Artificial intelligence-driven automated lung sizing from chest radiographs.

Lung size measurements play an important role in transplantation, as optimal donor-recipient size matching is necessary to ensure the best possible outcome. Although several strategies for size matching are currently used, all have limitations, and none has proven superior. In this pilot study, we leveraged deep learning and computer vision to develop an automated system for generating standardized lung size measurements using portable chest radiographs to improve accuracy, reduce variability, and streamline donor/recipient matching.

Large-Scale Study on AI's Impact on Identifying Chest Radiographs with No Actionable Disease in Outpatient Imaging.

Rationale And Objectives: Given the high volume of chest radiographs, radiologists frequently encounter heavy workloads. In outpatient imaging, a substantial portion of chest radiographs show no actionable findings. Automatically identifying these cases could improve efficiency by facilitating shorter reading workflows.

Commonly Missed Findings on Chest Radiographs: Causes and Consequences.

Chest radiography (CXR) continues to be the most frequently performed imaging examination worldwide, yet it remains prone to frequent errors in interpretation. These pose potential adverse consequences to patients and are a leading motivation for medical malpractice lawsuits. Commonly missed CXR findings and the principal causes of these errors are reviewed and illustrated.

Reducing Errors Resulting From Commonly Missed Chest Radiography Findings.

Chest radiography (CXR), the most frequently performed imaging examination, is vulnerable to interpretation errors resulting from commonly missed findings. Methods to reduce these errors are presented. A practical approach using a systematic and comprehensive visual search strategy is described.

Value of quantitative airspace disease measured on chest CT and chest radiography at initial diagnosis compared to clinical variables for prediction of severe COVID-19.

Rapid prognostication of COVID-19 patients is important for efficient resource allocation. We evaluated the relative prognostic value of baseline clinical variables (CVs), quantitative human-read chest CT (qCT), and AI-read chest radiograph (qCXR) airspace disease (AD) in predicting severe COVID-19. We retrospectively selected 131 COVID-19 patients (SARS-CoV-2 positive, March to October, 2020) at a tertiary hospital in the United States, who underwent chest CT and CXR within 48 hr of initial presentation.

Pulmonary Functional Imaging: Part 2-State-of-the-Art Clinical Applications and Opportunities for Improved Patient Care.

Pulmonary functional imaging may be defined as the regional quantification of lung function by using primarily CT, MRI, and nuclear medicine techniques. The distribution of pulmonary physiologic parameters, including ventilation, perfusion, gas exchange, and biomechanics, can be noninvasively mapped and measured throughout the lungs. This information is not accessible by using conventional pulmonary function tests, which measure total lung function without viewing the regional distribution.

Pulmonary Functional Imaging: Part 1-State-of-the-Art Technical and Physiologic Underpinnings.

Over the past few decades, pulmonary imaging technologies have advanced from chest radiography and nuclear medicine methods to high-spatial-resolution or low-dose chest CT and MRI. It is currently possible to identify and measure pulmonary pathologic changes before these are obvious even to patients or depicted on conventional morphologic images. Here, key technological advances are described, including multiparametric CT image processing methods, inhaled hyperpolarized and fluorinated gas MRI, and four-dimensional free-breathing CT and MRI methods to measure regional ventilation, perfusion, gas exchange, and biomechanics.

Automated Detection and Quantification of COVID-19 Airspace Disease on Chest Radiographs: A Novel Approach Achieving Expert Radiologist-Level Performance Using a Deep Convolutional Neural Network Trained on Digital Reconstructed Radiographs From Computed Tomography-Derived Ground Truth.

Objectives: The aim of this study was to leverage volumetric quantification of airspace disease (AD) derived from a superior modality (computed tomography [CT]) serving as ground truth, projected onto digitally reconstructed radiographs (DRRs) to (1) train a convolutional neural network (CNN) to quantify AD on paired chest radiographs (CXRs) and CTs, and (2) compare the DRR-trained CNN to expert human readers in the CXR evaluation of patients with confirmed COVID-19.

Materials And Methods: We retrospectively selected a cohort of 86 COVID-19 patients (with positive reverse transcriptase-polymerase chain reaction test results) from March to May 2020 at a tertiary hospital in the northeastern United States, who underwent chest CT and CXR within 48 hours. The ground-truth volumetric percentage of COVID-19-related AD (POv) was established by manual AD segmentation on CT.

Expanding Applications of Pulmonary MRI in the Clinical Evaluation of Lung Disorders: Fleischner Society Position Paper.

Pulmonary MRI provides structural and quantitative functional images of the lungs without ionizing radiation, but it has had limited clinical use due to low signal intensity from the lung parenchyma. The lack of radiation makes pulmonary MRI an ideal modality for pediatric examinations, pregnant women, and patients requiring serial and longitudinal follow-up. Fortunately, recent MRI techniques, including ultrashort echo time and zero echo time, are expanding clinical opportunities for pulmonary MRI.

The value of delayed phase enhanced imaging in malignant pleural mesothelioma.

Background: Cross-sectional imaging of malignant pleural mesothelioma (MPM) can underestimate the presence of local tumor invasion. Since accurate staging is vital optimal choice of therapy, techniques that optimize pleural imaging are needed. Here we estimate the optimal timing of MPM enhancement on magnetic resonance imaging (MRI).

Regional Fractional Ventilation by Using Multibreath Wash-in (3)He MR Imaging.

Purpose To assess the feasibility and optimize the accuracy of the multibreath wash-in hyperpolarized helium 3 ((3)He) approach to ventilation measurement by using magnetic resonance (MR) imaging as well as to examine the physiologic differences that this approach reveals among nonsmokers, asymptomatic smokers, and patients with chronic obstructive pulmonary disease (COPD). Materials and Methods All experiments were approved by the local institutional review board and compliant with HIPAA. Informed consent was obtained from all subjects.

Optimization of Radiology Reports for Intensive Care Unit Portable Chest Radiographs: Perceptions and Preferences of Radiologists and ICU Practitioners.

Purpose: The aim of the study was to evaluate opinions and perceptions of radiologists and referring practitioners regarding reports of portable chest radiography (pCXR) obtained in the intensive care unit (ICU).

Materials And Methods: A total of 1265 referring practitioners and 76 radiologists were invited to participate in 2 internet-based surveys, containing 15 and 17 multiple choice questions, respectively, similarly presented to both groups, utilizing a Likert scale or multiple choices. Results were compared using the Fisher exact test or χ test.

Oxygen-weighted Hyperpolarized (3)He MR Imaging: A Short-term Reproducibility Study in Human Subjects.

Purpose: To determine whether hyperpolarized helium 3 magnetic resonance (MR) imaging to measure alveolar partial pressure of oxygen (Pao2) shows sufficient test-retest repeatability and between-cohort differences to be used as a reliable technique for detection of alterations in gas exchange in asymptomatic smokers.

Materials And Methods: The protocol was approved by the local institutional review board and was HIPAA compliant. Informed consent was obtained from all subjects.

Alterations of regional alveolar oxygen tension in asymptomatic current smokers: assessment with hyperpolarized (3)He MR imaging.

Purpose: To assess the ability of helium 3 ((3)He) magnetic resonance (MR) imaging of regional alveolar partial pressure of oxygen (Pao2) to depict smoking-induced functional alterations and to compare its efficacy to that of current diagnostic techniques.

Materials And Methods: This study was approved by the local institutional review board and was compliant with HIPAA. All subjects provided informed consent.

Current role of imaging in the diagnosis and management of pulmonary hypertension.

Objective: The purpose of this review is to describe classification schemes and imaging findings in the diagnosis and management of pulmonary hypertension.

Conclusion: Pulmonary hypertension is a complex pathophysiologic condition in which several clinical entities increase pressure in the pulmonary circulation, progressively impairing cardiopulmonary function and, if untreated, causing right ventricular failure. Current classification schemes emphasize the necessity of an early, accurate etiologic diagnosis for a tailored therapeutic approach.

A comparative study of HRCT image metrics and PFT values for characterization of ILD and COPD.

Rationale And Objectives: The aim of this study was to compare the performance of various image-based metrics computed from thoracic high-resolution computed tomography (HRCT) with data from pulmonary function testing (PFT) in characterizing interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD).

Materials And Methods: Fourteen patients with ILD and 11 with COPD had undergone both PFT and HRCT within 3 days. For each patient, 93 image-based metrics were computed, and their relationships with the 21 clinically used PFT parameters were analyzed using a minimal-redundancy-maximal-relevance statistical framework.

A combined pulmonary-radiology workshop for visual evaluation of COPD: study design, chest CT findings and concordance with quantitative evaluation.

Unlabelled: The purposes of this study were: to describe chest CT findings in normal non-smoking controls and cigarette smokers with and without COPD; to compare the prevalence of CT abnormalities with severity of COPD; and to evaluate concordance between visual and quantitative chest CT (QCT) scoring.

Methods: Volumetric inspiratory and expiratory CT scans of 294 subjects, including normal non-smokers, smokers without COPD, and smokers with GOLD Stage I-IV COPD, were scored at a multi-reader workshop using a standardized worksheet. There were 58 observers (33 pulmonologists, 25 radiologists); each scan was scored by 9-11 observers.

Small-airway obstruction and emphysema in chronic obstructive pulmonary disease.

Background: The major sites of obstruction in chronic obstructive pulmonary disease (COPD) are small airways (<2 mm in diameter). We wanted to determine whether there was a relationship between small-airway obstruction and emphysematous destruction in COPD.

Methods: We used multidetector computed tomography (CT) to compare the number of airways measuring 2.

Computational analysis of thoracic multidetector row HRCT for segmentation and quantification of small airway air trapping and emphysema in obstructive pulmonary disease.

Rationale And Objectives: Obstructive pulmonary disease phenotypes are related to variable combinations of emphysema and small-airway disease, the latter manifested as air trapping (AT) on imaging. The investigators propose a method to extract AT information quantitatively from thoracic multi-detector row high-resolution computed tomography (HRCT), validated by pulmonary function testing (PFT) correlation.

Materials And Methods: Seventeen patients with obstructive pulmonary disease who underwent HRCT and PFT within a 3-day interval were retrospectively identified.