A hybrid diagnosis model for determining the types of the liver disease

Liver Disease Detection – Evaluation of Machine Learning Algorithms Performances with Optimal Thresholds

Intelligent predictive systems are showing a greater level of accuracy and effectiveness in early detection of critical diseases like cancer and liver and lung disease.Predictive models assist medical practitioners in identifying the diseases based on symptoms and health indicators like hormone,enzymes,age,bloodcounts,etc.This study proposes a framework to use classification models to accurately detect chronic liver disease by enhancing the prediction accuracy through cutting-edge analytics techniques.The article proposes an enhanced framework on the original study by Ramana et al. (2011).It uses evaluation measures like Precision and Balanced Accuracy to choose the most efficient classification algorithm in INDIA and USA patient datasets using various factors like enzymes,age,etc.Using Youden’s Index, individual thresholds for each model were identified to increase the power of sensitivity and specificity.A framework is proposed for highly accurate automated disease detection in the medical industry,and it helps in strategizing preventive measures for patients with liver diseases.

An Explainable Artificial Intelligence Framework for the Deterioration Risk Prediction of Hepatitis Patients

In recent years, artificial intelligence-based computer aided diagnosis (CAD) system for the hepatitis has made great progress. Especially, the complex models such as deep learning achieve better performance than the simple ones due to the nonlinear hypotheses of the real world clinical data. However,complex model as a black box, which ignores why it make a certain decision, causes the model distrust from clinicians. To solve these issues, an explainable artificial intelligence (XAI) framework is proposed in this paper to give the global and local interpretation of auxiliary diagnosis of hepatitis while retaining the good prediction performance. First, a public hepatitis classification benchmark from UCI is used to test the feasibility of the framework. Then, the transparent and black-box machine learning models are both employed to forecast the hepatitis deterioration. The transparent models such as logistic regression (LR), decision tree (DT)and k-nearest neighbor (KNN) are picked. While the black-box model such as the eXtreme Gradient Boosting (XGBoost), support vector machine (SVM), random forests (RF) are selected. Finally, the SHapley Additive exPlanations (SHAP), Local Interpretable Model-agnostic Explanations (LIME) and Partial Dependence Plots (PDP) are utilized to improve the model interpretation of liver disease. The experimental results show that the complex models outperform the simple ones. The developed RF achieves the highest accuracy (91.9%) among all the models. The proposed framework combining the global and local interpretable methods improves the transparency of complex models, and gets insight into the judgments from the complex models, thereby guiding the treatment strategy and improving the prognosis of hepatitis patients. In addition, the proposed framework could also assist the clinical data scientists to design a more appropriate structure of CAD.

AN IMPROVED GREY WOLF OPTIMIZATION-BASED LEARNING OF ARTIFICIAL NEURAL NETWORK FOR MEDICAL DATA CLASSIFICATION

Grey wolf optimization (GWO) is a recent and popular swarm-based metaheuristic approach. It has been used in numerous fields such as numerical optimization, engineering problems, and machine learning. The different variants of GWO have been developed in the last 5 years for solving optimization problems in diverse fields. Like other metaheuristic algorithms, GWO also suffers from local optima and slow convergence problems, resulted in degraded performance. An adequate equilibrium among exploration and exploitation is a key factor to the success of meta-heuristic algorithms especially for optimization task. In this paper, a new variant of GWO, called inertia motivated GWO (IMGWO) is proposed. The aim of IMGWO is to establish better balance between exploration and exploitation. Traditionally, artificial neural network (ANN) with backpropagation (BP) depends on initial values and in turn, attains poor convergence. The metaheuristic approaches are better alternative instead of BP. The proposed IMGWO is used to train the ANN to prove its competency in terms of prediction. The proposed IMGWO-ANN is used for medical diagnosis task. Some benchmark medical datasets including heart disease, breast cancer, hepatitis, and parkinson's diseases are used for assessing the performance of IMGWO-ANN. The performance measures are described in terms of mean squared errors (MSEs), classification accuracies, sensitivities, specificities, the area under the curve (AUC), and receiver operating characteristic (ROC) curve. It is found that IMGWO outperforms than three popular metaheuristic approaches including GWO, genetic algorithm (GA), and particle swarm optimization (PSO). Results confirmed the potency of IMGWO as a viable learning technique for an ANN.

Development of an artificial intelligence diagnostic model based on dynamic uncertain causality graph for the differential diagnosis of dyspnea

Dyspnea is one of the most common manifestations of patients with pulmonary disease, myocardial dysfunction, and neuromuscular disorder, among other conditions. Identifying the causes of dyspnea in clinical practice, especially for the general practitioner, remains a challenge. This pilot study aimed to develop a computer-aided tool for improving the efficiency of differential diagnosis. The disease set with dyspnea as the chief complaint was established on the basis of clinical experience and epidemiological data. Differential diagnosis approaches were established and optimized by clinical experts. The artificial intelligence (AI) diagnosis model was constructed according to the dynamic uncertain causality graph knowledge-based editor. Twenty-eight diseases and syndromes were included in the disease set. The model contained 132 variables of symptoms, signs, and serological and imaging parameters. Medical records from the electronic hospital records of Suining Central Hospital were randomly selected. A total of 202 discharged patients with dyspnea as the chief complaint were included for verification, in which the diagnoses of 195 cases were coincident with the record certified as correct. The overall diagnostic accuracy rate of the model was 96.5%. In conclusion, the diagnostic accuracy of the AI model is promising and may compensate for the limitation of medical experience.

A Real-world Evaluation of a Case-based Reasoning Algorithm to Support Antimicrobial Prescribing Decisions in Acute Care

Background

A locally developed case-based reasoning (CBR) algorithm, designed to augment antimicrobial prescribing in secondary care was evaluated.

Methods

Prescribing recommendations made by a CBR algorithm were compared to decisions made by physicians in clinical practice. Comparisons were examined in 2 patient populations: first, in patients with confirmed Escherichia coli blood stream infections (“E. coli patients”), and second in ward-based patients presenting with a range of potential infections (“ward patients”). Prescribing recommendations were compared against the Antimicrobial Spectrum Index (ASI) and the World Health Organization Essential Medicine List Access, Watch, Reserve (AWaRe) classification system. Appropriateness of a prescription was defined as the spectrum of the prescription covering the known or most-likely organism antimicrobial sensitivity profile.

Results

In total, 224 patients (145 E. coli patients and 79 ward patients) were included. Mean (standard deviation) age was 66 (18) years with 108/224 (48%) female sex. The CBR recommendations were appropriate in 202/224 (90%) compared to 186/224 (83%) in practice (odds ratio [OR]: 1.24 95% confidence interval [CI]: .392–3.936; P = .71). CBR recommendations had a smaller ASI compared to practice with a median (range) of 6 (0–13) compared to 8 (0–12) (P < .01). CBR recommendations were more likely to be classified as Access class antimicrobials compared to physicians’ prescriptions at 110/224 (49%) vs. 79/224 (35%) (OR: 1.77; 95% CI: 1.212–2.588; P < .01). Results were similar for E. coli and ward patients on subgroup analysis.

Conclusions

A CBR-driven decision support system provided appropriate recommendations within a narrower spectrum compared to current clinical practice. Future work must investigate the impact of this intervention on prescribing behaviors more broadly and patient outcomes.

Liver disease screening based on densely connected deep neural networks

Liver disease is an important public health problem. Liver Function Tests (LFT) is the most achievable test for liver disease diagnosis. Most liver diseases are manifested as abnormal LFT. Liver disease screening by LFT data is helpful for computer aided diagnosis. In this paper, we propose a densely connected deep neural network (DenseDNN), on 13 most commonly used LFT indicators and demographic information of subjects for liver disease screening. The algorithm was tested on a dataset of 76,914 samples (more than 100 times of data than the previous datasets). The Area Under Curve (AUC) of DenseDNN is 0.8919, that of DNN is 0.8867, that of random forest is 0.8790, and that of logistic regression is 0.7974. The performance of deep learning models are significantly better than conventional methods. As for the deep learning methods, DenseDNN shows better performance than DNN.

A New Intelligent Medical Decision Support System Based on Enhanced Hierarchical Clustering and Random Decision Forest for the Classification of Alcoholic Liver Damage, Primary Hepatoma, Liver Cirrhosis, and Cholelithiasis

Diagnosis of liver disease principally depends on physician's subjective knowledge. Automatic prediction of the disease is a critical real-world medical problem. This work presents an EHC-ERF-based intelligence-integrated model purposive to predict different types of liver disease including alcoholic liver damage, primary hepatoma, liver cirrhosis, and cholelithiasis. These diseases cause many clinical complications, and their accurate assessment is the only way for providing efficient treatment facilities to patients. EHC is deployed to divide the data into a hierarchy structure that is more informative for the disease predictions carried out by ERF. The occurrence of ERF error rate was dependent on correlation and strength of each individual tree where correlation is directly proportional to forest error rate and strength is inversely proportional to the forest rate. In total, two individual and three integrated classification models are developed to achieve enhanced predictions for the liver disease types. Analysis of results showed that the proposed framework achieved better outcomes in terms of accuracy, true positive rate, precision, F-measure, kappa statistic, mean absolute error, and root mean squared error. Furthermore, it achieved the highest accuracy rates when compared with the state-of-the-art techniques. Results also indicated that the weighted distance function employed in EHC has improved the efficiency of proposed system and has shown the capability to be used by physicians for diagnostic advice.

Application of Machine Learning Algorithms to a Well Defined Clinical Problem: Liver Disease

Liver diseases represent a major health burden worldwide. Machine learning (ML) algorithms have been extensively used to diagnose liver disease. This study accordingly aims to employ various individual and integrated ML algorithms on distinct liver disease datasets for evaluating the diagnostic performances, to integrate dimensionality reduction method with the ML algorithms for analyzing variation in results, to find the best classification model and to analyze the merits and demerits of these algorithms. KNN and PCA-KNN emerged to be the top individual and integrated models. The study also concluded that one specific algorithm can't show best results for all types of datasets and integrated models not always perform better than the individuals. It is observed that no algorithm is perfect and performance of an algorithm totally depends on the dataset type and structure, its number of observations, its dimensions and the decision boundary.

Computer-aided Characterization and Diagnosis of Diffuse Liver Diseases Based on Ultrasound Imaging: A Review

Diffuse liver diseases, such as hepatitis, fatty liver, and cirrhosis, are becoming a leading cause of fatality and disability all over the world. Early detection and diagnosis of these diseases is extremely important to save lives and improve effectiveness of treatment. Ultrasound imaging, a noninvasive diagnostic technique, is the most commonly used modality for examining liver abnormalities. However, the accuracy of ultrasound-based diagnosis depends highly on expertise of radiologists. Computer-aided diagnosis systems based on ultrasound imaging assist in fast diagnosis, provide a reliable "second opinion" for experts, and act as an effective tool to measure response of treatment on patients undergoing clinical trials. In this review, we first describe appearance of liver abnormalities in ultrasound images and state the practical issues encountered in characterization of diffuse liver diseases that can be addressed by software algorithms. We then discuss computer-aided diagnosis in general with features and classifiers relevant to diffuse liver diseases. In later sections of this paper, we review the published studies and describe the key findings of those studies. A concise tabular summary comparing image database, features extraction, feature selection, and classification algorithms presented in the published studies is also exhibited. Finally, we conclude with a summary of key findings and directions for further improvements in the areas of accuracy and objectiveness of computer-aided diagnosis.

Role of Soft Computing Approaches in HealthCare Domain: A Mini Review

In the present era, soft computing approaches play a vital role in solving the different kinds of problems and provide promising solutions. Due to popularity of soft computing approaches, these approaches have also been applied in healthcare data for effectively diagnosing the diseases and obtaining better results in comparison to traditional approaches. Soft computing approaches have the ability to adapt itself according to problem domain. Another aspect is a good balance between exploration and exploitation processes. These aspects make soft computing approaches more powerful, reliable and efficient. The above mentioned characteristics make the soft computing approaches more suitable and competent for health care data. The first objective of this review paper is to identify the various soft computing approaches which are used for diagnosing and predicting the diseases. Second objective is to identify various diseases for which these approaches are applied. Third objective is to categories the soft computing approaches for clinical support system. In literature, it is found that large number of soft computing approaches have been applied for effectively diagnosing and predicting the diseases from healthcare data. Some of these are particle swarm optimization, genetic algorithm, artificial neural network, support vector machine etc. A detailed discussion on these approaches are presented in literature section. This work summarizes various soft computing approaches used in healthcare domain in last one decade. These approaches are categorized in five different categories based on the methodology, these are classification model based system, expert system, fuzzy and neuro fuzzy system, rule based system and case based system. Lot of techniques are discussed in above mentioned categories and all discussed techniques are summarized in the form of tables also. This work also focuses on accuracy rate of soft computing technique and tabular information is provided for each category including author details, technique, disease and utility/accuracy.

Automated stratification of liver disease in ultrasound: An online accurate feature classification paradigm

PURPOSE

Fatty liver disease (FLD) is one of the most common diseases in liver. Early detection can improve the prognosis considerably. Using ultrasound for FLD detection is highly desirable due to its non-radiation nature, low cost and easy use. However, the results can be slow and ambiguous due to manual detection. The lack of computer trained systems leads to low image quality and inefficient disease classification. Thus, the current study proposes novel, accurate and reliable detection system for the FLD using computer-based training system.

MATERIALS AND METHODS

One hundred twenty-four ultrasound sample images were selected retrospectively from a database of 62 patients consisting of normal and cancerous. The proposed training system was generated offline parameters using training liver image database. The classifier applied transformation parameters to an online system in order to facilitate real-time detection during the ultrasound scan. The system utilized six sets of features (a total of 128 features), namely Haralick, basic geometric, Fourier transform, discrete cosine transform, Gupta transform and Gabor transform. These features were extracted for both offline training and online testing. Levenberg-Marquardt back propagation network (BPN) classifier was used to classify the liver disease into normal and abnormal categories.

RESULTS

Random partitioning approach was adapted to evaluate the classifier performance and compute its accuracy. Utilizing all the six sets of 128 features, the computer aided diagnosis (CAD) system achieved classification accuracy of 97.58%. Furthermore, the four performance metrics consisting of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) realized 98.08%, 97.22%, 96.23%, and 98.59%, respectively.

CONCLUSION

The proposed system was successfully able to detect and classify the FLD. Furthermore, the proposed system was benchmarked against previous methods. The comparison established an advanced set of features in the Levenberg-Marquardt back propagation network reports a significant improvement compared to the existing techniques.

Applying the Analytic Hierarchy Process in healthcare research: A systematic literature review and evaluation of reporting

Background

The Analytic Hierarchy Process (AHP), developed by Saaty in the late 1970s, is one of the methods for multi-criteria decision making. The AHP disaggregates a complex decision problem into different hierarchical levels. The weight for each criterion and alternative are judged in pairwise comparisons and priorities are calculated by the Eigenvector method. The slowly increasing application of the AHP was the motivation for this study to explore the current state of its methodology in the healthcare context.

Methods

A systematic literature review was conducted by searching the Pubmed and Web of Science databases for articles with the following keywords in their titles or abstracts: “Analytic Hierarchy Process,” “Analytical Hierarchy Process,” “multi-criteria decision analysis,” “multiple criteria decision,” “stated preference,” and “pairwise comparison.” In addition, we developed reporting criteria to indicate whether the authors reported important aspects and evaluated the resulting studies’ reporting.

Results

The systematic review resulted in 121 articles. The number of studies applying AHP has increased since 2005. Most studies were from Asia (almost 30 %), followed by the US (25.6 %). On average, the studies used 19.64 criteria throughout their hierarchical levels. Furthermore, we restricted a detailed analysis to those articles published within the last 5 years (n = 69). The mean of participants in these studies were 109, whereas we identified major differences in how the surveys were conducted. The evaluation of reporting showed that the mean of reported elements was about 6.75 out of 10. Thus, 12 out of 69 studies reported less than half of the criteria.

Conclusion

The AHP has been applied inconsistently in healthcare research. A minority of studies described all the relevant aspects. Thus, the statements in this review may be biased, as they are restricted to the information available in the papers. Hence, further research is required to discover who should be interviewed and how, how inconsistent answers should be dealt with, and how the outcome and stability of the results should be presented. In addition, we need new insights to determine which target group can best handle the challenges of the AHP.

The methodology of Dynamic Uncertain Causality Graph for intelligent diagnosis of vertigo

Vertigo is a common complaint with many potential causes involving otology, neurology and general medicine, and it is fairly difficult to distinguish the vertiginous disorders from each other accurately even for experienced physicians. Based on comprehensive investigations to relevant characteristics of vertigo, we propose a diagnostic modeling and reasoning methodology using Dynamic Uncertain Causality Graph. The symptoms, signs, findings of examinations, medical histories, etiology and pathogenesis, and so on, are incorporated in the diagnostic model. A modularized modeling scheme is presented to reduce the difficulty in model construction, providing multiple perspectives and arbitrary granularity for disease causality representations. We resort to the "chaining" inference algorithm and weighted logic operation mechanism, which guarantee the exactness and efficiency of diagnostic reasoning under situations of incomplete and uncertain information. Moreover, the causal insights into underlying interactions among diseases and symptoms intuitively demonstrate the reasoning process in a graphical manner. These solutions make the conclusions and advices more explicable and convincing, further increasing the objectivity of clinical decision-making. Verification experiments and empirical evaluations are performed with clinical vertigo cases. The results reveal that, even with incomplete observations, this methodology achieves encouraging diagnostic accuracy and effectiveness. This study provides a promising assistance tool for physicians in diagnosis of vertigo.

Artificial neural networks modeling gene-environment interaction

Background

Gene-environment interactions play an important role in the etiological pathway of complex diseases. An appropriate statistical method for handling a wide variety of complex situations involving interactions between variables is still lacking, especially when continuous variables are involved. The aim of this paper is to explore the ability of neural networks to model different structures of gene-environment interactions. A simulation study is set up to compare neural networks with standard logistic regression models. Eight different structures of gene-environment interactions are investigated. These structures are characterized by penetrance functions that are based on sigmoid functions or on combinations of linear and non-linear effects of a continuous environmental factor and a genetic factor with main effect or with a masking effect only.

Results

In our simulation study, neural networks are more successful in modeling gene-environment interactions than logistic regression models. This outperfomance is especially pronounced when modeling sigmoid penetrance functions, when distinguishing between linear and nonlinear components, and when modeling masking effects of the genetic factor.

Conclusion

Our study shows that neural networks are a promising approach for analyzing gene-environment interactions. Especially, if no prior knowledge of the correct nature of the relationship between co-variables and response variable is present, neural networks provide a valuable alternative to regression methods that are limited to the analysis of linearly separable data.

Case-based reasoning support for liver disease diagnosis

OBJECTIVES

In Taiwan, as well as in the other countries around the world, liver disease has reigned over the list of leading causes of mortality, and its resistance to early detection renders the disease even more threatening. It is therefore crucial to develop an auxiliary system for diagnosing liver disease so as to enhance the efficiency of medical diagnosis and to expedite the delivery of proper medical treatment.

METHODS

The study accordingly integrated the case-based reasoning (CBR) model into several common classification methods of data mining techniques, including back-propagation neural network (BPN), classification and regression tree, logistic regression, and discriminatory analysis, in an attempt to develop a more efficient model for early diagnosis of liver disease and to enhance classification accuracy. To minimize possible bias, this study used a ten-fold cross-validation to select a best model for more precise diagnosis results and to reduce problems caused by false diagnosis.

RESULTS

Through a comparison of five single models, BPN and CBR emerged to be the top two methods in terms of overall performance. For enhancing diagnosis performance, CBR was integrated with other methods, and the results indicated that the accuracy and sensitivity of each CBR-added hybrid model were higher than those of each single model. Of all the CBR-added hybrid models, the BPN-CBR method took the lead in terms of diagnosis capacity with an accuracy rate of 95%, a sensitivity of 98%, and a specificity of 94%.

CONCLUSIONS

After comparing the five single and hybrid models, the study found BPN-CBR the best model capable of helping physicians to determine the existence of liver disease, achieve an accurate diagnosis, diminish the possibility of a false diagnosis being given to sick people, and avoid the delay of clinical treatment.