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Coronary artery calcium (CAC) is highly predictive of cardiovascular events. While millions of chest CT scans are performed annually in the United States, CAC is not routinely quantified from scans done for non-cardiac purposes. A deep learning algorithm was developed using 446 expert segmentations to automatically quantify CAC on non-contrast, non-gated CT scans (AI-CAC). Our study differs from prior works as we leverage imaging data across the Veterans Affairs national healthcare system, from 98 medical centers, capturing extensive heterogeneity in imaging protocols, scanners, and patients. AI-CAC performance on non-gated scans was compared against clinical standard ECG-gated CAC scoring. Non-gated AI-CAC differentiated zero vs. non-zero and less than 100 vs. 100 or greater Agatston scores with accuracies of 89.4% (F1 0.93) and 87.3% (F1 0.89), respectively, in 795 patients with paired gated scans within a year of a non-gated CT scan. Non-gated AI-CAC was predictive of 10-year all-cause mortality (CAC 0 vs. >400 group: 25.4% vs. 60.2%, Cox HR 3.49, p < 0.005), and composite first-time stroke, MI, or death (CAC 0 vs. >400 group: 33.5% vs. 63.8%, Cox HR 3.00, p < 0.005). In a screening dataset of 8,052 patients with low-dose lung cancer-screening CTs (LDCT), 3,091/8,052 (38.4%) individuals had AI-CAC >400. Four cardiologists qualitatively reviewed LDCT images from a random sample of >400 AI-CAC patients and verified that 527/531 (99.2%) would benefit from lipid-lowering therapy. To the best of our knowledge, this is the first non-gated CT CAC algorithm developed across a national healthcare system, on multiple imaging protocols, without filtering intra-cardiac hardware, and compared against a strong gated CT reference. We report superior performance relative to previous CAC algorithms evaluated against paired gated scans that included patients with intra-cardiac hardware.

Despite major advances in artificial intelligence (AI) for medicine and healthcare, the deployment and adoption of AI technologies remain limited in real-world clinical practice. In recent years, concerns have been raised about the technical, clinical, ethical and legal risks associated with medical AI. To increase real world adoption, it is essential that medical AI tools are trusted and accepted by patients, clinicians, health organisations and authorities. This work describes the FUTURE-AI guideline as the first international consensus framework for guiding the development and deployment of trustworthy AI tools in healthcare. The FUTURE-AI consortium was founded in 2021 and currently comprises 118 inter-disciplinary experts from 51 countries representing all continents, including AI scientists, clinicians, ethicists, and social scientists. Over a two-year period, the consortium defined guiding principles and best practices for trustworthy AI through an iterative process comprising an in-depth literature review, a modified Delphi survey, and online consensus meetings. The FUTURE-AI framework was established based on 6 guiding principles for trustworthy AI in healthcare, i.e. Fairness, Universality, Traceability, Usability, Robustness and Explainability. Through consensus, a set of 28 best practices were defined, addressing technical, clinical, legal and socio-ethical dimensions. The recommendations cover the entire lifecycle of medical AI, from design, development and validation to regulation, deployment, and monitoring. FUTURE-AI is a risk-informed, assumption-free guideline which provides a structured approach for constructing medical AI tools that will be trusted, deployed and adopted in real-world practice. Researchers are encouraged to take the recommendations into account in proof-of-concept stages to facilitate future translation towards clinical practice of medical AI.

Public imaging datasets are critical for the development and evaluation of automated tools in cancer imaging. Unfortunately, many do not include annotations or image-derived features, complicating their downstream analysis. Artificial intelligence-based annotation tools have been shown to achieve acceptable performance and thus can be used to automatically annotate large datasets. As part of the effort to enrich public data available within NCI Imaging Data Commons (IDC), here we introduce AI-generated annotations for two collections of computed tomography images of the chest, NSCLC-Radiomics, and the National Lung Screening Trial. Using publicly available AI algorithms we derived volumetric annotations of thoracic organs at risk, their corresponding radiomics features, and slice-level annotations of anatomical landmarks and regions. The resulting annotations are publicly available within IDC, where the DICOM format is used to harmonize the data and achieve FAIR principles. The annotations are accompanied by cloud-enabled notebooks demonstrating their use. This study reinforces the need for large, publicly accessible curated datasets and demonstrates how AI can be used to aid in cancer imaging.

Generative models such as DALL-E 2 could represent a promising future tool for image generation, augmentation, and manipulation for artificial intelligence research in radiology provided that these models have sufficient medical domain knowledge. Here we show that DALL-E 2 has learned relevant representations of X-ray images with promising capabilities in terms of zero-shot text-to-image generation of new images, continuation of an image beyond its original boundaries, or removal of elements, while pathology generation or CT, MRI, and ultrasound images are still limited. The use of generative models for augmenting and generating radiological data thus seems feasible, even if further fine-tuning and adaptation of these models to the respective domain is required beforehand., Comment: 4 Figures

In this study we assessed the repeatability of the values of radiomics features for small prostate tumors using test-retest Multiparametric Magnetic Resonance Imaging (mpMRI) images. The premise of radiomics is that quantitative image features can serve as biomarkers characterizing disease. For such biomarkers to be useful, repeatability is a basic requirement, meaning its value must remain stable between two scans, if the conditions remain stable. We investigated repeatability of radiomics features under various preprocessing and extraction configurations including various image normalization schemes, different image pre-filtering, 2D vs 3D texture computation, and different bin widths for image discretization. Image registration as means to re-identify regions of interest across time points was evaluated against human-expert segmented regions in both time points. Even though we found many radiomics features and preprocessing combinations with a high repeatability (Intraclass Correlation Coefficient (ICC) > 0.85), our results indicate that overall the repeatability is highly sensitive to the processing parameters (under certain configurations, it can be below 0.0). Image normalization, using a variety of approaches considered, did not result in consistent improvements in repeatability. There was also no consistent improvement of repeatability through the use of pre-filtering options, or by using image registration between timepoints to improve consistency of the region of interest localization. Based on these results we urge caution when interpreting radiomics features and advise paying close attention to the processing configuration details of reported results. Furthermore, we advocate reporting all processing details in radiomics studies and strongly recommend making the implementation available.