Deep learning (DL) as part of artificial intelligence (AI) is based on artificial neural networks, which use a multi-step process to automatically analyze features of an image, then classify them. Medical image analysis using DL has been rapidly adopted across multiple medical fields. Neck ultrasound (US) is a gold standard diagnostic modality in thyroid nodules, and suitable for DL diagnosis because the characteristics of the thyroid nodules can be captured in one representative image. Therefore, a number of studies applied DL in analyzing neck US and tried to predict malignancy risk of the thyroid nodules, and showed relatively high diagnostic performances. For successful DL analysis for the thyroid US images, several issues should be solved which includes image selection by experienced clinicians, proper quality of US, enough number of US images to train the DL, accurate labeling, and adequate hyperparameters. However, DL analysis is still in its early stages, and the questions are unanswered yet. We do not know how many images we need to obtain for proper training, and there is no standard of US quality. Moreover, DL analysis may not be able to classify indeterminate nodules into benign or malignant even in the near future, not to mention now. In this review, we will discuss the current status, limitations, and the future directions of DL for thyroid US image analysis from a clinician’s point of view.
{"title":"Artificial intelligence for thyroid nodule ultrasound image analysis","authors":"Y. J. Chai, Junho Song, Mohammad Shaear, K. Yi","doi":"10.21037/AOT.2020.04.01","DOIUrl":"https://doi.org/10.21037/AOT.2020.04.01","url":null,"abstract":"Deep learning (DL) as part of artificial intelligence (AI) is based on artificial neural networks, which use a multi-step process to automatically analyze features of an image, then classify them. Medical image analysis using DL has been rapidly adopted across multiple medical fields. Neck ultrasound (US) is a gold standard diagnostic modality in thyroid nodules, and suitable for DL diagnosis because the characteristics of the thyroid nodules can be captured in one representative image. Therefore, a number of studies applied DL in analyzing neck US and tried to predict malignancy risk of the thyroid nodules, and showed relatively high diagnostic performances. For successful DL analysis for the thyroid US images, several issues should be solved which includes image selection by experienced clinicians, proper quality of US, enough number of US images to train the DL, accurate labeling, and adequate hyperparameters. However, DL analysis is still in its early stages, and the questions are unanswered yet. We do not know how many images we need to obtain for proper training, and there is no standard of US quality. Moreover, DL analysis may not be able to classify indeterminate nodules into benign or malignant even in the near future, not to mention now. In this review, we will discuss the current status, limitations, and the future directions of DL for thyroid US image analysis from a clinician’s point of view.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2020.04.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46720698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Funk, Florian Richter, Won Seo Park, Michael C. Yip, R. Orosco
: An autonomous robot is able to perceive its environment, make decisions and plans, then execute multi-step functions. Although surgical robotic technologies are widely accepted, robotic autonomy has not made its way into the operating rooms of today. As a result, robotic automation is an unfamiliar topic for most surgeons. In this review, we define the spectrum of robotic autonomy, provide a review of key components required for autonomy, and discuss some of the ways in which autonomy may be applied to endocrine surgery in the future. The integration of advanced imaging and surgical environment perception could augment surgical visualization and lead to the development of advanced semi-autonomous and autonomous robotic algorithms. The hope is that advanced robotic surgical technologies can make robotic surgeries safer, more efficient, precise and allow for greater patient access to advanced surgical expertise.
{"title":"Robotic autonomy in endocrine surgery","authors":"E. Funk, Florian Richter, Won Seo Park, Michael C. Yip, R. Orosco","doi":"10.21037/AOT-19-53","DOIUrl":"https://doi.org/10.21037/AOT-19-53","url":null,"abstract":": An autonomous robot is able to perceive its environment, make decisions and plans, then execute multi-step functions. Although surgical robotic technologies are widely accepted, robotic autonomy has not made its way into the operating rooms of today. As a result, robotic automation is an unfamiliar topic for most surgeons. In this review, we define the spectrum of robotic autonomy, provide a review of key components required for autonomy, and discuss some of the ways in which autonomy may be applied to endocrine surgery in the future. The integration of advanced imaging and surgical environment perception could augment surgical visualization and lead to the development of advanced semi-autonomous and autonomous robotic algorithms. The hope is that advanced robotic surgical technologies can make robotic surgeries safer, more efficient, precise and allow for greater patient access to advanced surgical expertise.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT-19-53","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41604073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01Epub Date: 2020-03-31DOI: 10.21037/aot.2020.03.03
Christopher R Razavi, Ved Tanavde, Mohammad Shaear, Jeremy D Richmon, Jonathon O Russell
Simulations and simulators have become an increasingly important tool in trainee education across many surgical disciplines, particularly for robotic and minimally invasive procedures. Thyroidectomy and parathyroidectomy are common procedures performed across multiple surgical disciplines, however, there is limited literature regarding training models/simulators for these operations. This is despite the advent and growing popularity of remote-access thyroidectomy techniques, where simulators may provide significant value in trainee education and safe implementation. Here we review the literature regarding available simulations/simulators in head and neck endocrine surgery for both conventional transcervical approaches and newer remote-access thyroidectomy techniques.
{"title":"Simulations and simulators in head and neck endocrine surgery.","authors":"Christopher R Razavi, Ved Tanavde, Mohammad Shaear, Jeremy D Richmon, Jonathon O Russell","doi":"10.21037/aot.2020.03.03","DOIUrl":"https://doi.org/10.21037/aot.2020.03.03","url":null,"abstract":"<p><p>Simulations and simulators have become an increasingly important tool in trainee education across many surgical disciplines, particularly for robotic and minimally invasive procedures. Thyroidectomy and parathyroidectomy are common procedures performed across multiple surgical disciplines, however, there is limited literature regarding training models/simulators for these operations. This is despite the advent and growing popularity of remote-access thyroidectomy techniques, where simulators may provide significant value in trainee education and safe implementation. Here we review the literature regarding available simulations/simulators in head and neck endocrine surgery for both conventional transcervical approaches and newer remote-access thyroidectomy techniques.</p>","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aot.2020.03.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37925742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
analysis of existing case-control studies to does not an association between LPP and any thyroid disease, hyperthyroidism or hypothyroidism. Our findings contradict those reported for lichen planus As such, this suggests that there are likely differences in the nuances underlying the pathogenesis of LPP versus lichen planus. Our study has several limitations. The included studies were mostly retrospective in design, thus susceptible to selection and assessment bias. The analysed effect sizes were unadjusted, and as such susceptible to influence by confounder variables. Large database studies may have errors in coding disease parameters, and there is heterogeneity in terms of criteria for diagnosis of thyroid disorders. Prospective studies with larger numbers of patients are required to reaffirm the findings in the present study.
{"title":"Lichen planopilaris and thyroid disease: systematic review and meta-analysis","authors":"K. Phan, Saxon D. Smith","doi":"10.21037/aot.2020.02.02","DOIUrl":"https://doi.org/10.21037/aot.2020.02.02","url":null,"abstract":"analysis of existing case-control studies to does not an association between LPP and any thyroid disease, hyperthyroidism or hypothyroidism. Our findings contradict those reported for lichen planus As such, this suggests that there are likely differences in the nuances underlying the pathogenesis of LPP versus lichen planus. Our study has several limitations. The included studies were mostly retrospective in design, thus susceptible to selection and assessment bias. The analysed effect sizes were unadjusted, and as such susceptible to influence by confounder variables. Large database studies may have errors in coding disease parameters, and there is heterogeneity in terms of criteria for diagnosis of thyroid disorders. Prospective studies with larger numbers of patients are required to reaffirm the findings in the present study.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aot.2020.02.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42037929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Barrios, E. Walgama, Yufei Chen, W. Sacks, A. Ho
Social media is an evolving phenomenon with the potential to impact an increasingly sophisticated thyroid and parathyroid patient population. Although there is steady growth in the number of social media users, the reluctance of physicians to participate in online communication with their patients emanates from perceived legal and ethical dilemmas online. Despite these concerns, it is vital for physicians, including those involved in thyroid and parathyroid surgery, to actively engage in their online presence to ensure accurate information is presented on their behalf. A well run online practice creates a centralized location for patients to find additional resources regarding their endocrine-related health. In addition, surgeons can facilitate search engine optimization algorithms driving traffic to their sites. When used well, social media has the ability to define a physician’s online narrative by creating a space for constructive communication, to help build a successful thyroid and parathyroid surgery practice.
{"title":"Emerging social media trends in thyroid and parathyroid surgery","authors":"L. Barrios, E. Walgama, Yufei Chen, W. Sacks, A. Ho","doi":"10.21037/AOT.2020.03.02","DOIUrl":"https://doi.org/10.21037/AOT.2020.03.02","url":null,"abstract":"Social media is an evolving phenomenon with the potential to impact an increasingly sophisticated thyroid and parathyroid patient population. Although there is steady growth in the number of social media users, the reluctance of physicians to participate in online communication with their patients emanates from perceived legal and ethical dilemmas online. Despite these concerns, it is vital for physicians, including those involved in thyroid and parathyroid surgery, to actively engage in their online presence to ensure accurate information is presented on their behalf. A well run online practice creates a centralized location for patients to find additional resources regarding their endocrine-related health. In addition, surgeons can facilitate search engine optimization algorithms driving traffic to their sites. When used well, social media has the ability to define a physician’s online narrative by creating a space for constructive communication, to help build a successful thyroid and parathyroid surgery practice.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45769962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The focused issue “ The Management of Thyroid Tumors in 2020 and Beyond ” edited by Drs. Jonathon Russell and Jeremy Richmon is going to be released in Annals of Thyroid ( AOT ) in the coming months. This issue aims to review the state-of-art in the management of thyroid pathology, to provide a venue for original research focused on remote access or minimally invasive thyroid management and to review the success at extending proven management strategies into new geographic regions. Taking this opportunity, we have done a series of interviews with the authors discussing the highlights of their articles and sharing their experiences or stories in this field.
{"title":"Dr. Raymon H. Grogan: transoral endocrine surgery","authors":"Silvia L. Zhou, Wymen Chen","doi":"10.21037/AOT.2019.07.03","DOIUrl":"https://doi.org/10.21037/AOT.2019.07.03","url":null,"abstract":"The focused issue “ The Management of Thyroid Tumors in 2020 and Beyond ” edited by Drs. Jonathon Russell and Jeremy Richmon is going to be released in Annals of Thyroid ( AOT ) in the coming months. This issue aims to review the state-of-art in the management of thyroid pathology, to provide a venue for original research focused on remote access or minimally invasive thyroid management and to review the success at extending proven management strategies into new geographic regions. Taking this opportunity, we have done a series of interviews with the authors discussing the highlights of their articles and sharing their experiences or stories in this field.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2019.07.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42816600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The focused issue “ The Management of Thyroid Tumors in 2020 and Beyond ” edited by Drs. Jonathon Russell and Jeremy Richmon is going to be released in Annals of Thyroid ( AOT ) in the coming months. This issue aims to review the state-of-art in the management of thyroid pathology, to provide a venue for original research focused on remote access or minimally invasive thyroid management and to review the success at extending proven management strategies into new geographic regions. Taking this opportunity, we have done a series of interviews with the authors discussing the highlights of their articles and sharing their experiences or stories in this field.
{"title":"Dr. Christopher Britt: my thoughts on telemedicine, patient satisfaction and tyrosine kinase inhibitors","authors":"Silvia L. Zhou, Wymen Chen","doi":"10.21037/AOT.2019.06.01","DOIUrl":"https://doi.org/10.21037/AOT.2019.06.01","url":null,"abstract":"The focused issue “ The Management of Thyroid Tumors in 2020 and Beyond ” edited by Drs. Jonathon Russell and Jeremy Richmon is going to be released in Annals of Thyroid ( AOT ) in the coming months. This issue aims to review the state-of-art in the management of thyroid pathology, to provide a venue for original research focused on remote access or minimally invasive thyroid management and to review the success at extending proven management strategies into new geographic regions. Taking this opportunity, we have done a series of interviews with the authors discussing the highlights of their articles and sharing their experiences or stories in this field.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42137278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The early identification of laryngeal nerves has been accepted as the safest technique to reduce recurrent morbidity, but the identification of the nerve alone can not ensure the presence of the function. Moreover, identification may not be easy, as in cases of reoperation, removal of central lymph nodes, thyrotoxicosis and in case of retrosternal goiter, thyroiditis or aberrant anatomy. Therefore it may be very useful to have an instrument that facilitates the safe completion of this important surgical step. For this reason, in recent years intraoperative neuromonitoring (IONM) has been proposed and applied in many centers in thyroid surgery in addition to the standard practice of visual identification of recurrent laryngeal nerve (RLN), with the primary purpose of evaluating its function and facilitating its identification and dissection. This work shows the benefits of the IONM technique, while recognizing that this technique cannot replace the fundamental elements in the performance of thyroidectomy. Moreover it describes that the introduction of IONM system, as a complement to the thyroidectomy procedure, may also have useful implications from medico-legal and training points of view.
{"title":"Training and learning curve of intraoperative neuromonitoring","authors":"A. Pino, E. Caruso, Alessandro Pontin, G. Dionigi","doi":"10.21037/AOT.2019.02.01","DOIUrl":"https://doi.org/10.21037/AOT.2019.02.01","url":null,"abstract":"The early identification of laryngeal nerves has been accepted as the safest technique to reduce recurrent morbidity, but the identification of the nerve alone can not ensure the presence of the function. Moreover, identification may not be easy, as in cases of reoperation, removal of central lymph nodes, thyrotoxicosis and in case of retrosternal goiter, thyroiditis or aberrant anatomy. Therefore it may be very useful to have an instrument that facilitates the safe completion of this important surgical step. For this reason, in recent years intraoperative neuromonitoring (IONM) has been proposed and applied in many centers in thyroid surgery in addition to the standard practice of visual identification of recurrent laryngeal nerve (RLN), with the primary purpose of evaluating its function and facilitating its identification and dissection. This work shows the benefits of the IONM technique, while recognizing that this technique cannot replace the fundamental elements in the performance of thyroidectomy. Moreover it describes that the introduction of IONM system, as a complement to the thyroidectomy procedure, may also have useful implications from medico-legal and training points of view.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2019.02.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43111268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Application of the CARE guideline as reporting standard in the Annals of Thyroid","authors":"","doi":"10.21037/aot.2019.10.01","DOIUrl":"https://doi.org/10.21037/aot.2019.10.01","url":null,"abstract":"","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48210056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The focused issue “ The Management of Thyroid Tumors in 2020 and Beyond ” edited by Drs. Jonathon Russell and Jeremy Richmon is going to be released in Annals of Thyroid ( AOT ) in the coming months. This issue aims to review the state-of-art in the management of thyroid pathology, to provide a venue for original research focused on remote access or minimally invasive thyroid management and to review the success at extending proven management strategies into new geographic regions. Taking this opportunity, we have done a series of interviews with the authors discussing the highlights of their articles and sharing their experiences or stories in this field.
{"title":"Dr. Joseph Scharpf: my opinions on nerve monitoring and anterior laryngeal electrodes","authors":"Silvia L. Zhou, Wymen Chen","doi":"10.21037/AOT.2019.06.02","DOIUrl":"https://doi.org/10.21037/AOT.2019.06.02","url":null,"abstract":"The focused issue “ The Management of Thyroid Tumors in 2020 and Beyond ” edited by Drs. Jonathon Russell and Jeremy Richmon is going to be released in Annals of Thyroid ( AOT ) in the coming months. This issue aims to review the state-of-art in the management of thyroid pathology, to provide a venue for original research focused on remote access or minimally invasive thyroid management and to review the success at extending proven management strategies into new geographic regions. Taking this opportunity, we have done a series of interviews with the authors discussing the highlights of their articles and sharing their experiences or stories in this field.","PeriodicalId":92168,"journal":{"name":"Annals of thyroid","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOT.2019.06.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41383079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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