Tag: X-rays

Categories : Cancer PaediatricsTags :

Study Assesses Cancers in Children Exposed to Medical Imaging

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Study of nearly 4 million children and adolescents finds that 10% of paediatric blood and bone marrow cancers may have stemmed from radiation exposure.

Credit: Pixabay CC0

A study led by UC San Francisco and UC Davis has concluded that radiation from medical imaging is associated with a higher risk of blood cancers in children.

For the study, which appears in NEJM, the researchers examined data from nearly 4 million children and estimated that 1 in 10 blood cancers – some 3000 cancers in all – may be attributable to radiation exposure from medical imaging. The risk increased proportionally based on the cumulative amount of radiation the children received.

The investigation is the first comprehensive assessment using data from children and adolescents in North America that quantifies the association between radiation exposure from medical imaging and blood and bone marrow cancers, such as leukaemia and lymphoma, which are the most common forms of cancer in children and adolescents.

Medical imaging saves lives by enabling timely diagnosis and effective treatment, but it also exposes patients to ionizing radiation, a known carcinogen, particularly through computed tomography (CT).

The authors caution that doctors and parents should avoid excessive radiation doses and minimize exposure when clinically feasible.

“Children are particularly vulnerable to radiation-induced cancer due to their heightened radiosensitivity and longer life expectancy,” said Rebecca Smith-Bindman, MD, a radiologist and professor of Epidemiology and Biostatistics, as well as Obstetrics, Gynecology and Reproductive Sciences at UCSF and the first author of the paper.

“While medical imaging can be lifesaving, our findings underscore the critical need to carefully evaluate and minimise radiation exposure during paediatric imaging to safeguard children’s long-term health,” said Smith-Bindman, who is also a member of the Philip R. Lee Institute for Health Policy Studies. “This involves ensuring that imaging is performed only when it provides essential information for the child’s care and, in cases such as CT scans, using the lowest possible radiation doses.”

Documenting risks in children

The study uses a retrospective cohort design, looking back at the complete imaging histories of 3.7 million children who were born between 1996 and 2016. The children were treated at six health care systems in the U.S. and Ontario, Canada. Investigators found a significant relationship between cumulative radiation dose and the risk of a hematologic malignancy, which includes tumours affecting the blood, bone marrow, lymph, and lymphatic system.

The risk of developing cancer varied significantly by imaging modality. CT, which is used to detect many abnormalities such as tumours, heart disease, and injuries of the spinal cord and brain, entails significant radiation exposure. But radiographs, which are used to diagnose both broken bones and pneumonia, expose children to much lower doses.

Among all the forms of medical imaging, the study found that chest radiography was the most common imaging exam that doctors performed. The most common form of CT was of the head and brain.

For children who underwent a head CT, the researchers attributed about a quarter of the children’s subsequent hematologic malignancies to radiation exposure. For those who had radiographs, by contrast, they estimated that only a small fraction of the children’s subsequent cancers were associated with radiation exposure.

Getting one or two head CTs was associated with a 1.8-fold increased risk of a cancer diagnosis, and this rose to 3.5 times for children who received more scans and were therefore exposed to more radiation.

Altogether, 2961 haematologic malignancies were diagnosed during the study period. Lymphoid malignancies accounted for 79.3%, while myeloid malignancies and acute leukaemia together accounted for 15.5%. About 58% of cancers occurred in males, and about half were diagnosed in children under 5.

The authors said that up to 10% of haematologic malignancies in children and adolescents could be prevented by reducing unnecessary imaging and optimising radiation doses. In many cases, the authors said, substituting non-ionising imaging modalities like ultrasound or MRI may be feasible without compromising diagnostic accuracy.

Benefits vs risks

The authors emphasised that while medical imaging remains an invaluable tool in paediatric care, their findings highlight the need to carefully balance its diagnostic benefits with potential long-term risks.

“This study provides robust, directly observed evidence of a clear dose–response relationship between radiation from medical imaging and hematologic malignancy risk in children and adolescents,” said Diana Miglioretti, PhD, UC Davis Health professor and chief of the Division of Biostatistics.

“Our findings align with international research highlighting that children are especially radiosensitive,” Miglioretti added. “It’s crucial for clinicians to weigh the immediate benefits of imaging against potential long-term health risks and to optimise imaging protocols to minimize radiation exposure.”

Source: University of California – San Francisco

Categories : IT in Healthcare Lab Tests and ImagingTags :

New AI–based Test Detects Early Signs of Osteoporosis from X-ray Images

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Photo by Cottonbro on Pexels

Investigators have developed an artificial intelligence-assisted diagnostic system that can estimate bone mineral density in both the lumbar spine and the femur of the upper leg, based on X-ray images. The advance is described in a study published in the Journal of Orthopaedic Research.

A total of 1454 X-ray images were analysed using the scientists’ system. Performance rates for the lumbar and femur of patients with bone density loss, or osteopenia, were 86.4% and 84.1%, respectively, in terms of sensitivity. The respective specificities were 80.4% and 76.3%. (Sensitivity reflected the ability of the test to correctly identify people with osteopenia, whereas specificity reflected its ability to correctly identify those without osteopenia). The test also had high sensitivity and specificity for categorising patients with and without osteoporosis.

“Bone mineral density measurement is essential for screening and diagnosing osteoporosis, but limited access to diagnostic equipment means that millions of people worldwide may remain undiagnosed,” said corresponding author Toru Moro, MD, PhD, of the University of Tokyo. “This AI system has the potential to transform routine clinical X-rays into a powerful tool for opportunistic screening, enabling earlier, broader, and more efficient detection of osteoporosis.”

Source: Wiley

Categories : IT in Healthcare Lab Tests and ImagingTags :

AI Models that can Identify Patient Demographics in X-rays are Also Unfair

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Photo by Anna Shvets

Artificial intelligence models often play a role in medical diagnoses, especially when it comes to analysing images such as X-rays. But these models have been found not perform as well across all demographic groups, usually faring worse on women and people of colour.

These models have also been shown to develop some surprising abilities. In 2022, MIT researchers reported that AI models can make accurate predictions about a patient’s race from their chest X-rays – something that the most skilled radiologists can’t do.

Now, in a new study appearing in Nature, the same research team has found that the models that are most accurate at making demographic predictions also show the biggest “fairness gaps”, ie having reduced accuracy diagnosing images of people of different races or genders. The findings suggest that these models may be using “demographic shortcuts” when making their diagnostic evaluations, which lead to incorrect results for women, Black people, and other groups, the researchers say.

“It’s well-established that high-capacity machine-learning models are good predictors of human demographics such as self-reported race or sex or age. This paper re-demonstrates that capacity, and then links that capacity to the lack of performance across different groups, which has never been done,” says senior author Marzyeh Ghassemi, an MIT associate professor of electrical engineering and computer science.

The researchers also found that they could retrain the models in a way that improves their fairness. However, their approached to “debiasing” worked best when the models were tested on the same types of patients they were trained on, such as patients from the same hospital. When these models were applied to patients from different hospitals, the fairness gaps reappeared.

“I think the main takeaways are, first, you should thoroughly evaluate any external models on your own data because any fairness guarantees that model developers provide on their training data may not transfer to your population. Second, whenever sufficient data is available, you should train models on your own data,” says Haoran Zhang, an MIT graduate student and one of the lead authors of the new paper.

Removing bias

As of May 2024, the FDA has approved 882 AI-enabled medical devices, with 671 of them designed to be used in radiology. Since 2022, when Ghassemi and her colleagues showed that these diagnostic models can accurately predict race, they and other researchers have shown that such models are also very good at predicting gender and age, even though the models are not trained on those tasks.

“Many popular machine learning models have superhuman demographic prediction capacity – radiologists cannot detect self-reported race from a chest X-ray,” Ghassemi says. “These are models that are good at predicting disease, but during training are learning to predict other things that may not be desirable.”

In this study, the researchers set out to explore why these models don’t work as well for certain groups. In particular, they wanted to see if the models were using demographic shortcuts to make predictions that ended up being less accurate for some groups. These shortcuts can arise in AI models when they use demographic attributes to determine whether a medical condition is present, instead of relying on other features of the images.

Using publicly available chest X-ray datasets from Beth Israel Deaconess Medical Center (BIDMC) in Boston, the researchers trained models to predict whether patients had one of three different medical conditions: fluid buildup in the lungs, collapsed lung, or enlargement of the heart. Then, they tested the models on X-rays that were held out from the training data.

Overall, the models performed well, but most of them displayed “fairness gaps” – that is, discrepancies between accuracy rates for men and women, and for white and Black patients.

The models were also able to predict the gender, race, and age of the X-ray subjects. Additionally, there was a significant correlation between each model’s accuracy in making demographic predictions and the size of its fairness gap. This suggests that the models may be using demographic categorisations as a shortcut to make their disease predictions.

The researchers then tried to reduce the fairness gaps using two types of strategies. For one set of models, they trained them to optimise “subgroup robustness,” meaning that the models are rewarded for having better performance on the subgroup for which they have the worst performance, and penalised if their error rate for one group is higher than the others.

In another set of models, the researchers forced them to remove any demographic information from the images, using “group adversarial” approaches. Both strategies worked fairly well, the researchers found.

“For in-distribution data, you can use existing state-of-the-art methods to reduce fairness gaps without making significant trade-offs in overall performance,” Ghassemi says. “Subgroup robustness methods force models to be sensitive to mispredicting a specific group, and group adversarial methods try to remove group information completely.”

Not always fairer

However, those approaches only worked when the models were tested on data from the same types of patients that they were trained on, eg from BIDMC.

When the researchers tested the models that had been “debiased” using the BIDMC data to analyse patients from five other hospital datasets, they found that the models’ overall accuracy remained high, but some of them exhibited large fairness gaps.

“If you debias the model in one set of patients, that fairness does not necessarily hold as you move to a new set of patients from a different hospital in a different location,” Zhang says.

This is worrisome because in many cases, hospitals use models that have been developed on data from other hospitals, especially in cases where an off-the-shelf model is purchased, the researchers say.

“We found that even state-of-the-art models which are optimally performant in data similar to their training sets are not optimal – that is, they do not make the best trade-off between overall and subgroup performance – in novel settings,” Ghassemi says. “Unfortunately, this is actually how a model is likely to be deployed. Most models are trained and validated with data from one hospital, or one source, and then deployed widely.”

The researchers found that the models that were debiased using group adversarial approaches showed slightly more fairness when tested on new patient groups than those debiased with subgroup robustness methods. They now plan to try to develop and test additional methods to see if they can create models that do a better job of making fair predictions on new datasets.

The findings suggest that hospitals that use these types of AI models should evaluate them on their own patient population before beginning to use them, to make sure they aren’t giving inaccurate results for certain groups.

Categories : IT in Healthcare Lab Tests and ImagingTags :

Is AI a Help or Hindrance to Radiologists? It’s Down to the Doctor

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New research shows AI isn’t always a help for radiologists

Photo by Anna Shvets

One of the most touted promises of medical artificial intelligence tools is their ability to augment human clinicians’ performance by helping them interpret images such as X-rays and CT scans with greater precision to make more accurate diagnoses.

But the benefits of using AI tools on image interpretation appear to vary from clinician to clinician, according to new research led by investigators at Harvard Medical School, working with colleagues at MIT and Stanford.

The study findings suggest that individual clinician differences shape the interaction between human and machine in critical ways that researchers do not yet fully understand. The analysis, published in Nature Medicine, is based on data from an earlier working paper by the same research group released by the National Bureau of Economic Research.

In some instances, the research showed, use of AI can interfere with a radiologist’s performance and interfere with the accuracy of their interpretation.

“We find that different radiologists, indeed, react differently to AI assistance – some are helped while others are hurt by it,” said co-senior author Pranav Rajpurkar, assistant professor of biomedical informatics in the Blavatnik Institute at HMS.

“What this means is that we should not look at radiologists as a uniform population and consider just the ‘average’ effect of AI on their performance,” he said. “To maximize benefits and minimize harm, we need to personalize assistive AI systems.”

The findings underscore the importance of carefully calibrated implementation of AI into clinical practice, but they should in no way discourage the adoption of AI in radiologists’ offices and clinics, the researchers said.

Instead, the results should signal the need to better understand how humans and AI interact and to design carefully calibrated approaches that boost human performance rather than hurt it.

“Clinicians have different levels of expertise, experience, and decision-making styles, so ensuring that AI reflects this diversity is critical for targeted implementation,” said Feiyang “Kathy” Yu, who conducted the work while at the Rajpurkar lab with co-first author on the paper with Alex Moehring at the MIT Sloan School of Management.

“Individual factors and variation would be key in ensuring that AI advances rather than interferes with performance and, ultimately, with diagnosis,” Yu said.

AI tools affected different radiologists differently

While previous research has shown that AI assistants can, indeed, boost radiologists’ diagnostic performance, these studies have looked at radiologists as a whole without accounting for variability from radiologist to radiologist.

In contrast, the new study looks at how individual clinician factors – area of specialty, years of practice, prior use of AI tools – come into play in human-AI collaboration.

The researchers examined how AI tools affected the performance of 140 radiologists on 15 X-ray diagnostic tasks – how reliably the radiologists were able to spot telltale features on an image and make an accurate diagnosis. The analysis involved 324 patient cases with 15 pathologies: abnormal conditions captured on X-rays of the chest.

To determine how AI affected doctors’ ability to spot and correctly identify problems, the researchers used advanced computational methods that captured the magnitude of change in performance when using AI and when not using it.

The effect of AI assistance was inconsistent and varied across radiologists, with the performance of some radiologists improving with AI and worsening in others.

AI tools influenced human performance unpredictably

AI’s effects on human radiologists’ performance varied in often surprising ways.

For instance, contrary to what the researchers expected, factors such how many years of experience a radiologist had, whether they specialised in thoracic, or chest, radiology, and whether they’d used AI readers before, did not reliably predict how an AI tool would affect a doctor’s performance.

Another finding that challenged the prevailing wisdom: Clinicians who had low performance at baseline did not benefit consistently from AI assistance. Some benefited more, some less, and some none at all. Overall, however, lower-performing radiologists at baseline had lower performance with or without AI. The same was true among radiologists who performed better at baseline. They performed consistently well, overall, with or without AI.

Then came a not-so-surprising finding: More accurate AI tools boosted radiologists’ performance, while poorly performing AI tools diminished the diagnostic accuracy of human clinicians.

While the analysis was not done in a way that allowed researchers to determine why this happened, the finding points to the importance of testing and validating AI tool performance before clinical deployment, the researchers said. Such pre-testing could ensure that inferior AI doesn’t interfere with human clinicians’ performance and, therefore, patient care.

What do these findings mean for the future of AI in the clinic?

The researchers cautioned that their findings do not provide an explanation for why and how AI tools seem to affect performance across human clinicians differently, but note that understanding why would be critical to ensuring that AI radiology tools augment human performance rather than hurt it.

To that end, the team noted, AI developers should work with physicians who use their tools to understand and define the precise factors that come into play in the human-AI interaction.

And, the researchers added, the radiologist-AI interaction should be tested in experimental settings that mimic real-world scenarios and reflect the actual patient population for which the tools are designed.

Apart from improving the accuracy of the AI tools, it’s also important to train radiologists to detect inaccurate AI predictions and to question an AI tool’s diagnostic call, the research team said. To achieve that, AI developers should ensure that they design AI models that can “explain” their decisions.

“Our research reveals the nuanced and complex nature of machine-human interaction,” said study co-senior author Nikhil Agarwal, professor of economics at MIT. “It highlights the need to understand the multitude of factors involved in this interplay and how they influence the ultimate diagnosis and care of patients.”

Source: Harvard Medical School

Categories : Injury & Trauma PaediatricsTags :

Portable Ultrasound Works Just as Well in Diagnosing Forearm Fractures in Kids

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Portable ultrasound devices could provide an alternative to x-ray machines for diagnosing forearm fractures in children, which could alleviate waiting times for families in hospital emergency departments (ED).

Griffith University researchers Professor Robert Ware and Senior Lecturer Peter Snelling compared functional outcomes in children given an ultrasound and those who received an x-ray on a suspected distal forearm fracture. Dr Snelling said the ultrasounds were performed by nurses, physiotherapists and emergency physicians at four south-east Queensland hospitals.

“They treated 270 children, aged between five and 15 years, during the randomised trial, which included a check-up 28 days later and another check-in at eight weeks,” Dr Snelling said. “The findings show the majority of children had similar recoveries and returned to full physical function.”

Less than one-third of children who were given an ultrasound needed a follow-up x-ray and care at an orthopaedic clinic. Those who didn’t have a buckle fracture or fractured arm were discharged from hospital without the need for further imaging.

Professor Ware said children who had an ultrasound initially had fewer x-rays, and shorter stays in the ED. “Families were also more satisfied with the treatment they received,” he said. “The results are promising and have wider implications beyond in hospital diagnosis and follow up care.

“By using a bedside ultrasound, this frees up the x-ray machine for patients who really need it and can potentially be a cost-cutting measure for hospitals as they reduce the number of x-rays without comprising the safety of patients.

“It also would be extremely beneficial in rural or remote areas eliminating the need for children and their families to travel to a larger hospital for an x-ray.”

Source: Griffith University

Categories : Medical Research & TechnologyTags :

X-Ray Images With Vastly Lower Radiation Doses

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A new scintillation material developed by KAUST scientists can bring significant improvements to X-ray imaging in medicine, industry and security. Credit: KAUST

Scientists have successfully produced an exceptionally efficient, robust and flexible scintillation film to bring significant improvements in X-ray imaging, enabling much lower radiation doses to be used.

Scintillation materials release visible light, or “scintillate,” in response to absorbing  high-energy X-ray photons, enabling an image to be captured.

Researchers are continually exploring ways to make scintillation technology more sensitive, efficient and readily adaptable. The researchers, led by  Omar F Mohammed, Associate Professor of Chemical Sciences at King Abdullah University of Science and Technology (KAUST), sought to come up with an improved scintillation screen.

“Currently used materials suffer from several drawbacks, including complex and high-cost fabrication processes, radioluminescence afterglow and nontunable scintillation,” said Yang Zhou, a postdoc in Prof Mohammed’s lab.

Materials called lead halide perovskites have attracted considerable attention and shown significant promise. Novel perovskites are a category of materials that share the same crystal structure as the natural perovskite mineral calcium titanium oxide, but they include a variety of different atoms that replace all or some of those found in natural perovskite. 
To avoid toxicity problems and reduce cost, the researchers explored the use of elements besides lead. The newly developed screens are described in ACS Energy Letters.

The flexible scintillation screens the team developed can detect X-rays at ultralow levels, “approximately 113 times lower than a typical standard dose for X-ray medical imaging,” said Omar Mohammed, leader of the research group.

“Another vital advance is that the X-ray spatial resolution reported in this study is the highest achieved to date for powder-based screens,” said Dr Zhou.

“The physical flexibility of our films is also very important,” added Prof Mohammed. He explains that highly efficient flexible scintillation screens are urgently needed for using X-rays to better analyse awkward shapes.

The team plans to commercialise their advance, and to hope to refine their fabrication techniques.

Source: EurekAlert!

Categories : Lab Tests and ImagingTags :

Discrepancies in Radiology Interpretation

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Source: National Cancer Institute

Researchers who conducted an analysis of nearly six million acute examinations suggest that leaders in imaging practice consider efforts to match interpretation of subspecialty examinations with radiologists’ fellowship training in the acute community setting.

Pointing out that major and minor discrepancy rates were not higher for acute community setting examinations outside of interpreting radiologists’ fellowship training, “discrepancy rates increased for advanced examinations,” acknowledged lead investigators Suzanne Chong from Indiana University in Indianapolis and Tarek Hanna of Emory University. The study was published in the American Journal of Roentgenology.

Using the databank of a large US teleradiology company, Chong, Hanna, and colleagues performed an analysis of 5 883 980 acute examinations that were preliminarily interpreted by 269 teleradiologists with a fellowship of neuroradiology, abdominal radiology, or musculoskeletal radiology. When providing final interpretations, client on-site radiologists voluntarily submitted quality assurance (QA) requests if preliminary and final interpretations were discrepant; the teleradiology company’s own QA committee categorised discrepancies as major (n=8444) or minor (n=17 208).

Among initial teleradiology interpretations of acute community setting examinations, common examinations’ major and minor discrepancies rates were not significantly different when concordant versus discordant with radiologists’ fellowship training. However, advanced examinations’ discrepancy rates were higher when concordant with radiologists’ fellowship (relative risk = 1.45 and 1.17, respectively).

Noting that their findings support multispecialty radiologist practice in acute community settings, “efforts to match examination and interpreting radiologist subspecialty may not reduce diagnostic discrepancies,” the article authors cautioned.

A supplement to the published article is available here [PDF].

Source: American Roentgen Ray Society