Leveraging wisdom of the crowds to improve consensus among radiologists by real time, blinded collaborations on a digital swarm platform

Radiologists today play a key role in making diagnostic decisions and labeling images for training A.I. algorithms. Low inter-reader reliability (IRR) can be seen between experts when interpreting challenging cases. While teams-based decisions are known to outperform individual decisions, inter-personal biases often creep up in group interactions which limit non-dominant participants from expressing true opinions. To overcome the dual problems of low consensus and inter-personal bias, we explored a solution modeled on biological swarms of bees. Two separate cohorts; three radiologists and five radiology residents collaborated on a digital swarm platform in real time and in a blinded fashion, grading meniscal lesions on knee MR exams. These consensus votes were benchmarked against clinical (arthroscopy) and radiological (senior-most radiologist) observations. The IRR of the consensus votes was compared to the IRR of the majority and most confident votes of the two cohorts.The radiologist cohort saw an improvement of 23% in IRR of swarm votes over majority vote. Similar improvement of 23% in IRR in 3-resident swarm votes over majority vote, was observed. The 5-resident swarm had an even higher improvement of 32% in IRR over majority vote. Swarm consensus votes also improved specificity by up to 50%. The swarm consensus votes outperformed individual and majority vote decisions in both the radiologists and resident cohorts. The 5-resident swarm had higher IRR than 3-resident swarm indicating positive effect of increased swarm size. The attending and resident swarms also outperformed predictions from a state-of-the-art A.I. algorithm. Utilizing a digital swarm platform improved agreement and allows participants to express judgement free intent, resulting in superior clinical performance and robust A.I. training labels.

Hierarchical Severity Staging of Anterior Cruciate Ligament Injuries using Deep Learning with MRI Images

Purpose: To evaluate the diagnostic utility of two convolutional neural networks (CNNs) for severity staging of anterior cruciate ligament (ACL) injuries. Materials and Methods: This retrospective analysis was conducted on 1243 knee MR images (1008 intact, 18 partially torn, 77 fully torn, and 140 reconstructed ACLs) from 224 patients (age 47 +/- 14 years, 54% women) acquired between 2011 and 2014. The radiologists used a modified scoring metric. To classify ACL injuries with deep learning, two types of CNNs were used, one with three-dimensional (3D) and the other with two-dimensional (2D) convolutional kernels. Performance metrics included sensitivity, specificity, weighted Cohen's kappa, and overall accuracy, followed by McNemar's test to compare the CNNs performance. Results: The overall accuracy and weighted Cohen's kappa reported for ACL injury classification were higher using the 2D CNN (accuracy: 92% (233/254) and kappa: 0.83) than the 3D CNN (accuracy: 89% (225/254) and kappa: 0.83) (P = .27). The 2D CNN and 3D CNN performed similarly in classifying intact ACLs (2D CNN: 93% (188/203) sensitivity and 90% (46/51) specificity; 3D CNN: 89% (180/203) sensitivity and 88% (45/51) specificity). Classification of full tears by both networks were also comparable (2D CNN: 82% (14/17) sensitivity and 94% (222/237) specificity; 3D CNN: 76% (13/17) sensitivity and 100% (236/237) specificity). The 2D CNN classified all reconstructed ACLs correctly. Conclusion: 2D and 3D CNNs applied to ACL lesion classification had high sensitivity and specificity, suggesting that these networks could be used to help grade ACL injuries by non-experts.