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Kanwal K, Asif M, Khalid SG, Liu H, Qurashi AG, Abdullah S. Current Diagnostic Techniques for Pneumonia: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:4291. [PMID: 39001069 PMCID: PMC11244398 DOI: 10.3390/s24134291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/22/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024]
Abstract
Community-acquired pneumonia is one of the most lethal infectious diseases, especially for infants and the elderly. Given the variety of causative agents, the accurate early detection of pneumonia is an active research area. To the best of our knowledge, scoping reviews on diagnostic techniques for pneumonia are lacking. In this scoping review, three major electronic databases were searched and the resulting research was screened. We categorized these diagnostic techniques into four classes (i.e., lab-based methods, imaging-based techniques, acoustic-based techniques, and physiological-measurement-based techniques) and summarized their recent applications. Major research has been skewed towards imaging-based techniques, especially after COVID-19. Currently, chest X-rays and blood tests are the most common tools in the clinical setting to establish a diagnosis; however, there is a need to look for safe, non-invasive, and more rapid techniques for diagnosis. Recently, some non-invasive techniques based on wearable sensors achieved reasonable diagnostic accuracy that could open a new chapter for future applications. Consequently, further research and technology development are still needed for pneumonia diagnosis using non-invasive physiological parameters to attain a better point of care for pneumonia patients.
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Affiliation(s)
- Kehkashan Kanwal
- College of Speech, Language, and Hearing Sciences, Ziauddin University, Karachi 75000, Pakistan
| | - Muhammad Asif
- Faculty of Computing and Applied Sciences, Sir Syed University of Engineering and Technology, Karachi 75300, Pakistan
| | - Syed Ghufran Khalid
- Department of Engineering, Faculty of Science and Technology, Nottingham Trent University, Nottingham B15 3TN, UK
| | - Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry CV1 5FB, UK
| | | | - Saad Abdullah
- School of Innovation, Design and Engineering, Mälardalen University, 721 23 Västerås, Sweden
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Chavoshi M, Zamani S, Mirshahvalad SA. Diagnostic performance of deep learning models versus radiologists in COVID-19 pneumonia: A systematic review and meta-analysis. Clin Imaging 2024; 107:110092. [PMID: 38301371 DOI: 10.1016/j.clinimag.2024.110092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Although several studies have compared the performance of deep learning (DL) models and radiologists for the diagnosis of COVID-19 pneumonia on CT of the chest, these results have not been collectively evaluated. We performed a meta-analysis of original articles comparing the performance of DL models versus radiologists in detecting COVID-19 pneumonia. METHODS A systematic search was conducted on the three main medical literature databases, Scopus, Web of Science, and PubMed, for articles published as of February 1st, 2023. We included original scientific articles that compared DL models trained to detect COVID-19 pneumonia on CT to radiologists. Meta-analysis was performed to determine DL versus radiologist performance in terms of model sensitivity and specificity, taking into account inter and intra-study heterogeneity. RESULTS Twenty-two articles met the inclusion criteria. Based on the meta-analytic calculations, DL models had significantly higher pooled sensitivity (0.933 vs. 0.829, p < 0.001) compared to radiologists with similar pooled specificity (0.905 vs. 0.897, p = 0.746). In the differentiation of COVID-19 versus community-acquired pneumonia, the DL models had significantly higher sensitivity compared to radiologists (0.915 vs. 0.836, p = 0.001). CONCLUSIONS DL models have high performance for screening of COVID-19 pneumonia on chest CT, offering the possibility of these models for augmenting radiologists in clinical practice.
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Affiliation(s)
- Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Zamani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Ali Mirshahvalad
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada.
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3
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Champendal M, Müller H, Prior JO, Dos Reis CS. A scoping review of interpretability and explainability concerning artificial intelligence methods in medical imaging. Eur J Radiol 2023; 169:111159. [PMID: 37976760 DOI: 10.1016/j.ejrad.2023.111159] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/26/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To review eXplainable Artificial Intelligence/(XAI) methods available for medical imaging/(MI). METHOD A scoping review was conducted following the Joanna Briggs Institute's methodology. The search was performed on Pubmed, Embase, Cinhal, Web of Science, BioRxiv, MedRxiv, and Google Scholar. Studies published in French and English after 2017 were included. Keyword combinations and descriptors related to explainability, and MI modalities were employed. Two independent reviewers screened abstracts, titles and full text, resolving differences through discussion. RESULTS 228 studies met the criteria. XAI publications are increasing, targeting MRI (n = 73), radiography (n = 47), CT (n = 46). Lung (n = 82) and brain (n = 74) pathologies, Covid-19 (n = 48), Alzheimer's disease (n = 25), brain tumors (n = 15) are the main pathologies explained. Explanations are presented visually (n = 186), numerically (n = 67), rule-based (n = 11), textually (n = 11), and example-based (n = 6). Commonly explained tasks include classification (n = 89), prediction (n = 47), diagnosis (n = 39), detection (n = 29), segmentation (n = 13), and image quality improvement (n = 6). The most frequently provided explanations were local (78.1 %), 5.7 % were global, and 16.2 % combined both local and global approaches. Post-hoc approaches were predominantly employed. The used terminology varied, sometimes indistinctively using explainable (n = 207), interpretable (n = 187), understandable (n = 112), transparent (n = 61), reliable (n = 31), and intelligible (n = 3). CONCLUSION The number of XAI publications in medical imaging is increasing, primarily focusing on applying XAI techniques to MRI, CT, and radiography for classifying and predicting lung and brain pathologies. Visual and numerical output formats are predominantly used. Terminology standardisation remains a challenge, as terms like "explainable" and "interpretable" are sometimes being used indistinctively. Future XAI development should consider user needs and perspectives.
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Affiliation(s)
- Mélanie Champendal
- School of Health Sciences HESAV, HES-SO, University of Applied Sciences Western Switzerland, Lausanne, CH, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, CH, Switzerland.
| | - Henning Müller
- Informatics Institute, University of Applied Sciences Western Switzerland (HES-SO Valais) Sierre, CH, Switzerland; Medical faculty, University of Geneva, CH, Switzerland.
| | - John O Prior
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, CH, Switzerland; Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital (CHUV), Lausanne, CH, Switzerland.
| | - Cláudia Sá Dos Reis
- School of Health Sciences HESAV, HES-SO, University of Applied Sciences Western Switzerland, Lausanne, CH, Switzerland.
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4
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Henao JAG, Depotter A, Bower DV, Bajercius H, Todorova PT, Saint-James H, de Mortanges AP, Barroso MC, He J, Yang J, You C, Staib LH, Gange C, Ledda RE, Caminiti C, Silva M, Cortopassi IO, Dela Cruz CS, Hautz W, Bonel HM, Sverzellati N, Duncan JS, Reyes M, Poellinger A. A Multiclass Radiomics Method-Based WHO Severity Scale for Improving COVID-19 Patient Assessment and Disease Characterization From CT Scans. Invest Radiol 2023; 58:882-893. [PMID: 37493348 PMCID: PMC10662611 DOI: 10.1097/rli.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/26/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the severity of COVID-19 patients' disease by comparing a multiclass lung lesion model to a single-class lung lesion model and radiologists' assessments in chest computed tomography scans. MATERIALS AND METHODS The proposed method, AssessNet-19, was developed in 2 stages in this retrospective study. Four COVID-19-induced tissue lesions were manually segmented to train a 2D-U-Net network for a multiclass segmentation task followed by extensive extraction of radiomic features from the lung lesions. LASSO regression was used to reduce the feature set, and the XGBoost algorithm was trained to classify disease severity based on the World Health Organization Clinical Progression Scale. The model was evaluated using 2 multicenter cohorts: a development cohort of 145 COVID-19-positive patients from 3 centers to train and test the severity prediction model using manually segmented lung lesions. In addition, an evaluation set of 90 COVID-19-positive patients was collected from 2 centers to evaluate AssessNet-19 in a fully automated fashion. RESULTS AssessNet-19 achieved an F1-score of 0.76 ± 0.02 for severity classification in the evaluation set, which was superior to the 3 expert thoracic radiologists (F1 = 0.63 ± 0.02) and the single-class lesion segmentation model (F1 = 0.64 ± 0.02). In addition, AssessNet-19 automated multiclass lesion segmentation obtained a mean Dice score of 0.70 for ground-glass opacity, 0.68 for consolidation, 0.65 for pleural effusion, and 0.30 for band-like structures compared with ground truth. Moreover, it achieved a high agreement with radiologists for quantifying disease extent with Cohen κ of 0.94, 0.92, and 0.95. CONCLUSIONS A novel artificial intelligence multiclass radiomics model including 4 lung lesions to assess disease severity based on the World Health Organization Clinical Progression Scale more accurately determines the severity of COVID-19 patients than a single-class model and radiologists' assessment.
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Khanna NN, Singh M, Maindarkar M, Kumar A, Johri AM, Mentella L, Laird JR, Paraskevas KI, Ruzsa Z, Singh N, Kalra MK, Fernandes JFE, Chaturvedi S, Nicolaides A, Rathore V, Singh I, Teji JS, Al-Maini M, Isenovic ER, Viswanathan V, Khanna P, Fouda MM, Saba L, Suri JS. Polygenic Risk Score for Cardiovascular Diseases in Artificial Intelligence Paradigm: A Review. J Korean Med Sci 2023; 38:e395. [PMID: 38013648 PMCID: PMC10681845 DOI: 10.3346/jkms.2023.38.e395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/15/2023] [Indexed: 11/29/2023] Open
Abstract
Cardiovascular disease (CVD) related mortality and morbidity heavily strain society. The relationship between external risk factors and our genetics have not been well established. It is widely acknowledged that environmental influence and individual behaviours play a significant role in CVD vulnerability, leading to the development of polygenic risk scores (PRS). We employed the PRISMA search method to locate pertinent research and literature to extensively review artificial intelligence (AI)-based PRS models for CVD risk prediction. Furthermore, we analyzed and compared conventional vs. AI-based solutions for PRS. We summarized the recent advances in our understanding of the use of AI-based PRS for risk prediction of CVD. Our study proposes three hypotheses: i) Multiple genetic variations and risk factors can be incorporated into AI-based PRS to improve the accuracy of CVD risk predicting. ii) AI-based PRS for CVD circumvents the drawbacks of conventional PRS calculators by incorporating a larger variety of genetic and non-genetic components, allowing for more precise and individualised risk estimations. iii) Using AI approaches, it is possible to significantly reduce the dimensionality of huge genomic datasets, resulting in more accurate and effective disease risk prediction models. Our study highlighted that the AI-PRS model outperformed traditional PRS calculators in predicting CVD risk. Furthermore, using AI-based methods to calculate PRS may increase the precision of risk predictions for CVD and have significant ramifications for individualized prevention and treatment plans.
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Affiliation(s)
- Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
- Asia Pacific Vascular Society, New Delhi, India
| | - Manasvi Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
- Bennett University, Greater Noida, India
| | - Mahesh Maindarkar
- Asia Pacific Vascular Society, New Delhi, India
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
- School of Bioengineering Sciences and Research, Maharashtra Institute of Technology's Art, Design and Technology University, Pune, India
| | | | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Canada
| | - Laura Mentella
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Canada
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St. Helena, CA, USA
| | | | - Zoltan Ruzsa
- Invasive Cardiology Division, University of Szeged, Szeged, Hungary
| | - Narpinder Singh
- Department of Food Science and Technology, Graphic Era Deemed to be University, Dehradun, Uttarakhand, India
| | | | | | - Seemant Chaturvedi
- Department of Neurology & Stroke Program, University of Maryland, Baltimore, MD, USA
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, Cyprus
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, USA
| | - Inder Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | - Jagjit S Teji
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mostafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON, Canada
| | - Esma R Isenovic
- Department of Radiobiology and Molecular Genetics, National Institute of The Republic of Serbia, University of Belgrade, Beograd, Serbia
| | | | - Puneet Khanna
- Department of Anaesthesiology, AIIMS, New Delhi, India
| | - Mostafa M Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | - Jasjit S Suri
- Asia Pacific Vascular Society, New Delhi, India
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
- Department of Computer Engineering, Graphic Era Deemed to be University, Dehradun, India.
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Zia T, Wahab A, Windridge D, Tirunagari S, Bhatti NB. Visual attribution using Adversarial Latent Transformations. Comput Biol Med 2023; 166:107521. [PMID: 37778213 DOI: 10.1016/j.compbiomed.2023.107521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/02/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
The ability to accurately locate all indicators of disease within medical images is vital for comprehending the effects of the disease, as well as for weakly-supervised segmentation and localization of the diagnostic correlators of disease. Existing methods either use classifiers to make predictions based on class-salient regions or else use adversarial learning based image-to-image translation to capture such disease effects. However, the former does not capture all relevant features for visual attribution (VA) and are prone to data biases; the latter can generate adversarial (misleading) and inefficient solutions when dealing in pixel values. To address this issue, we propose a novel approach Visual Attribution using Adversarial Latent Transformations (VA2LT). Our method uses adversarial learning to generate counterfactual (CF) normal images from abnormal images by finding and modifying discrepancies in the latent space. We use cycle consistency between the query and CF latent representations to guide our training. We evaluate our method on three datasets including a synthetic dataset, the Alzheimer's Disease Neuroimaging Initiative dataset, and the BraTS dataset. Our method outperforms baseline and related methods on all datasets.
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Affiliation(s)
- Tehseen Zia
- COMSATS University Islamabad, Pakistan; Medical Imaging and Diagnostics Lab, National Center of Artificial Intelligence, Pakistan.
| | - Abdul Wahab
- COMSATS University Islamabad, Pakistan; Medical Imaging and Diagnostics Lab, National Center of Artificial Intelligence, Pakistan
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Chu WT, Reza SMS, Anibal JT, Landa A, Crozier I, Bağci U, Wood BJ, Solomon J. Artificial Intelligence and Infectious Disease Imaging. J Infect Dis 2023; 228:S322-S336. [PMID: 37788501 PMCID: PMC10547369 DOI: 10.1093/infdis/jiad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/06/2023] [Indexed: 10/05/2023] Open
Abstract
The mass production of the graphics processing unit and the coronavirus disease 2019 (COVID-19) pandemic have provided the means and the motivation, respectively, for rapid developments in artificial intelligence (AI) and medical imaging techniques. This has led to new opportunities to improve patient care but also new challenges that must be overcome before these techniques are put into practice. In particular, early AI models reported high performances but failed to perform as well on new data. However, these mistakes motivated further innovation focused on developing models that were not only accurate but also stable and generalizable to new data. The recent developments in AI in response to the COVID-19 pandemic will reap future dividends by facilitating, expediting, and informing other medical AI applications and educating the broad academic audience on the topic. Furthermore, AI research on imaging animal models of infectious diseases offers a unique problem space that can fill in evidence gaps that exist in clinical infectious disease research. Here, we aim to provide a focused assessment of the AI techniques leveraged in the infectious disease imaging research space, highlight the unique challenges, and discuss burgeoning solutions.
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Affiliation(s)
- Winston T Chu
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Syed M S Reza
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - James T Anibal
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam Landa
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Ian Crozier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Ulaş Bağci
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeffrey Solomon
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA
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8
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Shin HJ, Kim MH, Son NH, Han K, Kim EK, Kim YC, Park YS, Lee EH, Kyong T. Clinical Implication and Prognostic Value of Artificial-Intelligence-Based Results of Chest Radiographs for Assessing Clinical Outcomes of COVID-19 Patients. Diagnostics (Basel) 2023; 13:2090. [PMID: 37370985 DOI: 10.3390/diagnostics13122090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to investigate the clinical implications and prognostic value of artificial intelligence (AI)-based results for chest radiographs (CXR) in coronavirus disease 2019 (COVID-19) patients. Patients who were admitted due to COVID-19 from September 2021 to March 2022 were retrospectively included. A commercial AI-based software was used to assess CXR data for consolidation and pleural effusion scores. Clinical data, including laboratory results, were analyzed for possible prognostic factors. Total O2 supply period, the last SpO2 result, and deterioration were evaluated as prognostic indicators of treatment outcome. Generalized linear mixed model and regression tests were used to examine the prognostic value of CXR results. Among a total of 228 patients (mean 59.9 ± 18.8 years old), consolidation scores had a significant association with erythrocyte sedimentation rate and C-reactive protein changes, and initial consolidation scores were associated with the last SpO2 result (estimate -0.018, p = 0.024). All consolidation scores during admission showed significant association with the total O2 supply period and the last SpO2 result. Early changing degree of consolidation score showed an association with deterioration (odds ratio 1.017, 95% confidence interval 1.005-1.03). In conclusion, AI-based CXR results for consolidation have potential prognostic value for predicting treatment outcomes in COVID-19 patients.
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Affiliation(s)
- Hyun Joo Shin
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16995, Republic of Korea
- Center for Digital Health, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16995, Republic of Korea
| | - Min Hyung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16995, Republic of Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Daegu 42601, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16995, Republic of Korea
| | - Yong Chan Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16995, Republic of Korea
| | - Yoon Soo Park
- Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16995, Republic of Korea
| | - Eun Hye Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16995, Republic of Korea
| | - Taeyoung Kyong
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16995, Republic of Korea
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de Vries BM, Zwezerijnen GJC, Burchell GL, van Velden FHP, Menke-van der Houven van Oordt CW, Boellaard R. Explainable artificial intelligence (XAI) in radiology and nuclear medicine: a literature review. Front Med (Lausanne) 2023; 10:1180773. [PMID: 37250654 PMCID: PMC10213317 DOI: 10.3389/fmed.2023.1180773] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
Rational Deep learning (DL) has demonstrated a remarkable performance in diagnostic imaging for various diseases and modalities and therefore has a high potential to be used as a clinical tool. However, current practice shows low deployment of these algorithms in clinical practice, because DL algorithms lack transparency and trust due to their underlying black-box mechanism. For successful employment, explainable artificial intelligence (XAI) could be introduced to close the gap between the medical professionals and the DL algorithms. In this literature review, XAI methods available for magnetic resonance (MR), computed tomography (CT), and positron emission tomography (PET) imaging are discussed and future suggestions are made. Methods PubMed, Embase.com and Clarivate Analytics/Web of Science Core Collection were screened. Articles were considered eligible for inclusion if XAI was used (and well described) to describe the behavior of a DL model used in MR, CT and PET imaging. Results A total of 75 articles were included of which 54 and 17 articles described post and ad hoc XAI methods, respectively, and 4 articles described both XAI methods. Major variations in performance is seen between the methods. Overall, post hoc XAI lacks the ability to provide class-discriminative and target-specific explanation. Ad hoc XAI seems to tackle this because of its intrinsic ability to explain. However, quality control of the XAI methods is rarely applied and therefore systematic comparison between the methods is difficult. Conclusion There is currently no clear consensus on how XAI should be deployed in order to close the gap between medical professionals and DL algorithms for clinical implementation. We advocate for systematic technical and clinical quality assessment of XAI methods. Also, to ensure end-to-end unbiased and safe integration of XAI in clinical workflow, (anatomical) data minimization and quality control methods should be included.
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Affiliation(s)
- Bart M. de Vries
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gerben J. C. Zwezerijnen
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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10
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Nazir S, Dickson DM, Akram MU. Survey of explainable artificial intelligence techniques for biomedical imaging with deep neural networks. Comput Biol Med 2023; 156:106668. [PMID: 36863192 DOI: 10.1016/j.compbiomed.2023.106668] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 01/12/2023] [Accepted: 02/10/2023] [Indexed: 02/21/2023]
Abstract
Artificial Intelligence (AI) techniques of deep learning have revolutionized the disease diagnosis with their outstanding image classification performance. In spite of the outstanding results, the widespread adoption of these techniques in clinical practice is still taking place at a moderate pace. One of the major hindrance is that a trained Deep Neural Networks (DNN) model provides a prediction, but questions about why and how that prediction was made remain unanswered. This linkage is of utmost importance for the regulated healthcare domain to increase the trust in the automated diagnosis system by the practitioners, patients and other stakeholders. The application of deep learning for medical imaging has to be interpreted with caution due to the health and safety concerns similar to blame attribution in the case of an accident involving autonomous cars. The consequences of both a false positive and false negative cases are far reaching for patients' welfare and cannot be ignored. This is exacerbated by the fact that the state-of-the-art deep learning algorithms comprise of complex interconnected structures, millions of parameters, and a 'black box' nature, offering little understanding of their inner working unlike the traditional machine learning algorithms. Explainable AI (XAI) techniques help to understand model predictions which help develop trust in the system, accelerate the disease diagnosis, and meet adherence to regulatory requirements. This survey provides a comprehensive review of the promising field of XAI for biomedical imaging diagnostics. We also provide a categorization of the XAI techniques, discuss the open challenges, and provide future directions for XAI which would be of interest to clinicians, regulators and model developers.
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Affiliation(s)
- Sajid Nazir
- Department of Computing, Glasgow Caledonian University, Glasgow, UK.
| | - Diane M Dickson
- Department of Podiatry and Radiography, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
| | - Muhammad Usman Akram
- Computer and Software Engineering Department, National University of Sciences and Technology, Islamabad, Pakistan
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Rivera AJ, Muñoz JC, Pérez-Goody MD, de San Pedro BS, Charte F, Elizondo D, Rodríguez C, Abolafia ML, Perea A, Del Jesus MJ. XAIRE: An ensemble-based methodology for determining the relative importance of variables in regression tasks. Application to a hospital emergency department. Artif Intell Med 2023; 137:102494. [PMID: 36868688 DOI: 10.1016/j.artmed.2023.102494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
Nowadays it is increasingly important in many applications to understand how different factors influence a variable of interest in a predictive modeling process. This task becomes particularly important in the context of Explainable Artificial Intelligence. Knowing the relative impact of each variable on the output allows us to acquire more information about the problem and about the output provided by a model. This paper proposes a new methodology, XAIRE, that determines the relative importance of input variables in a prediction environment, considering multiple prediction models in order to increase generality and avoid bias inherent in a particular learning algorithm. Concretely, we present an ensemble-based methodology that promotes the aggregation of results from several prediction methods to obtain a relative importance ranking. Also, statistical tests are considered in the methodology in order to reveal significant differences between the relative importance of the predictor variables. As a case study, XAIRE is applied to the arrival of patients in a Hospital Emergency Department, which has resulted in one of the largest sets of different predictor variables in the literature. Results show the extracted knowledge related to the relative importance of the predictors involved in the case study.
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Affiliation(s)
- A J Rivera
- Computer Science Department, University of Jaén, Spain.
| | - J Cobo Muñoz
- Emergency Department, University Hospital of Jaén, Spain.
| | | | | | - F Charte
- Computer Science Department, University of Jaén, Spain.
| | - D Elizondo
- Department of Computer Science and Informatics, De Montfort University, UK.
| | - C Rodríguez
- Emergency Department, University Hospital of Jaén, Spain.
| | - M L Abolafia
- Emergency Department, University Hospital of Jaén, Spain.
| | - A Perea
- Emergency Department, University Hospital of Jaén, Spain.
| | - M J Del Jesus
- Computer Science Department, University of Jaén, Spain.
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12
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Niranjan K, Shankar Kumar S, Vedanth S, Chitrakala DS. An Explainable AI driven Decision Support System for COVID-19 Diagnosis using Fused Classification and Segmentation. PROCEDIA COMPUTER SCIENCE 2023; 218:1915-1925. [PMID: 36743792 PMCID: PMC9886321 DOI: 10.1016/j.procs.2023.01.168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The coronavirus has caused havoc on billions of people worldwide. The Reverse Transcription Polymerase Chain Reaction(RT-PCR) test is widely accepted as a standard diagnostic tool for detecting infection, however, the severity of infection can't be measured accurately with RT-PCR results. Chest CT Scans of infected patients can manifest the presence of lesions with high sensitivity. During the pandemic, there is a dearth of competent doctors to examine chest CT images. Therefore, a Guided Gradcam based Explainable Classification and Segmentation system (GGECS) which is a real-time explainable classification and lesion identification decision support system is proposed in this work. The classification model used in the proposed GGECS system is inspired by Res2Net. Explainable AI techniques like GradCam and Guided GradCam are used to demystify Convolutional Neural Networks (CNNs). These explainable systems can assist in localizing the regions in the CT scan that contribute significantly to the system's prediction. The segmentation model can further reliably localize infected regions. The segmentation model is a fusion between the VGG-16 and the classification network. The proposed classification model in GGECS obtains an overall accuracy of 98.51 % and the segmentation model achieves an IoU score of 0.595.
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Affiliation(s)
- K Niranjan
- Computer Science and Engineering, College of Engineering Guindy, Anna University, Chennai, India
| | - S Shankar Kumar
- Computer Science and Engineering, College of Engineering Guindy, Anna University, Chennai, India
| | - S Vedanth
- Computer Science and Engineering, College of Engineering Guindy, Anna University, Chennai, India
| | - Dr. S. Chitrakala
- Computer Science and Engineering, College of Engineering Guindy, Anna University, Chennai, India
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13
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Farahani FV, Fiok K, Lahijanian B, Karwowski W, Douglas PK. Explainable AI: A review of applications to neuroimaging data. Front Neurosci 2022; 16:906290. [PMID: 36583102 PMCID: PMC9793854 DOI: 10.3389/fnins.2022.906290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
Deep neural networks (DNNs) have transformed the field of computer vision and currently constitute some of the best models for representations learned via hierarchical processing in the human brain. In medical imaging, these models have shown human-level performance and even higher in the early diagnosis of a wide range of diseases. However, the goal is often not only to accurately predict group membership or diagnose but also to provide explanations that support the model decision in a context that a human can readily interpret. The limited transparency has hindered the adoption of DNN algorithms across many domains. Numerous explainable artificial intelligence (XAI) techniques have been developed to peer inside the "black box" and make sense of DNN models, taking somewhat divergent approaches. Here, we suggest that these methods may be considered in light of the interpretation goal, including functional or mechanistic interpretations, developing archetypal class instances, or assessing the relevance of certain features or mappings on a trained model in a post-hoc capacity. We then focus on reviewing recent applications of post-hoc relevance techniques as applied to neuroimaging data. Moreover, this article suggests a method for comparing the reliability of XAI methods, especially in deep neural networks, along with their advantages and pitfalls.
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Affiliation(s)
- Farzad V. Farahani
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, United States
- Department of Industrial Engineering and Management Systems, University of Central Florida, Orlando, FL, United States
| | - Krzysztof Fiok
- Department of Industrial Engineering and Management Systems, University of Central Florida, Orlando, FL, United States
| | - Behshad Lahijanian
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, United States
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Waldemar Karwowski
- Department of Industrial Engineering and Management Systems, University of Central Florida, Orlando, FL, United States
| | - Pamela K. Douglas
- School of Modeling, Simulation, and Training, University of Central Florida, Orlando, FL, United States
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14
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Hassan MM, AlQahtani SA, Alelaiwi A, Papa JP. Explaining COVID-19 diagnosis with Taylor decompositions. Neural Comput Appl 2022; 35:1-14. [PMID: 36415284 PMCID: PMC9672580 DOI: 10.1007/s00521-022-08021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022]
Abstract
The COVID-19 pandemic has devastated the entire globe since its first appearance at the end of 2019. Although vaccines are now in production, the number of contaminations remains high, thus increasing the number of specialized personnel that can analyze clinical exams and points out the final diagnosis. Computed tomography and X-ray images are the primary sources for computer-aided COVID-19 diagnosis, but we still lack better interpretability of such automated decision-making mechanisms. This manuscript presents an insightful comparison of three approaches based on explainable artificial intelligence (XAI) to light up interpretability in the context of COVID-19 diagnosis using deep networks: Composite Layer-wise Propagation, Single Taylor Decomposition, and Deep Taylor Decomposition. Two deep networks have been used as the backbones to assess the explanation skills of the XAI approaches mentioned above: VGG11 and VGG16. We hope that such work can be used as a basis for further research on XAI and COVID-19 diagnosis for each approach figures its own positive and negative points.
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Affiliation(s)
- Mohammad Mehedi Hassan
- College of Computer and Information Sciences, King Saud University, Riyadh, 11543 Saudi Arabia
| | - Salman A. AlQahtani
- College of Computer and Information Sciences, King Saud University, Riyadh, 11543 Saudi Arabia
| | - Abdulhameed Alelaiwi
- College of Computer and Information Sciences, King Saud University, Riyadh, 11543 Saudi Arabia
| | - João P. Papa
- Department of Computing, São Paulo State University, Bauru, Brazil
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15
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Combi C, Amico B, Bellazzi R, Holzinger A, Moore JH, Zitnik M, Holmes JH. A manifesto on explainability for artificial intelligence in medicine. Artif Intell Med 2022; 133:102423. [PMID: 36328669 DOI: 10.1016/j.artmed.2022.102423] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 12/13/2022]
Abstract
The rapid increase of interest in, and use of, artificial intelligence (AI) in computer applications has raised a parallel concern about its ability (or lack thereof) to provide understandable, or explainable, output to users. This concern is especially legitimate in biomedical contexts, where patient safety is of paramount importance. This position paper brings together seven researchers working in the field with different roles and perspectives, to explore in depth the concept of explainable AI, or XAI, offering a functional definition and conceptual framework or model that can be used when considering XAI. This is followed by a series of desiderata for attaining explainability in AI, each of which touches upon a key domain in biomedicine.
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Affiliation(s)
| | | | | | | | - Jason H Moore
- Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Marinka Zitnik
- Harvard Medical School and Broad Institute of MIT & Harvard, MA, USA
| | - John H Holmes
- University of Pennsylvania Perelman School of Medicine Philadelphia, PA, USA
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16
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COVID-19 Classification from Chest X-Ray Images: A Framework of Deep Explainable Artificial Intelligence. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4254631. [PMID: 35845911 PMCID: PMC9284325 DOI: 10.1155/2022/4254631] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
COVID-19 detection and classification using chest X-ray images is a current hot research topic based on the important application known as medical image analysis. To halt the spread of COVID-19, it is critical to identify the infection as soon as possible. Due to time constraints and the expertise of radiologists, manually diagnosing this infection from chest X-ray images is a difficult and time-consuming process. Artificial intelligence techniques have had a significant impact on medical image analysis and have also introduced several techniques for COVID-19 diagnosis. Deep learning and explainable AI have shown significant popularity among AL techniques for COVID-19 detection and classification. In this work, we propose a deep learning and explainable AI technique for the diagnosis and classification of COVID-19 using chest X-ray images. Initially, a hybrid contrast enhancement technique is proposed and applied to the original images that are later utilized for the training of two modified deep learning models. The deep transfer learning concept is selected for the training of pretrained modified models that are later employed for feature extraction. Features of both deep models are fused using improved canonical correlation analysis that is further optimized using a hybrid algorithm named Whale-Elephant Herding. Through this algorithm, the best features are selected and classified using an extreme learning machine (ELM). Moreover, the modified deep models are utilized for Grad-CAM visualization. The experimental process was conducted on three publicly available datasets and achieved accuracies of 99.1, 98.2, and 96.7%, respectively. Moreover, the ablation study was performed and showed that the proposed accuracy is better than the other methods.
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17
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Bacciu D, Girardi E, Maratea M, Sousa J. AI & COVID-19. INTELLIGENZA ARTIFICIALE 2022. [DOI: 10.3233/ia-210121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The COVID-19 pandemic has influenced our lives significantly since March 2020, and a number of initiatives have been put forward in order to tackle its effects, including those focused on technological solutions. In this paper, we present one of such initiatives, i.e. the CLAIRE’s taskforce on AI and COVID-19, in which Artificial Intelligence methodologies and tools are being developed to help the society contrasting the pandemic. We present the different lines of development within the taskforce, some fields in which they are used, and draw few recommendations.
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Affiliation(s)
| | | | | | - Jose Sousa
- SANO-Centre for Computational Medicine, Krakow, Poland
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18
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Mansour RF, Escorcia-Gutierrez J, Gamarra M, Gupta D, Castillo O, Kumar S. Unsupervised Deep Learning based Variational Autoencoder Model for COVID-19 Diagnosis and Classification. Pattern Recognit Lett 2021; 151:267-274. [PMID: 34566223 PMCID: PMC8455283 DOI: 10.1016/j.patrec.2021.08.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/24/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
At present times, COVID-19 has become a global illness and infected people has increased exponentially and it is difficult to control due to the non-availability of large quantity of testing kits. Artificial intelligence (AI) techniques including machine learning (ML), deep learning (DL), and computer vision (CV) approaches find useful for the recognition, analysis, and prediction of COVID-19. Several ML and DL techniques are trained to resolve the supervised learning issue. At the same time, the potential measure of the unsupervised learning technique is quite high. Therefore, unsupervised learning techniques can be designed in the existing DL models for proficient COVID-19 prediction. In this view, this paper introduces a novel unsupervised DL based variational autoencoder (UDL-VAE) model for COVID-19 detection and classification. The UDL-VAE model involved adaptive Wiener filtering (AWF) based preprocessing technique to enhance the image quality. Besides, Inception v4 with Adagrad technique is employed as a feature extractor and unsupervised VAE model is applied for the classification process. In order to verify the superior diagnostic performance of the UDL-VAE model, a set of experimentation was carried out to highlight the effective outcome of the UDL-VAE model. The obtained experimental values showcased the effectual results of the UDL-VAE model with the higher accuracy of 0.987 and 0.992 on the binary and multiple classes respectively.
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Affiliation(s)
- Romany F Mansour
- Department of Mathematics, Faculty of Science, New Valley University, El-Kharga 72511, Egypt
| | - José Escorcia-Gutierrez
- Electronic and telecommunications program, Universidad Autónoma del Caribe, Barranquilla, Colombia
| | - Margarita Gamarra
- Department of Computational Science and Electronic, Universidad de la Costa, CUC, Barranquilla, Colombia
| | - Deepak Gupta
- Department of Computer Science & Engineering, Maharaja Agrasen Institute of Technology, Delhi, India
| | | | - Sachin Kumar
- Department of Computer Science, South Ural State University, Chelyabinsk, Russian Federation
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