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Developing the Digital Lung: From First Lung CT to Clinical AI The Development of Quantitative X-ray Computed Tomography of Diffuse Lung Disease Through the Use of Artificial Intelligence Developing the Digital Lung: From First Lung CT to Clinical AI The Development of Quantitative X-ray Computed Tomography of Diffuse Lung Disease Through the Use of Artificial Intelligence JOHN D. NEWELL, Jr., MD, FACR Elsevier 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 DEVELOPING THE DIGITAL LUNG ISBN: 9780323795012 Copyright © 2024 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. International Standard Book Number: 9780323795012 Content Strategist: Melanie Tucker Content Development Specialist: Rebecca Corradetti Publishing Services Manager: Shereen Jameel Project Manager: Shereen Jameel Design Direction: Margaret M. Reid Printed in India Last digit is the print number: 9 8 7 6 5 4 3 2 1 C O N T E N T S Introduction to Lung CT AI 1 1 Three-Dimensional (3D) Digital Images of the Lung Using X-ray Computed 2 Tomography 12 X-ray CT Scanning Protocols for Lung CT AI Applications 40 3 Quantitative Assessment of Lung Nodule Size, Shape, and Malignant Potential 4 Using Both Reactive and Limited-Memory Lung CT AI 55 Using Reactive Machine AI to Derive Quantitative Lung CT Metrics of COPD, ILD, 5 and COVID-19 Pneumonia 68 Using Reactive Machine AI and Dynamic Changes in Lung Structure to Derive 6 Functional Quantitative Lung CT Metrics of COPD, ILD, and Asthma 88 Using Limited Memory Lung CT AI to Derive Advanced Quantitative CT Lung 7 Metrics of COPD, ILD, and COVID-19 Pneumonia 103 Lung CT AI Enables Advanced Computer Modeling of Lung Physiome Structure 8 and Function 121 Adoption of Lung CT AI Into Clinical Medicine 130 9 Index 143 xi I dedicate this book to all who suffer from lung disease and to those who strive to research, diagnose, and treat lung disease. P R E F A C E I am a cardiothoracic radiologist and biomedical engineer with over 40 years of experience in clinical radiology, and teaching and research, most recently at the University of Iowa and VIDA. I have marveled for many years at the ability of x-ray computed tomography to generate 3D images of the lung for both visual interpretation and quantitative analysis. Computed tomography images of the lungs have been shown to be a powerful method of detecting and assessing a variety of lung diseases, including lung cancer, asthma, COPD, COVID-19, and pulmonary fibrosis. I was approached by Elsevier in December 2019 at the RSNA convention to write a book on medical imaging AI, and we agreed that a book on lung CT AI would be the best fit for both of us. I wrote this book between January 2020 and February 2021 in Port Townsend, Washington, where I live. I hope you enjoy reading the book as much as I did writing it. ix Conf idence is ClinicalKey Evidence-based answers, continually updated The latest answers, always at your fingertips A subscription to ClinicalKey draws content from countless procedural videos, peer-reviewed journals, patient education materials, and books authored by the most respected names in medicine. Your patients trust you. You can trust ClinicalKey. Equip yourself with trusted, current content that provides you with the clinical knowledge to improve patient outcomes. Get to know ClinicalKey at store.clinicalkey.com. 2019v1.0 A C K N O W L E D G M E N T S I want to express my deep thanks and gratitude to all my patients, mentors, students, and colleagues who have all taught me so much over the past 45 years. I want to thank all the people at Elsevier, and especially my editor, Rebecca Corradetti and Shereen Jameel, who helped me so much in improving the quality of this book. vii Any screen. Any time. Anywhere. 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