S4ND: Single-Shot Single-Scale Lung Nodule Detection

The state of the art lung nodule detection studies rely on computationally expensive multi-stage frameworks to detect nodules from CT scans. To address this computational challenge and provide better performance, in this paper we propose S4ND, a new deep learning based method for lung nodule detection. Our approach uses a single feed forward pass of a single network for detection and provides better performance when compared to the current literature. The whole detection pipeline is designed as a single $3D$ Convolutional Neural Network (CNN) with dense connections, trained in an end-to-end manner. S4ND does not require any further post-processing or user guidance to refine detection results. Experimentally, we compared our network with the current state-of-the-art object detection network (SSD) in computer vision as well as the state-of-the-art published method for lung nodule detection (3D DCNN). We used publically available $888$ CT scans from LUNA challenge dataset and showed that the proposed method outperforms the current literature both in terms of efficiency and accuracy by achieving an average FROC-score of $0.897$. We also provide an in-depth analysis of our proposed network to shed light on the unclear paradigms of tiny object detection.Comment: Accepted for publication at MICCAI 2018 (21st International Conference on Medical Image Computing and Computer Assisted Intervention

Keluaran Laser ZatWarna Rhodamine-6g Pulsa sebagai Fungsi Desain Sel Alir

Telah dilakukan studi keluaran laser zatwarna pulsa (2. = 577 nm) sebagai fungsi desain set alir larutan zatwarna Rhodamin-6G dalain methanol dengan menggunakan berkas laser Nd:YAG pulsa (2 = 532 nm) sebagai pemompa. Larutan zatwarna dialirkan secara laminer melalui sel alir pada kecepatan dan konsentrasi tertentu dan kemudian ditembak dengan berkas laser pemompa hingga diperoleh keluaran laser zatwarna pulsa. Pada tinjauan keluaran laser zatwarna pulsa sebagai fungsi desain lebar cekungan sel alir diperoleh basil bahwa penambahan ukuran lebar cekungan akan menambah panjang daerah aktif bahan laser yang dipompa, berarti menambah luas permukaan aliran larutan yang menerima berkas pemompa dan akan mengurangi kecepatan aliran larutan. Kompromi antara kedua variabel sehingga dapat diperoteh intensitas keluaran laser yang maksimum. Namun, penurunan kecepatan aliran tersebut tidak boleh berada dibawah kecepatan aliran optimum, karena pada kecepatan aliran yang rendah justru menyebabkan intensitas keluaran laser menjadi turun. Kata kunci : intensitas laser, sel alir dan zatwarna Rh-6G

Breakdown of Conformal Invariance at Strongly Random Critical Points

We consider the breakdown of conformal and scale invariance in random systems with strongly random critical points. Extending previous results on one-dimensional systems, we provide an example of a three-dimensional system which has a strongly random critical point. The average correlation functions of this system demonstrate a breakdown of conformal invariance, while the typical correlation functions demonstrate a breakdown of scale invariance. The breakdown of conformal invariance is due to the vanishing of the correlation functions at the infinite disorder fixed point, causing the critical correlation functions to be controlled by a dangerously irrelevant operator describing the approach to the fixed point. We relate the computation of average correlation functions to a problem of persistence in the RG flow.Comment: 9 page

CASED: Curriculum Adaptive Sampling for Extreme Data Imbalance

We introduce CASED, a novel curriculum sampling algorithm that facilitates the optimization of deep learning segmentation or detection models on data sets with extreme class imbalance. We evaluate the CASED learning framework on the task of lung nodule detection in chest CT. In contrast to two-stage solutions, wherein nodule candidates are first proposed by a segmentation model and refined by a second detection stage, CASED improves the training of deep nodule segmentation models (e.g. UNet) to the point where state of the art results are achieved using only a trivial detection stage. CASED improves the optimization of deep segmentation models by allowing them to first learn how to distinguish nodules from their immediate surroundings, while continuously adding a greater proportion of difficult-to-classify global context, until uniformly sampling from the empirical data distribution. Using CASED during training yields a minimalist proposal to the lung nodule detection problem that tops the LUNA16 nodule detection benchmark with an average sensitivity score of 88.35%. Furthermore, we find that models trained using CASED are robust to nodule annotation quality by showing that comparable results can be achieved when only a point and radius for each ground truth nodule are provided during training. Finally, the CASED learning framework makes no assumptions with regard to imaging modality or segmentation target and should generalize to other medical imaging problems where class imbalance is a persistent problem.Comment: 20th International Conference on Medical Image Computing and Computer Assisted Intervention 201

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362