164 results on '"Brent P. Little"'
Search Results
2. Pulmonary and coronary arterial abnormalities in patients with IgG4-related disease
- Author
-
Rory L. Cochran, MD, PhD, Holly R. Brideau, MD, MS, Markus Y. Wu, MD, John H. Stone, MD, MPH, Zachary S. Wallace, MD, MSc, and Brent P. Little, MD
- Subjects
IgG4-related disease ,Pulmonary artery aneurysm ,Coronary artery aneurysm ,Arteritis ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
IgG4-related disease (IgG4-RD) is an immune-mediated multiorgan fibroinflammatory disorder with variable clinical presentations. IgG4-RD cardiovascular involvement is considered rare, with pulmonary arterial involvement reported in a small subset of cases. Known pulmonary artery manifestations include pulmonary arteritis, pulmonary artery stenoses and central pulmonary artery aneurysms. Here we report 2 different patients with multifocal dilatation of the segmental and subsegmental pulmonary arteries with differing degrees of severity. Both patients also had coronary arterial abnormalities.
- Published
- 2022
- Full Text
- View/download PDF
3. Accurate auto-labeling of chest X-ray images based on quantitative similarity to an explainable AI model
- Author
-
Doyun Kim, Joowon Chung, Jongmun Choi, Marc D. Succi, John Conklin, Maria Gabriela Figueiro Longo, Jeanne B. Ackman, Brent P. Little, Milena Petranovic, Mannudeep K. Kalra, Michael H. Lev, and Synho Do
- Subjects
Science - Abstract
Here the authors develop a method for accurate auto-labelling of CXR images from large public datasets based on quantitative probability-of similarity to an explainable AI model. The labels can be used to fine-tune the original model through iterative re-training.
- Published
- 2022
- Full Text
- View/download PDF
4. Practical application and validation of the 2018 ATS/ERS/JRS/ALAT and Fleischner Society guidelines for the diagnosis of idiopathic pulmonary fibrosis
- Author
-
Angela R. Shih, Chayanin Nitiwarangkul, Brent P. Little, Benjamin W. Roop, Sreyankar Nandy, Margit V. Szabari, Nathaniel Mercaldo, Sarah Mercaldo, Sydney B. Montesi, Ashok Muniappan, Sarita R. Berigei, David A. Lynch, Amita Sharma, and Lida P. Hariri
- Subjects
Interstitial lung disease ,Lung fibrosis ,Pulmonary fibrosis ,Radiology and other imaging ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Background Accurate diagnosis of idiopathic pulmonary fibrosis (IPF) is essential to inform prognosis and treatment. In 2018, the ATS/ERS/JRS/ALAT and Fleischner Society released new diagnostic guidelines for usual interstitial pneumonitis (UIP)/IPF, adding Probable UIP as a CT category based on prior studies demonstrating this category had relatively high positive predictive value (PPV) for histopathologic UIP/Probable UIP. This study applies the 2018 ATS/ERS/JRS/ALAT and Fleischner Society guidelines to determine test characteristics of CT categories in academic clinical practice. Methods CT and histopathology were evaluated by three thoracic radiologists and two thoracic pathologists. Comparison of consensus categorization by the 2018 ATS and Fleischner Society guidelines by CT and histopathology was performed. Results Of patients with CT UIP, 87% (PPV, 95% CI: 60–98%) had histopathologic UIP with 97% (CI: 90–100%) specificity. Of patients with CT Probable UIP, 38% (PPV, CI: 14–68%) had histopathologic UIP and 46% (PPV, CI: 19–75%) had either histopathologic UIP or Probable UIP, with 88% (CI: 77–95%) specificity. Patients with CT Indeterminate and Alternative Diagnosis had histopathologic UIP in 27% (PPV, CI: 6–61%) and 21% (PPV, CI: 11–33%) of cases with specificities of 90% (CI: 80–96%) and 25% (CI: 16–37%). Interobserver variability (kappa) between radiologists ranged 0.32–0.81. Conclusions CT UIP and Probable UIP have high specificity for histopathologic UIP, and CT UIP has high PPV for histopathologic UIP. PPV of CT Probable UIP was 46% for combined histopathologic UIP/Probable UIP. Our results indicate that additional studies are needed to further assess and refine the guideline criteria to improve classification performance.
- Published
- 2021
- Full Text
- View/download PDF
5. Assessing Public Interest in Elective Surgery During the COVID-19 Pandemic
- Author
-
Austin Snyder, BS, Michael Lanuti, MD, Ashok Muniappan, MD, Melissa C. Price, MD, Avik Som, MD, PhD, and Brent P. Little, MD
- Subjects
Surgery ,RD1-811 - Abstract
Objective:. To determine trends in internet search volume for elective surgery terms during the first peak of the coronavirus disease 2019 (COVID-19) pandemic using Google Trends data. Background:. Postponement of much-needed elective and urgent oncologic surgeries takes a toll on patients and the health care system. The COVID-19 pandemic has led to a decline in elective surgery volume, partially due to the cancellation of elective surgeries at the start of the pandemic. Methods:. We performed a cross-sectional analysis of internet search volume trends for elective surgery terms during the first peak of the COVID-19 pandemic using Google Trends data and compared to a control group of terms representing common urgent and oncologic surgeries. Results:. Search volume for elective surgery terms (“knee replacement,” “spinal fusion,” “hip replacement,” “laminectomy,” “cataract surgery”) revealed a decrease of up to 54% compared to the prepandemic period, a significantly greater decrease than search volume for urgent and oncologic surgery terms (“C-section,” “cholecystectomy,” “CABG,” “colectomy,” “lobectomy,” and “mastectomy”). Conclusions:. The first phase of the COVID-19 pandemic led to sharp declines in search volume for essential elective surgical procedures, which may have been partially due to the cancellation of elective surgeries, but patient factors such as a temporary decline in interest in elective surgery might have also played a role. Attention to internet search volume may be used during future public health crises to monitor public engagement and interest in important health topics, including preventive health measures such as cancer screening.
- Published
- 2022
- Full Text
- View/download PDF
6. Low-loss and polarization insensitive 32 × 4 optical switch for ROADM applications
- Author
-
Xiaotian Zhu, Xiang Wang, Yanlu Huang, Liyan Wu, Chunfei Zhao, Mingzhu Xiao, Luyi Wang, Roy Davidson, Yanni Ou, Brent E. Little, and Sai T. Chu
- Subjects
Applied optics. Photonics ,TA1501-1820 ,Optics. Light ,QC350-467 - Abstract
Abstract Integrated switches play a crucial role in the development of reconfigurable optical add-drop multiplexers (ROADMs) that have greater flexibility and compactness, ultimately leading to robust single-chip solutions. Despite decades of research on switches with various structures and platforms, achieving a balance between dense integration, low insertion loss (IL), and polarization-dependent loss (PDL) remains a significant challenge. In this paper, we propose and demonstrate a 32 × 4 optical switch using high-index doped silica glass (HDSG) for ROADM applications. This switch is designed to route any of the 32 inputs to the express ports or drop any channels from 32 inputs to the target 4 drop ports or add any of the 4 ports to any of the 32 express channels. The switch comprises 188 Mach-Zehnder Interferometer (MZI) type switch elements, 88 optical vias for the 44 optical bridges, and 618 waveguide-waveguide crossings with three-dimensional (3D) structures. At 1550 nm, the fiber-to-fiber loss for each express channel is below 2 dB, and across the C and L bands, below 3 dB. For each input channel to all 4 drop/add channels at 1550 nm, the loss is less than 3.5 dB and less than 5 dB across the C and L bands. The PDLs for all express and input channels to the 4 drop/add channels are below 0.3 dB over the C band, and the crosstalk is under −50 dB for both the C and L bands.
- Published
- 2024
- Full Text
- View/download PDF
7. Genetic algorithm-enhanced microcomb state generation
- Author
-
Celine Mazoukh, Luigi Di Lauro, Imtiaz Alamgir, Bennet Fischer, Nicolas Perron, A. Aadhi, Armaghan Eshaghi, Brent E. Little, Sai T. Chu, David J. Moss, and Roberto Morandotti
- Subjects
Astrophysics ,QB460-466 ,Physics ,QC1-999 - Abstract
Abstract Microcavities enable the generation of highly efficient microcombs, which find applications in various domains, such as high-precision metrology, sensing, and telecommunications. Such applications generally require precise control over the spectral features of the microcombs, such as free spectral range, spectral envelope, and bandwidth. Most existing methods for customizing microcomb still rely on manual exploration of a large parameter space, often lacking practicality and versatility. In this work, we propose a smart approach that employs genetic algorithms to autonomously optimize the parameters for generating and tailoring stable microcombs. Our scheme controls optical parametric oscillation in a microring resonator to achieve broadband microcombs spanning the entire telecommunication C-band. The high flexibility of our approach allows us to obtain complex microcomb spectral envelopes corresponding to various operation regimes, with the potential to be directly adapted to different microcavity geometries and materials. Our work provides a robust and effective solution for targeted soliton crystal and multi-soliton state generation, with future potential for next-generation telecommunication applications and artificial intelligence-assisted data processing.
- Published
- 2024
- Full Text
- View/download PDF
8. Scalable parallel ultrafast optical random bit generation based on a single chaotic microcomb
- Author
-
Pu Li, Qizhi Li, Wenye Tang, Weiqiang Wang, Wenfu Zhang, Brent E. Little, Sai Tek Chu, K. Alan Shore, Yuwen Qin, and Yuncai Wang
- Subjects
Applied optics. Photonics ,TA1501-1820 ,Optics. Light ,QC350-467 - Abstract
Abstract Random bit generators are critical for information security, cryptography, stochastic modeling, and simulations. Speed and scalability are key challenges faced by current physical random bit generation. Herein, we propose a massively parallel scheme for ultrafast random bit generation towards rates of order 100 terabit per second based on a single micro-ring resonator. A modulation-instability-driven chaotic comb in a micro-ring resonator enables the simultaneous generation of hundreds of independent and unbiased random bit streams. A proof-of-concept experiment demonstrates that using our method, random bit streams beyond 2 terabit per second can be successfully generated with only 7 comb lines. This bit rate can be easily enhanced by further increasing the number of comb lines used. Our approach provides a chip-scale solution to random bit generation for secure communication and high-performance computation, and offers superhigh speed and large scalability.
- Published
- 2024
- Full Text
- View/download PDF
9. Enhanced efficiency of correlated photon pairs generation in silicon nitride with a low-loss 3D edge coupler
- Author
-
Xiaotian Zhu, Changyue Wang, Brent E. Little, Z. Y. Ou, Sai T. Chu, Liang Cui, and Xiaoying Li
- Subjects
Applied optics. Photonics ,TA1501-1820 - Abstract
We demonstrate the generation of correlated photon pairs by using a hybrid integrated quantum photonic platform, where the dual-layer platform consists of a high-index doped silica glass (HDSG) layer to accommodate low-loss linear components and an SiN-based layer to accommodate the photon source. Leveraging the low-loss fiber coupling to the HDSG waveguide and the high nonlinearity of the SiN waveguide, we experimentally realize integrated source of photon pairs with high heralding efficiency. The directly measured photon pair rate is up to 87 KHz (corresponding to 1.74 × 10−3 pairs per pulse) when the coincidence-to-accidental ratio is greater than 10. The raw heralding efficiency can reach 18%. If the filtering loss is excluded, the heralding efficiency can further reach 29%.
- Published
- 2024
- Full Text
- View/download PDF
10. Photonic signal processor based on a Kerr microcomb for real-time video image processing
- Author
-
Mengxi Tan, Xingyuan Xu, Andreas Boes, Bill Corcoran, Thach G. Nguyen, Sai T. Chu, Brent E. Little, Roberto Morandotti, Jiayang Wu, Arnan Mitchell, and David J. Moss
- Subjects
Engineering (General). Civil engineering (General) ,TA1-2040 - Abstract
Abstract Signal processing has become central to many fields, from coherent optical telecommunications, where it is used to compensate signal impairments, to video image processing. Image processing is particularly important for observational astronomy, medical diagnosis, autonomous driving, big data and artificial intelligence. For these applications, signal processing traditionally has mainly been performed electronically. However these, as well as new applications, particularly those involving real time video image processing, are creating unprecedented demand for ultrahigh performance, including high bandwidth and reduced energy consumption. Here, we demonstrate a photonic signal processor operating at 17 Terabits/s and use it to process video image signals in real-time. The system processes 400,000 video signals concurrently, performing 34 functions simultaneously that are key to object edge detection, edge enhancement and motion blur. As compared with spatial-light devices used for image processing, our system is not only ultra-high speed but highly reconfigurable and programable, able to perform many different functions without any change to the physical hardware. Our approach is based on an integrated Kerr soliton crystal microcomb, and opens up new avenues for ultrafast robotic vision and machine learning.
- Published
- 2023
- Full Text
- View/download PDF
11. Mode-locked laser with multiple timescales in a microresonator-based nested cavity
- Author
-
A. Aadhi, Imtiaz Alamgir, Luigi Di Lauro, Bennet Fischer, Nicolas Perron, Pavel Dmitriev, Celine Mazoukh, Piotr Roztocki, Cristina Rimoldi, Mario Chemnitz, Armaghan Eshaghi, Evgeny A. Viktorov, Anton V. Kovalev, Brent E. Little, Sai T. Chu, David J. Moss, and Roberto Morandotti
- Subjects
Applied optics. Photonics ,TA1501-1820 - Abstract
Mode-locking techniques have played a pivotal role in developing and advancing laser technology. Stable fiber-cavity configurations can generate trains of pulses spanning from MHz to GHz speeds, which are fundamental to various applications in micromachining, spectroscopy, and communications. However, the generation and exploitation of multiple timescales in a single laser cavity configuration remain unexplored. Our work demonstrates a fiber-cavity laser configuration designed to generate and control pulse trains from nanosecond to picosecond timescales with a broadband output and a low mode-locking threshold. Our approach exploits a frequency mode-locking mechanism that simultaneously drives the modes of an integrated microring resonator nested within an external fiber-loop cavity, guaranteeing ultra-stable operation. By selectively filtering the nested cavity modes, we can transition from nanosecond pulses to pulse burst trains in which nanosecond and picosecond components coexist. Our laser configuration produces a train of pulses with durations of 5.1 ns and 3.1 ps at repetition rates of 4.4 MHz and 48.7 GHz, with time-bandwidth products close to the transform-limited values of 0.5 and 0.46, respectively. Moreover, in the absence of frequency modulation, we demonstrate the generation of comb spectra with an adjustable central wavelength. Our findings have the potential to significantly contribute to the development of cutting-edge technologies and applications, harnessing the distinct advantages of mode-locked pulses across various scientific and engineering disciplines.
- Published
- 2024
- Full Text
- View/download PDF
12. Slot-Waveguide Based All-Optical RF Spectrum Analyzer
- Author
-
Yuhua Li, Zhe Kang, Wai-Lok Ho, Roy R. Davidson, Brent E. Little, Sai-Tak Chu, and Kun Zhu
- Subjects
nonlinear optics ,optical signal processing ,slot-waveguides ,radio-frequency (RF) spectrum analysis ,Applied optics. Photonics ,TA1501-1820 - Abstract
All-optical radio-frequency spectrum analyzers (AORFSAs) with ultrabroad bandwidth break the electronic bottleneck and provide an efficient frequency analysis means for ultrafast optical signals in communications, signal generation and processing systems. Here, we propose and experimentally demonstrate an AORFSA built on the cross-phase modulation effect in a 50 cm long CMOS-compatible photonic slot-waveguide. The waveguide has a 100 nm thick thin-film core of fused silica that is sandwiched by two 750 nm thick cladding layers of high-index doped silica, which shows optimized dispersion and comparable nonlinear characteristics. The measured 3 dB bandwidth of the proposed slot-waveguide-based AORFSA has a three-fold increase over the conventional channel waveguide having the same dimension and length. The sensitivity and wavelength- and polarization-dependence properties are investigated, confirming the proposed waveguide as a versatile platform for frequency analysis of ultrafast optical signals, such as Kerr microcombs with hundreds of GHz or even THz mode spacing.
- Published
- 2023
- Full Text
- View/download PDF
13. Thermo-Optic Response and Optical Bistablility of Integrated High-Index Doped Silica Ring Resonators
- Author
-
Junkai Hu, Jiayang Wu, Di Jin, Sai Tak Chu, Brent E. Little, Duan Huang, Roberto Morandotti, and David J. Moss
- Subjects
integrated optics ,thermo-optic effects ,microring resonator ,optical bistability ,Chemical technology ,TP1-1185 - Abstract
The engineering of thermo-optic effects has found broad applications in integrated photonic devices, facilitating efficient light manipulation to achieve various functionalities. Here, we perform both an experimental characterization and a theoretical analysis of these effects in integrated microring resonators made from high-index doped silica, which have had many applications in integrated photonics and nonlinear optics. By fitting the experimental results with theory, we obtain fundamental parameters that characterize their thermo-optic performance, including the thermo-optic coefficient, the efficiency of the optically induced thermo-optic process, and the thermal conductivity. The characteristics of these parameters are compared to those of other materials commonly used for integrated photonic platforms, such as silicon, silicon nitride, and silica. These results offer a comprehensive insight into the thermo-optic properties of doped silica-based devices. Understanding these properties is essential for efficiently controlling and engineering them in many practical applications.
- Published
- 2023
- Full Text
- View/download PDF
14. ACR Appropriateness Criteria® Routine Chest Imaging
- Author
-
Tami J. Bang, Jonathan H. Chung, Christopher M. Walker, Anupama G. Brixey, Jared D. Christensen, Saadia A. Faiz, Michael Hanak, Stephen B. Hobbs, Asha Kandathil, Brent P. Little, Rachna Madan, William H. Moore, Ilana B. Richman, Belinda Setters, Michael J. Todd, Stephen C. Yang, and Edwin F. Donnelly
- Subjects
Radiology, Nuclear Medicine and imaging - Published
- 2023
15. Trends in coronary calcium score and coronary CT angiography imaging volume during the COVID-19 pandemic
- Author
-
Thomas J. An, Nicole Kim, Alexander H. King, Bruno Panzarini, Brent P. Little, Reece J. Goiffon, Nandini Meyersohn, Sherief Garrana, Justin Stowell, Sanjay Saini, Brian B. Ghoshhajra, Sandeep Hedgire, and Marc D. Succi
- Subjects
Radiology, Nuclear Medicine and imaging - Abstract
The COVID-19 pandemic disrupted the delivery of preventative care and management of acute diseases. This study assesses the effect of the COVID-19 pandemic on coronary calcium score and coronary CT angiography imaging volume.A single institution retrospective review of consecutive patients presenting for coronary calcium score or coronary CT angiography examinations between January 1, 2020 to January 4, 2022 was performed. The weekly volume of calcium score and coronary CT angiogram exams were compared.In total, 1,817 coronary calcium score CT and 5,895 coronary CT angiogram examinations were performed. The average weekly volume of coronary CTA and coronary calcium score CT exams decreased by up to 83% and 100%, respectively, during the COVID-19 peak period compared to baseline (P0.0001). The post-COVID recovery through 2020 saw weekly coronary CTA volumes rebound to 86% of baseline (P = 0.024), while coronary calcium score CT volumes remained muted at only a 53% recovery (P0.001). In 2021, coronary CTA imaging eclipsed pre-COVID rates (P = 0.012), however coronary calcium score CT volume only reached 67% of baseline (P0.001).A significant decrease in both coronary CTA and coronary calcium score CT volume occurred during the peak-COVID-19 period. In 2020 and 2021, coronary CTA imaging eventually superseded baseline rates, while coronary calcium score CT volumes only reached two thirds of baseline. These findings highlight the importance of resumption of screening exams and should prompt clinicians to be aware of potential undertreatment of patients with coronary artery disease.
- Published
- 2023
16. Abdominal Imaging Findings on Computed Tomography as a Tool for COVID-19 Mortality Risk Assessment: Comparison With Chest Radiograph Severity Scores
- Author
-
Patricia Balthazar, Nathaniel Mercaldo, Nisanard Pisuchpen, Dexter P. Mendoza, Brent P. Little, Efren J. Flores, and Avinash Kambadakone
- Subjects
Radiology, Nuclear Medicine and imaging - Published
- 2022
17. Radiology Implementation Considerations for Artificial Intelligence (AI) Applied to COVID-19, From the AJR Special Series on AI Applications
- Author
-
Brent P. Little, Jayashree Kalpathy-Cramer, Matthew D. Li, Michael H. Chung, Xueyan Mei, Sharon Steinberger, Ken Chang, and Adam Bernheim
- Subjects
medicine.medical_specialty ,business.industry ,General Medicine ,Institutional review board ,Field (computer science) ,Systematic review ,Software deployment ,Medical imaging ,Medicine ,Radiology, Nuclear Medicine and imaging ,Use case ,Applications of artificial intelligence ,Artificial intelligence ,Radiology ,User interface ,business - Abstract
Hundreds of imaging-based artificial intelligence (AI) models have been developed in response to the COVID-19 pandemic. AI systems that incorporate imaging have shown promise in primary detection, severity grading, and prognostication of outcomes in COVID-19, and have enabled integration of imaging with a broad range of additional clinical and epidemiologic data. However, systematic reviews of AI models applied to COVID-19 medical imaging have highlighted problems in the field, including methodologic issues and problems in real-world deployment. Clinical use of such models should be informed by both the promise and potential pitfalls of implementation. How does a practicing radiologist make sense of this complex topic, and what factors should be considered in the implementation of AI tools for imaging of COVID-19? This critical review aims to help the radiologist understand the nuances that impact the clinical deployment of AI for imaging of COVID-19. We review imaging use cases for AI models in COVID-19 (e.g., diagnosis, severity assessment, and prognostication) and explore considerations for AI model development and testing, deployment infrastructure, clinical user interfaces, quality control, and institutional review board and regulatory approvals, with a practical focus on what a radiologist should consider when implementing an AI tool for COVID-19.
- Published
- 2022
18. United States lung cancer screening program websites: radiology representation, multimedia and multilingual content
- Author
-
Brent P, Little, Staci M, Gagne, Florian J, Fintelmann, Shaunagh, McDermott, Dexter P, Mendoza, Milena, Petranovic, Melissa C, Price, Justin T, Stowell, Anand K, Narayan, and Efren J, Flores
- Subjects
Search Engine ,Internet ,Lung Neoplasms ,Multimedia ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,Early Detection of Cancer ,United States - Abstract
To assess radiology representation, multimedia content, and multilingual content of United States lung cancer screening (LCS) program websites.We identified the websites of US LCS programs with the Google internet search engine using the search terms lung cancer screening, low-dose CT screening, and lung screening. We used a standardized checklist to assess and collect specific content, including information regarding LCS staff composition and references to radiologists and radiology. We also tabulated types and frequencies of included multimedia and multilingual content and patient narratives.We analyzed 257 unique websites. Of these, only 48% (124 of 257) referred to radiologists or radiology in text, images, or videos. Radiologists were featured in images or videos on only 14% (36 of 257) of websites. Radiologists were most frequently acknowledged for their roles in reading or interpreting imaging studies (35% [90 of 574]). Regarding multimedia content, only 36% (92 of 257) of websites had 1 image, 27% (70 of 257) included 2 or more images, and 26% (68 of 257) of websites included one or more videos. Only 3% (7 of 257) of websites included information in a language other than English. Patient narratives were found on only 15% (39 of 257) of websites.The field of Radiology is mentioned in text, images, or videos by less than half of LCS program websites. Most websites make only minimal use of multimedia content such as images, videos, and patient narratives. Few websites provide LCS information in languages other than English, potentially limiting accessibility to diverse populations.
- Published
- 2022
19. Chronic Pulmonary Manifestations of COVID-19 Infection: Imaging Evaluation
- Author
-
Mark C. Murphy and Brent P. Little
- Subjects
Radiology, Nuclear Medicine and imaging - Published
- 2023
20. U.S. Newspaper Coverage of Lung Cancer Screening from 2010 to 2022
- Author
-
Zachary D. Zippi, Isabel O. Cortopassi, Elizabeth M. Johnson, Shaunagh McDermott, Patricia J. Mergo, Milena Petranovic, Melissa C. Price, Justin T. Stowell, and Brent P. Little
- Subjects
Radiology, Nuclear Medicine and imaging ,General Medicine - Published
- 2023
21. Rate of True-Positive Findings of COVID-19 Typical Appearance at Chest CT per RSNA Consensus Guidelines in an Increasingly Vaccinated Population
- Author
-
Nicole J. Polyakov, Avik Som, Nathaniel D. Mercaldo, John Di Capua, Brent P. Little, and Efrén J. Flores
- Subjects
Radiology, Nuclear Medicine and imaging - Published
- 2023
22. Thoracic Radiology: Recent Developments and Future Trends
- Author
-
Theresa C. McLoud and Brent P. Little
- Subjects
Radiology, Nuclear Medicine and imaging - Published
- 2023
23. Community and Hospital Acquired Pneumonia
- Author
-
Kevin Delijani, Melissa C. Price, and Brent P. Little
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Radiography ,Healthcare-Associated Pneumonia ,Computed tomography ,Pneumonia ,Gold standard (test) ,medicine.disease ,Hospital-acquired pneumonia ,respiratory tract diseases ,Community-Acquired Infections ,medicine ,Etiology ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
Community-acquired pneumonia is the most common cause of death among infectious diseases, and responsible for millions of hospitalizations annually. Pneumonia may be classified based on how it is acquired, etiology, and clinical presentation. Chest radiographs are the gold standard for initial imaging evaluation and chest computed tomography plays an important role in diagnostic problem-solving and evaluation of complicated and treatment-resistant pneumonia. Follow-up imaging with chest radiographs or computed tomography post-illness resolution may be used to identify treatment-resistant inflammation or unidentified underlying malignancies.
- Published
- 2022
24. Rituximab for interstitial pneumonia with autoimmune features at two medical centres
- Author
-
Flavia V Castelino, Brent P. Little, Amita Sharma, Sydney B. Montesi, Hyon K. Choi, Mary E. Strek, Iazsmin Bauer Ventura, Ayodeji Adegunsoye, Marcy B. Bolster, and Kristin M. D’Silva
- Subjects
interstitial lung disease ,medicine.medical_specialty ,interstitial pneumonia with autoimmune features ,business.industry ,Cost effectiveness ,lung fibrosis ,Interstitial lung disease ,Articles ,medicine.disease ,law.invention ,Rheumatology ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Observational study ,Rituximab ,Lost to follow-up ,AcademicSubjects/MED00010 ,Prospective cohort study ,Adverse effect ,business ,medicine.drug - Abstract
Objectives Many patients with interstitial lung disease (ILD) have autoimmune manifestations but do not meet criteria for a systemic rheumatic disease. A subset meets criteria for interstitial pneumonia with autoimmune features (IPAF) and have ILD requiring therapy. We conducted a multicentre observational study to examine the use of rituximab (RTX) in IPAF. Methods Patients from Mass General Brigham (MGB) and University of Chicago Medicine (UCM) were included if they were ≥18 years old, met the 2015 classification criteria for IPAF and were treated with RTX. Clinical improvement was defined as improvement in four out of four domains at 1 year after RTX initiation: documented clinician global assessment; oxygen requirement; need for respiratory-related hospitalization; and survival. Results At MGB, 36 IPAF patients (mean age 61 years, 44% female) were treated with RTX. At 1 year, 18 (50%) were clinically improved, 12 (33%) were stable, and 6 (17%) died from progressive respiratory failure. At UCM, 14 IPAF patients (mean age 53 years, 71% female) were treated with RTX. At 1 year, eight (57%) were improved, two (14%) were stable, three (21%) died from progressive respiratory failure, and one (7%) was lost to follow-up. Two patients experienced minor infusion reactions, and two patients discontinued therapy owing to adverse events (infections). Conclusion In patients with IPAF treated with RTX at two medical centres, the majority (40 [80%]) demonstrated improvement/stability at 1 year. These findings call for prospective studies, including randomized clinical trials, to determine the risks, benefits and cost effectiveness of RTX in IPAF.
- Published
- 2021
25. Turing patterns in a fiber laser with a nested microresonator: Robust and controllable microcomb generation
- Author
-
Hualong Bao, Luana Olivieri, Maxwell Rowley, Sai T. Chu, Brent E. Little, Roberto Morandotti, David J. Moss, Juan Sebastian Totero Gongora, Marco Peccianti, and Alessia Pasquazi
- Subjects
Physics ,QC1-999 - Abstract
Microcombs based on Turing patterns have been extensively studied in configurations that can be modeled by the Lugiato-Lefever equation. Typically, such schemes are implemented experimentally by resonant coupling of a continuous wave laser to a Kerr microcavity in order to generate highly coherent and robust waves. Here, we study the formation of such patterns in a system composed of a microresonator nested in an amplifying laser cavity, a scheme recently used to demonstrate laser cavity solitons with high optical efficiency and easy repetition rate control. Utilizing this concept, we study different regimes of Turing patterns, unveiling their formation dynamics and demonstrating their controllability and robustness. By conducting a comprehensive modulational instability study with a mean-field model of the system, we explain the pattern formation in terms of its evolution from background noise, paving the way towards complete self-starting operation. Our theoretical and experimental paper provides a clear pathway for repetition rate control of these waves over both fine (Megahertz) and large (Gigahertz) scales, featuring a fractional frequency nonuniformity better than 7×10^{−14} with a 100-ms time gate and without the need for active stabilization.
- Published
- 2020
- Full Text
- View/download PDF
26. Variants and Vaccination in COVID-19: New Complexities and Challenges for Radiology Research and Practice
- Author
-
Brent P, Little
- Published
- 2022
27. True-Positive Rate of RSNA Typical Chest CT Findings for COVID-19 Pneumonia in an Increasingly Vaccinated Population
- Author
-
Nicole J, Polyakov, Avik, Som, Nathaniel D, Mercaldo, John, Di Capua, Brent P, Little, and Efren J, Flores
- Abstract
Background RSNA COVID-19 chest CT consensus guidelines are widely used, but their true positive rate for COVID-19 pneumonia has not been assessed among vaccinated patients. Purpose To assess true positive rate of RSNA typical chest CT findings of COVID-19 among fully vaccinated subjects with PCR-confirmed COVID-19 infection compared with unvaccinated subjects. Materials and Methods Patients with COVID Typical chest CT findings and one positive or two negative PCR tests for COVID-19 within 7 days of their chest CT between January 2021 - January 2022 at a quaternary academic medical center were included. True positives were defined as chest CTs interpreted as COVID Typical and PCR-confirmed COVID-19 infection within 7 days. Logistic regression models were constructed to quantify the association between PCR results and vaccination status, vaccination status and COVID-19 variants, and vaccination status and months. Results 652 subjects (median age 59, [IQR, 48-72]); 371 [57%] men) with CT scans classified as COVID Typical were included. 483 (74%) were unvaccinated and 169 (26%) were fully vaccinated. The overall true positive rate of COVID Typical CTs was lower among vaccinated versus unvaccinated (70/169 [41%; 95% CI: 34, 49%] vs 352/483 [73%; 69, 77%]; OR (95% CI): 3.8 (2.6, 5.5); P.001). Unvaccinated subjects were more likely to have true positive CTs compared with fully vaccinated subjects during the peaks of COVID-19 variants Alpha (OR, 16 [95% CI: 6.1, 42]
- Published
- 2022
28. Long-Term Lung Abnormalities Associated with COVID-19 Pneumonia
- Author
-
Jeffrey P. Kanne, Brent P. Little, Jefree J. Schulte, Adina Haramati, and Linda B. Haramati
- Subjects
Radiology, Nuclear Medicine and imaging - Abstract
In the third year of the SARS-CoV-2 pandemic, much has been learned about the long- term effect of COVID-19 pneumonia on the lungs. Approximately one-third of patients with moderate-to-severe pneumonia, especially those requiring intensive care therapy or mechanical ventilation, have residual abnormalities on chest CT one year after presentation. Abnormalities range from parenchymal bands to bronchial dilation to frank fibrosis. Less is known about the long-term pulmonary vascular sequelae, but there appears to be a persistent, increased risk of venothromboembolic events in a small cohort of patients. Finally, the associated histologic abnormalities resulting from SARS- CoV-2 infection are similar to those of patients with other causes of acute lung injury.
- Published
- 2022
29. Addressing Linguistic Barriers to Care: Evaluation of Breast Cancer Online Patient Educational Materials for Spanish-Speaking Patients
- Author
-
Brent P. Little, Juan Carlos Villa Camacho, Efren J. Flores, Yasha Parikh, Anand K. Narayan, Miguel A. Pena, and Randy C. Miles
- Subjects
Breast biopsy ,medicine.medical_specialty ,Word count ,MEDLINE ,Breast Neoplasms ,Health Services Accessibility ,symbols.namesake ,Breast cancer screening ,Breast cancer ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Fisher's exact test ,Language ,Internet ,medicine.diagnostic_test ,business.industry ,Linguistics ,medicine.disease ,Readability ,Health Literacy ,symbols ,Female ,Comprehension ,business ,Patient education - Abstract
The purpose of this study was to evaluate the readability of breast cancer online patient educational materials (OPEM) written in Spanish and to compare to equivalent English-language OPEM.The breast cancer-related terms cáncer de seno (breast cancer), detección de cáncer de seno (breast cancer screening), and biopsia de seno (breast biopsy) were queried using an online search engine. After each query, educational information related to the queried term was downloaded from each website appearing on the first five search engine result pages. Readability of Spanish-language OPEM was evaluated using the Crawford reading grade score. When available, equivalent English-language OPEM from the same website was then evaluated using the mean of five validated readability indices. Differences in readability, word count, and reading time between Spanish- and English-language OPEM were compared using an unpaired t test. The Fisher exact test was used to compare the proportion of websites meeting AMA recommendations for patient educational resources.Queries for cáncer de seno, detección de cáncer de seno, and biopsia de seno yielded 27, 31, and 30 results of term-specific OPEM. Equivalent English-language versions were available for 19 (70.4%), 18 (58.1%), and 20 (66.7%) websites, respectively. Spanish-language OPEM were written at a lower grade reading level than equivalent English-language versions overall (5.49 ± 0.50 versus 7.77 ± 1.95, P.01). Spanish-language OPEM were also more likely than English-language OPEM to meet AMA recommendations (82.9% versus 40.4%, P.01).Breast cancer-related Spanish-language OPEM were written at a significantly lower grade reading level compared with equivalent information written in English.
- Published
- 2021
30. COVID-19 Imaging: What We Know Now and What Remains Unknown
- Author
-
Harrison X. Bai, Brent P. Little, Michael H. Chung, Geoffrey D. Rubin, Linda B. Haramati, Adam Bernheim, Jeffrey P. Kanne, David F. Kallmes, and Nicola Sverzellati
- Subjects
Mechanical ventilation ,medicine.medical_specialty ,Myocarditis ,Coronavirus disease 2019 (COVID-19) ,SARS-CoV-2 ,business.industry ,Radiography ,medicine.medical_treatment ,COVID-19 ,Lung injury ,medicine.disease ,Sensitivity and Specificity ,Asymptomatic ,Triage ,Communications ,Pneumonia ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,Tomography, X-Ray Computed ,Letters to the Editor ,business ,Intensive care medicine ,Lung - Abstract
Infection with SARS-CoV-2 ranges from an asymptomatic condition to a severe and sometimes fatal disease, with mortality most frequently being the result of acute lung injury. The role of imaging has evolved during the pandemic, with CT initially being an alternative and possibly superior testing method compared with reverse transcriptase-polymerase chain reaction (RT-PCR) testing and evolving to having a more limited role based on specific indications. Several classification and reporting schemes were developed for chest imaging early during the pandemic for patients suspected of having COVID-19 to aid in triage when the availability of RT-PCR testing was limited and its level of performance was unclear. Interobserver agreement for categories with findings typical of COVID-19 and those suggesting an alternative diagnosis is high across multiple studies. Furthermore, some studies looking at the extent of lung involvement on chest radiographs and CT images showed correlations with critical illness and a need for mechanical ventilation. In addition to pulmonary manifestations, cardiovascular complications such as thromboembolism and myocarditis have been ascribed to COVID-19, sometimes contributing to neurologic and abdominal manifestations. Finally, artificial intelligence has shown promise for use in determining both the diagnosis and prognosis of COVID-19 pneumonia with respect to both radiography and CT.
- Published
- 2021
31. Editorial Comment: Influential Images-CT Shows Lower Severity of COVID-19 Pneumonia in Vaccinated Patients
- Author
-
Brent P. Little
- Subjects
Adenovirus Vaccines ,Humans ,COVID-19 ,Radiology, Nuclear Medicine and imaging ,General Medicine ,RNA, Messenger ,Pneumonia ,Tomography, X-Ray Computed ,Adenoviridae - Published
- 2022
32. Vasculopathy and Increased Vascular Congestion in Fatal COVID-19 and Acute Respiratory Distress Syndrome
- Author
-
Julian A. Villalba, Caroline F. Hilburn, Michelle A. Garlin, Grant A. Elliott, Yijia Li, Keiko Kunitoki, Sergio Poli, George A. Alba, Emilio Madrigal, Manuel Taso, Melissa C. Price, Alexis J. Aviles, Milagros Araujo-Medina, Liana Bonanno, Baris Boyraz, Samantha N. Champion, Cynthia K. Harris, Timothy L. Helland, Bailey Hutchison, Soma Jobbagy, Michael S. Marshall, Daniel J. Shepherd, Jaimie L. Barth, Yin P. Hung, Amy Ly, Lida P. Hariri, Sarah E. Turbett, Virginia M. Pierce, John A. Branda, Eric S. Rosenberg, Javier Mendez-Pena, Ivan Chebib, Ivy A. Rosales, Rex N. Smith, Miles A. Miller, Ivan O. Rosas, Charles C. Hardin, Lindsey R. Baden, Benjamin D. Medoff, Robert B. Colvin, Brent P. Little, James R. Stone, Mari Mino-Kenudson, and Angela R. Shih
- Subjects
Pulmonary and Respiratory Medicine ,Pulmonary Alveoli ,Respiratory Distress Syndrome ,COVID-19 ,Humans ,Pneumonia ,Vascular Diseases ,Critical Care and Intensive Care Medicine ,Lung - Published
- 2022
33. The Global Reading Room: Workup of Mediastinal Lymphadenopathy
- Author
-
Tae Jung Kim, Brent P. Little, Daria Manos, and Nicola Sverzellati
- Subjects
Radiology, Nuclear Medicine and imaging ,General Medicine - Published
- 2022
34. Operational Challenges of a Low-Dose CT Lung Cancer Screening Program During the Coronavirus Disease 2019 Pandemic
- Author
-
Tristan Yeung, Milena Petranovic, Min Lang, Jo-Anne O. Shepard, Amita Sharma, Brent P. Little, Anand M. Prabhakar, Avik Som, Marc D. Succi, Efren J. Flores, Theresa C. McLoud, and Sanjay Saini
- Subjects
Pulmonary and Respiratory Medicine ,2019-20 coronavirus outbreak ,Lung Neoplasms ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Change Management ,Critical Care and Intensive Care Medicine ,LDCT, low dose CT ,Pandemic ,Research Letter ,Humans ,Low dose ct ,Medicine ,Program Development ,Early Detection of Cancer ,COVID-19, coronavirus disease 2019 ,Infection Control ,SARS-CoV-2 ,business.industry ,COVID-19 ,EMR, electronic medical record ,Virology ,Organizational Innovation ,LCS, lung cancer screening ,CT, computed tomography ,Massachusetts ,LR, Lung-RADS ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Lung cancer screening ,Program Evaluation - Published
- 2021
35. Right Ventricular Strain Is Common in Intubated COVID-19 Patients and Does Not Reflect Severity of Respiratory Illness
- Author
-
Raffaele Di Fenza, Lauren E. Gibson, Marvin G. Chang, Jayashree Kalpathy-Cramer, Min Lang, Fumito Ichinose, Brent P. Little, Pankaj Arora, Ariel Mueller, Martin Capriles, Matthew D. Li, Lorenzo Berra, and Edward A. Bittner
- Subjects
Adult ,Male ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Critical Illness ,Heart Ventricles ,Ventricular Dysfunction, Right ,Strain (injury) ,Acute respiratory distress ,030204 cardiovascular system & hematology ,right ventricle ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,strain ,Internal medicine ,Severity of illness ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Original Research ,Aged ,Randomized Controlled Trials as Topic ,Respiratory illness ,cardiac dysfunction ,business.industry ,COVID-19 ,acute respiratory distress syndrome ,Middle Aged ,medicine.disease ,Respiration, Artificial ,Ventricular Function, Right ,Female ,business ,Respiratory Insufficiency - Abstract
Background: Right ventricular (RV) dysfunction is common and associated with worse outcomes in patients with coronavirus disease 2019 (COVID-19). In non-COVID-19 acute respiratory distress syndrome, RV dysfunction develops due to pulmonary hypoxic vasoconstriction, inflammation, and alveolar overdistension or atelectasis. Although similar pathogenic mechanisms may induce RV dysfunction in COVID-19, other COVID-19-specific pathology, such as pulmonary endothelialitis, thrombosis, or myocarditis, may also affect RV function. We quantified RV dysfunction by echocardiographic strain analysis and investigated its correlation with disease severity, ventilatory parameters, biomarkers, and imaging findings in critically ill COVID-19 patients. Methods: We determined RV free wall longitudinal strain (FWLS) in 32 patients receiving mechanical ventilation for COVID-19-associated respiratory failure. Demographics, comorbid conditions, ventilatory parameters, medications, and laboratory findings were extracted from the medical record. Chest imaging was assessed to determine the severity of lung disease and the presence of pulmonary embolism. Results: Abnormal FWLS was present in 66% of mechanically ventilated COVID-19 patients and was associated with higher lung compliance (39.6 vs 29.4 mL/cmH2O, P = 0.016), lower airway plateau pressures (21 vs 24 cmH2O, P = 0.043), lower tidal volume ventilation (5.74 vs 6.17 cc/kg, P = 0.031), and reduced left ventricular function. FWLS correlated negatively with age (r = −0.414, P = 0.018) and with serum troponin (r = 0.402, P = 0.034). Patients with abnormal RV strain did not exhibit decreased oxygenation or increased disease severity based on inflammatory markers, vasopressor requirements, or chest imaging findings. Conclusions: RV dysfunction is common among critically ill COVID-19 patients and is not related to abnormal lung mechanics or ventilatory pressures. Instead, patients with abnormal FWLS had more favorable lung compliance. RV dysfunction may be secondary to diffuse intravascular micro- and macro-thrombosis or direct myocardial damage. Trial Registration: National Institutes of Health #NCT04306393. Registered 10 March 2020, https://clinicaltrials.gov/ct2/show/NCT04306393
- Published
- 2021
36. Guideline-Discordant Lung Cancer Screening: Emerging Demand and Provided Indications
- Author
-
Anand K. Narayan, Florian J. Fintelmann, Gary X. Wang, Brent P. Little, Efren J. Flores, and Jordan M. Neil
- Subjects
medicine.medical_specialty ,Lung Neoplasms ,Best practice ,Medicare ,Clinical decision support system ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Cancer risk assessment ,medicine ,Humans ,Mass Screening ,Radiology, Nuclear Medicine and imaging ,Family history ,Lung cancer ,Early Detection of Cancer ,Aged ,Heavy smoking ,business.industry ,Guideline ,medicine.disease ,United States ,030220 oncology & carcinogenesis ,Family medicine ,business ,Lung cancer screening - Abstract
It is unclear whether patients and providers have started to knowingly request lung cancer screening (LCS) outside US guidelines and insurance coverage for risk factors besides a history of heavy smoking. The authors analyzed their institution's best practices advisory (BPA) clinical decision support system to determine whether providers knowingly order guideline-discordant LCS and the indications given.CT examinations ordered for LCS at an academic medical center that triggered BPA alerts from November 2018 to December 2019 were reviewed. Alerts were triggered by attempts to order examinations outside Medicare coverage, which resembles most US guidelines. Providers can override alerts to order the examinations. Primary outcomes were the number of examinations performed using orders with overridden BPA alerts and indications given. Qualitative exploratory and directed content analyses identified motivators and decision-making processes that drove guideline-discordant screening use.Forty-two patients underwent guideline-discordant LCS, constituting 1.9% of all patients screened (42 of 2,248): 42.9% (18 of 42) were54 or77 years old, 14.3% (6 of 42) had never smoked, 40.5% (17 of 42) had quit15 years earlier, and 31% (13 of 42) had smoked30 pack-years; 45.2% (19 of 42) fell outside all US guidelines. The most common indication was a family history of lung cancer (21.4% [9 of 42]). Perceptions of elevated cancer risk from both patients and referring providers drove guideline-discordant screening use.Referring providers knowingly ordered screening CT examinations outside Medicare coverage and US guidelines, including for never smokers, for indications including a family history of lung cancer. LCS programs may need tailored strategies to guide these patients and providers, such as help with cancer risk assessment.
- Published
- 2021
37. Racial and Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed Coronavirus Disease 2019: A Retrospective Cohort Study
- Author
-
Anand K. Narayan, Matthew D. Li, Francis Deng, Caitlin M Dugdale, Avik Som, Brent P. Little, Emily P. Hyle, Joseph R. Betancourt, Efren J. Flores, Dexter P. Mendoza, Nicholos Joseph, Min Lang, and Nicholas J. Reid
- Subjects
medicine.medical_specialty ,business.industry ,Hazard ratio ,Retrospective cohort study ,medicine.disease ,Intensive care unit ,Confidence interval ,law.invention ,Pneumonia ,law ,Internal medicine ,Severity of illness ,medicine ,Radiology, Nuclear Medicine and imaging ,Young adult ,business ,Cohort study - Abstract
Background Disease severity on chest radiographs has been associated with higher risk of disease progression and adverse outcomes from coronavirus disease 2019 (COVID-19). Few studies have evaluated COVID-19-related racial and/or ethnic disparities in radiology. Purpose To evaluate whether non-White minority patients hospitalized with confirmed COVID-19 infection presented with increased severity on admission chest radiographs compared with White or non-Hispanic patients. Materials and Methods This single-institution retrospective cohort study was approved by the institutional review board. Patients hospitalized with confirmed COVID-19 infection between March 17, 2020, and April 10, 2020, were identified by using the electronic medical record (n = 326; mean age, 59 years ±17 [standard deviation]; male-to-female ratio: 188:138). The primary outcome was the severity of lung disease on admission chest radiographs, measured by using the modified Radiographic Assessment of Lung Edema (mRALE) score. The secondary outcome was a composite adverse clinical outcome of intubation, intensive care unit admission, or death. The primary exposure was the racial and/or ethnic category: White or non-Hispanic versus non-White (ie, Hispanic, Black, Asian, or other). Multivariable linear regression analyses were performed to evaluate the association between mRALE scores and race and/or ethnicity. Results Non-White patients had significantly higher mRALE scores (median score, 6.1; 95% confidence interval [CI]: 5.4, 6.7) compared with White or non-Hispanic patients (median score, 4.2; 95% CI: 3.6, 4.9) (unadjusted average difference, 1.8; 95% CI: 0.9, 2.8; P < .01). For both White (adjusted hazard ratio, 1.3; 95% CI: 1.2, 1.4; P < .001) and non-White (adjusted hazard ratio, 1.2; 95% CI: 1.1, 1.3; P < .001) patients, increasing mRALE scores were associated with a higher likelihood of experiencing composite adverse outcome with no evidence of interaction (P = .16). Multivariable linear regression analyses demonstrated that non-White patients presented with higher mRALE scores at admission chest radiography compared with White or non-Hispanic patients (adjusted average difference, 1.6; 95% CI: 0.5, 2.7; P < .01). Adjustment for hypothesized mediators revealed that the association between race and/or ethnicity and mRALE scores was mediated by limited English proficiency (P < .01). Conclusion Non-White patients hospitalized with coronavirus disease 2019 infection were more likely to have a higher severity of disease on admission chest radiographs than White or non-Hispanic patients, and increased severity was associated with worse outcomes for all patients. © RSNA, 2020 Online supplemental material is available for this article.
- Published
- 2020
38. CT Features of Coronavirus Disease (COVID-19) in 30 Pediatric Patients
- Author
-
Brent P. Little, Xueyan Mei, Zongyu Xie, Sharon Steinberger, Adam Bernheim, Tongtong Zhao, Junli Xia, Michael H. Chung, Bin Lin, and Yuantong Gao
- Subjects
Male ,China ,medicine.medical_specialty ,Adolescent ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Disease ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Cohen's kappa ,Patient age ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Child ,Pandemics ,Retrospective Studies ,Lung ,SARS-CoV-2 ,business.industry ,COVID-19 ,Infant ,Retrospective cohort study ,General Medicine ,medicine.anatomical_structure ,Child, Preschool ,030220 oncology & carcinogenesis ,Female ,Radiology ,Differential diagnosis ,Tomography, X-Ray Computed ,business - Abstract
OBJECTIVE. The purpose of this study is to characterize the CT findings of 30 children from mainland China who had laboratory-confirmed coronavirus disease (COVID-19). Although recent American College of Radiology recommendations assert that CT should not be used as a screening or diagnostic tool for patients with suspected COVID-19, radiologists should be familiar with the imaging appearance of this disease to identify its presence in patients undergoing CT for other reasons. MATERIALS AND METHODS. We retrospectively reviewed the CT findings and clinical symptoms of 30 pediatric patients with laboratory-confirmed COVID-19 who were seen at six centers in China from January 23, 2020, to February 8, 2020. Patient age ranged from 10 months to 18 years. Patients older than 18 years of age or those without chest CT examinations were excluded. Two cardiothoracic radiologists and a cardiothoracic imaging fellow characterized and scored the extent of lung involvement. Cohen kappa coefficient was used to calculate interobserver agreement between the readers. RESULTS. Among children, CT findings were often negative (77%). Positive CT findings seen in children included ground-glass opacities with a peripheral lung distribution, a crazy paving pattern, and the halo and reverse halo signs. There was a correlation between increasing age and increasing severity of findings, consistent with reported symptomatology in children. Eleven of 30 patients (37%) underwent follow-up chest CT, with 10 of 11 examinations (91%) showing no change, raising questions about the utility of CT in the diagnosis and management of COVID-19 in children. CONCLUSION. The present study describes the chest CT findings encountered in children with COVID-19 and questions the utility of CT in the diagnosis and management of pediatric patients.
- Published
- 2020
39. Lung cancer screening eligibility and use with low‐dose computed tomography: Results from the 2018 Behavioral Risk Factor Surveillance System cross‐sectional survey
- Author
-
Anand K. Narayan, Brent P. Little, Yasha Gupta, Jo-Anne O. Shepard, and Efren J. Flores
- Subjects
Cancer Research ,medicine.medical_specialty ,Lung Neoplasms ,Cross-sectional study ,Logistic regression ,law.invention ,Behavioral Risk Factor Surveillance System ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Lung cancer ,Early Detection of Cancer ,Aged ,Response rate (survey) ,integumentary system ,business.industry ,Confounding ,Middle Aged ,medicine.disease ,Cross-Sectional Studies ,Oncology ,030220 oncology & carcinogenesis ,Educational Status ,Tomography, X-Ray Computed ,business ,Lung cancer screening - Abstract
Background In randomized controlled trials, lung cancer screening with low-dose chest computed tomography (LCS) has been reported to reduce lung cancer mortality. Although initial studies suggested that only approximately 5% of eligible patients have undergone LCS, recent studies have indicated that use of LCS may be increasing nationwide. The objective of the current study was to estimate recent LCS use using cross-sectional survey data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) survey. Methods The BRFSS is a nationally representative, cross-sectional telephone survey of adults in the United States (response rate of approximately 50%). The 2018 BRFSS survey included questions regarding LCS eligibility and use in 8 states. The primary outcome was the percentage of participants (aged 55-79 years with a smoking history of >30 pack-years) who reported undergoing LCS. Logistic regression analyses evaluated the association between LCS use and sociodemographic characteristics, adjusted for potential confounders and accounting for complex survey design elements. Results A total of 26,910 participants were included, 9.9% of whom were eligible for LCS (95% CI, 8.8%-10.6%). Of the eligible patients, 19.2% reported undergoing LCS (95% CI, 14.0%-24.4%). Approximately 16.4% of current smokers were eligible for LCS (95% CI, 14.2%-18.6%). In our multiple variable analyses of eligible patients, age, sex, marital status, current smoking status, and race were not found to be associated with statistically significant differences in reported LCS (P > .05). Retired patients, patients with personal physicians, and patients who did not complete a high school education were more likely to report receiving LCS (P Conclusions Compared with previously published studies, the results of the current study suggested that LCS use is increasing. However, LCS use remains low (19%) among eligible participants.
- Published
- 2020
40. Evaluation of interstitial lung disease: An algorithmic review using ILD-RADS
- Author
-
Andrew M. Pagano, Tam Vu, Eugene A. Berkowitz, Brent P. Little, Michael Chung, and Adam Bernheim
- Subjects
Diagnosis, Differential ,Humans ,Radiology, Nuclear Medicine and imaging ,Lung Diseases, Interstitial ,Lung - Abstract
Interstitial lung diseases (ILDs) may present a diagnostic dilemma due to their many classifications and overlapping imaging findings. In this review, we present an algorithmic approach for assessing ILDs based on identifying and understanding key imaging features to aid in narrowing a differential diagnosis or reaching a specific diagnosis. We use the recently introduced Interstitial Lung Disease Reporting And Data System (ILD-RADS) as a framework for our discussion.
- Published
- 2022
41. Analysis of Out-of-Pocket Cost of Lung Cancer Screening for Uninsured Patients Among ACR-Accredited Imaging Centers
- Author
-
Jennifer A Febbo, Brent P. Little, Jo-Anne O. Shepard, Natalia Fischl-Lanzoni, Efren J. Flores, Keenae M. Tiersma, Anand K. Narayan, and McKinley Glover
- Subjects
Medically Uninsured ,medicine.medical_specialty ,Lung Neoplasms ,Public health insurance ,business.industry ,Telephone call ,Insurance Coverage ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Family medicine ,Geographic regions ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cost Sharing ,Health Expenditures ,Out of pocket cost ,business ,Chargemaster ,Early Detection of Cancer ,Lung cancer screening ,Insurance coverage ,Accreditation - Abstract
Purpose To determine the variability in out-of-pocket costs of lung cancer screening (LCS) for uninsured patients and assess accessibility of this information by telephone or Internet. Methods LCS centers from the ACR’s LCS database were randomly selected. Centers were called between July and August 2019 to determine out-of-pocket cost. Telephone call variables, accessibility of cost information on screening centers’ websites, screening centers’ chargemasters, and publicly available facility and state insurance coverage variables were obtained. Cost information was summarized using descriptive analyses. Multiple variable linear regression analyses were conducted to evaluate effects of facility and state-level characteristics on out-of-pocket costs. Results Fifty-five ACR-accredited LCS centers were included with 78% (43 of 55) willing to provide out-of-pocket cost. Average out-of-pocket cost was $583 ± $607 (mean ± standard deviation), range $49 to $2,409. Average telephone call length 6 ± 3.8 min. Two of fifty-five screening centers’ websites provided out-of-pocket cost information, and one matched cost given over the telephone. A chargemaster was found for 30 of 55 screening centers. No statistically significant differences in out-of-pocket costs were found by geographic region, state percentages of uninsured residents, state percentages of residents with public insurance, or facility safety net hospital affiliation. Discussion Out-of-pocket LCS costs for uninsured patients and availability of this information is highly variable. Radiology practices should be aware of this variability that may influence participation rates among uninsured patients.
- Published
- 2020
42. Artificial intelligence–enabled rapid diagnosis of patients with COVID-19
- Author
-
Zahi A. Fayad, Hao-Chih Lee, Shaolin Li, Claudia Calcagno, Junli Xia, Bin Lin, Yang Yang, Michael H. Chung, Kaiyue Diao, Marta Luksza, Brent P. Little, Zongyu Xie, Hong Shan, Chenyu Liu, Adam Jacobi, Sharon Steinberger, Qihua Long, Jian Lv, Philip M. Robson, Fang Liu, Tongtong Zhao, Venkatesh Mani, Adam Bernheim, Kunwei Li, Xueyan Mei, Yixuan Ma, Timothy W. Deyer, and Mingqian Huang
- Subjects
0301 basic medicine ,Alternative methods ,Thorax ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Area under the curve ,General Medicine ,Disease ,medicine.disease ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,Pneumonia ,030104 developmental biology ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Radiological weapon ,Medicine ,Artificial intelligence ,business - Abstract
For diagnosis of coronavirus disease 2019 (COVID-19), a SARS-CoV-2 virus-specific reverse transcriptase polymerase chain reaction (RT-PCR) test is routinely used. However, this test can take up to 2 d to complete, serial testing may be required to rule out the possibility of false negative results and there is currently a shortage of RT-PCR test kits, underscoring the urgent need for alternative methods for rapid and accurate diagnosis of patients with COVID-19. Chest computed tomography (CT) is a valuable component in the evaluation of patients with suspected SARS-CoV-2 infection. Nevertheless, CT alone may have limited negative predictive value for ruling out SARS-CoV-2 infection, as some patients may have normal radiological findings at early stages of the disease. In this study, we used artificial intelligence (AI) algorithms to integrate chest CT findings with clinical symptoms, exposure history and laboratory testing to rapidly diagnose patients who are positive for COVID-19. Among a total of 905 patients tested by real-time RT-PCR assay and next-generation sequencing RT-PCR, 419 (46.3%) tested positive for SARS-CoV-2. In a test set of 279 patients, the AI system achieved an area under the curve of 0.92 and had equal sensitivity as compared to a senior thoracic radiologist. The AI system also improved the detection of patients who were positive for COVID-19 via RT-PCR who presented with normal CT scans, correctly identifying 17 of 25 (68%) patients, whereas radiologists classified all of these patients as COVID-19 negative. When CT scans and associated clinical history are available, the proposed AI system can help to rapidly diagnose COVID-19 patients.
- Published
- 2020
43. Intubation and mortality prediction in hospitalized COVID-19 patients using a combination of convolutional neural network-based scoring of chest radiographs and clinical data
- Author
-
Aileen O'Shea, Matthew D Li, Nathaniel D Mercaldo, Patricia Balthazar, Avik Som, Tristan Yeung, Marc D Succi, Brent P Little, Jayashree Kalpathy-Cramer, and Susanna I Lee
- Subjects
General Medicine - Abstract
Objective: To predict short-term outcomes in hospitalized COVID-19 patients using a model incorporating clinical variables with automated convolutional neural network (CNN) chest radiograph analysis. Methods: A retrospective single center study was performed on patients consecutively admitted with COVID-19 between March 14 and April 21 2020. Demographic, clinical and laboratory data were collected, and automated CNN scoring of the admission chest radiograph was performed. The two outcomes of disease progression were intubation or death within 7 days and death within 14 days following admission. Multiple imputation was performed for missing predictor variables and, for each imputed data set, a penalized logistic regression model was constructed to identify predictors and their functional relationship to each outcome. Cross-validated area under the characteristic (AUC) curves were estimated to quantify the discriminative ability of each model. Results: 801 patients (median age 59; interquartile range 46–73 years, 469 men) were evaluated. 36 patients were deceased and 207 were intubated at 7 days and 65 were deceased at 14 days. Cross-validated AUC values for predictive models were 0.82 (95% CI, 0.79–0.86) for death or intubation within 7 days and 0.82 (0.78–0.87) for death within 14 days. Automated CNN chest radiograph score was an important variable in predicting both outcomes. Conclusion: Automated CNN chest radiograph analysis, in combination with clinical variables, predicts short-term intubation and death in patients hospitalized for COVID-19 infection. Chest radiograph scoring of more severe disease was associated with a greater probability of adverse short-term outcome. Advances in knowledge: Model-based predictions of intubation and death in COVID-19 can be performed with high discriminative performance using admission clinical data and convolutional neural network-based scoring of chest radiograph severity.
- Published
- 2022
44. Radiology Implementation Considerations for Artificial Intelligence (AI) Applied to COVID-19, From the
- Author
-
Matthew D, Li, Ken, Chang, Xueyan, Mei, Adam, Bernheim, Michael, Chung, Sharon, Steinberger, Jayashree, Kalpathy-Cramer, and Brent P, Little
- Subjects
Radiography ,Artificial Intelligence ,COVID-19 ,Humans ,Radiology ,Pandemics - Abstract
Hundreds of imaging-based artificial intelligence (AI) models have been developed in response to the COVID-19 pandemic. AI systems that incorporate imaging have shown promise in primary detection, severity grading, and prognostication of outcomes in COVID-19, and have enabled integration of imaging with a broad range of additional clinical and epidemiologic data. However, systematic reviews of AI models applied to COVID-19 medical imaging have highlighted problems in the field, including methodologic issues and problems in real-world deployment. Clinical use of such models should be informed by both the promise and potential pitfalls of implementation. How does a practicing radiologist make sense of this complex topic, and what factors should be considered in the implementation of AI tools for imaging of COVID-19? This critical review aims to help the radiologist understand the nuances that impact the clinical deployment of AI for imaging of COVID-19. We review imaging use cases for AI models in COVID-19 (e.g., diagnosis, severity assessment, and prognostication) and explore considerations for AI model development and testing, deployment infrastructure, clinical user interfaces, quality control, and institutional review board and regulatory approvals, with a practical focus on what a radiologist should consider when implementing an AI tool for COVID-19.
- Published
- 2021
45. Nonpulmonary Infections of the Thorax
- Author
-
Brent P. Little, Nikhil Goyal, Graham Keir, and Matthew Pavlica
- Subjects
Thorax ,business.industry ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Anatomy ,business - Published
- 2021
46. Coronary artery calcification in COVID-19 patients: an imaging biomarker for adverse clinical outcomes
- Author
-
Mark Finkelstein, Brent P. Little, Samuel Z. Maron, Nina Kukar, Zahi A. Fayad, Sayan Manna, Danielle Toussie, Corey Eber, Partha Hota, Adam Bernheim, Yogesh Sean Gupta, Ajit Fernandes, Adam Jacobi, Mario A. Cedillo, Nicholas Voutsinas, Jose Concepcion, and Michael H. Chung
- Subjects
Imaging biomarker ,medicine.medical_treatment ,CAC, coronary artery calcium ,VTE, venous thromboembolism ,Disease ,Coronary Artery Disease ,Logistic regression ,Coronary Angiography ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,Risk Factors ,Medicine ,Intubation ,Cardiothoracic Imaging ,Computed tomography (CT) ,COVID-19, coronavirus disease 2019 ,DAPT, dual antiplatelet therapy ,OAC, oral anticoagulant ,SAPT, single antiplatelet therapy ,Coronary Vessels ,medicine.anatomical_structure ,Radiology Nuclear Medicine and imaging ,030220 oncology & carcinogenesis ,Cardiology ,Artery ,Adult ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,NCCT, non-contrast computed tomography ,AKI, acute kidney injury ,03 medical and health sciences ,Young Adult ,Predictive Value of Tests ,Internal medicine ,Coronary stent ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Coronary artery calcification (CAC) ,Vascular Calcification ,Retrospective Studies ,business.industry ,SARS-CoV-2 ,nutritional and metabolic diseases ,COVID-19 ,AOR, adjusted odds ratio ,Coronary artery disease (CAD) ,COPD, chronic obstructive pulmonary disease ,Coronary artery calcification ,UOR, unadjusted odds ratio ,ECG, electrocardiogram ,business ,Biomarkers - Abstract
Background Recent studies have demonstrated a complex interplay between comorbid cardiovascular disease, COVID-19 pathophysiology, and poor clinical outcomes. Coronary artery calcification (CAC) may therefore aid in risk stratification of COVID-19 patients. Methods Non-contrast chest CT studies on 180 COVID-19 patients ≥ age 21 admitted from March 1, 2020 to April 27, 2020 were retrospectively reviewed by two radiologists to determine CAC scores. Following feature selection, multivariable logistic regression was utilized to evaluate the relationship between CAC scores and patient outcomes. Results The presence of any identified CAC was associated with intubation (AOR: 3.6, CI: 1.4–9.6) and mortality (AOR: 3.2, CI: 1.4–7.9). Severe CAC was independently associated with intubation (AOR: 4.0, CI: 1.3–13) and mortality (AOR: 5.1, CI: 1.9–15). A greater CAC score (UOR: 1.2, CI: 1.02–1.3) and number of vessels with calcium (UOR: 1.3, CI: 1.02–1.6) was associated with mortality. Visualized coronary stent or coronary artery bypass graft surgery (CABG) had no statistically significant association with intubation (AOR: 1.9, CI: 0.4–7.7) or death (AOR: 3.4, CI: 1.0–12). Conclusion COVID-19 patients with any CAC were more likely to require intubation and die than those without CAC. Increasing CAC and number of affected arteries was associated with mortality. Severe CAC was associated with higher intubation risk. Prior CABG or stenting had no association with elevated intubation or death.
- Published
- 2021
- Full Text
- View/download PDF
47. Imaging Manifestations of Chest Trauma
- Author
-
Brittany T Lewis, Scott A. Hamlin, David M. Naeger, Tarek N. Hanna, Brent P. Little, Travis S. Henry, and Keith D. Herr
- Subjects
medicine.medical_specialty ,Lung ,medicine.diagnostic_test ,Thoracic Injuries ,business.industry ,Radiography ,Lung Injury ,Lung injury ,Wounds, Nonpenetrating ,medicine.anatomical_structure ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,Chest radiograph ,business ,Airway ,Tomography, X-Ray Computed ,Grading (tumors) ,Grading scale ,Cause of death - Abstract
Trauma is the leading cause of death among individuals under 40 years of age, and pulmonary trauma is common in high-impact injuries. Unlike most other organs, the lung is elastic and distensible, with a physiologic capacity to withstand significant changes in contour and volume. The most common types of lung parenchymal injury are contusions, lacerations, and hematomas, each having characteristic imaging appearances. A less common type of lung injury is herniation. Chest radiography is often the first-line imaging modality performed in the assessment of the acutely injured patient, although there are inherent limitations in the use of this modality in trauma. CT images are more accurate for the assessment of the nature and extent of pulmonary injury than the single-view anteroposterior chest radiograph that is typically obtained in the trauma bay. However, the primary limitations of CT concern the need to transport the patient to the CT scanner and a longer processing time. The American Association for the Surgery of Trauma has established the most widely used grading scale to describe lung injury, which serves to communicate severity, guide management, and provide useful prognostic factors in a systematic fashion. The authors provide an in-depth exploration of the most common types of pulmonary parenchymal, pleural, and airway injuries. Injury grading, patient management, and potential complications of pulmonary injury are also discussed. ©RSNA, 2021.
- Published
- 2021
48. Impact of Significant Coronary Artery Calcification Reported on Low-Dose Computed Tomography Lung Cancer Screening
- Author
-
Dexter P. Mendoza, Brent P. Little, Subba R. Digumarthy, Jo-Anne O. Shepard, and Bashar Kako
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung Neoplasms ,medicine.medical_treatment ,Computed tomography ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Radiation Dosage ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Vascular Calcification ,Lung ,Aged ,Retrospective Studies ,Aged, 80 and over ,Incidental Findings ,medicine.diagnostic_test ,business.industry ,Medical record ,Low dose ,Percutaneous coronary intervention ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Coronary Vessels ,Coronary artery calcification ,Female ,Tomography, X-Ray Computed ,business ,Lung cancer screening - Abstract
Background Coronary artery calcification (CAC) is a common and important incidental finding in low-dose computed tomography (LDCT) performed for lung cancer screening (LCS). The impact of these incidental findings on patient management is unclear. Purpose The goals of our study were to determine the impact of reporting CAC on patient management and to determine whether standardized reporting of CAC affects the likelihood of future interventions. Methods In this IRB-approved retrospective study, we queried our LCS database for reports of LDCT performed between January 2016 and September 2018. All reports with significant findings of CAC designated with the letter "S" for any Lung-RADS category were selected. The grading of CAC was extracted from the reports. Medical records were reviewed for each patient to determine demographics, clinical history, medications, and cardiac-related diagnostic and interventional procedures. The changes in management after the report of significant CAC on LDCT were documented. Statistical analysis with Student t test and Pearson χ test was performed. Results A total of 756/3110 patients (mean age: 67±6.4 y; M=466, 61.6%: F=290, 38.4%) were reported to have significant CAC on LDCT for LCS. Of them, 236/756 patients (31.2%) had established coronary artery disease (CAD) at baseline, before the initial LDCT. A change in management was observed in 155/756 patients (20.5%). The most common changes in management included the following: alteration in medication regimen (n=114/155, 73.5%), stress testing (n=65/155, 41.9%), and referral to a cardiologist (36/155, 23.2%). Percutaneous coronary intervention (4, 2.6%) and surgery (3, 1.9%) were uncommon. Changes in management were more common in those without established CAD and in those whose CAC was semiquantitatively graded (35% vs. 25%, P=0.02). Conclusion CAC is a common significant finding in LDCT for LCS. Reporting of CAC in patients with nonestablished CAD and semiquantitative assessment resulted in changes in management.
- Published
- 2019
49. Multiple calcifying fibrous pseudotumors of the pleura: ultrastructural analysis provides insight on mechanism of dissemination
- Author
-
Richard L. Kradin, Ivan Chebib, Brent P. Little, Lucas R. Massoth, and Martin K. Selig
- Subjects
Male ,0301 basic medicine ,Pathology ,medicine.medical_specialty ,Pleural Neoplasms ,Soft Tissue Neoplasms ,Pathology and Forensic Medicine ,Neoplasms, Multiple Primary ,03 medical and health sciences ,0302 clinical medicine ,Microscopy, Electron, Transmission ,Structural Biology ,Humans ,Medicine ,Carcinoma, Renal Cell ,Incidental Findings ,business.industry ,Calcinosis ,Middle Aged ,respiratory system ,Kidney Neoplasms ,respiratory tract diseases ,Benign Soft Tissue Tumor ,030104 developmental biology ,030220 oncology & carcinogenesis ,Ultrastructure ,Calcifying Fibrous Pseudotumor ,business - Abstract
Calcifying fibrous pseudotumor (CFP) is a rare, benign soft tissue tumor that may uncommonly arise in the pleura. These tumors can show multifocal dissemination across the pleural surface, but the mechanism underlying this dissemination is unclear. Review of previously reported cases of pleural CFP demonstrates a strong predilection for basal and diaphragmatic pleural surfaces, and a significantly higher rate of multifocality compared with other locations. We present a 59-year-old male with multiple CFP of the pleura. Reactive-appearing adhesions spanning the pleural surfaces were present, and by electron microscopy, were involved by tumor. We suggest this is the likely mode of dissemination across the pleural surfaces.
- Published
- 2019
50. Multi-population generalizability of a deep learning-based chest radiograph severity score for COVID-19
- Author
-
Matthew D, Li, Nishanth T, Arun, Mehak, Aggarwal, Sharut, Gupta, Praveer, Singh, Brent P, Little, Dexter P, Mendoza, Gustavo C A, Corradi, Marcelo S, Takahashi, Suely F, Ferraciolli, Marc D, Succi, Min, Lang, Bernardo C, Bizzo, Ittai, Dayan, Felipe C, Kitamura, and Jayashree, Kalpathy-Cramer
- Subjects
Deep Learning ,Radiologists ,COVID-19 ,Humans ,Radiography, Thoracic ,General Medicine ,Lung ,Article - Abstract
Purpose: To improve and test the generalizability of a deep learning-based model for assessment of COVID-19 lung disease severity on chest radiographs (CXRs) from different patient populations. Materials and Methods: A published convolutional Siamese neural network-based model previously trained on hospitalized patients with COVID-19 was tuned using 250 outpatient CXRs. This model produces a quantitative measure of COVID-19 lung disease severity (pulmonary x-ray severity (PXS) score). The model was evaluated on CXRs from four test sets, including 3 from the United States (patients hospitalized at an academic medical center (N=154), patients hospitalized at a community hospital (N=113), and outpatients (N=108)) and 1 from Brazil (patients at an academic medical center emergency department (N=303)). Radiologists from both countries independently assigned reference standard CXR severity scores, which were correlated with the PXS scores as a measure of model performance (Pearson r). The Uniform Manifold Approximation and Projection (UMAP) technique was used to visualize the neural network results. Results: Tuning the deep learning model with outpatient data improved model performance in two United States hospitalized patient datasets (r=0.88 and r=0.90, compared to baseline r=0.86). Model performance was similar, though slightly lower, when tested on the United States outpatient and Brazil emergency department datasets (r=0.86 and r=0.85, respectively). UMAP showed that the model learned disease severity information that generalized across test sets. Conclusions: Performance of a deep learning-based model that extracts a COVID-19 severity score on CXRs improved using training data from a different patient cohort (outpatient versus hospitalized) and generalized across multiple populations.
- Published
- 2022
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.