Performance of a CAD scheme applied to images obtained from mammographic film digitization and full-field digital mammography (FFDM).

This work has as purpose to compare the effects of a CAD scheme applied to digitized and \ud direct digital mamograms sets. A routine designed to be applied to mammogram in \ud DICOM standard was developed and a schema based on the Watershed Transform to \ud masses detection was applied to 252 ROIs from 130 digitized mammograms, resulting in \ud 92% of true positive and 10% of false positives. For clustered microcalcifications \ud detection, another procedure was applied to 165 ROIs from 120 mammograms, resulting in \ud 93% of true positive and 16% of false positive. By using the same procedures to 154 \ud digital mammograms obtained from FFDM, the rates have shown a little decrease in the \ud scheme performance: 89% of true positive and 16% of false positive for masses detection; \ud 90% of true positive and 27% of false positive for clusters detection. Although the tests \ud with digital mammograms have been carried with a smaller number of images and \ud different cases compared to the digitized ones, including several dense breasts images, the \ud results can be considered comparable, mainly forclustered microcalcifications detection \ud with a difference of only 3% between the sensibility rates for the both images sets. Another \ud important feature affecting these results is the contrast difference between the two images \ud set. This implies the need of extensive investigations not only with a larger number of \ud cases from FFDM but also on the parameters related to its image acquisition as well as to \ud its corresponding processing.Este trabalho tem como objetivo comparar os resultados de um esquema CAD aplicado em \ud conjunto de mamografias digitalizadas e em um conjunto de mamografias obtidas de um \ud mamógrafo digital. Para extrair as imagens do padrão DICOM, padrão utilizado pelos \ud mamógrafos digitais, uma rotina computacional foi desenvolvida. Para a detecção de \ud nódulos, um esquema baseado em Transforma Watershed foi aplicado a 252 regiões de \ud interesse (ROIs) de 130 mamografias digitalizadas, resultando em 92% de verdadeiro \ud positivo e 10%de falsos positivos. Para a detecção de microcalcificações agrupadas, outro \ud procedimento foi aplicado a165 ROIs extraídas de 120 mamografias digitalizadas, \ud resultando em 93% de verdadeiro positivo e 16% de falso positivo. Ao utilizar os mesmos \ud procedimentos para154 mamografias digitais obtidas a partir de um FFDM, as taxas \ud mostraram uma diminuição pequena no desempenho: 89% do verdadeiro positivo e 16% \ud de falso positivo para a detecção de nódulos, e 90% de verdadeiro positivo e 27% de falsos \ud positivo para a detecção de clusters de microcalcificações. Embora os testes com \ud mamografias digitais tenham sido realizados com um menor número de imagens e casos \ud diferentes em comparação com os digitalizados, incluindo várias imagens de mamas \ud densas, os resultados podem ser considerados comparáveis, principalmente para a detecção \ud de clusters de microcalcificações com uma diferença de apenas 3% entre as taxas de \ud sensibilidade para as imagens dos dois conjuntos. Outra característica importante que afeta \ud esses resultados é a diferença de contraste dos dois grupos de imagens analisados. Isto \ud implica na necessidade de extensas investigações não só com um maior número de casos \ud de mamografias digitais, mas também um estudo sobre os parâmetros relacionados a \ud aquisição da imagem, bem como para o seu processamentoCNPqFAPESPHospital of Clinics in Botucatu/S

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

not available

Os Esquemas CAD (\"Computer - Aided Diagnosis\") têm mostrado bons resultados no auxílio ao diagnóstico precoce do câncer de mama. A classificação, nesses esquemas, é algo complexo e abrange investigações não só de técnicas computacionais, mas também das caracterizações citológicas dos achados de interesse clínico. Por isso, o presente trabalho objetivou o desenvolvimento de um esquema classificador visando a indicação de cada caso como \"suspeito\" e \"não-suspeito\", com base em investigações de imagens mamográficas digitalizadas. Nessa investigação em particular, o foco de análise foram agrupamentos de microcalcificações detectadas por técnicas de processamento de imagens. A técnica de classificação utilizada no esquema baseou-se em redes neurais artificiais (RNA) supervisionadas, empregando algoritmo de aprendizagem \"backpropagation\". O esquema classificador usando RNA, mostrou a eficiência dos descritores de forma na caracterização dos agrupamentos de microcalcificações e também a influência de atributos extraídos dos laudos das imagens como a idade e a \"densificação\". Os melhores resultados obtidos - apresentados aqui em forma de porcentagens e também de curvas ROC - mostraram 92% de acerto total com Az = 0,96 aproximadamente, índices compatíveis aos dos melhores classificadores descritos pela literatura.Computer-aided diagnosis (CAD) schemes have shown good results in aiding the early diagnosis of breast câncer. In such schemes, the classification is usually complex and it in uses not only computer techniques, but also cythologycal characterization of the clinical findings. Thus, this work has aimed to develop a classifier scheme regarding to indicate each case as \"suspected\" or \"non-suspected\", based upon digitized mammographic images investigation. This analysis focus was clustered microcalcifications detected by image processing techniques. The classification technique used in the scheme was based on supervised artificial neural networks (ANN), with backpropagation as learning algorithm. The classifier using ANN has shown the geometric descriptors efficiency for characterizing microcalcifications clusters as well as the influence of features extracted from images reports, as \"age\" and \"density\". The best data - presented here by percentage values and also by ROC curves - have shown 92% of conect results, with Az = 0,96, which are comparable to the values from the best classifiers describeb by literature

Automatic classifier of mammographic findings in dense breast digital images using hybrid techniques

Esta tese apresenta uma metodologia para classificação automática de achados mamográficos em mamas densas através de uma abordagem híbrida de classificadores e extração de atributos, como parte de um esquema computadorizado de auxílio ao diagnóstico (CAD) para mamografia. Foram implementadas duas redes Backpropagation. Uma responde pela classificação de clusters de microcalcificações, através de atributos descritores geométricos, em duas classes - suspeito e não suspeito. A outra rede classifica nódulos utilizando descritores geométricos e uma entrada com informação extraída de atributos de intensidade, produzindo na saída dois tipos de informação: presença ou não do nódulo, e constatada a presença do nódulo, classificação da região de interesse (RI) entre as categorias BI-RADS. As respostas de um \"clusterizador\" de RIs através de atributos de intensidade serviram de entrada para essa rede fornecendo uma informação de grau de densidade da RI. Uma interface foi desenvolvida para a apresentação dos resultados a fim de fornecer informações mais detalhadas da classificação e do caso analisado. Os resultados do classificador foram analisados através de análise estatística de sensibilidade e especificidade, e também por curvas ROC. Os resultados obtidos ficaram próximos a 89% de acerto total (verdadeiros-positivos mais verdadeiros-negativos) para nódulos produzindo valor de Az superior a 0,92 e ultrapassaram 75% de acerto da classificação entre as classes BI-RADS. Na classificação dos clusters os acertos totais do classificador ficaram próximos de 90%, com Az superior a 0,94. Para ambos tipos de lesões, as taxas de respostas falsas-negativas ficaram abaixo de 0,1, o que significa baixo erro em relação à não detecção da doença quando o sinal está presente. O classificador apresentado nesse trabalho é a conclusão de uma etapa importante do esquema CAD que vem sendo desenvolvido pelo grupo, além de possibilitar a disponibilização de mais uma ferramenta automática de auxílio ao diagnóstico do câncer de mama aos serviços de mamografia.This thesis presents a methodology for automatic classification of mamographic findings in image of dense breast through hybrid approach of classifiers and features extraction techniques, as part of a computer-aided diagnostic (CAD) scheme for mammography. Two Backpropagation neural networks were implemented. One for microcalcifications clustered classification, through geometric descriptors, in two classes - suspect and non-suspect. The other neural network classifies nodules using geometric descriptors and additional information from intensity features extracted, producing in the output two kinds of information: presence or not of the nodule, and if nodule is present in the image, classification among BI-RADS categories. The result of clustering technique by using intensity features is presented as a new input to neural network, supplying density degree of image. An interface was developed for results presentation in order to supply more detailed information from the classifier outputs and of the analyzed case. The results of the classifier were analyzed through sensibility and specificity statistical analysis, and also for ROC curves. The results were close to 89% of total accuracy (positive-true plus negative-true) for nodules producing value of Az more than 0,92 and 75% of accuracy to classification among BI-RADS categories. In the cluster classification the total accuracy is about 90%, and Az greater than 0,94. In both kinds of lesions, negative-false result rates were below 0,1, which means low error related to the fail to detect the disease when the signal is present. The classifier presented in this work is the conclusion of an important stage of the CAD scheme that has been developed by the group, besides making possible the availability of one more automatic tool of aid to the breast cancer diagnosis to be used in mammography centers

Automatic classifier of mammographic findings in dense breast digital images using hybrid techniques

Esta tese apresenta uma metodologia para classificação automática de achados mamográficos em mamas densas através de uma abordagem híbrida de classificadores e extração de atributos, como parte de um esquema computadorizado de auxílio ao diagnóstico (CAD) para mamografia. Foram implementadas duas redes Backpropagation. Uma responde pela classificação de clusters de microcalcificações, através de atributos descritores geométricos, em duas classes - suspeito e não suspeito. A outra rede classifica nódulos utilizando descritores geométricos e uma entrada com informação extraída de atributos de intensidade, produzindo na saída dois tipos de informação: presença ou não do nódulo, e constatada a presença do nódulo, classificação da região de interesse (RI) entre as categorias BI-RADS. As respostas de um \"clusterizador\" de RIs através de atributos de intensidade serviram de entrada para essa rede fornecendo uma informação de grau de densidade da RI. Uma interface foi desenvolvida para a apresentação dos resultados a fim de fornecer informações mais detalhadas da classificação e do caso analisado. Os resultados do classificador foram analisados através de análise estatística de sensibilidade e especificidade, e também por curvas ROC. Os resultados obtidos ficaram próximos a 89% de acerto total (verdadeiros-positivos mais verdadeiros-negativos) para nódulos produzindo valor de Az superior a 0,92 e ultrapassaram 75% de acerto da classificação entre as classes BI-RADS. Na classificação dos clusters os acertos totais do classificador ficaram próximos de 90%, com Az superior a 0,94. Para ambos tipos de lesões, as taxas de respostas falsas-negativas ficaram abaixo de 0,1, o que significa baixo erro em relação à não detecção da doença quando o sinal está presente. O classificador apresentado nesse trabalho é a conclusão de uma etapa importante do esquema CAD que vem sendo desenvolvido pelo grupo, além de possibilitar a disponibilização de mais uma ferramenta automática de auxílio ao diagnóstico do câncer de mama aos serviços de mamografia.This thesis presents a methodology for automatic classification of mamographic findings in image of dense breast through hybrid approach of classifiers and features extraction techniques, as part of a computer-aided diagnostic (CAD) scheme for mammography. Two Backpropagation neural networks were implemented. One for microcalcifications clustered classification, through geometric descriptors, in two classes - suspect and non-suspect. The other neural network classifies nodules using geometric descriptors and additional information from intensity features extracted, producing in the output two kinds of information: presence or not of the nodule, and if nodule is present in the image, classification among BI-RADS categories. The result of clustering technique by using intensity features is presented as a new input to neural network, supplying density degree of image. An interface was developed for results presentation in order to supply more detailed information from the classifier outputs and of the analyzed case. The results of the classifier were analyzed through sensibility and specificity statistical analysis, and also for ROC curves. The results were close to 89% of total accuracy (positive-true plus negative-true) for nodules producing value of Az more than 0,92 and 75% of accuracy to classification among BI-RADS categories. In the cluster classification the total accuracy is about 90%, and Az greater than 0,94. In both kinds of lesions, negative-false result rates were below 0,1, which means low error related to the fail to detect the disease when the signal is present. The classifier presented in this work is the conclusion of an important stage of the CAD scheme that has been developed by the group, besides making possible the availability of one more automatic tool of aid to the breast cancer diagnosis to be used in mammography centers

not available

Os Esquemas CAD (\"Computer - Aided Diagnosis\") têm mostrado bons resultados no auxílio ao diagnóstico precoce do câncer de mama. A classificação, nesses esquemas, é algo complexo e abrange investigações não só de técnicas computacionais, mas também das caracterizações citológicas dos achados de interesse clínico. Por isso, o presente trabalho objetivou o desenvolvimento de um esquema classificador visando a indicação de cada caso como \"suspeito\" e \"não-suspeito\", com base em investigações de imagens mamográficas digitalizadas. Nessa investigação em particular, o foco de análise foram agrupamentos de microcalcificações detectadas por técnicas de processamento de imagens. A técnica de classificação utilizada no esquema baseou-se em redes neurais artificiais (RNA) supervisionadas, empregando algoritmo de aprendizagem \"backpropagation\". O esquema classificador usando RNA, mostrou a eficiência dos descritores de forma na caracterização dos agrupamentos de microcalcificações e também a influência de atributos extraídos dos laudos das imagens como a idade e a \"densificação\". Os melhores resultados obtidos - apresentados aqui em forma de porcentagens e também de curvas ROC - mostraram 92% de acerto total com Az = 0,96 aproximadamente, índices compatíveis aos dos melhores classificadores descritos pela literatura.Computer-aided diagnosis (CAD) schemes have shown good results in aiding the early diagnosis of breast câncer. In such schemes, the classification is usually complex and it in uses not only computer techniques, but also cythologycal characterization of the clinical findings. Thus, this work has aimed to develop a classifier scheme regarding to indicate each case as \"suspected\" or \"non-suspected\", based upon digitized mammographic images investigation. This analysis focus was clustered microcalcifications detected by image processing techniques. The classification technique used in the scheme was based on supervised artificial neural networks (ANN), with backpropagation as learning algorithm. The classifier using ANN has shown the geometric descriptors efficiency for characterizing microcalcifications clusters as well as the influence of features extracted from images reports, as \"age\" and \"density\". The best data - presented here by percentage values and also by ROC curves - have shown 92% of conect results, with Az = 0,96, which are comparable to the values from the best classifiers describeb by literature

Comparative study between powers of sigmoid functions, MLP-backpropagation and polynomials in function approximation problems

Function approximation is a very important task in environments where the computation has to be based on extracting information from data samples in real world processes. So, the development of new mathematical model is a very important activity to guarantee the evolution of the function approximation area. In this sense, we will present the Polynomials Powers of Sigmoid (PPS) as a linear neural network. In this paper, we will introduce one series of practical results for the Polynomials Powers of Sigmoid, where we will show some advantages of the use of the powers of sigmiod functions in relationship the traditional MLP-Backpropagation and Polynomials in functions approximation problems

Evaluation of the clinical efficacy of minimally invasive procedures for breast cancer screening at a teaching hospital

Aims To assess the clinical efficacy of diagnostic procedures for breast cancer at a teaching hospital using internal auditing tools and quality control measures.Methods A retrospective assessment of 500 patients who underwent core needle biopsy (wide-bore needle biopsy; WBN) of palpable or non-palpable breast nodes that were submitted for at least one cytological examination (fine needle aspiration (FNA) cytology and/or imprint of a WBN specimen). for statistical analysis the auditing tool and quality control proposed by the National Health Service breast screening programme was utilised.Results for FNA, full specificity, positive predictive value, inadequate rates and suspicious rates were satisfactory while absolute sensitivity, complete sensitivity, false negatives and false positives were unsatisfactory. for imprint, absolute sensitivity, complete sensitivity, inadequate rate from cancers and suspicious rates were satisfactory, and the remaining indicators were unsatisfactory. WBN displayed the best performance with absolute sensitivity, complete sensitivity, false negative, suspicious rates, full specificity and predictive value showing satisfactory results and only one unsatisfactory result (false positive).Conclusions Based on an overall analysis, WBN displayed the highest clinical efficacy compared with FNA and imprint, and demonstrated adequate safety for confirming the appropriate diagnosis and management of patients, ensuring the efficacy of the service.Universidade Federal de São Paulo, Dept Gynecol, Breast Clin, Sch Med, São Paulo, BrazilUniv Fed Uberlandia, Dept Elect Engn, BR-38400 Uberlandia, MG, BrazilUniversidade Federal de São Paulo, Dept Pathol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Gynecol, Breast Clin, Sch Med, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, São Paulo, BrazilWeb of Scienc