Background and purposeAccurate estimation of Overall Survival (OS) in Non-Small Cell Lung Cancer (NSCLC) patients provides critical insights for treatment planning. While previous studies showed that radiomics and Deep Learning (DL) features increased prediction accuracy, this study aimed to examine whether a model that combines the radiomics and DL features with the clinical and dosimetric features outperformed other models. Materials and methodsWe collected pre-treatment lung CT scans and clinical data for 225 NSCLC patients from the Maastro Clinic: 180 for training and 45 for testing. Radiomics features were extracted using the Python radiomics feature extractor, and DL features were obtained using a 3D ResNet model. An ensemble model comprising XGB and NN classifiers was developed using: (1) clinical features only; (2) clinical and radiomics features; (3) clinical and DL features; and (4) clinical, radiomics, and DL features. The performance metrics were evaluated for the test and K-fold cross-validation data sets. ResultsThe prediction model utilizing only clinical variables provided an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.64 and a test accuracy of 77.55%. The best performance came from combining clinical, radiomics, and DL features (AUC: 0.84, accuracy: 85.71%). The prediction improvement of this model was statistically significant compared to models trained with clinical features alone or with a combination of clinical and radiomics features. ConclusionIntegrating radiomics and DL features with clinical characteristics improved the prediction of OS after radiotherapy for NSCLC patients. The increased accuracy of our integrated model enables personalized, risk-based treatment planning, guiding clinicians toward more effective interventions, improved patient outcomes and enhanced quality of life.

We evaluated the accuracy of ChatGPT-3.5's responses to common questions regarding acute breast symptoms and explored whether using lay language, as opposed to medical language, affected the accuracy of the responses. Questions were formulated addressing acute breast conditions, informed by the American College of Radiology (ACR) Appropriateness Criteria (AC) and our clinical experience at a tertiary referral breast center. Of these, seven addressed the most common acute breast symptoms, nine addressed pregnancy-associated breast symptoms, and four addressed specific management and imaging recommendations for a palpable breast abnormality. Questions were submitted three times to ChatGPT-3.5 and all responses were assessed by five fellowship-trained breast radiologists. Evaluation criteria included clinical judgment and adherence to the ACR guidelines, with responses scored as: 1) "appropriate," 2) "inappropriate" if any response contained inappropriate information, or 3) "unreliable" if responses were inconsistent. A majority vote determined the appropriateness for each question. ChatGPT-3.5 generated responses were appropriate for 7/7 (100 %) questions regarding common acute breast symptoms when phrased both colloquially and using standard medical terminology. In contrast, ChatGPT-3.5 generated responses were appropriate for 3/9 (33 %) questions about pregnancy-associated breast symptoms and 3/4 (75 %) questions about management and imaging recommendations for a palpable breast abnormality. ChatGPT-3.5 can automate healthcare information related to appropriate management of acute breast symptoms when prompted with both standard medical terminology or lay phrasing of the questions. However, physician oversight remains critical given the presence of inappropriate recommendations for pregnancy associated breast symptoms and management of palpable abnormalities.

This study focuses on artificial intelligence-driven classification of glioma and Ki-67 leveling using T2w-FLAIR MRI, exploring the association of Ki-67 biomarkers with deep learning (DL) features through explainable artificial intelligence (XAI) and SHapley Additive exPlanations (SHAP). This IRB-approved study included 101 patients with glioma brain tumor acquired MR images with the T2W-FLAIR sequence. We extracted DL bottleneck features using ResNet50 from glioma MR images. Principal component analysis (PCA) was deployed for dimensionality reduction. XAI was used to identify potential features. The XGBosst classified the histologic grades of the glioma and the level of Ki-67. We integrated potential DL features with patient demographics (age and sex) and Ki-67 biomarkers, utilizing SHAP to determine the model's essential features and interactions. Glioma grade classification and Ki-67 level predictions achieved overall accuracies of 0.94 and 0.91, respectively. It achieved precision scores of 0.92, 0.94, and 0.96 for glioma grades 2, 3, and 4, and 0.88, 0.94, and 0.97 for Ki-67 levels (low: 5%≤Ki-67<10%, moderate: 10%≤Ki-67≤20, and high: Ki-67>20%). Corresponding F1-scores were 0.95, 0.88, and 0.96 for glioma grades and 0.92, 0.93, and 0.87 for Ki-67 levels. SHAP analysis further highlighted a strong association between bottleneck DL features and Ki-67 biomarkers, demonstrating their potential to differentiate glioma grades and Ki-67 levels while offering valuable insights into glioma aggressiveness. This study demonstrates the precise classification of glioma grades and the prediction of Ki-67 levels to underscore the potential of AI-driven MRI analysis to enhance clinical decision-making in glioma management.

Three-dimensional (3D) ultrasound (US) aims to provide sonographers with the spatial relationships of anatomical structures, playing a crucial role in clinical diagnosis. Recently, deep-learning-based freehand 3D US has made significant advancements. It reconstructs volumes by estimating transformations between images without external tracking. However, image-only reconstruction poses difficulties in reducing cumulative drift and further improving reconstruction accuracy, particularly in scenarios involving complex motion trajectories. In this context, we propose an enhanced motion network (MoNetV2) to enhance the accuracy and generalizability of reconstruction under diverse scanning velocities and tactics. First, we propose a sensor-based temporal and multi-branch structure that fuses image and motion information from a velocity perspective to improve image-only reconstruction accuracy. Second, we devise an online multi-level consistency constraint that exploits the inherent consistency of scans to handle various scanning velocities and tactics. This constraint exploits both scan-level velocity consistency, path-level appearance consistency, and patch-level motion consistency to supervise inter-frame transformation estimation. Third, we distill an online multi-modal self-supervised strategy that leverages the correlation between network estimation and motion information to further reduce cumulative errors. Extensive experiments clearly demonstrate that MoNetV2 surpasses existing methods in both reconstruction quality and generalizability performance across three large datasets.

Retrospective single-institution study. To develop and validate an automated convolutional neural network (CNN) to measure the Cobb angle, T1 tilt angle, coronal balance, clavicular angle, height of the shoulders, T5-T12 Cobb angle, and sagittal balance for accurate scoliosis diagnosis. Scoliosis, characterized by a Cobb angle >10°, requires accurate and reliable measurements to guide treatment. Traditional manual measurements are time-consuming and have low interobserver and intraobserver reliability. While some automated tools exist, they often require manual intervention and focus primarily on the Cobb angle. In this study, we utilized four data sets comprising the anterior-posterior (AP) and lateral radiographs of 1682 patients with scoliosis. The CNN includes coarse segmentation, landmark localization, and fine segmentation. The measurements were evaluated using the dice coefficient, mean absolute error (MAE), and percentage of correct key-points (PCK) with a 3-mm threshold. An internal testing set, including 87 adolescent (7-16 yr) and 26 older adult patients (≥60 yr), was used to evaluate the agreement between automated and manual measurements. The automated measures by the CNN achieved high mean dice coefficients (>0.90), PCK of 89.7%-93.7%, and MAE for vertebral corners of 2.87-3.62 mm on AP radiographs. Agreement on the internal testing set for manual measurements was acceptable, with an MAE of 0.26 mm or degree-0.51 mm or degree for the adolescent subgroup and 0.29 mm or degree-4.93 mm or degree for the older adult subgroup on AP radiographs. The MAE for the T5-T12 Cobb angle and sagittal balance, on lateral radiographs, was 1.03° and 0.84 mm, respectively, in adolescents, and 4.60° and 9.41 mm, respectively, in older adults. Automated measurement time was significantly shorter compared with manual measurements. The deep learning automated system provides rapid, accurate, and reliable measurements for scoliosis diagnosis, which could improve clinical workflow efficiency and guide scoliosis treatment. Level III.

The study of biological age prediction using various biological data has been widely explored. However, single biological data may offer limited insights into the pathological process of aging and diseases. Here we evaluated the performance of machine learning models for biological age prediction by using the integrated features from multi-biological data of 140 healthy controls and 43 patients with schizophrenia, including brain MRI, gut microbiome, and blood data. Our results revealed that the models using multi-biological data achieved higher predictive accuracy than those using only brain MRI. Feature interpretability analysis of the optimal model elucidated that the substantial contributions of the frontal lobe, the temporal lobe and the fornix were effective for biological age prediction. Notably, patients with schizophrenia exhibited a pronounced increase in the predicted biological age gap (BAG) when compared to healthy controls. Moreover, the BAG in the SZ group was negatively and positively correlated with the MCCB and PANSS scores, respectively. These findings underscore the potential of BAG as a valuable biomarker for assessing cognitive decline and symptom severity of neuropsychiatric disorders.

Major Depressive Disorder (MDD) and Bipolar Disorder (BD) exhibit overlapping depressive symptoms, complicating their differentiation in clinical practice. Traditional neuroimaging studies have focused on specific regions of interest, but few have employed whole-brain analyses like regional homogeneity (ReHo). This study aims to differentiate MDD from BD by identifying key brain regions with abnormal ReHo and using advanced machine learning techniques to improve diagnostic accuracy. A total of 63 BD patients, 65 MDD patients, and 70 healthy controls were recruited from the Shanghai Mental Health Center. Resting-state functional MRI (rs-fMRI) was used to analyze ReHo across the brain. We applied Support Vector Machine (SVM) and SVM-Recursive Feature Elimination (SVM-RFE), a robust machine learning model known for its high precision in feature selection and classification, to identify critical brain regions that could serve as biomarkers for distinguishing BD from MDD. SVM-RFE allows for the recursive removal of non-informative features, enhancing the model's ability to accurately classify patients. Correlations between ReHo values and clinical scores were also evaluated. ReHo analysis revealed significant differences in several brain regions. The study results revealed that, compared to healthy controls, both BD and MDD patients exhibited reduced ReHo in the superior parietal gyrus. Additionally, MDD patients showed decreased ReHo values in the Right Lenticular nucleus, putamen (PUT.R), Right Angular gyrus (ANG.R), and Left Superior occipital gyrus (SOG.L). Compared to the MDD group, BD patients exhibited increased ReHo values in the Left Inferior occipital gyrus (IOG.L). In BD patients only, the reduction in ReHo values in the right superior parietal gyrus and the right angular gyrus was positively correlated with Hamilton Depression Scale (HAMD) scores. SVM-RFE identified the IOG.L, SOG.L, and PUT.R as the most critical features, achieving an area under the curve (AUC) of 0.872, with high sensitivity and specificity in distinguishing BD from MDD. This study demonstrates that BD and MDD patients exhibit distinct patterns of regional brain activity, particularly in the occipital and parietal regions. The combination of ReHo analysis and SVM-RFE provides a powerful approach for identifying potential biomarkers, with the left inferior occipital gyrus, left superior occipital gyrus, and right putamen emerging as key differentiating regions. These findings offer valuable insights for improving the diagnostic accuracy between BD and MDD, contributing to more targeted treatment strategies.

This study aims to develop a radiomics machine learning (ML) model that uses preoperative computed tomography angiography (CTA) data to predict the prognosis of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) patients. In this retrospective study, 164 AAA patients underwent EVAR and were categorized into shrinkage (good prognosis) or stable (poor prognosis) groups based on post-EVAR sac regression. From preoperative AAA and perivascular adipose tissue (PVAT) image, radiomics features (RFs) were extracted for model creation. Patients were split into 80 % training and 20 % test sets. A support vector machine model was constructed for prediction. Accuracy is evaluated via the area under the receiver operating characteristic curve (AUC). Demographics and comorbidities showed no significant differences between shrinkage and stable groups. The model containing 5 AAA RFs (which are original_firstorder_InterquartileRange, log-sigma-3-0-mm-3D_glrlm_GrayLevelNonUniformityNormalized, log-sigma-3-0-mm-3D_glrlm_RunPercentage, log-sigma-4-0-mm-3D_glrlm_ShortRunLowGrayLevelEmphasis, wavelet-LLH_glcm_SumEntropy) had AUCs of 0.86 (training) and 0.77 (test). The model containing 7 PVAT RFs (which are log-sigma-3-0-mm-3D_firstorder_InterquartileRange, log-sigma-3-0-mm-3D_glcm_Correlation, wavelet-LHL_firstorder_Energy, wavelet-LHL_firstorder_TotalEnergy, wavelet-LHH_firstorder_Mean, wavelet-LHH_glcm_Idmn, wavelet-LHH_glszm_GrayLevelNonUniformityNormalized) had AUCs of 0.76 (training) and 0.78 (test). Combining AAA and PVAT RFs yielded the highest accuracy: AUCs of 0.93 (training) and 0.87 (test). Radiomics-based CTA model predicts aneurysm sac regression post-EVAR in AAA patients. PVAT RFs from preoperative CTA images were closely related to AAA prognosis after EVAR, enhancing accuracy when combined with AAA RFs. This preliminary study explores a predictive model designed to assist clinicians in optimizing therapeutic strategies during clinical decision-making processes.

Early screening for gastrointestinal (GI) diseases is critical for preventing cancer development. With the rapid advancement of deep learning technology, artificial intelligence (AI) has become increasingly prominent in the early detection of GI diseases. Capsule endoscopy is a non-invasive medical imaging technique used to examine the gastrointestinal tract. In our previous work, we developed a near-infrared fluorescence capsule endoscope (NIRF-CE) capable of exciting and capturing near-infrared (NIR) fluorescence images to specifically identify subtle mucosal microlesions and submucosal abnormalities while simultaneously capturing conventional white-light images to detect lesions with significant morphological changes. However, limitations such as low camera resolution and poor lighting within the gastrointestinal tract may lead to misdiagnosis and other medical errors. Manually reviewing and interpreting large volumes of capsule endoscopy images is time-consuming and prone to errors. Deep learning models have shown potential in automatically detecting abnormalities in NIRF-CE images. This study focuses on an improved deep learning model called Retinex-Attention-YOLO (RAY), which is based on single-modality image data and built on the YOLO series of object detection models. RAY enhances the accuracy and efficiency of anomaly detection, especially under low-light conditions. To further improve detection performance, we also propose a multimodal deep learning model, Multimodal-Retinex-Attention-YOLO (MRAY), which combines both white-light and fluorescence image data. The dataset used in this study consists of images of pig stomachs captured by our NIRF-CE system, simulating the human GI tract. In conjunction with a targeted fluorescent probe, which accumulates at lesion sites and releases fluorescent signals for imaging when abnormalities are present, a bright spot indicates a lesion. The MRAY model achieved an impressive precision of 96.3%, outperforming similar object detection models. To further validate the model's performance, ablation experiments were conducted, and comparisons were made with publicly available datasets. MRAY shows great promise for the automated detection of GI cancers, ulcers, inflammations, and other medical conditions in clinical practice.

Fairness concerns stemming from known and unknown biases in healthcare practices have raised questions about the trustworthiness of Artificial Intelligence (AI)-driven Clinical Decision Support Systems (CDSS). Studies have shown unforeseen performance disparities in subpopulations when applied to clinical settings different from training. Existing unfairness mitigation strategies often struggle with scalability and accessibility, while their pursuit of group-level prediction performance parity does not effectively translate into fairness at the point of care. This study introduces FairICP, a flexible and cost-effective post-implementation framework based on Inductive Conformal Prediction (ICP), to provide users with actionable knowledge of model uncertainty due to subpopulation level biases at the point of care. FairICP applies ICP to identify the model's scope of competence through group specific calibration, ensuring equitable prediction reliability by filtering predictions that fall within the trusted competence boundaries. We evaluated FairICP against four benchmarks on three medical imaging modalities: (1) Cardiac Magnetic Resonance Imaging (MRI), (2) Chest X-ray and (3) Dermatology Imaging, acquired from both private and large public datasets. Frameworks are assessed on prediction performance enhancement and unfairness mitigation capabilities. Compared to the baseline, FairICP improved prediction accuracy by 7.2% and reduced the accuracy gap between the privileged and unprivileged subpopulations by 2.2% on average across all three datasets. Our work provides a robust solution to promote trust and transparency in AI-CDSS, fostering equality and equity in healthcare for diverse patient populations. Such post-process methods are critical to enabling a robust framework for AI-CDSS implementation and monitoring for healthcare settings.