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      ESUR/ESUI position paper: developing artificial intelligence for precision diagnosis of prostate cancer using magnetic resonance imaging

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          Abstract

          Abstract

          Artificial intelligence developments are essential to the successful deployment of community-wide, MRI-driven prostate cancer diagnosis. AI systems should ensure that the main benefits of biopsy avoidance are delivered while maintaining consistent high specificities, at a range of disease prevalences. Since all current artificial intelligence / computer-aided detection systems for prostate cancer detection are experimental, multiple developmental efforts are still needed to bring the vision to fruition. Initial work needs to focus on developing systems as diagnostic supporting aids so their results can be integrated into the radiologists’ workflow including gland and target outlining tasks for fusion biopsies. Developing AI systems as clinical decision-making tools will require greater efforts. The latter encompass larger multicentric, multivendor datasets where the different needs of patients stratified by diagnostic settings, disease prevalence, patient preference, and clinical setting are considered. AI-based, robust, standard operating procedures will increase the confidence of patients and payers, thus enabling the wider adoption of the MRI-directed approach for prostate cancer diagnosis.

          Key Points

          • AI systems need to ensure that the benefits of biopsy avoidance are delivered with consistent high specificities, at a range of disease prevalence.

          • Initial work has focused on developing systems as diagnostic supporting aids for outlining tasks, so they can be integrated into the radiologists’ workflow to support MRI-directed biopsies.

          • Decision support tools require a larger body of work including multicentric, multivendor studies where the clinical needs, disease prevalence, patient preferences, and clinical setting are additionally defined.

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          Deep learning.

          Deep learning allows computational models that are composed of multiple processing layers to learn representations of data with multiple levels of abstraction. These methods have dramatically improved the state-of-the-art in speech recognition, visual object recognition, object detection and many other domains such as drug discovery and genomics. Deep learning discovers intricate structure in large data sets by using the backpropagation algorithm to indicate how a machine should change its internal parameters that are used to compute the representation in each layer from the representation in the previous layer. Deep convolutional nets have brought about breakthroughs in processing images, video, speech and audio, whereas recurrent nets have shone light on sequential data such as text and speech.
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            Development and Validation of a Deep Learning Algorithm for Detection of Diabetic Retinopathy in Retinal Fundus Photographs.

            Deep learning is a family of computational methods that allow an algorithm to program itself by learning from a large set of examples that demonstrate the desired behavior, removing the need to specify rules explicitly. Application of these methods to medical imaging requires further assessment and validation.
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              Assessing the performance of prediction models: a framework for traditional and novel measures.

              The performance of prediction models can be assessed using a variety of methods and metrics. Traditional measures for binary and survival outcomes include the Brier score to indicate overall model performance, the concordance (or c) statistic for discriminative ability (or area under the receiver operating characteristic [ROC] curve), and goodness-of-fit statistics for calibration.Several new measures have recently been proposed that can be seen as refinements of discrimination measures, including variants of the c statistic for survival, reclassification tables, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Moreover, decision-analytic measures have been proposed, including decision curves to plot the net benefit achieved by making decisions based on model predictions.We aimed to define the role of these relatively novel approaches in the evaluation of the performance of prediction models. For illustration, we present a case study of predicting the presence of residual tumor versus benign tissue in patients with testicular cancer (n = 544 for model development, n = 273 for external validation).We suggest that reporting discrimination and calibration will always be important for a prediction model. Decision-analytic measures should be reported if the predictive model is to be used for clinical decisions. Other measures of performance may be warranted in specific applications, such as reclassification metrics to gain insight into the value of adding a novel predictor to an established model.
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                Author and article information

                Contributors
                tobias.penzkofer@charite.de
                Journal
                Eur Radiol
                Eur Radiol
                European Radiology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0938-7994
                1432-1084
                15 May 2021
                15 May 2021
                2021
                : 31
                : 12
                : 9567-9578
                Affiliations
                [1 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Department of Radiology, , Charité University Hospital, ; Augustenburger Platz 1, 13354 Berlin, Germany
                [2 ]GRID grid.484013.a, Berlin Institute of Health, ; Berlin, Germany
                [3 ]GRID grid.477623.3, ISNI 0000 0004 0400 1422, Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, ; Northwood, UK
                [4 ]GRID grid.48336.3a, ISNI 0000 0004 1936 8075, Molecular Imaging Branch, National Cancer Institute, NIH, ; Bethesda, MD USA
                [5 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Joint Department of Medical Imaging, Sinai Health System, University Health Network, , University of Toronto, ; Toronto, Canada
                [6 ]GRID grid.10417.33, ISNI 0000 0004 0444 9382, Department of Radiology and Nuclear Medicine, , Radboud University Medical Center, ; Nijmegen, The Netherlands
                [7 ]GRID grid.418443.e, ISNI 0000 0004 0598 4440, Department of Urology, , Institut Paoli-Calmettes Cancer Centre, ; Marseille, France
                [8 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Martini-Klinik am UKE, , University Hospital Hamburg, ; Hamburg, Germany
                [9 ]GRID grid.5645.2, ISNI 000000040459992X, Radiology & Nuclear Medicine, , Erasmus MC, ; Rotterdam, The Netherlands
                [10 ]GRID grid.430814.a, ISNI 0000 0001 0674 1393, Department of Radiology, , Netherlands Cancer Institute, ; Amsterdam, The Netherlands
                [11 ]Department of Imaging, BSUH NHS Trust, Brighton, UK
                [12 ]GRID grid.410566.0, ISNI 0000 0004 0626 3303, Department of Radiology and Nuclear Medicine, , Ghent University Hospital, ; Ghent, Belgium
                [13 ]GRID grid.417007.5, Department of Radiological Sciences, Oncology and Pathology, , Sapienza/Policlinico Umberto I, ; Rome, Italy
                [14 ]GRID grid.413852.9, ISNI 0000 0001 2163 3825, Department of Urinary and Vascular Imaging, , Hospices Civils de Lyon, ; Lyon, France
                [15 ]GRID grid.25697.3f, ISNI 0000 0001 2172 4233, Faculté de médecine Lyon-Est, , Université de Lyon, Université Lyon 1, ; Lyon, France
                [16 ]GRID grid.411900.d, ISNI 0000 0004 0646 8325, Radiological Department, , Copenhagen University Hospital in Herlev-Gentofte, ; Herlev, Denmark
                Author information
                http://orcid.org/0000-0001-9591-8575
                Article
                8021
                10.1007/s00330-021-08021-6
                8589789
                33991226
                5bbc33dc-8019-4e78-9576-0ae205e23876
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 24 November 2020
                : 19 March 2021
                : 27 April 2021
                Funding
                Funded by: Berlin Institute of Health
                Award ID: Clinician Scientist Program
                Award Recipient :
                Categories
                Urogenital
                Custom metadata
                © The Author(s), under exclusive licence to European Society of Radiology 2021

                Radiology & Imaging
                artificial intelligence,deep learning,prostate cancer,multiparametric magnetic resonance imaging,image-guided biopsy

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