CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison

Large, labeled datasets have driven deep learning methods to achieve expert-level performance on a variety of medical imaging tasks. We present CheXpert, a large dataset that contains 224,316 chest radiographs of 65,240 patients. We design a labeler to automatically detect the presence of 14 observations in radiology reports, capturing uncertainties inherent in radiograph interpretation. We investigate different approaches to using the uncertainty labels for training convolutional neural networks that output the probability of these observations given the available frontal and lateral radiographs. On a validation set of 200 chest radiographic studies which were manually annotated by 3 board-certified radiologists, we find that different uncertainty approaches are useful for different pathologies. We then evaluate our best model on a test set composed of 500 chest radiographic studies annotated by a consensus of 5 board-certified radiologists, and compare the performance of our model to that of 3 additional radiologists in the detection of 5 selected pathologies. On Cardiomegaly, Edema, and Pleural Effusion, the model ROC and PR curves lie above all 3 radiologist operating points. We release the dataset to the public as a standard benchmark to evaluate performance of chest radiograph interpretation models. The dataset is freely available at https://stanfordmlgroup.github.io/competitions/chexpert .Comment: Published in AAAI 201

The Effectiveness of Family Constellation Therapy in Improving Mental Health:A Systematic ReviewPalabras clave(sic)(sic)(sic)

Family/systemic constellation therapy is a short-term group intervention aiming to help clients better understand and then change their conflictive experiences within a social system (e.g., family). The aim of the present systematic review was to synthetize the empirical evidence on the tolerability and effectiveness of this intervention in improving mental health. The PsycINFO, Embase, MEDLINE, ISI Web of Science, Psyndex, PsycEXTRA, ProQuest Dissertations & Theses, The Cochrane Library, Google Scholar, and an intervention-specific organization's databases were searched for quantitative, prospective studies published in English, German, Spanish, French, Dutch or Hungarian up until April 2020. Out of 4,197 identified records, 67 were assessed for eligibility, with 12 studies fulfilling inclusion criteria (10 independent samples; altogether 568 participants). Outcome variables were diverse ranging from positive self-image through psychopathology to perceived quality of family relationships. Out of the 12 studies, nine showed statistically significant improvement postintervention. The studies showing no significant treatment benefit were of lower methodological quality. The random-effect meta-analysis-conducted on five studies in relation to general psychopathology-indicated a moderate effect (Hedges' g of 0.531, CI: 0.387-0.676). Authors of seven studies also investigated potential iatrogenic effects and four studies reported minor or moderate negative effects in a small proportion (5-8%) of participants that potentially could have been linked to the intervention. The data accumulated to date point into the direction that family constellation therapy is an effective intervention with significant mental health benefits in the general population; however, the quantity and overall quality of the evidence is low

Structured reporting: if, why, when, how—and at what expense? Results of a focus group meeting of radiology professionals from eight countries

Purpose: To determine why, despite growing evidence that radiologists and referring physicians prefer structured reporting (SR) to free text (FT) reporting, SR has not been widely adopted in most radiology departments. Methods: A focus group was formed consisting of 11 radiology professionals from eight countries. Eight topics were submitted for discussion. The meeting was videotaped, transcribed, and analyzed according to the principles of qualitative healthcare research. Results: Perceived advantages of SR were facilitation of research, easy comparison, discouragement of ambiguous reports, embedded links to images, highlighting important findings, not having to dictate text nobody will read, and automatic translation of teleradiology reports. Being compelled to report within a rigid frame was judged unacceptable. Personal convictions appeared to have high emotional value. It was felt that other healthcare stakeholders would impose SR without regard to what radiologists thought of it. If the industry were to provide ready-made templates for selected examinations, most radiologists would use them. Conclusion: If radiologists can be convinced of the advantages of SR and the risks associated with failing to participate actively in its implementation, they will take a positive stand. The industry should propose technology allowing SR without compromising accuracy, completeness, workflows, and cost-benefit balance

Multidisciplinary team meetings and their impact on workflow in radiology and pathology departments

<p>Abstract</p> <p>Background</p> <p>The development of multidisciplinary team meetings (MDTMs) for radiology and pathology is a burgeoning area that increasingly impacts on work processes in both of these departments. The aim of this study was to examine work processes and quantify the time demands on radiologists and pathologists associated with MDTM practices at a large teaching hospital. The observations reported in this paper reflect a general trend affecting hospitals and our conclusions will have relevance for others implementing clinical practice guidelines.</p> <p>Methods</p> <p>For one month, all work related to clinical meetings between pathology and radiology with clinical staff was documented and later analysed.</p> <p>Results</p> <p>The number of meetings to which pathology and radiology contribute at a large university teaching hospital, ranges from two to eight per day, excluding grand rounds, and amounts to approximately 50 meetings per month for each department. For one month, over 300 h were spent by pathologists and radiologists on 81 meetings, where almost 1000 patients were discussed. For each meeting hour, there were, on average, 2.4 pathology hours and 2 radiology hours spent in preparation. Two to three meetings per week are conducted over a teleconferencing link. Average meeting time is 1 h. Preparation time per meeting ranges from 0.3 to 6 h for pathology, and 0.5 to 4 for radiology. The review process in preparation for meetings improves internal quality standards. Materials produced externally (for example imaging) can amount to almost 50% of the material to be reviewed on a single patient. The number of meetings per month has increased by 50% over the past two years. Further increase is expected in both the numbers and duration of meetings when scheduling issues are resolved. A changing trend in the management of referred patients with the development of MDTMs and the introduction of teleconferencing was noted.</p> <p>Conclusion</p> <p>Difficulties are being experienced by pathology and radiology departments participating fully in several multidisciplinary teams. Time spent at meetings, and in preparation for MDTMs is significant. Issues of timing and the coordination of materials to be reviewed are sometimes irreconcilable. The exchange of patient materials with outside institutions is a cause for concern when full data are not made available in a timely fashion. The process of preparation for meetings is having a positive influence on quality, but more resources are needed in pathology and radiology to realise the full benefits of multidisciplinary team working.</p

A Situational Alignment Framework for PACS

This paper reports the outcomes of a study on an integrated situational alignment framework for picture archiving and communication systems (PACS) labeled as PISA. Following the design research cycle, complementary validation methods and pilot cases were used to assess the proposed framework and its operationalized survey. In this paper, the authors outline (a) the process of the framework’ development, (b) the validation process with its underlying iterative steps, (c) the outcomes of pilot cases, and (d) improvement opportunities to refine and further validate the PISA framework. Results of this study support empirical application of the framework to hospital enterprises in order to gain insights into their PACS maturity and alignment. We argue that the framework can be applied as a valuable tool for assessments, monitoring and benchmarking purposes and strategic PACS planning

Range of motion in anterior femoroacetabular impingement

The range of motion of normal hips and hips with femoroacetabular impingement relative to some specific anatomic reference landmarks is unknown. We therefore described: (1) the range of motion pattern relative to landmarks; (2) the location of the impingement zones in normal and impinging hips; and (3) the influence of surgical débridement on the range of motion. We used a previously developed and validated noninvasive 3-D CT-based method for kinematic hip analysis to compare the range of motion pattern, the location of impingement, and the effect of virtual surgical reconstruction in 28 hips with anterior femoroacetabular impingement and a control group of 33 normal hips. Hips with femoroacetabular impingement had decreased flexion, internal rotation, and abduction. Internal rotation decreased with increasing flexion and adduction. The calculated impingement zones were localized in the anterosuperior quadrant of the acetabulum and were similar in the two groups and in impingement subgroups. The average improvement of internal rotation was 5.4 degrees for pincer hips, 8.5 degrees for cam hips, and 15.7 degrees for mixed impingement. This method helps the surgeon quantify the severity of impingement and choose the appropriate treatment option; it provides a basis for future image-guided surgical reconstruction in femoroacetabular impingement with less invasive techniques

Estimation of pelvic tilt on anteroposterior X-rays--a comparison of six parameters

OBJECTIVE: To compare six different parameters described in literature for estimation of pelvic tilt on an anteroposterior pelvic radiograph and to create a simple nomogram for tilt correction of prosthetic cup version in total hip arthroplasty. DESIGN: Simultaneous anteroposterior and lateral pelvic radiographs are taken routinely in our institution and were analyzed prospectively. The different parameters (including three distances and three ratios) were measured and compared to the actual pelvic tilt on the lateral radiograph using simple linear regression analysis. PATIENTS: One hundred and four consecutive patients (41 men, 63 women with a mean age of 31.7 years, SD 9.2 years, range 15.7-59.1 years) were studied. RESULTS: The strongest correlation between pelvic tilt and one of the six parameters for both men and women was the distance between the upper border of the symphysis and the sacrococcygeal joint. The correlation coefficient was 0.68 for men (P<0.001) and 0.61 for women (P<0.001). Based on this linear correlation, a nomogram was created that enables fast, tilt-corrected cup version measurements in clinical routine use. CONCLUSION: This simple method for correcting variations in pelvic tilt on plain radiographs can potentially improve the radiologist's ability to diagnose and interpret malformations of the acetabulum (particularly acetabular retroversion and excessive acetabular overcoverage) and post-operative orientation of the prosthetic acetabulum