ABSTRACT
PurposeTo evaluate the potential of using artificial intelligence (AI) focused pulmonary nodule search on chest CT data obtained during the COVID-19 pandemic to identify lung cancer (LC) patients. MethodsA multicenter, retrospective study in the Krasnoyarsk region, Russia analyzed CTs of COVID-19 patients using the automated algorithm, Chest-IRA by IRA Labs. Pulmonary nodules larger than 100 mm3 were identified by the AI and assessed by four radiologists, who categorized them into three groups: "high probability of LC", "insufficiently convincing evidence of LC", "without evidence of LC". Patients with findings were analyzed by radiologists, checked with the state cancer registry and electronic medical records. Patients with confirmed findings that were not available in the cancer registry were invited for chest CT and verification was performed according to the decision of the medical consilium. The study also estimated the economic impact of the AI by considering labor costs and savings on treatment for patients in the early stages compared to late stages, taking into account the saved life years and their potential contribution to the gross regional product. ResultsAn AI identified lung nodules in 484 out of 10,500 chest CTs. Of the 484, 355 could be evaluated, the remaining 129 had de-anonymization problems and were excluded. Of the 355, 252 cases having high and intermediate probabilities of LC, 103 were found to be false positives. From 252 was 100 histologically verified LC cases, 35 were in stages I-II and 65 were in stages III-IV. 2 lung cancers were diagnosed for the first time. Using AI instead of CT review by radiologists will save 2.43 million rubles (23,786 EUR/ 26690 USD/ 196,536 CNY) in direct salary, with expected savings to the regional budget of 8.22 million rubles (80,463 EUR/ 90,466 USD/ 666,162 CNY). The financial equivalent of the life years saved was 173.25 million rubles (1,695,892 EUR/ 1905750 USD/ 14,033,250 CNY). The total effect over five years is estimated at 183.9 million rubles (1,800,142 EUR/ 2,022,907 USD/ 14,895,949 CNY). ConclusionUsing AI to evaluate large volumes of chest CTs done for reasons unrelated to lung cancer screening may facilitate early and cost-effective detection of incidental pulmonary nodules that might otherwise be missed.
Subject(s)
COVID-19 , Lung Neoplasms , NeoplasmsABSTRACT
Background: Coronavirus disease-2019 (COVID-19) poses a risk for health care workers necessitating modifications to existing medical pathways. In particular, managing patients with suspected COVID-19 represents a risk to the delivery of a primary percutaneous coronary intervention (PPCI) pathway where time-dependent revascularization is key. Methods: We sought to evaluate the effect of the COVID-19 pandemic on an established ambulance-triggered PPCI program involving 2 high-volume heart attack centers in London, United Kingdom. A systematic analysis was performed in patients with ST-segment elevation myocardial infarction undergoing PPCI comparing the COVID-19 pandemic period March 1, 2020, to April 30, 2020, with a control group from the previous year. Results: During the study period, admissions through the PPCI pathway decreased by 34%. The time from symptoms onset to first call for help (2020: 11 min vs. 2019: 12 min;p = 0.90) and from symptom onset to arrival at PPCI center (2020: 183 min vs. 2019: 178 min;p = 0.99) were comparable;however, the time from arrival at PPCI center to revascularization decreased (2020: 44 min vs. 2019: 53 min;p = 0.0004). In-hospital mortality during the study period was significantly lower (5% vs. 15%;p = 0.04). COVID-19–positive patients (n = 8) had higher rates of cardiogenic shock (25%), intensive care unit admission (50%), and inpatient mortality (38%). [Formula presented] Conclusion: Our data show that the modifications to the existing PPCI pathway were not associated with treatment delay or adverse outcome. The reduction in ST-segment elevation myocardial infarction presentations raises concern that patients may not be seeking appropriate medical attention for chest pain. Importantly, we demonstrate that PPCI can be delivered safely and efficiently during the COVID-19 pandemic. Categories: OTHER: COVID-19