Assessment of artificial intelligence (AI) reporting methodology in glioma MRI studies using the Checklist for AI in Medical Imaging (CLAIM).

PURPOSE: The Checklist for Artificial Intelligence in Medical Imaging (CLAIM) is a recently released guideline designed for the optimal reporting methodology of artificial intelligence (AI) studies. Gliomas are the most common form of primary malignant brain tumour and numerous outcomes derived from AI algorithms such as grading, survival, treatment-related effects and molecular status have been reported. The aim of the study is to evaluate the AI reporting methodology for outcomes relating to gliomas in magnetic resonance imaging (MRI) using the CLAIM criteria. METHODS: A literature search was performed on three databases pertaining to AI augmentation of glioma MRI, published between the start of 2018 and the end of 2021 RESULTS: A total of 4308 articles were identified and 138 articles remained after screening. These articles were categorised into four main AI tasks: grading (n= 44), predicting molecular status (n= 50), predicting survival (n= 25) and distinguishing true tumour progression from treatment-related effects (n= 10). The average CLAIM score was 20/42 (range: 10-31). Studies most consistently reported the scientific background and clinical role of their AI approach. Areas of improvement were identified in the reporting of data collection, data management, ground truth and validation of AI performance. CONCLUSION: AI may be a means of producing high-accuracy results for certain tasks in glioma MRI; however, there remain issues with reporting quality. AI reporting guidelines may aid in a more reproducible and standardised approach to reporting and will aid in clinical integration.

Positioning for acute respiratory distress in hospitalised infants and children.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a significant cause of hospitalisation and death in young children. Positioning and mechanical ventilation have been regularly used to reduce respiratory distress and improve oxygenation in hospitalised patients. Due to the association of prone positioning (lying on the abdomen) with sudden infant death syndrome (SIDS) within the first six months, it is recommended that young infants be placed on their back (supine). However, prone positioning may be a non-invasive way of increasing oxygenation in individuals with acute respiratory distress, and offers a more significant survival advantage in those who are mechanically ventilated. There are substantial differences in respiratory mechanics between adults and infants. While the respiratory tract undergoes significant development within the first two years of life, differences in airway physiology between adults and children become less prominent by six to eight years old. However, there is a reduced risk of SIDS during artificial ventilation in hospitalised infants. Thus, an updated review focusing on positioning for infants and young children with ARDS is warranted. This is an update of a review published in 2005, 2009, and 2012. OBJECTIVES: To compare the effects of different body positions in hospitalised infants and children with acute respiratory distress syndrome aged between four weeks and 16 years. SEARCH METHODS: We searched CENTRAL, which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, and CINAHL from January 2004 to July 2021. SELECTION CRITERIA: Randomised controlled trials (RCTs) or quasi-RCTs comparing two or more positions for the management of infants and children hospitalised with ARDS. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from each study. We resolved differences by consensus, or referred to a third contributor to arbitrate. We analysed bivariate outcomes using an odds ratio (OR) and 95% confidence interval (CI). We analysed continuous outcomes using a mean difference (MD) and 95% CI. We used a fixed-effect model, unless heterogeneity was significant (I2 statistic > 50%), when we used a random-effects model. MAIN RESULTS: We included six trials: four cross-over trials, and two parallel randomised trials, with 198 participants aged between 4 weeks and 16 years, all but 15 of whom were mechanically ventilated. Four trials compared prone to supine positions. One trial compared the prone position to good-lung dependent (where the person lies on the side of the healthy lung, e.g. if the right lung was healthy, they were made to lie on the right side), and independent (or non-good-lung independent, where the person lies on the opposite side to the healthy lung, e.g. if the right lung was healthy, they were made to lie on the left side) position. One trial compared good-lung independent to good-lung dependent positions. When the prone (with ventilators) and supine positions were compared, there was no information on episodes of apnoea or mortality due to respiratory events. There was no conclusive result in oxygen saturation (SaO2; MD 0.40 mmHg, 95% CI -1.22 to 2.66; 1 trial, 30 participants; very low certainty evidence); blood gases, PCO2 (MD 3.0 mmHg, 95% CI -1.93 to 7.93; 1 trial, 99 participants; low certainty evidence), or PO2 (MD 2 mmHg, 95% CI -5.29 to 9.29; 1 trial, 99 participants; low certainty evidence); or lung function (PaO2/FiO2 ratio; MD 28.16 mmHg, 95% CI -9.92 to 66.24; 2 trials, 121 participants; very low certainty evidence). However, there was an improvement in oxygenation index (FiO2% X MPAW/ PaO2) with prone positioning in both the parallel trials (MD -2.42, 95% CI -3.60 to -1.25; 2 trials, 121 participants; very low certainty evidence), and the cross-over study (MD -8.13, 95% CI -15.01 to -1.25; 1 study, 20 participants). Derived indices of respiratory mechanics, such as tidal volume, respiratory rate, and positive end-expiratory pressure (PEEP) were reported. There was an apparent decrease in tidal volume between prone and supine groups in a parallel study (MD -0.60, 95% CI -1.05 to -0.15; 1 study, 84 participants; very low certainty evidence). When prone and supine positions were compared in a cross-over study, there were no conclusive results in respiratory compliance (MD 0.07, 95% CI -0.10 to 0.24; 1 study, 10 participants); changes in PEEP (MD -0.70 cm H2O, 95% CI -2.72 to 1.32; 1 study, 10 participants); or resistance (MD -0.00, 95% CI -0.05 to 0.04; 1 study, 10 participants). One study reported adverse events. There were no conclusive results for potential harm between groups in extubation (OR 0.57, 95% CI 0.13 to 2.54; 1 trial, 102 participants; very low certainty evidence); obstructions of the endotracheal tube (OR 5.20, 95% CI 0.24 to 111.09; 1 trial, 102 participants; very low certainty evidence); pressure ulcers (OR 1.00, 95% CI 0.41 to 2.44; 1 trial, 102 participants; very low certainty evidence); and hypercapnia (high levels of arterial carbon dioxide; OR 3.06, 95% CI 0.12 to 76.88; 1 trial, 102 participants; very low certainty evidence). One study (50 participants) compared supine positions to good-lung dependent and independent positions. There was no conclusive evidence that PaO2 was different between supine and good-lung dependent positioning (MD 3.44 mm Hg, 95% CI -23.12 to 30.00; 1 trial, 25 participants; very low certainty evidence). There was also no conclusive evidence for supine position and good-lung independent positioning (MD -2.78 mmHg, 95% CI -28.84, 23.28; 25 participants; very low certainty evidence); or between good-lung dependent and independent positioning (MD 6.22, 95% CI -21.25 to 33.69; 1 trial, 25 participants; very low certainty evidence). As most trials did not describe how possible biases were addressed, the potential for bias in these findings is unclear. AUTHORS' CONCLUSIONS: Although included studies suggest that prone positioning may offer some advantage, there was little evidence to make definitive recommendations. There appears to be low certainty evidence that positioning improves oxygenation in mechanically ventilated children with ARDS. Due to the increased risk of SIDS with prone positioning and lung injury with artificial ventilation, it is recommended that hospitalised infants and children should only be placed in this position while under continuous cardiorespiratory monitoring.

Machine learning imaging applications in the differentiation of true tumour progression from treatment-related effects in brain tumours: A systematic review and meta-analysis.

INTRODUCTION: Chemotherapy and radiotherapy can produce treatment-related effects, which may mimic tumour progression. Advances in Artificial Intelligence (AI) offer the potential to provide a more consistent approach of diagnosis with improved accuracy. The aim of this study was to determine the efficacy of machine learning models to differentiate treatment-related effects (TRE), consisting of pseudoprogression (PsP) and radiation necrosis (RN), and true tumour progression (TTP). METHODS: The systematic review was conducted in accordance with PRISMA-DTA guidelines. Searches were performed on PubMed, Scopus, Embase, Medline (Ovid) and ProQuest databases. Quality was assessed according to the PROBAST and CLAIM criteria. There were 25 original full-text journal articles eligible for inclusion. RESULTS: For gliomas: PsP versus TTP (16 studies, highest AUC = 0.98), RN versus TTP (4 studies, highest AUC = 0.9988) and TRE versus TTP (3 studies, highest AUC = 0.94). For metastasis: RN vs. TTP (2 studies, highest AUC = 0.81). A meta-analysis was performed on 9 studies in the gliomas PsP versus TTP group using STATA. The meta-analysis reported a high sensitivity of 95.2% (95%CI: 86.6-98.4%) and specificity of 82.4% (95%CI: 67.0-91.6%). CONCLUSION: TRE can be distinguished from TTP with good performance using machine learning-based imaging models. There remain issues with the quality of articles and the integration of models into clinical practice. Future studies should focus on the external validation of models and utilize standardized criteria such as CLAIM to allow for consistency in reporting.

Knowledge and attitudes towards artificial intelligence in imaging: a look at the quantitative survey literature.

RATIONALE AND OBJECTIVES: There exists many single sample perspectives on artificial intelligence (AI). The aim of this review was to collate the current data on attitudes/knowledge towards AI in three unique populations: medical students, clinicians and patients. MATERIALS AND METHODS: A literature search was performed on PubMed, Scopus and Web of Science pertaining to survey data on AI in radiology. Quality assessment was performed by an adapted version of the assessment tool from the National Heart, Lung and Blood Institute for Observational Studies. RESULTS: Fourteen studies were found on attitudes/knowledge towards AI in radiology. Four studies examined medical students, seven on clinicians and three on patient populations. Deficiencies in the literature mainly related to sampling bias. Students had anxiety relating to future job prospects. Clinicians were optimistic and viewed AI as an aid to the diagnosis and wanted to further their knowledge. Patients were concerned about the lack of human interaction and accountability during error. CONCLUSION: Attitudes and knowledge regarding AI in radiology remains a topic that needs to be researched further and education given pertaining to its use in a clinical setting.

The role of 2-hydroxyglutarate magnetic resonance spectroscopy for the determination of isocitrate dehydrogenase status in lower grade gliomas versus glioblastoma: a systematic review and meta-analysis of diagnostic test accuracy.

PURPOSE: Magnetic resonance spectroscopy (MRS) provides a non-invasive means of determining isocitrate dehydrogenase (IDH) status. Determination of 2-hydroxyglutarate (2-HG) presence through MRS is a means of determining IDH status; however, differences may be seen by grade. The goal of this paper is to perform a diagnostic test accuracy (DTA) meta-analysis on 2-HG MRS for IDH status in both lower-grade glioma (LGG) and glioblastoma (GBM) in preoperative patients. METHODS: A systematic review and meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Diagnostic Test Accuracy guidelines. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies 2. The search was up to date as of 09/02/2021. Nine English-language journal articles were included. RESULTS: The meta-analysis found a pooled sensitivity of 93% (95% CI 58-99%) and specificity of 84% (95% CI 51-96%) for LGG (n= 181). For GBM (n= 77), the pooled sensitivity was 84% (95% CI 25.0-99%) and the specificity was 97% (95% CI 43-100%). CONCLUSION: 2-HG MRS shows promise as a non-invasive means of determining IDH status, with specificity higher for GBM and sensitivity higher for LGG. The wide confidence intervals are notable, however, in particular related to the small number of IDH-mutant GBM studied. Diagnostic heterogeneity was particularly present for LGG, and the hierarchical summary receiver operator curves showed poor predictive accuracy in both groups. For more conclusive results, diagnostic test accuracy statistics need to be quantified with larger studies and more deliberate study design.

CT-based radiomics for differentiating renal tumours: a systematic review.

PURPOSE: Differentiating renal tumours into grades and tumour subtype from medical imaging is important for patient management; however, there is an element of subjectivity when performed qualitatively. Quantitative analysis such as radiomics may provide a more objective approach. The purpose of this article is to systematically review the literature on computed tomography (CT) radiomics for grading and differentiating renal tumour subtypes. An educational perspective will also be provided. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed. PubMed, Scopus and Web of Science were searched for relevant articles. The quality of each study was assessed using the Radiomic Quality Score (RQS). RESULTS: 13 studies were found. The main outcomes were prediction of pathological grade and differentiating between renal tumour types, measured as area under the curve (AUC) for either the receiver operator curve or precision recall curve. Features extracted to predict pathological grade or tumour subtype included shape, intensity, texture and wavelet (a type of higher order feature). Four studies differentiated between low-grade and high-grade clear cell renal cell cancer (RCC) with good performance (AUC = 0.82-0.978). One other study differentiated low- and high-grade chromophobe with AUC = 0.84. Finally, eight studies used radiomics to differentiate between tumour types such as clear cell RCC, fat-poor angiomyolipoma, papillary RCC, chromophobe RCC and renal oncocytoma with high levels of performance (AUC 0.82-0.96). CONCLUSION: Renal tumours can be pathologically classified using CT-based radiomics with good performance. The main radiomic feature used for tumour differentiation was texture. Fuhrman was the most common pathologic grading system used in the reviewed studies. Renal tumour grading studies should be extended beyond clear cell RCC and chromophobe RCC. Further research with larger prospective studies, performed in the clinical setting, across multiple institutions would help with clinical translation to the radiologist's workstation.

Convolutional neural networks for brain tumour segmentation.

The introduction of quantitative image analysis has given rise to fields such as radiomics which have been used to predict clinical sequelae. One growing area of interest for analysis is brain tumours, in particular glioblastoma multiforme (GBM). Tumour segmentation is an important step in the pipeline in the analysis of this pathology. Manual segmentation is often inconsistent as it varies between observers. Automated segmentation has been proposed to combat this issue. Methodologies such as convolutional neural networks (CNNs) which are machine learning pipelines modelled on the biological process of neurons (called nodes) and synapses (connections) have been of interest in the literature. We investigate the role of CNNs to segment brain tumours by firstly taking an educational look at CNNs and perform a literature search to determine an example pipeline for segmentation. We then investigate the future use of CNNs by exploring a novel field-radiomics. This examines quantitative features of brain tumours such as shape, texture, and signal intensity to predict clinical outcomes such as survival and response to therapy.

Psychological therapies for children and adolescents exposed to trauma.

BACKGROUND: Children and adolescents who have experienced trauma are at high risk of developing post-traumatic stress disorder (PTSD) and other negative emotional, behavioural and mental health outcomes, all of which are associated with high personal and health costs. A wide range of psychological treatments are used to prevent negative outcomes associated with trauma in children and adolescents. OBJECTIVES: To assess the effects of psychological therapies in preventing PTSD and associated negative emotional, behavioural and mental health outcomes in children and adolescents who have undergone a traumatic event. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Group's Specialised Register to 29 May 2015. This register contains reports of relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We also checked reference lists of relevant studies and reviews. We did not restrict the searches by date, language or publication status. SELECTION CRITERIA: All randomised controlled trials of psychological therapies compared with a control such as treatment as usual, waiting list or no treatment, pharmacological therapy or other treatments in children or adolescents who had undergone a traumatic event. DATA COLLECTION AND ANALYSIS: Two members of the review group independently extracted data. We calculated odds ratios for binary outcomes and standardised mean differences for continuous outcomes using a random-effects model. We analysed data as short-term (up to and including one month after therapy), medium-term (one month to one year after therapy) and long-term (one year or longer). MAIN RESULTS: Investigators included 6201 participants in the 51 included trials. Twenty studies included only children, two included only preschool children and ten only adolescents; all others included both children and adolescents. Participants were exposed to sexual abuse in 12 trials, to war or community violence in ten, to physical trauma and natural disaster in six each and to interpersonal violence in three; participants had suffered a life-threatening illness and had been physically abused or maltreated in one trial each. Participants in remaining trials were exposed to a range of traumas.Most trials compared a psychological therapy with a control such as treatment as usual, wait list or no treatment. Seventeen trials used cognitive-behavioural therapy (CBT); four used family therapy; three required debriefing; two trials each used eye movement desensitisation and reprocessing (EMDR), narrative therapy, psychoeducation and supportive therapy; and one trial each provided exposure and CBT plus narrative therapy. Eight trials compared CBT with supportive therapy, two compared CBT with EMDR and one trial each compared CBT with psychodynamic therapy, exposure plus supportive therapy with supportive therapy alone and narrative therapy plus CBT versus CBT alone. Four trials compared individual delivery of psychological therapy to a group model of the same therapy, and one compared CBT for children versus CBT for both mothers and children.The likelihood of being diagnosed with PTSD in children and adolescents who received a psychological therapy was significantly reduced compared to those who received no treatment, treatment as usual or were on a waiting list for up to a month following treatment (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.34 to 0.77; number needed to treat for an additional beneficial outcome (NNTB) 6.25, 95% CI 3.70 to 16.67; five studies; 874 participants). However the overall quality of evidence for the diagnosis of PTSD was rated as very low. PTSD symptoms were also significantly reduced for a month after therapy (standardised mean difference (SMD) -0.42, 95% CI -0.61 to -0.24; 15 studies; 2051 participants) and the quality of evidence was rated as low. These effects of psychological therapies were not apparent over the longer term.CBT was found to be no more or less effective than EMDR and supportive therapy in reducing diagnosis of PTSD in the short term (OR 0.74, 95% CI 0.29 to 1.91; 2 studies; 160 participants), however this was considered very low quality evidence. For reduction of PTSD symptoms in the short term, there was a small effect favouring CBT over EMDR, play therapy and supportive therapies (SMD -0.24, 95% CI -0.42 to -0.05; 7 studies; 466 participants). The quality of evidence for this outcome was rated as moderate.We did not identify any studies that compared pharmacological therapies with psychological therapies. AUTHORS' CONCLUSIONS: The meta-analyses in this review provide some evidence for the effectiveness of psychological therapies in prevention of PTSD and reduction of symptoms in children and adolescents exposed to trauma for up to a month. However, our confidence in these findings is limited by the quality of the included studies and by substantial heterogeneity between studies. Much more evidence is needed to demonstrate the relative effectiveness of different psychological therapies for children exposed to trauma, particularly over the longer term. High-quality studies should be conducted to compare these therapies.

A Systematic Review and Meta-Analysis of Circulating Biomarkers Associated with Failure of Arteriovenous Fistulae for Haemodialysis.

BACKGROUND: Arteriovenous fistula (AVF) failure is a significant cause of morbidity and expense in patients on maintenance haemodialysis (HD). Circulating biomarkers could be valuable in detecting patients at risk of AVF failure and may identify targets to improve AVF outcome. Currently there is little consensus on the relationship between circulating biomarkers and AVF failure. The aim of this systematic review was to identify circulating biomarkers associated with AVF failure. METHODS: Studies evaluating the association between circulating biomarkers and the presence or risk of AVF failure were systematically identified from the MEDLINE, EMBASE and Cochrane Library databases. No restrictions on the type of study were imposed. Concentrations of circulating biomarkers of routine HD patients with and without AVF failure were recorded and meta-analyses were performed on biomarkers that were assessed in three or more studies with a composite population of at least 100 participants. Biomarker concentrations were synthesized into inverse-variance random-effects models to calculate standardized mean differences (SMD) and 95% confidence intervals (CI). RESULTS: Thirteen studies comprising a combined population of 1512 participants were included after screening 2835 unique abstracts. These studies collectively investigated 48 biomarkers, predominantly circulating molecules which were assessed as part of routine clinical care. Meta-analysis was performed on twelve eligible biomarkers. No significant association between any of the assessed biomarkers and AVF failure was observed. CONCLUSION: This paper is the first systematic review of biomarkers associated with AVF failure. Our results suggest that blood markers currently assessed do not identify an at-risk AVF. Further, rigorously designed studies assessing biological plausible biomarkers are needed to clarify whether assessment of circulating markers can be of any clinical value. PROSPERO registration number CRD42016033845.

Positioning for acute respiratory distress in hospitalised infants and children.

BACKGROUND: Because of the association of prone positioning with sudden infant death syndrome (SIDS) it is recommended that young infants be placed on their backs (supine). However, the prone position may be a non-invasive way of increasing oxygenation in participants with acute respiratory distress. Because of substantial differences in respiratory mechanics between adults and children and the risk of SIDS in young infants, a specific review of positioning for infants and young children with acute respiratory distress is warranted. OBJECTIVES: To compare the effects of different body positions in hospitalised infants and children with acute respiratory distress. SEARCH METHODS: We searched Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 3), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to April week 1, 2012), EMBASE (2004 to April 2012) and CINAHL (2004 to April 2012). SELECTION CRITERIA: Randomised controlled trials (RCTs) or pseudo-RCTs comparing two or more positions in the management of infants and children hospitalised with acute respiratory distress. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from each study. We resolved differences by consensus or referral to a third review author. We analysed bivariate outcomes using an odds ratio and 95% confidence interval (CI). We analysed continuous outcomes using a mean difference and 95% CI. We used a fixed-effect model unless heterogeneity was significant, in which case we used a random-effects model. MAIN RESULTS: We extracted data from 53 studies. We included 24 studies with a total of 581 participants. Three studies used a parallel-group, randomised design which compared prone and supine positions only. The remaining 21 studies used a randomised cross-over design. These studies compared prone, supine, lateral, elevated and flat positions.Prone positioning was significantly more beneficial than supine positioning in terms of oxygen saturation (mean difference (MD) 1.97%, 95% CI 1.18 to 2.77), arterial oxygen (MD 6.24 mm Hg, 95% confidence interval (CI) 2.20 to 10.28), episodes of hypoxaemia (MD -3.46, 95% CI -4.60 to -2.33) and thoracoabdominal synchrony (MD -30.76, 95% CI -41.39 to -20.14). No adverse effects were identified. There were no statistically significant differences between any other positions.As the majority of studies did not describe how possible biases were addressed, the potential for bias in these findings is unclear. AUTHORS' CONCLUSIONS: The prone position was significantly superior to the supine position in terms of oxygenation. However, as most participants were ventilated preterm infants, the benefits of prone positioning may be most relevant to these infants. In addition, although placing infants and children in the prone position may improve respiratory function, the association of SIDS with prone positioning means that infants should only be placed in this position while under continuous cardiorespiratory monitoring.