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Aims
Human-computer interactions (HCI) may have a relevant impact on the performance of Artificial Intelligence (AI). Studies show that although endoscopists assessing Barrett’s esophagus (BE) with AI improve their performance significantly, they do not achieve the level of the stand-alone performance of AI. One aspect of HCI is the impact of AI on the degree of certainty and confidence displayed by the endoscopist. Indirectly, diagnostic confidence when using AI may be linked to trust and acceptance of AI. In a BE video study, we aimed to understand the impact of AI on the diagnostic confidence of endoscopists and the possible correlation with diagnostic performance.
Methods
22 endoscopists from 12 centers with varying levels of BE experience reviewed ninety-six standardized endoscopy videos. Endoscopists were categorized into experts and non-experts and randomly assigned to assess the videos with and without AI. Participants were randomized in two arms: Arm A assessed videos first without AI and then with AI, while Arm B assessed videos in the opposite order. Evaluators were tasked with identifying BE-related neoplasia and rating their confidence with and without AI on a scale from 0 to 9.
Results
The utilization of AI in Arm A (without AI first, with AI second) significantly elevated confidence levels for experts and non-experts (7.1 to 8.0 and 6.1 to 6.6, respectively). Only non-experts benefitted from AI with a significant increase in accuracy (68.6% to 75.5%). Interestingly, while the confidence levels of experts without AI were higher than those of non-experts with AI, there was no significant difference in accuracy between these two groups (71.3% vs. 75.5%). In Arm B (with AI first, without AI second), experts and non-experts experienced a significant reduction in confidence (7.6 to 7.1 and 6.4 to 6.2, respectively), while maintaining consistent accuracy levels (71.8% to 71.8% and 67.5% to 67.1%, respectively).
Conclusions
AI significantly enhanced confidence levels for both expert and non-expert endoscopists. Endoscopists felt significantly more uncertain in their assessments without AI. Furthermore, experts with or without AI consistently displayed higher confidence levels than non-experts with AI, irrespective of comparable outcomes. These findings underscore the possible role of AI in improving diagnostic confidence during endoscopic assessment.
Aims
While AI has been successfully implemented in detecting and characterizing colonic polyps, its role in therapeutic endoscopy remains to be elucidated. Especially third space endoscopy procedures like ESD and peroral endoscopic myotomy (POEM) pose a technical challenge and the risk of operator-dependent complications like intraprocedural bleeding and perforation. Therefore, we aimed at developing an AI-algorithm for intraprocedural real time vessel detection during ESD and POEM.
Methods
A training dataset consisting of 5470 annotated still images from 59 full-length videos (47 ESD, 12 POEM) and 179681 unlabeled images was used to train a DeepLabV3+neural network with the ECMT semi-supervised learning method. Evaluation for vessel detection rate (VDR) and time (VDT) of 19 endoscopists with and without AI-support was performed using a testing dataset of 101 standardized video clips with 200 predefined blood vessels. Endoscopists were stratified into trainees and experts in third space endoscopy.
Results
The AI algorithm had a mean VDR of 93.5% and a median VDT of 0.32 seconds. AI support was associated with a statistically significant increase in VDR from 54.9% to 73.0% and from 59.0% to 74.1% for trainees and experts, respectively. VDT significantly decreased from 7.21 sec to 5.09 sec for trainees and from 6.10 sec to 5.38 sec for experts in the AI-support group. False positive (FP) readings occurred in 4.5% of frames. FP structures were detected significantly shorter than true positives (0.71 sec vs. 5.99 sec).
Conclusions
AI improved VDR and VDT of trainees and experts in third space endoscopy and may reduce performance variability during training. Further research is needed to evaluate the clinical impact of this new technology.
Background
This study evaluated the effect of an artificial intelligence (AI)-based clinical decision support system on the performance and diagnostic confidence of endoscopists in their assessment of Barrett’s esophagus (BE).
Methods
96 standardized endoscopy videos were assessed by 22 endoscopists with varying degrees of BE experience from 12 centers. Assessment was randomized into two video sets: group A (review first without AI and second with AI) and group B (review first with AI and second without AI). Endoscopists were required to evaluate each video for the presence of Barrett’s esophagus-related neoplasia (BERN) and then decide on a spot for a targeted biopsy. After the second assessment, they were allowed to change their clinical decision and confidence level.
Results
AI had a stand-alone sensitivity, specificity, and accuracy of 92.2%, 68.9%, and 81.3%, respectively. Without AI, BE experts had an overall sensitivity, specificity, and accuracy of 83.3%, 58.1%, and 71.5%, respectively. With AI, BE nonexperts showed a significant improvement in sensitivity and specificity when videos were assessed a second time with AI (sensitivity 69.8% [95%CI 65.2%–74.2%] to 78.0% [95%CI 74.0%–82.0%]; specificity 67.3% [95%CI 62.5%–72.2%] to 72.7% [95%CI 68.2%–77.3%]). In addition, the diagnostic confidence of BE nonexperts improved significantly with AI.
Conclusion
BE nonexperts benefitted significantly from additional AI. BE experts and nonexperts remained significantly below the stand-alone performance of AI, suggesting that there may be other factors influencing endoscopists’ decisions to follow or discard AI advice.
Real-time computational speed and a high degree of precision are requirements for computer-assisted interventions. Applying a segmentation network to a medical video processing task can introduce significant inter-frame prediction noise. Existing approaches can reduce inconsistencies by including temporal information but often impose requirements on the architecture or dataset. This paper proposes a method to include temporal information in any segmentation model and, thus, a technique to improve video segmentation performance without alterations during training or additional labeling. With Motion-Corrected Moving Average, we refine the exponential moving average between the current and previous predictions. Using optical flow to estimate the movement between consecutive frames, we can shift the prior term in the moving-average calculation to align with the geometry of the current frame. The optical flow calculation does not require the output of the model and can therefore be performed in parallel, leading to no significant runtime penalty for our approach. We evaluate our approach on two publicly available segmentation datasets and two proprietary endoscopic datasets and show improvements over a baseline approach.
Limitations in computer-assisted diagnosis include lack of labeled data and inability to model the relation between what experts see and what computers learn. Even though artificial intelligence and machine learning have demonstrated remarkable performances in medical image computing, their accountability and transparency level must be improved to transfer this success into clinical practice. The reliability of machine learning decisions must be explained and interpreted, especially for supporting the medical diagnosis. While deep learning techniques are broad so that unseen information might help learn patterns of interest, human insights to describe objects of interest help in decision-making. This paper proposes a novel approach, DeepCraftFuse, to address the challenge of combining information provided by deep networks with visual-based features to significantly enhance the correct identification of cancerous tissues in patients affected with Barrett’s esophagus (BE). We demonstrate that DeepCraftFuse outperforms state-of-the-art techniques on private and public datasets, reaching results of around 95% when distinguishing patients affected by BE that is either positive or negative to esophageal cancer.