Estimation of gastrointestinal polyp size in video endoscopy

Abstract Worldwide the colorectal cancer is one of the most common public health problems, constituting in 2010 the seventh cause of death. This aggressive cancer is firstly identified during an endoscopy routine examination by characterizing a set of polyps that appear along the digestive tract, mainly in the colon and rectum. The polyp size is one of the most important features that determines the surgical endoscopy management and even can be used to predict the level of aggressiveness. For instance, the gastroenterologists only send a polyp sample to the pathology examination if the polyp diameter is larger than 10 mm, a measure that is achieved typically by examining the lesion with a calibrated endoscopy tool. However, the polyp size measure is very challenging because it must be performed during a procedure subjected to a complex mix of noise sources, such as: the distorted optical characteristics of the endoscopy, the exacerbated physiological conditions and abrupt motion. The main goal of this thesis was estimated the polyp size during an endoscopy video sequence using a spatio-temporal characterization. Firstly, the method estimated the region with more motion within which the polyp shape is approximated by those pixels with the largest temporal variance. On the above, an initial manual polyp delineation in the first frame captures the main features to be follow in posterior frames by a cross correlation procedure. Afterwards, a bayesian tracking strategy is used to refine the polyp segmentation. Finally a defocus strategy allows to estimate on the clear cut frame at a certain depth as a reference to determine the polyp size obtaining reliable results. In the segmentation task, the approach achieved a Dice Score of 0.7 in real endoscopy video-sequences, when comparing with an expert. In addition, the results polyp size estimation obtained a Root Mean Square Error (RMSE) of 0.87 mm with spheres of known size that simulated the polyps, and in real endoscopy sequences obtaining a RMSE of 4.7 mm compared with measures obtained by a group of four experts with similar experience.El cáncer colorectal es uno de los problemas de salud pública más comunes a nivel mundial, ocupando la séptima causa de muerte en el 2010. Este tipo de cáncer tan agresivo es identificado prematuramente por un conjunto de pólipos que crecen a lo largo del tracto digestivo, principalmente en el colon y el recto. El tamaño de los pólipos es una de las características mas importantes, con la cual se determina el manejo quirúrgico de la lesión e incluso puede ser usado para predecir el grado de malignidad. Acorde a esto, el experto solo envía una muestra del pólipo para un examen patológico, sí el diámetro del pólipo es más largo que 10 mm. típica mente, esta medida es tomada examinando la lesión con una herramienta endoscópica calibrada. Sin embargo, la medición del tamaño del pólipo es realmente difícil debido a que el procedimiento está sujeto a fuentes de ruido bastante complejas, tales como: la distorsión óptica que es característica del endoscopio, las condiciones fisiológicas del tracto digestivo y los movimientos abruptos con el dispositivo. La contribución principal de este trabajo fue la estimación del tamaño de los pólipos, sobre una secuencia de vídeo de un procedimiento de endoscopia usando una caracterización espacio-temporal. En primera parte, el método estima la región con mayor movimiento que corresponde aproximadamente a la región del pólipo, tomando aquellos pixeles con mayor varianza temporal. Sobre lo anterior, una delineación manual de la lesión es realizada en el primer cuadro para establecer las principales características, para ser seguidas en los cuadros posteriores usando un método de correlación cruzada. Después, se usó una estrategia de seguimiento bayesiana para refinar la segmentación del pólipo. Finalmente, una estrategia basada en la correspondencia del desenfoque de las imágenes de una secuencia a una profundidad o distancia determinada, se pudo obtener una referencia para determinar el tamaño de los pólipos, obteniendo resultados fiables. En la etapa de segmentación, la estrategia logra un Dice score de 0, 7 al comparar con un experto en secuencias de endoscopia reales. Y en la estimación del tamaño de los pólipo se obtuvo un error cuadrático medio (RMSE) de 0.87 mm, comparando con esferas de tamaño conocido que simulaban los pólipos, y en secuencias de endoscopia reales se obtuvo un RMSE de 4.7 mm comparando con las medidas obtenidas por un grupo de cuatro. expertos con experiencia similar.Maestrí

Characterization and modelling of complex motion patterns

Movement analysis is the principle of any interaction with the world and the survival of living beings completely depends on the effciency of such analysis. Visual systems have remarkably developed eficient mechanisms that analyze motion at different levels, allowing to recognize objects in dynamical and cluttered environments. In artificial vision, there exist a wide spectrum of applications for which the study of complex movements is crucial to recover salient information. Yet each domain may be different in terms of scenarios, complexity and relationships, a common denominator is that all of them require a dynamic understanding that captures the relevant information. Overall, current strategies are highly dependent on the appearance characterization and usually they are restricted to controlled scenarios. This thesis proposes a computational framework that is inspired in known motion perception mechanisms and structured as a set of modules. Each module is in due turn composed of a set of computational strategies that provide qualitative and quantitative descriptions of the dynamic associated to a particular movement. Diverse applications were herein considered and an extensive validation was performed for each of them. Each of the proposed strategies has shown to be reliable at capturing the dynamic patterns of different tasks, identifying, recognizing, tracking and even segmenting objects in sequences of video.Resumen. El análisis del movimiento es el principio de cualquier interacción con el mundo y la supervivencia de los seres vivos depende completamente de la eficiencia de este tipo de análisis. Los sistemas visuales notablemente han desarrollado mecanismos eficientes que analizan el movimiento en diferentes niveles, lo cual permite reconocer objetos en entornos dinámicos y saturados. En visión artificial existe un amplio espectro de aplicaciones para las cuales el estudio de los movimientos complejos es crucial para recuperar información saliente. A pesar de que cada dominio puede ser diferente en términos de los escenarios, la complejidad y las relaciones de los objetos en movimiento, un común denominador es que todos ellos requieren una comprensión dinámica para capturar información relevante. En general, las estrategias actuales son altamente dependientes de la caracterización de la apariencia y por lo general están restringidos a escenarios controlados. Esta tesis propone un marco computacional que se inspira en los mecanismos de percepción de movimiento conocidas y esta estructurado como un conjunto de módulos. Cada módulo esta a su vez compuesto por un conjunto de estrategias computacionales que proporcionan descripciones cualitativas y cuantitativas de la dinámica asociada a un movimiento particular. Diversas aplicaciones fueron consideradas en este trabajo y una extensa validación se llevó a cabo para cada uno de ellas. Cada una de las estrategias propuestas ha demostrado ser fiable en la captura de los patrones dinámicos de diferentes tareas identificando, reconociendo, siguiendo e incluso segmentando objetos en secuencias de video.Doctorad

Optimizing endoscopic strategies for colorectal cancer screening : improving colonoscopy effectiveness by optical, non-optical, and computer-based models

Introduction: Le cancer colorectal demeure un grave problème de santé publique au Canada. Les programmes de dépistage pourraient réduire l'incidence du cancer colorectal et la mortalité qui lui est associée. Une coloscopie de haute qualité est considérée comme un moyen rentable de prévenir le cancer en identifiant et en éliminant les lésions précurseurs du cancer. Bien que la coloscopie puisse servir de mesure préventive contre le cancer, la procédure peut imposer un fardeau supplémentaire à la santé publique par l'enlèvement et l'évaluation histologique de polypes colorectaux diminutifs et insignifiants, qui présentent un risque minime d'histologie avancée ou de cancer. La technologie de l'amélioration de l'image permettrait aux médecins de réséquer et de rejeter les polypes diminutifs ou de diagnostiquer et de laisser les polypes rectosigmoïdiens diminutifs sans examen histopathologique. Malgré la disponibilité de systèmes informatiques de caractérisation des polypes, la pratique du diagnostic optique reste limitée en raison de la crainte d'un mauvais diagnostic de cancer, d'une mauvaise surveillance des patients et des problèmes médico-légaux correspondants. Il est donc indispensable d'élaborer des stratégies alternatives de résection et d'élimination non optiques pour améliorer la précision et la sécurité du diagnostic optique et l'adapter à la pratique clinique. Ces stratégies doivent répondre à des critères cliniques simples et ne nécessitent pas de formation supplémentaire ni de dispositifs d'amélioration de l'image. De plus, la pratique sûre du diagnostic optique, la prise de décision appropriée concernant la technique de polypectomie ou l'intervalle de surveillance dépendent de l'estimation précise de la taille des polypes. La variabilité inter-endoscopistes dans la mesure de la taille des polypes exige le développement de méthodes fiables et validées pour augmenter la précision de la mesure de la taille. Une balance virtuelle intégrée à un endoscope haute définition est actuellement disponible pour le calcul automatique de la taille des polypes, mais sa faisabilité clinique n'a pas encore été établie. En dehors des points susmentionnés, une coloscopie de haute qualité nécessite l'examen complet de la muqueuse colique, ainsi que la visualisation de la valve iléocæcale et de l'orifice appendiculaire. À ce jour, aucune solution informatique n'a été capable d'assister les endoscopistes pendant les coloscopies en temps réel en détectant et en différenciant les points de repère cæcaux de façon automatique. Objectifs: Les objectifs de cette thèse sont : 1) d'étudier l'effet de la limitation du diagnostic optique aux polypes de 1 à 3 mm sur la sécurité du diagnostic optique pour le traitement des polypes diminutifs et l'acceptation par les endoscopistes de son utilisation dans les pratiques en temps réel tout en préservant ses potentiels de temps et de rentabilité ; 2) élaborer et examiner des stratégies non optiques de résection et d'élimination qui peuvent remplacer le diagnostic optique tout en offrant les mêmes possibilités d'économie de temps et d'argent ; 3) examiner la précision relative d'un endoscope à échelle virtuelle pour mesurer la taille des polypes ; 4) former, valider et tester un modèle d'intelligence artificielle qui peut prédire la complétude d'une procédure de coloscopie en identifiant les points de repère anatomiques du cæcum (c'est-à-dire la valve iléo-cæcale et l'orifice appendiculaire) et en les différenciant les uns des autres, des polypes et de la muqueuse normale. Méthodes: Pour atteindre le premier objectif de cette thèse, une analyse post-hoc de trois études prospectives a été réalisée pour évaluer la proportion de patients chez lesquels des adénomes avancés ont été découverts et le diagnostic optique a entraîné une surveillance retardée dans trois groupes de taille de polypes : 1–3, 1–5, et 1–10 mm. Pour atteindre le second objectif de cette thèse, deux stratégies non optiques ont été développées et testées dans deux études prospectives: une stratégie de résection et d'élimination basée sur la localisation qui utilise la localisation anatomique des polypes pour classer les polypes du côlon en non-néoplasiques ou néoplasiques à faible risque et une stratégie de résection et d'élimination basée sur les polypes qui attribue des intervalles de surveillance en fonction du nombre et de la taille des polypes. Dans les trois études, la concordance de l'attribution d'intervalles de surveillance basée sur un diagnostic optique à haute confiance ou sur des stratégies non optiques avec les recommandations basées sur la pathologie, ainsi que la proportion d'examens pathologiques évités et la proportion de communications immédiates d'intervalles de surveillance, ont été évaluées. Le troisième objectif de cette thèse a été abordé par le biais d'une étude de faisabilité pilote prospective qui a utilisé la mesure de spécimens de polypes immédiatement après leur prélèvement, suite à une polypectomie par un pied à coulisse Vernier comme référence pour comparer la précision relative des mesures de la taille des polypes entre les endoscopistes et un endoscope à échelle virtuelle. Enfin, le quatrième objectif de cette thèse a été évalué par l'enregistrement et l'annotation prospective de vidéos de coloscopie. Des images non modifiées de polype, de valve iléo-caecale, d'orifice appendiculaire et de muqueuse normale ont été extraites et utilisées pour développer et tester un modèle de réseau neuronal convolutionnel profond pour classer les images pour les points de repère qu'elles contiennent. Résultats: La réduction du seuil du diagnostic optique favoriserait la sécurité du diagnostic optique en diminuant de manière significative le risque d'écarter un polype avec une histologie avancée ou la mauvaise surveillance d'un patient avec de tels polypes. En outre, les stratégies non optiques de résection et d'élimination pourraient dépasser le critère de référence d'au moins 90% de concordance dans l'attribution des intervalles de surveillance post-polypectomie par rapport aux décisions basées sur l'évaluation pathologique. De plus, il a été démontré que l'endoscope à échelle virtuelle est plus précis que l'estimation visuelle de la taille des polypes en temps réel. Enfin, un modèle d'apprentissage profond s'est révélé très efficace pour détecter les repères cæcaux, les polypes et la muqueuse normale, à la fois individuellement et en combinaison. Discussion: La prédiction histologique optique des polypes de 1 à 3 mm est une approche efficace pour améliorer la sécurité et la faisabilité de la stratégie de résection et d'écartement dans la pratique. Les approches non optiques de résection et d'élimination offrent également des alternatives viables au diagnostic optique lorsque les endoscopistes ne sont pas en mesure de répondre aux conditions de mise en œuvre systématique du diagnostic optique, ou lorsque la technologie d'amélioration de l'image n'est pas accessible. Les stratégies de résection et de rejet, qu'elles soient optiques ou non, pourraient réduire les coûts supplémentaires liés aux examens histopathologiques et faciliter la communication du prochain intervalle de surveillance le même jour que la coloscopie de référence. Un endoscope virtuel à échelle réduite faciliterait l'utilisation du diagnostic optique pour la détection des polypes diminutifs et permet une prise de décision appropriée pendant et après la coloscopie. Enfin, le modèle d'apprentissage profond peut être utile pour promouvoir et contrôler la qualité des coloscopies par la prédiction d'une coloscopie complète. Cette technologie peut être intégrée dans le cadre d'une plateforme de vérification et de génération de rapports qui élimine le besoin d'intervention humaine. Conclusion: Les résultats présentés dans cette thèse contribueront à l'état actuel des connaissances dans la pratique de la coloscopie concernant les stratégies pour améliorer l'efficacité de la coloscopie dans la prévention du cancer colorectal. Cette étude fournira des indications précieuses pour les futurs chercheurs intéressés par le développement de méthodes efficaces de traitement des polypes colorectaux diminutifs. Le diagnostic optique nécessite une formation complémentaire et une mise en œuvre à l'aide de modules de caractérisation informatisés. En outre, malgré la lenteur de l'adoption des solutions informatiques dans la pratique clinique, la coloscopie assistée par l'IA ouvrira la voie à la détection automatique, à la caractérisation et à la rédaction semi-automatique des rapports de procédure.Introduction: Colorectal cancer remains a critical public health concern in Canada. Screening programs could reduce the incidence of colorectal cancer and its associated mortality. A high-quality colonoscopy is appraised to be a cost-effective means of cancer prevention through identifying and removing cancer precursor lesions. Although colonoscopy can serve as a preventative measure against cancer, the procedure can impose an additional burden on the public health by removing and histologically evaluating insignificant diminutive colorectal polyps, which pose a minimal risk of advanced histology or cancer. The image-enhance technology would enable physicians to resect and discard diminutive polyps or diagnose and leave diminutive rectosigmoid polyps without histopathology examination. Despite the availability of computer-based polyp characterization systems, the practice of optical diagnosis remains limited due to the fear of cancer misdiagnosis, patient mismanagement, and the related medicolegal issues. Thus, alternative non-optical resection and discard strategies are imperative for improving the accuracy and safety of optical diagnosis for adaptation to clinical practice. These strategies should follow simple clinical criteria and do not require additional education or image enhanced devices. Furthermore, the safe practice of optical diagnosis, adequate decision-making regarding polypectomy technique, or surveillance interval depends on accurate polyp size estimation. The inter-endoscopist variability in polyp sizing necessitates the development of reliable and validated methods to enhance the accuracy of size measurement. A virtual scale integrated into a high-definition endoscope is currently available for automated polyp sizing, but its clinical feasibility has not yet been demonstrated. In addition to the points mentioned above, a high-quality colonoscopy requires the complete examination of the entire colonic mucosa, as well as the visualization of the ileocecal valve and appendiceal orifice. To date, no computer-based solution has been able to support endoscopists during live colonoscopies by automatically detecting and differentiating cecal landmarks. Aims: The aims of this thesis are: 1) to investigate the effect of limiting optical diagnosis to polyps 1–3mm on the safety of optical diagnosis for the management of diminutive polyps and the acceptance of endoscopists for its use in real-time practices while preserving its time- and cost-effectiveness potentials; 2) to develop and examine non-optical resect and discard strategies that can replace optical diagnosis while offering the same time- and cost-saving potentials; 3) to examine the relative accuracy of a virtual scale endoscope for measuring polyp size; 4) to train, validate, and test an artificial intelligence-empower model that can predict the completeness of a colonoscopy procedure by identifying cecal anatomical landmarks (i.e., ileocecal valve and appendiceal orifice) and differentiating them from one another, polyps, and normal mucosa. Methods: To achieve the first aim of this thesis, a post-hoc analysis of three prospective studies was performed to evaluate the proportion of patients in which advanced adenomas were found and optical diagnosis resulted in delayed surveillance in three polyp size groups: 1‒3, 1‒5, and 1‒10 mm. To achieve the second aim of this thesis, two non-optical strategies were developed and tested in two prospective studies: a location-based resect and discard strategy that uses anatomical polyp location to classify colon polyps into non-neoplastic or low-risk neoplastic and a polyp-based resect and discard strategy that assigns surveillance intervals based on polyp number and size. In all three studies, the agreement of assigning surveillance intervals based on high-confidence optical diagnosis or non-optical strategies with pathology-based recommendations, as well as the proportion of avoided pathology examinations and the proportion of immediate surveillance interval communications, was evaluated. The third aim of this thesis was addressed through a prospective pilot feasibility study that used the measurement of polyp specimens immediately after retrieving, following a polypectomy by a Vernier caliper as a reference to compare the relative accuracy of polyp size measurements between endoscopists and a virtual scale endoscope. Finally, the fourth aim of this thesis was assessed through prospective recording and annotation of colonoscopy videos. Unaltered images of polyp, ileocecal valve, appendiceal orifice and normal mucosa were extracted and used to develop and test a deep convolutional neural network model for classifying images for the containing landmarks. Results: Reducing the threshold of optical diagnosis would promote the safety of optical diagnosis by significantly decreasing the risk of discarding a polyp with advanced histology or the mismanagement of a patient with such polyps. Additionally, the non-optical resect and discard strategies could surpass the benchmark of at least 90% agreement in the assignment of post-polypectomy surveillance intervals compared with decisions based on pathologic assessment. Moreover, the virtual scale endoscope was demonstrated to be more accurate than visual estimation of polyp size in real-time. Finally, a deep learning model proved to be highly effective in detecting cecal landmarks, polyps, and normal mucosa, both individually and in combination. Discussion: Optical histology prediction of polyps 1‒3 mm in size is an effective approach to enhance the safety and feasibility of resect and discard strategy in practice. Non-optical resect and discard approaches also offer feasible alternatives to optical diagnosis when endoscopists are unable to meet the conditions for routine implementation of optical diagnosis, or when image-enhanced technology is not accessible. Both optical and non-optical resect and discard strategies could reduce additional costs related to histopathology examinations and facilitate the communication of the next surveillance interval in the same day as the index colonoscopy. A virtual scale endoscope would facilitate the use of optical diagnosis for the detection of diminutive polyps and allows for appropriate decision-making during and after colonoscopy. Additionally, the deep learning model may be useful in promoting and monitoring the quality of colonoscopies through the prediction of a complete colonoscopy. This technology may be incorporated as part of a platform for auditing and report generation that eliminates the need for human intervention. Conclusion: The results presented in this thesis will contribute to the current state of knowledge in colonoscopy practice regarding strategies for improving the efficacy of colonoscopy in the prevention of colorectal cancer. This study will provide valuable insights for future researchers interested in developing effective methods for treating diminutive colorectal polyps. Optical diagnosis requires further training and implementation using computer-based characterization modules. Furthermore, despite the slow adoption of computer-based solutions in clinical practice, AI-empowered colonoscopy will eventually pave the way for automatic detection, characterization, and semi-automated completion of procedure reports in the future

SCALING ARTIFICIAL INTELLIGENCE IN ENDOSCOPY: FROM MODEL DEVELOPMENT TO MACHINE LEARNING OPERATIONS FRAMEWORKS

Questa tesi esplora l'integrazione dell'intelligenza artificiale (IA) in Otorinolaringoiatria – Chirurgia di Testa e Collo, concentrandosi sui progressi della computer vision per l’endoscopia e le procedure chirurgiche. La ricerca inizia con una revisione completa dello stato dell’arte dell'IA e della computer vision in questo campo, identificando aree per ulteriori sviluppi. L'obiettivo principale è stato quello di sviluppare un sistema di computer vision per l'analisi di immagini e video endoscopici. La ricerca ha coinvolto la progettazione di strumenti per la rilevazione e segmentazione di neoplasie nelle vie aerodigestive superiori (VADS) e la valutazione della motilità delle corde vocali, cruciale nella stadiazione del carcinoma laringeo. Inoltre, lo studio si è focalizzato sul potenziale dei foundation vision models, vision transformers basati su self-supervised learning, per ridurre la necessità di annotazione da parte di esperti, approccio particolarmente vantaggioso in campi con dati limitati. Inoltre, la ricerca ha incluso lo sviluppo di un'applicazione web per migliorare e velocizzare il processo di annotazione in endoscopia delle VADS, nell’ambito generale delle tecniche di MLOps. La tesi copre varie fasi della ricerca, a partire dalla definizione del quadro concettuale e della metodologia, denominata "Videomics". Include una revisione della letteratura sull'IA in endoscopia clinica, focalizzata sulla Narrow Band Imaging (NBI) e sulle reti neurali convoluzionali (CNN). Lo studio progredisce attraverso diverse fasi, dalla valutazione della qualità delle immagini endoscopiche alla caratterizzazione approfondita delle lesioni neoplastiche. Si affronta anche la necessità di standard nel reporting degli studi di computer vision in ambito medico e si valuta l'applicazione dell'IA in setting dinamici come la motilità delle corde vocali. Una parte significativa della ricerca indaga l'uso di algoritmi di computer vision generalizzati (“foundation models”) e la “commoditization” degli algoritmi di machine learning, utilizzando polipi nasali e il carcinoma orofaringeo come casi studio. Infine, la tesi discute lo sviluppo di ENDO-CLOUD, un sistema basato su cloud per l’analisi della videolaringoscopia, evidenziando le sfide e le soluzioni nella gestione dei dati e l’utilizzo su larga scala di modelli di IA nell'imaging medico.This thesis explores the integration of artificial intelligence (AI) in Otolaryngology – Head and Neck Surgery, focusing on advancements in computer vision for endoscopy and surgical procedures. It begins with a comprehensive review of AI and computer vision advancements in this field, identifying areas for further exploration. The primary aim was to develop a computer vision system for endoscopy analysis. The research involved designing tools for detecting and segmenting neoplasms in the upper aerodigestive tract (UADT) and assessing vocal fold motility, crucial in laryngeal cancer staging. Further, the study delves into the potential of vision foundation models, like vision transformers trained via self-supervision, to reduce the need for expert annotations, particularly beneficial in fields with limited cases. Additionally, the research includes the development of a web application for enhancing and speeding up the annotation process in UADT endoscopy, under the umbrella of Machine Learning Operations (MLOps). The thesis covers various phases of research, starting with defining the conceptual framework and methodology, termed "Videomics". It includes a literature review on AI in clinical endoscopy, focusing on Narrow Band Imaging (NBI) and convolutional neural networks (CNNs). The research progresses through different stages, from quality assessment of endoscopic images to in-depth characterization of neoplastic lesions. It also addresses the need for standards in medical computer vision study reporting and evaluates the application of AI in dynamic vision scenarios like vocal fold motility. A significant part of the research investigates the use of "general purpose" vision algorithms and the commoditization of machine learning algorithms, using nasal polyps and oropharyngeal cancer as case studies. Finally, the thesis discusses the development of ENDO-CLOUD, a cloud-based system for videolaryngoscopy, highlighting the challenges and solutions in data management and the large-scale deployment of AI models in medical imaging

Evaluation of the competence of an artificial intelligence-assisted colonoscopy system in clinical practice: A post hoc analysis

BackgroundArtificial intelligence-assisted colonoscopy (AIAC) has been proposed and validated in recent years, but the effectiveness of clinic application remains unclear since it was only validated in some clinical trials rather than normal conditions. In addition, previous clinical trials were mostly concerned with colorectal polyp identification, while fewer studies are focusing on adenoma identification and polyps size measurement. In this study, we validated the effectiveness of AIAC in the clinical environment and further investigated its capacity for adenoma identification and polyps size measurement.MethodsThe information of 174 continued patients who went for coloscopy in Chongqing Rongchang District People’s hospital with detected colon polyps was retrospectively collected, and their coloscopy images were divided into three validation datasets, polyps dataset, polyps/adenomas dataset (all containing narrow band image, NBI images), and polyp size measurement dataset (images with biopsy forceps and polyps) to assess the competence of the artificial intelligence system, and compare its diagnostic ability with endoscopists with different experiences.ResultsA total of 174 patients were included, and the sensitivity of the colorectal polyp recognition model was 99.40%, the accuracy of the colorectal adenoma diagnostic model was 93.06%, which was higher than that of endoscopists, and the mean absolute error of the polyp size measurement model was 0.62 mm and the mean relative error was 10.89%, which was lower than that of endoscopists.ConclusionArtificial intelligence-assisted model demonstrated higher competence compared with endoscopists and stable diagnosis ability in clinical use

Unveiling healthcare data archiving: Exploring the role of artificial intelligence in medical image analysis

Gli archivi sanitari digitali possono essere considerati dei moderni database progettati per immagazzinare e gestire ingenti quantità di informazioni mediche, dalle cartelle cliniche dei pazienti, a studi clinici fino alle immagini mediche e a dati genomici. I dati strutturati e non strutturati che compongono gli archivi sanitari sono oggetto di scrupolose e rigorose procedure di validazione per garantire accuratezza, affidabilità e standardizzazione a fini clinici e di ricerca. Nel contesto di un settore sanitario in continua e rapida evoluzione, l’intelligenza artificiale (IA) si propone come una forza trasformativa, capace di riformare gli archivi sanitari digitali migliorando la gestione, l’analisi e il recupero di vasti set di dati clinici, al fine di ottenere decisioni cliniche più informate e ripetibili, interventi tempestivi e risultati migliorati per i pazienti. Tra i diversi dati archiviati, la gestione e l’analisi delle immagini mediche in archivi digitali presentano numerose sfide dovute all’eterogeneità dei dati, alla variabilità della qualità delle immagini, nonché alla mancanza di annotazioni. L’impiego di soluzioni basate sull’IA può aiutare a risolvere efficacemente queste problematiche, migliorando l’accuratezza dell’analisi delle immagini, standardizzando la qualità dei dati e facilitando la generazione di annotazioni dettagliate. Questa tesi ha lo scopo di utilizzare algoritmi di IA per l’analisi di immagini mediche depositate in archivi sanitari digitali. Il presente lavoro propone di indagare varie tecniche di imaging medico, ognuna delle quali è caratterizzata da uno specifico dominio di applicazione e presenta quindi un insieme unico di sfide, requisiti e potenziali esiti. In particolare, in questo lavoro di tesi sarà oggetto di approfondimento l’assistenza diagnostica degli algoritmi di IA per tre diverse tecniche di imaging, in specifici scenari clinici: i) Immagini endoscopiche ottenute durante esami di laringoscopia; ciò include un’esplorazione approfondita di tecniche come la detection di keypoints per la stima della motilità delle corde vocali e la segmentazione di tumori del tratto aerodigestivo superiore; ii) Immagini di risonanza magnetica per la segmentazione dei dischi intervertebrali, per la diagnosi e il trattamento di malattie spinali, così come per lo svolgimento di interventi chirurgici guidati da immagini; iii) Immagini ecografiche in ambito reumatologico, per la valutazione della sindrome del tunnel carpale attraverso la segmentazione del nervo mediano. Le metodologie esposte in questo lavoro evidenziano l’efficacia degli algoritmi di IA nell’analizzare immagini mediche archiviate. I progressi metodologici ottenuti sottolineano il notevole potenziale dell’IA nel rivelare informazioni implicitamente presenti negli archivi sanitari digitali

Online Super-Resolution For Fibre-Bundle-Based Confocal Laser Endomicroscopy

Probe-based Confocal Laser Endomicroscopy (pCLE) produces microscopic images enabling real-time in vivo optical biopsy. However, the miniaturisation of the optical hardware, specifically the reliance on an optical fibre bundle as an imaging guide, fundamentally limits image quality by producing artefacts, noise, and relatively low contrast and resolution. The reconstruction approaches in clinical pCLE products do not fully alleviate these problems. Consequently, image quality remains a barrier that curbs the full potential of pCLE. Enhancing the image quality of pCLE in real-time remains a challenge. The research in this thesis is a response to this need. I have developed dedicated online super-resolution methods that account for the physics of the image acquisition process. These methods have the potential to replace existing reconstruction algorithms without interfering with the fibre design or the hardware of the device. In this thesis, novel processing pipelines are proposed for enhancing the image quality of pCLE. First, I explored a learning-based super-resolution method that relies on mapping from the low to the high-resolution space. Due to the lack of high-resolution pCLE, I proposed to simulate high-resolution data and use it as a ground truth model that is based on the pCLE acquisition physics. However, pCLE images are reconstructed from irregularly distributed fibre signals, and grid-based Convolutional Neural Networks are not designed to take irregular data as input. To alleviate this problem, I designed a new trainable layer that embeds Nadaraya- Watson regression. Finally, I proposed a novel blind super-resolution approach by deploying unsupervised zero-shot learning accompanied by a down-sampling kernel crafted for pCLE. I evaluated these new methods in two ways: a robust image quality assessment and a perceptual quality test assessed by clinical experts. The results demonstrate that the proposed super-resolution pipelines are superior to the current reconstruction algorithm in terms of image quality and clinician preference