AI-based computer-aided diagnostic system of chest digital tomography synthesis: Demonstrating comparative advantage with X-ray-based AI systems

Compared with chest X-ray (CXR) imaging, which is a single image projected from the front of the patient, chest digital tomosynthesis (CDTS) imaging can be more advantageous for lung lesion detection because it acquires multiple images projected from multiple angles of the patient. Various clinical comparative analysis and verification studies have been reported to demonstrate this, but there were no artificial intelligence (AI)-based comparative analysis studies. Existing AI-based computer-aided detection (CAD) systems for lung lesion diagnosis have been developed mainly based on CXR images; however, CAD-based on CDTS, which uses multi-angle images of patients in various directions, has not been proposed and verified for its usefulness compared to CXR-based counterparts. This study develops/tests a CDTS-based AI CAD system to detect lung lesions to demonstrate performance improvements compared to CXR-based AI CAD. We used multiple projection images as input for the CDTS-based AI model and a single-projection image as input for the CXR-based AI model to fairly compare and evaluate the performance between models. The proposed CDTS-based AI CAD system yielded sensitivities of 0.782 and 0.785 and accuracies of 0.895 and 0.837 for the performance of detecting tuberculosis and pneumonia, respectively, against normal subjects. These results show higher performance than sensitivities of 0.728 and 0.698 and accuracies of 0.874 and 0.826 for detecting tuberculosis and pneumonia through the CXR-based AI CAD, which only uses a single projection image in the frontal direction. We found that CDTS-based AI CAD improved the sensitivity of tuberculosis and pneumonia by 5.4% and 8.7% respectively, compared to CXR-based AI CAD without loss of accuracy. Therefore, we comparatively prove that CDTS-based AI CAD technology can improve performance more than CXR, enhancing the clinical applicability of CDTS.

3D unsupervised anomaly detection and localization through virtual multi-view projection and reconstruction: Clinical validation on low-dose chest computed tomography

Computer-aided diagnosis for low-dose computed tomography (CT) based on deep learning has recently attracted attention as a first-line automatic testing tool because of its high accuracy and low radiation exposure. However, existing methods rely on supervised learning, imposing an additional burden to doctors for collecting disease data or annotating spatial labels for network training, consequently hindering their implementation. We propose a method based on a deep neural network for computer-aided diagnosis called virtual multi-view projection and reconstruction for unsupervised anomaly detection. Presumably, this is the first method that only requires data from healthy patients for training to identify three-dimensional (3D) regions containing any anomalies. The method has three key components. Unlike existing computer-aided diagnosis tools that use conventional CT slices as the network input, our method 1) improves the recognition of 3D lung structures by virtually projecting an extracted 3D lung region to obtain two-dimensional (2D) images from diverse views to serve as network inputs, 2) accommodates the input diversity gain for accurate anomaly detection, and 3) achieves 3D anomaly/disease localization through a novel 3D map restoration method using multiple 2D anomaly maps. The proposed method based on unsupervised learning improves the patient-level anomaly detection by 10% (area under the curve, 0.959) compared with a gold standard based on supervised learning (area under the curve, 0.848), and it localizes the anomaly region with 93% accuracy, demonstrating its high performance.