The vast amount of data produced by today's medical imaging systems has led medical professionals to turn to novel technologies in order to efficiently handle their data and exploit the rich information present in them. In this context, artificial intelligence (AI) is emerging as one of the most prominent solutions, promising to revolutionise every day clinical practice and medical research. The pillar supporting the development of reliable and robust AI algorithms is the appropriate preparation of the medical images to be used by the AI-driven solutions. Here, we provide a comprehensive guide for the necessary steps to prepare medical images prior to developing or applying AI algorithms. The main steps involved in a typical medical image preparation pipeline include: (i) image acquisition at clinical sites, (ii) image de-identification to remove personal information and protect patient privacy, (iii) data curation to control for image and associated information quality, (iv) image storage, and (v) image annotation. There exists a plethora of open access tools to perform each of the aforementioned tasks and are hereby reviewed. Furthermore, we detail medical image repositories covering different organs and diseases. Such repositories are constantly increasing and enriched with the advent of big data. Lastly, we offer directions for future work in this rapidly evolving field.

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Computer-aided detection systems based on deep learning have shown good performance in breast cancer detection. However, high-density breasts show poorer detection performance since dense tissues can mask or even simulate masses. Therefore, the sensitivity of mammography for breast cancer detection can be reduced by more than 20% in dense breasts. Additionally, extremely dense cases reported an increased risk of cancer compared to low-density breasts. This study aims to improve the mass detection performance in high-density breasts using synthetic high-density full-field digital mammograms (FFDM) as data augmentation during breast mass detection model training. To this end, a total of five cycle-consistent GAN (CycleGAN) models using three FFDM datasets were trained for low-to-high-density image translation in high-resolution mammograms. The training images were split by breast density BI-RADS categories, being BI-RADS A almost entirely fatty and BI-RADS D extremely dense breasts. Our results showed that the proposed data augmentation technique improved the sensitivity and precision of mass detection in models trained with small datasets and improved the domain generalization of the models trained with large databases. In addition, the clinical realism of the synthetic images was evaluated in a reader study involving two expert radiologists and one surgical oncologist.

Despite technological and medical advances, the detection, interpretation, and treatment of cancer based on imaging data continue to pose significant challenges. These include high inter-observer variability, difficulty of small-sized lesion detection, nodule interpretation and malignancy determination, inter-and intra-tumour heterogeneity, class imbalance, segmentation inaccuracies, and treatment effect uncertainty. The recent advancements in Generative Adversarial Networks (GANs) in computer vision as well as in medical imaging may provide a basis for enhanced capabilities in cancer detection and analysis. In this review, we assess the potential of GANs to address a number of key challenges of cancer imaging, including data scarcity and imbalance, domain and dataset shifts, data access and privacy, data annotation and quantification, as well as cancer detection, tumour profiling and treatment planning. We provide a critical appraisal of the existing literature of GANs applied to cancer imagery, together with suggestions on future research directions to address these challenges. We analyse and discuss 163 papers that apply adversarial training techniques in the context of cancer imaging and elaborate their methodologies, advantages and limitations. With this work, we strive to bridge the gap between the needs of the clinical cancer imaging community and the current and prospective research on GANs in the artificial intelligence community.

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