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Pigeons are surprisingly good at detecting cancer

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EMeRALDS: Electronic Medical Record Driven Automated Lung Nodule Detection and Classification in Thoracic CT Images

arXiv.org Artificial Intelligence

Objective: Lung cancer is a leading cause of cancer-related mortality worldwide, primarily due to delayed diagnosis and poor early detection. This study aims to develop a computer-aided diagnosis (CAD) system that leverages large vision-language models (VLMs) for the accurate detection and classification of pulmonary nodules in computed tomography (CT) scans. Methods: We propose an end-to-end CAD pipeline consisting of two modules: (i) a detection module (CADe) based on the Segment Anything Model 2 (SAM2), in which the standard visual prompt is replaced with a text prompt encoded by CLIP (Contrastive Language-Image Pretraining), and (ii) a diagnosis module (CADx) that calculates similarity scores between segmented nodules and radiomic features. To add clinical context, synthetic electronic medical records (EMRs) were generated using radiomic assessments by expert radiologists and combined with similarity scores for final classification. The method was tested on the publicly available LIDC-IDRI dataset (1,018 CT scans). Results: The proposed approach demonstrated strong performance in zero-shot lung nodule analysis. The CADe module achieved a Dice score of 0.92 and an IoU of 0.85 for nodule segmentation. The CADx module attained a specificity of 0.97 for malignancy classification, surpassing existing fully supervised methods. Conclusions: The integration of VLMs with radiomics and synthetic EMRs allows for accurate and clinically relevant CAD of pulmonary nodules in CT scans. The proposed system shows strong potential to enhance early lung cancer detection, increase diagnostic confidence, and improve patient management in routine clinical workflows.


Unified Supervision For Vision-Language Modeling in 3D Computed Tomography

arXiv.org Artificial Intelligence

General-purpose vision-language models (VLMs) have emerged as promising tools in radiology, offering zero-shot capabilities that mitigate the need for large labeled datasets. However, in high-stakes domains like diagnostic radiology, these models often lack the discriminative precision required for reliable clinical use. This challenge is compounded by the scarcity and heterogeneity of publicly available volumetric CT datasets, which vary widely in annotation formats and granularity. To address these limitations, we introduce Uniferum, a volumetric VLM that unifies diverse supervision signals, encoded in classification labels and segmentation masks, into a single training framework. By harmonizing three public 3D CT datasets with distinct annotations, Uniferum achieves state-of-the-art performance, improving AUROC on the CT-RATE benchmark by 7% compared to CLIP-based and conventional multi-label convolutional models. The model demonstrates robust out-of-distribution generalization, with observed evidence of unexpected zero-shot performance on the RAD-CHEST and INSPECT datasets. Our results highlight the effectiveness of integrating heterogeneous annotations and body segmentation to enhance model performance, setting a new direction for clinically reliable, data-efficient VLMs in 3D medical imaging.


SYN-LUNGS: Towards Simulating Lung Nodules with Anatomy-Informed Digital Twins for AI Training

arXiv.org Artificial Intelligence

AI models for lung cancer screening are limited by data scarcity, impacting generalizability and clinical applicability. Generative models address this issue but are constrained by training data variability. We introduce SYN-LUNGS, a framework for generating high-quality 3D CT images with detailed annotations. SYN-LUNGS integrates XCAT3 phantoms for digital twin generation, X-Lesions for nodule simulation (varying size, location, and appearance), and DukeSim for CT image formation with vendor and parameter variability. The dataset includes 3,072 nodule images from 1,044 simulated CT scans, with 512 lesions and 174 digital twins. Models trained on clinical + simulated data outperform clinical only models, achieving 10% improvement in detection, 2-9% in segmentation and classification, and enhanced synthesis.By incorporating anatomy-informed simulations, SYN-LUNGS provides a scalable approach for AI model development, particularly in rare disease representation and improving model reliability.


Development and Validation of a Dynamic-Template-Constrained Large Language Model for Generating Fully-Structured Radiology Reports

arXiv.org Artificial Intelligence

Current LLMs for creating fully-structured reports face the challenges of formatting errors, content hallucinations, and privacy leakage issues when uploading data to external servers.We aim to develop an open-source, accurate LLM for creating fully-structured and standardized LCS reports from varying free-text reports across institutions and demonstrate its utility in automatic statistical analysis and individual lung nodule retrieval. With IRB approvals, our retrospective study included 5,442 de-identified LDCT LCS radiology reports from two institutions. We constructed two evaluation datasets by labeling 500 pairs of free-text and fully-structured radiology reports and one large-scale consecutive dataset from January 2021 to December 2023. Two radiologists created a standardized template for recording 27 lung nodule features on LCS. We designed a dynamic-template-constrained decoding method to enhance existing LLMs for creating fully-structured reports from free-text radiology reports. Using consecutive structured reports, we automated descriptive statistical analyses and a nodule retrieval prototype. Our best LLM for creating fully-structured reports achieved high performance on cross-institutional datasets with an F1 score of about 97%, with neither formatting errors nor content hallucinations. Our method consistently improved the best open-source LLMs by up to 10.42%, and outperformed GPT-4o by 17.19%. The automatically derived statistical distributions were consistent with prior findings regarding attenuation, location, size, stability, and Lung-RADS. The retrieval system with structured reports allowed flexible nodule-level search and complex statistical analysis. Our developed software is publicly available for local deployment and further research.


Self-DenseMobileNet: A Robust Framework for Lung Nodule Classification using Self-ONN and Stacking-based Meta-Classifier

arXiv.org Artificial Intelligence

In this study, we propose a novel and robust framework, Self-DenseMobileNet, designed to enhance the classification of nodules and non-nodules in chest radiographs (CXRs). Our approach integrates advanced image standardization and enhancement techniques to optimize the input quality, thereby improving classification accuracy. To enhance predictive accuracy and leverage the strengths of multiple models, the prediction probabilities from Self-DenseMobileNet were transformed into tabular data and used to train eight classical machine learning (ML) models; the top three performers were then combined via a stacking algorithm, creating a robust meta-classifier that integrates their collective insights for superior classification performance. To enhance the interpretability of our results, we employed class activation mapping (CAM) to visualize the decision-making process of the best-performing model. Our proposed framework demonstrated remarkable performance on internal validation data, achieving an accuracy of 99.28\% using a Meta-Random Forest Classifier. When tested on an external dataset, the framework maintained strong generalizability with an accuracy of 89.40\%. These results highlight a significant improvement in the classification of CXRs with lung nodules.


Lung-DETR: Deformable Detection Transformer for Sparse Lung Nodule Anomaly Detection

arXiv.org Artificial Intelligence

Accurate lung nodule detection for computed tomography (CT) scan imagery is challenging in real-world settings due to the sparse occurrence of nodules and similarity to other anatomical structures. In a typical positive case, nodules may appear in as few as 3% of CT slices, complicating detection. This paper presents a novel approach to lung tumor detection in CT data by framing the task as anomaly detection, targeting rare nodule occurrences in a predominantly normal dataset. Our novel method, named Lung-DETR combines Deformable Detection Transformer, Focal Loss, and Maximum Intensity Projection into a unified framework for sparse lung nodule detection. A 7.5mm Maximum Intensity Projection (MIP) is utilized to combine adjacent lung slices, decreasing nodule sparsity and enhancing spatial context to allow for better differentiation between nodules, bronchioles, and other complex vascular structures. Lung-DETR is trained with a custom focal loss function to better handle the imbalanced dataset, and outputs bounding boxes around detected nodules. Our model achieves an F1 score of 94.2% (95.2% recall, 93.3% precision) on the LUNA16 dataset, with test dataset nodule sparsity of 4% that is reflective of real-world clinical data.


Lung-CADex: Fully automatic Zero-Shot Detection and Classification of Lung Nodules in Thoracic CT Images

arXiv.org Artificial Intelligence

Lung cancer has been one of the major threats to human life for decades. Computer-aided diagnosis can help with early lung nodul detection and facilitate subsequent nodule characterization. Large Visual Language models (VLMs) have been found effective for multiple downstream medical tasks that rely on both imaging and text data. However, lesion level detection and subsequent diagnosis using VLMs have not been explored yet. We propose CADe, for segmenting lung nodules in a zero-shot manner using a variant of the Segment Anything Model called MedSAM. CADe trains on a prompt suite on input computed tomography (CT) scans by using the CLIP text encoder through prefix tuning. We also propose, CADx, a method for the nodule characterization as benign/malignant by making a gallery of radiomic features and aligning image-feature pairs through contrastive learning. Training and validation of CADe and CADx have been done using one of the largest publicly available datasets, called LIDC. To check the generalization ability of the model, it is also evaluated on a challenging dataset, LUNGx. Our experimental results show that the proposed methods achieve a sensitivity of 0.86 compared to 0.76 that of other fully supervised methods.The source code, datasets and pre-processed data can be accessed using the link:


Full-resolution Lung Nodule Segmentation from Chest X-ray Images using Residual Encoder-Decoder Networks

arXiv.org Artificial Intelligence

Lung cancer is the leading cause of cancer death and early diagnosis is associated with a positive prognosis. Chest X-ray (CXR) provides an inexpensive imaging mode for lung cancer diagnosis. Suspicious nodules are difficult to distinguish from vascular and bone structures using CXR. Computer vision has previously been proposed to assist human radiologists in this task, however, leading studies use down-sampled images and computationally expensive methods with unproven generalization. Instead, this study localizes lung nodules using efficient encoder-decoder neural networks that process full resolution images to avoid any signal loss resulting from down-sampling. Encoder-decoder networks are trained and tested using the JSRT lung nodule dataset. The networks are used to localize lung nodules from an independent external CXR dataset. Sensitivity and false positive rates are measured using an automated framework to eliminate any observer subjectivity. These experiments allow for the determination of the optimal network depth, image resolution and pre-processing pipeline for generalized lung nodule localization. We find that nodule localization is influenced by subtlety, with more subtle nodules being detected in earlier training epochs. Therefore, we propose a novel self-ensemble model from three consecutive epochs centered on the validation optimum. This ensemble achieved a sensitivity of 85% in 10-fold internal testing with false positives of 8 per image. A sensitivity of 81% is achieved at a false positive rate of 6 following morphological false positive reduction. This result is comparable to more computationally complex systems based on linear and spatial filtering, but with a sub-second inference time that is faster than other methods. The proposed algorithm achieved excellent generalization results against an external dataset with sensitivity of 77% at a false positive rate of 7.6.


Evaluating LeNet Algorithms in Classification Lung Cancer from Iraq-Oncology Teaching Hospital/National Center for Cancer Diseases

arXiv.org Artificial Intelligence

The advancement of computer-aided detection systems had a significant impact on clinical analysis and decision-making on human disease. Lung cancer requires more attention among the numerous diseases being examined because it affects both men and women, increasing the mortality rate. LeNet, a deep learning model, is used in this study to detect lung tumors. The studies were run on a publicly available dataset made up of CT image data (IQ-OTH/NCCD). Convolutional neural networks (CNNs) were employed in the experiment for feature extraction and classification. The proposed system was evaluated on Iraq-Oncology Teaching Hospital/National Center for Cancer Diseases datasets the success percentage was calculated as 99.51%, sensitivity (93%) and specificity (95%), and better results were obtained compared to the existing methods. Development and validation of algorithms such as ours are important initial steps in the development of software suites that could be adopted in routine pathological practices and potentially help reduce the burden on pathologists.