Artificial intelligence and large language models (LLMs)-particularly GPT-4 and GPT-4o-have demonstrated high correct-answer rates in medical examinations. GPT-4o has enhanced diagnostic capabilities, advanced image processing, and updated knowledge. Japanese surgeons face critical challenges, including a declining workforce, regional health care disparities, and work-hour-related challenges. Nonetheless, although LLMs could be beneficial in surgical education, no studies have yet assessed GPT-4o's surgical knowledge or its performance in the field of surgery. This study aims to evaluate the potential of GPT-4 and GPT-4o in surgical education by using them to take the Japan Surgical Board Examination (JSBE), which includes both textual questions and medical images-such as surgical and computed tomography scans-to comprehensively assess their surgical knowledge. We used 297 multiple-choice questions from the 2021-2023 JSBEs. The questions were in Japanese, and 104 of them included images. First, the GPT-4 and GPT-4o responses to only the textual questions were collected via OpenAI's application programming interface to evaluate their correct-answer rate. Subsequently, the correct-answer rate of their responses to questions that included images was assessed by inputting both text and images. The overall correct-answer rates of GPT-4o and GPT-4 for the text-only questions were 78% (231/297) and 55% (163/297), respectively, with GPT-4o outperforming GPT-4 by 23% (P=<.01). By contrast, there was no significant improvement in the correct-answer rate for questions that included images compared with the results for the text-only questions. GPT-4o outperformed GPT-4 on the JSBE. However, the results of the LLMs were lower than those of the examinees. Despite the capabilities of LLMs, image recognition remains a challenge for them, and their clinical application requires caution owing to the potential inaccuracy of their results.

In recent years, the application of deep learning (DL) technology in the thyroid field has shown exponential growth, greatly promoting innovation in thyroid disease research. As the most common malignant tumor of the endocrine system, the precise diagnosis and treatment of thyroid cancer has been a key focus of clinical research. This article systematically reviews the latest research progress in DL research for the diagnosis and treatment of thyroid malignancies, focusing on the breakthrough application of advanced models such as convolutional neural networks (CNNs), long short-term memory networks (LSTMs), and generative adversarial networks (GANs) in key areas such as ultrasound images analysis for thyroid nodules, automatic classification of pathological images, and assessment of extrathyroidal extension. Furthermore, the review highlights the great potential of DL techniques in the development of individualized treatment planning and prognosis prediction. In addition, it analyzes the technical bottlenecks and clinical challenges faced by current DL applications in thyroid cancer diagnosis and treatment and looks ahead to future directions for development. The aim of this review is to provide the latest research insights for clinical practitioners, promote further improvements in the precision diagnosis and treatment system for thyroid cancer, and ultimately achieve better diagnostic and therapeutic outcomes for thyroid cancer patients.

Accurate segmentation of the prostate peripheral zone (PZ) in T2-weighted MRI is critical for the early detection of prostate cancer. Existing segmentation methods are hindered by significant inter-observer variability (37.4 ± 5.6%), poor boundary localization, and the presence of motion artifacts, along with challenges in clinical integration. In this study, we propose BioAug-Net, a novel framework that integrates real-time physiological signal feedback with MRI data, leveraging transformer-based attention mechanisms and a probabilistic clinical decision support system (PCDSS). BioAug-Net features a dual-branch asymmetric attention mechanism: one branch processes spatial MRI features, while the other incorporates temporal sensor signals through a BiGRU-driven adaptive masking module. Additionally, a Markov Decision Process-based PCDSS maps segmentation outputs to clinical PI-RADS scores, with uncertainty quantification. We validated BioAug-Net on a multi-institutional dataset (n=1,542) and demonstrated state-of-the-art performance, achieving a Dice Similarity Coefficient of 89.7% (p < 0.001), sensitivity of 91.2% (p < 0.001), specificity of 88.4% (p < 0.001), and HD95 of 2.14 mm (p < 0.001), outperforming U-Net, Attention U-Net, and TransUNet. Sensor integration improved segmentation accuracy by 12.6% (p < 0.001) and reduced inter-observer variation by 48.3% (p < 0.001). Radiologist evaluations (n=3) confirmed a 15.0% reduction in diagnosis time (p = 0.003) and an increase in inter-reader agreement from K = 0.68 to K = 0.82 (p = 0.001). Our results show that BioAug-Net offers a clinically viable solution for early prostate cancer detection through enhanced physiological coupling and explainable AI diagnostics.

Diagnosis of prostate cancer requires histopathology of tissue samples. Following an MRI to identify suspicious areas, a biopsy is performed under ultrasound (US) guidance. In existing assistance systems, 3D US information is generally available (taken before the biopsy session and/or in between samplings). However, without registration between 2D images and 3D volumes, the urologist must rely on cognitive navigation. This work introduces a deep learning model to track the orientation of real-time US slices relative to a reference 3D US volume using only image and volume data. The dataset comprises 515 3D US volumes collected from 51 patients during routine transperineal biopsy. To generate 2D images streams, volumes are resampled to simulate three degrees of freedom rotational movements around the rectal entrance. The proposed model comprises two ResNet-based sub-modules to address the symmetry ambiguity arising from complex out-of-plane movement of the probe. The first sub-module predicts the unsigned relative orientation between consecutive slices, while the second leverages a custom similarity model and a spatial context volume to determine the sign of this relative orientation. From the sub-modules predictions, slices orientations along the navigated trajectory can then be derived in real-time. Results demonstrate that registration error remains below 2.5 mm in 92% of cases over a 5-second trajectory, and 80% over a 25-second trajectory. These findings show that accurate, sensorless 2D/3D US registration given a spatial context is achievable with limited drift over extended navigation. This highlights the potential of AI-driven biopsy assistance to increase the accuracy of freehand biopsy.

This study introduces a novel approach to improve Cone Beam CT (CBCT) image quality by developing a synthetic CT (sCT) generation method using CycleGAN with a Vision Transformer (ViT) and an Adaptive Fourier Neural Operator (AFNO). &#xD;&#xD;Approach: A dataset of 20 prostate cancer patients who received stereotactic body radiation therapy (SBRT) was used, consisting of paired CBCT and planning CT (pCT) images. The dataset was preprocessed by registering pCTs to CBCTs using deformation registration techniques, such as B-spline, followed by resampling to uniform voxel sizes and normalization. The model architecture integrates a CycleGAN with bidirectional generators, where the UNet generator is enhanced with a ViT at the bottleneck. AFNO functions as the attention mechanism for the ViT, operating on the input data in the Fourier domain. AFNO's innovations handle varying resolutions, mesh invariance, and efficient long-range dependency capture.&#xD;&#xD;Main Results: Our model improved significantly in preserving anatomical details and capturing complex image dependencies. The AFNO mechanism processed global image information effectively, adapting to interpatient variations for accurate sCT generation. Evaluation metrics like Mean Absolute Error (MAE), Peak Signal to Noise Ratio (PSNR), Structural Similarity Index (SSIM), and Normalized Cross Correlation (NCC), demonstrated the superiority of our method. Specifically, the model achieved an MAE of 9.71, PSNR of 37.08 dB, SSIM of 0.97, and NCC of 0.99, confirming its efficacy. &#xD;&#xD;Significance: The integration of AFNO within the CycleGAN UNet framework addresses Cone Beam CT image quality limitations. The model generates synthetic CTs that allow adaptive treatment planning during SBRT, enabling adjustments to the dose based on tumor response, thus reducing radiotoxicity from increased doses. This method's ability to preserve both global and local anatomical features shows potential for improving tumor targeting, adaptive radiotherapy planning, and clinical decision-making.

This study aimed to develop an interpretable machine learning model using magnetic resonance imaging (MRI) radiomics features to predict preoperative microscopic peritumoral small cancer foci (MSF) and explore its relationship with early recurrence in hepatocellular carcinoma (HCC) patients. A total of 1049 patients from three hospitals were divided into a training set (Hospital 1: 614 cases), a test set (Hospital 2: 248 cases), and a validation set (Hospital 3: 187 cases). Independent risk factors from clinical and MRI features were identified using univariate and multivariate logistic regression to build a clinicoradiological model. MRI radiomics features were then selected using methods like least absolute shrinkage and selection operator (LassoCV) and modeled with various machine learning algorithms, choosing the best-performing model as the radiomics model. The clinical and radiomics features were combined to form a fusion model. Model performance was evaluated by comparing receiver operating characteristic (ROC) curves, area under the curve (AUC) values, calibration curves, and decision curve analysis (DCA) curves. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) values assessed improvements in predictive efficacy. The model's prognostic value was verified using Kaplan-Meier analysis. SHapley Additive exPlanations (SHAP) was used to interpret how the model makes predictions. Three models were developed as follows: Clinical Radiology, XGBoost, and Clinical XGBoost. XGBoost was selected as the final model for predicting MSF, with AUCs of 0.841, 0.835, and 0.817 in the training, test, and validation sets, respectively. These results were comparable to the Clinical XGBoost model (0.856, 0.826, 0.837) and significantly better than the Clinical Radiology model (0.688, 0.561, 0.613). Additionally, the XGBoost model effectively predicted early recurrence in HCC patients. This study successfully developed an interpretable XGBoost machine learning model based on MRI radiomics features to predict preoperative MSF and early recurrence in HCC patients.

This study aims to evaluate the diagnostic value of machine learning-based MRI imaging in differentiating benign and malignant prostate cancer and detecting clinically significant prostate cancer (csPCa, defined as Gleason score ≥7) using systematic review and meta-analysis methods. Electronic databases (PubMed, Web of Science, Cochrane Library, and Embase) were systematically searched for predictive studies using machine learning-based MRI imaging for prostate cancer diagnosis. Sensitivity, specificity, and area under the curve (AUC) were used to assess the diagnostic accuracy of machine learning-based MRI imaging for both benign/malignant prostate cancer and csPCa. A total of 12 studies met the inclusion criteria, with 3474 patients included in the meta-analysis. Machine learning-based MRI imaging demonstrated good diagnostic value for both benign/malignant prostate cancer and csPCa. The pooled sensitivity and specificity for diagnosing benign/malignant prostate cancer were 0.92 (95% CI: 0.83-0.97) and 0.90 (95% CI: 0.68-0.97), respectively, with a combined AUC of 0.96 (95% CI: 0.94-0.98). For csPCa diagnosis, the pooled sensitivity and specificity were 0.83 (95% CI: 0.77-0.87) and 0.73 (95% CI: 0.65-0.81), respectively, with a combined AUC of 0.86 (95% CI: 0.83-0.89). Machine learning-based MRI imaging shows good diagnostic accuracy for both benign/malignant prostate cancer and csPCa. Further in-depth studies are needed to validate these findings.

This study aimed to develop an interpretable machine learning model integrating delayed-phase contrast-enhanced CT radiomics with clinical features for noninvasive prediction of pathological grading in appendiceal pseudomyxoma peritonei (PMP), using Shapley Additive Explanations (SHAP) for model interpretation. This retrospective study analyzed 158 pathologically confirmed PMP cases (85 low-grade, 73 high-grade) from January 4, 2015 to April 30, 2024. Comprehensive clinical data including demographic characteristics, serum tumor markers (CEA, CA19-9, CA125, D-dimer, CA-724, CA-242), and CT-peritoneal cancer index (CT-PCI) were collected. Radiomics features were extracted from preoperative contrast-enhanced CT scans using standardized protocols. After rigorous feature selection and five-fold cross-validation, we developed three predictive models: clinical-only, radiomics-only, and a combined clinical-radiomics model using logistic regression. Model performance was evaluated through ROC analysis (AUC), Delong test, decision curve analysis (DCA), and Brier score, with SHAP values providing interpretability. The combined model demonstrated superior performance, achieving AUCs of 0.91 (95%CI:0.86-0.95) and 0.88 (95%CI:0.82-0.93) in training and testing sets respectively, significantly outperforming standalone models (P < 0.05). DCA confirmed greater clinical utility across most threshold probabilities, with favorable Brier scores (training:0.124; testing:0.142) indicating excellent calibration. SHAP analysis identified the top predictive features: wavelet-LHH_glcm_InverseVariance (radiomics), original_shape_Elongation (radiomics), and CA-199 (clinical). Our SHAP-interpretable combined model provides an accurate, noninvasive tool for PMP grading, facilitating personalized treatment decisions. The integration of radiomics and clinical data demonstrates superior predictive performance compared to conventional approaches, with potential to improve patient outcomes.

This study aimed to develop a fully automated 3D multi-modal deep learning model using preoperative ¹⁸F-FDG PET/CT to predict the T-stage of colorectal cancer (CRC) and evaluate its clinical utility. A retrospective cohort of 474 CRC patients was included, with 400 patients for internal cohort and 74 patients for external cohort. Patients were classified into early T-stage (T1-T2) and advanced T-stage (T3-T4) groups. Automatic segmentation of the volume of interest (VOI) was achieved based on TotalSegmentator. A 3D ResNet18-based deep learning model integrated with a cross-multi-head attention mechanism was developed. Five models (CT + PET + Clinic (CPC), CT + PET (CP), PET (P), CT (C), Clinic) and two radiologists' assessment were compared. Performance was evaluated using Area Under the Curve (AUC). Grad-CAM was employed to provide visual interpretability of decision-critical regions. The automated segmentation achieved Dice scores of 0.884 (CT) and 0.888 (PET). The CPC and CP models achieved superior performance, with AUCs of 0.869 and 0.869 in the internal validation cohort, respectively, outperforming single-modality models (P: 0.832; C: 0.809; Clinic: 0.728) and the radiologists (AUC: 0.627, P < 0.05 for all models vs. radiologists, except for the Clinical model). External validation exhibited a similar trend, with AUCs of 0.814, 0.812, 0.763, 0.714, 0.663 and 0.704, respectively. Grad-CAM visualization highlighted tumor-centric regions for early T-stage and peri-tumoral tissue infiltration for advanced T-stage. The fully automated multimodal, fusing PET/CT with cross-multi-head-attention, improved T-stage prediction in CRC, surpassing the single-modality models and radiologists, offering a time-efficient tool to aid clinical decision-making.

Accurate identification of anal fistulas is essential, as it directly impacts the severity of subsequent perianal infections, prognostic indicators, and overall treatment outcomes. Traditional manual recognition methods are inefficient. In response, computer vision methods have been adopted to improve efficiency. Convolutional neural networks(CNNs) are the main basis for detecting anal fistulas in current computer vision techniques. However, these methods often struggle to capture long-range dependencies effectively, which results in inadequate handling of images of anal fistulas. This study proposes a new fusion model, CVT-HNet, that integrates MobileNet with vision transformer technology. This design utilizes CNNs to extract local features and Transformers to capture long-range dependencies. In addition, the MobileNetV2 with Coordinate Attention mechanism and encoder modules are optimized to improve the precision of detecting anal fistulas. Comparative experimental results show that CVT-HNet achieves an accuracy of 80.66% with significant robustness. It surpasses both pure Transformer architecture models and other fusion networks. Internal validation results demonstrate the reliability and consistency of CVT-HNet. External validation demonstrates that our model exhibits commendable transportability and generalizability. In visualization analysis, CVT-HNet exhibits a more concentrated focus on the region of interest in images of anal fistulas. Furthermore, the contribution of each CVT-HNet component module is evaluated by ablation experiments. The experimental results highlight the superior performance and practicality of CVT-HNet in detecting anal fistulas. By combining local and global information, CVT-HNet demonstrates strong performance. The model not only achieves high accuracy and robustness but also exhibits strong generalizability. This makes it suitable for real-world applications where variability in data is common.These findings emphasize its effectiveness in clinical contexts.