To perform a systematic review on the impact of deep learning (DL)-based triage for reducing diagnostic delays and improving patient outcomes in peer-reviewed and pre-print publications. A search was conducted of primary research studies focused on DL-based worklist optimization for diagnostic imaging triage published on multiple databases from January 2018 until July 2024. Extracted data included study design, dataset characteristics, workflow metrics including report turnaround time and time-to-treatment, and patient outcome differences. Further analysis between clinical settings and integration modality was investigated using nonparametric statistics. Risk of bias was assessed with the risk of bias in non-randomized studies-of interventions (ROBINS-I) checklist. A total of 38 studies from 20 publications, involving 138,423 images, were analyzed. Workflow interventions concerned pulmonary embolism (n = 8), stroke (n = 3), intracranial hemorrhage (n = 12), and chest conditions (n = 15). Patients in the post DL-triage group had shorter median report turnaround times: a mean difference of 12.3 min (IQR: -25.7, -7.6) for pulmonary embolism, 20.5 min (IQR: -32.1, -9.3) for stroke, 4.3 min (IQR: -8.6, 1.3) for intracranial hemorrhage and 29.7 min (IQR: -2947.7, -18.3) for chest diseases. Sub-group analysis revealed that reductions varied per clinical environment and relative prevalence rates but were the highest when algorithms actively stratified and reordered the radiological worklist, with reductions of -43.7% in report turnaround time compared to -7.6% from widget-based systems (p < 0.01). DL-based triage systems had comparable report turnaround time improvements, especially in outpatient and high-prevalence settings, suggesting that AI-based triage holds promise in alleviating radiology workloads. Question Can DL-based triage address lengthening imaging report turnaround times and improve patient outcomes across distinct clinical environments? Findings DL-based triage improved report turnaround time across disease groups, with higher reductions reported in high-prevalence or lower acuity settings. Clinical relevance DL-based workflow prioritization is a reliable tool for reducing diagnostic imaging delay for time-sensitive disease across clinical settings. However, further research and reliable metrics are needed to provide specific recommendations with regards to false-negative examinations and multi-condition prioritization.

<i>"Just Accepted" papers have undergone full peer review and have been accepted for publication in <i>Radiology: Artificial Intelligence</i>. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content.</i> Purpose To develop a deep learning segmentation model that can segment abdominal organs on CT and MR images with high accuracy and generalization ability. Materials and Methods In this study, an extended nnU-Net model was trained for abdominal organ segmentation. A domain randomization method in both the image and feature space was developed to improve the generalization ability under cross-site and cross-modality settings on public prostate MRI and abdominal CT and MRI datasets. The prostate MRI dataset contains data from multiple health care institutions with domain shifts. The abdominal CT and MRI dataset is structured for cross-modality evaluation, training on one modality (eg, MRI) and testing on the other (eg, CT). This domain randomization method was then used to train a segmentation model with enhanced generalization ability on the abdominal multiorgan segmentation challenge (AMOS) dataset to improve abdominal CT and MR multiorgan segmentation, and the model was compared with two commonly used segmentation algorithms (TotalSegmentator and MRSegmentator). Model performance was evaluated using the Dice similarity coefficient (DSC). Results The proposed domain randomization method showed improved generalization ability on the cross-site and cross-modality datasets compared with the state-of-the-art methods. The segmentation model using this method outperformed two other publicly available segmentation models on data from unseen test domains (Average DSC: 0.88 versus 0.79; <i>P</i> < .001 and 0.88 versus 0.76; <i>P</i> < .001). Conclusion The combination of image and feature domain randomizations improved the accuracy and generalization ability of deep learning-based abdominal segmentation on CT and MR images. © RSNA, 2025.

Our objective is to develop and validate a deep learning radiomics nomogram (DLRN) based on preoperative ultrasound images and clinical features, for predicting the malignancy of thyroid nodules with indeterminate cytology (Bethesda III). Between June 2017 and June 2022, we conducted a retrospective study on 194 patients with surgically confirmed indeterminate cytology (Bethesda III) in our hospital. The training and internal validation cohorts were comprised of 155 and 39 patients, in a 7:3 ratio. To facilitate external validation, we selected an additional 80 patients from each of the remaining two medical centers. Utilizing preoperative ultrasound data, we obtained imaging markers that encompass both deep learning and manually radiomic features. After feature selection, we developed a comprehensive diagnostic model to evaluate the predictive value for Bethesda III benign and malignant cases. The model's diagnostic accuracy, calibration, and clinical applicability were systematically assessed. The results showed that the prediction model, which integrated 512 DTL features extracted from the pre-trained Resnet34 network, ultrasound radiomics, and clinical features, exhibited superior stability in distinguishing between benign and malignant indeterminate thyroid nodules (Bethesda Class III). In the validation set, the AUC was 0.92 (95% CI: 0.831-1.000), and the accuracy, sensitivity, specificity, precision, and recall were 0.897, 0.882, 0.909, 0.882, and 0.882, respectively. The comprehensive multidimensional data model based on deep transfer learning, ultrasound radiomics features, and clinical characteristics can effectively distinguish the benign and malignant indeterminate thyroid nodules (Bethesda Class III), providing valuable guidance for treatment selection in patients with indeterminate thyroid nodules (Bethesda Class III).

Self-supervised learning has emerged as a powerful paradigm for training deep neural networks, particularly in medical imaging where labeled data is scarce. While current approaches typically rely on synthetic augmentations of single images, we propose VET-DINO, a framework that leverages a unique characteristic of medical imaging: the availability of multiple standardized views from the same study. Using a series of clinical veterinary radiographs from the same patient study, we enable models to learn view-invariant anatomical structures and develop an implied 3D understanding from 2D projections. We demonstrate our approach on a dataset of 5 million veterinary radiographs from 668,000 canine studies. Through extensive experimentation, including view synthesis and downstream task performance, we show that learning from real multi-view pairs leads to superior anatomical understanding compared to purely synthetic augmentations. VET-DINO achieves state-of-the-art performance on various veterinary imaging tasks. Our work establishes a new paradigm for self-supervised learning in medical imaging that leverages domain-specific properties rather than merely adapting natural image techniques.

Visual grounding (VG) is the capability to identify the specific regions in an image associated with a particular text description. In medical imaging, VG enhances interpretability by highlighting relevant pathological features corresponding to textual descriptions, improving model transparency and trustworthiness for wider adoption of deep learning models in clinical practice. Current models struggle to associate textual descriptions with disease regions due to inefficient attention mechanisms and a lack of fine-grained token representations. In this paper, we empirically demonstrate two key observations. First, current VLMs assign high norms to background tokens, diverting the model's attention from regions of disease. Second, the global tokens used for cross-modal learning are not representative of local disease tokens. This hampers identifying correlations between the text and disease tokens. To address this, we introduce simple, yet effective Disease-Aware Prompting (DAP) process, which uses the explainability map of a VLM to identify the appropriate image features. This simple strategy amplifies disease-relevant regions while suppressing background interference. Without any additional pixel-level annotations, DAP improves visual grounding accuracy by 20.74% compared to state-of-the-art methods across three major chest X-ray datasets.

[¹⁸F]FDG PET/CT scan combined with [¹⁸F]PSMA-1007 PET/CT scan is commonly conducted for detecting bone metastases in prostate cancer (PCa). However, it is expensive and may expose patients to more radiation hazards. This study explores deep learning (DL) techniques to synthesize [¹⁸F]PSMA-1007 PET bone images from CT bone images for the early detection of bone metastases in PCa, which may reduce additional PET/CT scans and relieve the burden on patients. We retrospectively collected paired whole-body (WB) [¹⁸F]PSMA-1007 PET/CT images from 152 patients with clinical and pathological diagnosis results, including 123 PCa and 29 cases of benign lesions. The average age of the patients was 67.48 ± 10.87 years, and the average lesion size was 8.76 ± 15.5 mm. The paired low-dose CT and PET images were preprocessed and segmented to construct the WB bone structure images. 152 subjects were randomly stratified into training, validation, and test groups in the number of 92:41:19. Two generative adversarial network (GAN) models-Pix2pix and Cycle GAN-were trained to synthesize [¹⁸F]PSMA-1007 PET bone images from paired CT bone images. The performance of two synthesis models was evaluated using quantitative metrics of mean absolute error (MAE), mean squared error (MSE), peak signal-to-noise ratio (PSNR), and structural similarity index metrics (SSIM), as well as the target-to-background ratio (TBR). The results of DL-based image synthesis indicated that the synthesis of [¹⁸F]PSMA-1007 PET bone images from low-dose CT bone images was highly feasible. The Pix2pix model performed better with an SSIM of 0.97, PSNR of 44.96, MSE of 0.80, and MAE of 0.10, respectively. The TBRs of bone metastasis lesions calculated on DL-synthesized PET bone images were highly correlated with those of real PET bone images (Pearson's r > 0.90) and had no significant differences (p < 0.05). It is feasible to generate synthetic [¹⁸F]PSMA-1007 PET bone images from CT bone images by using DL techniques with reasonable accuracy, which can provide information for early detection of PCa bone metastases.

Liver cancer, especially hepatocellular carcinoma (HCC), remains one of the most fatal cancers globally, emphasizing the critical need for accurate tumor segmentation to enable timely diagnosis and effective treatment planning. Traditional imaging techniques, such as CT and MRI, rely on manual interpretation, which can be both time-intensive and subject to variability. This study introduces FasNet, an innovative hybrid deep learning model that combines ResNet-50 and VGG-16 architectures, incorporating Channel and Spatial Attention mechanisms alongside Monte Carlo Dropout to improve segmentation precision and reliability. FasNet leverages ResNet-50's robust feature extraction and VGG-16's detailed spatial feature capture to deliver superior liver tumor segmentation accuracy. Channel and spatial attention mechanisms could selectively focus on the most relevant features and spatial regions for suitable segmentation with good accuracy and reliability. Monte Carlo Dropout estimates uncertainty and adds robustness, which is critical for high-stakes medical applications. Tested on the LiTS17 dataset, FasNet achieved a Dice Coefficient of 0.8766 and a Jaccard Index of 0.8487, surpassing several state-of-the-art methods. The Channel and Spatial Attention mechanisms in FasNet enhance feature selection, focusing on the most relevant spatial and channel information, while Monte Carlo Dropout improves model robustness and uncertainty estimation. These results position FasNet as a powerful diagnostic tool, offering precise and automated liver tumor segmentation that aids in early detection and precise treatment, ultimately enhancing patient outcomes.

Friedreich ataxia (FRDA) is a rare, inherited progressive movement disorder for which there is currently no cure. The field urgently requires more sensitive, objective, and clinically relevant biomarkers to enhance the evaluation of treatment efficacy in clinical trials and to speed up the process of drug discovery. This study pioneers the development of clinically relevant, multidomain, fully objective composite biomarkers of disease severity and progression, using multimodal neuroimaging and background data (i.e., demographic, disease history, genetics). Data from 31 individuals with FRDA and 31 controls from a longitudinal multimodal natural history study IMAGE-FRDA, were included. Using an elasticnet predictive machine learning (ML) regression model, we derived a weighted combination of background, structural MRI, diffusion MRI, and quantitative susceptibility imaging (QSM) measures that predicted Friedreich ataxia rating scale (FARS) with high accuracy (R² = 0.79, root mean square error (RMSE) = 13.19). This composite also exhibited strong sensitivity to disease progression over two years (Cohen's d = 1.12), outperforming the sensitivity of the FARS score alone (d = 0.88). The approach was validated using the Scale for the assessment and rating of ataxia (SARA), demonstrating the potential and robustness of ML-derived composites to surpass individual biomarkers and act as complementary or surrogate markers of disease severity and progression. However, further validation, refinement, and the integration of additional data modalities will open up new opportunities for translating these biomarkers into clinical practice and clinical trials for FRDA, as well as other rare neurodegenerative diseases.

The precise and timely diagnosis of brain tumors is essential for accelerating patient recovery and preserving lives. Brain tumors exhibit a variety of sizes, shapes, and visual characteristics, requiring individualized treatment strategies for each patient. Radiologists require considerable proficiency to manually detect brain malignancies. However, tumor recognition remains inefficient, imprecise, and labor-intensive in manual procedures, underscoring the need for automated methods. This study introduces an effective approach for identifying brain lesions in magnetic resonance imaging (MRI) images, minimizing dependence on manual intervention. The proposed method improves image clarity by combining guided filtering techniques with anisotropic Gaussian side windows (AGSW). A morphological analysis is conducted prior to segmentation to exclude non-tumor regions from the enhanced MRI images. Deep neural networks segment the images, extracting high-quality regions of interest (ROIs) and multiscale features. Identifying salient elements is essential and is accomplished through an attention module that isolates distinctive features while eliminating irrelevant information. An ensemble model is employed to classify brain tumors into different categories. The proposed technique achieves an overall accuracy of 99.94% and 99.67% on the publicly available brain tumor datasets BraTS2020 and Figshare, respectively. Furthermore, it surpasses existing technologies in terms of automation and robustness, thereby enhancing the entire diagnostic process.

We propose a novel framework for integrating fragmented multi-modal data in Alzheimer's disease (AD) research using large language models (LLMs) and knowledge graphs. While traditional multimodal analysis requires matched patient IDs across datasets, our approach demonstrates population-level integration of MRI, gene expression, biomarkers, EEG, and clinical indicators from independent cohorts. Statistical analysis identified significant features in each modality, which were connected as nodes in a knowledge graph. LLMs then analyzed the graph to extract potential correlations and generate hypotheses in natural language. This approach revealed several novel relationships, including a potential pathway linking metabolic risk factors to tau protein abnormalities via neuroinflammation (r>0.6, p<0.001), and unexpected correlations between frontal EEG channels and specific gene expression profiles (r=0.42-0.58, p<0.01). Cross-validation with independent datasets confirmed the robustness of major findings, with consistent effect sizes across cohorts (variance <15%). The reproducibility of these findings was further supported by expert review (Cohen's k=0.82) and computational validation. Our framework enables cross modal integration at a conceptual level without requiring patient ID matching, offering new possibilities for understanding AD pathology through fragmented data reuse and generating testable hypotheses for future research.