18 research outputs found
What scans we will read: imaging instrumentation trends in clinical oncology
Oncological diseases account for a significant portion of the burden on public healthcare systems with associated
costs driven primarily by complex and long-lasting therapies. Through the visualization of patient-specific
morphology and functional-molecular pathways, cancerous tissue can be detected and characterized non-
invasively, so as to provide referring oncologists with essential information to support therapy management
decisions. Following the onset of stand-alone anatomical and functional imaging, we witness a push towards
integrating molecular image information through various methods, including anato-metabolic imaging (e.g., PET/
CT), advanced MRI, optical or ultrasound imaging.
This perspective paper highlights a number of key technological and methodological advances in imaging
instrumentation related to anatomical, functional, molecular medicine and hybrid imaging, that is understood as
the hardware-based combination of complementary anatomical and molecular imaging. These include novel
detector technologies for ionizing radiation used in CT and nuclear medicine imaging, and novel system
developments in MRI and optical as well as opto-acoustic imaging. We will also highlight new data processing
methods for improved non-invasive tissue characterization. Following a general introduction to the role of imaging
in oncology patient management we introduce imaging methods with well-defined clinical applications and
potential for clinical translation. For each modality, we report first on the status quo and point to perceived
technological and methodological advances in a subsequent status go section. Considering the breadth and
dynamics of these developments, this perspective ends with a critical reflection on where the authors, with the
majority of them being imaging experts with a background in physics and engineering, believe imaging methods
will be in a few years from now.
Overall, methodological and technological medical imaging advances are geared towards increased image contrast,
the derivation of reproducible quantitative parameters, an increase in volume sensitivity and a reduction in overall
examination time. To ensure full translation to the clinic, this progress in technologies and instrumentation is
complemented by progress in relevant acquisition and image-processing protocols and improved data analysis. To
this end, we should accept diagnostic images as “data”, and – through the wider adoption of advanced analysis,
including machine learning approaches and a “big data” concept – move to the next stage of non-invasive tumor
phenotyping. The scans we will be reading in 10 years from now will likely be composed of highly diverse multi-
dimensional data from multiple sources, which mandate the use of advanced and interactive visualization and
analysis platforms powered by Artificial Intelligence (AI) for real-time data handling by cross-specialty clinical experts
with a domain knowledge that will need to go beyond that of plain imaging
Posterior circulation stroke: machine learning-based detection of early ischemic changes in acute non-contrast CT scans
Objectives!#!Triage of patients with basilar artery occlusion for additional imaging diagnostics, therapy planning, and initial outcome prediction requires assessment of early ischemic changes in early hyperacute non-contrast computed tomography (NCCT) scans. However, accuracy of visual evaluation is impaired by inter- and intra-reader variability, artifacts in the posterior fossa and limited sensitivity for subtle density shifts. We propose a machine learning approach for detecting early ischemic changes in pc-ASPECTS regions (Posterior circulation Alberta Stroke Program Early CT Score) based on admission NCCTs.!##!Methods!#!The retrospective study includes 552 pc-ASPECTS regions (144 with infarctions in follow-up NCCTs) extracted from pre-therapeutic early hyperacute scans of 69 patients with basilar artery occlusion that later underwent successful recanalization. We evaluated 1218 quantitative image features utilizing random forest algorithms with fivefold cross-validation for the ability to detect early ischemic changes in hyperacute images that lead to definitive infarctions in follow-up imaging. Classifier performance was compared to conventional readings of two neuroradiologists.!##!Results!#!Receiver operating characteristic area under the curves for detection of early ischemic changes were 0.70 (95% CI [0.64; 0.75]) for cerebellum to 0.82 (95% CI [0.77; 0.86]) for thalamus. Predictive performance of the classifier was significantly higher compared to visual reading for thalamus, midbrain, and pons (P value < 0.05).!##!Conclusions!#!Quantitative features of early hyperacute NCCTs can be used to detect early ischemic changes in pc-ASPECTS regions. The classifier performance was higher or equal to results of human raters. The proposed approach could facilitate reproducible analysis in research and may allow standardized assessments for outcome prediction and therapy planning in clinical routine