum HU less than 150, and a minimum HU between -30 and 20. Lesions outside these ranges were mostly benign. CONCLUSION: Quantitative CT analysis may differentiate malignant from benign lesions without specific malignancy patterns on unenhanced chest CT image.

Student Observations Reveal Gaps Between Chest Imaging Theory and Practice.

PURPOSE: To assess whether first-year radiography students observed differences between what they were taught in didactic and laboratory courses and how technologists perform chest imaging procedures during clinical experiences. METHODS: This study used a mixed-methods approach with a cross-sectional survey, consisting of 11 quantitative and 11 qualitative items, during the fall 2020 semester. The survey asked participants to evaluate survey statements based on their observations of radiographers' behaviors during chest imaging procedures in relation to the 11 American Registry of Radiologic Technologist clinical competency areas. Participants rated their evaluations based on the degree to which they agreed or disagreed with statements regarding radiographers' behaviors using a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). For each statement, a follow-up, open-ended question asked participants to provide reasons why they thought technologists did or did not exhibit certain behaviors. Data were analyzed quantitatively with differential statistics and qualitatively by thematically categorizing open-ended responses. RESULTS: A total of 19 first-year radiography students (N = 19) completed the survey. Most participants somewhat agreed or strongly agreed with 8 out of the 11 competency statements based on their observations of technologists when performing chest imaging procedures: room preparation (73.7%), patient identity verification (89.5%), examination order verification (79%), patient assessment (79%), equipment operation (52.6%), patient management (100%), technique selection (73.6%), and image evaluation (94.7%). Most participants somewhat disagreed, strongly disagreed, or were neutral with 3 out of the 11 categories: patient positioning, radiation safety, and image processing. Qualitatively, participants responded that technologists only provided lead shielding for pediatric patients, were not instructing patients to take 2 inspirations before making an exposure, and were cropping their images electronically before submitting them for diagnoses. DISCUSSION: Participants reported inconsistencies between what they were taught and what they saw technologists doing during chest imaging procedures related to patient positioning, radiation safety, and imaging processing. Participants' responses stated that these inconsistencies might be because of an increase in technologist responsibilities, patient volumes, and fear of not including relative anatomy on their images. CONCLUSION: Participants reported the most disagreement with radiation safety during chest imaging procedures. Although lead shielding for abdominal and pelvic procedures is no longer recommended, shielding patients during chest imaging procedures is still recommended. Radiography programs can educate students that inconsistency between task order does not mean there is a gap between theory and practice.

BarlowTwins-CXR: enhancing chest X-ray abnormality localization in heterogeneous data with cross-domain self-supervised learning.

BACKGROUND: Chest X-ray imaging based abnormality localization, essential in diagnosing various diseases, faces significant clinical challenges due to complex interpretations and the growing workload of radiologists. While recent advances in deep learning offer promising solutions, there is still a critical issue of domain inconsistency in cross-domain transfer learning, which hampers the efficiency and accuracy of diagnostic processes. This study aims to address the domain inconsistency problem and improve autonomic abnormality localization performance of heterogeneous chest X-ray image analysis, particularly in detecting abnormalities, by developing a self-supervised learning strategy called "BarlwoTwins-CXR". METHODS: We utilized two publicly available datasets: the NIH Chest X-ray Dataset and the VinDr-CXR. The BarlowTwins-CXR approach was conducted in a two-stage training process. Initially, self-supervised pre-training was performed using an adjusted Barlow Twins algorithm on the NIH dataset with a Resnet50 backbone pre-trained on ImageNet. This was followed by supervised fine-tuning on the VinDr-CXR dataset using Faster R-CNN with Feature Pyramid Network (FPN). The study employed mean Average Precision (mAP) at an Intersection over Union (IoU) of 50% and Area Under the Curve (AUC) for performance evaluation. RESULTS: Our experiments showed a significant improvement in model performance with BarlowTwins-CXR. The approach achieved a 3% increase in mAP50 accuracy compared to traditional ImageNet pre-trained models. In addition, the Ablation CAM method revealed enhanced precision in localizing chest abnormalities. The study involved 112,120 images from the NIH dataset and 18,000 images from the VinDr-CXR dataset, indicating robust training and testing samples. CONCLUSION: BarlowTwins-CXR significantly enhances the efficiency and accuracy of chest X-ray image-based abnormality localization, outperforming traditional transfer learning methods and effectively overcoming domain inconsistency in cross-domain scenarios. Our experiment results demonstrate the potential of using self-supervised learning to improve the generalizability of models in medical settings with limited amounts of heterogeneous data. This approach can be instrumental in aiding radiologists, particularly in high-workload environments, offering a promising direction for future AI-driven healthcare solutions.

Chest Intensive Care Unit Imaging: Pearls and Pitfalls.

Imaging plays a major role in the care of the intensive care unit (ICU) patients. An understanding of the monitoring devices is essential for the interpretation of imaging studies. An awareness of their expected locations aids in identifying complications in a timely manner. This review describes the imaging of ICU monitoring and support catheters, tubes, and pulmonary and cardiac devices, some more commonly encountered and others that have been introduced into clinical patient care more recently. Special focus will be placed on chest radiography and potential pitfalls encountered.

Pulmonary Infection.

Pneumonia is a significant cause of morbidity and mortality in the community and hospital settings. Bacterial, viral, mycobacterial, and fungal pathogens are all potential causative agents of pulmonary infection. Chest radiographs and computed tomography are frequently utilized in the assessment of pneumonia. Learning the imaging patterns of different potential organisms allows the radiologist to formulate an appropriate differential diagnosis. An organism-based approach is used to discuss the imaging findings of different etiologies of pulmonary infection.

Diagnostic performance of chest CT average intensity projection (AIP) reconstruction for the assessment of pleuro-parenchymal abnormalities.

AIM: The comparison between chest x-ray (CXR) and computed tomography (CT) images is commonly required in clinical practice to assess the evolution of chest pathological manifestations. Intrinsic differences between the two techniques, however, limit reader confidence in such a comparison. CT average intensity projection (AIP) reconstruction allows obtaining "synthetic" CXR (s-CXR) images, which are thought to have the potential to increase the accuracy of comparison between CXR and CT imaging. We aim at assessing the diagnostic performance of s-CXR imaging in detecting common pleuro-parenchymal abnormalities. MATERIALS AND METHODS: 142 patients who underwent chest CT examination and CXR within 24 hours were enrolled. CT was the standard of reference. Both conventional CXR (c-CXR) and s-CXR images were retrospectively reviewed for the presence of consolidation, nodule/mass, linear opacities, reticular opacities, and pleural effusion by 3 readers in two separate sessions. Sensitivity, specificity, accuracy and their 95% confidence interval were calculated for each reader and setting and tested by McNemar test. Inter-observer agreement was tested by Cohen's K test and its 95%CI. RESULTS: Overall, s-CXR sensitivity ranged 45-67% for consolidation, 12-28% for nodule/mass, 17-33% for linear opacities, 2-61% for reticular opacities, and 33-58% for pleural effusion; specificity 65-83%, 83-94%, 94-98%, 93-100% and 79-86%; accuracy 66-68%, 74-79%, 89-91%, 61-65% and 68-72%, respectively. K values ranged 0.38-0.50, 0.05-0.25, -0.05-0.11, -0.01-0.15, and 0.40-0.66 for consolidation, nodule/mass, linear opacities, reticular opacities, and pleural effusion, respectively. CONCLUSION: S-CXR images, reconstructed with AIP technique, can be compared with conventional images in clinical practice and for educational purposes.

A multistage framework for respiratory disease detection and assessing severity in chest X-ray images.

Chest Radiography is a non-invasive imaging modality for diagnosing and managing chronic lung disorders, encompassing conditions such as pneumonia, tuberculosis, and COVID-19. While it is crucial for disease localization and severity assessment, existing computer-aided diagnosis (CAD) systems primarily focus on classification tasks, often overlooking these aspects. Additionally, prevalent approaches rely on class activation or saliency maps, providing only a rough localization. This research endeavors to address these limitations by proposing a comprehensive multi-stage framework. Initially, the framework identifies relevant lung areas by filtering out extraneous regions. Subsequently, an advanced fuzzy-based ensemble approach is employed to categorize images into specific classes. In the final stage, the framework identifies infected areas and quantifies the extent of infection in COVID-19 cases, assigning severity scores ranging from 0 to 3 based on the infection's severity. Specifically, COVID-19 images are classified into distinct severity levels, such as mild, moderate, severe, and critical, determined by the modified RALE scoring system. The study utilizes publicly available datasets, surpassing previous state-of-the-art works. Incorporating lung segmentation into the proposed ensemble-based classification approach enhances the overall classification process. This solution can be a valuable alternative for clinicians and radiologists, serving as a secondary reader for chest X-rays, reducing reporting turnaround times, aiding clinical decision-making, and alleviating the workload on hospital staff.

Labelling with dynamics: A data-efficient learning paradigm for medical image segmentation.

The success of deep learning on image classification and recognition tasks has led to new applications in diverse contexts, including the field of medical imaging. However, two properties of deep neural networks (DNNs) may limit their future use in medical applications. The first is that DNNs require a large amount of labeled training data, and the second is that the deep learning-based models lack interpretability. In this paper, we propose and investigate a data-efficient framework for the task of general medical image segmentation. We address the two aforementioned challenges by introducing domain knowledge in the form of a strong prior into a deep learning framework. This prior is expressed by a customized dynamical system. We performed experiments on two different datasets, namely JSRT and ISIC2016 (heart and lungs segmentation on chest X-ray images and skin lesion segmentation on dermoscopy images). We have achieved competitive results using the same amount of training data compared to the state-of-the-art methods. More importantly, we demonstrate that our framework is extremely data-efficient, and it can achieve reliable results using extremely limited training data. Furthermore, the proposed method is rotationally invariant and insensitive to initialization.

Which is a real valuable screening tool for lung cancer and measure thoracic diseases, chest radiography or low-dose computed tomography?: A review on the current status of Japan and other countries.

Chest radiography (CR) has been used as a screening tool for lung cancer and the use of low-dose computed tomography (LDCT) is not recommended in Japan. We need to reconsider whether CR really contributes to the early detection of lung cancer. In addition, we have not well discussed about other major thoracic disease detection by CR and LDCT compared with lung cancer despite of its high frequency. We review the usefulness of CR and LDCT as veridical screening tools for lung cancer and other thoracic diseases. In the case of lung cancer, many studies showed that LDCT has capability of early detection and improving outcomes compared with CR. Recent large randomized trial also supports former results. In the case of chronic obstructive pulmonary disease (COPD), LDCT contributes to early detection and leads to the implementation of smoking cessation treatments. In the case of pulmonary infections, LDCT can reveal tiny inflammatory changes that are not observed on CR, though many of these cases improve spontaneously. Therefore, LDCT screening for pulmonary infections may be less useful. CR screening is more suitable for the detection of pulmonary infections. In the case of cardiovascular disease (CVD), CR may be a better screening tool for detecting cardiomegaly, whereas LDCT may be a more useful tool for detecting vascular changes. Therefore, the current status of thoracic disease screening is that LDCT may be a better screening tool for detecting lung cancer, COPD, and vascular changes. CR may be a suitable screening tool for pulmonary infections and cardiomegaly.

Influence of deep learning image reconstruction algorithm for reducing radiation dose and image noise compared to iterative reconstruction and filtered back projection for head and chest computed tomography examinations: a systematic review.

Background: The most recent advances in Computed Tomography (CT) image reconstruction technology are Deep learning image reconstruction (DLIR) algorithms. Due to drawbacks in Iterative reconstruction (IR) techniques such as negative image texture and nonlinear spatial resolutions, DLIRs are gradually replacing them. However, the potential use of DLIR in Head and Chest CT has to be examined further. Hence, the purpose of the study is to review the influence of DLIR on Radiation dose (RD), Image noise (IN), and outcomes of the studies compared with IR and FBP in Head and Chest CT examinations. Methods: We performed a detailed search in PubMed, Scopus, Web of Science, Cochrane Library, and Embase to find the articles reported using DLIR for Head and Chest CT examinations between 2017 to 2023. Data were retrieved from the short-listed studies using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Results: Out of 196 articles searched, 15 articles were included. A total of 1292 sample size was included. 14 articles were rated as high and 1 article as moderate quality. All studies compared DLIR to IR techniques. 5 studies compared DLIR with IR and FBP. The review showed that DLIR improved IQ, and reduced RD and IN for CT Head and Chest examinations. Conclusions: DLIR algorithm have demonstrated a noted enhancement in IQ with reduced IN for CT Head and Chest examinations at lower dose compared with IR and FBP. DLIR showed potential for enhancing patient care by reducing radiation risks and increasing diagnostic accuracy.

CheXmask: a large-scale dataset of anatomical segmentation masks for multi-center chest x-ray images.

The development of successful artificial intelligence models for chest X-ray analysis relies on large, diverse datasets with high-quality annotations. While several databases of chest X-ray images have been released, most include disease diagnosis labels but lack detailed pixel-level anatomical segmentation labels. To address this gap, we introduce an extensive chest X-ray multi-center segmentation dataset with uniform and fine-grain anatomical annotations for images coming from five well-known publicly available databases: ChestX-ray8, CheXpert, MIMIC-CXR-JPG, Padchest, and VinDr-CXR, resulting in 657,566 segmentation masks. Our methodology utilizes the HybridGNet model to ensure consistent and high-quality segmentations across all datasets. Rigorous validation, including expert physician evaluation and automatic quality control, was conducted to validate the resulting masks. Additionally, we provide individualized quality indices per mask and an overall quality estimation per dataset. This dataset serves as a valuable resource for the broader scientific community, streamlining the development and assessment of innovative methodologies in chest X-ray analysis.

Chest Radiograph Screening for Detecting Subclinical Tuberculosis in Asymptomatic Household Contacts, Peru.

The World Health Organization's end TB strategy promotes the use of symptom and chest radiograph screening for tuberculosis (TB) disease. However, asymptomatic early states of TB beyond latent TB infection and active disease can go unrecognized using current screening criteria. We conducted a longitudinal cohort study enrolling household contacts initially free of TB disease and followed them for the occurrence of incident TB over 1 year. Among 1,747 screened contacts, 27 (52%) of the 52 persons in whom TB subsequently developed during follow-up had a baseline abnormal radiograph. Of contacts without TB symptoms, persons with an abnormal radiograph were at higher risk for subsequent TB than persons with an unremarkable radiograph (adjusted hazard ratio 15.62 [95% CI 7.74-31.54]). In young adults, we found a strong linear relationship between radiograph severity and time to TB diagnosis. Our findings suggest chest radiograph screening can extend to detecting early TB states, thereby enabling timely intervention.

Relationship between interleukin-6 (IL-6) levels and chest X-ray severity scoring in COVID-19 patients.

The severity of coronavirus disease 2019 (COVID-19) may be measured by interleukin-6 (IL-6) and chest X-rays. Brixia score of the chest radiographs is usually used to monitor COVID-19 patients' lung problems. The aim of this study was to demonstrate the relationship between IL-6 levels and chest radiographs (Brixia score) that represent COVID-19 severity. A retrospective cohort study was conducted among COVID-19 patients who had a chest X-ray and examination of IL-6 levels at H. Adam Malik General Hospital, Medan, Indonesia. A multinomial logistic regression analysis was conducted to evaluate the association between IL-6 levels and the severity of the chest radiograph. A total of 76 COVID-19 patients were included in the study and 39.5% of them were 60-69 years old, with more than half were female (52.6%). A total of 17.1%, 48.7%, and 34.2% had IL-6 level of <7 pg/mL, 7-50 pg/mL and >50 pg/mL, respectively. There were 39.5%, 36.8% and 23.7% of the patients had mild, moderate and severe chest X-rays based on Brixia score, respectively. Statistics analysis revealed that moderate (OR: 1.77; 95% CI: 1.05- 3.32) and severe (OR: 1.33; 95% CI: 1.03-3.35) lung conditions in the chest X-rays were significantly associated with IL-6 levels of 7-50 pg/mL. IL-6 more than 50 pg/mL was associated with severe chest X-ray condition (OR: 1.97; 95% CI: 1.15-3.34). In conclusion, high IL-6 levels significantly reflected COVID-19 severity through chest X-rays in COVID-19 patients.

Weakly-supervised preclinical tumor localization associated with survival prediction from lung cancer screening Chest X-ray images.

In this paper, we hypothesize that it is possible to localize image regions of preclinical tumors in a Chest X-ray (CXR) image by a weakly-supervised training of a survival prediction model using a dataset containing CXR images of healthy patients and their time-to-death label. These visual explanations can empower clinicians in early lung cancer detection and increase patient awareness of their susceptibility to the disease. To test this hypothesis, we train a censor-aware multi-class survival prediction deep learning classifier that is robust to imbalanced training, where classes represent quantized number of days for time-to-death prediction. Such multi-class model allows us to use post-hoc interpretability methods, such as Grad-CAM, to localize image regions of preclinical tumors. For the experiments, we propose a new benchmark based on the National Lung Cancer Screening Trial (NLST) dataset to test weakly-supervised preclinical tumor localization and survival prediction models, and results suggest that our proposed method shows state-of-the-art C-index survival prediction and weakly-supervised preclinical tumor localization results. To our knowledge, this constitutes a pioneer approach in the field that is able to produce visual explanations of preclinical events associated with survival prediction results.

Chest Radiograph Interpretation: Online Teaching Resources for Non-Radiologists.

Chest radiographs provide vital information to clinicians. Medical professionals need to be proficient in interpreting chest radiographs to care for patients. This review examines online methods for teaching chest radiograph interpretation to non-radiologists. An online database search of PubMed and the Cochrane Databases of Systematic Reviews revealed 25 potential evidence sources. After using the similar articles tool on PubMed, eight evidence sources met the inclusion criteria. Three sources supported the use of online learning to increase students' confidence regarding chest radiograph interpretation. The evidence suggests that through self-directed online learning, students can learn skills to diagnose disease processes as well as to confirm the placement of invasive lines and tubes. Using online learning for teaching radiograph interpretation to non-radiologists is an evolving practice. A flexible schedule is needed when implementing the electronic learning process for busy students. Monitoring module completion and postlearning assessment of knowledge is important. Further research is warranted on electronic teaching of chest radiograph interpretation in nurse anesthesia programs. A list of potential online resources for teaching chest radiograph interpretation is presented.

Automated thorax disease diagnosis using multi-branch residual attention network.

Chest X-ray (CXR) is an extensively utilized radiological modality for supporting the diagnosis of chest diseases. However, existing research approaches suffer from limitations in effectively integrating multi-scale CXR image features and are also hindered by imbalanced datasets. Therefore, there is a pressing need for further advancement in computer-aided diagnosis (CAD) of thoracic diseases. To tackle these challenges, we propose a multi-branch residual attention network (MBRANet) for thoracic disease diagnosis. MBRANet comprises three components. Firstly, to address the issue of inadequate extraction of spatial and positional information by the convolutional layer, a novel residual structure incorporating a coordinate attention (CA) module is proposed to extract features at multiple scales. Next, based on the concept of a Feature Pyramid Network (FPN), we perform multi-scale feature fusion in the following manner. Thirdly, we propose a novel Multi-Branch Feature Classifier (MFC) approach, which leverages the class-specific residual attention (CSRA) module for classification instead of relying solely on the fully connected layer. In addition, the designed BCEWithLabelSmoothing loss function improves the generalization ability and mitigates the problem of class imbalance by introducing a smoothing factor. We evaluated MBRANet on the ChestX-Ray14, CheXpert, MIMIC-CXR, and IU X-Ray datasets and achieved average AUCs of 0.841, 0.895, 0.805, and 0.745, respectively. Our method outperformed state-of-the-art baselines on these benchmark datasets.