The Impact of Artificial Intelligence on Emergency Medicine: A Review of Recent Advances

Artificial Intelligence (AI) is revolutionizing emergency medicine by enhancing diagnostic processes and improving patient outcomes. This article provides a review of the current applications of AI in emergency imaging studies, focusing on the last five years of advancements. AI technologies, particularly machine learning and deep learning, are pivotal in interpreting complex imaging data, offering rapid, accurate diagnoses and potentially surpassing traditional diagnostic methods. Studies highlighted within the article demonstrate AI's capabilities in accurately detecting conditions such as fractures, pneumothorax, and pulmonary diseases from various imaging modalities including X-rays, CT scans, and MRIs. Furthermore, AI's ability to predict clinical outcomes like mechanical ventilation needs illustrates its potential in crisis resource optimization. Despite these advancements, the integration of AI into clinical practice presents challenges such as data privacy, algorithmic bias, and the need for extensive validation across diverse settings. This review underscores the transformative potential of AI in emergency settings, advocating for a future where AI and clinical expertise synergize to elevate patient care standards.

RFUDS -- A Brain Metastases Imaging Dataset of Radiotherapy Follow-Up

Brain metastases are a common diagnosis that affects between 20% and 40% of cancer patients. Subsequent to radiation therapy, patients with brain metastases undergo follow-up sessions during which the response to treatment is monitored. In this study, a dataset of medical images from 44 patients with at least one brain metastasis and different primary tumor locations was collected and processed. Each patient was treated with either a linear accelerator or a gamma knife. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans were collected at various time points, including before treatment and during follow-up sessions. The CT datasets were processed using windowing and artifact reduction techniques, while the MRI datasets were subjected to CLAHE. The NifTI files corresponding to the CT and MRI images were made public available. In order to align the datasets of each patient, a multimodal registration was performed between the CT and MRI datasets, with different software options being tested. The fusion matrices were provided together with the dataset. The aforementioned steps resulted in the creation of an optimized dataset, prepared for use in a range of studies related to brain metastases. RFUds is publicity available at zenodo under the DOI 10.5281/zenodo.14524784.

Comparative Analysis of nnUNet and MedNeXt for Head and Neck Tumor Segmentation in MRI-guided Radiotherapy

Radiation therapy (RT) is essential in treating head and neck cancer (HNC), with magnetic resonance imaging(MRI)-guided RT offering superior soft tissue contrast and functional imaging. However, manual tumor segmentation is time-consuming and complex, and therfore remains a challenge. In this study, we present our solution as team TUMOR to the HNTS-MRG24 MICCAI Challenge which is focused on automated segmentation of primary gross tumor volumes (GTVp) and metastatic lymph node gross tumor volume (GTVn) in pre-RT and mid-RT MRI images. We utilized the HNTS-MRG2024 dataset, which consists of 150 MRI scans from patients diagnosed with HNC, including original and registered pre-RT and mid-RT T2-weighted images with corresponding segmentation masks for GTVp and GTVn. We employed two state-of-the-art models in deep learning, nnUNet and MedNeXt. For Task 1, we pretrained models on pre-RT registered and mid-RT images, followed by fine-tuning on original pre-RT images. For Task 2, we combined registered pre-RT images, registered pre-RT segmentation masks, and mid-RT data as a multi-channel input for training. Our solution for Task 1 achieved 1st place in the final test phase with an aggregated Dice Similarity Coefficient of 0.8254, and our solution for Task 2 ranked 8th with a score of 0.7005. The proposed solution is publicly available at Github Repository.

Brain Tumour Removing and Missing Modality Generation using 3D WDM

This paper presents the second-placed solution for task 8 and the participation solution for task 7 of BraTS 2024. The adoption of automated brain analysis algorithms to support clinical practice is increasing. However, many of these algorithms struggle with the presence of brain lesions or the absence of certain MRI modalities. The alterations in the brain's morphology leads to high variability and thus poor performance of predictive models that were trained only on healthy brains. The lack of information that is usually provided by some of the missing MRI modalities also reduces the reliability of the prediction models trained with all modalities. In order to improve the performance of these models, we propose the use of conditional 3D wavelet diffusion models. The wavelet transform enabled full-resolution image training and prediction on a GPU with 48 GB VRAM, without patching or downsampling, preserving all information for prediction. For the inpainting task of BraTS 2024, the use of a large and variable number of healthy masks and the stability and efficiency of the 3D wavelet diffusion model resulted in 0.007, 22.61 and 0.842 in the validation set and 0.07 , 22.8 and 0.91 in the testing set (MSE, PSNR and SSIM respectively). The code for these tasks is available at https://github.com/ShadowTwin41/BraTS_2023_2024_solutions.

Improved Multi-Task Brain Tumour Segmentation with Synthetic Data Augmentation

This paper presents the winning solution of task 1 and the third-placed solution of task 3 of the BraTS challenge. The use of automated tools in clinical practice has increased due to the development of more and more sophisticated and reliable algorithms. However, achieving clinical standards and developing tools for real-life scenarios is a major challenge. To this end, BraTS has organised tasks to find the most advanced solutions for specific purposes. In this paper, we propose the use of synthetic data to train state-of-the-art frameworks in order to improve the segmentation of adult gliomas in a post-treatment scenario, and the segmentation of meningioma for radiotherapy planning. Our results suggest that the use of synthetic data leads to more robust algorithms, although the synthetic data generation pipeline is not directly suited to the meningioma task. The code for these tasks is available at https://github.com/ShadowTwin41/BraTS_2023_2024_solutions.

Subthalamic Nucleus segmentation in high-field Magnetic Resonance data. Is space normalization by template co-registration necessary?

Deep Brain Stimulation (DBS) is one of the most successful methods to diminish late-stage Parkinson's Disease (PD) symptoms. It is a delicate surgical procedure which requires detailed pre-surgical patient's study. High-field Magnetic Resonance Imaging (MRI) has proven its improved capacity of capturing the Subthalamic Nucleus (STN) - the main target of DBS in PD - in greater detail than lower field images. Here, we present a comparison between the performance of two different Deep Learning (DL) automatic segmentation architectures, one based in the registration to a brain template and the other performing the segmentation in in the MRI acquisition native space. The study was based on publicly available high-field 7 Tesla (T) brain MRI datasets of T1-weighted and T2-weighted sequences. nnUNet was used on the segmentation step of both architectures, while the data pre and post-processing pipelines diverged. The evaluation metrics showed that the performance of the segmentation directly in the native space yielded better results for the STN segmentation, despite not showing any advantage over the template-based method for the to other analysed structures: the Red Nucleus (RN) and the Substantia Nigra (SN).

Deep Dive into MRI: Exploring Deep Learning Applications in 0.55T and 7T MRI

The development of magnetic resonance imaging (MRI) for medical imaging has provided a leap forward in diagnosis, providing a safe, non-invasive alternative to techniques involving ionising radiation exposure for diagnostic purposes. It was described by Block and Purcel in 1946, and it was not until 1980 that the first clinical application of MRI became available. Since that time the MRI has gone through many advances and has altered the way diagnosing procedures are performed. Due to its ability to improve constantly, MRI has become a commonly used practice among several specialisations in medicine. Particularly starting 0.55T and 7T MRI technologies have pointed out enhanced preservation of image detail and advanced tissue characterisation. This review examines the integration of deep learning (DL) techniques into these MRI modalities, disseminating and exploring the study applications. It highlights how DL contributes to 0.55T and 7T MRI data, showcasing the potential of DL in improving and refining these technologies. The review ends with a brief overview of how MRI technology will evolve in the coming years.

How we won BraTS 2023 Adult Glioma challenge? Just faking it! Enhanced Synthetic Data Augmentation and Model Ensemble for brain tumour segmentation

Deep Learning is the state-of-the-art technology for segmenting brain tumours. However, this requires a lot of high-quality data, which is difficult to obtain, especially in the medical field. Therefore, our solutions address this problem by using unconventional mechanisms for data augmentation. Generative adversarial networks and registration are used to massively increase the amount of available samples for training three different deep learning models for brain tumour segmentation, the first task of the BraTS2023 challenge. The first model is the standard nnU-Net, the second is the Swin UNETR and the third is the winning solution of the BraTS 2021 Challenge. The entire pipeline is built on the nnU-Net implementation, except for the generation of the synthetic data. The use of convolutional algorithms and transformers is able to fill each other's knowledge gaps. Using the new metric, our best solution achieves the dice results 0.9005, 0.8673, 0.8509 and HD95 14.940, 14.467, 17.699 (whole tumour, tumour core and enhancing tumour) in the validation set.

Deep PCCT: Photon Counting Computed Tomography Deep Learning Applications Review

Medical imaging faces challenges such as limited spatial resolution, interference from electronic noise and poor contrast-to-noise ratios. Photon Counting Computed Tomography (PCCT) has emerged as a solution, addressing these issues with its innovative technology. This review delves into the recent developments and applications of PCCT in pre-clinical research, emphasizing its potential to overcome traditional imaging limitations. For example PCCT has demonstrated remarkable efficacy in improving the detection of subtle abnormalities in breast, providing a level of detail previously unattainable. Examining the current literature on PCCT, it presents a comprehensive analysis of the technology, highlighting the main features of scanners and their varied applications. In addition, it explores the integration of deep learning into PCCT, along with the study of radiomic features, presenting successful applications in data processing. While acknowledging these advances, it also discusses the existing challenges in this field, paving the way for future research and improvements in medical imaging technologies. Despite the limited number of articles on this subject, due to the recent integration of PCCT at a clinical level, its potential benefits extend to various diagnostic applications.

Multilingual Natural Language Processing Model for Radiology Reports -- The Summary is all you need!

The impression section of a radiology report summarizes important radiology findings and plays a critical role in communicating these findings to physicians. However, the preparation of these summaries is time-consuming and error-prone for radiologists. Recently, numerous models for radiology report summarization have been developed. Nevertheless, there is currently no model that can summarize these reports in multiple languages. Such a model could greatly improve future research and the development of Deep Learning models that incorporate data from patients with different ethnic backgrounds. In this study, the generation of radiology impressions in different languages was automated by fine-tuning a model, publicly available, based on a multilingual text-to-text Transformer to summarize findings available in English, Portuguese, and German radiology reports. In a blind test, two board-certified radiologists indicated that for at least 70% of the system-generated summaries, the quality matched or exceeded the corresponding human-written summaries, suggesting substantial clinical reliability. Furthermore, this study showed that the multilingual model outperformed other models that specialized in summarizing radiology reports in only one language, as well as models that were not specifically designed for summarizing radiology reports, such as ChatGPT.