While the recent advancements of computed tomography (CT) technology have contributed in reducing radiation dose and image noise, an objective evaluation of image quality in patient scans has not yet been established. In this study, we present a patient-specific CT image quality evaluation method that includes fully automated measurements of noise level, structure sharpness, and alteration of structure. This study used the CT images of 120 patients from four different CT scanners reconstructed with three types of algorithm: filtered back projection (FBP), vendor-specific iterative reconstruction (IR), and a vendor-agnostic deep learning model (DLM, ClariCT.AI, ClariPi Inc.). The structure coherence feature (SCF) was used to divide an image into the homogeneous (R_H) and structure edge (R_S) regions, which in turn were used to localize the regions of interests (ROIs) for subsequent analysis of image quality indices. The noise level was calculated by averaging the standard deviations from five randomly selected ROIs on R_H, and the mean SCFs on R_S was used to estimate the structure sharpness. The structure alteration was defined by the standard deviation ratio between R_S and R_H on the subtraction image between FBP and IR or DLM, in which lower structure alterations indicate successful noise reduction without degradation of structure details. The estimated structure sharpness showed a high correlation of 0.793 with manually measured edge slopes. Compared to FBP, IR and DLM showed 34.38% and 51.30% noise reduction, 2.87% and 0.59% lower structure sharpness, and 2.20% and -12.03% structure alteration, respectively, on an average. DLM showed statistically superior performance to IR in all three image quality metrics. This study is expected to contribute to enhance the CT protocol optimization process by allowing a high throughput and quantitative image quality evaluation during the introduction or adjustment of lower-dose CT protocol into routine practice.

We propose a deep learning-assisted overscan decision algorithm in chest low-dose computed tomography (LDCT) applicable to the lung cancer screening. The algorithm reflects the radiologists’ subjective evaluation criteria according to the Korea institute for accreditation of medical imaging (KIAMI) guidelines, where it judges whether a scan range is beyond landmarks’ criterion. The algorithm consists of three stages: deep learning-based landmark segmentation, rule-based logical operations, and overscan determination. A total of 210 cases from a single institution (internal data) and 50 cases from 47 institutions (external data) were utilized for performance evaluation. Area under the receiver operating characteristic (AUROC), accuracy, sensitivity, specificity, and Cohen’s kappa were used as evaluation metrics. Fisher’s exact test was performed to present statistical significance for the overscan detectability, and univariate logistic regression analyses were performed for validation. Furthermore, an excessive effective dose was estimated by employing the amount of overscan and the absorbed dose to effective dose conversion factor. The algorithm presented AUROC values of 0.976 (95% confidence interval [CI]: 0.925–0.987) and 0.997 (95% CI: 0.800–0.999) for internal and external dataset, respectively. All metrics showed average performance scores greater than 90% in each evaluation dataset. The AI-assisted overscan decision and the radiologist’s manual evaluation showed a statistically significance showing a p-value less than 0.001 in Fisher’s exact test. In the logistic regression analysis, demographics (age and sex), data source, CT vendor, and slice thickness showed no statistical significance on the algorithm (each p-value > 0.05). Furthermore, the estimated excessive effective doses were 0.02 ± 0.01 mSv and 0.03 ± 0.05 mSv for each dataset, not a concern within slight deviations from an acceptable scan range. We hope that our proposed overscan decision algorithm enables the retrospective scan range monitoring in LDCT for lung cancer screening program, and follows an as low as reasonably achievable (ALARA) principle.

Recent advancements in deep learning have significantly improved medical image segmentation. However, the generalization performance and potential risks of data-driven models remain insufficiently validated. Specifically, unrealistic segmentation predictions deviating from actual anatomical structures, known as a Seg-Hallucination, often occur in deep learning-based models. The Seg-Hallucinations can result in erroneous quantitative analyses and distort critical imaging biomarker information, yet effective audits or corrections to address these issues are rare. Therefore, we propose an automated Seg-Hallucination surveillance and correction (ASHSC) algorithm utilizing only 3D organ mask information derived from CT images without reliance on the ground truth. Two publicly available datasets were used in developing the ASHSC algorithm: 280 CT scans from the TotalSegmentator dataset for training and 274 CT scans from the Cancer Imaging Archive (TCIA) dataset for performance evaluation. The ASHSC algorithm utilizes a two-stage on-demand strategy with mesh-based convolutional neural networks and generative artificial intelligence. The segmentation quality level (SQ-level)-based surveillance stage was evaluated using the area under the receiver operating curve, sensitivity, specificity, and positive predictive value. The on-demand correction performance of the algorithm was assessed using similarity metrics: volumetric Dice score, volume error percentage, average surface distance, and Hausdorff distance. Average performance of the surveillance stage resulted in an AUROC of 0.94 ± 0.01, sensitivity of 0.82 ± 0.03, specificity of 0.90 ± 0.01, and PPV of 0.92 ± 0.01 for test dataset. After the on-demand refinement of the correction stage, all the four similarity metrics were improved compared to a single use of the AI-segmentation model. This study not only enhances the efficiency and reliability of handling the Seg-Hallucination but also eliminates the reliance on ground truth. The ASHSC algorithm offers intuitive 3D guidance for uncertainty regions, while maintaining manageable computational complexity. The SQ-level-based on-demand correction strategy adaptively minimizes uncertainties inherent in deep-learning-based organ masks and advances automated auditing and correction methodologies.

Purpose: Myosteatosis, defined as fat infiltration in muscle tissue, has been linked to poor outcomes in various cancers. However, the prognostic impact of myosteatosis on renal cell carcinoma (RCC) remains poorly understood. This study evaluated the predictive value of myosteatosis based on an artificial intelligence (AI)-driven computed tomography (CT) analysis in patients with localized RCC who underwent partial nephrectomy.Materials and Methods: This retrospective study included 170 patients with localized RCC who underwent partial nephrectomy at a single institution between 2011 and 2017. Myosteatosis was assessed on CT scans using an AI-based tool. The patients were categorized into 2 groups according to the presence or absence of myosteatosis. The clinical outcomes, including disease-free survival (DFS), were compared to determine the prognostic significance of myosteatosis.Results: Of 170 patients, 36 (21.2%) were diagnosed with myosteatosis. These patients were older and had a higher body mass index. The myosteatosis group had a higher proportion of females than the no myosteatosis group. Lymphovascular invasion and tumor necrosis were prevalent pathological features in patients with myosteatosis. Kaplan-Meier analysis demonstrated that myosteatosis was associated with significantly shorter DFS (p<0.05). Multivariate analysis confirmed that myosteatosis independently predicted adverse outcomes in patients with localized RCC.Conclusion: AI-based CT analysis of myosteatosis is a reliable method for improving the risk stratification of patients with localized RCC. Patients with myosteatosis demonstrate poor pathological features and shorter DFS. These findings highlight the potential of AI-driven body composition analysis to refine prognostic models and personalized treatment strategies.

Sihwan Kim, Chulkyun Ahn, Woo Kyoung Jeong, Jong Hyo Kim, Minsoo Chun. Progress in Medical Physics 2021;32:92-8. https://doi.org/10.14316/pmp.2021.32.4.92