Clinically applicable artificial intelligence system for dental diagnosis with CBCT

Abstract In this study, a novel AI system based on deep learning methods was evaluated to determine its real-time performance of CBCT imaging diagnosis of anatomical landmarks, pathologies, clinical effectiveness, and safety when used by dentists in a clinical setting. The system consists of 5 modules: ROI-localization-module (segmentation of teeth and jaws), tooth-localization and numeration-module, periodontitis-module, caries-localization-module, and periapical-lesion-localization-module. These modules use CNN based on state-of-the-art architectures. In total, 1346 CBCT scans were used to train the modules. After annotation and model development, the AI system was tested for diagnostic capabilities of the Diagnocat AI system. 24 dentists participated in the clinical evaluation of the system. 30 CBCT scans were examined by two groups of dentists, where one group was aided by Diagnocat and the other was unaided. The results for the overall sensitivity and specificity for aided and unaided groups were calculated as an aggregate of all conditions. The sensitivity values for aided and unaided groups were 0.8537 and 0.7672 while specificity was 0.9672 and 0.9616 respectively. There was a statistically significant difference between the groups (p = 0.032). This study showed that the proposed AI system significantly improved the diagnostic capabilities of dentists

Automated Teeth Extraction and Dental Caries Detection in Panoramic X-ray

Dental caries is one of the most chronic diseases that involves the majority of people at least once during their lifetime. This expensive disease accounts for 5-10% of the healthcare budget in developing countries. Caries lesions appear as the result of dental biofi lm metabolic activity, caused by bacteria (most prominently Streptococcus mutans) feeding on uncleaned sugars and starches in oral cavity. Also known as tooth decay, they are primarily diagnosed by general dentists solely based on clinical assessments. Since in many cases dental problems cannot be detected with simple observations, dental x-ray imaging is introduced as a standard tool for domain experts, i.e. dentists and radiologists, to distinguish dental diseases, such as proximal caries. Among different dental radiography methods, Panoramic or Orthopantomogram (OPG) images are commonly performed as the initial step toward assessment. OPG images are captured with a small dose of radiation and can depict the entire patient dentition in a single image. Dental caries can sometimes be hard to identify by general dentists relying only on their visual inspection using dental radiography. Tooth decays can easily be misinterpreted as shadows due to various reasons, such as low image quality. Besides, OPG images have poor quality and structures are not presented with strong edges due to low contrast, uneven exposure, etc. Thus, disease detection is a very challenging task using Panoramic radiography. With the recent development of Artificial Intelligence (AI) in dentistry, and with the introduction of Convolutional Neural Network (CNN) for image classification, developing medical decision support systems is becoming a topic of interest in both academia and industry. Providing more accurate decision support systems using CNNs to assist dentists can enhance their diagnosis performance, resulting in providing improved dental care assistance for patients. In the following thesis, the first automated teeth extraction system for Panoramic images, using evolutionary algorithms, is proposed. In contrast to other intraoral radiography methods, Panoramic is captured with x-ray film outside the patient mouth. Therefore, Panoramic x-rays contain regions outside of the jaw, which make teeth segmentation extremely difficult. Considering that we solely need an image of each tooth separately to build a caries detection model, segmentation of teeth from the OPG image is essential. Due to the absence of significant pixel intensity difference between different regions in OPG radiography, teeth segmentation becomes very hard to implement. Consequently, an automated system is introduced to get an OPG as input and gives images of single teeth as the output. Since only a few research studies are utilizing similar task for Panoramic radiography, there is room for improvement. A genetic algorithm is applied along with different image processing methods to perform teeth extraction by jaw extraction, jaw separation, and teeth-gap valley detection, respectively. The proposed system is compared to the state-of-the-art in teeth extraction on other image types. After teeth are segmented from each image, a model based on various untrained and pretrained CNN-based architectures is proposed to detect dental caries for each tooth. Autoencoder-based model along with famous CNN architectures are used for feature extraction, followed by capsule networks to perform classification. The dataset of Panoramic x-rays is prepared by the authors, with help from an expert radiologist to provide labels. The proposed model has demonstrated an acceptable detection rate of 86.05%, and an increase in caries detection speed. Considering the challenges of performing such task on low quality OPG images, this work is a step towards developing a fully automated efficient caries detection model to assist domain experts

Automated Teeth Extraction and Dental Caries Detection in Panoramic X-ray

Dental caries is one of the most chronic diseases that involves the majority of people at least once during their lifetime. This expensive disease accounts for 5-10% of the healthcare budget in developing countries. Caries lesions appear as the result of dental biofi lm metabolic activity, caused by bacteria (most prominently Streptococcus mutans) feeding on uncleaned sugars and starches in oral cavity. Also known as tooth decay, they are primarily diagnosed by general dentists solely based on clinical assessments. Since in many cases dental problems cannot be detected with simple observations, dental x-ray imaging is introduced as a standard tool for domain experts, i.e. dentists and radiologists, to distinguish dental diseases, such as proximal caries. Among different dental radiography methods, Panoramic or Orthopantomogram (OPG) images are commonly performed as the initial step toward assessment. OPG images are captured with a small dose of radiation and can depict the entire patient dentition in a single image. Dental caries can sometimes be hard to identify by general dentists relying only on their visual inspection using dental radiography. Tooth decays can easily be misinterpreted as shadows due to various reasons, such as low image quality. Besides, OPG images have poor quality and structures are not presented with strong edges due to low contrast, uneven exposure, etc. Thus, disease detection is a very challenging task using Panoramic radiography. With the recent development of Artificial Intelligence (AI) in dentistry, and with the introduction of Convolutional Neural Network (CNN) for image classification, developing medical decision support systems is becoming a topic of interest in both academia and industry. Providing more accurate decision support systems using CNNs to assist dentists can enhance their diagnosis performance, resulting in providing improved dental care assistance for patients. In the following thesis, the first automated teeth extraction system for Panoramic images, using evolutionary algorithms, is proposed. In contrast to other intraoral radiography methods, Panoramic is captured with x-ray film outside the patient mouth. Therefore, Panoramic x-rays contain regions outside of the jaw, which make teeth segmentation extremely difficult. Considering that we solely need an image of each tooth separately to build a caries detection model, segmentation of teeth from the OPG image is essential. Due to the absence of significant pixel intensity difference between different regions in OPG radiography, teeth segmentation becomes very hard to implement. Consequently, an automated system is introduced to get an OPG as input and gives images of single teeth as the output. Since only a few research studies are utilizing similar task for Panoramic radiography, there is room for improvement. A genetic algorithm is applied along with different image processing methods to perform teeth extraction by jaw extraction, jaw separation, and teeth-gap valley detection, respectively. The proposed system is compared to the state-of-the-art in teeth extraction on other image types. After teeth are segmented from each image, a model based on various untrained and pretrained CNN-based architectures is proposed to detect dental caries for each tooth. Autoencoder-based model along with famous CNN architectures are used for feature extraction, followed by capsule networks to perform classification. The dataset of Panoramic x-rays is prepared by the authors, with help from an expert radiologist to provide labels. The proposed model has demonstrated an acceptable detection rate of 86.05%, and an increase in caries detection speed. Considering the challenges of performing such task on low quality OPG images, this work is a step towards developing a fully automated efficient caries detection model to assist domain experts

Odontology & artificial intelligence

Neste trabalho avaliam-se os três fatores que fizeram da inteligência artificial uma tecnologia essencial hoje em dia, nomeadamente para a odontologia: o desempenho do computador, Big Data e avanços algorítmicos. Esta revisão da literatura avaliou todos os artigos publicados na PubMed até Abril de 2019 sobre inteligência artificial e odontologia. Ajudado com inteligência artificial, este artigo analisou 1511 artigos. Uma árvore de decisão (If/Then) foi executada para selecionar os artigos mais relevantes (217), e um algoritmo de cluster k-means para resumir e identificar oportunidades de inovação. O autor discute os artigos mais interessantes revistos e compara o que foi feito em inovação durante o International Dentistry Show, 2019 em Colónia. Concluiu, assim, de forma crítica que há uma lacuna entre tecnologia e aplicação clínica desta, sendo que a inteligência artificial fornecida pela indústria de hoje pode ser considerada um atraso para o clínico de amanhã, indicando-se um possível rumo para a aplicação clínica da inteligência artificial.There are three factors that have made artificial intelligence (AI) an essential technology today: the computer performance, Big Data and algorithmic advances. This study reviews the literature on AI and Odontology based on articles retrieved from PubMed. With the help of AI, this article analyses a large number of articles (a total of 1511). A decision tree (If/Then) was run to select the 217 most relevant articles-. Ak-means cluster algorithm was then used to summarize and identify innovation opportunities. The author discusses the most interesting articles on AI research and compares them to the innovation presented during the International Dentistry Show 2019 in Cologne. Three technologies available now are evaluated and three suggested options are been developed. The author concludes that AI provided by the industry today is a hold-up for the praticioner of tomorrow. The author gives his opinion on how to use AI for the profit of patients

A hybrid mask RCNN-based tool to localize dental cavities from real-time mixed photographic images

Nearly 3.5 billion humans have oral health issues, including dental caries, which requires dentist-patient exposure in oral examinations. The automated approaches identify and locate carious regions from dental images by localizing and processing either colored photographs or X-ray images taken via specialized dental photography cameras. The dentists’ interpretation of carious regions is difficult since the detected regions are masked using solid coloring and limited to a particular dental image type. The software-based automated tools to localize caries from dental images taken via ordinary cameras requires further investigation. This research provided a mixed dataset of dental photographic (colored or X-ray) images, instantiated a deep learning approach to enhance the existing dental image carious regions’ localization procedure, and implemented a full-fledged tool to present carious regions via simple dental images automatically. The instantiation mainly exploits the mixed dataset of dental images (colored photographs or X-rays) collected from multiple sources and pre-trained hybrid Mask RCNN to localize dental carious regions. The evaluations performed by the dentists showed that the correctness of annotated datasets is up to 96%, and the accuracy of the proposed system is between 78% and 92%. Moreover, the system achieved the overall satisfaction level of dentists above 80%

Artificial Intelligence in Oral Health

This Special Issue is intended to lay the foundation of AI applications focusing on oral health, including general dentistry, periodontology, implantology, oral surgery, oral radiology, orthodontics, and prosthodontics, among others

Object Detection in medical imaging

A thesis submitted in partial fulfillment of the requirements for the degree of Doctor in Information Management, specialization in Information and Decision SystemsArtificial Intelligence, assisted by deep learning, has emerged in various fields of our society. These systems allow the automation and the improvement of several tasks, even surpassing, in some cases, human capability. Object detection methods are used nowadays in several areas, including medical imaging analysis. However, these methods are susceptible to errors, and there is a lack of a universally accepted method that can be applied across all types of applications with the needed precision in the medical field. Additionally, the application of object detectors in medical imaging analysis has yet to be thoroughly analyzed to achieve a richer understanding of the state of the art. To tackle these shortcomings, we present three studies with distinct goals. First, a quantitative and qualitative analysis of academic research was conducted to gather a perception of which object detectors are employed, the modality of medical imaging used, and the particular body parts under investigation. Secondly, we propose an optimized version of a widely used algorithm to overcome limitations commonly addressed in medical imaging by fine-tuning several hyperparameters. Thirdly, we develop a novel stacking approach to augment the precision of detections on medical imaging analysis. The findings show that despite the late arrival of object detection in medical imaging analysis, the number of publications has increased in recent years, demonstrating the significant potential for growth. Additionally, we establish that it is possible to address some constraints on the data through an exhaustive optimization of the algorithm. Finally, our last study highlights that there is still room for improvement in these advanced techniques, using, as an example, stacking approaches. The contributions of this dissertation are several, as it puts forward a deeper overview of the state-of-the-art applications of object detection algorithms in the medical field and presents strategies for addressing typical constraints in this area.A Inteligência Artificial, auxiliada pelo deep learning, tem emergido em diversas áreas da nossa sociedade. Estes sistemas permitem a automatização e a melhoria de diversas tarefas, superando mesmo, em alguns casos, a capacidade humana. Os métodos de detecção de objetos são utilizados atualmente em diversas áreas, inclusive na análise de imagens médicas. No entanto, esses métodos são suscetíveis a erros e falta um método universalmente aceite que possa ser aplicado em todos os tipos de aplicações com a precisão necessária na área médica. Além disso, a aplicação de detectores de objetos na análise de imagens médicas ainda precisa ser analisada minuciosamente para alcançar uma compreensão mais rica do estado da arte. Para enfrentar essas limitações, apresentamos três estudos com objetivos distintos. Inicialmente, uma análise quantitativa e qualitativa da pesquisa acadêmica foi realizada para obter uma percepção de quais detectores de objetos são empregues, a modalidade de imagem médica usada e as partes específicas do corpo sob investigação. Num segundo estudo, propomos uma versão otimizada de um algoritmo amplamente utilizado para superar limitações comumente abordadas em imagens médicas por meio do ajuste fino de vários hiperparâmetros. Em terceiro lugar, desenvolvemos uma nova abordagem de stacking para aumentar a precisão das detecções na análise de imagens médicas. Os resultados demostram que, apesar da chegada tardia da detecção de objetos na análise de imagens médicas, o número de publicações aumentou nos últimos anos, evidenciando o significativo potencial de crescimento. Adicionalmente, estabelecemos que é possível resolver algumas restrições nos dados por meio de uma otimização exaustiva do algoritmo. Finalmente, o nosso último estudo destaca que ainda há espaço para melhorias nessas técnicas avançadas, usando, como exemplo, abordagens de stacking. As contribuições desta dissertação são várias, apresentando uma visão geral em maior detalhe das aplicações de ponta dos algoritmos de detecção de objetos na área médica e apresenta estratégias para lidar com restrições típicas nesta área

Studies on neutron diffraction and X-ray radiography for material inspection

Among the different probes to study the structures of the bio and structural materials, X-ray and neutron are widely used because of their distinctive usefulness in investigating different structures. X-ray radiography and neutron diffraction are two widely known non-destructive techniques for material inspection. Here we demonstrate the design of neutron diffractometer with low power source and analyze the digital image produced by the X-ray radiography instead of neutron diffraction because of the availability of the data. Neutron diffraction is a powerful tool for understanding the behavior of crystal structures and phase behaviors of materials. While neutron diffraction capabilities continue to explore new frontiers of materials science, such capabilities currently exist in limited places, which require high neutron flux. The study seeks to design a low-resolution neutron diffraction system that can be installed on low power reactors (e.g. 250 kW thermal power). The performance of the diffractometer is estimated using Monte-Carlo ray-tracing simulations with McStas with an application in material science. Both monochromatic and polychromatic configurations are considered in order to maximize the net diffracted neutron flux at the detectors with reasonable resolution. On the other hand, considering X-ray radiography as a structure inspecting technique, analysis of dental X-ray panorama is performed for the detection of oral lesions. A novel automatic computer-aided method to identify dental lesions from dental X-ray is presented. Morphological operations, intensity profile analysis, automated seed point selection, region growing, feature extraction and neural network application are carried out to perform the job. Results show that the performance of the proposed method surpasses existing automated methods utilizing dental X-rays --Abstract, page iii

Preparándonos para el impacto de la inteligencia artificial: ¿Cómo evolucionará la formación y la práctica de la radiología?

La inteligencia artificial (IA) ha llegado a la Odontología y promete quedarse. La constante escalada de la IA se remonta a casi diez años atrás. Aunque la mayoría de los principios básicos del aprendizaje automático y el aprendizaje profundo se desarrollaron a partir de 1980, las investigaciones en redes neuronales convolucionales (CNN) implementadas con unidades de procesamiento gráfico ganaron varios concursos en reconocimiento de imágenes entre los años 2011-2012 1,2. No tomó mucho tiempo para que sus aplicaciones en radiología fueran exploradas 3. Unos años más tarde, se publicaron los primeros estudios de investigación con CNN para aplicaciones dentales 4,5