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Artificial Intelligence-Based Identification of Normal Chest Radiographs: A Simulation Study in a Multicenter Health Screening Cohort

  • Hyunsuk Yoo;Eun Young Kim;Hyungjin Kim;Ye Ra Choi;Moon Young Kim;Sung Ho Hwang;Young Joong Kim;Young Jun Cho;Kwang Nam Jin
    • Korean Journal of Radiology
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    • v.23 no.10
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    • pp.1009-1018
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    • 2022
  • Objective: This study aimed to investigate the feasibility of using artificial intelligence (AI) to identify normal chest radiography (CXR) from the worklist of radiologists in a health-screening environment. Materials and Methods: This retrospective simulation study was conducted using the CXRs of 5887 adults (mean age ± standard deviation, 55.4 ± 11.8 years; male, 4329) from three health screening centers in South Korea using a commercial AI (Lunit INSIGHT CXR3, version 3.5.8.8). Three board-certified thoracic radiologists reviewed CXR images for referable thoracic abnormalities and grouped the images into those with visible referable abnormalities (identified as abnormal by at least one reader) and those with clearly visible referable abnormalities (identified as abnormal by at least two readers). With AI-based simulated exclusion of normal CXR images, the percentages of normal images sorted and abnormal images erroneously removed were analyzed. Additionally, in a random subsample of 480 patients, the ability to identify visible referable abnormalities was compared among AI-unassisted reading (i.e., all images read by human readers without AI), AI-assisted reading (i.e., all images read by human readers with AI assistance as concurrent readers), and reading with AI triage (i.e., human reading of only those rendered abnormal by AI). Results: Of 5887 CXR images, 405 (6.9%) and 227 (3.9%) contained visible and clearly visible abnormalities, respectively. With AI-based triage, 42.9% (2354/5482) of normal CXR images were removed at the cost of erroneous removal of 3.5% (14/405) and 1.8% (4/227) of CXR images with visible and clearly visible abnormalities, respectively. In the diagnostic performance study, AI triage removed 41.6% (188/452) of normal images from the worklist without missing visible abnormalities and increased the specificity for some readers without decreasing sensitivity. Conclusion: This study suggests the feasibility of sorting and removing normal CXRs using AI with a tailored cut-off to increase efficiency and reduce the workload of radiologists.

Coexisting Bronchogenic Carcinoma and Pulmonary Tuberculosis in the Same Lobe: Radiologic Findings and Clinical Significance

  • Young Il Kim;Jin Mo Goo;Hyae Young KIm;Jae Woo Song;Jung-Gi Im
    • Korean Journal of Radiology
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    • v.2 no.3
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    • pp.138-144
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    • 2001
  • Objective: Bronchogenic carcinoma can mimic or be masked by pulmonary tuberculosis (TB), and the aim of this study was to describe the radiologic findings and clinical significance of bronchogenic carcinoma and pulmonary TB which coexist in the same lobe. Materials and Methods: The findings of 51 patients (48 males and three females, aged 48-79 years) in whom pulmonary TB and bronchogenic carcinoma coexisted in the same lobe were analyzed. The morphologic characteristics of a tumor, such as its diameter and margin, the presence of calcification or cavitation, and mediastinal lymphadenopathy, as seen at CT, were retrospectively assessed, and the clinical stage of the lung cancer was also determined. Using the serial chest radiographs available for 21 patients, the possible causes of delay in the diagnosis of lung cancer were analyzed. Results: Lung cancers with coexisting pulmonary TB were located predominantly in the upper lobes (82.4%). The mean diameter of the mass was 5.3 cm, and most tumors (n=42, 82.4%) had a lobulated border. Calcification within the tumor was seen in 20 patients (39.2%), and cavitation in five (9.8%). Forty-two (82.4%) had mediastinal lymphadenopathy, and more than half the tumors (60.8%) were at an advanced stage [IIIB (n=11) or IV (n=20)]. The average delay in diagnosing lung cancer was 11.7 (range, 1-24) months, and the causes of this were failure to observe new nodules masked by coexisting stable TB lesions (n=8), misinterpretation of new lesions as aggravation of TB (n=5), misinterpretation of lung cancer as tuberculoma at initial radiography (n=4), masking of the nodule by an active TB lesion (n=3), and subtleness of the lesion (n=1). Conclusion: Most cancers concurrent with TB are large, lobulated masses with mediastinal lymphadenopathy, indicating that the morphologic characteristics of lung cancer with coexisting pulmonary TB are similar to those of lung cancer without TB. The diagnosis of lung cancer is delayed mainly because of masking by a tuberculous lesion, and this suggests that in patients in whom a predominant or growing nodule is present and who show little improvement of symptoms despite antituberculous or other medical therapy, coexisting cancer should be suspected.

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Comparison of Esophageal Cancer Radiation Therapy Plans Using Volumetric Modulated Arc Therapy (체적 조절 호형 방사선치료(VMAT)를 활용한 식도암 치료계획 비교)

  • Won-Young Jeong;Jae-Bok Han;Young-Hyun Seo;Jong-Nam Song
    • Journal of the Korean Society of Radiology
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    • v.18 no.3
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    • pp.249-256
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    • 2024
  • The study aimed to evaluate the efficacy of treatment plans using full Arc and Partial Arc Coplanar volumetric modulated arc therapy and Non-Coplanar volumetric modulated arc therapy to minimize radiation treatment side effects, such as pneumonia, and protect normal organs in esophageal cancer radiotherapy. 30 patients who underwent Concurrent Chemoradiotherapy for esophageal cancer were included. Compared planning target volume, lung, heart, spinal cord and total monitor units among three treatment plans: fVMAT(2 Full Arc), pVMAT(4 Partial Arc), and ncVMAT(2 Partial Arc + 2 Non-Coplanar Arc). All plans met the PTV criteria, showing uniform distribution. The average dose to the heart was 5.8 Gy for fVMAT, 6.97 Gy for pVMAT, and 7.6 Gy for ncVMAT, with the lowest value in fVMAT, which was statistically significant. However, the average lung dose was 9.01 Gy for fVMAT, 7.71 Gy for pVMAT, and 7.12 Gy for ncVMAT, with V5Gy(%) values of 52.22%, 38.61%, 36.35% and V10Gy(%) values of 37.8%, 27.33%, 24.15% respectively. ncVMAT showed the lowest values, while fVMAT had the highest, with statistical significance. In conclusion, ncVMAT effectively reduces lung radiation exposure in esophageal cancer radiotherapy, potentially reducing the incidence of side effects such as pneumonia. However, considering factors like setup accuracy and treatment time, applying an appropriate treatment plan may lead to better outcomes.

Diagnostic Performance of Rectal CT for Staging Rectal Cancer: Comparison with Rectal MRI and Histopathology (직장암 병기결정에서 직장 CT의 진단능: 직장 MRI 및 병리결과와의 비교분석)

  • Seok Yoon Son;Yun Seok Seo;Jeong Hee Yoon;Bo Yun Hur;Jae Seok Bae;Se Hyung Kim
    • Journal of the Korean Society of Radiology
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    • v.84 no.6
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    • pp.1290-1308
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    • 2023
  • Purpose To compare the diagnostic performance of rectal CT with that of high-resolution rectal MRI and histopathology in assessing rectal cancer. Materials and Methods Sixty-seven patients with rectal cancer who underwent rectal CT with rectal distension using sonographic gel and high-resolution MRI were enrolled in this study. The distance from the anal verge/anorectal junction, distance to the mesorectal fascia (MRF), extramural depth (EMD), extramesorectal lymph node (LN) involvement, extramural venous invasion (EMVI), and T/N stages in rectal CT/MRI were analyzed by two gastrointestinal radiologists. The CT findings of 20 patients who underwent radical surgery without concurrent chemoradiotherapy were compared using histopathology. Interclass correlations and kappa statistics were used. Results The distance from the anal verge/anorectal junction showed an excellent intraclass correlation between CT and MRI for both reviewers. For EMD, the distance to the MRF, presence of LNs, extramesorectal LN metastasis, EMVI, T stage, and intermodality kappa or weighted kappa values between CT and MRI showed excellent agreement. Among the 20 patients who underwent radical surgery, T staging, circumferential resection margin involvement, EMVI, and LN metastasis on rectal CT showed acceptable concordance rates with histopathology. Conclusion Dedicated rectal CT may be on par with rectal MRI in providing critical information to patients with rectal cancer.

Verifying the Reliability and Validity of the Yonsei Lifestyle Profile for Adolescents (청소년을 위한 연세 라이프스타일 프로파일(Yonsei Lifestyle Profile)의 신뢰도 및 타당도 연구)

  • Kim, Ah-Ram;Lim, Young-Myoung;Park, Ji-Hyuk
    • Therapeutic Science for Rehabilitation
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    • v.13 no.2
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    • pp.41-51
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    • 2024
  • Objective : This study aimed to assess the applicability of the Yonsei Lifestyle Profile (YLP), initially developed for adults, for adolescents and verify its reliability and validity. Methods : This study evaluated the reliability and validity of the YLP among 436 middle and high school students in South Korea. The internal consistency of this scale was analyzed using Cronbach's alpha and Spearman-Brown's coefficient. Concurrent validity was assessed using Pearson's correlation coefficient with the Korean Youth Physical Activity Questionnaire, the Korean version of the Children and Adolescents Participation Scale, and the Nutrition Quotient for Adolescents. Results : The overall internal consistency of the YLP items demonstrated high reliability, with a Cronbach's α of .811 and Spearman-Brown's coefficient of .779. Significant positive correlations were observed for physical activity (r=.555, p<.01), activity participation (r=.177, p<.01), and dietary habits (r=.633, p<.05), indicating consistent correlations with the related scales. Conclusion : This study analyzed the YLP targeting adolescents and confirmed its high reliability and significant validity in the areas of physical activity, activity participation, and dietary habits. These findings suggest that the YLP can be utilized as a reliable tool for evaluating healthy lifestyles among adolescents.

Comparison of soil arthropod community characteristics in organic and conventional orchards in Gangwon Province (강원지역 유기 및 관행 과수원에서의 절지동물 군집 특성 비교)

  • June Wee;Yong Ho Lee;Sun Hee Hong;Kijong Cho;Young Ju Oh;Chae Sun Na;Kwang Lai Park
    • Korean Journal of Environmental Biology
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    • v.41 no.4
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    • pp.530-538
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    • 2023
  • This study conducted an investigation into the effects of fruit type and cultivation practices (organic and conventional) on soil characteristics and soil arthropod communities within apple, blueberry, grape, peach, and pear orchards. The collection of soil arthropod communities was achieved through the utilization of pitfall traps, with concurrent measurements taken for soil moisture content, electrical conductivity, and temperature. The findings of this study unveiled substantial impacts attributed to fruit type and cultivation practices on soil characteristics. Specifically, within organic apple orchards, discernibly higher levels of soil moisture content, electrical conductivity, and temperature were observed when compared to their conventional counterparts. The investigation into soil arthropod communities yielded a total of 1,527 individuals, classified in to five phyla and 15 orders. The range of abundance, species richness, and diversity indices varied across conventional and organic orchards. Cultivation practices were found not to exert a significant influence on soil arthropod community characteristics. However, Non-metric Multidimensional Scaling (NMDS) analysis indicated a significant differentiation in soil arthropod community structure based on cultivation practices. This study underscores the importance of considering vegetation structure and environmental characteristics that may influence soil arthropod communities comprehensively when assessing the impact of cultivation practices on soil arthropods. Furthermore, it emphasizes the need to account for both the characteristics and structure of soil arthropod communities in understanding the implications of cultivation practices on these organisms.

Survivorship Analysis in Asymptomatic COVID-19+ Hip Fracture Patients: Is There an Increase in Mortality?

  • Mason D. Vialonga;Luke G. Menken;Alex Tang;John W. Yurek;Li Sun;John J. Feldman;Frank A. Liporace;Richard S. Yoon
    • Hip & pelvis
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    • v.34 no.1
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    • pp.25-34
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    • 2022
  • Purpose: Mortality rates following hip fracture surgery have been well-studied. This study was conducted to examine mortality rates in asymptomatic patients presenting for treatment of acute hip fractures with concurrent positive COVID-19(+) tests compared to those with negative COVID-19(-) tests. Materials and Methods: A total of 149 consecutive patients undergoing hip fracture surgery during the COVID-19 pandemic at two academic medical centers were reviewed retrospectively. Patients were divided into two groups for comparative analysis: one group included asymptomatic patients with COVID-19+ tests versus COVID-19- tests. The primary outcome was mortality at 30-days and 90-days. Results: COVID-19+ patients had a higher mortality rate than COVID-19- patients at 30-days (26.7% vs 6.0%, P=0.005) and 90-days (41.7% vs 17.2%, P=0.046) and trended towards an increased length of hospital stay (10.1±6.2 vs 6.8±3.8 days, P=0.06). COVID-19+ patients had more pre-existing respiratory disease (46.7% vs 11.2%, P=0.0002). Results of a Cox regression analysis showed an increased risk of mortality at 30-days and 90-days from COVID-19+ status alone without an increased risk of death in patients with pre-existing chronic respiratory disease. Conclusion: Factors including time to surgery, age, preexisting comorbidities, and postoperative ambulatory status have been proven to affect mortality and complications in hip fracture patients; however, a positive COVID-19 test result adds another variable to this process. Implementation of protocols that will promote prompt orthogeriatric assessments, expedite patient transfer, limit operating room traffic, and optimize anesthesia time can preserve the standard of care in this unique patient population.

A Study on the Countmeasures of the Korean Pharmaceutical/Bio Industry to the EU Corporate Sustainability Due Diligence Directive, by using Text Mining (텍스트 마이닝을 활용한 국내 제약·바이오 업종의 EU 공급망 실사법 대응 방안 연구)

  • Sori Kim;Joonhak Ki
    • Information Systems Review
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    • v.26 no.1
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    • pp.93-117
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    • 2024
  • In February 2022, the EU announced a draft of the EU Corporate Sustainability Due Diligence Directive requiring due diligence and disclosure of information on environmental and human rights risks in corporate supply chains. This study evaluated the ability of 13 Korean pharmaceutical/bio companies to respond to the EU's demand for due diligence in the supply chain and compared it to 13 globally leading pharmaceutical/bio companies which are considered good in environmental and human rights risk management. For comparative analysis, text mining analysis was performed using R. Basic word frequency and concurrent words were analyzed and topic modeling was performed by applying Latent Dirichlet Allocation. As a result of the analysis, it was found that compared to advanced companies, domestic pharmaceutical and bio companies lack negative issue reporting and identification systems and supply chain due diligence implementation processes, and require advancement of data management for environmental and human rights information disclosure. Accordingly, domestic pharmaceutical and bio companies need to prepare differentiated support measures to systematically identify and reduce risks in the supply chain of small and medium-sized businesses beyond simply providing financial support. It is also desirable for the government to provide policy support by mandating Korea's own supply chain environment and human rights due diligence system, along with support for strengthening the ability to respond to due diligence of domestic pharmaceutical and bio companies, such as expert consulting and financial support.

A Study on Jurisdiction under the International Aviation Terrorism Conventions (국제항공테러협약의 관할권 연구)

  • Kim, Han-Taek
    • The Korean Journal of Air & Space Law and Policy
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    • v.24 no.1
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    • pp.59-89
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    • 2009
  • The objectives of the 1963 Tokyo Convention cover a variety of subjects, with the intention of providing safety in aircraft, protection of life and property on board, and promoting the security of civil aviation. These objectives will be treated as follows: first, the unification of rules on jurisdiction; second, the question of filling the gap in jurisdiction; third, the scheme of maintaining law and order on board aircraft; fourth, the protection of persons acting in accordance with the Convention; fifth, the protection of the interests of disembarked persons; sixth, the question of hijacking of aircraft; and finally some general remarks on the objectives of the Convention. The Tokyo Convention mainly deals with general crimes such as murder, violence, robbery on board aircraft rather than aviation terrorism. The Article 11 of the Convention deals with hijacking in a simple way. As far as aviation terrorism is concerned 1970 Hague Convention and 1971 Montreal Convention cover the hijacking and sabotage respectively. The Problem of national jurisdiction over the offence and the offender was as tangled at the Hague and Montreal Convention, as under the Tokyo Convention. Under the Tokyo Convention the prime base of jurisdiction is the law of the flag (Article 3), but concurrent jurisdiction is also allowed on grounds of: territorial principle, active nationality and passive personality principle, security of the state, breach of flight rules, and exercise of jurisdiction necessary for the performance of obligations under multilateral agreements (Article 4). No Criminal jurisdiction exercised in accordance with national law is excluded [Article 3(2)]. However, Article 4 of the Hague Convention(hereafter Hague Article 4) and Article 5 of the Montreal Convention(hereafter Montreal Article 5), dealing with jurisdiction have moved a step further, inasmuch as the opening part of both paragraphs 1 and 2 of the Hague Article 4 and the Montreal Article 5 impose an obligation on all contracting states to take measures to establish jurisdiction over the offence (i.e., to ensure that their law is such that their courts will have jurisdiction to try offender in all the circumstances covered by Hague Article 4 and Montreal Article 5). The state of registration and the state where the aircraft lands with the hijacker still on board will have the most interest, and would be in the best position to prosecute him; the paragraphs 1(a) and (b) of the Hague Article 4 and paragraphs 1(b) and (c) of the Montreal Article 5 deal with it, respectively. However, paragraph 1(b) of the Hague Article 4 and paragraph 1(c) of the Montreal Article 5 do not specify if the aircraft is still under the control of the hijacker or if the hijacker has been overpowered by the aircraft commander, or if the offence has at all occurred in the airspace of the state of landing. The language of the paragraph would probably cover all these cases. The weaknesses of Hague Article 4 and Montreal Article 5 are however, patent. The Jurisdictions of the state of registration, the state of landing, the state of the lessee and the state where the offender is present, are concurrent. No priorities have been fixed despite a proposal to this effect in the Legal Committee and the Diplomatic Conference, and despite the fact that it was pointed out that the difficulty in accepting the Tokyo Convention has been the question of multiple jurisdiction, for the reason that it would be too difficult to determine the priorities. Disputes over the exercise of jurisdiction can be endemic, more so when Article 8(4) of the Hague Convention and the Montreal Convention give every state mentioned in Hague Article 4(1) and Montreal Article 5(1) the right to seek extradition of the offender. A solution to the problem should not have been given up only because it was difficult. Hague Article 4(3) and Montreal Article 5(3) provide that they do not exclude any criminal jurisdiction exercised in accordance with national law. Thus the provisions of the two Conventions create additional obligations on the state, and do not exclude those already existing under national laws. Although the two Conventions do not require a state to establish jurisdiction over, for example, hijacking or sabotage committed by its own nationals in a foreign aircraft anywhere in the world, they do not preclude any contracting state from doing so. However, it has be noted that any jurisdiction established merely under the national law would not make the offence an extraditable one under Article 8 of the Hague and Montreal Convention. As far as international aviation terrorism is concerned 1988 Montreal Protocol and 1991 Convention on Marking of Plastic Explosives for the Purpose of Detention are added. The former deals with airport terrorism and the latter plastic explosives. Compared to the other International Terrorism Conventions, the International Aviation Terrorism Conventions do not have clauses of the passive personality principle. If the International Aviation Terrorism Conventions need to be revised in the future, those clauses containing the passive personality principle have to be inserted for the suppression of the international aviation terrorism more effectively. Article 3 of the 1973 Convention on the Prevention and Punishment of Crimes Against Internationally Protected Persons, Including Diplomatic Agents, Article 5 of the 1979 International Convention against the Taking of Hostages and Article 6 of the 1988 Convention for the Suppression of Unlawful Acts Against the Safety of Maritime Navigation would be models that the revised International Aviation Terrorism Conventions could follow in the future.

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The Development of the Korean Form of Childhood Attention Problem(CAP) Scale: A Study on the Reliability and Validity (한국형 소아기 집중력 문제척도: 신뢰도 및 타당도 연구)

  • Seo, Wan-Seok;Lee, Jong-Bum;Park, Hyung-Bae;Suh, Hyea-Soo;Lee, Kwang-Hun;SaKong, Jeong-Kyu
    • Journal of Yeungnam Medical Science
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    • v.14 no.1
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    • pp.123-136
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    • 1997
  • The purpose of this study was to examine the reliability and validity of a Korean form of Childhood Attention Problem(CAP) scale. CAP were administered to 98 normal elementary school students as control group and 98 attention deficit hyperactivity disorder patients. Male students showed high scores than female students in both subscale and total scores, but not statistically significant. There were no significant difference in CAP scale between male students and female students in attention deficit hyperactivity disorder patients. In the reliability test, the test-retest reliability coefficient was highly satisfactory and that of inattention subscale was 0.83, impulsivity subscale was 0.70 and total score was 0.82. In the reliability test by internal consistency, the Cronbach $\alpha$ coefficient was highly satisfactory and that of inattention subscale was 0.91, overactivity subscale was 0.89(p<0.05). The concurrent validity between CAP scale and ADDES-BV scale was 0.85 in attention deficit hyperactivity disorder patient group and 0.73 in normal control group(p<0.05). In discriminant validity test between attention deficit hyperactivity disorder patient group and normal control group, the patient group showed higher score(p<0.05). The total discriminant capacity of the patient group in CAP was 93.4%. In this point of view, CAP scale showed high reliability and validity in applying to Korean subjects and was proved to be the good and simple screening test tool for attention deficit hyperactivity disorder research and can help many young patient to treat early.

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