Lung segmentation on standard and mobile chest radiographs using oriented Gaussian derivatives filter

Computer-aided diagnosis using embedded ensemble deep learning for multiclass drug-resistant tuberculosis classification

Introduction

This study aims to develop a web application, TB-DRD-CXR, for the categorization of tuberculosis (TB) patients into subgroups based on their level of drug resistance. The application utilizes an ensemble deep learning model that classifies TB strains into five subtypes: drug sensitive tuberculosis (DS-TB), drug resistant TB (DR-TB), multidrug-resistant TB (MDR-TB), pre-extensively drug-resistant TB (pre-XDR-TB), and extensively drug-resistant TB (XDR-TB).

Methods

The ensemble deep learning model employed in the TB-DRD-CXR web application incorporates novel fusion techniques, image segmentation, data augmentation, and various learning rate strategies. The performance of the proposed model is compared with state-of-the-art techniques and standard homogeneous CNN architectures documented in the literature.

Results

Computational results indicate that the suggested method outperforms existing methods reported in the literature, providing a 4.0%-33.9% increase in accuracy. Moreover, the proposed model demonstrates superior performance compared to standard CNN models, including DenseNet201, NASNetMobile, EfficientNetB7, EfficientNetV2B3, EfficientNetV2M, and ConvNeXtSmall, with accuracy improvements of 28.8%, 93.4%, 2.99%, 48.0%, 4.4%, and 7.6% respectively.

Conclusion

The TB-DRD-CXR web application was developed and tested with 33 medical staff. The computational results showed a high accuracy rate of 96.7%, time-based efficiency (ET) of 4.16 goals/minutes, and an overall relative efficiency (ORE) of 100%. The system usability scale (SUS) score of the proposed application is 96.7%, indicating user satisfaction and a likelihood of recommending the TB-DRD-CXR application to others based on previous literature.

A deep learning based dual encoder-decoder framework for anatomical structure segmentation in chest X-ray images

Automated multi-organ segmentation plays an essential part in the computer-aided diagnostic (CAD) of chest X-ray fluoroscopy. However, developing a CAD system for the anatomical structure segmentation remains challenging due to several indistinct structures, variations in the anatomical structure shape among different individuals, the presence of medical tools, such as pacemakers and catheters, and various artifacts in the chest radiographic images. In this paper, we propose a robust deep learning segmentation framework for the anatomical structure in chest radiographs that utilizes a dual encoder-decoder convolutional neural network (CNN). The first network in the dual encoder-decoder structure effectively utilizes a pre-trained VGG19 as an encoder for the segmentation task. The pre-trained encoder output is fed into the squeeze-and-excitation (SE) to boost the network's representation power, which enables it to perform dynamic channel-wise feature calibrations. The calibrated features are efficiently passed into the first decoder to generate the mask. We integrated the generated mask with the input image and passed it through a second encoder-decoder network with the recurrent residual blocks and an attention the gate module to capture the additional contextual features and improve the segmentation of the smaller regions. Three public chest X-ray datasets are used to evaluate the proposed method for multi-organs segmentation, such as the heart, lungs, and clavicles, and single-organ segmentation, which include only lungs. The results from the experiment show that our proposed technique outperformed the existing multi-class and single-class segmentation methods.

Research on the Application of Artificial Intelligence in Public Health Management: Leveraging Artificial Intelligence to Improve COVID-19 CT Image Diagnosis

Since the start of 2020, the outbreak of the Coronavirus disease (COVID-19) has been a global public health emergency, and it has caused unprecedented economic and social disaster. In order to improve the diagnosis efficiency of COVID-19 patients, a number of researchers have conducted extensive studies on applying artificial intelligence techniques to the analysis of COVID-19-related medical images. The automatic segmentation of lesions from computed tomography (CT) images using deep learning provides an important basis for the quantification and diagnosis of COVID-19 cases. For a deep learning-based CT diagnostic method, a few of accurate pixel-level labels are essential for the training process of a model. However, the translucent ground-glass area of the lesion usually leads to mislabeling while performing the manual labeling operation, which weakens the accuracy of the model. In this work, we propose a method for correcting rough labels; that is, to hierarchize these rough labels into precise ones by performing an analysis on the pixel distribution of the infected and normal areas in the lung. The proposed method corrects the incorrectly labeled pixels and enables the deep learning model to learn the infected degree of each infected pixel, with which an aiding system (named DLShelper) for COVID-19 CT image diagnosis using the hierarchical labels is also proposed. The DLShelper targets lesion segmentation from CT images, as well as the severity grading. The DLShelper assists medical staff in efficient diagnosis by providing rich auxiliary diagnostic information (including the severity grade, the proportions of the lesion and the visualization of the lesion area). A comprehensive experiment based on a public COVID-19 CT image dataset is also conducted, and the experimental results show that the DLShelper significantly improves the accuracy of segmentation for the lesion areas and also achieves a promising accuracy for the severity grading task.

A Patient-Specific Algorithm for Lung Segmentation in Chest Radiographs

Lung segmentation plays an important role in computer-aided detection and diagnosis using chest radiographs (CRs). Currently, the U-Net and DeepLabv3+ convolutional neural network architectures are widely used to perform CR lung segmentation. To boost performance, ensemble methods are often used, whereby probability map outputs from several networks operating on the same input image are averaged. However, not all networks perform adequately for any specific patient image, even if the average network performance is good. To address this, we present a novel multi-network ensemble method that employs a selector network. The selector network evaluates the segmentation outputs from several networks; on a case-by-case basis, it selects which outputs are fused to form the final segmentation for that patient. Our candidate lung segmentation networks include U-Net, with five different encoder depths, and DeepLabv3+, with two different backbone networks (ResNet50 and ResNet18). Our selector network is a ResNet18 image classifier. We perform all training using the publicly available Shenzhen CR dataset. Performance testing is carried out with two independent publicly available CR datasets, namely, Montgomery County (MC) and Japanese Society of Radiological Technology (JSRT). Intersection-over-Union scores for the proposed approach are 13% higher than the standard averaging ensemble method on MC and 5% better on JSRT.

CardioNet: Automatic Semantic Segmentation to Calculate the Cardiothoracic Ratio for Cardiomegaly and Other Chest Diseases

Semantic segmentation for diagnosing chest-related diseases like cardiomegaly, emphysema, pleural effusions, and pneumothorax is a critical yet understudied tool for identifying the chest anatomy. A dangerous disease among these is cardiomegaly, in which sudden death is a high risk. An expert medical practitioner can diagnose cardiomegaly early using a chest radiograph (CXR). Cardiomegaly is a heart enlargement disease that can be analyzed by calculating the transverse cardiac diameter (TCD) and the cardiothoracic ratio (CTR). However, the manual estimation of CTR and other chest-related diseases requires much time from medical experts. Based on their anatomical semantics, artificial intelligence estimates cardiomegaly and related diseases by segmenting CXRs. Unfortunately, due to poor-quality images and variations in intensity, the automatic segmentation of the lungs and heart with CXRs is challenging. Deep learning-based methods are being used to identify the chest anatomy segmentation, but most of them only consider the lung segmentation, requiring a great deal of training. This work is based on a multiclass concatenation-based automatic semantic segmentation network, CardioNet, that was explicitly designed to perform fine segmentation using fewer parameters than a conventional deep learning scheme. Furthermore, the semantic segmentation of other chest-related diseases is diagnosed using CardioNet. CardioNet is evaluated using the JSRT dataset (Japanese Society of Radiological Technology). The JSRT dataset is publicly available and contains multiclass segmentation of the heart, lungs, and clavicle bones. In addition, our study examined lung segmentation using another publicly available dataset, Montgomery County (MC). The experimental results of the proposed CardioNet model achieved acceptable accuracy and competitive results across all datasets.

Anatomic Point-Based Lung Region with Zone Identification for Radiologist Annotation and Machine Learning for Chest Radiographs

Our objective is to investigate the reliability and usefulness of anatomic point-based lung zone segmentation on chest radiographs (CXRs) as a reference standard framework and to evaluate the accuracy of automated point placement. Two hundred frontal CXRs were presented to two radiologists who identified five anatomic points: two at the lung apices, one at the top of the aortic arch, and two at the costophrenic angles. Of these 1000 anatomic points, 161 (16.1%) were obscured (mostly by pleural effusions). Observer variations were investigated. Eight anatomic zones then were automatically generated from the manually placed anatomic points, and a prototype algorithm was developed using the point-based lung zone segmentation to detect cardiomegaly and levels of diaphragm and pleural effusions. A trained U-Net neural network was used to automatically place these five points within 379 CXRs of an independent database. Intra- and inter-observer variation in mean distance between corresponding anatomic points was larger for obscured points (8.7 mm and 20 mm, respectively) than for visible points (4.3 mm and 7.6 mm, respectively). The computer algorithm using the point-based lung zone segmentation could diagnostically measure the cardiothoracic ratio and diaphragm position or pleural effusion. The mean distance between corresponding points placed by the radiologist and by the neural network was 6.2 mm. The network identified 95% of the radiologist-indicated points with only 3% of network-identified points being false-positives. In conclusion, a reliable anatomic point-based lung segmentation method for CXRs has been developed with expected utility for establishing reference standards for machine learning applications.

Extreme Learning Machine based Differentiation of Pulmonary Tuberculosis in Chest Radiographs using Integrated Local Feature Descriptors

BACKGROUND AND OBJECTIVE

Computer aided diagnostics of Pulmonary Tuberculosis in chest radiographs relies on the differentiation of subtle and non-specific alterations in the images. In this study, an attempt has been made to identify and classify Tuberculosis conditions from healthy subjects in chest radiographs using integrated local feature descriptors and variants of extreme learning machine.

METHODS

Lung fields in the chest images are segmented using Reaction Diffusion Level Set method. Local feature descriptors such as Median Robust Extended Local Binary Patterns and Gradient Local Ternary Patterns are extracted. Extreme Learning Machine (ELM) and Online Sequential ELM (OSELM) classifiers are employed to identify Tuberculosis conditions and, their performances are analysed using standard metrics.

RESULTS

Results show that the adopted segmentation method is able to delineate lung fields in both healthy and Tuberculosis images. Extracted features are statistically significant even in images with inter and intra subject variability. Sigmoid activation function yields accuracy and sensitivity values greater than 98% for both the classifiers. Highest sensitivity is observed with OSELM for minimal significant features in detecting Tuberculosis images.

CONCLUSION

As ELM based method is able to differentiate the subtle changes in inter and intra subject variations of chest X-ray images, the proposed methodology seems to be useful for computer-based detection of Pulmonary Tuberculosis.

Artificial Intelligence-Based Diagnosis of Cardiac and Related Diseases

Automatic chest anatomy segmentation plays a key role in computer-aided disease diagnosis, such as for cardiomegaly, pleural effusion, emphysema, and pneumothorax. Among these diseases, cardiomegaly is considered a perilous disease, involving a high risk of sudden cardiac death. It can be diagnosed early by an expert medical practitioner using a chest X-Ray (CXR) analysis. The cardiothoracic ratio (CTR) and transverse cardiac diameter (TCD) are the clinical criteria used to estimate the heart size for diagnosing cardiomegaly. Manual estimation of CTR and other diseases is a time-consuming process and requires significant work by the medical expert. Cardiomegaly and related diseases can be automatically estimated by accurate anatomical semantic segmentation of CXRs using artificial intelligence. Automatic segmentation of the lungs and heart from the CXRs is considered an intensive task owing to inferior quality images and intensity variations using nonideal imaging conditions. Although there are a few deep learning-based techniques for chest anatomy segmentation, most of them only consider single class lung segmentation with deep complex architectures that require a lot of trainable parameters. To address these issues, this study presents two multiclass residual mesh-based CXR segmentation networks, X-RayNet-1 and X-RayNet-2, which are specifically designed to provide fine segmentation performance with a few trainable parameters compared to conventional deep learning schemes. The proposed methods utilize semantic segmentation to support the diagnostic procedure of related diseases. To evaluate X-RayNet-1 and X-RayNet-2, experiments were performed with a publicly available Japanese Society of Radiological Technology (JSRT) dataset for multiclass segmentation of the lungs, heart, and clavicle bones; two other publicly available datasets, Montgomery County (MC) and Shenzhen X-Ray sets (SC), were evaluated for lung segmentation. The experimental results showed that X-RayNet-1 achieved fine performance for all datasets and X-RayNet-2 achieved competitive performance with a 75% parameter reduction.

Development of Rheumatoid Arthritis Classification from Electronic Image Sensor Using Ensemble Method

Rheumatoid arthritis (RA) is an autoimmune illness that impacts the musculoskeletal system by causing chronic, inflammatory, and systemic effects. The disease often becomes progressive and reduces physical function, causes suffering, fatigue, and articular damage. Over a long period of time, RA causes harm to the bone and cartilage of the joints, weakens the joints' muscles and tendons, eventually causing joint destruction. Sensors such as accelerometer, wearable sensors, and thermal infrared camera sensor are widely used to gather data for RA. In this paper, the classification of medical disorders based on RA and orthopaedics datasets using Ensemble methods are discussed. The RA dataset was gathered from the analysis of white blood cell classification using features extracted from the image of lymphocytes acquired from a digital microscope with an electronic image sensor. The orthopaedic dataset is a benchmark dataset for this study, as it posed a similar classification problem with several numerical features. Three ensemble algorithms such as bagging, Adaboost, and random subspace were used in the study. These ensemble classifiers use k-NN (K-nearest neighbours) and Random forest (RF) as the base learners of the ensemble classifiers. The data classification is accessed using holdout and 10-fold cross-validation evaluation methods. The assessment was based on set of performance measures such as precision, recall, F-measure, and receiver operating characteristic (ROC) curve. The performance was also measured based on the comparison of the overall classification accuracy rate between different ensembles classifiers and the base learners. Overall, it was found that for Dataset 1, random subspace classifier with k-NN shows the best results in terms of overall accuracy rate of 97.50% and for Dataset 2, bagging-RF shows the highest overall accuracy rate of 94.84% over different ensemble classifiers. The findings indicate that the efficiency of the base classifiers with ensemble classifier have substantially improved.

A review on lung boundary detection in chest X-rays

PURPOSE

Chest radiography is the most common imaging modality for pulmonary diseases. Due to its wide usage, there is a rich literature addressing automated detection of cardiopulmonary diseases in digital chest X-rays (CXRs). One of the essential steps for automated analysis of CXRs is localizing the relevant region of interest, i.e., isolating lung region from other less relevant parts, for applying decision-making algorithms there. This article provides an overview of the recent literature on lung boundary detection in CXR images.

METHODS

We review the leading lung segmentation algorithms proposed in period 2006-2017. First, we present a review of articles for posterior-anterior view CXRs. Then, we mention studies which operate on lateral views. We pay particular attention to works that focus their efforts on deformed lungs and pediatric cases. We also highlight the radiographic measures extracted from lung boundary and their use in automatically detecting cardiopulmonary abnormalities. Finally, we identify challenges in dataset curation and expert delineation process, and we listed publicly available CXR datasets.

RESULTS

(1) We classified algorithms into four categories: rule-based, pixel classification-based, model-based, hybrid, and deep learning-based algorithms. Based on the reviewed articles, hybrid methods and deep learning-based methods surpass the algorithms in other classes and have segmentation performance as good as inter-observer performance. However, they require long training process and pose high computational complexity. (2) We found that most of the algorithms in the literature are evaluated on posterior-anterior view adult CXRs with a healthy lung anatomy appearance without considering challenges in abnormal CXRs. (3) We also found that there are limited studies for pediatric CXRs. The lung appearance in pediatrics, especially in infant cases, deviates from adult lung appearance due to the pediatric development stages. Moreover, pediatric CXRs are noisier than adult CXRs due to interference by other objects, such as someone holding the child's arms or the child's body, and irregular body pose. Therefore, lung boundary detection algorithms developed on adult CXRs may not perform accurately in pediatric cases and need additional constraints suitable for pediatric CXR imaging characteristics. (4) We have also stated that one of the main challenges in medical image analysis is accessing the suitable datasets. We listed benchmark CXR datasets for developing and evaluating the lung boundary algorithms. However, the number of CXR images with reference boundaries is limited due to the cumbersome but necessary process of expert boundary delineation.

CONCLUSIONS

A reliable computer-aided diagnosis system would need to support a greater variety of lung and background appearance. To our knowledge, algorithms in the literature are evaluated on posterior-anterior view adult CXRs with a healthy lung anatomy appearance, without considering ambiguous lung silhouettes due to pathological deformities, anatomical alterations due to misaligned body positioning, patient's development stage and gross background noises such as holding hands, jewelry, patient's head and legs in CXR. Considering all the challenges which are not very well addressed in the literature, developing lung boundary detection algorithms that are robust to such interference remains a challenging task. We believe that a broad review of lung region detection algorithms would be useful for researchers working in the field of automated detection/diagnosis algorithms for lung/heart pathologies in CXRs.

Segmentation of lung fields from chest radiographs-a radiomic feature-based approach

Precisely segmented lung fields restrict the region-of-interest from which radiological patterns are searched, and is thus an indispensable prerequisite step in any chest radiographic CADx system. Recently, a number of deep learning-based approaches have been proposed to implement this step. However, deep learning has its own limitations and cannot be used in resource-constrained settings. Medical systems generally have limited RAM, computational power, storage, and no GPUs. They are thus not always suited for running deep learning-based models. Shallow learning-based models with appropriately selected features give comparable performance but with modest resources. The present paper thus proposes a shallow learning-based method that makes use of 40 radiomic features to segment lung fields from chest radiographs. A distance regularized level set evolution (DRLSE) method along with other post-processing steps are used to refine its output. The proposed method is trained and tested using publicly available JSRT dataset. The testing results indicate that the performance of the proposed method is comparable to the state-of-the-art deep learning-based lung field segmentation (LFS) methods and better than other LFS methods.

Computer-aided detection in chest radiography based on artificial intelligence: a survey

As the most common examination tool in medical practice, chest radiography has important clinical value in the diagnosis of disease. Thus, the automatic detection of chest disease based on chest radiography has become one of the hot topics in medical imaging research. Based on the clinical applications, the study conducts a comprehensive survey on computer-aided detection (CAD) systems, and especially focuses on the artificial intelligence technology applied in chest radiography. The paper presents several common chest X-ray datasets and briefly introduces general image preprocessing procedures, such as contrast enhancement and segmentation, and bone suppression techniques that are applied to chest radiography. Then, the CAD system in the detection of specific disease (pulmonary nodules, tuberculosis, and interstitial lung diseases) and multiple diseases is described, focusing on the basic principles of the algorithm, the data used in the study, the evaluation measures, and the results. Finally, the paper summarizes the CAD system in chest radiography based on artificial intelligence and discusses the existing problems and trends.

Systematic Review of Data Mining Applications in Patient-Centered Mobile-Based Information Systems

Objectives

Smartphones represent a promising technology for patient-centered healthcare. It is claimed that data mining techniques have improved mobile apps to address patients’ needs at subgroup and individual levels. This study reviewed the current literature regarding data mining applications in patient-centered mobile-based information systems.

Methods

We systematically searched PubMed, Scopus, and Web of Science for original studies reported from 2014 to 2016. After screening 226 records at the title/abstract level, the full texts of 92 relevant papers were retrieved and checked against inclusion criteria. Finally, 30 papers were included in this study and reviewed.

Results

Data mining techniques have been reported in development of mobile health apps for three main purposes: data analysis for follow-up and monitoring, early diagnosis and detection for screening purpose, classification/prediction of outcomes, and risk calculation (n = 27); data collection (n = 3); and provision of recommendations (n = 2). The most accurate and frequently applied data mining method was support vector machine; however, decision tree has shown superior performance to enhance mobile apps applied for patients’ self-management.

Conclusions

Embedded data-mining-based feature in mobile apps, such as case detection, prediction/classification, risk estimation, or collection of patient data, particularly during self-management, would save, apply, and analyze patient data during and after care. More intelligent methods, such as artificial neural networks, fuzzy logic, and genetic algorithms, and even the hybrid methods may result in more patients-centered recommendations, providing education, guidance, alerts, and awareness of personalized output.