Computed tomography (CT) has been widely explored as a COVID-19 screening and assessment tool to complement RT-PCR testing. To assist radiologists with CT-based COVID-19 screening, a number of computer-aided systems have been proposed; however, many proposed systems are built using CT data which is limited in both quantity and diversity. Motivated to support efforts in the development of machine learning-driven screening systems, we introduce COVIDx CT-3, a large-scale multinational benchmark dataset for detection of COVID-19 cases from chest CT images. COVIDx CT-3 includes 431,205 CT slices from 6,068 patients across at least 17 countries, which to the best of our knowledge represents the largest, most diverse dataset of COVID-19 CT images in open-access form. Additionally, we examine the data diversity and potential biases of the COVIDx CT-3 dataset, finding that significant geographic and class imbalances remain despite efforts to curate data from a wide variety of sources.
Medical image analysis continues to hold interesting challenges given the subtle characteristics of certain diseases and the significant overlap in appearance between diseases. In this work, we explore the concept of self-attention for tackling such subtleties in and between diseases. To this end, we introduce MEDUSA, a multi-scale encoder-decoder self-attention mechanism tailored for medical image analysis. While self-attention deep convolutional neural network architectures in existing literature center around the notion of multiple isolated lightweight attention mechanisms with limited individual capacities being incorporated at different points in the network architecture, MEDUSA takes a significant departure from this notion by possessing a single, unified self-attention mechanism with significantly higher capacity with multiple attention heads feeding into different scales in the network architecture. To the best of the authors' knowledge, this is the first "single body, multi-scale heads" realization of self-attention and enables explicit global context amongst selective attention at different levels of representational abstractions while still enabling differing local attention context at individual levels of abstractions. With MEDUSA, we obtain state-of-the-art performance on multiple challenging medical image analysis benchmarks including COVIDx, RSNA RICORD, and RSNA Pneumonia Challenge when compared to previous work. Our MEDUSA model is publicly available.
As the COVID-19 pandemic continues to devastate globally, one promising field of research is machine learning-driven computer vision to streamline various parts of the COVID-19 clinical workflow. These machine learning methods are typically stand-alone models designed without consideration for the integration necessary for real-world application workflows. In this study, we take a machine learning and systems (MLSys) perspective to design a system for COVID-19 patient screening with the clinical workflow in mind. The COVID-Net system is comprised of the continuously evolving COVIDx dataset, COVID-Net deep neural network for COVID-19 patient detection, and COVID-Net S deep neural networks for disease severity scoring for COVID-19 positive patient cases. The deep neural networks within the COVID-Net system possess state-of-the-art performance, and are designed to be integrated within a user interface (UI) for clinical decision support with automatic report generation to assist clinicians in their treatment decisions.
The Coronavirus Disease 2019 (COVID-19) pandemic has impacted many aspects of life globally, and a critical factor in mitigating its effects is screening individuals for infections, thereby allowing for both proper treatment for those individuals as well as action to be taken to prevent further spread of the virus. Point-of-care ultrasound (POCUS) imaging has been proposed as a screening tool as it is a much cheaper and easier to apply imaging modality than others that are traditionally used for pulmonary examinations, namely chest x-ray and computed tomography. Given the scarcity of expert radiologists for interpreting POCUS examinations in many highly affected regions around the world, low-cost deep learning-driven clinical decision support solutions can have a large impact during the on-going pandemic. Motivated by this, we introduce COVID-Net US, a highly efficient, self-attention deep convolutional neural network design tailored for COVID-19 screening from lung POCUS images. Experimental results show that the proposed COVID-Net US can achieve an AUC of over 0.98 while achieving 353X lower architectural complexity, 62X lower computational complexity, and 14.3X faster inference times on a Raspberry Pi. Clinical validation was also conducted, where select cases were reviewed and reported on by a practicing clinician (20 years of clinical practice) specializing in intensive care (ICU) and 15 years of expertise in POCUS interpretation. To advocate affordable healthcare and artificial intelligence for resource-constrained environments, we have made COVID-Net US open source and publicly available as part of the COVID-Net open source initiative.
In this study, we take a departure and explore an explainability-driven strategy to data auditing, where actionable insights into the data at hand are discovered through the eyes of quantitative explainability on the behaviour of a dummy model prototype when exposed to data. We demonstrate this strategy by auditing two popular medical benchmark datasets, and discover hidden data quality issues that lead deep learning models to make predictions for the wrong reasons. The actionable insights gained from this explainability driven data auditing strategy is then leveraged to address the discovered issues to enable the creation of high-performing deep learning models with appropriate prediction behaviour. The hope is that such an explainability-driven strategy can be complimentary to data-driven strategies to facilitate for more responsible development of machine learning algorithms for computer vision applications.
As the COVID-19 pandemic continues to devastate globally, the use of chest X-ray (CXR) imaging as a complimentary screening strategy to RT-PCR testing continues to grow given its routine clinical use for respiratory complaint. As part of the COVID-Net open source initiative, we introduce COVID-Net CXR-2, an enhanced deep convolutional neural network design for COVID-19 detection from CXR images built using a greater quantity and diversity of patients than the original COVID-Net. To facilitate this, we also introduce a new benchmark dataset composed of 19,203 CXR images from a multinational cohort of 16,656 patients from at least 51 countries, making it the largest, most diverse COVID-19 CXR dataset in open access form. The COVID-Net CXR-2 network achieves sensitivity and positive predictive value of 95.5%/97.0%, respectively, and was audited in a transparent and responsible manner. Explainability-driven performance validation was used during auditing to gain deeper insights in its decision-making behaviour and to ensure clinically relevant factors are leveraged for improving trust in its usage. Radiologist validation was also conducted, where select cases were reviewed and reported on by two board-certified radiologists with over 10 and 19 years of experience, respectively, and showed that the critical factors leveraged by COVID-Net CXR-2 are consistent with radiologist interpretations. While not a production-ready solution, we hope the open-source, open-access release of COVID-Net CXR-2 and the respective CXR benchmark dataset will encourage researchers, clinical scientists, and citizen scientists to accelerate advancements and innovations in the fight against the pandemic.
The COVID-19 pandemic continues to rage on, with multiple waves causing substantial harm to health and economies around the world. Motivated by the use of CT imaging at clinical institutes around the world as an effective complementary screening method to RT-PCR testing, we introduced COVID-Net CT, a neural network tailored for detection of COVID-19 cases from chest CT images as part of the open source COVID-Net initiative. However, one potential limiting factor is restricted quantity and diversity given the single nation patient cohort used. In this study, we introduce COVID-Net CT-2, enhanced deep neural networks for COVID-19 detection from chest CT images trained on the largest quantity and diversity of multinational patient cases in research literature. We introduce two new CT benchmark datasets, the largest comprising a multinational cohort of 4,501 patients from at least 15 countries. We leverage explainability to investigate the decision-making behaviour of COVID-Net CT-2, with the results for select cases reviewed and reported on by two board-certified radiologists with over 10 and 30 years of experience, respectively. The COVID-Net CT-2 neural networks achieved accuracy, COVID-19 sensitivity, PPV, specificity, and NPV of 98.1%/96.2%/96.7%/99%/98.8% and 97.9%/95.7%/96.4%/98.9%/98.7%, respectively. Explainability-driven performance validation shows that COVID-Net CT-2's decision-making behaviour is consistent with radiologist interpretation by leveraging correct, clinically relevant critical factors. The results are promising and suggest the strong potential of deep neural networks as an effective tool for computer-aided COVID-19 assessment. While not a production-ready solution, we hope the open-source, open-access release of COVID-Net CT-2 and benchmark datasets will continue to enable researchers, clinicians, and citizen data scientists alike to build upon them.
The coronavirus disease 2019 (COVID-19) pandemic continues to have a tremendous impact on patients and healthcare systems around the world. In the fight against this novel disease, there is a pressing need for rapid and effective screening tools to identify patients infected with COVID-19, and to this end CT imaging has been proposed as one of the key screening methods which may be used as a complement to RT-PCR testing, particularly in situations where patients undergo routine CT scans for non-COVID-19 related reasons, patients with worsening respiratory status or developing complications that require expedited care, and patients suspected to be COVID-19-positive but have negative RT-PCR test results. Motivated by this, in this study we introduce COVIDNet-CT, a deep convolutional neural network architecture that is tailored for detection of COVID-19 cases from chest CT images via a machine-driven design exploration approach. Additionally, we introduce COVIDx-CT, a benchmark CT image dataset derived from CT imaging data collected by the China National Center for Bioinformation comprising 104,009 images across 1,489 patient cases. Furthermore, in the interest of reliability and transparency, we leverage an explainability-driven performance validation strategy to investigate the decision-making behaviour of COVIDNet-CT, and in doing so ensure that COVIDNet-CT makes predictions based on relevant indicators in CT images. Both COVIDNet-CT and the COVIDx-CT dataset are available to the general public in an open-source and open access manner as part of the COVID-Net initiative. While COVIDNet-CT is not yet a production-ready screening solution, we hope that releasing the model and dataset will encourage researchers, clinicians, and citizen data scientists alike to leverage and build upon them.