Computed Tomography(CT)images have been extensively employed in disease diagnosis and treatment,causing a huge concern over the dose of radiation to which patients are exposed.Increasing the radiation dose to get a be...Computed Tomography(CT)images have been extensively employed in disease diagnosis and treatment,causing a huge concern over the dose of radiation to which patients are exposed.Increasing the radiation dose to get a better image may lead to the development of genetic disorders and cancer in the patients;on the other hand,decreasing it by using a Low-Dose CT(LDCT)image may cause more noise and increased artifacts,which can compromise the diagnosis.So,image reconstruction from LDCT image data is necessary to improve radiologists’judgment and confidence.This study proposed three novel models for denoising LDCT images based on Wasserstein Generative Adversarial Network(WGAN).They were incorporated with different loss functions,including Visual Geometry Group(VGG),Structural Similarity Loss(SSIM),and Structurally Sensitive Loss(SSL),to reduce noise and preserve important information on LDCT images and investigate the effect of different types of loss functions.Furthermore,experiments have been conducted on the Graphical Processing Unit(GPU)and Central Processing Unit(CPU)to compare the performance of the proposed models.The results demonstrated that images from the proposed WGAN-SSIM,WGAN-VGG-SSIM,and WGAN-VGG-SSL were denoised better than those from state-of-the-art models(WGAN,WGAN-VGG,and SMGAN)and converged to a stable equilibrium compared with WGAN and WGAN-VGG.The proposed models are effective in reducing noise,suppressing artifacts,and maintaining informative structure and texture details,especially WGAN-VGG-SSL which achieved a high peak-signalto-noise ratio(PNSR)on both GPU(26.1336)and CPU(25.8270).The average accuracy of WGAN-VGG-SSL outperformed that of the state-ofthe-art methods by 1 percent.Experiments prove that theWGAN-VGG-SSL is more stable than the other models on both GPU and CPU.展开更多
Background: Mortality outcomes in trials of low-dose computed tomography(CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung canc...Background: Mortality outcomes in trials of low-dose computed tomography(CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung cancer mortality and to investigate the factors that associate with the screening effect.Methods: A decision tree model with three scenarios(low-dose CT screening, chest X-ray screening, and no screening) was developed to compare screening results in a simulated Chinese urban cohort(100,000 smokers aged45-80 years). Data of participant characteristics were obtained from national registries and epidemiological surveys for estimating lung cancer prevalence. The selection of other tree variables such as sensitivities and specificities of low-dose CT and chest X-ray screening were based on literature research. Differences in lung cancer mortality(primary outcome), false diagnoses, and deaths due to false diagnosis were calculated. Sensitivity analyses were performed to identify the factors that associate with the screening results and to ascertain worst and optimal screening effects considering possible ranges of the variables.Results: Among the 100,000 subjects, there were 448,541, and 591 lung cancer deaths in the low-dose CT, chest X-ray, and no screening scenarios, respectively(17.2% reduction in low-dose CT screening over chest X-ray screening and 24.2% over no screening). The costs of the two screening scenarios were 9387 and 2497 false diagnoses and 7and 2 deaths due to false diagnosis among the 100,000 persons, respectively. The factors that most influenced death reduction with low-dose CT screening over no screening were lung cancer prevalence in the screened cohort, lowdose CT sensitivity, and proportion of early-stage cancers among low-dose CT detected lung cancers. Considering all possibilities, reduction in deaths(relative numbers) with low-dose CT screening in the worst and optimal cases were16(5.4%) and 288(40.2%) over no screening, respectively.Conclusions: In terms of mortality outcomes, our findings favor conducting low-dose CT screening in urban China.However, approaches to reducing false diagnoses and optimizing important screening conditions such as enrollment criteria for screening are highly needed.展开更多
目的基于Markov模型评价肺结节低剂量螺旋CT(LDCT)筛查的卫生经济学。方法利用2021年—2023年北京市某三甲医院的肺结节LDCT筛查数据和部分国外临床研究数据,采用成本效用分析方法,通过增量成本效用比(ICUR)确定优势筛查策略;使用R语言...目的基于Markov模型评价肺结节低剂量螺旋CT(LDCT)筛查的卫生经济学。方法利用2021年—2023年北京市某三甲医院的肺结节LDCT筛查数据和部分国外临床研究数据,采用成本效用分析方法,通过增量成本效用比(ICUR)确定优势筛查策略;使用R语言获得转移概率参数,利用TreeAge Pro 2011软件构建Markov模型。假设以我国10万名55岁及以上人群为肺结节筛查对象,模拟其疾病发展情况,并通过敏感性分析评价该模型的稳定性。结果成本效用分析显示,该模型经20次循环后,LDCT筛查策略的总成本为3543088618元,相较于不筛查策略的总成本增加了784130651元,额外获得了7996个质量调整生命年(QALY),每获得一个QALY需多花费98059.77元。采用WHO卫生经济学评价标准,LDCT筛查策略的ICUR大于1倍人均国内生产总值(GDP)但小于3倍人均GDP,为优势策略。敏感性分析显示,各变量在其敏感性分析范围内无论如何变化,都不会对ICUR产生较大影响,表明该模型具有较好的稳定性。结论在55岁及以上人群中开展每年一次肺结节LDCT筛查的ICUR小于3倍人均GDP,具有一定的经济学效用,该筛查策略有利于肺癌的“早发现、早诊断、早治疗”。展开更多
文摘Computed Tomography(CT)images have been extensively employed in disease diagnosis and treatment,causing a huge concern over the dose of radiation to which patients are exposed.Increasing the radiation dose to get a better image may lead to the development of genetic disorders and cancer in the patients;on the other hand,decreasing it by using a Low-Dose CT(LDCT)image may cause more noise and increased artifacts,which can compromise the diagnosis.So,image reconstruction from LDCT image data is necessary to improve radiologists’judgment and confidence.This study proposed three novel models for denoising LDCT images based on Wasserstein Generative Adversarial Network(WGAN).They were incorporated with different loss functions,including Visual Geometry Group(VGG),Structural Similarity Loss(SSIM),and Structurally Sensitive Loss(SSL),to reduce noise and preserve important information on LDCT images and investigate the effect of different types of loss functions.Furthermore,experiments have been conducted on the Graphical Processing Unit(GPU)and Central Processing Unit(CPU)to compare the performance of the proposed models.The results demonstrated that images from the proposed WGAN-SSIM,WGAN-VGG-SSIM,and WGAN-VGG-SSL were denoised better than those from state-of-the-art models(WGAN,WGAN-VGG,and SMGAN)and converged to a stable equilibrium compared with WGAN and WGAN-VGG.The proposed models are effective in reducing noise,suppressing artifacts,and maintaining informative structure and texture details,especially WGAN-VGG-SSL which achieved a high peak-signalto-noise ratio(PNSR)on both GPU(26.1336)and CPU(25.8270).The average accuracy of WGAN-VGG-SSL outperformed that of the state-ofthe-art methods by 1 percent.Experiments prove that theWGAN-VGG-SSL is more stable than the other models on both GPU and CPU.
基金supported by Peking Union Medical College Youth Fund and the Fundamental Research Funds for the Central Universities(No.2017310049)
文摘Background: Mortality outcomes in trials of low-dose computed tomography(CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung cancer mortality and to investigate the factors that associate with the screening effect.Methods: A decision tree model with three scenarios(low-dose CT screening, chest X-ray screening, and no screening) was developed to compare screening results in a simulated Chinese urban cohort(100,000 smokers aged45-80 years). Data of participant characteristics were obtained from national registries and epidemiological surveys for estimating lung cancer prevalence. The selection of other tree variables such as sensitivities and specificities of low-dose CT and chest X-ray screening were based on literature research. Differences in lung cancer mortality(primary outcome), false diagnoses, and deaths due to false diagnosis were calculated. Sensitivity analyses were performed to identify the factors that associate with the screening results and to ascertain worst and optimal screening effects considering possible ranges of the variables.Results: Among the 100,000 subjects, there were 448,541, and 591 lung cancer deaths in the low-dose CT, chest X-ray, and no screening scenarios, respectively(17.2% reduction in low-dose CT screening over chest X-ray screening and 24.2% over no screening). The costs of the two screening scenarios were 9387 and 2497 false diagnoses and 7and 2 deaths due to false diagnosis among the 100,000 persons, respectively. The factors that most influenced death reduction with low-dose CT screening over no screening were lung cancer prevalence in the screened cohort, lowdose CT sensitivity, and proportion of early-stage cancers among low-dose CT detected lung cancers. Considering all possibilities, reduction in deaths(relative numbers) with low-dose CT screening in the worst and optimal cases were16(5.4%) and 288(40.2%) over no screening, respectively.Conclusions: In terms of mortality outcomes, our findings favor conducting low-dose CT screening in urban China.However, approaches to reducing false diagnoses and optimizing important screening conditions such as enrollment criteria for screening are highly needed.
文摘目的基于Markov模型评价肺结节低剂量螺旋CT(LDCT)筛查的卫生经济学。方法利用2021年—2023年北京市某三甲医院的肺结节LDCT筛查数据和部分国外临床研究数据,采用成本效用分析方法,通过增量成本效用比(ICUR)确定优势筛查策略;使用R语言获得转移概率参数,利用TreeAge Pro 2011软件构建Markov模型。假设以我国10万名55岁及以上人群为肺结节筛查对象,模拟其疾病发展情况,并通过敏感性分析评价该模型的稳定性。结果成本效用分析显示,该模型经20次循环后,LDCT筛查策略的总成本为3543088618元,相较于不筛查策略的总成本增加了784130651元,额外获得了7996个质量调整生命年(QALY),每获得一个QALY需多花费98059.77元。采用WHO卫生经济学评价标准,LDCT筛查策略的ICUR大于1倍人均国内生产总值(GDP)但小于3倍人均GDP,为优势策略。敏感性分析显示,各变量在其敏感性分析范围内无论如何变化,都不会对ICUR产生较大影响,表明该模型具有较好的稳定性。结论在55岁及以上人群中开展每年一次肺结节LDCT筛查的ICUR小于3倍人均GDP,具有一定的经济学效用,该筛查策略有利于肺癌的“早发现、早诊断、早治疗”。
