A Guideline for Open-Source Tools to Make Medical Imaging Data Ready for Artificial Intelligence Applications: A Society of Imaging Informatics in Medicine (SIIM) Survey.

In recent years, the role of Artificial Intelligence (AI) in medical imaging has become increasingly prominent, with the majority of AI applications approved by the FDA being in imaging and radiology in 2023. The surge in AI model development to tackle clinical challenges underscores the necessity for preparing high-quality medical imaging data. Proper data preparation is crucial as it fosters the creation of standardized and reproducible AI models while minimizing biases. Data curation transforms raw data into a valuable, organized, and dependable resource and is a fundamental process to the success of machine learning and analytical projects. Considering the plethora of available tools for data curation in different stages, it is crucial to stay informed about the most relevant tools within specific research areas. In the current work, we propose a descriptive outline for different steps of data curation while we furnish compilations of tools collected from a survey applied among members of the Society of Imaging Informatics (SIIM) for each of these stages. This collection has the potential to enhance the decision-making process for researchers as they select the most appropriate tool for their specific tasks.

Utility of skin tone on pulse oximetry in critically ill patients: a prospective cohort study.

Importance: Pulse oximetry, a ubiquitous vital sign in modern medicine, has inequitable accuracy that disproportionately affects Black and Hispanic patients, with associated increases in mortality, organ dysfunction, and oxygen therapy. Although the root cause of these clinical performance discrepancies is believed to be skin tone, previous retrospective studies used self-reported race or ethnicity as a surrogate for skin tone. Objective: To determine the utility of objectively measured skin tone in explaining pulse oximetry discrepancies. Design Setting and Participants: Admitted hospital patients at Duke University Hospital were eligible for this prospective cohort study if they had pulse oximetry recorded up to 5 minutes prior to arterial blood gas (ABG) measurements. Skin tone was measured across sixteen body locations using administered visual scales (Fitzpatrick Skin Type, Monk Skin Tone, and Von Luschan), reflectance colorimetry (Delfin SkinColorCatch [L*, individual typology angle {ITA}, Melanin Index {MI}]), and reflectance spectrophotometry (Konica Minolta CM-700D [L*], Variable Spectro 1 [L*]). Main Outcomes and Measures: Mean directional bias, variability of bias, and accuracy root mean square (ARMS), comparing pulse oximetry and ABG measurements. Linear mixed-effects models were fitted to estimate mean directional bias while accounting for clinical confounders. Results: 128 patients (57 Black, 56 White) with 521 ABG-pulse oximetry pairs were recruited, none with hidden hypoxemia. Skin tone data was prospectively collected using 6 measurement methods, generating 8 measurements. The collected skin tone measurements were shown to yield differences among each other and overlap with self-reported racial groups, suggesting that skin tone could potentially provide information beyond self-reported race. Among the eight skin tone measurements in this study, and compared to self-reported race, the Monk Scale had the best relationship with differences in pulse oximetry bias (point estimate: -2.40%; 95% CI: -4.32%, -0.48%; p=0.01) when comparing patients with lighter and dark skin tones. Conclusions and relevance: We found clinical performance differences in pulse oximetry, especially in darker skin tones. Additional studies are needed to determine the relative contributions of skin tone measures and other potential factors on pulse oximetry discrepancies.

Identifying and improving the "ground truth" of race in disparities research through improved EMR data reporting. A systematic review.

BACKGROUND: Studies about racial disparities in healthcare are increasing in quantity; however, they are subject to vast differences in definition, classification, and utilization of race/ethnicity data. Improved standardization of this information can strengthen conclusions drawn from studies using such data. The objective of this study is to examine how data related to race/ethnicity are recorded in research through examining articles on race/ethnicity health disparities and examine problems and solutions in data reporting that may impact overall data quality. METHODS: In this systematic review, Business Source Complete, Embase.com, IEEE Xplore, PubMed, Scopus and Web of Science Core Collection were searched for relevant articles published from 2000 to 2020. Search terms related to the concepts of electronic medical records, race/ethnicity, and data entry related to race/ethnicity were used. Exclusion criteria included articles not in the English language and those describing pediatric populations. Data were extracted from published articles. This review was organized and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement for systematic reviews. FINDINGS: In this systematic review, 109 full text articles were reviewed. Weaknesses and possible solutions have been discussed in current literature, with the predominant problem and solution as follows: the electronic medical record (EMR) is vulnerable to inaccuracies and incompleteness in the methods that research staff collect this data; however, improved standardization of the collection and use of race data in patient care may help alleviate these inaccuracies. INTERPRETATION: Conclusions drawn from large datasets concerning peoples of certain race/ethnic groups should be made cautiously, and a careful review of the methodology of each publication should be considered prior to implementation in patient care.

Efficient adversarial debiasing with concept activation vector - Medical image case-studies.

BACKGROUND: A major hurdle for the real time deployment of the AI models is ensuring trustworthiness of these models for the unseen population. More often than not, these complex models are black boxes in which promising results are generated. However, when scrutinized, these models begin to reveal implicit biases during the decision making, particularly for the minority subgroups. METHOD: We develop an efficient adversarial de-biasing approach with partial learning by incorporating the existing concept activation vectors (CAV) methodology, to reduce racial disparities while preserving the performance of the targeted task. CAV is originally a model interpretability technique which we adopted to identify convolution layers responsible for learning race and only fine-tune up to that layer instead of fine-tuning the complete network, limiting the drop in performance RESULTS:: The methodology has been evaluated on two independent medical image case-studies - chest X-ray and mammograms, and we also performed external validation on a different racial population. On the external datasets for the chest X-ray use-case, debiased models (averaged AUC 0.87 ) outperformed the baseline convolution models (averaged AUC 0.57 ) as well as the models trained with the popular fine-tuning strategy (averaged AUC 0.81). Moreover, the mammogram models is debiased using a single dataset (white, black and Asian) and improved the performance on an external datasets (averaged AUC 0.8 to 0.86 ) with completely different population (primarily Hispanic patients). CONCLUSION: In this study, we demonstrated that the adversarial models trained only with internal data performed equally or often outperformed the standard fine-tuning strategy with data from an external setting. The adversarial training approach described can be applied regardless of predictor's model architecture, as long as the convolution model is trained using a gradient-based method. We release the training code with academic open-source license - https://github.com/ramon349/JBI2023_TCAV_debiasing.

Enabling chronic obstructive pulmonary disease diagnosis through chest X-rays: A multi-site and multi-modality study.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic illnesses in the world. Unfortunately, COPD is often difficult to diagnose early when interventions can alter the disease course, and it is underdiagnosed or only diagnosed too late for effective treatment. Currently, spirometry is the gold standard for diagnosing COPD but it can be challenging to obtain, especially in resource-poor countries. Chest X-rays (CXRs), however, are readily available and may have the potential as a screening tool to identify patients with COPD who should undergo further testing or intervention. In this study, we used three CXR datasets alongside their respective electronic health records (EHR) to develop and externally validate our models. METHOD: To leverage the performance of convolutional neural network models, we proposed two fusion schemes: (1) model-level fusion, using Bootstrap aggregating to aggregate predictions from two models, (2) data-level fusion, using CXR image data from different institutions or multi-modal data, CXR image data, and EHR data for model training. Fairness analysis was then performed to evaluate the models across different demographic groups. RESULTS: Our results demonstrate that DL models can detect COPD using CXRs with an area under the curve of over 0.75, which could facilitate patient screening for COPD, especially in low-resource regions where CXRs are more accessible than spirometry. CONCLUSIONS: By using a ubiquitous test, future research could build on this work to detect COPD in patients early who would not otherwise have been diagnosed or treated, altering the course of this highly morbid disease.

Decoding radiology reports: Potential application of OpenAI ChatGPT to enhance patient understanding of diagnostic reports.

PURPOSE: To evaluate the complexity of diagnostic radiology reports across major imaging modalities and the ability of ChatGPT (Early March 2023 Version, OpenAI, California, USA) to simplify these reports to the 8th grade reading level of the average U.S. adult. METHODS: We randomly sampled 100 radiographs (XR), 100 ultrasound (US), 100 CT, and 100 MRI radiology reports from our institution's database dated between 2022 and 2023 (N = 400). These were processed by ChatGPT using the prompt "Explain this radiology report to a patient in layman's terms in second person: ". Mean report length, Flesch reading ease score (FRES), and Flesch-Kincaid reading level (FKRL) were calculated for each report and ChatGPT output. T-tests were used to determine significance. RESULTS: Mean report length was 164 ± 117 words, FRES was 38.0 ± 11.8, and FKRL was 10.4 ± 1.9. FKRL was significantly higher for CT and MRI than for US and XR. Only 60/400 (15%) had a FKRL <8.5. The mean simplified ChatGPT output length was 103 ± 36 words, FRES was 83.5 ± 5.6, and FKRL was 5.8 ± 1.1. This reflects a mean decrease of 61 words (p < 0.01), increase in FRES of 45.5 (p < 0.01), and decrease in FKRL of 4.6 (p < 0.01). All simplified outputs had FKRL <8.5. DISCUSSION: Our study demonstrates the effective use of ChatGPT when tasked with simplifying radiology reports to below the 8th grade reading level. We report significant improvements in FRES, FKRL, and word count, the last of which requires modality-specific context.

Structural under-reporting of informed consent, data handling and sharing, ethical approval, and application of Open Science principles as proxies for study quality conduct in COVID-19 research: a systematic scoping review.

BACKGROUND: The COVID-19 pandemic required science to provide answers rapidly to combat the outbreak. Hence, the reproducibility and quality of conducting research may have been threatened, particularly regarding privacy and data protection, in varying ways around the globe. The objective was to investigate aspects of reporting informed consent and data handling as proxies for study quality conduct. METHODS: A systematic scoping review was performed by searching PubMed and Embase. The search was performed on November 8th, 2020. Studies with hospitalised patients diagnosed with COVID-19 over 18 years old were eligible for inclusion. With a focus on informed consent, data were extracted on the study design, prestudy protocol registration, ethical approval, data anonymisation, data sharing and data transfer as proxies for study quality. For reasons of comparison, data regarding country income level, study location and journal impact factor were also collected. RESULTS: 972 studies were included. 21.3% of studies reported informed consent, 42.6% reported waivers of consent, 31.4% did not report consent information and 4.7% mentioned other types of consent. Informed consent reporting was highest in clinical trials (94.6%) and lowest in retrospective cohort studies (15.0%). The reporting of consent versus no consent did not differ significantly by journal impact factor (p=0.159). 16.8% of studies reported a prestudy protocol registration or design. Ethical approval was described in 90.9% of studies. Information on anonymisation was provided in 17.0% of studies. In 257 multicentre studies, 1.2% reported on data sharing agreements, and none reported on Findable, Accessible, Interoperable and Reusable data principles. 1.2% reported on open data. Consent was most often reported in the Middle East (42.4%) and least often in North America (4.7%). Only one report originated from a low-income country. DISCUSSION: Informed consent and aspects of data handling and sharing were under-reported in publications concerning COVID-19 and differed between countries, which strains study quality conduct when in dire need of answers.

Special Section Guest Editorial: Global Health, Bias, and Diversity in AI in Medical Imaging.

The editorial comments on the JMI Special Section on Global Health, Bias, and Diversity in AI in Medical Imaging.

Intellectual property: A primer for radiologists.

Typically the creative product of the mind, intellectual property often forms the basis of a new product, service line, or company. Intellectual property law is complicated and nuanced, and poorly understood by many physicians, innovators, and entrepreneurs. Successfully navigating the process of intellectual property protection is critical in facilitating the translation of innovation into clinical practice. We define intellectual property and common terms used in intellectual property law and offer justification for the importance of intellectual property protections. We additionally highlight resources to assist radiologists with intellectual property protection and outline basic guidelines to successfully initiate discussions around intellectual property with third party vendors and consultants. SUMMARY: Proactive intellectual property protection is critically important for radiologist innovators seeking to bring new ideas to the marketplace.

The Radiology: Artificial Intelligence Trainee Editorial Board: Initial Experience and Future Directions.

In 2019, the journal Radiology: Artificial Intelligence introduced its Trainee Editorial Board (TEB) to offer formal training in medical journalism to medical students, radiology residents and fellows, and research-career trainees. The TEB aims to build a community of radiologists, radiation oncologists, medical physicists, and researchers in fields related to artificial intelligence (AI) in radiology. The program presented opportunities to learn about the editorial process, improve skills in writing and reviewing, advance the field of AI in radiology, and help translate and disseminate AI research. To meet these goals, TEB members contribute actively to the editorial process from peer review to publication, participate in educational webinars, and create and curate content in a variety of forms. Almost all of the contact has been mediated through the web. In this article, we share initial experiences and identify future directions and opportunities.

Margin-aware intraclass novelty identification for medical images.

Purpose: Existing anomaly detection methods focus on detecting interclass variations while medical image novelty identification is more challenging in the presence of intraclass variations. For example, a model trained with normal chest x-ray and common lung abnormalities is expected to discover and flag idiopathic pulmonary fibrosis, which is a rare lung disease and unseen during training. The nuances of intraclass variations and lack of relevant training data in medical image analysis pose great challenges for existing anomaly detection methods. Approach: We address the above challenges by proposing a hybrid model-transformation-based embedding learning for novelty detection (TEND), which combines the merits of classifier-based approach and AutoEncoder (AE)-based approach. Training TEND consists of two stages. In the first stage, we learn in-distribution embeddings with an AE via the unsupervised reconstruction. In the second stage, we learn a discriminative classifier to distinguish in-distribution data and the transformed counterparts. Additionally, we propose a margin-aware objective to pull in-distribution data in a hypersphere while pushing away the transformed data. Eventually, the weighted sum of class probability and the distance to margin constitutes the anomaly score. Results: Extensive experiments are performed on three public medical image datasets with the one-vs-rest setup (namely one class as in-distribution data and the left as intraclass out-of-distribution data) and the rest-vs-one setup. Additional experiments on generated intraclass out-of-distribution data with unused transformations are implemented on the datasets. The quantitative results show competitive performance as compared to the state-of-the-art approaches. Provided qualitative examples further demonstrate the effectiveness of TEND. Conclusion: Our anomaly detection model TEND can effectively identify the challenging intraclass out-of-distribution medical images in an unsupervised fashion. It can be applied to discover unseen medical image classes and serve as the abnormal data screening for downstream medical tasks. The corresponding code is available at https://github.com/XiaoyuanGuo/TEND_MedicalNoveltyDetection.

Systematic Review of Generative Adversarial Networks (GANs) for Medical Image Classification and Segmentation.

In recent years, generative adversarial networks (GANs) have gained tremendous popularity for various imaging related tasks such as artificial image generation to support AI training. GANs are especially useful for medical imaging-related tasks where training datasets are usually limited in size and heavily imbalanced against the diseased class. We present a systematic review, following the PRISMA guidelines, of recent GAN architectures used for medical image analysis to help the readers in making an informed decision before employing GANs in developing medical image classification and segmentation models. We have extracted 54 papers that highlight the capabilities and application of GANs in medical imaging from January 2015 to August 2020 and inclusion criteria for meta-analysis. Our results show four main architectures of GAN that are used for segmentation or classification in medical imaging. We provide a comprehensive overview of recent trends in the application of GANs in clinical diagnosis through medical image segmentation and classification and ultimately share experiences for task-based GAN implementations.

Multireader evaluation of radiologist performance for COVID-19 detection on emergency department chest radiographs.

BACKGROUND: Chest radiographs (CXR) are frequently used as a screening tool for patients with suspected COVID-19 infection pending reverse transcriptase polymerase chain reaction (RT-PCR) results, despite recommendations against this. We evaluated radiologist performance for COVID-19 diagnosis on CXR at the time of patient presentation in the Emergency Department (ED). MATERIALS AND METHODS: We extracted RT-PCR results, clinical history, and CXRs of all patients from a single institution between March and June 2020. 984 RT-PCR positive and 1043 RT-PCR negative radiographs were reviewed by 10 emergency radiologists from 4 academic centers. 100 cases were read by all radiologists and 1927 cases by 2 radiologists. Each radiologist chose the single best label per case: Normal, COVID-19, Other - Infectious, Other - Noninfectious, Non-diagnostic, and Endotracheal Tube. Cases labeled with endotracheal tube (246) or non-diagnostic (54) were excluded. Remaining cases were analyzed for label distribution, clinical history, and inter-reader agreement. RESULTS: 1727 radiographs (732 RT-PCR positive, 995 RT-PCR negative) were included from 1594 patients (51.2% male, 48.8% female, age 59 ± 19 years). For 89 cases read by all readers, there was poor agreement for RT-PCR positive (Fleiss Score 0.36) and negative (Fleiss Score 0.46) exams. Agreement between two readers on 1638 cases was 54.2% (373/688) for RT-PCR positive cases and 71.4% (679/950) for negative cases. Agreement was highest for RT-PCR negative cases labeled as Normal (50.4%, n = 479). Reader performance did not improve with clinical history or time between CXR and RT-PCR result. CONCLUSION: At the time of presentation to the emergency department, emergency radiologist performance is non-specific for diagnosing COVID-19.

PLHI-MC10: A dataset of exercise activities captured through a triple synchronous medically-approved sensor.

Most human activity recognition datasets that are publicly available have data captured by using either smartphones or smartwatches, which are usually placed on the waist or the wrist, respectively. These devices obtain one set of acceleration and angular velocity in the x-, y-, and z-axis from the accelerometer and the gyroscope planted in these devices. The PLHI-MC10 dataset contains data obtained by using 3 BioStamp nPoint® sensors from 7 physically healthy adult test subjects performing different exercise activities. These sensors are the state-of-the-art biomedical sensors manufactured by MC10. Each of the three sensors was attached to the subject externally on three muscles-Extensor Digitorum (Posterior Forearm), Gastrocnemius (Calf), and Pectoralis (Chest)-giving us three sets of 3 axial acceleration, two sets of 3 axial angular velocities, and 1 set of voltage values from the heart. Using three different sensors instead of a single sensor improves precision. It helps distinguish between human activities as it simultaneously captures the movement and contractions of various muscles from separate parts of the human body. Each test subject performed five activities (stairs, jogging, skipping, lifting kettlebell, basketball throws) in a supervised environment. The data is cleaned, filtered, and synced.

Just in Time Radiology Decision Support Using Real-time Data Feeds.

Ready access to relevant real-time information in medical imaging offers several potential benefits. Knowing both when important information will be available and that important information is available can facilitate optimization of workflow and management of time. Unexpected findings, as well as deficiencies in reporting and documentation, can be immediately managed. Herein, we present our experience developing and implementing a real-time web-centric dashboard system for radiologists, clinicians, and support staff. The dashboards are driven by multi-sourced HL7 message streams that are monitored, analyzed, aggregated, and transformed into multiple real-time displays to improve operations within our department. We call this framework Pipeline. Ruby on Rails, JavaScript, HTML, and SQL serve as the foundations of the Pipeline application. HL7 messages are processed in real-time by a Mirth interface engine which posts exam data into SQL. Users utilize web browsers to visit the Ruby on Rails-based dashboards on any device connected to our hospital network. The dashboards will automatically refresh every 30 seconds using JavaScript. The Pipeline application has been well received by clinicians and radiologists.