Advancing human-centric AI for robust X-ray analysis through holistic self-supervised learning

AI Foundation models are gaining traction in various applications, including medical fields like radiology. However, medical foundation models are often tested on limited tasks, leaving their generalisability and biases unexplored. We present RayDINO, a large visual encoder trained by self-supervision on 873k chest X-rays. We compare RayDINO to previous state-of-the-art models across nine radiology tasks, from classification and dense segmentation to text generation, and provide an in depth analysis of population, age and sex biases of our model. Our findings suggest that self-supervision allows patient-centric AI proving useful in clinical workflows and interpreting X-rays holistically. With RayDINO and small task-specific adapters, we reach state-of-the-art results and improve generalization to unseen populations while mitigating bias, illustrating the true promise of foundation models: versatility and robustness

Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Purpose:We aimed to identify modifiable and nonmodifiable risk factors for hemoptysis complicating computed tomography (CT)-guided transthoracic needle biopsy.Methods:All procedures performed in our institution from November 2013 to May 2015 were reviewed. Hemoptysis was classified as mild if limited to hemoptoic sputum and abundant otherwise. Presence of intra-alveolar hemorrhage on postbiopsy CT images was also evaluated. Patient- and lesion-related variables were considered nonmodifiable, while procedure-related variables were considered modifiable.Results:A total of 249 procedures were evaluated. Hemoptysis and alveolar hemorrhage occurred in 18% and 58% of procedures, respectively, and were abundant or significant in 8% and 17% of procedures, respectively. Concordance between the occurrence of significant alveolar hemorrhage (grade ≥2) and hemoptysis was poor (κ=0.28; 95% CI [0.16–0.40]). In multivariate analysis, female gender (P = 0.008), a longer transpulmonary needle path (P = 0.014), and smaller lesion size (P = 0.044) were independent risk factors for hemoptysis. Transpulmonary needle-path length was the only risk factor for abundant hemoptysis with borderline statistical significance (P = 0.049).Conclusion:The transpulmonary needle path should be as short as possible to reduce the risk of abundant hemoptysis during CT-guided transthoracic needle biopsy

Willingness to participate in combination screening for lung cancer, chronic obstructive pulmonary disease and cardiovascular disease in four European countries

OBJECTIVES: Lung cancer screening (LCS), using low-dose computed tomography (LDCT), can be more efficient by simultaneously screening for chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), the Big-3 diseases. This study aimed to determine the willingness to participate in (combinations of) Big-3 screening in four European countries and the relative importance of amendable participation barriers.METHODS: An online cross-sectional survey aimed at (former) smokers aged 50-75 years elicited the willingness of individuals to participate in Big-3 screening and used analytical hierarchy processing (AHP) to determine the importance of participation barriers.RESULTS: Respondents were from France (n = 391), Germany (n = 338), Italy (n = 399), and the Netherlands (n = 342), and consisted of 51.2% men. The willingness to participate in screening was marginally influenced by the diseases screened for (maximum difference of 3.1%, for Big-3 screening (73.4%) vs. lung cancer and COPD screening (70.3%)) and by country (maximum difference of 3.7%, between France (68.5%) and the Netherlands (72.3%)). The largest effect on willingness to participate was personal perceived risk of lung cancer. The most important barriers were the missed cases during screening (weight 0.19) and frequency of screening (weight 0.14), while diseases screened for (weight 0.11) ranked low.CONCLUSIONS: The difference in willingness to participate in LCS showed marginal increase with inclusion of more diseases and limited variation between countries. A marginal increase in participation might result in a marginal additional benefit of Big-3 screening. The amendable participation barriers are similar to previous studies, and the new criterion, diseases screened for, is relatively unimportant.CLINICAL RELEVANCE STATEMENT: Adding diseases to combination screening modestly improves participation, driven by personal perceived risk. These findings guide program design and campaigns for lung cancer and Big-3 screening. Benefits of Big-3 screening lie in long-term health and economic impact, not participation increase.KEY POINTS: • It is unknown whether or how combination screening might affect participation. • The addition of chronic obstructive pulmonary disease and cardiovascular disease to lung cancer screening resulted in a marginal increase in willingness to participate. • The primary determinant influencing individuals' engagement in such programs is their personal perceived risk of the disease.</p

Willingness to participate in combination screening for lung cancer, chronic obstructive pulmonary disease and cardiovascular disease in four European countries

OBJECTIVES: Lung cancer screening (LCS), using low-dose computed tomography (LDCT), can be more efficient by simultaneously screening for chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), the Big-3 diseases. This study aimed to determine the willingness to participate in (combinations of) Big-3 screening in four European countries and the relative importance of amendable participation barriers.METHODS: An online cross-sectional survey aimed at (former) smokers aged 50-75 years elicited the willingness of individuals to participate in Big-3 screening and used analytical hierarchy processing (AHP) to determine the importance of participation barriers.RESULTS: Respondents were from France (n = 391), Germany (n = 338), Italy (n = 399), and the Netherlands (n = 342), and consisted of 51.2% men. The willingness to participate in screening was marginally influenced by the diseases screened for (maximum difference of 3.1%, for Big-3 screening (73.4%) vs. lung cancer and COPD screening (70.3%)) and by country (maximum difference of 3.7%, between France (68.5%) and the Netherlands (72.3%)). The largest effect on willingness to participate was personal perceived risk of lung cancer. The most important barriers were the missed cases during screening (weight 0.19) and frequency of screening (weight 0.14), while diseases screened for (weight 0.11) ranked low.CONCLUSIONS: The difference in willingness to participate in LCS showed marginal increase with inclusion of more diseases and limited variation between countries. A marginal increase in participation might result in a marginal additional benefit of Big-3 screening. The amendable participation barriers are similar to previous studies, and the new criterion, diseases screened for, is relatively unimportant.CLINICAL RELEVANCE STATEMENT: Adding diseases to combination screening modestly improves participation, driven by personal perceived risk. These findings guide program design and campaigns for lung cancer and Big-3 screening. Benefits of Big-3 screening lie in long-term health and economic impact, not participation increase.KEY POINTS: • It is unknown whether or how combination screening might affect participation. • The addition of chronic obstructive pulmonary disease and cardiovascular disease to lung cancer screening resulted in a marginal increase in willingness to participate. • The primary determinant influencing individuals' engagement in such programs is their personal perceived risk of the disease.</p

Automatic detection of pulmonary nodules: Evaluation of performance using two different MDCT scanners

The purpose of this study was to evaluate the diagnostic performance of a computer-aided diagnosis (CAD) system, on the detection of pulmonary nodules in multidetector row computed tomography (MDCT) images, by using two different MDCT scanners. The computerized scheme was based on the iris filter. We have collected CT cases of patients with pulmonary nodules. We have included in the study one hundred and thirty-two calcified and noncalcified nodules, measuring 4-30 mm in diameter. CT examinations were performed by using two different equipments: a CT scanner (SOMATOM Emotion 6), and a dual-source computed tomography system (SOMATOM Definition) (Siemens Medical System, Forchheim, Germany), with the following parameters: collimation, 6x1.0mm (Emotion 6); and 64×0.6mm (Definition); 100-130 kV; 70-110 mAs. Data were reconstructed with a slice thickness of 1.25mm (Emotion 6) and 1mm (Definition). True positive cases were determined by an independent interpretation of the study by three experienced chest radiologists, the panel decision being used as the reference standard. Free-response Receiver Operating Characteristic curves, sensitivity and number of false-positive per scan, were calculated. Our CAD scheme, for the test set of the study, yielded a sensitivity of 80%, with an average of 5.2 FPs per examination. At an average false positive rate of 9 per scan, our CAD scheme achieved sensitivities of 94% for all nodules, 94.5% for solid, 80% for non-solid, 84% for spiculated, and 97% for non-spiculated nodules. These encouraging results suggest that our CAD system, advocated as a second reader, may help radiologists in the detection of lung nodules in MDCTThis work has been partially supported by the Xunta de Galicia (expte. nº PGIDIT06BTF20802PR), and by the FIS (expte. nº PI060058) and (expte. nº PI080072)S

COVID‑19 pneumonia imaging follow‑up: when and how? A proposition from ESTI and ESR

Abstract This document from the European Society of Thoracic Imaging (ESTI) and the European Society of Radiology (ESR) discusses the role of imaging in the long-term follow-up of COVID-19 patients, to define which patients may benefit from imaging, and what imaging modalities and protocols should be used. Insights into imaging features encountered on computed tomography (CT) scans and potential pitfalls are discussed and possible areas for future review and research are also included. Key Points • Post-COVID-19 pneumonia changes are mainly consistent with prior organizing pneumonia and are likely to disappear within 12 months of recovery from the acute infection in the majority of patients. • At present, with the longest series of follow-up examinations reported not exceeding 12 months, the development of persistent or progressive fibrosis in at least some individuals cannot yet be excluded. • Residual ground glass opacification may be associated with persisting bronchial dilatation and distortion, and might be termed “fibrotic-like changes” probably consistent with prior organizing pneumonia.publishedVersio

Feedback in radiology: essential tool for improving user experience and providing value-based care

Measuring the value that radiology brings to patient care can be challenging. A positive patient experience is consistently associated with patient safety, clinical effectiveness, and outcome measures and is therefore a tool for measuring value-based care. Monitoring the experience of users of radiology services is an indispensable component of quality improvement programmes for radiology departments. The integration of comprehensive feedback mechanisms brings numerous benefits, including enhanced care, strengthened trust, and greater engagement with our stakeholders and service users. Feedback should be collected from a variety of stakeholders through a 360-degree approach, combining both systematically performed structured methods, such as formal surveys, and unstructured methods, such as informal and opportunistic information gathering during multidisciplinary rounds. To maximise the impact of feedback, it should be frequent and diverse, ensuring that all perspectives are considered. Leaders in radiology must prioritise embedding a culture of feedback within their institutions, recognising its crucial role in continuous improvement. It is essential to ensure that our departments consistently provide value to our most important stakeholders—the patients—but also to our referrers and trainees. In this article, we consider methods for collecting feedback and provide some of the key findings from the literature. By fostering an environment that values and acts upon feedback, we can achieve significant advancements in patient care and overall service quality in radiology