Accurate diagnosis of orthopedic injuries, especially pelvic and hip fractures, is vital in trauma management. While pelvic radiographs (PXRs) are widely used, misdiagnosis is common. This study proposes an automated system that uses convolutional neural networks (CNNs) to detect potential fracture areas and predict fracture conditions, aiming to outperform traditional object detection-based systems. We developed two deep learning models for hip fracture detection and prediction, trained on PXRs from three hospitals. The first model utilized automated hip area detection, cropping, and classification of the resulting patches. The images were preprocessed using the Contrast Limited Adaptive Histogram Equalization (CLAHE) algorithm. The YOLOv5 architecture was employed for the object detection model, while three different pre-trained deep neural network (DNN) architectures were used for classification, applying transfer learning. Their performance was evaluated on a test dataset, and compared with 35 clinicians. YOLOv5 achieved a 92.66% accuracy on regular images and 88.89% on CLAHE-enhanced images. The classifier models, MobileNetV2, Xception, and InceptionResNetV2, achieved accuracies between 94.66% and 97.67%. In contrast, the clinicians demonstrated a mean accuracy of 84.53% and longer prediction durations. The DNN models showed significantly better accuracy and speed compared to human evaluators (p < 0.0005, p < 0.01). These DNN models highlight promising utility in trauma diagnosis due to their high accuracy and speed. Integrating such systems into clinical practices may enhance the diagnostic efficiency of PXRs.

Pneumonia is the leading cause of hospitalisation and mortality among children under five, particularly in low-resource settings. Accurate differentiation between viral and bacterial pneumonia is essential for guiding appropriate treatment, yet it remains challenging due to overlapping clinical and radiographic features. Advances in machine learning (ML), particularly deep learning (DL), have shown promise in classifying pneumonia using chest X-ray (CXR) images. This scoping review summarises the evidence on ML techniques for classifying viral and bacterial pneumonia using CXR images in paediatric patients. This scoping review was conducted following the Joanna Briggs Institute methodology and the PRISMA-ScR guidelines. A comprehensive search was performed in PubMed, Embase, and Scopus to identify studies involving children (0-18 years) with pneumonia diagnosed through CXR, using ML models for binary or multiclass classification. Data extraction included ML models, dataset characteristics, and performance metrics. A total of 35 studies, published between 2018 and 2025, were included in this review. Of these, 31 studies used the publicly available Kermany dataset, raising concerns about overfitting and limited generalisability to broader, real-world clinical populations. Most studies (n=33) used convolutional neural networks (CNNs) for pneumonia classification. While many models demonstrated promising performance, significant variability was observed due to differences in methodologies, dataset sizes, and validation strategies, complicating direct comparisons. For binary classification (viral vs bacterial pneumonia), a median accuracy of 92.3% (range: 80.8% to 97.9%) was reported. For multiclass classification (healthy, viral pneumonia, and bacterial pneumonia), the median accuracy was 91.8% (range: 76.8% to 99.7%). Current evidence is constrained by a predominant reliance on a single dataset and variability in methodologies, which limit the generalisability and clinical applicability of findings. To address these limitations, future research should focus on developing diverse and representative datasets while adhering to standardised reporting guidelines. Such efforts are essential to improve the reliability, reproducibility, and translational potential of machine learning models in clinical settings.

Radiologists' eye movements during medical image interpretation reflect their perceptual-cognitive processes of diagnostic decisions. The eye movement data can be modeled to represent clinically relevant regions in a medical image and potentially integrated into an artificial intelligence (AI) system for automatic diagnosis in medical imaging. In this article, we first conduct a large-scale eye-tracking study involving 13 radiologists interpreting 191 chest X-ray (CXR) images, establishing a best-of-its-kind CXR visual saliency benchmark. We then perform analysis to quantify the reliability and clinical relevance of saliency maps (SMs) generated for CXR images. We develop CXR image saliency prediction method (CXRSalNet), a novel saliency prediction model that leverages radiologists' gaze information to optimize the use of unlabeled CXR images, enhancing training and mitigating data scarcity. We also demonstrate the application of our CXR saliency model in enhancing the performance of AI-powered diagnostic imaging systems.

To develop an early budget impact analysis of and inform future research on the national adoption of a commercially available AI application to support clinicians reviewing radiographs for suspected fractures across NHS emergency departments in England. A decision tree framework was coded to assess a change in outcomes for suspected fractures in adults when AI fracture detection was integrated into clinical workflow over a 1-year time horizon. Standard of care was the comparator scenario and the ground truth reference cases were characterised by radiology report findings. The effect of AI on assisting ED clinicians when detecting fractures was sourced from US literature. Data on resource use conditioned on the correct identification of a fracture in the ED was extracted from a London NHS trust. Sensitivity analysis was conducted to account for the influence of parameter uncertainty on results. In one year, an estimated 658,564 radiographs were performed in emergency departments across England for suspected wrist, ankle or hip fractures. The number of patients returning to the ED with a missed fracture was reduced by 21,674 cases and a reduction of 20, 916 unnecessary referrals to fracture clinics. The cost of current practice was estimated at £66,646,542 and £63,012,150 with the integration of AI. Overall, generating a return on investment of £3,634,392 to the NHS. The adoption of AI in EDs across England has the potential to generate cost savings. However, additional evidence on radiograph review accuracy and subsequent resource use is required to further demonstrate this.

Chest X-ray (CXR) is a diagnostic tool for cardiothoracic assessment. They make up 50% of all diagnostic imaging tests. With hundreds of images examined every day, radiologists can suffer from fatigue. This fatigue may reduce diagnostic accuracy and slow down report generation. We describe a prototype computer-assisted diagnosis (CAD) pipeline employing computer vision (CV) and Natural Language Processing (NLP). It was trained and evaluated on the publicly available MIMIC-CXR dataset. We perform image quality assessment, view labelling, and segmentation-based cardiomegaly severity classification. We use the output of the severity classification for large language model-based report generation. Four board-certified radiologists assessed the output accuracy of our CAD pipeline. Across the dataset composed of 377,100 CXR images and 227,827 free-text radiology reports, our system identified 0.18% of cases with mixed-sex mentions, 0.02% of poor quality images (F1 = 0.81), and 0.28% of wrongly labelled views (accuracy 99.4%). We assigned views for 4.18% of images which have unlabelled views. Our binary cardiomegaly classification model has 95.2% accuracy. The inter-radiologist agreement on evaluating the generated report's semantics and correctness for radiologist-MIMIC is 0.62 (strict agreement) and 0.85 (relaxed agreement) similar to the radiologist-CAD agreement of 0.55 (strict) and 0.93 (relaxed). Our work found and corrected several incorrect or missing metadata annotations for the MIMIC-CXR dataset. The performance of our CAD system suggests performance on par with human radiologists. Future improvements revolve around improved text generation and the development of CV tools for other diseases.

Artificial intelligence (AI) is a promising and powerful technology with increasing use in orthopedics. The global morbidity of knee arthroplasty is expanding. This study investigated the use of AI algorithms to review radiographs of knee arthroplasty. The Ovid-Embase, Web of Science, Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), WeiPu (VIP), WanFang, and China Biology Medicine (CBM) databases were systematically screened from inception to March 2024 (PROSPERO study protocol registration: CRD42024507549). The quality assessment of the diagnostic accuracy studies tool assessed the risk of bias. A total of 21 studies were included in the analysis. Of these, 10 studies identified and classified implant brands, 6 measured implant size and component alignment, 3 detected implant loosening, and 2 diagnosed prosthetic joint infections (PJI). For classifying and identifying implant brands, 5 studies demonstrated near-perfect prediction with an area under the curve (AUC) ranging from 0.98 to 1.0, and 10 achieved accuracy (ACC) between 96-100%. Regarding implant measurement, one study showed an AUC of 0.62, and two others exhibited over 80% ACC in determining component sizes. Moreover, Artificial intelligence showed good to excellent reliability across all angles in three separate studies (Intraclass Correlation Coefficient > 0.78). In predicting PJI, one study achieved an AUC of 0.91 with a corresponding ACC of 90.5%, while another reported a positive predictive value ranging from 75% to 85%. For detecting implant loosening, the AUC was found to be at least as high as 0.976 with ACC ranging from 85.8% to 97.5%. These studies show that AI is promising in recognizing implants in knee arthroplasty. Future research should follow a rigorous approach to AI development, with comprehensive and transparent reporting of methods and the creation of open-source software programs and commercial tools that can provide clinicians with objective clinical decisions.

Early and accurate detection of COVID-19 and pneumonia through medical imaging is critical for effective patient management. This study aims to develop a robust framework that integrates synthetic image augmentation with advanced deep learning (DL) models to address dataset imbalance, improve diagnostic accuracy, and enhance trust in artificial intelligence (AI)-driven diagnoses through Explainable AI (XAI) techniques. The proposed framework benchmarks state-of-the-art models (InceptionV3, DenseNet, ResNet) for initial performance evaluation. Synthetic images are generated using Feature Interpolation through Linear Mapping and principal component analysis to enrich dataset diversity and balance class distribution. YOLOv8 and InceptionV3 models, fine-tuned via transfer learning, are trained on the augmented dataset. Grad-CAM is used for model explainability, while large language models (LLMs) support visualization analysis to enhance interpretability. YOLOv8 achieved superior performance with 97% accuracy, precision, recall, and F1-score, outperforming benchmark models. Synthetic data generation effectively reduced class imbalance and improved recall for underrepresented classes. Comparative analysis demonstrated significant advancements over existing methodologies. XAI visualizations (Grad-CAM heatmaps) highlighted anatomically plausible focus areas aligned with clinical markers of COVID-19 and pneumonia, thereby validating the model's decision-making process. The integration of synthetic data generation, advanced DL, and XAI significantly enhances the detection of COVID-19 and pneumonia while fostering trust in AI systems. YOLOv8's high accuracy, coupled with interpretable Grad-CAM visualizations and LLM-driven analysis, promotes transparency crucial for clinical adoption. Future research will focus on developing a clinically viable, human-in-the-loop diagnostic workflow, further optimizing performance through the integration of transformer-based language models to improve interpretability and decision-making.

Lung cancer imaging plays a crucial role in early diagnosis and treatment, where machine learning and deep learning have significantly advanced the accuracy and efficiency of disease classification. This study introduces the Explainable and Lightweight Lung Cancer Net (XLLC-Net), a streamlined convolutional neural network designed for classifying lung cancer from histopathological images. Using the LC25000 dataset, which includes three lung cancer classes and two colon cancer classes, we focused solely on the three lung cancer classes for this study. XLLC-Net effectively discerns complex disease patterns within these classes. The model consists of four convolutional layers and contains merely 3 million parameters, considerably reducing its computational footprint compared to existing deep learning models. This compact architecture facilitates efficient training, completing each epoch in just 60 seconds. Remarkably, XLLC-Net achieves a classification accuracy of 99.62% [Formula: see text] 0.16%, with precision, recall, and F1 score of 99.33% [Formula: see text] 0.30%, 99.67% [Formula: see text] 0.30%, and 99.70% [Formula: see text] 0.30%, respectively. Furthermore, the integration of Explainable AI techniques, such as Saliency Map and GRAD-CAM, enhances the interpretability of the model, offering clear visual insights into its decision-making process. Our results underscore the potential of lightweight DL models in medical imaging, providing high accuracy and rapid training while ensuring model transparency and reliability.

Despite significant progress in applying large language models (LLMs) to the medical domain, several limitations still prevent them from practical applications. Among these are the constraints on model size and the lack of cohort-specific labeled datasets. In this work, we investigated the potential of improving a lightweight LLM, such as Llama 3.1-8B, through fine-tuning with datasets using synthetic labels. Two tasks are jointly trained by combining their respective instruction datasets. When the quality of the task-specific synthetic labels is relatively high (e.g., generated by GPT4-o), Llama 3.1-8B achieves satisfactory performance on the open-ended disease detection task, with a micro F1 score of 0.91. Conversely, when the quality of the task-relevant synthetic labels is relatively low (e.g., from the MIMIC-CXR dataset), fine-tuned Llama 3.1-8B is able to surpass its noisy teacher labels (micro F1 score of 0.67 v.s. 0.63) when calibrated against curated labels, indicating the strong inherent underlying capability of the model. These findings demonstrate the potential offine-tuning LLMs with synthetic labels, offering a promising direction for future research on LLM specialization in the medical domain.

Thoracic diseases, including pneumonia, tuberculosis, lung cancer, and others, pose significant health risks and require timely and accurate diagnosis to ensure proper treatment. Thus, in this research, a model for thorax disease classification using Chest X-rays is proposed by considering deep learning model. The input is pre-processed by resizing, normalizing pixel values, and applying data augmentation to address the issue of imbalanced datasets and improve model generalization. Significant features are extracted from the images using an Enhanced Auto-Encoder (EnAE) model, which combines a stacked auto-encoder architecture with an attention module to enhance feature representation and classification accuracy. To further improve feature selection, we utilize the Chaotic Whale Optimization (ChWO) Algorithm, which optimally selects the most relevant attributes from the extracted features. Finally, the disease classification is performed using the novel Improved Swin Transformer (IMSTrans) model, which is designed to efficiently process high-dimensional medical image data and achieve superior classification performance. The proposed EnAE + ChWO+IMSTrans model for thorax disease classification was evaluated using extensive Chest X-ray datasets and the Lung Disease Dataset. The proposed method demonstrates enhanced Accuracy, Precision, Recall, F-Score, MCC and MAE of 0.964, 0.977, 0.9845, 0.964, 0.9647, and 0.184 respectively indicating the reliable and efficient solution for thorax disease classification.