To evaluate how different test set sampling strategies-random selection and balanced sampling-affect the performance of artificial intelligence (AI) models in pediatric wrist fracture detection using radiographs, aiming to highlight the need for standardization in test set design. This retrospective study utilized the open-sourced GRAZPEDWRI-DX dataset of 6091 pediatric wrist radiographs. Two test sets, each containing 4588 images, were constructed: one using a balanced approach based on case difficulty, projection type, and fracture presence and the other a random selection. EfficientNet and YOLOv11 models were trained and validated on 18,762 radiographs and tested on both sets. Binary classification and object detection tasks were evaluated using metrics such as precision, recall, F1 score, AP50, and AP50-95. Statistical comparisons between test sets were performed using nonparametric tests. Performance metrics significantly decreased in the balanced test set with more challenging cases. For example, the precision for YOLOv11 models decreased from 0.95 in the random set to 0.83 in the balanced set. Similar trends were observed for recall, accuracy, and F1 score, indicating that models trained on easy-to-recognize cases performed poorly on more complex ones. These results were consistent across all model variants tested. AI models for pediatric wrist fracture detection exhibit reduced performance when tested on balanced datasets containing more difficult cases, compared to randomly selected cases. This highlights the importance of constructing representative and standardized test sets that account for clinical complexity to ensure robust AI performance in real-world settings. Question Do different sampling strategies based on samples' complexity have an influence in deep learning models' performance in fracture detection? Findings AI performance in pediatric wrist fracture detection significantly drops when tested on balanced datasets with more challenging cases, compared to randomly selected cases. Clinical relevance Without standardized and validated test datasets for AI that reflect clinical complexities, performance metrics may be overestimated, limiting the utility of AI in real-world settings.

Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy, frequently presenting with pain, numbness, and muscle weakness due to median nerve compression. However, diagnosing CTS becomes particularly challenging in patients with Congenital Thenar Hypoplasia (CTH), a rare congenital anomaly characterized by underdeveloped thenar muscles. The overlapping symptoms of CTH and CTS, such as thumb weakness, impaired hand function, and thenar muscle atrophy, can obscure the identification of median nerve compression. This review highlights the diagnostic complexities arising from this overlap and evaluates existing clinical, imaging, and electrophysiological assessment methods. While traditional diagnostic tests, including Phalen's and Tinel's signs, exhibit limited sensitivity in CTH patients, advanced imaging modalities like ultrasonography (US), magnetic resonance imaging (MRI), and diffusion tensor imaging (DTI) provide valuable insights into structural abnormalities. Additionally, emerging technologies such as artificial intelligence (AI) enhance diagnostic precision by automating imaging analysis and identifying subtle nerve alterations. Combining clinical history, functional assessments, and advanced imaging, an interdisciplinary approach is critical to differentiate between CTH-related anomalies and CTS accurately. This comprehensive review underscores the need for tailored diagnostic protocols to improve early detection, personalised management, and outcomes for this unique patient population.

Chemotherapy administration is a balancing act between giving enough to achieve the desired tumour response while limiting adverse effects. Chemotherapy dosing is based on body surface area (BSA). Emerging evidence suggests body composition plays a crucial role in the pharmacokinetic and pharmacodynamic profile of cytotoxic agents and could inform optimal dosing. This study aims to assess how lumbosacral body composition influences adverse events in patients receiving neoadjuvant chemotherapy for rectal cancer. A retrospective study (February 2013 to March 2023) examined the impact of body composition on neoadjuvant treatment outcomes for rectal cancer patients. Staging CT scans were analysed using a validated AI model to measure lumbosacral skeletal muscle (SM), intramuscular adipose tissue (IMAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue volume and density. Multivariate analyses explored the relationship between body composition and chemotherapy outcomes. 242 patients were included (164 males, 78 Females), median age 63.4 years. Chemotherapy dose reductions occurred more frequently in females (26.9% vs. 15.9%, p = 0.042) and in females with greater VAT density (-82.7 vs. -89.1, p = 0.007) and SM: IMAT + VAT volume ratio (1.99 vs. 1.36, p = 0.042). BSA was a poor predictor of dose reduction (AUC 0.397, sensitivity 38%, specificity 60%) for female patients, whereas the SM: IMAT + VAT volume ratio (AUC 0.651, sensitivity 76%, specificity 61%) and VAT density (AUC 0.699, sensitivity 57%, specificity 74%) showed greater predictive ability. Body composition didn't influence dose adjustment of male patients. Lumbosacral body composition outperformed BSA in predicting adverse events in female patients with rectal cancer undergoing neoadjuvant chemotherapy.

Despite current screening models, enhanced imaging modalities, and treatment regimens, diabetic retinopathy (DR) remains one of the leading causes of vision loss in working age adults. DR can result in irreversible structural and functional retinal damage, leading to visual impairment and reduced quality of life. Given potentially irreversible photoreceptor damage, diagnosis and treatment at the earliest stages will provide the best opportunity to avoid visual disturbances or retinopathy progression. We will review herein the current structural imaging methods used for DR assessment and their capability of detecting DR in the first stages of disease. Imaging tools, such as fundus photography, optical coherence tomography, fundus fluorescein angiography, optical coherence tomography angiography and adaptive optics-assisted imaging will be reviewed. Finally, we describe the future of DR screening programmes and the introduction of artificial intelligence as an innovative approach to detecting subtle changes in the diabetic retina. CLINICAL TRIAL REGISTRATION NUMBER: N/A.

Accurate and fully automated pancreas segmentation is critical for advancing imaging biomarkers in early pancreatic cancer detection and for biomarker discovery in endocrine and exocrine pancreatic diseases. We developed and evaluated a deep learning (DL)-based convolutional neural network (CNN) for automated pancreas segmentation using the largest single-institution dataset to date (n = 3031 CTs). Ground truth segmentations were performed by radiologists, which were used to train a 3D nnU-Net model through five-fold cross-validation, generating an ensemble of top-performing models. To assess generalizability, the model was externally validated on the multi-institutional AbdomenCT-1K dataset (n = 585), for which volumetric segmentations were newly generated by expert radiologists and will be made publicly available. In the test subset (n = 452), the CNN achieved a mean Dice Similarity Coefficient (DSC) of 0.94 (SD 0.05), demonstrating high spatial concordance with radiologist-annotated volumes (Concordance Correlation Coefficient [CCC]: 0.95). On the AbdomenCT-1K dataset, the model achieved a DSC of 0.96 (SD 0.04) and a CCC of 0.98, confirming its robustness across diverse imaging conditions. The proposed DL model establishes new performance benchmarks for fully automated pancreas segmentation, offering a scalable and generalizable solution for large-scale imaging biomarker research and clinical translation.

Retinal diseases recognition is still a challenging task. Many deep learning classification methods and their modifications have been developed for medical imaging. Recently, Vision Transformers (ViT) have been applied for classification of retinal diseases with great success. Therefore, in this study a novel method was proposed, the Residual Self-Attention Vision Transformer (RS-A ViT), for automatic detection of acquired vitelliform lesions (AVL), macular drusen as well as distinguishing them from healthy cases. The Residual Self-Attention module instead of Self-Attention was applied in order to improve model's performance. The new tool outperforms the classical deep learning methods, like EfficientNet, InceptionV3, ResNet50 and VGG16. The RS-A ViT method also exceeds the ViT algorithm, reaching 96.62%. For the purpose of this research a new dataset was created that combines AVL data gathered from two research centers and drusen as well as normal cases from the OCT dataset. The augmentation methods were applied in order to enlarge the samples. The Grad-CAM interpretability method indicated that this model analyses the appropriate areas in optical coherence tomography images in order to detect retinal diseases. The results proved that the presented RS-A ViT model has a great potential in classification retinal disorders with high accuracy and thus may be applied as a supportive tool for ophthalmologists.

Radiation pneumonia (RP) is the most common side effect of chest radiotherapy, and can affect patients' quality of life. This study aimed to establish a combined model of radiomics, dosiomics, deep learning (DL) based on simulated location CT and dosimetry images combining with clinical parameters to improve the predictive ability of ≥ 2 grade RP (RP2) in patients with non-small cell lung cancer (NSCLC). This study retrospectively collected 245 patients with NSCLC who received radiotherapy from three hospitals. 162 patients from Hospital I were randomly divided into training cohort and internal validation cohort according to 7:3. 83 patients from two other hospitals served as an external validation cohort. Multivariate analysis was used to screen independent clinical predictors and establish clinical model (CM). The radiomic and dosiomics (RD) features and DL features were extracted from simulated location CT and dosimetry images based on the region of interest (ROI) of total lung-PTV (TL-PTV). The features screened by the t-test and least absolute shrinkage and selection operator (LASSO) were used to construct the RD and DL model, and RD-score and DL-score were calculated. RD-score, DL-score and independent clinical features were combined to establish deep learning radiomics and dosiomics nomogram (DLRDN). The model performance was evaluated by area under the curve (AUC). Three clinical factors, including V20, V30, and mean lung dose (MLD), were used to establish the CM. 7 RD features including 4 radiomics features and 3 dosiomics features were selected to establish RD model. 10 DL features were selected to establish DL model. Among the different models, DLRDN showed the best predictions, with the AUCs of 0.891 (0.826-0.957), 0.825 (0.693-0.957), and 0.801 (0.698-0.904) in the training cohort, internal validation cohort and external validation cohort, respectively. DCA showed that DLRDN had a higher overall net benefit than other models. The calibration curve showed that the predicted value of DLRDN was in good agreement with the actual value. Overall, radiomics, dosiomics, and DL features based on simulated location CT and dosimetry images have the potential to help predict RP2. The combination of multi-dimensional data produced the optimal predictive model, which could provide guidance for clinicians.

Identifying patients suitable for conversion therapy through early non-invasive screening is crucial for tailoring treatment in advanced gastric cancer (AGC). This study aimed to develop and validate a deep learning method, utilizing preoperative computed tomography (CT) images, to predict the response to conversion therapy in AGC patients. This retrospective study involved 140 patients. We utilized Progressive Distill (PD) methodology to construct a deep learning model for predicting clinical response to conversion therapy based on preoperative CT images. Patients in the training set (n = 112) and in the test set (n = 28) were sourced from The First Affiliated Hospital of Wenzhou Medical University between September 2017 and November 2023. Our PD models' performance was compared with baseline models and those utilizing Knowledge Distillation (KD), with evaluation metrics including accuracy, sensitivity, specificity, receiver operating characteristic curves, areas under the receiver operating characteristic curve (AUCs), and heat maps. The PD model exhibited the best performance, demonstrating robust discrimination of clinical response to conversion therapy with an AUC of 0.99 and accuracy of 99.11% in the training set, and 0.87 AUC and 85.71% accuracy in the test set. Sensitivity and specificity were 97.44% and 100% respectively in the training set, 85.71% and 85.71% each in the test set, suggesting absence of discernible bias. The deep learning model of PD method accurately predicts clinical response to conversion therapy in AGC patients. Further investigation is warranted to assess its clinical utility alongside clinicopathological parameters.

Deep learning models are increasingly being implemented for automated medical image analysis to inform patient care. Most models, however, lack uncertainty information, without which the reliability of model outputs cannot be ensured. Several uncertainty quantification (UQ) methods exist to capture model uncertainty. Yet, it is not clear which method is optimal for a given task. The purpose of this work was to investigate several commonly used UQ methods for the critical yet understudied task of metastatic lesion segmentation on whole body PET/CT. 
Approach:
59 whole body 68Ga-DOTATATE PET/CT images of patients undergoing theranostic treatment of metastatic neuroendocrine tumors were used in this work. A 3D U-Net was trained for lesion segmentation following five-fold cross validation. Uncertainty measures derived from four UQ methods-probability entropy, Monte Carlo dropout, deep ensembles, and test time augmentation-were investigated. Each uncertainty measure was assessed across four quantitative evaluations: (1) its ability to detect artificially degraded image data at low, medium, and high degradation magnitudes; (2) to detect false-positive (FP) predicted regions; (3) to recover false-negative (FN) predicted regions; and (3) to establish correlations with model biomarker extraction and segmentation performance metrics. 
Results: Test time augmentation and probability entropy respectively achieved the highest and lowest degraded image detection at low (AUC=0.54 vs. 0.68), medium (AUC=0.70 vs. 0.82), and high (AUC=0.83 vs. 0.90) degradation magnitudes. For detecting FPs, all UQ methods achieve strong performance, with AUC values ranging narrowly between 0.77 and 0.81. FN region recovery performance was strongest for test time augmentation and weakest for probability entropy. Performance for the correlation analysis was mixed, where the strongest performance was achieved by test time augmentation for SUVtotal capture (ρ=0.57) and segmentation Dice coefficient (ρ=0.72), by Monte Carlo dropout for SUVmean capture (ρ=0.35), and by probability entropy for segmentation cross entropy (ρ=0.96).
Significance: Overall, test time augmentation demonstrated superior uncertainty quantification performance and is recommended for use in metastatic lesion segmentation task. It also offers the advantage of being post hoc and computationally efficient. In contrast, probability entropy performed the worst, highlighting the need for advanced UQ approaches for this task.&#xD.

To evaluate the impact of fluid volume fluctuations quantified with artificial intelligence in optical coherence tomography scans during the maintenance phase and visual outcomes at 12 and 24 months in a real-world, multicentre, national cohort of treatment-naïve neovascular age-related macular degeneration (nAMD) eyes. Demographics, visual acuity (VA) and number of injections were collected using the Fight Retinal Blindness tool. Intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), total fluid (TF) and central subfield thickness (CST) were quantified using the RetinAI Discovery tool. Fluctuations were defined as the SD of within-eye quantified values, and eyes were distributed according to SD quartiles for each biomarker. A total of 452 naïve nAMD eyes were included. Eyes with highest (Q4) versus lowest (Q1) fluid fluctuations showed significantly worse VA change (months 3-12) in IRF -3.91 versus 3.50 letters, PED -4.66 versus 3.29, TF -2.07 versus 2.97 and CST -1.85 versus 2.96 (all p<0.05), but not for SRF 0.66 versus 0.93 (p=0.91). Similar VA outcomes were observed at month 24 for PED -8.41 versus 4.98 (p<0.05), TF -7.38 versus 1.89 (p=0.07) and CST -10.58 versus 3.60 (p<0.05). The median number of injections (months 3-24) was significantly higher in Q4 versus Q1 eyes in IRF 9 versus 8, SRF 10 versus 8 and TF 10 versus 8 (all p<0.05). This multicentre study reports a negative effect in VA outcomes of fluid volume fluctuations during the maintenance phase in specific fluid compartments, suggesting that anatomical and functional treatment response patterns may be fluid-specific.