AIDCOV: An Interpretable Artificial Intelligence Model for Detection of COVID-19 from Chest Radiography Images

Thorax computed tomography (CTX) guided ground truth annotation of CHEST radiographs (CXR) for improved classification and detection of COVID-19

Several data sets have been collected and various artificial intelligence models have been developed for COVID-19 classification and detection from both chest radiography (CXR) and thorax computed tomography (CTX) images. However, the pitfalls and shortcomings of these systems significantly limit their clinical use. In this respect, improving the weaknesses of advanced models can be very effective besides developing new ones. The inability to diagnose ground-glass opacities by conventional CXR has limited the use of this modality in the diagnostic work-up of COVID-19. In our study, we investigated whether we could increase the diagnostic efficiency by collecting a novel CXR data set, which contains pneumonic regions that are not visible to the experts and can only be annotated under CTX guidance. We develop an ensemble methodology of well-established deep CXR models for this new data set and develop a machine learning-based non-maximum suppression strategy to boost the performance for challenging CXR images. CTX and CXR images of 379 patients who applied to our hospital with suspected COVID-19 were evaluated with consensus by seven radiologists. Among these, CXR images of 161 patients who also have had a CTX examination on the same day or until the day before or after and whose CTX findings are compatible with COVID-19 pneumonia, are selected for annotating. CTX images are arranged in the main section passing through the anterior, middle, and posterior according to the sagittal plane with the reformed maximum intensity projection (MIP) method in the coronal plane. Based on the analysis of coronal MIP reconstructed CTX images, the regions corresponding to the pneumonia foci are annotated manually in CXR images. Radiologically classified posterior to anterior (PA) CXR of 218 patients with negative thorax CTX imaging were classified as COVID-19 pneumonia negative group. Accordingly, we have collected a new data set using anonymized CXR (JPEG) and CT (DICOM) images, where the PA CXRs contain pneumonic regions that are hidden or not easily recognized and annotated under CTX guidance. The reference finding was the presence of pneumonic infiltration consistent with COVID-19 on chest CTX examination. COVID-Net, a specially designed convolutional neural network, was used to detect cases of COVID-19 among CXRs. Diagnostic performances were evaluated by ROC analysis by applying six COVID-Net variants (COVIDNet-CXR3-A, -B, -C/COVIDNet-CXR4-A, -B, -C) to the defined data set and combining these models in various ways via ensemble strategies. Finally, a convex optimization strategy is carried out to find the outperforming weighted ensemble of individual models. The mean age of 161 patients with pneumonia was 49.31 ± 15.12, and the median age was 48 years. The mean age of 218 patients without signs of pneumonia in thorax CTX examination was 40.04 ± 14.46, and the median was 38. When working with different combinations of COVID-Net's six variants, the area under the curve (AUC) using the ensemble COVID-Net CXR 4A-4B-3C was .78, sensitivity 67%, specificity 95%; COVID-Net CXR 4a-3b-3c was .79, sensitivity 69% and specificity 94%. When diverse and complementary COVID-Net models are used together through an ensemble, it has been determined that the AUC values are close to other studies, and the specificity is significantly higher than other studies in the literature.

Explainable artificial intelligence (XAI) in radiology and nuclear medicine: a literature review

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.

Artificial Intelligence: A Next-Level Approach in Confronting the COVID-19 Pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which caused coronavirus diseases (COVID-19) in late 2019 in China created a devastating economical loss and loss of human lives. To date, 11 variants have been identified with minimum to maximum severity of infection and surges in cases. Bacterial co-infection/secondary infection is identified during viral respiratory infection, which is a vital reason for morbidity and mortality. The occurrence of secondary infections is an additional burden to the healthcare system; therefore, the quick diagnosis of both COVID-19 and secondary infections will reduce work pressure on healthcare workers. Therefore, well-established support from Artificial Intelligence (AI) could reduce the stress in healthcare and even help in creating novel products to defend against the coronavirus. AI is one of the rapidly growing fields with numerous applications for the healthcare sector. The present review aims to access the recent literature on the role of AI and how its subfamily machine learning (ML) and deep learning (DL) are used to curb the pandemic's effects. We discuss the role of AI in COVID-19 infections, the detection of secondary infections, technology-assisted protection from COVID-19, global laws and regulations on AI, and the impact of the pandemic on public life.

Artificial Intelligence-Assisted Chest X-ray for the Diagnosis of COVID-19: A Systematic Review and Meta-Analysis

Because it is an accessible and routine image test, medical personnel commonly use a chest X-ray for COVID-19 infections. Artificial intelligence (AI) is now widely applied to improve the precision of routine image tests. Hence, we investigated the clinical merit of the chest X-ray to detect COVID-19 when assisted by AI. We used PubMed, Cochrane Library, MedRxiv, ArXiv, and Embase to search for relevant research published between 1 January 2020 and 30 May 2022. We collected essays that dissected AI-based measures used for patients diagnosed with COVID-19 and excluded research lacking measurements using relevant parameters (i.e., sensitivity, specificity, and area under curve). Two independent researchers summarized the information, and discords were eliminated by consensus. A random effects model was used to calculate the pooled sensitivities and specificities. The sensitivity of the included research studies was enhanced by eliminating research with possible heterogeneity. A summary receiver operating characteristic curve (SROC) was generated to investigate the diagnostic value for detecting COVID-19 patients. Nine studies were recruited in this analysis, including 39,603 subjects. The pooled sensitivity and specificity were estimated as 0.9472 (p = 0.0338, 95% CI 0.9009-0.9959) and 0.9610 (p < 0.0001, 95% CI 0.9428-0.9795), respectively. The area under the SROC was 0.98 (95% CI 0.94-1.00). The heterogeneity of diagnostic odds ratio was presented in the recruited studies (I² = 36.212, p = 0.129). The AI-assisted chest X-ray scan for COVID-19 detection offered excellent diagnostic potential and broader application.

In Search of an Efficient and Reliable Deep Learning Model for Identification of COVID-19 Infection from Chest X-ray Images

The virus responsible for COVID-19 is mutating day by day with more infectious characteristics. With the limited healthcare resources and overburdened medical practitioners, it is almost impossible to contain this virus. The automatic identification of this viral infection from chest X-ray (CXR) images is now more demanding as it is a cheaper and less time-consuming diagnosis option. To that cause, we have applied deep learning (DL) approaches for four-class classification of CXR images comprising COVID-19, normal, lung opacity, and viral pneumonia. At first, we extracted features of CXR images by applying a local binary pattern (LBP) and pre-trained convolutional neural network (CNN). Afterwards, we utilized a pattern recognition network (PRN), support vector machine (SVM), decision tree (DT), random forest (RF), and k-nearest neighbors (KNN) classifiers on the extracted features to classify aforementioned four-class CXR images. The performances of the proposed methods have been analyzed rigorously in terms of classification performance and classification speed. Among different methods applied to the four-class test images, the best method achieved classification performances with 97.41% accuracy, 94.94% precision, 94.81% recall, 98.27% specificity, and 94.86% F1 score. The results indicate that the proposed method can offer an efficient and reliable framework for COVID-19 detection from CXR images, which could be immensely conducive to the effective diagnosis of COVID-19-infected patients.

COVIDAL: A machine learning classifier for digital COVID-19 diagnosis in German hospitals

For the fight against the COVID-19 pandemic, it is particularly important to map the course of infection, in terms of patients who have currently tested SARS-CoV-2 positive, as accurately as possible. In hospitals, this is even more important because resources have become scarce. Although polymerase chain reaction (PCR) and point of care (POC) antigen testing capacities have been massively expanded, they are often very time-consuming and cost-intensive and, in some cases, lack appropriate performance. To meet these challenges, we propose the COVIDAL classifier for AI-based diagnosis of symptomatic COVID-19 subjects in hospitals based on laboratory parameters. We evaluate the algorithm's performance by unique multicenter data with approx. 4,000 patients and an extraordinary high ratio of SARS-CoV-2 positive patients. We analyze the influence of data preparation, flexibility in optimization targets as well as the selection of the test set on the COVIDAL outcome. The algorithm is compared with standard AI, PCR, POC antigen testing and manual classifications of seven physicians by a decision theoretic scoring model including performance metrics, turnaround times and cost. Thereby, we define health care settings in which a certain classifier for COVID-19 diagnosis is to be applied. We find sensitivities, specificities and accuracies of the COVIDAL algorithm of up to 90 percent. Our scoring model suggests using PCR testing for a focus on performance metrics. For turnaround times, POC antigen testing should be used. If balancing performance, turnaround times and cost is of interest, as, for example, in the emergency department, COVIDAL is superior based on the scoring model.

Roadside Unit-Based Unknown Object Detection in Adverse Weather Conditions for Smart Internet of Vehicles

For Internet of Vehicles (IoV) applications, reliable autonomous driving systems usually perform the majority of their computations on the cloud due to the limited computing power of edge devices. The communication delay between cloud platforms and edge devices, however, can cause dangerous consequences, particularly for latency-sensitive object detection tasks. Object detection tasks are also vulnerable to significantly degraded model performance caused by unknown objects, which creates unsafe driving conditions. To address these problems, this study develops an orchestrated system that allows real-time object detection and incrementally learns unknown objects in a complex and dynamic environment. A YOLO-based object detection model in edge computing mode uses thermal images to detect objects accurately in poor lighting conditions. In addition, an attention mechanism improves the system’s performance without significantly increasing model complexity. An unknown object detector (UOD) automatically classifies and labels unknown objects without direct supervision on edge devices, while a roadside unit (RSU)-based mechanism is developed to update classes and ensure a secure driving experience for autonomous vehicles. Moreover, the interactions between edge devices, RSU servers, and the cloud are designed to allow efficient collaboration. The experimental results indicate that the proposed system learns uncategorized objects dynamically and detects instances accurately.

Examining Disease Multimorbidity in U.S. Hospital Visits Before and During COVID-19 Pandemic: A Graph Analytics Approach

Enduring effects of the COVID-19 pandemic on healthcare systems can be preempted by identifying patterns in diseases recorded in hospital visits over time. Disease multimorbidity or simultaneous occurrence of multiple diseases is a growing global public health challenge as populations age and long-term conditions become more prevalent. We propose a graph analytics framework for analyzing disease multimorbidity in hospital visits. Within the framework, we propose a graph model to explain multimorbidity as a function of prevalence, category, and chronic nature of the underlying disease. We apply our model to examine and compare multimorbidity patterns in public hospitals in Arizona, U.S., during five six-month time periods before and during the pandemic. We observe that while multimorbidity increased by 34.26% and 41.04% during peak pandemic for mental disorders and respiratory disorders respectively, the gradients for endocrine diseases and circulatory disorders were not significant. Multimorbidity for acute conditions is observed to be decreasing during the pandemic while multimorbidity for chronic conditions remains unchanged. Our graph analytics framework provides guidelines for empirical analysis of disease multimorbidity using electronic health records. The patterns identified using our proposed graph model informs future research and healthcare policy makers for pre-emptive decision making.

A Multi-Label Classification with An Adversarial-Based Denoising Autoencoder for Medical Image Annotation

Medical image annotation aims to automatically describe the content of medical images. It helps doctors to understand the content of medical image and make better informed decisions like diagnosis. Existing methods mainly follow the approach for natural images and fail to emphasize the object abnormalities, which is the essence of medical images annotation. In light of this, we propose to transform the medical image annotation to a multi-label classification problem, where object abnormalities are focused directly. However, extant multi-label classification studies rely on arduous feature engineering, or do not solve label correlation issues well in medical images. To solve these problems, we propose a novel deep learning model where a frequent pattern mining component and an adversarial-based denoising autoencoder component are introduced. Extensive experiments are conducted on a real retinal image dataset to evaluate the performance of the proposed model. Results indicate that the proposed model significantly outperforms image captioning baselines and multi-label classification baselines.

The role of artificial intelligence in plain chest radiographs interpretation during the Covid-19 pandemic

Artificial intelligence (AI) plays a crucial role in the future development of all healthcare sectors ranging from clinical assistance of physicians by providing accurate diagnosis, prognosis and treatment to the development of vaccinations and aiding in the combat against the Covid-19 global pandemic. AI has an important role in diagnostic radiology where the algorithms can be trained by large datasets to accurately provide a timely diagnosis of the radiological images given. This has led to the development of several AI algorithms that can be used in regions of scarcity of radiologists during the current pandemic by simply denoting the presence or absence of Covid-19 pneumonia in PCR positive patients on plain chest radiographs as well as in helping to levitate the over-burdened radiology departments by accelerating the time for report delivery. Plain chest radiography is the most common radiological study in the emergency department setting and is readily available, fast and a cheap method that can be used in triaging patients as well as being portable in the medical wards and can be used as the initial radiological examination in Covid-19 positive patients to detect pneumonic changes. Numerous studies have been done comparing several AI algorithms to that of experienced thoracic radiologists in plain chest radiograph reports measuring accuracy of each in Covid-19 patients. The majority of studies have reported performance equal or higher to that of the well-experienced thoracic radiologist in predicting the presence or absence of Covid-19 pneumonic changes in the provided chest radiographs.

A Literature Review on the Use of Artificial Intelligence for the Diagnosis of COVID-19 on CT and Chest X-ray

A COVID-19 diagnosis is primarily determined by RT-PCR or rapid lateral-flow testing, although chest imaging has been shown to detect manifestations of the virus. This article reviews the role of imaging (CT and X-ray), in the diagnosis of COVID-19, focusing on the published studies that have applied artificial intelligence with the purpose of detecting COVID-19 or reaching a differential diagnosis between various respiratory infections. In this study, ArXiv, MedRxiv, PubMed, and Google Scholar were searched for studies using the criteria terms ‘deep learning’, ‘artificial intelligence’, ‘medical imaging’, ‘COVID-19’ and ‘SARS-CoV-2’. The identified studies were assessed using a modified version of the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD). Twenty studies fulfilled the inclusion criteria for this review. Out of those selected, 11 papers evaluated the use of artificial intelligence (AI) for chest X-ray and 12 for CT. The size of datasets ranged from 239 to 19,250 images, with sensitivities, specificities and AUCs ranging from 0.789–1.00, 0.843–1.00 and 0.850–1.00. While AI demonstrates excellent diagnostic potential, broader application of this method is hindered by the lack of relevant comparators in studies, sufficiently sized datasets, and independent testing.