Smartphone image analysis for real time adequacy assessment during kidney biopsy

智能手机图像分析用于肾活检期间实时充分性评估

• 批准号: 10546275
• 负责人: Vijaya B. Kolachalama
• 金额: $ 25.21万
• 依托单位: NEPHROPATHOLOGY ASSOCIATES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10546275
• 关键词: Adoption; Algorithmic Analysis; Algorithms; Biopsy; Boston; Caliber; Cellular Phone; Consensus; Core Biopsy; Data; Data Set; Diagnosis; Ensure; Evaluation; Fatty acid glycerol esters; Feedback; Formalin; Goals; Guns; Healthcare Systems; Image; Image Analysis; Kidney; Kidney Diseases; Laboratories; Learning; Measures; Medical; Microscope; Modeling; Needle biopsy procedure; Needles; Paraffin Embedding; Pathologist; Patient Care; Patient risk; Patients; Phase; Physicians; Procedures; Process; Research; Resources; Risk; Sampling; Secure; Slide; Stains; Standardization; Testing; Time; Tissues; Training; Translations; United Network for Organ Sharing; Universities; accurate diagnosis; capsule; deep learning model; deep neural network; improved; interest; kidney biopsy; kidney cortex; kidney imaging; kidney medulla; lens; precision medicine; predictive modeling; preference; programs; radiologist; response; smartphone Application; technology development; tool; virtual

SUMMARY. The goal of this project is to develop image analysis tools that can be deployed as a smartphone application to aid in the real time assessment of biopsy adequacy during percutaneous renal biopsy (PRB) procedures. PRB remains an essential tool for the diagnosis and treatment of patients with medical kidney disease and involves obtaining a small needle core of tissue from the kidney with the use of a biopsy gun. A biopsy is deemed “adequate” if sufficient renal cortical tissue is obtained to meet criteria for rendering a histopathologic diagnosis. If insufficient tissue is obtained, or if the tissue does not contain renal cortex with enough glomeruli, then the core is deemed “inadequate”. Over the last 15 years, the rate of kidney biopsies that are inadequate for complete diagnosis due to insufficient tissue has risen to 15%, representing a significant drain on the health care system as well as a direct risk to patients who must be re-biopsied or go without an accurate diagnosis. Ideally, adequacy can be assessed at the time of biopsy by examination of the obtained cores under a microscope by a pathologist. Such real time assessment enables the biopsy physician to obtain additional cores of tissue if existing cores are deemed to be inadequate. However, resource constraints have markedly limited the availability of adequacy evaluation within many biopsy suites. With the widespread adoption of smartphones, there is now an opportunity to evaluate biopsy tissue via macro images instead of a microscope. An additional step is to build image analysis capabilities into an application on the smartphone, thus enabling the biopsy physician to obtain reliable instantaneous feedback about whether the material they have collected is sufficient or whether the biopsy “missed”, and more tissue needs to be obtained. A recent study of 123,372 native kidney biopsies found that the miss rate in PRB increased markedly from 2% in 2005 to 14% in 2020, largely attributed to the increased involvement of radiologists performing the biopsies and their preference for smaller diameter biopsy needles. This increase in kidney biopsy miss rate significantly impacts patient care in the management of medical kidney disease and highlights the need for improved tools for assessing the adequacy of tissue collected before the patient leaves the biopsy suite. In Phase I, Arkana Laboratories will collaborate with the Kolachalama laboratory at Boston University using biopsy cores taken from unused deceased donor kidneys to develop a deep neural network that can accurately classify which portions of a biopsy core represent renal cortex vs non-cortex tissue, which may include renal medulla, perirenal fat, fibrous capsule, and non-renal tissue. In Phase II, we will extend these efforts using images taken from kidney biopsies received by Arkana to optimize the algorithmic assessment of adequacy and then use these results to develop a professional version of the smartphone application that will be available to all kidney biopsy practitioners using virtually any smartphone camera.

摘要该项目的目标是开发可以部署为智能手机的图像分析工具。 应用程序可帮助实时评估经皮肾活检 (PRB) 期间活检的充分性 PRB 仍然是诊断和治疗医学肾病患者的重要工具。 疾病，涉及使用活检枪从肾脏获取小针芯组织。 如果获得足够的肾皮质组织以满足进行活检的标准，则活检被认为是“充分的” 如果获得的组织不足，或者组织不包含肾皮质，则进行组织病理学诊断。 如果肾小球数量足够，则核心被认为“不足”。 在过去 15 年中，肾活检的比率 由于组织不足而不足以进行完整诊断已上升至 15%，代表着显着的流失 对医疗保健系统的影响，以及对必须重新活检或没有准确活检的患者的直接风险 理想情况下，可以在活检时通过检查所获得的岩心来评估其充分性。 这种实时评估使病理学家能够获得额外的信息。 如果现有核心被认为不足，则可以使用组织核心。 然而，资源限制明显。 随着活检的广泛采用，充分性评估的可用性受到限制。 智能手机，现在有机会通过宏观图像而不是显微镜来评估活检组织。 另一个步骤是将图像分析功能构建到智能手机上的应用程序中，从而使 活检医生获得可靠的即时反馈，了解他们收集的材料是否正确 最近一项针对 123,372 名当地人的研究表明，活检是否足够或是否“遗漏”，以及是否需要获取更多组织。 肾活检发现，PRB 的漏诊率从 2005 年的 2% 显着增加到 2020 年的 14%，很大程度上 归因于放射科医生越来越多地参与活检以及他们更喜欢较小的活检 肾活检漏检率的增加显着影响了患者的护理。 医学肾脏疾病的管理，并强调需要改进评估工具 在第一阶段，阿卡纳实验室在患者离开活检室之前收集的组织是否充足。 将与波士顿大学 Kolachalama 实验室合作，使用从未使用过的活检核心 已故捐赠肾脏开发一个深层神经网络，可以准确分类活检的哪些部分 核心代表肾皮质与非皮质组织，其中可能包括肾髓质、肾周脂肪、纤维囊、 在第二阶段，我们将使用从肾脏活检中获取的图像来扩展这些努力。 由 Arkana 优化充分性的算法评估，然后使用这些结果来开发 智能手机应用程序的专业版，可供所有肾活检医生使用 几乎任何智能手机相机。