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Objectives: Evaluating the effects and artifacts introduced by medical foreign bodies in clinical dark-field chest radiographs and assessing their influence on the evaluation of pulmonary tissue, compared to conventional radiographs. Material & Methods: This retrospective study analyzed data from subjects enrolled in clinical trials conducted between 2018 and 2021, focusing on chronic obstructive pulmonary disease (COPD) and COVID-19 patients. All patients obtained a radiograph using an in-house developed clinical prototype for grating-based dark-field chest radiography. The prototype simultaneously delivers a conventional and dark-field radiograph. Two radiologists independently assessed the clinical studies to identify patients with foreign bodies. Subsequently, an analysis was conducted on the effects and artifacts attributed to distinct foreign bodies and their impact on the assessment of pulmonary tissue. Results: Overall, 30 subjects with foreign bodies were included in this study (mean age, 64 years +/- 11 [standard deviation]; 15 men). Foreign bodies composed of materials lacking microstructure exhibited a diminished dark-field signal or no discernible signal. Foreign bodies with a microstructure, in our investigations the cementation of the kyphoplasty, produce a positive dark-field signal. Since most foreign bodies lack microstructural features, dark-field imaging revealed fewer signals and artifacts by foreign bodies compared to conventional radiographs. Conclusion: Dark-field radiography enhances the assessment of pulmonary tissue with overlaying foreign bodies compared to conventional radiography. Reduced interfering signals result in fewer overlapping radiopaque artifacts within the investigated regions. This mitigates the impact on image quality and interpretability of the radiographs and the projection-related limitations of radiography compared to CT.

Background: We aimed at improving image quality (IQ) of sparse-view computed tomography (CT) images using a U-Net for lung metastasis detection and determining the best tradeoff between number of views, IQ, and diagnostic confidence. Methods: CT images from 41 subjects aged 62.8 $\pm$ 10.6 years (mean $\pm$ standard deviation), 23 men, 34 with lung metastasis, 7 healthy, were retrospectively selected (2016-2018) and forward projected onto 2,048-view sinograms. Six corresponding sparse-view CT data subsets at varying levels of undersampling were reconstructed from sinograms using filtered backprojection with 16, 32, 64, 128, 256, and 512 views. A dual-frame U-Net was trained and evaluated for each subsampling level on 8,658 images from 22 diseased subjects. A representative image per scan was selected from 19 subjects (12 diseased, 7 healthy) for a single-blinded multireader study. These slices, for all levels of subsampling, with and without U-Net postprocessing, were presented to three readers. IQ and diagnostic confidence were ranked using predefined scales. Subjective nodule segmentation was evaluated using sensitivity and Dice similarity coefficient (DSC); clustered Wilcoxon signed-rank test was used. Results: The 64-projection sparse-view images resulted in 0.89 sensitivity and 0.81 DSC, while their counterparts, postprocessed with the U-Net, had improved metrics (0.94 sensitivity and 0.85 DSC) (p = 0.400). Fewer views led to insufficient IQ for diagnosis. For increased views, no substantial discrepancies were noted between sparse-view and postprocessed images. Conclusions: Projection views can be reduced from 2,048 to 64 while maintaining IQ and the confidence of the radiologists on a satisfactory level.

This is a preprint. The latest version has been published here: https://pubs.rsna.org/doi/10.1148/ryai.230275 Purpose: Sparse-view computed tomography (CT) is an effective way to reduce dose by lowering the total number of views acquired, albeit at the expense of image quality, which, in turn, can impact the ability to detect diseases. We explore deep learning-based artifact reduction in sparse-view cranial CT scans and its impact on automated hemorrhage detection. Methods: We trained a U-Net for artefact reduction on simulated sparse-view cranial CT scans from 3000 patients obtained from a public dataset and reconstructed with varying levels of sub-sampling. Additionally, we trained a convolutional neural network on fully sampled CT data from 17,545 patients for automated hemorrhage detection. We evaluated the classification performance using the area under the receiver operator characteristic curves (AUC-ROCs) with corresponding 95% confidence intervals (CIs) and the DeLong test, along with confusion matrices. The performance of the U-Net was compared to an analytical approach based on total variation (TV). Results: The U-Net performed superior compared to unprocessed and TV-processed images with respect to image quality and automated hemorrhage diagnosis. With U-Net post-processing, the number of views can be reduced from 4096 (AUC-ROC: 0.974; 95% CI: 0.972-0.976) views to 512 views (0.973; 0.971-0.975) with minimal decrease in hemorrhage detection (P<.001) and to 256 views (0.967; 0.964-0.969) with a slight performance decrease (P<.001). Conclusion: The results suggest that U-Net based artifact reduction substantially enhances automated hemorrhage detection in sparse-view cranial CTs. Our findings highlight that appropriate post-processing is crucial for optimal image quality and diagnostic accuracy while minimizing radiation dose., Comment: 11 pages, 6 figures, 1 table

We aim to optimize the binary detection of Chronic Obstructive Pulmonary Disease (COPD) based on emphysema presence in the lung with convolutional neural networks (CNN) by exploring manually adjusted versus automated window-setting optimization (WSO) on computed tomography (CT) images. 7,194 CT images (3,597 with COPD; 3,597 healthy controls) from 78 subjects (43 with COPD; 35 healthy controls) were selected retrospectively (10.2018-12.2019) and preprocessed. For each image, intensity values were manually clipped to the emphysema window setting and a baseline 'full-range' window setting. Class-balanced train, validation, and test sets contained 3,392, 1,114, and 2,688 images. The network backbone was optimized by comparing various CNN architectures. Furthermore, automated WSO was implemented by adding a customized layer to the model. The image-level area under the Receiver Operating Characteristics curve (AUC) [lower, upper limit 95% confidence] was utilized to compare model variations. Repeated inference (n=7) on the test set showed that the DenseNet was the most efficient backbone and achieved a mean AUC of 0.80 [0.76, 0.85] without WSO. Comparably, with input images manually adjusted to the emphysema window, the DenseNet model predicted COPD with a mean AUC of 0.86 [0.82, 0.89]. By adding a customized WSO layer to the DenseNet, an optimal window in the proximity of the emphysema window setting was learned automatically, and a mean AUC of 0.82 [0.78, 0.86] was achieved. Detection of COPD with DenseNet models was improved by WSO of CT data to the emphysema window setting range.

Deep learning based solutions are being succesfully implemented for a wide variety of applications. Most notably, clinical use-cases have gained an increased interest and have been the main driver behind some of the cutting-edge data-driven algorithms proposed in the last years. For applications like sparse-view tomographic reconstructions, where the amount of measurement data is small in order to keep acquisition time short and radiation dose low, reduction of the streaking artifacts has prompted the development of data-driven denoising algorithms with the main goal of obtaining diagnostically viable images with only a subset of a full-scan data. We propose WNet, a data-driven dual-domain denoising model which contains a trainable reconstruction layer for sparse-view artifact denoising. Two encoder-decoder networks perform denoising in both sinogram- and reconstruction-domain simultaneously, while a third layer implementing the Filtered Backprojection algorithm is sandwiched between the first two and takes care of the reconstruction operation. We investigate the performance of the network on sparse-view chest CT scans, and we highlight the added benefit of having a trainable reconstruction layer over the more conventional fixed ones. We train and test our network on two clinically relevant datasets and we compare the obtained results with three different types of sparse-view CT denoising and reconstruction algorithms., Comment: Publisehd at IEEE TCI in January 2023. Supplementary materials are available @IEEE

Purpose: We aimed to estimate the total lung volume (TLV) from real and synthetic frontal X-ray radiographs on a pixel level using lung thickness maps generated by a U-Net. Methods: 5,959 thorax X-ray computed tomography (CT) scans were retrieved from two publicly available datasets of the lung nodule analysis 2016 (n=656) and the RSNA pulmonary embolism detection challenge 2020 (n=5,303). Additionally, thorax CT scans from 72 subjects (33 healthy: 20 men, mean age [range] = 62.4 [34, 80]; 39 suffering from chronic obstructive pulmonary disease: 25 men, mean age [range] = 69.0 [47, 91]) were retrospectively selected (10.2018-12.2019) from our in-house dataset such that for each subject, a frontal chest X-ray radiograph no older than seven days was available. All CT scans and their corresponding lung segmentation were forward projected using a simulated X-ray spectrum to generate synthetic radiographs and lung thickness maps, respectively. A U-Net model was trained and tested on synthetic radiographs from the public datasets to predict lung thickness maps and consequently estimate TLV. Model performance was further assessed by evaluating the TLV estimations for the in-house synthetic and real radiograph pairs using Pearson correlation coefficient (r) and significance testing. Results: Strong correlations were measured between the predicted and CT-derived ground truth TLV values for test data from synthetic ($n_{Public}$=1,191, r=0.987, P < 0.001; $n_{In-house}$=72, r=0.973, P < 0.001) and real radiographs (n=72, r=0.908, P < 0.001). Conclusion: TLV from U-Net-generated pixel-level lung thickness maps were successfully estimated for synthetic and real radiographs.