@article{EbigboPalmProbstetal., author = {Ebigbo, Alanna and Palm, Christoph and Probst, Andreas and Mendel, Robert and Manzeneder, Johannes and Prinz, Friederike and Souza Jr., Luis Antonio de and Papa, Jo{\~a}o Paulo and Siersema, Peter and Messmann, Helmut}, title = {A technical review of artificial intelligence as applied to gastrointestinal endoscopy: clarifying the terminology}, series = {Endoscopy International Open}, volume = {07}, journal = {Endoscopy International Open}, number = {12}, publisher = {Georg Thieme Verlag}, address = {Stuttgart}, doi = {10.1055/a-1010-5705}, pages = {1616 -- 1623}, abstract = {The growing number of publications on the application of artificial intelligence (AI) in medicine underlines the enormous importance and potential of this emerging field of research. In gastrointestinal endoscopy, AI has been applied to all segments of the gastrointestinal tract most importantly in the detection and characterization of colorectal polyps. However, AI research has been published also in the stomach and esophagus for both neoplastic and non-neoplastic disorders. The various technical as well as medical aspects of AI, however, remain confusing especially for non-expert physicians. This physician-engineer co-authored review explains the basic technical aspects of AI and provides a comprehensive overview of recent publications on AI in gastrointestinal endoscopy. Finally, a basic insight is offered into understanding publications on AI in gastrointestinal endoscopy.}, subject = {Diagnose}, language = {en} } @article{SouzaJrMendelStrasseretal., author = {Souza Jr., Luis Antonio de and Mendel, Robert and Strasser, Sophia and Ebigbo, Alanna and Probst, Andreas and Messmann, Helmut and Papa, Jo{\~a}o Paulo and Palm, Christoph}, title = {Convolutional Neural Networks for the evaluation of cancer in Barrett's esophagus: Explainable AI to lighten up the black-box}, series = {Computers in Biology and Medicine}, volume = {135}, journal = {Computers in Biology and Medicine}, publisher = {Elsevier}, issn = {0010-4825}, doi = {10.1016/j.compbiomed.2021.104578}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-20126}, pages = {1 -- 14}, abstract = {Even though artificial intelligence and machine learning have demonstrated remarkable performances in medical image computing, their level of accountability and transparency must be provided in such evaluations. The reliability related to machine learning predictions must be explained and interpreted, especially if diagnosis support is addressed. For this task, the black-box nature of deep learning techniques must be lightened up to transfer its promising results into clinical practice. Hence, we aim to investigate the use of explainable artificial intelligence techniques to quantitatively highlight discriminative regions during the classification of earlycancerous tissues in Barrett's esophagus-diagnosed patients. Four Convolutional Neural Network models (AlexNet, SqueezeNet, ResNet50, and VGG16) were analyzed using five different interpretation techniques (saliency, guided backpropagation, integrated gradients, input × gradients, and DeepLIFT) to compare their agreement with experts' previous annotations of cancerous tissue. We could show that saliency attributes match best with the manual experts' delineations. Moreover, there is moderate to high correlation between the sensitivity of a model and the human-and-computer agreement. The results also lightened that the higher the model's sensitivity, the stronger the correlation of human and computational segmentation agreement. We observed a relevant relation between computational learning and experts' insights, demonstrating how human knowledge may influence the correct computational learning.}, subject = {Deep Learning}, language = {en} } @article{SchulzePalmKerschbaumetal., author = {Schulze, Elke and Palm, Christoph and Kerschbaum, Maximilian and Seidel, Roman and Lehmann, Lars and Koller, Michael and Pfingsten, Andrea}, title = {KI-gest{\"u}tzte Untersuchung in der nicht-operativen Versorgung symptomgebender Erkrankungen des Kniegelenks - ein multiprofessionelles Konzept (KINEESIO)}, series = {MSK - Muskuloskelettale Physiotherapie}, volume = {28}, journal = {MSK - Muskuloskelettale Physiotherapie}, number = {5}, publisher = {Thieme}, issn = {2701-6986}, doi = {10.1055/a-2402-9982}, pages = {312 -- 321}, abstract = {Beschwerdebilder am Kniegelenk aufgrund muskuloskelettaler degenerativer oder verletzungsbedingter Erkrankungen sind h{\"a}ufig, nehmen im Alter zu und sind mit der steigenden Inanspruchnahme {\"a}rztlicher und therapeutischer Behandlungsmaßnahmen verbunden. Einer erfolgreichen Therapie gehen oft notwendige zeit- und ressourcenaufwendige Untersuchungen zur Erkennung und Differenzierung der patient*innenspezifischen Problematik voraus. Im Zusammenhang mit der nicht-operativen Versorgung des Kniegelenks hat ein sektor{\"u}bergreifendes multiprofessionelles Forschungsteam ein Konzept entwickelt, um k{\"u}nstliche neuronale Netze so zu trainieren, dass sie bei der {\"a}rztlichen und physiotherapeutischen Untersuchung unterst{\"u}tzend Einsatz finden k{\"o}nnen. Denn gerade in der Erfassung und Auswertung umfassender Datenmengen liegen große Potenziale in der K{\"u}nstlichen Intelligenz (KI) im Gesundheitswesen. Das Projekt KINEESIO trainiert und testet KI-gest{\"u}tzte Screening- Tools zur Untersuchung von Patient*innen mit Kniegelenkerkrankungen. Diese unterst{\"u}tzen die Abl{\"a}ufe zwischen Leistungserbringern und Patient*innen, tragen zu einer verbesserten Differenzierung individueller Beschwerdebilder bei und dienen Entscheidungsprozessen f{\"u}r eine ad{\"a}quate Versorgung. Dadurch sollen Ressourcen im Gesundheitswesen geschont und eine qualitativ hochwertige Therapie ausreichend erm{\"o}glicht werden.}, language = {de} } @misc{EbigboMendelTziatziosetal., author = {Ebigbo, Alanna and Mendel, Robert and Tziatzios, Georgios and Probst, Andreas and Palm, Christoph and Messmann, Helmut}, title = {Real-Time Diagnosis of an Early Barrett's Carcinoma using Artificial Intelligence (AI) - Video Case Demonstration}, series = {Endoscopy}, volume = {52}, journal = {Endoscopy}, number = {S 01}, publisher = {Thieme}, doi = {10.1055/s-0040-1704075}, pages = {S23}, abstract = {Introduction We present a clinical case showing the real-time detection, characterization and delineation of an early Barrett's cancer using AI. Patients and methods A 70-year old patient with a long-segment Barrett's esophagus (C5M7) was assessed with an AI algorithm. Results The AI system detected a 10 mm focal lesion and AI characterization predicted cancer with a probability of >90\%. After ESD resection, histopathology showed mucosal adenocarcinoma (T1a (m), R0) confirming AI diagnosis. Conclusion We demonstrate the real-time AI detection, characterization and delineation of a small and early mucosal Barrett's cancer.}, subject = {Speiser{\"o}hrenkrebs}, language = {en} } @article{EbigboPalmMessmann, author = {Ebigbo, Alanna and Palm, Christoph and Messmann, Helmut}, title = {Barrett esophagus: What to expect from Artificial Intelligence?}, series = {Best Practice \& Research Clinical Gastroenterology}, volume = {52-53}, journal = {Best Practice \& Research Clinical Gastroenterology}, number = {June-August}, publisher = {Elsevier}, issn = {1521-6918}, doi = {10.1016/j.bpg.2021.101726}, abstract = {The evaluation and assessment of Barrett's esophagus is challenging for both expert and nonexpert endoscopists. However, the early diagnosis of cancer in Barrett's esophagus is crucial for its prognosis, and could save costs. Pre-clinical and clinical studies on the application of Artificial Intelligence (AI) in Barrett's esophagus have shown promising results. In this review, we focus on the current challenges and future perspectives of implementing AI systems in the management of patients with Barrett's esophagus.}, subject = {Deep Learning}, language = {en} } @misc{ScheppachMendelProbstetal., author = {Scheppach, Markus W. and Mendel, Robert and Probst, Andreas and Rauber, David and R{\"u}ckert, Tobias and Meinikheim, Michael and Palm, Christoph and Messmann, Helmut and Ebigbo, Alanna}, title = {Real-time detection and delineation of tissue during third-space endoscopy using artificial intelligence (AI)}, series = {Endoscopy}, volume = {55}, journal = {Endoscopy}, number = {S02}, publisher = {Thieme}, doi = {10.1055/s-0043-1765128}, pages = {S53 -- S54}, abstract = {Aims AI has proven great potential in assisting endoscopists in diagnostics, however its role in therapeutic endoscopy remains unclear. Endoscopic submucosal dissection (ESD) is a technically demanding intervention with a slow learning curve and relevant risks like bleeding and perforation. Therefore, we aimed to develop an algorithm for the real-time detection and delineation of relevant structures during third-space endoscopy. Methods 5470 still images from 59 full length videos (47 ESD, 12 POEM) were annotated. 179681 additional unlabeled images were added to the training dataset. Consequently, a DeepLabv3+ neural network architecture was trained with the ECMT semi-supervised algorithm (under review elsewhere). Evaluation of vessel detection was performed on a dataset of 101 standardized video clips from 15 separate third-space endoscopy videos with 200 predefined blood vessels. Results Internal validation yielded an overall mean Dice score of 85\% (68\% for blood vessels, 86\% for submucosal layer, 88\% for muscle layer). On the video test data, the overall vessel detection rate (VDR) was 94\% (96\% for ESD, 74\% for POEM). The median overall vessel detection time (VDT) was 0.32 sec (0.3 sec for ESD, 0.62 sec for POEM). Conclusions Evaluation of the developed algorithm on a video test dataset showed high VDR and quick VDT, especially for ESD. Further research will focus on a possible clinical benefit of the AI application for VDR and VDT during third-space endoscopy.}, subject = {Speiser{\"o}hrenkrankheit}, language = {en} } @misc{MeinikheimMendelScheppachetal., author = {Meinikheim, Michael and Mendel, Robert and Scheppach, Markus W. and Probst, Andreas and Prinz, Friederike and Schwamberger, Tanja and Schlottmann, Jakob and G{\"o}lder, Stefan Karl and Walter, Benjamin and Steinbr{\"u}ck, Ingo and Palm, Christoph and Messmann, Helmut and Ebigbo, Alanna}, title = {Einsatz von k{\"u}nstlicher Intelligenz (KI) als Entscheidungsunterst{\"u}tzungssystem f{\"u}r nicht-Experten bei der Beurteilung von Barrett-{\"O}sophagus assoziierten Neoplasien (BERN)}, series = {Zeitschrift f{\"u}r Gastroenterologie}, volume = {60}, journal = {Zeitschrift f{\"u}r Gastroenterologie}, number = {4}, publisher = {Thieme}, address = {Stuttgart}, doi = {10.1055/s-0042-1745653}, pages = {251}, abstract = {Einleitung Die sichere Detektion und Charakterisierung von Barrett-{\"O}sophagus assoziierten Neoplasien (BERN) stellt selbst f{\"u}r erfahrene Endoskopiker eine Herausforderung dar. Ziel Ziel dieser Studie ist es, den Add-on Effekt eines k{\"u}nstlichen Intelligenz (KI) Systems (Barrett-Ampel) als Entscheidungsunterst{\"u}zungssystem f{\"u}r Endoskopiker ohne Expertise bei der Untersuchung von BERN zu evaluieren. Material und Methodik Zw{\"o}lf Videos in „Weißlicht" (WL), „narrow-band imaging" (NBI) und „texture and color enhanced imaging" (TXI) von histologisch best{\"a}tigten Barrett-Metaplasien oder BERN wurden von Experten und Untersuchern ohne Barrett-Expertise evaluiert. Die Probanden wurden dazu aufgefordert in den Videos auftauchende BERN zu identifizieren und gegebenenfalls die optimale Biopsiestelle zu markieren. Unser KI-System wurde demselben Test unterzogen, wobei dieses BERN in Echtzeit segmentierte und farblich von umliegendem Epithel differenzierte. Anschließend wurden den Probanden die Videos mit zus{\"a}tzlicher KI-Unterst{\"u}tzung gezeigt. Basierend auf dieser neuen Information, wurden die Probanden zu einer Reevaluation ihrer initialen Beurteilung aufgefordert. Ergebnisse Die „Barrett-Ampel" identifizierte unabh{\"a}ngig von den verwendeten Darstellungsmodi (WL, NBI, TXI) alle BERN. Zwei entz{\"u}ndlich ver{\"a}nderte L{\"a}sionen wurden fehlinterpretiert (Genauigkeit=75\%). W{\"a}hrend Experten vergleichbare Ergebnisse erzielten (Genauigkeit=70,8\%), hatten Endoskopiker ohne Expertise bei der Beurteilung von Barrett-Metaplasien eine Genauigkeit von lediglich 58,3\%. Wurden die nicht-Experten allerdings von unserem KI-System unterst{\"u}tzt, erreichten diese eine Genauigkeit von 75\%. Zusammenfassung Unser KI-System hat das Potential als Entscheidungsunterst{\"u}tzungssystem bei der Differenzierung zwischen Barrett-Metaplasie und BERN zu fungieren und so Endoskopiker ohne entsprechende Expertise zu assistieren. Eine Limitation dieser Studie ist die niedrige Anzahl an eingeschlossenen Videos. Um die Ergebnisse dieser Studie zu best{\"a}tigen, m{\"u}ssen randomisierte kontrollierte klinische Studien durchgef{\"u}hrt werden.}, language = {de} } @misc{MeinikheimMendelScheppachetal., author = {Meinikheim, Michael and Mendel, Robert and Scheppach, Markus W. and Probst, Andreas and Prinz, Friederike and Schwamberger, Tanja and Schlottmann, Jakob and G{\"o}lder, Stefan Karl and Walter, Benjamin and Steinbr{\"u}ck, Ingo and Palm, Christoph and Messmann, Helmut and Ebigbo, Alanna}, title = {INFLUENCE OF AN ARTIFICIAL INTELLIGENCE (AI) BASED DECISION SUPPORT SYSTEM (DSS) ON THE DIAGNOSTIC PERFORMANCE OF NON-EXPERTS IN BARRETT´S ESOPHAGUS RELATED NEOPLASIA (BERN)}, series = {Endoscopy}, volume = {54}, journal = {Endoscopy}, number = {S 01}, publisher = {Thieme}, doi = {10.1055/s-00000012}, pages = {S39}, abstract = {Aims Barrett´s esophagus related neoplasia (BERN) is difficult to detect and characterize during endoscopy, even for expert endoscopists. We aimed to assess the add-on effect of an Artificial Intelligence (AI) algorithm (Barrett-Ampel) as a decision support system (DSS) for non-expert endoscopists in the evaluation of Barrett's esophagus (BE) and BERN. Methods Twelve videos with multimodal imaging white light (WL), narrow-band imaging (NBI), texture and color enhanced imaging (TXI) of histologically confirmed BE and BERN were assessed by expert and non-expert endoscopists. For each video, endoscopists were asked to identify the area of BERN and decide on the biopsy spot. Videos were assessed by the AI algorithm and regions of BERN were highlighted in real-time by a transparent overlay. Finally, endoscopists were shown the AI videos and asked to either confirm or change their initial decision based on the AI support. Results Barrett-Ampel correctly identified all areas of BERN, irrespective of the imaging modality (WL, NBI, TXI), but misinterpreted two inflammatory lesions (Accuracy=75\%). Expert endoscopists had a similar performance (Accuracy=70,8\%), while non-experts had an accuracy of 58.3\%. When AI was implemented as a DSS, non-expert endoscopists improved their diagnostic accuracy to 75\%. Conclusions AI may have the potential to support non-expert endoscopists in the assessment of videos of BE and BERN. Limitations of this study include the low number of videos used. Randomized clinical trials in a real-life setting should be performed to confirm these results.}, subject = {Speiser{\"o}hrenkrankheit}, language = {en} } @article{HartwigBerletCzempieletal., author = {Hartwig, Regine and Berlet, Maximilian and Czempiel, Tobias and Fuchtmann, Jonas and R{\"u}ckert, Tobias and Feussner, Hubertus and Wilhelm, Dirk}, title = {Bildbasierte Unterst{\"u}tzungsmethoden f{\"u}r die zuk{\"u}nftige Anwendung in der Chirurgie}, series = {Die Chirurgie}, volume = {93}, journal = {Die Chirurgie}, publisher = {Springer}, doi = {10.1007/s00104-022-01668-x}, pages = {956 -- 965}, abstract = {Hintergrund: Die Entwicklung assistiver Technologien wird in den kommenden Jahren nicht nur in der Chirurgie von zunehmender Bedeutung sein. Die Wahrnehmung der Istsituation stellt hierbei die Grundlage jeder autonomen Handlung dar. Hierf{\"u}r k{\"o}nnen unterschiedliche Sensorsysteme genutzt werden, wobei videobasierte Systeme ein besonderes Potenzial aufweisen. Methode: Anhand von Literaturangaben und auf Basis eigener Forschungsarbeiten werden zentrale Aspekte bildbasierter Unterst{\"u}tzungssysteme f{\"u}r die Chirurgie dargestellt. Hierbei wird deren Potenzial, aber auch die Limitationen der Methoden erl{\"a}utert. Ergebnisse: Eine etablierte Anwendung stellt die Phasendetektion chirurgischer Eingriffe dar, f{\"u}r die Operationsvideos mittels neuronaler Netzwerke analysiert werden. Durch eine zeitlich gest{\"u}tzte und transformative Analyse konnten die Ergebnisse der Pr{\"a}diktion j{\"u}ngst deutlich verbessert werden. Aber auch robotische Kameraf{\"u}hrungssysteme nutzen Bilddaten, um das Laparoskop zuk{\"u}nftig autonom zu navigieren. Um die Zuverl{\"a}ssigkeit an die hohen Anforderungen in der Chirurgie anzugleichen, m{\"u}ssen diese jedoch durch zus{\"a}tzliche Informationen erg{\"a}nzt werden. Ein vergleichbarer multimodaler Ansatz wurde bereits f{\"u}r die Navigation und Lokalisation bei laparoskopischen Eingriffen umgesetzt. Hierzu werden Videodaten mittels verschiedener Methoden analysiert und diese Ergebnisse mit anderen Sensormodalit{\"a}ten fusioniert. Diskussion: Bildbasierte Unterst{\"u}tzungsmethoden sind bereits f{\"u}r diverse Aufgaben verf{\"u}gbar und stellen einen wichtigen Aspekt f{\"u}r die Chirurgie der Zukunft dar. Um hier jedoch zuverl{\"a}ssig und f{\"u}r autonome Funktionen eingesetzt werden zu k{\"o}nnen, m{\"u}ssen sie zuk{\"u}nftig in multimodale Ans{\"a}tze eingebettet werden, um die erforderliche Sicherheit bieten zu k{\"o}nnen.}, language = {de} } @misc{ScheppachMendelProbstetal., author = {Scheppach, Markus W. and Mendel, Robert and Probst, Andreas and Meinikheim, Michael and Palm, Christoph and Messmann, Helmut and Ebigbo, Alanna}, title = {Artificial Intelligence (AI) - assisted vessel and tissue recognition during third space endoscopy (Smart ESD)}, series = {Zeitschrift f{\"u}r Gastroenterologie}, volume = {60}, journal = {Zeitschrift f{\"u}r Gastroenterologie}, number = {08}, publisher = {Georg Thieme Verlag}, address = {Stuttgart}, doi = {10.1055/s-0042-1755110}, abstract = {Clinical setting Third space procedures such as endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) are complex minimally invasive techniques with an elevated risk for operator-dependent adverse events such as bleeding and perforation. This risk arises from accidental dissection into the muscle layer or through submucosal blood vessels as the submucosal cutting plane within the expanding resection site is not always apparent. Deep learning algorithms have shown considerable potential for the detection and characterization of gastrointestinal lesions. So-called AI - clinical decision support solutions (AI-CDSS) are commercially available for polyp detection during colonoscopy. Until now, these computer programs have concentrated on diagnostics whereas an AI-CDSS for interventional endoscopy has not yet been introduced. We aimed to develop an AI-CDSS („Smart ESD") for real-time intra-procedural detection and delineation of blood vessels, tissue structures and endoscopic instruments during third-space endoscopic procedures. Characteristics of Smart ESD An AI-CDSS was invented that delineates blood vessels, tissue structures and endoscopic instruments during third-space endoscopy in real-time. The output can be displayed by an overlay over the endoscopic image with different modes of visualization, such as a color-coded semitransparent area overlay, or border tracing (demonstration video). Hereby the optimal layer for dissection can be visualized, which is close above or directly at the muscle layer, depending on the applied technique (ESD or POEM). Furthermore, relevant blood vessels (thickness> 1mm) are delineated. Spatial proximity between the electrosurgical knife and a blood vessel triggers a warning signal. By this guidance system, inadvertent dissection through blood vessels could be averted. Technical specifications A DeepLabv3+ neural network architecture with KSAC and a 101-layer ResNeSt backbone was used for the development of Smart ESD. It was trained and validated with 2565 annotated still images from 27 full length third-space endoscopic videos. The annotation classes were blood vessel, submucosal layer, muscle layer, electrosurgical knife and endoscopic instrument shaft. A test on a separate data set yielded an intersection over union (IoU) of 68\%, a Dice Score of 80\% and a pixel accuracy of 87\%, demonstrating a high overlap between expert and AI segmentation. Further experiments on standardized video clips showed a mean vessel detection rate (VDR) of 85\% with values of 92\%, 70\% and 95\% for POEM, rectal ESD and esophageal ESD respectively. False positive measurements occurred 0.75 times per minute. 7 out of 9 vessels which caused intraprocedural bleeding were caught by the algorithm, as well as both vessels which required hemostasis via hemostatic forceps. Future perspectives Smart ESD performed well for vessel and tissue detection and delineation on still images, as well as on video clips. During a live demonstration in the endoscopy suite, clinical applicability of the innovation was examined. The lag time for processing of the live endoscopic image was too short to be visually detectable for the interventionist. Even though the algorithm could not be applied during actual dissection by the interventionist, Smart ESD appeared readily deployable during visual assessment by ESD experts. Therefore, we plan to conduct a clinical trial in order to obtain CE-certification of the algorithm. This new technology may improve procedural safety and speed, as well as training of modern minimally invasive endoscopic resection techniques.}, subject = {Bildgebendes Verfahren}, language = {en} }