There is a crucial need for quick testing and diagnosis of patients during the COVID-19 pandemic. Lung ultrasound is an imaging modality that is cost-effective, widely accessible, and can be used to diagnose acute respiratory distress syndrome in patients with COVID-19. It can be used to find important characteristics in the images, including A-lines, B-lines, consolidation, and pleural effusion, which all inform the clinician in monitoring and diagnosing the disease. With the use of portable ultrasound transducers, lung ultrasound images can be easily acquired, however, the images are often of poor quality. They often require an expert clinician interpretation, which may be time-consuming and is highly subjective. We propose a method for fast and reliable interpretation of lung ultrasound images by use of deep learning, based on the Kinetics-I3D network. Our learned model can classify an entire lung ultrasound scan obtained at point-of-care, without requiring the use of preprocessing or a frame-by-frame analysis. We compare our video classifier against ground truth classification annotations provided by a set of expert radiologists and clinicians, which include A-lines, B-lines, consolidation, and pleural effusion. Our classification method achieves an accuracy of 90% and an average precision score of 95% with the use of 5-fold cross-validation. The results indicate the potential use of automated analysis of portable lung ultrasound images to assist clinicians in screening and diagnosing patients.

Objectives: The Prostate Imaging Quality (PI-QUAL) score is a new metric to evaluate the diagnostic quality of multiparametric magnetic resonance imaging (MRI) of the prostate. This study assesses the impact of an intervention, namely a prostate MRI quality training lecture, on the participant’s ability to apply PI-QUAL. Methods: Sixteen participants (radiologists, urologists, physicists, and computer scientists) of varying experience in reviewing diagnostic prostate MRI all assessed the image quality of ten examinations from different vendors and machines. Then, they attended a dedicated lecture followed by a hands-on workshop on MRI quality assessment using the PI-QUAL score. Five scans assessed by the participants were evaluated in the workshop using the PI-QUAL score for teaching purposes. After the course, the same participants evaluated the image quality of a new set of ten scans applying the PI-QUAL score. Results were assessed using receiver operating characteristic analysis. The reference standard was the PI-QUAL score assessed by one of the developers of PI-QUAL. Results: There was a significant improvement in average area under the curve for the evaluation of image quality from baseline (0.59 [95 % confidence intervals: 0.50–0.66]) to post-teaching (0.96 [0.92–0.98]), an improvement of 0.37 [0.21–0.41] (p < 0.001). Conclusions: A teaching course (dedicated lecture + hands-on workshop) on PI-QUAL significantly improved the application of this scoring system to assess the quality of prostate MRI examinations. Key Points: • A significant improvement in the application of PI-QUAL for the assessment of prostate MR image quality was observed after an educational intervention. • Appropriate training on image quality can be delivered to those involved in the acquisition and interpretation of prostate MRI. • Further investigation will be needed to understand the impact on improving the acquisition of high-quality diagnostic prostate MR examinations.

Artificial intelligence (AI) algorithms hold the potential to revolutionize radiology. However, a significant portion of the published literature lacks transparency and reproducibility, which hampers sustained progress toward clinical translation. Although several reporting guidelines have been proposed, identifying practical means to address these issues remains challenging. Here, we show the potential of cloud-based infrastructure for implementing and sharing transparent and reproducible AI-based radiology pipelines. We demonstrate end-to-end reproducibility from retrieving cloud-hosted data, through data pre-processing, deep learning inference, and post-processing, to the analysis and reporting of the final results. We successfully implement two distinct use cases, starting from recent literature on AI-based biomarkers for cancer imaging. Using cloud-hosted data and computing, we confirm the findings of these studies and extend the validation to previously unseen data for one of the use cases. Furthermore, we provide the community with transparent and easy-to-extend examples of pipelines impactful for the broader oncology field. Our approach demonstrates the potential of cloud resources for implementing, sharing, and using reproducible and transparent AI pipelines, which can accelerate the translation into clinical solutions.

Cardiac segmentation from magnetic resonance imaging (MRI) is one of the essential tasks in analyzing the anatomy and function of the heart for the assessment and diagnosis of cardiac diseases. However, cardiac MRI generates hundreds of images per scan, and manual annotation of them is challenging and time-consuming, and therefore processing these images automatically is of interest. This study proposes a novel end-to-end supervised cardiac MRI segmentation framework based on a diffeomorphic deformable registration that can segment cardiac chambers from 2D and 3D images or volumes. To represent actual cardiac deformation, the method parameterizes the transformation using radial and rotational components computed via deep learning, with a set of paired images and segmentation masks used for training. The formulation guarantees transformations that are invertible and prevents mesh folding, which is essential for preserving the topology of the segmentation results. A physically plausible transformation is achieved by employing diffeomorphism in computing the transformations and activation functions that constrain the range of the radial and rotational components. The method was evaluated over three different data sets and showed significant improvements compared to exacting learning and non-learning based methods in terms of the Dice score and Hausdorff distance metrics.

Rapid advances in medical imaging Artificial Intelligence (AI) offer unprecedented opportunities for automatic analysis and extraction of data from large imaging collections. Computational demands of such modern AI tools may be difficult to satisfy with the capabilities available on premises. Cloud computing offers the promise of economical access and extreme scalability. Few studies examine the price/performance tradeoffs of using the cloud, in particular for medical image analysis tasks. We investigate the use of cloud-provisioned compute resources for AI-based curation of the National Lung Screening Trial (NLST) Computed Tomography (CT) images available from the National Cancer Institute (NCI) Imaging Data Commons (IDC). We evaluated NCI Cancer Research Data Commons (CRDC) Cloud Resources - Terra (FireCloud) and Seven Bridges-Cancer Genomics Cloud (SB-CGC) platforms - to perform automatic image segmentation with TotalSegmentator and pyradiomics feature extraction for a large cohort containing >126,000 CT volumes from >26,000 patients. Utilizing >21,000 Virtual Machines (VMs) over the course of the computation we completed analysis in under 9 hours, as compared to the estimated 522 days that would be needed on a single workstation. The total cost of utilizing the cloud for this analysis was $1,011.05. Our contributions include: 1) an evaluation of the numerous tradeoffs towards optimizing the use of cloud resources for large-scale image analysis; 2) CloudSegmentator, an open source reproducible implementation of the developed workflows, which can be reused and extended; 3) practical recommendations for utilizing the cloud for large-scale medical image computing tasks. We also share the results of the analysis: the total of 9,565,554 segmentations of the anatomic structures and the accompanying radiomics features in IDC as of release v18.

Left ventricular segmentation is a difficult and time-consuming task performed by clinicians, requiring the use of manual contours. We propose a novel three-dimensional diffeomorphic registration algorithm for endocardial segmentation of the left ventricle in magnetic resonance images and ultrasound temporal sequences. The proposed diffeomorphic registration method computes a voxel-to-voxel correspondence in three-dimensional space and is parameterized by one radial and three curl components to emulate the cardiac deformations. In addition, the proposed method allows for enforcing constraints to control the amount of deformation. The method was evaluated on 521 temporal frames from 20 patients from the Automated Cardiac Diagnosis Challenge magnetic resonance imaging dataset and 213 frames from 10 patients undergoing ultrasound scans from the Mazankowski Alberta Heart Institute. The algorithm was compared against six other registration methods, the Symmetric Normalization algorithm from the Dipy package, two variants of the Demons algorithm from the Insight Toolkit software package, two versions of RealTiTracker, and Elastix. The proposed method yielded overall Dice scores of 98.10 (0.90)% for the MRI dataset and 92.90 (2.42)% for the ultrasound dataset. The robustness of the algorithm is demonstrated by the high performance on multiple imaging modalities and various patient abnormalities.