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Dosiomics in the analysis of medical images and prospects for its use in clinical practice 剂量组学在医学图像分析中的应用及其在临床中的应用前景
Pub Date : 2023-08-30 DOI: 10.17816/dd420053
V. Solodkiy, Nikolay V. Nudnov, Mikhail E. Ivannikov, Elina S-A. Shakhvalieva, Vladimir M. Sotnikov, Aleksei Yu. Smyslov
Background. In recent years, the number of articles using the term dosiomics has increased, but there are no literature reviews in Russian on this topic. Aim. To describe the basic principles of dosiomics as a derivative of radiomics and to analyse studies devoted to assessing the possibilities of its application in clinical practice. Materials and methods. A systematic literature search was performed in the PubMed database using the search query dosiomics OR dosiomic, and in the eLibrary database using the search query дозиомика. By April 2023, 43 foreign and 1 Russian articles had been published. Results. 43 foreign studies on the use of dosiomics in clinical practice and one Russian article with a definition of the term "dosiomics" were analysed. The analysed papers were divided into three groups according to their subject matter and two tables describing the results of 27 studies on the prediction of clinical outcomes were created. Conclusion. Currently, dosiomics is a new and promising derivative of radiomics used in the textural analysis of medical images associated with radiation treatment of cancer patients. Dosiomics can contribute to the development of a more personalised approach to the planning of radiotherapy, the prediction of radiation damage of normal tissues and the diagnosis of recurrence.
背景近年来,使用“剂量学”一词的文章数量有所增加,但没有关于这一主题的俄语文献综述。目标描述作为放射组学衍生物的剂量学的基本原理,并分析专门用于评估其在临床实践中应用的可能性的研究。材料和方法。使用检索查询dosiomics OR dosiomic在PubMed数据库中进行系统的文献检索,并使用检索查询дозиомика在电子图书馆数据库中进行检索。截至2023年4月,共发表了43篇外国文章和1篇俄罗斯文章。后果分析了43项关于在临床实践中使用剂量学的外国研究和一篇关于“剂量学”一词定义的俄罗斯文章。分析的论文根据主题分为三组,并创建了两个表格,描述了27项临床结果预测研究的结果。结论目前,剂量学是放射组学的一种新的和有前景的衍生物,用于癌症患者放射治疗相关医学图像的纹理分析。剂量学可以帮助开发一种更个性化的方法来规划放射治疗、预测正常组织的辐射损伤和诊断复发。
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引用次数: 0
Precise low dose brachytheray of prostate cancer uder PSMA-receptor molecular visualization 癌症前列腺低剂量精确近距离放射治疗uder-PSMA-受体分子可视化
Pub Date : 2023-08-25 DOI: 10.17816/dd340815
P. Sviridov, P. Rumiantsev, M. Degtyarev, S. Serzhenko, Dmitry Borisovich Sanin, S. V. Styrov, Dmitry Yuryevich Agibalov
The method of choice in the treatment of localized prostate cancer (prostate cancer) without signs of germination of the gland capsule and in the absence of signs of metastases (stage cT1-T3aN0M0) is brachytherapy with implantation of seeds with 125I. Structural imaging methods (ultrasound, CT, MRI) do not have high specificity in the differential diagnosis of prostate cancer. Hybrid technologies of radiation imaging (SPECT/CT, PET/CT, PET/MRI) combine the advantages of high sensitivity of cross-sectional structural imaging methods (CT, MRI) and high specificity of molecular imaging methods (SPECT, PET) with tumorotropic radiopharmaceuticals. In this original clinical study, based on 7 patients with localized prostate cancer (Gleason 6-7), it was shown that the precision of low-dose brachytherapy with 125I micro sources of localized prostate carcinomas, as well as their targeted biopsy, can be increased when using hybrid methods of PSMA-receptor molecular imaging (SPECT) for navigation/CT, PET/CT). The SPECT/CT method is more accessible than PET/CT, and in the presence of cold kits (HYNIC-PSMA), it allows you to perform research in any radioisotope diagnostics laboratory with the appropriate equipment. The innovative technology of PSMA-precision biopsy of brachytherapy under the control of hybrid molecular imaging can be used in primary and recurrent cases of localized prostate cancer, increases the accuracy and reduces the traumatic nature of procedures, increases the medical and economic efficiency of low-dose brachytherapy with 125I seeds. Further research is needed to improve the technology and evaluate long-term treatment outcomes in a large group of patients.
在没有腺囊发芽迹象和没有转移迹象的情况下(阶段cT1-T3aN0M0)治疗局限性前列腺癌症(癌症)的选择方法是植入125I种子的近距离治疗。结构成像方法(超声、CT、MRI)对前列腺癌症的鉴别诊断没有很高的特异性。辐射成像的混合技术(SPECT/CT、PET/CT、PET/MRI)结合了横截面结构成像方法(CT、MRI)的高灵敏度和分子成像方法(SPECT、PET)与肿瘤致敏放射性药物的高特异性的优点。在这项最初的临床研究中,基于7名局限性前列腺癌症患者(Gleason 6-7),研究表明,当使用PSMA-受体分子成像(SPECT)导航/CT、PET/CT的混合方法时,使用125I微源对局限性前列腺癌进行低剂量近距离治疗以及靶向活检的精度可以提高。SPECT/CT方法比PET/CT更容易获得,并且在有冷试剂盒(HYNIC-PSMA)的情况下,它允许您使用适当的设备在任何放射性同位素诊断实验室进行研究。在混合分子成像的控制下,PSMA-精确活检近距离治疗的创新技术可用于局限性前列腺癌症的原发性和复发性病例,提高了手术的准确性并减少了手术的创伤性,提高了125I种子低剂量近距离疗法的医疗和经济效率。需要进一步的研究来改进这项技术,并评估一大群患者的长期治疗结果。
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引用次数: 0
Conventional MRI of peripheral nerves: MR-neurography. 常规周围神经MRI: MR-neurography。
Pub Date : 2023-08-24 DOI: 10.17816/dd430292
Sofya N. Morozova, V. Sinkova, D. Grishina, Taisia Tumilovich, A. Chechetkin, M. Krotenkova, N. Suponeva
Peripheral neuropathy is known to be one of the most common neurological disorders. Despite the great diagnostic value of electroneuromyography and ultrasound, diagnostics and differential diagnostics of peripheral nerves diseases of different origin could be challenging. Magnetic resonance tomography has been increasingly used in recent years to evaluate cases of suspected or established peripheral neuropathy with excellent results. Manuscript deals mainly with advantages and limitations of abovementioned diagnostic instruments, technical considerations according to different anatomy of peripheral nerves and state-of-the-art technical decisions, frequently used MRI-sequences and their diagnostic value based on own observation, recommendations for contrast enhancement use, different methods of fat suppression. Currently there is practically no standardized description of normal MRI features of peripheral nerves as well as their changes in different diseases, evaluation of images is based mainly on the radiologist experience, which obviously decreases methods diagnostic value. Studies of large numbers of healthy volunteers and patients with peripheral neuropathies of different origin are required to solve this problem.
周围神经病变是最常见的神经系统疾病之一。尽管神经肌电图和超声有很大的诊断价值,但不同来源的周围神经疾病的诊断和鉴别诊断可能具有挑战性。近年来,磁共振断层扫描越来越多地用于评估疑似或已确诊的周围神经病变病例,并取得了良好的结果。本文主要讨论了上述诊断仪器的优点和局限性,根据周围神经的不同解剖结构和最新技术决策的技术考虑,常用的mri序列及其基于自己观察的诊断价值,对比度增强使用的建议,不同的脂肪抑制方法。目前,对于周围神经的正常MRI特征及其在不同疾病中的变化,几乎没有标准化的描述,对图像的评价主要基于放射科医生的经验,这明显降低了方法的诊断价值。为了解决这个问题,需要对大量健康志愿者和不同来源的周围神经病变患者进行研究。
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引用次数: 0
Update of the federal governmental statistical surveillance form №3-DOZ “Data on patient doses from medical X-ray examinations”. Part 2. Recommendations for filling out the form 更新联邦政府统计监测表№3-DOZ“医疗x射线检查患者剂量数据”。第2部分。填写表格的建议
Pub Date : 2023-08-24 DOI: 10.17816/dd530656
A. Vodovatov, L. Chipiga, A. A. Bratilova, P. S. Druzhinina, I. Shatskiy, Anastasiya V. Petryakova, S. Sarycheva, A. Biblin, R. R. Akhmatdinov, Y. Kapyrina, Z. Lantukh, I. Soldatov, V. Puzyrev, S. Ryzhov
The form of federal governmental statistical surveillance №3-DOZ Data on patient doses from medical X-ray examinations has changed significantly by the order of Rosstat №880. In particular, the structure of the tables of form №3-DOZ has been adjusted and changed: studies with high doses were dedicated from the rest; the section on radionuclide diagnostics has been redesigned the information on the levels of patient exposure when using individual radionuclides and in hybrid studies have been displayed; information on the number of radiological studies and collective doses for pediatric patients have been introduced. The structure of the updated form №3-DOZ is presented within the framework of this work. In this article, recommendations for filling out №3-DOZ have been developed in order to increase the reliability of the data provided and reduce the number of procedural errors.
联邦政府统计监测№3-DOZ的形式,从医疗x射线检查的病人剂量的数据已被Rosstat№880命令显著改变。特别是,表格的结构№3-DOZ已被调整和改变:高剂量的研究从其余部分专用;重新设计了关于放射性核素诊断的部分,展示了使用单个放射性核素和混合研究时患者暴露水平的信息;介绍了关于儿科患者放射学研究次数和集体剂量的信息。更新的表格№3-DOZ的结构是在这项工作的框架内提出的。在本文中,已经制定了填写№3-DOZ的建议,以提高所提供数据的可靠性并减少程序错误的数量。
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引用次数: 0
Cardiac magnetic resonance imaging in patients with history of COVID-19 COVID-19病史患者的心脏磁共振成像
Pub Date : 2023-08-23 DOI: 10.17816/dd494103
Aleksandra S. Maksimova, N. Ryumshina, T. Shelkovnikova, O. Mochula, N. D. Anfinogenova, V. Ussov
Background. Myocarditis is among the most common complications of coronavirus infection (COVID-19). Aim. The aim of the study was to find the differences in the patterns of myocardial injury in patients who had COVID-19 and patients during pre-pandemic period according to contrast-enhanced cardiac magnetic resonance imaging (CE-CMR). Materials and Methods. The study included a total of 47 retrospective patients who underwent CE-CMR to rule out acute myocarditis. Group 1 comprised 34 patients with history of COVID-19 confirmed by PCR test (nasal and/or throat swabs). Group 2 included 13 individuals who underwent CE-CMR in 2017 before onset of COVID-19 pandemic. All patients enrolled in the study had clinical manifestation of cardiac injury without signs of coronary artery disease as an underlying cause of condition. Results. Mean time from onset of heart symptoms to administration of CE-CMR was 166 days. In in group 1, a decrease in exercise tolerance was observed in 77% of patients, and 14 (42%), 30 (88%), and 28 (85%) of patients complained of chest pain, shortness of breath, and heart palpitations, respectively. In group 2, four patients (30%) had dyspnea; nine patients (69%) complained of chest pain; and six patients (46%) had heart palpitations and/or feeling of arrhythmia. Myocardial injury in patients of group 1 was more generalized. The third of them had preserved increased pulmonary vascularity and pleural effusion. Men in group 1 had significantly lower left ventricular ejection fraction, lower values of global longitudinal deformation, and higher values of left atrial function compared with the corresponding parameters in women. Differences in women were found only in the number of the affected segments in the left ventricular myocardium. Conclusion. SARS-CoV-2 virus caused extended myocardial injury with involvement of significant number of myocardial segments. Men had more frequent postinflammatory complications in the form of abnormal function of the left ventricle and left atrium. Obtained results require continuous efforts for further assessment of long-term consequences of previous COVID-19 to the cardiovascular system. In this regard, CE-CMR may represent a sensitive imaging tool for the assessment of cardiac injury severity.
背景。心肌炎是冠状病毒感染(COVID-19)最常见的并发症之一。的目标。本研究的目的是通过对比增强心脏磁共振成像(CE-CMR)发现COVID-19患者和大流行前患者心肌损伤模式的差异。材料与方法。该研究共纳入47例接受CE-CMR排除急性心肌炎的回顾性患者。第一组包括34例经PCR检测(鼻和/或咽拭子)确诊的COVID-19病史患者。第二组包括13名在2017年COVID-19大流行发病前接受CE-CMR的患者。所有参与研究的患者均有心脏损伤的临床表现,没有冠状动脉疾病的迹象作为病情的根本原因。结果。从出现心脏症状到给予CE-CMR的平均时间为166天。在第一组中,77%的患者运动耐量下降,分别有14例(42%)、30例(88%)和28例(85%)患者主诉胸痛、呼吸短促和心悸。2组4例(30%)患者出现呼吸困难;9名患者(69%)主诉胸痛;6名患者(46%)有心悸和/或心律失常的感觉。1组患者心肌损伤更为广泛性。其中三分之一保留了增加的肺血管和胸腔积液。与女性的相应参数相比,1组男性的左室射血分数明显较低,整体纵向变形值较低,左房功能值较高。女性之间的差异只存在于左心室心肌受影响节段的数量上。结论。SARS-CoV-2病毒引起延展性心肌损伤,并累及大量心肌节段。男性的炎症后并发症更常见,表现为左心室和左心房功能异常。获得的结果需要继续努力,进一步评估既往COVID-19对心血管系统的长期后果。在这方面,CE-CMR可能是评估心脏损伤严重程度的敏感成像工具。
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引用次数: 0
Computed tomography in the diagnosis of fever of unknown origin: case report. 计算机断层扫描对不明原因发热的诊断:病例报告。
Pub Date : 2023-08-23 DOI: 10.17816/dd472068
Y. Shumskaya, N. Kostikova, D. A. Akhmedzyanova, M. M. Suleymanova, E. Fominykh, M. Mnatsakanyan, R. Reshetnikov
Fever of unknown origin (FUO) can be a symptom of at least two hundred diseased. Positron emission tomography-computed tomography (PET/CT) is an informative, but not readily available imaging tool. We present a clinical case of giant cell arteritis where computed tomography (CT) played a key role in the diagnosis. A 61-year-old woman presented to the hospital with a nocturnal fever up to 39,5С, chest and scapular pain, weight loss (10 kg in 3 months). Lymphoproliferative and infectious diseases were excluded. Baseline colonoscopy had revealed erosions in the colonic mucosa, and the patient was admitted to the gastroenterology department with the preliminary diagnosis of ulcerative colitis. Follow-up colonoscopy had excluded this diagnosis. Additional imaging via chest and abdominal CT scan revealed wall thickening of aorta and its branches with subtle contrast enhancement. Tuberculous aortoarteritis and syphilitic aortitis were excluded. The patient was diagnosed with giant cell arteritis involving brachiocephalic trunk, subclavian arteries and celiac trunk. Prednisolone was administered with subsequent reduction in symptoms. Despite the fact that CT is not the gold standard for the differential diagnosis of FUO, in this case it assisted in establishing the definitive diagnosis.
不明原因发热(FUO)可能是至少200名患者的症状。正电子发射断层扫描计算机断层扫描(PET/CT)是一种信息丰富但不易获得的成像工具。我们报告了一例巨细胞动脉炎的临床病例,其中计算机断层扫描(CT)在诊断中起着关键作用。一名61岁的妇女因夜间发烧高达39.5С、胸部和肩胛骨疼痛、体重减轻(3个月内减轻10公斤)而被送往医院。排除淋巴增生性疾病和传染病。基线结肠镜检查显示结肠粘膜有侵蚀,患者被送入胃肠科,初步诊断为溃疡性结肠炎。随访结肠镜检查排除了这一诊断。胸部和腹部CT扫描的额外成像显示主动脉及其分支的壁增厚,并有细微的对比增强。排除结核性大动脉炎和梅毒性大动动脉炎。患者被诊断为巨细胞动脉炎,累及头臂干、锁骨下动脉和腹腔干。泼尼松龙给药后症状减轻。尽管CT不是FUO鉴别诊断的金标准,但在这种情况下,它有助于确定最终诊断。
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引用次数: 0
Postmortem radiology studies in the world and national healthcare: analysis of the literature data and opinions of russian specialists 世界和国家卫生保健的死后放射学研究:文献资料分析和俄罗斯专家的意见
Pub Date : 2023-08-22 DOI: 10.17816/dd375328
A. Shchegolev, U. Tumanova
Despite the special importance of autopsies of the deceased patients to determine the cause of death and the effectiveness of the treatment, in all countries there is a progressive decrease in their number. At the same time, there is an active introduction of postmortem radiological studies for the analysis of the bodies of deceased patients. The article presents an analysis of literature data summarizing the results of surveys of foreign specialists, as well as the opinions of Russian specialists on the possibilities and features of postmortem radiological studies, mainly of deceased newborns and infants. It is noted that postmortem radiological studies are carried out both as part of a pathoanatomical autopsy and forensic medical examination. Postmortem CT in cases of violent death and post-mortem MRI in cases of death from diseases were performed more often. The general clinical equipment located in clinical radiology departments was used more often than those located in the mortuary, pathology department or forensic facility. Analysis of the results of postmortem radiological examinations was carried out by radiologists in most cases, and a joint analysis by a radiologist and a pathologist was much less often. It is emphasized that in the Russian Federation, postmortem radiological studies are mostly of a single nature. According to Russian researchers, at the present time, when personalized medicine, radiation techniques and information technologies are developing, there is a need to use postmortem radiological studies to objectify and improve the accuracy of traditional autopsies. Postmortem radiological studies, which are objective operator-independent methods of examining the bodies of dead people, should be considered as a highly effective stage of pathology and, especially, forensic autopsy.
尽管对死亡病人进行尸检对确定死亡原因和治疗效果具有特别重要的意义,但在所有国家,尸检人数都在逐步减少。与此同时,还积极引入了对死者尸体进行分析的死后放射学研究。本文对文献资料进行了分析,总结了外国专家的调查结果,以及俄罗斯专家对主要针对死亡新生儿和婴儿的死后放射学研究的可能性和特点的意见。报告指出,作为病理解剖和法医检查的一部分,进行了死后放射学研究。在暴力死亡的情况下进行尸检CT和在疾病死亡的情况下进行尸检MRI的频率更高。位于临床放射科的一般临床设备比位于停尸房、病理科或法医设施的设备使用得更多。在大多数情况下,对死后放射检查结果的分析是由放射科医生进行的,而由放射科医生和病理学家联合分析的情况要少得多。需要强调的是,在俄罗斯联邦,死后放射学研究大多是单一性质的。据俄罗斯研究人员称,目前,随着个性化医疗、放射技术和信息技术的发展,有必要利用尸检后放射学研究来客观化和提高传统尸检的准确性。死后放射学研究是一种客观的、独立于操作人员的检查死者尸体的方法,应该被认为是病理学,特别是法医尸检的一个非常有效的阶段。
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引用次数: 0
Evaluation of fetal absorbed doses from computed tomography examinations of pregnant patients: A systematic review 评估胎儿吸收剂量的计算机断层扫描检查孕妇:一个系统的回顾
Pub Date : 2023-07-12 DOI: 10.17816/dd472150
A. Vodovatov, Olga A. Golchenko, I. Mashchenko, Darya V. Alekseeva, L. Chipiga, I. V. Khutornoy, P. V. Kozlova, G. E. Trufanov, P. S. Druzhinina, S. Ryzhov, I. V. Soldatov
BACKGROUND: Currently, no systematic data are available on fetal radiation exposure as a result of radiographic studies during pregnancy. Consequently, there are no approved methods of its calculation that can be used in clinical practice. It is especially relevant for computed tomography scans as it is a widely used and highly informative method of diagnostic imaging associated with high exposure levels. AIM: to systematize currently available data on radiation dose absorbed by the fetus from computed tomography scans in pregnant women. MATERIALS AND METHODS: The search for publications in Russian and English was conducted in PubMed/Medline, Google Scholar and еLibrary. The final analysis included 12 papers including 8 studies using human body phantoms, 3 retrospective studies and one prospective clinical study. RESULTS: Abdominal and pelvic computed tomography scans as well as whole-body scans were found to be associated with the highest fetal radiation exposure. However, in none of the publications the fetal exposure limit was exceeded. CONCLUSION: Clinically indicated non-contrast-enhanced computed tomography scans in pregnant women are not likely to be associated with the fetal absorbed doses that exceed the limit of 100 mGy regardless of the scanned area. However, this limit might be exceeded in case of performing multiple studies or if multiphase abdominal or pelvic computed tomography scans, or whole-body computed tomography scans are performed in patients with multiple trauma. In these cases, a decision regarding the need for these investigations should be made by a multi-disciplinary team (including radiation safety specialists, diagnostic radiologists and clinicians) based on the results of additional risk assessment.
背景:目前,由于妊娠期间的放射学研究,没有关于胎儿辐射暴露的系统数据。因此,没有可用于临床实践的经批准的计算方法。它与计算机断层扫描特别相关,因为它是一种广泛使用且信息量大的与高暴露水平相关的诊断成像方法。目的:系统化目前可获得的孕妇计算机断层扫描胎儿吸收辐射剂量的数据。材料和方法:在PubMed/Medline、Google Scholar和еLibrary中搜索俄语和英语出版物。最终分析包括12篇论文,包括8项使用人体模型的研究、3项回顾性研究和一项前瞻性临床研究。结果:腹部和骨盆计算机断层扫描以及全身扫描被发现与最高的胎儿辐射暴露有关。然而,没有一份出版物超过了胎儿暴露限值。结论:无论扫描区域如何,孕妇的非造影增强计算机断层扫描不太可能与超过100 mGy限制的胎儿吸收剂量有关。然而,在进行多项研究的情况下,或者如果对多发性创伤患者进行多期腹部或骨盆计算机断层扫描或全身计算机断层扫描,则可能会超过这一限制。在这些情况下,应由多学科团队(包括辐射安全专家、诊断放射科医生和临床医生)根据额外风险评估的结果,决定是否需要进行这些调查。
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引用次数: 0
Three-dimensional reconstruction of the pelvic bones on MRI scans 三维重建的骨盆骨MRI扫描
Pub Date : 2023-06-26 DOI: 10.17816/dd430345
Egor O. Ikryannikov
BACKGROUND: Pelvimetry is an important part of the obstetric examination for predicting a mismatch between the size of the fetus and the mothers pelvis, which leads to difficulty or impossibility of vaginal delivery. Contracted pelvis is one of the main causes of maternal birth trauma and perinatal morbidity and mortality. AIM: To create a computer vision model for automatic segmentation and three-dimensional (3D) reconstruction of the pelvic bones. METHODS: A 3D U-Net-based neural network was used and trained on T2 weighted images in frontal projection (repetition time, 7500; echo time, 130; slice thickness, 4mm; field-of-view, 4039; matrix, 256256). The sample size covered 49 patients. The training and test samples included 42 and 7 examinations, respectively. The segmentation of areas of interest was done manually and verified by a specialist. The sample size was justified by achieving representativeness of the data for obtaining a qualitative model (according to the SorensenDice coefficient). RESULTS: 3D reconstructions of the pelvic bones were obtained. The average Sorensen-Dice coefficient on the accuracy of pelvic bone segmentation in the test sample was 0.86. The result justified the use of a 3D U-Net-based neural network as a tool capable of perceiving a 3D structure of images and conducting qualitative segmentation. The results allow further work on automating the determination of key points at reconstructions. CONCLUSIONS: A computer vision model for automatic segmentation of the pelvic bones to obtain 3D reconstruction of images was created. This enabled the next stage of the study, i.e. the development of a model for determining the key points in the images and the distances between the points.
背景:骨盆测量是产科检查的重要组成部分,用于预测胎儿和母亲骨盆大小不匹配,从而导致阴道分娩困难或不可能。骨盆收缩是产妇分娩创伤和围产期发病率和死亡率的主要原因之一。目的:建立骨盆骨自动分割和三维重建的计算机视觉模型。方法:采用基于u - net的三维神经网络对T2加权图像进行正面投影训练(重复时间,7500;回声时间,130;切片厚度,4mm;场,4039;矩阵,256256)。样本量涵盖49例患者。训练样本42个,测试样本7个。感兴趣区域的分割是手工完成的,并由专家进行验证。样本量通过实现数据的代表性来获得定性模型(根据SorensenDice系数)。结果:获得骨盆骨三维重建。测试样本中骨盆骨分割精度的平均Sorensen-Dice系数为0.86。结果证明使用基于3D u - net的神经网络作为工具能够感知图像的3D结构并进行定性分割。该结果允许在重建过程中进一步自动化关键点的确定。结论:建立了骨盆骨自动分割的计算机视觉模型,获得三维重建图像。这使得研究的下一阶段成为可能,即开发一个模型来确定图像中的关键点和点之间的距离。
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引用次数: 0
Ethical issues of implementing artificial intelligence in medicine 在医学中实施人工智能的伦理问题
Pub Date : 2023-06-26 DOI: 10.17816/dd430348
Maxim I. Konkov
Artificial intelligence (AI) systems are highly efficient. However, their implementation in medical practice is accompanied by a range of ethical issues. The black box problem is basic to the AI philosophy, although having its own specificity in relation to medicine. A selection of relevant papers for the last three years by citations and their analysis through PubMed and Google Scholar search engines was conducted to study the problems of the AI implementation in medicine. One of the central problems is that the algorithms to justify decisions are still unclear to doctors and patients. The lack of clear and reasonable principles of AI operation is called the black box problem. How can doctors rely on AI findings without enough data to explain a particular decision? Who will be responsible for the final decision in case of an adverse outcome (death or serious injury)? In routine practice, medical decisions are based on an integrative approach (understanding of pathophysiology and biochemistry and interpretation of past findings), clinical trials and cohort studies. AI may be used to build a plan for disease diagnosis and treatment, while not providing a convincing justification for specific decisions. This creates a black box, since the information that the AI considers important for making a conclusion is not always clear, nor is it clear how or why the AI reaches that conclusion. Thus, Juan M. Durn writes, Even if we claim to understand the principles underlying AI annotation and training, it is still difficult and often even impossible to understand the inner workings of such systems. The doctor can interpret or verify the results of these algorithms, but cannot explain how the algorithm arrived at its recommendations or diagnosis. Currently, AI models are trained to recognize microscopic adenomas and polyps in the colon. However, doctors still have insufficient understanding of how AI differentiates between different types of polyps despite the high accuracy, and the signs that are key to making an AI diagnosis remain unclear to experienced endoscopists. Another example is the biomarkers of colorectal cancer recognized by AI. The doctor does not know how algorithms determine the quantitative and qualitative criteria of detectable biomarkers to formulate a final diagnosis in each individual case, i.e., a black box of process pathology emerges. For the trust of doctors and patients to be earned, the processes underlying the work of AI must be deciphered and explained, describing how it is done sequentially, step by step, and a specific result is to be formulated. Although the black box algorithms cannot be called transparent, the possibility of applying these technologies in practical medicine is worth considering. Despite the above problems, the accuracy and efficiency of solutions does not allow to neglect the use of AI. On the contrary, this use is necessary. Emerging problems should serve as a basis for training and educating doctors to wor
人工智能(AI)系统效率很高。然而,它们在医疗实践中的实施伴随着一系列伦理问题。黑箱问题是人工智能哲学的基础,尽管它与医学有自己的特殊性。通过PubMed和谷歌Scholar搜索引擎,选取近三年的相关论文,并对其进行分析,研究人工智能在医学领域的应用问题。其中一个核心问题是,医生和患者仍然不清楚证明决策合理性的算法。缺乏清晰合理的人工智能操作原则被称为黑匣子问题。如果没有足够的数据来解释一个特定的决定,医生怎么能依赖人工智能的发现呢?如果出现不利结果(死亡或严重伤害),谁将负责最终决定?在常规实践中,医疗决策是基于综合方法(对病理生理学和生物化学的理解以及对过去发现的解释)、临床试验和队列研究。人工智能可以用来制定疾病诊断和治疗计划,但不能为具体决策提供令人信服的理由。这就产生了一个黑盒,因为AI认为对得出结论很重要的信息并不总是很清楚,也不清楚AI如何或为什么得出结论。因此,Juan M. Durn写道,即使我们声称理解了人工智能注释和训练的基本原理,要理解这些系统的内部工作原理仍然很困难,甚至常常是不可能的。医生可以解释或验证这些算法的结果,但无法解释算法是如何得出建议或诊断的。目前,人工智能模型被训练来识别结肠中的微观腺瘤和息肉。然而,尽管人工智能具有很高的准确性,但医生对人工智能如何区分不同类型的息肉仍然了解不足,而且对于经验丰富的内窥镜医生来说,人工智能诊断的关键迹象仍然不清楚。另一个例子是人工智能识别的结直肠癌生物标志物。医生不知道算法如何确定可检测生物标志物的定量和定性标准,从而在每个病例中制定最终诊断,即过程病理学的黑箱出现。为了赢得医生和病人的信任,必须破译和解释人工智能工作的基本过程,描述它是如何循序渐进地完成的,并制定一个具体的结果。虽然黑箱算法不能称为透明,但在实际医学中应用这些技术的可能性值得考虑。尽管存在上述问题,但解决方案的准确性和效率不容忽视人工智能的使用。相反,这种用法是必要的。新出现的问题应作为培训和教育医生与人工智能合作、扩大应用范围和开发新的诊断技术的基础。
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