Looking in the Right place for Anomalies: Explainable AI through Automatic Location Learning

Deep learning has now become the de facto approach to the recognition of anomalies in medical imaging. Their 'black box' way of classifying medical images into anomaly labels poses problems for their acceptance, particularly with clinicians. Current explainable AI methods offer justifications through visualizations such as heat maps but cannot guarantee that the network is focusing on the relevant image region fully containing the anomaly. In this paper, we develop an approach to explainable AI in which the anomaly is assured to be overlapping the expected location when present. This is made possible by automatically extracting location-specific labels from textual reports and learning the association of expected locations to labels using a hybrid combination of Bi-Directional Long Short-Term Memory Recurrent Neural Networks (Bi-LSTM) and DenseNet-121. Use of this expected location to bias the subsequent attention-guided inference network based on ResNet101 results in the isolation of the anomaly at the expected location when present. The method is evaluated on a large chest X-ray dataset.

Chest X-ray Report Generation through Fine-Grained Label Learning

Obtaining automated preliminary read reports for common exams such as chest X-rays will expedite clinical workflows and improve operational efficiencies in hospitals. However, the quality of reports generated by current automated approaches is not yet clinically acceptable as they cannot ensure the correct detection of a broad spectrum of radiographic findings nor describe them accurately in terms of laterality, anatomical location, severity, etc. In this work, we present a domain-aware automatic chest X-ray radiology report generation algorithm that learns fine-grained description of findings from images and uses their pattern of occurrences to retrieve and customize similar reports from a large report database. We also develop an automatic labeling algorithm for assigning such descriptors to images and build a novel deep learning network that recognizes both coarse and fine-grained descriptions of findings. The resulting report generation algorithm significantly outperforms the state of the art using established score metrics.

Self-Training with Improved Regularization for Few-Shot Chest X-Ray Classification

Automated diagnostic assistants in healthcare necessitate accurate AI models that can be trained with limited labeled data, can cope with severe class imbalances and can support simultaneous prediction of multiple disease conditions. To this end, we present a novel few-shot learning approach that utilizes a number of key components to enable robust modeling in such challenging scenarios. Using an important use-case in chest X-ray classification, we provide several key insights on the effective use of data augmentation, self-training via distillation and confidence tempering for few-shot learning in medical imaging. Our results show that using only ~10% of the labeled data, we can build predictive models that match the performance of classifiers trained in a large-scale data setting.

Boosting the rule-out accuracy of deep disease detection using class weight modifiers

In many screening applications, the primary goal of a radiologist or assisting artificial intelligence is to rule out certain findings. The classifiers built for such applications are often trained on large datasets that derive labels from clinical notes written for patients. While the quality of the positive findings described in these notes is often reliable, lack of the mention of a finding does not always rule out the presence of it. This happens because radiologists comment on the patient in the context of the exam, for example focusing on trauma as opposed to chronic disease at emergency rooms. However, this disease finding ambiguity can affect the performance of algorithms. Hence it is critical to model the ambiguity during training. We propose a scheme to apply reasonable class weight modifiers to our loss function for the no mention cases during training. We experiment with two different deep neural network architectures and show that the proposed method results in a large improvement in the performance of the classifiers, specially on negated findings. The baseline performance of a custom-made dilated block network proposed in this paper shows an improvement in comparison with baseline DenseNet-201, while both architectures benefit from the new proposed loss function weighting scheme. Over 200,000 chest X-ray images and three highly common diseases, along with their negated counterparts, are included in this study.

Building a Benchmark Dataset and Classifiers for Sentence-Level Findings in AP Chest X-rays

Chest X-rays are the most common diagnostic exams in emergency rooms and hospitals. There has been a surge of work on automatic interpretation of chest X-rays using deep learning approaches after the availability of large open source chest X-ray dataset from NIH. However, the labels are not sufficiently rich and descriptive for training classification tools. Further, it does not adequately address the findings seen in Chest X-rays taken in anterior-posterior (AP) view which also depict the placement of devices such as central vascular lines and tubes. In this paper, we present a new chest X-ray benchmark database of 73 rich sentence-level descriptors of findings seen in AP chest X-rays. We describe our method of obtaining these findings through a semi-automated ground truth generation process from crowdsourcing of clinician annotations. We also present results of building classifiers for these findings that show that such higher granularity labels can also be learned through the framework of deep learning classifiers.

Age prediction using a large chest X-ray dataset

Age prediction based on appearances of different anatomies in medical images has been clinically explored for many decades. In this paper, we used deep learning to predict a persons age on Chest X-Rays. Specifically, we trained a CNN in regression fashion on a large publicly available dataset. Moreover, for interpretability, we explored activation maps to identify which areas of a CXR image are important for the machine (i.e. CNN) to predict a patients age, offering insight. Overall, amongst correctly predicted CXRs, we see areas near the clavicles, shoulders, spine, and mediastinum being most activated for age prediction, as one would expect biologically. Amongst incorrectly predicted CXRs, we have qualitatively identified disease patterns that could possibly make the anatomies appear older or younger than expected. A further technical and clinical evaluation would improve this work. As CXR is the most commonly requested imaging exam, a potential use case for estimating age may be found in the preventative counseling of patient health status compared to their age-expected average, particularly when there is a large discrepancy between predicted age and the real patient age.

Building Disease Detection Algorithms with Very Small Numbers of Positive Samples

Although deep learning can provide promising results in medical image analysis, the lack of very large annotated datasets confines its full potential. Furthermore, limited positive samples also create unbalanced datasets which limit the true positive rates of trained models. As unbalanced datasets are mostly unavoidable, it is greatly beneficial if we can extract useful knowledge from negative samples to improve classification accuracy on limited positive samples. To this end, we propose a new strategy for building medical image analysis pipelines that target disease detection. We train a discriminative segmentation model only on normal images to provide a source of knowledge to be transferred to a disease detection classifier. We show that using the feature maps of a trained segmentation network, deviations from normal anatomy can be learned by a two-class classification network on an extremely unbalanced training dataset with as little as one positive for 17 negative samples. We demonstrate that even though the segmentation network is only trained on normal cardiac computed tomography images, the resulting feature maps can be used to detect pericardial effusion and cardiac septal defects with two-class convolutional classification networks.

Color Space Transformation Network

Deep networks have become very popular over the past few years. The main reason for this widespread use is their excellent ability to learn and predict knowledge in a very easy and efficient way. Convolutional neural networks and auto-encoders have become the normal in the area of imaging and computer vision achieving unprecedented accuracy levels in many applications. The most common strategy is to build and train networks with many layers by tuning their hyper-parameters. While this approach has proven to be a successful way to build robust deep learning schemes it suffers from high complexity. In this paper we introduce a module that learns color space transformations within a network. Given a large dataset of colored images the color space transformation module tries to learn color space transformations that increase overall classification accuracy. This module has shown to increase overall accuracy for the same network design and to achieve faster convergence. It is part of a broader family of image transformations (e.g. spatial transformer network).