Lung cancer is the leading cause of cancer-related death among both men and women and second most commonly diagnosed cancer, accounting for 18% of the total cancer deaths world-wide [4]. Screening high-risk patients with low dose Computed Tomography (CT) can lead to earlier treatment and increase the survival rate [5]. However, cancer diagnosis remains a challenging problem due to the subtle visual differences between benign and malignant nodules in CT images. Hence, computer-aided diagnosis (CADx) systems may prove useful in assisting radiologists in the malignancy prediction task. Previously we developed a convolutional attention-based network that allows for use of pre-trained 2-D convolutional feature extractors and is extendable to multi-timepoint classification in a Siamese structure [6]. The use of a sequence of parallel 2-D CNNs in place of a 3D CNN will result in significant reduction in the number of network parameters. In this paper, we keep the same overall structure utilized in [6] including the attention mechanism. However, herein, we report on use of Efficient-Net [1] for 2-D feature extractors due to its success on the Image-Net classification challenge. Variations of the Efficient-Net B0 to B7 pretrained on Image-Net were fine-tuned and applied to NLSTx data [6] a subset of data acquired in the National Lung Screening Trial (NLST) [2]. NLSTx includes data from biopsy confirmed scans in 650 benign and 207 malignant nodules at up to 3 time points. In our study, the performance of the best Efficient- Net reached an area under ROC curve of .7896 for the benign/malignant classification.
The use of low-dose Computed Tomography (CT) has been effective in reducing the mortality rate due to lung cancer. With the rapid increase in the number of studies, computer aided diagnosis (CAD) systems need to be developed to further assist radiologists in detecting lung nodules and determining their malignancy in CT scans. An important factor for determining malignancy in a sequential of scans is the rate of change and growth. In the past, deformable registration techniques have been widely applied to assess longitudinal change in data. In this paper we propose a new deep learning system based on Convolutional Neural Networks and U-Net architecture to assess longitudinal change in CT scans for a nodule over time. The VoxelMorph network [1] has been effective in deformable registration of brain MRIs. This paper extends the application of VoxelMorph to registration of lung nodules in multiple time point scans based on a subset of data from the National Lung Screening Trial (NLST), referred to as NLSTx. VoxelMorph has been modified to include both a sum-of-squared-differences (SSD) image similarity loss and spatial domain regularization to reduce the number of fold-overs and non-invertible transformations, indicated by the presence of negative Jacobian determinants. The network effectively performs 3D Deformable Registration of longitudinal nodule CT scans, providing the means to quantify nodule growth over time.
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