Lucian Itu

Manuela Daniela Danu, George Marica, Sanjeev Kumar Karn et al.

Among all the sub-sections in a typical radiology report, the Clinical Indications, Findings, and Impression often reflect important details about the health status of a patient. The information included in Impression is also often covered in Findings. While Findings and Impression can be deduced by inspecting the image, Clinical Indications often require additional context. The cognitive task of interpreting medical images remains the most critical and often time-consuming step in the radiology workflow. Instead of generating an end-to-end radiology report, in this paper, we focus on generating the Findings from automated interpretation of medical images, specifically chest X-rays (CXRs). Thus, this work focuses on reducing the workload of radiologists who spend most of their time either writing or narrating the Findings. Unlike past research, which addresses radiology report generation as a single-step image captioning task, we have further taken into consideration the complexity of interpreting CXR images and propose a two-step approach: (a) detecting the regions with abnormalities in the image, and (b) generating relevant text for regions with abnormalities by employing a generative large language model (LLM). This two-step approach introduces a layer of interpretability and aligns the framework with the systematic reasoning that radiologists use when reviewing a CXR.

Andreea Bianca Popescu, Cosmin Ioan Nita, Ioana Antonia Taca et al.

Deep learning (DL)-based solutions have been extensively researched in the medical domain in recent years, enhancing the efficacy of diagnosis, planning, and treatment. Since the usage of health-related data is strictly regulated, processing medical records outside the hospital environment for developing and using DL models demands robust data protection measures. At the same time, it can be challenging to guarantee that a DL solution delivers a minimum level of performance when being trained on secured data, without being specifically designed for the given task. Our approach uses singular value decomposition (SVD) and principal component analysis (PCA) to obfuscate the medical images before employing them in the DL analysis. The capability of DL algorithms to extract relevant information from secured data is assessed on a task of angiographic view classification based on obfuscated frames. The security level is probed by simulated artificial intelligence (AI)-based reconstruction attacks, considering two threat actors with different prior knowledge of the targeted data. The degree of privacy is quantitatively measured using similarity indices. Although a trade-off between privacy and accuracy should be considered, the proposed technique allows for training the angiographic view classifier exclusively on secured data with satisfactory performance and with no computational overhead, model adaptation, or hyperparameter tuning. While the obfuscated medical image content is well protected against human perception, the hypothetical reconstruction attack proved that it is also difficult to recover the complete information of the original frames.

Manuela Daniela Danu, George Marica, Constantin Suciu et al.

The rapidly increasing volume of electronic health record (EHR) data underscores a pressing need to unlock biomedical knowledge from unstructured clinical texts to support advancements in data-driven clinical systems, including patient diagnosis, disease progression monitoring, treatment effects assessment, prediction of future clinical events, etc. While contextualized language models have demonstrated impressive performance improvements for named entity recognition (NER) systems in English corpora, there remains a scarcity of research focused on clinical texts in low-resource languages. To bridge this gap, our study aims to develop multiple deep contextual embedding models to enhance clinical NER in the cardiology domain, as part of the BioASQ MultiCardioNER shared task. We explore the effectiveness of different monolingual and multilingual BERT-based models, trained on general domain text, for extracting disease and medication mentions from clinical case reports written in English, Spanish, and Italian. We achieved an F1-score of 77.88% on Spanish Diseases Recognition (SDR), 92.09% on Spanish Medications Recognition (SMR), 91.74% on English Medications Recognition (EMR), and 88.9% on Italian Medications Recognition (IMR). These results outperform the mean and median F1 scores in the test leaderboard across all subtasks, with the mean/median values being: 69.61%/75.66% for SDR, 81.22%/90.18% for SMR, 89.2%/88.96% for EMR, and 82.8%/87.76% for IMR.

Andreea Bianca Popescu, Andreas Seitz, Heiko Mahrholdt et al.

Objectives Parametric tissue mapping enables quantitative cardiac tissue characterization but is limited by inter-observer variability during manual delineation. Traditional approaches relying on average relaxation values and single cutoffs may oversimplify myocardial complexity. This study evaluates whether deep learning (DL) can achieve segmentation accuracy comparable to inter-observer variability, explores the utility of statistical features beyond mean T1/T2 values, and assesses whether machine learning (ML) combining multiple features enhances disease detection. Materials & Methods T1 and T2 maps were manually segmented. The test subset was independently annotated by two observers, and inter-observer variability was assessed. A DL model was trained to segment left ventricle blood pool and myocardium. Average (A), lower quartile (LQ), median (M), and upper quartile (UQ) were computed for the myocardial pixels and employed in classification by applying cutoffs or in ML. Dice similarity coefficient (DICE) and mean absolute percentage error evaluated segmentation performance. Bland-Altman plots assessed inter-user and model-observer agreement. Receiver operating characteristic analysis determined optimal cutoffs. Pearson correlation compared features from model and manual segmentations. F1-score, precision, and recall evaluated classification performance. Wilcoxon test assessed differences between classification methods, with p < 0.05 considered statistically significant. Results 144 subjects were split into training (100), validation (15) and evaluation (29) subsets. Segmentation model achieved a DICE of 85.4%, surpassing inter-observer agreement. Random forest applied to all features increased F1-score (92.7%, p < 0.001). Conclusion DL facilitates segmentation of T1/ T2 maps. Combining multiple features with ML improves disease detection.

Cosmin-Andrei Hatfaludi, Daniel Bunescu, Costin Florian Ciusdel et al.

Coronary artery disease (CAD) is the dominant cause of death and hospitalization across the globe. Atherosclerosis, an inflammatory condition that gradually narrows arteries and has potentially fatal effects, is the most frequent cause of CAD. Nonetheless, the circulation regularly adapts in the presence of atherosclerosis, through the formation of collateral arteries, resulting in significant long-term health benefits. Therefore, timely detection of coronary collateral circulation (CCC) is crucial for CAD personalized medicine. We propose a novel deep learning based method to detect CCC in angiographic images. Our method relies on a convolutional backbone to extract spatial features from each frame of an angiography sequence. The features are then concatenated, and subsequently processed by another convolutional layer that processes embeddings temporally. Due to scarcity of data, we also experiment with pretraining the backbone on coronary artery segmentation, which improves the results consistently. Moreover, we experiment with few-shot learning to further improve performance, given our low data regime. We present our results together with subgroup analyses based on Rentrop grading, collateral flow, and collateral grading, which provide valuable insights into model performance. Overall, the proposed method shows promising results in detecting CCC, and can be further extended to perform landmark based CCC detection and CCC quantification.

Costin Ciusdel, Alexandru Turcea, Andrei Puiu et al.

Invasive coronary angiography (ICA) is the gold standard in Coronary Artery Disease (CAD) imaging. Detection of the end-diastolic frame (EDF) and, in general, cardiac phase detection on each temporal frame of a coronary angiography acquisition is of significant importance for the anatomical and non-invasive functional assessment of CAD. This task is generally performed via manual frame selection or semi-automated selection based on simultaneously acquired ECG signals - thus introducing the requirement of simultaneous ECG recordings. We evaluate the performance of a purely image based workflow based on deep neural networks for fully automated cardiac phase and EDF detection on coronary angiographies. A first deep neural network (DNN), trained to detect coronary arteries, is employed to preselect a subset of frames in which coronary arteries are well visible. A second DNN predicts cardiac phase labels for each frame. Only in the training and evaluation phases for the second DNN, ECG signals are used to provide ground truth labels for each angiographic frame. The networks were trained on 17800 coronary angiographies from 3900 patients and evaluated on 27900 coronary angiographies from 6250 patients. No exclusion criteria related to patient state, previous interventions, or pathology were formulated. Cardiac phase detection had an accuracy of 97.6%, a sensitivity of 97.6% and a specificity of 97.5% on the evaluation set. EDF prediction had a precision of 97.4% and a recall of 96.9%. Several sub-group analyses were performed, indicating that the cardiac phase detection performance is largely independent from acquisition angles and the heart rate of the patient. The average execution time of cardiac phase detection for one angiographic series was on average less than five seconds on a standard workstation.

Dominik Neumann, Tommaso Mansi, Lucian Itu et al.

Personalization is the process of fitting a model to patient data, a critical step towards application of multi-physics computational models in clinical practice. Designing robust personalization algorithms is often a tedious, time-consuming, model- and data-specific process. We propose to use artificial intelligence concepts to learn this task, inspired by how human experts manually perform it. The problem is reformulated in terms of reinforcement learning. In an off-line phase, Vito, our self-taught artificial agent, learns a representative decision process model through exploration of the computational model: it learns how the model behaves under change of parameters. The agent then automatically learns an optimal strategy for on-line personalization. The algorithm is model-independent; applying it to a new model requires only adjusting few hyper-parameters of the agent and defining the observations to match. The full knowledge of the model itself is not required. Vito was tested in a synthetic scenario, showing that it could learn how to optimize cost functions generically. Then Vito was applied to the inverse problem of cardiac electrophysiology and the personalization of a whole-body circulation model. The obtained results suggested that Vito could achieve equivalent, if not better goodness of fit than standard methods, while being more robust (up to 11% higher success rates) and with faster (up to seven times) convergence rate. Our artificial intelligence approach could thus make personalization algorithms generalizable and self-adaptable to any patient and any model.