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ComputeraideddiagnosisWikipedia,thefreeencyclopedia

Computeraideddiagnosis
FromWikipedia,thefreeencyclopedia

Inradiology,computeraideddetection(CADe),alsocalledcomputeraideddiagnosis(CADx),areprocedures
inmedicinethatassistdoctorsintheinterpretationofmedicalimages.ImagingtechniquesinXray,MRI,and
Ultrasounddiagnosticsyieldagreatdealofinformation,whichtheradiologisthastoanalyzeandevaluate
comprehensivelyinashorttime.CADsystemshelpscandigitalimages,e.g.fromcomputedtomography,for
typicalappearancesandtohighlightconspicuoussections,suchaspossiblediseases.
CADisaninterdisciplinarytechnologycombiningelementsofartificialintelligenceandcomputervisionwith
radiologicalimageprocessing.Atypicalapplicationisthedetectionofatumor.Forinstance,somehospitalsuse
CADtosupportpreventivemedicalcheckupsinmammography(diagnosisofbreastcancer),thedetectionof
polypsinthecolon,andlungcancer.
Computeraideddetection(CADe)systemsareusuallyconfinedtomarkingconspicuousstructuresandsections.
Computeraideddiagnosis(CADx)systemsevaluatetheconspicuousstructures.Forexample,inmammography
CADhighlightsmicrocalcificationclustersandhyperdensestructuresinthesofttissue.Thisallowstheradiologist
todrawconclusionsabouttheconditionofthepathology.AnotherapplicationisCADq,whichquantifies,e.g.,the
sizeofatumororthetumor'sbehaviorincontrastmediumuptake.Computeraidedsimpletriage(CAST)is
anothertypeofCAD,whichperformsafullyautomaticinitialinterpretationandtriageofstudiesintosome
meaningfulcategories(e.g.negativeandpositive).CASTisparticularlyapplicableinemergencydiagnostic
imaging,whereapromptdiagnosisofcritical,lifethreateningconditionisrequired.
AlthoughCADhasbeenusedinclinicalenvironmentsforover40years,CADdoesnotsubstitutethedoctor,but
ratherplaysasupportingrole.[1]Thedoctor(generallyaradiologist)isalwaysresponsibleforthefinal
interpretationofamedicalimage.

Contents
1 Computeraideddiagnosistopics
1.1 Methodology
1.2 Sensitivityandspecificity
1.3 Absolutedetectionrate
2 Applications
2.1 PathologicalBrainDetection(PBD)
2.2 Breastcancer
2.3 Lungcancer(bronchialcarcinoma)
2.4 Coloncancer
2.5 Coronaryarterydisease
2.6 Congenitalheartdefect
2.7 Alzheimer'sdisease
2.8 Nuclearmedicine
3 References

Computeraideddiagnosistopics
Methodology
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CADisfundamentallybasedonhighlycomplexpatternrecognition.Xrayimagesarescannedforsuspicious
structures.Normallyafewthousandimagesarerequiredtooptimizethealgorithm.Digitalimagedataarecopied
toaCADserverinaDICOMformatandarepreparedandanalyzedinseveralsteps.
1.Preprocessingfor
Reductionofartifacts(bugsinimages)
Imagenoisereduction
Leveling(harmonization)ofimagequalityforclearingtheimage'sdifferentbasicconditionse.g.different
exposureparameter.
2.Segmentationfor
Differentiationofdifferentstructuresintheimage,e.g.heart,lung,ribcage,possibleroundlesions
Matchingwithanatomicdatabank
3.Structure/ROI(RegionofInterest)AnalyzeEverydetectedregionisanalyzedindividuallyforspecial
characteristics:
Compactness
Form,sizeandlocation
Referencetoclosebystructures/ROIs
AveragegreylevelvalueanalyzewithinaROI
ProportionofgreylevelstoborderofthestructureinsidetheROI
4.Evaluation/classificationAfterthestructureisanalyzed,everyROIisevaluatedindividually(scoring)forthe
probabilityofaTP.Therefore,theproceduresare:
NearestNeighborRule
Minimumdistanceclassifier
CascadeClassifier
BayesianClassifier
ArtificialNeuralNetwork
Radialbasisfunctionnetwork(RBF)
SVM
Ifthedetectedstructureshavereachedacertainthresholdlevel,theyarehighlightedintheimageforthe
radiologist.DependingontheCADsystemthesemarkingscanbepermanentlyortemporarysaved.Thelatter's
advantageisthatonlythemarkingswhichareapprovedbytheradiologistaresaved.Falsehitsshouldnotbe
saved,becauseanexaminationatalaterdatebecomesmoredifficultthen.

Sensitivityandspecificity
CADsystemsseektohighlightsuspiciousstructures.Today'sCADsystemscannotdetect100%ofpathological
changes.Thehitrate(sensitivity)canbeupto90%dependingonsystemandapplication.[2]Acorrecthitistermed
aTruePositive(TP),whiletheincorrectmarkingofhealthysectionsconstitutesaFalsePositive(FP).ThelessFPs
indicated,thehigherthespecificityis.AlowspecificityreducestheacceptanceoftheCADsystembecausethe
userhastoidentifyallofthesewronghits.TheFPrateinlungoverviewexaminations(CADChest)couldbe
reducedto2perexamination.Inothersegments(e.g.CTlungexaminations)theFPratecouldbe25ormore.In
CASTsystemstheFPratemustbeextremelylow(lessthan1perexamination)toallowameaningfulstudytriage.

Absolutedetectionrate
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Theabsolutedetectionrateoftheradiologistisanalternativemetrictosensitivityandspecificity.Overall,results
ofclinicaltrialsaboutsensitivity,specificity,andtheabsolutedetectionratecanvarymarkedly.Eachstudyresult
dependsonitsbasicconditionsandhastobeevaluatedonthoseterms.Thefollowingfactshaveastrong
influence:
Retrospectiveorprospectivedesign
Qualityoftheusedimages
Conditionofthexrayexamination
Radiologist'sexperienceandeducation
Typeoflesion
Sizeoftheconsideredlesion

Applications
CADisusedinthediagnosisofPathologicalBrainDetection(PBD),breastcancer,lungcancer,coloncancer,
prostatecancer,bonemetastases,coronaryarterydisease,congenitalheartdefect,andAlzheimer'sdisease.

PathologicalBrainDetection(PBD)
Chaplotetal.wasthefirsttouseDiscreteWaveletTransform(DWT)coefficientstodetectpathologicalbrains.[3]
MaitraandChatterjeeemployedtheSlantlettransform,whichisanimprovedversionofDWT.Theirfeaturevector
ofeachimageiscreatedbyconsideringthemagnitudesofSlantlettransformoutputscorrespondingtosixspatial
positionschosenaccordingtoaspecificlogic.[4]
In2010,WangandWupresentedaforwardneuralnetwork(FNN)basedmethodtoclassifyagivenMRbrain
imageasnormalorabnormal.TheparametersofFNNwereoptimizedviaadaptivechaoticparticleswarm
optimization(ACPSO).Resultsover160imagesshowedthattheclassificationaccuracywas98.75%.[5]
In2011,WuandWangproposedusingDWTforfeatureextraction,PCAforfeaturereduction,andFNNwith
scaledchaoticartificialbeecolony(SCABC)asclassifier.[6]
In2013,Sarithaetal.werethefirsttoapplywaveletentropy(WE)todetectpathologicalbrains.Sarithaalso
suggestedtousespiderwebplots.[7]Later,Zhangetal.provedremovingspiderwebplotsdidnotinfluencethe
performance.[8]Geneticpatternsearchmethodwasappliedtoidentifyabnormalbrainfromnormalcontrols.Its
classificationaccuracywasreportedas95.188%.[9]Dasetal.proposedtouseRipplettransform.[10]Zhangetal.
proposedtouseparticleswarmoptimization(PSO).[11]Kalbkhanietal.suggestedtouseGARCHmodel.[12]
In2014,ElDahshanetal.suggestedtousepulsecoupledneuralnetwork.[13]
In2015,Zhouetal.suggestedtoapplynaiveBayesclassifiertodetectpathologicalbrains.[14]

Breastcancer
CADisusedinscreeningmammography(Xrayexaminationofthefemalebreast).Screeningmammographyis
usedfortheearlydetectionofbreastcancer.CADisespeciallyestablishedinUSandtheNetherlandsandisused
inadditiontohumanevaluation,usuallybyaradiologist.ThefirstCADsystemformammographywasdeveloped
inaresearchprojectattheUniversityofChicago.TodayitiscommerciallyofferedbyiCADandHologic.There
arecurrentlysomenoncommercialprojectsbeingdeveloped,suchasAshitaProject,agradientbasedscreening
softwarebyAlanHshieh,aswell.However,whileachievinghighsensitivities,CADsystemstendtohavevery
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lowspecificityandthebenefitsofusingCADremainuncertain.Somestudiessuggestapositiveimpacton
mammographyscreeningprograms,[15][16]butothersshownoimprovement.[17][18]A2008systematicreviewon
computeraideddetectioninscreeningmammographyconcludedthatCADdoesnothaveasignificanteffecton
cancerdetectionrate,butdoesundesirablyincreaserecallrate(i.e.therateoffalsepositives).However,itnoted
considerableheterogeneityintheimpactonrecallrateacrossstudies.[19]
Procedurestoevaluatemammographybasedonmagneticresonanceimagingexisttoo.

Lungcancer(bronchialcarcinoma)
Inthediagnosisoflungcancer,computedtomographywithspecialthreedimensionalCADsystemsare
establishedandconsideredasgoldstandard.Atthisavolumetricdatasetwithupto3,000singleimagesisprepared
andanalyzed.Roundlesions(lungcancer,metastasesandbenignchanges)from1mmaredetectable.Todayall
wellknownvendorsofmedicalsystemsoffercorrespondingsolutions.
Earlydetectionoflungcancerisvaluable.The5yearsurvivalrateoflungcancerhasstagnatedinthelast30years
andisnowatapproximatelyjust15%.Lungcancertakesmorevictimsthanbreastcancer,prostatecancerand
coloncancertogether.Thisisduetotheasymptomaticgrowthofthiscancer.Inthemajorityofcasesitistoolate
forasuccessfultherapyifthepatientdevelopsfirstsymptoms(e.g.chroniccroakinessorhemoptysis).Butifthe
lungcancerisdetectedearly(mostlybychance),thereisasurvivalrateat47%accordingtotheAmericanCancer
Society.[20]Atthesametimethestandardxrayexaminationofthelungisthemostfrequentlyxrayexamination
witha50%share.Indeed,therandomdetectionoflungcancerintheearlystage(stage1)inthexrayimageis
difficult.Itisafactthatroundlesionsvaryfrom510mmareeasilyoverlooked.[21]Theroutineapplicationof
CADChestSystemsmayhelptodetectsmallchangeswithoutinitialsuspicion.Philipswasthefirstvendorto
presentaCADforearlydetectionofroundlunglesionsonxrayimages.[22]

Coloncancer
CADisavailablefordetectionofcolorectalpolypsinthecolon.Polypsaresmallgrowthsthatarisefromtheinner
liningofthecolon.CADdetectsthepolypsbyidentifyingtheircharacteristic"bumplike"shape.Toavoid
excessivefalsepositives,CADignoresthenormalcolonwall,includingthehaustralfolds.Inearlyclinicaltrials,
CADhelpedradiologistsfindmorepolypsinthecolonthantheyfoundpriortousingCAD.[23][24]

Coronaryarterydisease
CADisavailablefortheautomaticdetectionofsignificant(causingmorethan50%stenosis)coronaryartery
diseaseincoronaryCTangiography(CCTA)studies.Alowfalsepositivesrate(6070%specificityper
patient)[25][26][27]allowsusingitasacomputeraidedsimpletriage(CAST)tooldistinguishingbetweenpositive
andnegativestudiesandyieldingapreliminaryreport.This,forexample,canbeusedforchestpainpatients'triage
inanemergencysetting.

Congenitalheartdefect
Earlydetectionofpathologycanbethedifferencebetweenlifeanddeath.CADecanbedonebyauscultationwith
adigitalstethoscopeandspecializedsoftware,alsoknownasComputeraidedauscultation.Murmurs,irregular
heartsounds,causedbybloodflowingthroughadefectiveheart,canbedetectedwithhighsensitivityand
specificity.Computeraidedauscultationissensitivetoexternalnoiseandbodilysoundsandrequiresanalmost
silentenvironmenttofunctionaccurately.

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Alzheimer'sdisease
CADscanbeusedtoidentifysubjectswithAlzheimer'sandmildcognitiveimpairmentfromnormalelder
controls.
In2014,Padmaetal.usedcombinedwaveletstatisticaltexturefeaturestosegmentandclassifyADbenignand
malignanttumorslices.[28]Zhangetal.foundkernelsupportvectormachinedecisiontreehad80%classification
accuracy,withanaveragecomputationtimeof0.022sforeachimageclassification.[29]
EigenbranisanovelbrainfeaturethatcanhelptodetectAD.TheresultsshowedpolynomialkernelSVM
achievedaccuracyof92.360.94,sensitivityof83.483.27,specificityof94.901.09,andprecisionof
82.282.78.ThepolynomialKSVMperformsbetterthanlinearSVMandRBFkernelSVM.[30]

Nuclearmedicine
CADxisavailablefornuclearmedicineimages.CommercialCADxsystemsforthediagnosisofbonemetastases
inwholebodybonescansandcoronaryarterydiseaseinmyocardialperfusionimagesexist.[31]

References
1.https://blog.semantic.md/ui
2.WollenweberT.JankeB.TeichmannA.FreundM.(2007)."KorrelationzwischenhistologischemBefundundeinem
ComputerassistiertenDetektionssystem(CAD)frdieMammografie.".GeburtshFrauenheilk.67:135141.
doi:10.1055/s2006955983.
3.Chaplot,S.,L.M.Patnaik,andN.R.Jagannathan,Classificationofmagneticresonancebrainimagesusingwaveletsas
inputtosupportvectormachineandneuralnetwork.BiomedicalSignalProcessingandControl,2006.1(1):p.8692.
4.Maitra,M.andA.Chatterjee,ASlantlettransformbasedintelligentsystemformagneticresonancebrainimage
classification.BiomedicalSignalProcessingandControl,2006.1(4):p.299306.
5.Wang,S.Wu,W.(2010)."ANovelMethodforMagneticResonanceBrainImageClassificationbasedonAdaptive
ChaoticPSO".ProgressinElectromagneticsResearch.109:325343.
6.Zhang,YudongWu,L.(2011)."MagneticResonanceBrainImageClassificationbyanImprovedArtificialBeeColony
Algorithm".ProgressinElectromagneticsResearch.2011:6579.
7.Saritha,M.,K.P.Joseph,andA.T.Mathew,ClassificationofMRIbrainimagesusingcombinedwaveletentropybased
spiderwebplotsandprobabilisticneuralnetwork.PatternRecognitionLetters,2013.34(16):p.21512156.
8.Zhang,YudongDong,ZhengchaoJi,Genlin(2015)."EffectofspiderwebplotinMRbrainimageclassification".
PatternRecognitionLetters.62:1416.doi:10.1016/j.patrec.2015.04.016.
9.Zhang,Y.Wang,S.Ji,G.Dong,Z.(2013)."GeneticPatternSearchanditsApplicationtoBrainImageClassification".
MathematicalProblemsinEngineering.2013:18.doi:10.1155/2013/580876.
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Ripplet".ProgressinElectromagneticsResearchPier.137:117.doi:10.2528/pier13010105.
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SupportVectorMachine".TheScientificWorldJournal.2013:9.doi:10.1155/2013/130134.
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classificationbasedonGARCHvariancesseries".BiomedicalSignalProcessingandControl.8(6):909919.
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13.ElDahshanE.S.A.MohsenH.M.RevettK.etal.(2014)."Computeraideddiagnosisofhumanbraintumorthrough
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ScreeningMammogramsPerSkaane,AshwiniKshirsagar,SandraStapleton,KariYoungandRonaldA.Castellino
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