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Artificial intelligence applications in thyroid cancer care.

Pozdeyev N, White SL, Bell CC, Haugen BR, Thomas J

pubmed logopapersSep 25 2025
Artificial intelligence (AI) has created tremendous opportunities to improve thyroid cancer care. We used the "artificial intelligence thyroid cancer" query to search the PubMed database until May 31, 2025. We highlight a set of high-impact publications selected based on technical innovation, large generalizable training datasets, and independent and/or prospective validation of AI. We review the key applications of AI for diagnosing and managing thyroid cancer. Our primary focus is on using computer vision to evaluate thyroid nodules on thyroid ultrasound, an area of thyroid AI that has gained the most attention from researchers and will likely have a significant clinical impact. We also highlight AI for detecting and predicting thyroid cancer neck lymph node metastases, digital cyto- and histopathology, large language models for unstructured data analysis, patient education, and other clinical applications. We discuss how thyroid AI technology has evolved and cite the most impactful research studies. Finally, we balance our excitement about the potential of AI to improve clinical care for thyroid cancer with current limitations, such as the lack of high-quality, independent prospective validation of AI in clinical trials, the uncertain added value of AI software, unknown performance on non-papillary thyroid cancer types, and the complexity of clinical implementation. AI promises to improve thyroid cancer diagnosis, reduce healthcare costs and enable personalized management. High-quality, independent prospective validation of AI in clinical trials is lacking and is necessary for the clinical community's broad adoption of this technology.

Incidental Cardiovascular Findings in Lung Cancer Screening and Noncontrast Chest Computed Tomography.

Cham MD, Shemesh J

pubmed logopapersSep 24 2025
While the primary goal of lung cancer screening CT is to detect early-stage lung cancer in high-risk populations, it often reveals asymptomatic cardiovascular abnormalities that can be clinically significant. These findings include coronary artery calcifications (CACs), myocardial pathologies, cardiac chamber enlargement, valvular lesions, and vascular disease. CAC, a marker of subclinical atherosclerosis, is particularly emphasized due to its strong predictive value for cardiovascular events and mortality. Guidelines recommend qualitative or quantitative CAC scoring on all noncontrast chest CTs. Other actionable findings include aortic aneurysms, pericardial disease, and myocardial pathology, some of which may indicate past or impending cardiac events. This article explores the wide range of incidental cardiovascular findings detectable during low-dose CT (LDCT) scans for lung cancer screening, as well as noncontrast chest CT scans. Distinguishing which findings warrant further evaluation is essential to avoid overdiagnosis, unnecessary anxiety, and resource misuse. The article advocates for a structured approach to follow-up based on the clinical significance of each finding and the patient's overall risk profile. It also notes the rising role of artificial intelligence in automatically detecting and quantifying these abnormalities, potentiating early behavioral modification or medical and surgical interventions. Ultimately, this piece highlights the opportunity to reframe LDCT as a comprehensive cardiothoracic screening tool.

Deep Learning-based Automated Detection of Pulmonary Embolism: Is It Reliable?

Babacan Ö, Karkaş AY, Durak G, Uysal E, Durak Ü, Shrestha R, Bingöl Z, Okumuş G, Medetalibeyoğlu A, Ertürk ŞM

pubmed logopapersSep 24 2025
To assess the diagnostic accuracy and clinical applicability of the artificial intelligence (AI) program "Canon Automation Platform" for the automated detection and localization of pulmonary embolisms (PEs) in chest computed tomography pulmonary angiograms (CTPAs). A total of 1474 CTPAs suspected of PEs were retrospectively evaluated by 2 senior radiology residents with 5 years of experience. The final diagnosis was verified through radiology reports by 2 thoracic radiologists with 20 and 25 years of experience, along with the patients' clinical records and histories. The images were transferred to the Canon Automation Platform, which integrates with the picture archiving and communication system (PACS), and the diagnostic success of the platform was evaluated. This study examined all anatomic levels of the pulmonary arteries, including the left pulmonary artery, right pulmonary artery, and interlobar, segmental, and subsegmental branches. The confusion matrix data obtained at all anatomic levels considered in our study were as follows: AUC-ROC score of 0.945 to 0.996, accuracy of 95.4% to 99.7%, sensitivity of 81.4% to 99.1%, specificity of 98.7% to 100%, PPV of 89.1% to 100%, NPV of 95.6% to 99.9%, F1 score of 0.868 to 0.987, and Cohen Kappa of 0.842 to 0.986. Notably, sensitivity in the subsegmental branches was lower (81.4% to 84.7%) compared with more central locations, whereas specificity remained consistent (98.7% to 98.9%). The results showed that the chest pain package of the Canon Automation Platform accurately provides rapid automatic PE detection in chest CTPAs by leveraging deep learning algorithms to facilitate the clinical workflow. This study demonstrates that AI can provide physicians with robust diagnostic support for acute PE, particularly in hospitals without 24/7 access to radiology specialists.

Artificial intelligence in cerebral cavernous malformations: a scoping review.

Santos AN, Venkatesh V, Chidambaram S, Piedade Santos G, Dawoud B, Rauschenbach L, Choucha A, Bingöl S, Wipplinger T, Wipplinger C, Siegel AM, Dammann P, Abou-Hamden A

pubmed logopapersSep 24 2025
Artificial Intelligence (AI) and Machine Learning (ML) are increasingly being applied in medical research, including studies on cerebral cavernous malformations (CCM). This scoping review aims to analyze the scope and impact of AI in CCM, focusing on diagnostic tools, risk assessment, biomarker identification, outcome prediction, and treatment planning. We conducted a comprehensive literature search across different databases, reviewing articles that explore AI applications in CCM. Articles were selected based on predefined eligibility criteria and categorized according to their primary focus: drug discovery, diagnostic imaging, genetic analysis, biomarker identification, outcome prediction, and treatment planning. Sixteen studies met the inclusion criteria, showcasing diverse AI applications in CCM. Nearly half (47%) were cohort or prospective studies, primarily focused on biomarker discovery and risk prediction. Technical notes and diagnostic studies accounted for 27%, concentrating on computer-aided diagnosis (CAD) systems and drug screening. Other studies included a conceptual review on AI for surgical planning and a systematic review confirming ML's superiority in predicting clinical outcomes within neurosurgery. AI applications in CCM show significant promise, particularly in enhancing diagnostic accuracy, risk assessment, and surgical planning. These advancements suggest that AI could transform CCM management, offering pathways to improved patient outcomes and personalized care strategies.

Anomaly Detection by Clustering DINO Embeddings using a Dirichlet Process Mixture

Nico Schulthess, Ender Konukoglu

arxiv logopreprintSep 24 2025
In this work, we leverage informative embeddings from foundational models for unsupervised anomaly detection in medical imaging. For small datasets, a memory-bank of normative features can directly be used for anomaly detection which has been demonstrated recently. However, this is unsuitable for large medical datasets as the computational burden increases substantially. Therefore, we propose to model the distribution of normative DINOv2 embeddings with a Dirichlet Process Mixture model (DPMM), a non-parametric mixture model that automatically adjusts the number of mixture components to the data at hand. Rather than using a memory bank, we use the similarity between the component centers and the embeddings as anomaly score function to create a coarse anomaly segmentation mask. Our experiments show that through DPMM embeddings of DINOv2, despite being trained on natural images, achieve very competitive anomaly detection performance on medical imaging benchmarks and can do this while at least halving the computation time at inference. Our analysis further indicates that normalized DINOv2 embeddings are generally more aligned with anatomical structures than unnormalized features, even in the presence of anomalies, making them great representations for anomaly detection. The code is available at https://github.com/NicoSchulthess/anomalydino-dpmm.

Threshold optimization in AI chest radiography analysis: integrating real-world data and clinical subgroups.

Rudolph J, Huemmer C, Preuhs A, Buizza G, Dinkel J, Koliogiannis V, Fink N, Goller SS, Schwarze V, Heimer M, Hoppe BF, Liebig T, Ricke J, Sabel BO, Rueckel J

pubmed logopapersSep 22 2025
Manufacturer-defined AI thresholds for chest x-ray (CXR) often lack customization options. Threshold optimization strategies utilizing users' clinical real-world data along with pathology-enriched validation data may better address subgroup-specific and user-specific needs. A pathology-enriched dataset (study cohort, 563 (CXRs)) with pleural effusions, consolidations, pneumothoraces, nodules, and unremarkable findings was analysed by an AI system and six reference radiologists. The same AI model was applied to a routine dataset (clinical cohort, 15,786 consecutive routine CXRs). Iterative receiver operating characteristic analysis linked achievable sensitivities (study cohort) to resulting AI alert rates in clinical routine inpatient or outpatient subgroups. "Optimized" thresholds (OTs) were defined by a 1% sensitivity increase leading to more than a 1% rise in AI alert rates. Threshold comparisons (OTs versus AI vendor's default thresholds (AIDT) versus Youden's thresholds) were based on 400 clinical cohort cases with expert radiologists' reference. AIDTs, OTs, and Youden's thresholds varied across scenarios, with OTs differing based on tailoring for inpatient or outpatient CXRs. AIDT lowering most reasonably improved sensitivity for pleural effusion, with increases from 46.8% (AIDT) to 87.2% (OT) for outpatients and from 76.3% (AIDT) to 93.5% (OT) for inpatients; similar trends appeared for consolidations. Conversely, regarding inpatient nodule detection, increasing the threshold improved accuracy from 69.5% (AIDT) to 82.5% (OT) without compromising sensitivity. Graphical analysis supports threshold selection by illustrating estimated sensitivities and clinical routine AI alert rates. An innovative, subgroup-specific AI threshold optimization is proposed, automatically implemented and transferable to other AI algorithms and varying clinical subgroup settings. Individually customizing thresholds tailored to specific medical experts' needs and patient subgroup characteristics is promising and may enhance diagnostic accuracy and the clinical acceptance of diagnostic AI algorithms. Customizing AI thresholds individually addresses specific user/patient subgroup needs. The presented approach utilizes pathology-enriched and real-world subgroup data for optimization. Potential is shown by comparing individualized thresholds with vendor defaults. Distinct thresholds for in- and outpatient CXR AI analysis may improve perception. The automated pipeline methodology is transferable to other AI models or subgroups.

Development and Temporal Validation of a Deep Learning Model for Automatic Fetal Biometry from Ultrasound Videos.

Goetz-Fu M, Haller M, Collins T, Begusic N, Jochum F, Keeza Y, Uwineza J, Marescaux J, Weingertner AS, Sananès N, Hostettler A

pubmed logopapersSep 22 2025
The objective was to develop an artificial intelligence (AI)-based system, using deep neural network (DNN) technology, to automatically detect standard fetal planes during video capture, measure fetal biometry parameters and estimate fetal weight. A standard plane recognition DNN was trained to classify ultrasound images into four categories: head circumference (HC), abdominal circumference (AC), femur length (FL) standard planes, or 'other'. The recognized standard plane images were subsequently processed by three fetal biometry DNNs, automatically measuring HC, AC and FL. Fetal weight was then estimated with the Hadlock 3 formula. The training dataset consisted of 16,626 images. A prospective temporal validation was then conducted using an independent set of 281 ultrasound videos of healthy fetuses. Fetal weight and biometry measurements were compared against an expert sonographer. Two less experienced sonographers were used as controls. The AI system obtained a significantly lower absolute relative measurement error in fetal weight estimation than the controls (AI vs. medium-level: p = 0.032, AI vs. beginner: p < 1e-8), so in AC measurements (AI vs. medium-level: p = 1.72e-04, AI vs. beginner: p < 1e-06). Average absolute relative measurement errors of AI versus expert were: 0.96 % (S.D. 0.79 %) for HC, 1.56 % (S.D. 1.39 %) for AC, 1.77 % (S.D. 1.46 %) for FL and 3.10 % (S.D. 2.74 %) for fetal weight estimation. The AI system produced similar biometry measurements and fetal weight estimation to those of the expert sonographer. It is a promising tool to enhance non-expert sonographers' performance and reproducibility in fetal biometry measurements, and to reduce inter-operator variability.

Evaluation of Operator Variability and Validation of an AI-Assisted α-Angle Measurement System for DDH Using a Phantom Model.

Ohashi Y, Shimizu T, Koyano H, Nakamura Y, Takahashi D, Yamada K, Iwasaki N

pubmed logopapersSep 22 2025
Ultrasound examination using the Graf method is widely applied for early detection of developmental dysplasia of the hip (DDH), but intra- and inter-operator variability remains a limitation. This study aimed to quantify operator variability in hip ultrasound assessments and to validate an AI-assisted system for automated α-angle measurement to improve reproducibility. Thirty participants of different experience levels, including trained clinicians, residents, and medical students, each performed six ultrasound scans on a standardized infant hip phantom. Examination time, iliac margin inclination, and α-angle measurements were analyzed to assess intra- and inter-operator variability. In parallel, an AI-based system was developed to automatically detect anatomical landmarks and calculate α-angles from static images and dynamic video sequences. Validation was conducted using the phantom model with a known α-angle of 70°. Clinicians achieved shorter examination times and higher reproducibility than residents and students, with manual measurements systematically underestimating the reference α-angle. Static AI produced closer estimates with greater variability, whereas dynamic AI achieved the highest accuracy (mean 69.2°) and consistency with narrower limits of agreement than manual measurements. These findings confirm substantial operator variability and demonstrate that AI-assisted dynamic ultrasound analysis can improve reproducibility and reliability in routine DDH screening.

The Role of Artificial Intelligence, Including Endoscopic Diagnosis, in the Prediction of Presence, Bleeding, and Mortality of Esophageal Varices.

Furuichi Y, Nishiguchi R, Furuichi Y, Kobayashi S, Fujiwara T, Sato K

pubmed logopapersSep 18 2025
Esophagogastric varices (EGVs) are a disease that occurs as a complication of the progression of liver cirrhosis, and since bleeding can be fatal, regular endoscopy is necessary. With the development of artificial intelligence (AI) in recent years, it is beginning to be applied to predicting the presence of EGVs, predicting bleeding, and making a diagnosis and prognosis. Based on previous reports, application methods of AI can be classified into the following four categories: (1) noninvasive prediction using clinical data obtained from clinical records such as laboratory data, past history, and present illness, (2) invasive detection and prediction using endoscopy and computed tomography (CT), (3) invasive prediction using multimodal AI (clinical data and endoscopy), (4) invasive virtual measurement on the image of endoscopy and CT. These methods currently allow for the use of AI in the following ways: (1) prediction of EGVs existence, variceal grade, bleeding risk, and survival rate, (2) detection and diagnosis of esophageal varices (EVs), (3) prediction of bleeding within 1 year, (4) prediction of variceal diameter and portal pressure gradient. This review explores current studies on AI applications in assessing EGVs, highlighting their benefits, limitations, and future directions.

Real-world clinical impact of three commercial AI algorithms on musculoskeletal radiography interpretation: A prospective crossover reader study.

Prucker P, Lemke T, Mertens CJ, Ziegelmayer S, Graf MM, Weller D, Kim SH, Gassert FT, Kader A, Dorfner FJ, Meddeb A, Makowski MR, Lammert J, Huber T, Lohöfer F, Bressem KK, Adams LC, Luiken I, Busch F

pubmed logopapersSep 17 2025
To prospectively assess the diagnostic performance, workflow efficiency, and clinical impact of three commercial deep-learning tools (BoneView, Rayvolve, RBfracture) for routine musculoskeletal radiograph interpretation. From January to March 2025, two radiologists (4 and 5 years' experience) independently interpreted 1,037 adult musculoskeletal studies (2,926 radiographs) first unaided and, after 14-day washouts, with each AI tool in a randomized crossover design. Ground truth was established by confirmatory CT when available. Outcomes included sensitivity, specificity, accuracy, area under the receiver operating characteristic curve (AUC), interpretation time, diagnostic confidence (5-point Likert), and rates of additional CT recommendations and senior consultations. DeLong tests compared AUCs; Mann-Whitney U and χ2 tests assessed secondary endpoints. AI assistance did not significantly change performance for fractures, dislocations, or effusions. For fractures, AUCs were comparable to baseline (Reader 1: 96.50 % vs. 96.30-96.50 %; Reader 2: 95.35 % vs. 95.97 %; all p > 0.11). For dislocations, baseline AUCs (Reader 1: 92.66 %; Reader 2: 90.68 %) were unchanged with AI (92.76-93.95 % and 92.00 %; p ≥ 0.280). For effusions, baseline AUCs (Reader 1: 92.52 %; Reader 2: 96.75 %) were similar with AI (93.12 % and 96.99 %; p ≥ 0.157). Median interpretation times decreased with AI (Reader 1: 34 s to 21-25 s; Reader 2: 30 s to 21-26 s; all p < 0.001). Confidence improved across tools: BoneView increased combined "very good/excellent" ratings versus unaided reads (Reader 1: 509 vs. 449, p < 0.001; Reader 2: 483 vs. 439, p < 0.001); Rayvolve (Reader 1: 456 vs. 449, p = 0.029; Reader 2: 449 vs. 439, p < 0.001) and RBfracture (Reader 1: 457 vs. 449, p = 0.017; Reader 2: 448 vs. 439, p = 0.001) yielded smaller but significant gains. Reader 1 recommended fewer CT scans with AI assistance (33 vs. 22-23, p = 0.007). In a real-world clinical setting, AI-assisted interpretation of musculoskeletal radiographs reduced reading time and increased diagnostic confidence without materially affecting diagnostic performance. These findings support AI assistance as a lever for workflow efficiency and potential cost-effectiveness at scale.
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