MAY 20219In the field of gastroenterology, there has been increasing interest in using AI as an adjunctive detection method in endoscopyauthors reported that 1058 patients were randomized for CAD and standard colonoscopy and they reported the CAD assisted colonoscopy significantly increased ADR (29.1 percent vs 20.3 percent, p<0.001). The major goal of CAD for colonoscopy is to provide fully-automated polyp detection and characterization. CAD potentially alerts the endoscopists to the presence of polyps by outlining the polyp with a boundary box (Figure 1). In addition, CAD could provide accurate optical biopsy characterization of colorectal polyps, which could lead to a significant reduction in the number of unnecessary polypectomies of non-neoplastic polyps.Machine learning is a type of artificial intelligence that allows systems to automatically learn from data and improve performance without explicit instructions. Here are some examples of machine learning; a thermostat, which learns household temperature preferences over time, or an application, which learns to identify and discard spam emails. Earlier image-based CAD systems were constructed on traditional machine learning approaches that require human researchers to design significant image features, which would then create a trainable prediction algorithm. Currently, deep learning technique overcomes this issue by discovering the informative features in a trainable way that optimally represents the data for a specific task. Deep learning models trust on artificial neural networks, which are biologically inspired by the concept of central nervous system including neurons and synapsis in the human brain. To date, the best results have been achieved with a particular type of model known as convolutional neural networks (CNNs) within the field of image analysis, which comprises complex connections simulating the action of the human visual cortex, allowing learning of increasingly higher-level features. Currently, machine learning, and more specifically deep learning technique, has been widely applied in different tasks such as weather, security, gaming, and media. These approaches are now gaining exceptional interest and success with regards to medical imaging due to advances in the development of algorithms with increasing availability of enhanced computational power with graphics processing units and access to large sets of data. CAD assisted colonoscopy is no doubt an attractive option to standard colonoscopy, which is certainly imperfect due to human error. Endoscopic societies are anxious to report clinical trials of CAD assisted colonoscopy with the possibility of an impending revolution in endoscopy. On the other hand, we should keep in mind some concerns. First, the current evidence supporting the effectiveness of the CAD assisted colonoscopy is weak because of the limited quality of previously published study designs. Second, for now, there is no commercial CAD system currently in use, and its practical usefulness is still unknown. Therefore, high-quality randomized controlled clinical trials must be conducted to accumulate evidenced based data in the future. After these issues are properly addressed, the world of endoscopy may open the door to CAD assisted endoscopy. Figure 1: CAD assisted colonoscopy showing a diminutive polyp.Sahin Coban
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