Search Results (60)

Objectives: Deep learning-based artificial intelligence (AI) tools have been gradually used to detect and segment pulmonary nodules in clinical practice. This study aimed to assess the diagnostic performance of quantitative measures derived from a commercially available AI software for predicting the invasiveness of pulmonary adenocarcinomas that manifested as pure ground-glass nodules (pGGNs) on low-dose CT (LDCT) in lung cancer screening. Methods: A total of 388 pGGNs were consecutively enrolled and divided into a training cohort (198 from center 1 between February 2019 and April 2022), testing cohort (99 from center 1 between April 2022 and March 2023), and external validation cohort (91 from centers 2 and 3 between January 2021 and August 2023). The automatically extracted quantitative measures included diameter, volume, attenuation, and mass. The diameter was also manually measured by radiologists. The agreement of diameter between AI and radiologists was evaluated by intra-class correlation coefficient (ICC) and Bland–Altman method. The diagnostic performance was evaluated by the area under curve (AUC) of receiver operating characteristic curve. Results: The ICCs of diameter between AI and radiologists were from 0.972 to 0.981 and Bland–Altman biases were from −1.9% to −2.3%. The mass showed the highest AUCs of 0.915 (0.867–0.950), 0.913 (0.840–0.960), and 0.893 (0.810–0.948) in the training, testing, and external validation cohorts, which were higher than those of diameters of radiologists and AI, volume, and attenuation (all p < 0.05). Conclusions: The automated measurement of pGGNs diameter using the AI software demonstrated comparable accuracy to that of radiologists on LDCT images. Among the quantitative measures of diameter, volume, attenuation, and mass, mass was the most optimal predictor of invasiveness in pulmonary adenocarcinomas on LDCT, which might be used to assist clinical decision of pGGNs during lung cancer screening. Full article

Background and Objectives: The accurate segmentation of pulmonary nodules in computed tomography (CT) remains a critical yet challenging task due to variations in nodule size, shape, and boundary ambiguity. This study proposes CAAF-ResUNet (Context-Aware Adaptive Attention Fusion ResUNet), a novel deep learning model designed to address these challenges through adaptive feature fusion and edge-sensitive learning. Materials and Methods: Central to our approach is the Adaptive Attention Controller (AAC), which dynamically adjusts the contribution of channel and position attention based on contextual features in each input. To further enhance boundary localization, we incorporate three complementary boundary-aware loss functions: Sobel, Laplacian, and Hausdorff. Results: An extensive evaluation of two benchmark datasets demonstrates the superiority of the proposed model, achieving Dice scores of 90.88% on LUNA16 and 85.92% on LIDC-IDRI, both exceeding prior state-of-the-art methods. A clinical validation of a dataset comprising 804 CT slices from 35 patients at the University Medical Center of Ho Chi Minh City confirmed the model’s practical reliability, yielding a Dice score of 95.34% and a notably low Miss Rate of 4.60% under the Hausdorff loss configuration. Conclusions: These results establish CAAF-ResUNet as a robust and clinically viable solution for pulmonary nodule segmentation, offering enhanced boundary precision and minimized false negatives, two critical properties in early-stage lung cancer diagnosis and radiological decision support. Full article

Background/Objectives: Lung cancer is a major global health challenge and the leading cause of cancer-related mortality, due to its high morbidity and mortality rates. Early and accurate diagnosis is crucial for improving patient outcomes. Computed tomography (CT) imaging plays a vital role in detection, and deep learning (DL) has emerged as a transformative tool to enhance diagnostic precision and enable early identification. This systematic review examined the advancements, challenges, and clinical implications of DL in lung cancer diagnosis via CT imaging, focusing on model performance, data variability, generalizability, and clinical integration. Methods: Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we analyzed 1448 articles published between 2015 and 2024. These articles are sourced from major scientific databases, including the Institute of Electrical and Electronics Engineers (IEEE), Scopus, Springer, PubMed, and Multidisciplinary Digital Publishing Institute (MDPI). After applying stringent inclusion and exclusion criteria, we selected 80 articles for review and analysis. Our analysis evaluated DL methodologies for lung nodule detection, segmentation, and classification, identified methodological limitations, and examined challenges to clinical adoption. Results: Deep learning (DL) models demonstrated high accuracy, achieving nodule detection rates exceeding 95% (with a maximum false-positive rate of 4 per scan) and a classification accuracy of 99% (sensitivity: 98%). However, challenges persist, including dataset scarcity, annotation variability, and population generalizability. Hybrid architectures, such as convolutional neural networks (CNNs) and transformers, show promise in improving nodule localization. Nevertheless, fewer than 15% of the studies validated models using multicenter datasets or diverse demographic data. Conclusions: While DL exhibits significant potential for lung cancer diagnosis, limitations in reproducibility and real-world applicability hinder its clinical translation. Future research should prioritize explainable artificial intelligence (AI) frameworks, multimodal integration, and rigorous external validation across diverse clinical settings and patient populations to bridge the gap between theoretical innovation and practical deployment. Full article

Radiomics, an emerging discipline integrating imaging science, computational biology, and clinical oncology, enables the extraction of quantitative biomarkers from medical images for improved diagnosis and prognosis. However, variability in imaging protocols and insufficient validation studies hinder the clinical reliability of these biomarkers, limiting their integration into precision medicine. This study addresses these challenges by proposing an RW-ensemble method for extracting and validating radiomic features from segmented lung nodules. Using the Lung CT-Diagnosis dataset, which comprises CT images of 61 patients with segmentation annotations, nearly 38 radiomic features were extracted, incorporating texture-based features from the Grey-Level Co-occurrence Matrix (GLCM) and Grey-Level Run Length Matrix (GLRLM), as well as histogram-based features. The extracted features were validated against ground-truth data using Spearman’s correlation coefficient (SCC), demonstrating moderate to strong correlations. These findings confirm the robustness of the RW-ensemble segmentation and reinforce the potential of radiomics in enhancing diagnostic accuracy and guiding therapeutic decisions in precision oncology. Establishing the reliability and reproducibility of these features is crucial for their seamless clinical integration, ultimately advancing the role of radiomics in the diagnosis and treatment of lung adenocarcinoma. Full article

Lung cancer is by far the leading cause of cancer death among both men and women, making up almost 25% of all cancer deaths Each year, more people die of lung cancer than colon, breast, and prostate cancer combined. The early detection of lung cancer is critical for improving patient outcomes, and automation through advanced image analysis techniques can significantly assist radiologists. This paper presents the development and evaluation of a computer-aided diagnostic system for lung cancer screening, focusing on pulmonary nodule segmentation in low-dose CT images, by employing HighRes3DNet. HighRes3DNet is a specialized 3D convolutional neural network (CNN) architecture based on ResNet principles which uses residual connections to efficiently learn complex spatial features from 3D volumetric data. To address the challenges of processing large CT volumes, an efficient patch-based extraction pipeline was developed. This method dynamically extracts 3D patches during training with a probabilistic approach, prioritizing patches likely to contain nodules while maintaining diversity. Data augmentation techniques, including random flips, affine transformations, elastic deformations, and swaps, were applied in the 3D space to enhance the robustness of the training process and mitigate overfitting. Using a public low-dose CT dataset, this approach achieved a Dice coefficient of 82.65% on the testing set for 3D nodule segmentation, demonstrating precise and reliable predictions. The findings highlight the potential of this system to enhance efficiency and accuracy in lung cancer screening, providing a valuable tool to support radiologists in clinical decision-making. Full article

Background/Objectives: Lung cancer is a devastating disease with the highest mortality rate among cancer types. Over 60% of non-small cell lung cancer (NSCLC) patients, accounting for 87% of lung cancer diagnoses, require radiation therapy. Rapid treatment initiation significantly increases the patient’s survival rate and reduces the mortality rate. Accurate tumor segmentation is a critical step in diagnosing and treating NSCLC. Manual segmentation is time- and labor-consuming and causes delays in treatment initiation. Although many lung nodule detection methods, including deep learning-based models, have been proposed. Most of these methods still have a long-standing problem of high false positives (FPs). Methods: Here, we developed an electronic health record (EHR)-guided lung tumor auto-segmentation called EXACT-Net (EHR-enhanced eXACtitude in Tumor segmentation), where the extracted information from EHRs using a pre-trained large language model (LLM) was used to remove the FPs and keep the TP nodules only. Results: The auto-segmentation model was trained on NSCLC patients’ computed tomography (CT), and the pre-trained LLM was used with the zero-shot learning approach. Our approach resulted in a 250% boost in successful nodule detection using the data from ten NSCLC patients treated in our institution. Conclusions: We demonstrated that combining vision-language information in EXACT-Net multi-modal AI framework greatly enhances the performance of vision only models, paving the road to multimodal AI framework for medical image processing. Full article

Lung cancer, the leading cause of cancer-related deaths globally, presents significant challenges in early detection and diagnosis. The effective analysis of pulmonary medical imaging, particularly computed tomography (CT) scans, is critical in this endeavor. Traditional diagnostic methods, which are manual and time-intensive, underscore the need for innovative, efficient, and accurate detection approaches. To address this need, we introduce the Adaptive Range Slice Grouping Network (ARSGNet), a novel deep learning framework that enhances early lung cancer diagnosis through advanced segmentation and classification techniques in CT imaging. ARSGNet synergistically integrates the strengths of EfficientNet and Transformer architectures, leveraging their superior feature extraction and contextual processing capabilities. This hybrid model proficiently handles the complexities of 3D CT images, ensuring precise and reliable lung nodule detection. The algorithm processes CT scans using short slice grouping (SSG) and long slice grouping (LSG) techniques to extract critical features from each slice, culminating in the generation of nodule probabilities and the identification of potential nodular regions. Incorporating shapley additive explanations (SHAP) analysis further enhances model interpretability by highlighting the contributory features. Our extensive experimentation demonstrated a significant improvement in diagnostic accuracy, with training accuracy increasing from 0.9126 to 0.9817. This advancement not only reflects the model’s efficient learning curve but also its high proficiency in accurately classifying a majority of training samples. Given its high accuracy, interpretability, and consistent reduction in training loss, ARSGNet holds substantial potential as a groundbreaking tool for early lung cancer detection and diagnosis. Full article

Background: Lung cancer, also known as lung carcinoma, has a high mortality rate; however, an early prediction helps to reduce the risk. In the current literature, various approaches have been developed for the prediction of lung carcinoma (at an early stage), but these still have various issues, such as low accuracy, high noise, low contrast, poor recognition rates, and a high false-positive rate, etc. Thus, in this research effort, we have proposed an advanced algorithm and combined two different types of deep neural networks to make it easier to spot lung melanoma in the early phases. Methods: We have used WDSI (weakly supervised dense instance-level lung segmentation) for laborious pixel-level annotations. In addition, we suggested an SS-CL (deep continuous learning-based deep neural network) that can be applied to the labeled and unlabeled data to improve efficiency. This work intends to evaluate potential lightweight, low-memory deep neural net (DNN) designs for image processing. Results: Our experimental results show that, by combining WDSI and LSO segmentation, we can achieve super-sensitive, specific, and accurate early detection of lung cancer. For experiments, we used the lung nodule (LUNA16) dataset, which consists of the patients’ 3D CT scan images. We confirmed that our proposed model is lightweight because it uses less memory. We have compared them with state-of-the-art models named PSNR and SSIM. The efficiency is 32.8% and 0.97, respectively. The proposed lightweight deep neural network (DNN) model archives a high accuracy of 98.2% and also removes noise more effectively. Conclusions: Our proposed approach has a lot of potential to help medical image analysis to help improve the accuracy of test results, and it may also prove helpful in saving patients’ lives. Full article

Objective: This study aims to investigate the association between the arteries and veins surrounding a pulmonary nodule and its malignancy. Methods: A dataset of 146 subjects from a LDCT lung cancer screening program was used in this study. AI algorithms were used to automatically segment and quantify nodules and their surrounding macro-vasculature. The macro-vasculature was differentiated into arteries and veins. Vessel branch count, volume, and tortuosity were quantified for arteries and veins at different distances from the nodule surface. Univariate and multivariate logistic regression (LR) analyses were performed, with a special emphasis on the nodules with diameters ranging from 8 to 20 mm. ROC-AUC was used to assess the performance based on the k-fold cross-validation method. Average feature importance was evaluated in several machine learning models. Results: The LR models using macro-vasculature features achieved an AUC of 0.78 (95% CI: 0.71–0.86) for all nodules and an AUC of 0.67 (95% CI: 0.54–0.80) for nodules between 8–20 mm. Models including macro-vasculature features, demographics, and CT-derived nodule features yielded an AUC of 0.91 (95% CI: 0.87–0.96) for all nodules and an AUC of 0.82 (95% CI: 0.71–0.92) for nodules between 8–20 mm. In terms of feature importance, arteries within 5.0 mm from the nodule surface were the highest-ranked among macro-vasculature features and retained their significance even with the inclusion of demographics and CT-derived nodule features. Conclusions: Arteries within 5.0 mm from the nodule surface emerged as a potential biomarker for effectively discriminating between malignant and benign nodules. Full article

This paper aims to conduct a statistical analysis of different components of nnU-Net models to build an optimal pipeline for lung nodule segmentation in computed tomography images (CT scan). This study focuses on semantic segmentation of lung nodules, using the UniToChest dataset. Our approach is based on the nnU-Net framework and is designed to configure a whole segmentation pipeline, thereby avoiding many complex design choices, such as data properties and architecture configuration. Although these framework results provide a good starting point, many configurations in this problem can be optimized. In this study, we tested two U-Net-based architectures, using different preprocessing techniques, and we modified the existing hyperparameters provided by nnU-Net. To study the impact of different settings on model segmentation accuracy, we conducted an analysis of variance (ANOVA) statistical analysis. The factors studied included the datasets according to nodule diameter size, model, preprocessing, polynomial learning rate scheduler, and number of epochs. The results of the ANOVA analysis revealed significant differences in the datasets, models, and preprocessing. Full article

Lung screening is really crucial in the early detection and management of masses, with particular regard to cancer. Studies have shown that lung cancer screening, can reduce lung cancer mortality by 20–30% in high-risk populations. In recent times, the advent of deep learning, with particular regard to computer vision, demonstrated the ability to effectively detect and locate objects from video streams and also (medical) images. Considering these aspects, in this paper, we propose a method aimed to perform instance segmentation, i.e., by providing a mask for each lung mass instance detected, allowing for the identification of individual masses even if they overlap or are close to each other by classifying the detected masses into (generic) nodules, cancer or adenocarcinoma. In this paper, we considered the you-only-look-once model for lung nodule segmentation. An experimental analysis, performed on a set of real-world lung computed tomography images, demonstrated the effectiveness of the proposed method not only in the detection of lung masses but also in lung mass segmentation, thus providing a helpful way not only for radiologist to conduct automatic lung screening but also for discovering very small masses not easily recognizable to the naked eye and that may deserve attention. As a matter of fact, in the evaluation of a dataset composed of 3654 lung scans, the proposed method obtains an average precision of 0.757 and an average recall of 0.738 in the classification task. Additionally, it reaches an average mask precision of 0.75 and an average mask recall of 0.733. These results indicate that the proposed method is capable of not only classifying masses as nodules, cancer, and adenocarcinoma, but also effectively segmenting the areas, thereby performing instance segmentation. Full article

In the computer-aided diagnosis of lung cancer, the automatic segmentation of pulmonary nodules and the classification of benign and malignant tumors are two fundamental tasks. However, deep learning models often overlook the potential benefits of task correlations in improving their respective performances, as they are typically designed for a single task only. Therefore, we propose a multi-task network (MT-Net) that integrates shared backbone architecture and a prediction distillation structure for the simultaneous segmentation and classification of pulmonary nodules. The model comprises a coarse segmentation subnetwork (Coarse Seg-net), a cooperative classification subnetwork (Class-net), and a cooperative segmentation subnetwork (Fine Seg-net). Coarse Seg-net and Fine Seg-net share identical structure, where Coarse Seg-net provides prior location information for the subsequent Fine Seg-net and Class-net, thereby boosting pulmonary nodule segmentation and classification performance. We quantitatively and qualitatively analyzed the performance of the model by using the public dataset LIDC-IDRI. Our results show that the model achieves a Dice similarity coefficient (DI) index of 83.2% for pulmonary nodule segmentation, as well as an accuracy (ACC) of 91.9% for benign and malignant pulmonary nodule classification, which is competitive with other state-of-the-art methods. The experimental results demonstrate that the performance of pulmonary nodule segmentation and classification can be improved by a unified model that leverages the potential correlation between tasks. Full article

Lung cancer is a leading cause of cancer-related deaths worldwide, emphasizing the significance of early detection. Computer-aided diagnostic systems have emerged as valuable tools for aiding radiologists in the analysis of medical images, particularly in the context of lung cancer screening. A typical pipeline for lung cancer diagnosis involves pulmonary nodule detection, segmentation, and classification. Although traditional machine learning methods have been deployed in the previous years with great success, this literature review focuses on state-of-the-art deep learning methods. The objective is to extract key insights and methodologies from deep learning studies that exhibit high experimental results in this domain. This paper delves into the databases utilized, preprocessing steps applied, data augmentation techniques employed, and proposed methods deployed in studies with exceptional outcomes. The reviewed studies predominantly harness cutting-edge deep learning methodologies, encompassing traditional convolutional neural networks (CNNs) and advanced variants such as 3D CNNs, alongside other innovative approaches such as Capsule networks and transformers. The methods examined in these studies reflect the continuous evolution of deep learning techniques for pulmonary nodule detection, segmentation, and classification. The methodologies, datasets, and techniques discussed here collectively contribute to the development of more efficient computer-aided diagnostic systems, empowering radiologists and dfhealthcare professionals in the fight against this deadly disease. Full article

Background and Objectives: This study’s objective was to investigate the influence of increased scan speed and pitch on image quality and nodule volumetry in patients who underwent ultra-low-dose chest computed tomography (CT). Material and Methods: One hundred and two patients who had lung nodules were included in this study. Standard-speed, standard-pitch (SSSP) ultra-low-dose CT and high-speed, high-pitch (HSHP) ultra-low-dose CT were obtained for all patients. Image noise was measured as the standard deviation of attenuation. One hundred and sixty-three nodules were identified and classified according to location, volume, and nodule type. Volume measurement of detected pulmonary nodules was compared according to nodule location, volume, and nodule type. Motion artifacts at the right middle lobe, the lingular segment, and both lower lobes near the lung bases were evaluated. Subjective image quality analysis was also performed. Results: The HSHP CT scan demonstrated decreased motion artifacts at the left upper lobe lingular segment and left lower lobe compared to the SSSP CT scan (p < 0.001). The image noise was higher and the radiation dose was lower in the HSHP scan (p < 0.001). According to the nodule type, the absolute relative volume difference was significantly higher in ground glass opacity nodules compared with those of part-solid and solid nodules (p < 0.001). Conclusion: Our study results suggest that HSHP ultra-low-dose chest CT scans provide decreased motion artifacts and lower radiation doses compared to SSSP ultra-low-dose chest CT. However, lung nodule volumetry should be performed with caution for ground glass opacity nodules. Full article

The accurate segmentation of lung nodules in computed tomography (CT) images is crucial for the early screening and diagnosis of lung cancer. However, the heterogeneity of lung nodules and their similarity to other lung tissue features make this task more challenging. By using large receptive fields from large convolutional kernels, convolutional neural networks (CNNs) can achieve higher segmentation accuracies with fewer parameters. However, due to the fixed size of the convolutional kernel, CNNs still struggle to extract multi-scale features for lung nodules of varying sizes. In this study, we propose a novel network to improve the segmentation accuracy of lung nodules. The network integrates adaptive large kernel attention (ALK) blocks, employing multiple convolutional layers with variously sized convolutional kernels and expansion rates to extract multi-scale features. A dynamic selection mechanism is also introduced to aggregate the multi-scale features obtained from variously sized convolutional kernels based on selection weights. Based on this, we propose a lightweight convolutional neural network with large convolutional kernels, called ALKU-Net, which integrates the ALKA module in a hierarchical encoder and adopts a U-shaped decoder to form a novel architecture. ALKU-Net efficiently utilizes the multi-scale large receptive field and enhances the model perception capability through spatial attention and channel attention. Extensive experiments demonstrate that our method outperforms other state-of-the-art models on the public dataset LUNA-16, exhibiting considerable accuracy in the lung nodule segmentation task. Full article