Clinical evaluation of AI-assisted muscle ultrasound for monitoring muscle wasting in ICU patients
Phung Tran Huy Nhat, Nguyen Van Chuc, Lam Minh Yen, Nguyễn Hoàng Ánh, Dong Phu Khiem, Hamideh Kerdegari, Le Thanh Phuong, Vo Tan Hoang, Nguyễn Thanh Ngọc, Le Ngoc Minh Thu, Truong Ngoc Trung, Luigi Pisani, Liane S. Canas, Alberto Gómez, Hamideh Kerdegari, Andrew P. King, Marc Modat, Reza Razavi, Miguel Xochicale, Dang Phuong Thao, Dang Trung Kien, Doan Bui Xuan Thy, Dong Huu Khanh Trinh, Du Hong Duc, Ronald B. Geskus, Ho Bich Hai, Ho Quang Chanh, Ho Van Hien, Huynh Trung Trieu, Evelyne Kestelyn, Le Dinh Van Khoa, Le Thuy Thuy Khanh, Luu Hoai Bao Tran, An Phuoc Luu, Angela McBride, Nguyen Lam Vuong, Nguyễn Quang Huy, Nguyen Than Ha Quyen, Nguyen Thi Giang, Nguyen Thi Diem Trinh, Nguyen Thi Le Thanh, Nguyễn Thị Phương Dung, Nguyễn Thị Phương Thảo, Ninh Thi Thanh Van, Pham Tieu Kieu, Phan Nguyen Quoc Khanh, Phung Khanh Lam, Guy Thwaites, Louise Thwaites, Duc Minh Tran, Trinh Manh Hung, Hugo C. Turner, Jennifer Ilo Van Nuil, Vu Ngo Thanh Huyen, Sophie Yacoub, Cao Thi Tam, Duong Bich Thuy, Ha Thi Hai Duong, Ho Dang Trung Nghia, Le Buu Chau, Le Mau Toan, Le Ngoc Minh Thu, Le Thi Mai Thao, Luong Thi Hue Tai, Nguyen Hoan Phu, Nguyễn Quốc Việt, Nguyen Thanh Dung, Nguyen Thanh Nguyen, Nguyễn Thanh Phong, Nguyễn Thị Kim Ánh, Nguyen Van Chuc, Nguyen Van Thanh Duoc, Pham Kieu Nguyet Oanh, Phan Thi Van, Phan Tu Qui, Phan Vinh Tho, Truong Thi Phuong Thao, Luigi Pisani, Marcus J. Schultz, Natasha Ali, David A. Clifton, Mike English, Jannis Hagenah, Ping Lü, Jacob McKnight, Chris Paton, Tingting Zhu, Linda Denehy, Thomas Rollinson, Pantelis Georgiou, Bernard Hernandez Perez, Kerri Hill-Cawthorne, Alison Holmes, Štefan Karolčík, Damien Ming, Nicolas Moser, Jesús Rodríguez-Manzano, Walter Karlen, Reza Razavi, Sophie Yacoub
Abstract
Muscle ultrasound has been shown to be a valid and safe imaging modality to assess muscle wasting in critically ill patients in the intensive care unit (ICU). This typically involves manual delineation to measure the rectus femoris cross-sectional area (RFCSA), which is a subjective, time-consuming, and laborious task that requires significant expertise. We aimed to develop and evaluate an AI tool that performs automated recognition and measurement of RFCSA to support non-expert operators in measurement of the RFCSA using muscle ultrasound. Twenty patients were recruited between Feb 2023 and July 2023 and were randomized sequentially to operators using AI (n = 10) or non-AI (n = 10). Muscle loss during ICU stay was similar for both methods: 26 ± 15% for AI and 23 ± 11% for the non-AI, respectively (p = 0.13). In total 59 ultrasound examinations were carried out (30 without AI and 29 with AI). When assisted by our AI tool, the operators showed less variability between measurements with higher intraclass correlation coefficients (ICCs 0.999 95% CI 0.998-0.999 vs. 0.982 95% CI 0.962-0.993) and lower Bland Altman limits of agreement (± 1.9% vs. ± 6.6%) compared to not using the AI tool. The time spent on scans reduced significantly from a median of 19.6 min (IQR 16.9-21.7) to 9.4 min (IQR 7.2-11.7) compared to when using the AI tool (p < 0.001). AI-assisted muscle ultrasound removes the need for manual tracing, increases reproducibility and saves time. This system may aid monitoring muscle size in ICU patients assisting rehabilitation programmes.