X-ray Dissectography Improves Lung Nodule Detection

Although radiographs are the most frequently used worldwide due to their cost-effectiveness and widespread accessibility, the structural superposition along the x-ray paths often renders suspicious or concerning lung nodules difficult to detect. In this study, we apply "X-ray dissectography" to dissect lungs digitally from a few radiographic projections, suppress the interference of irrelevant structures, and improve lung nodule detectability. For this purpose, a collaborative detection network is designed to localize lung nodules in 2D dissected projections and 3D physical space. Our experimental results show that our approach can significantly improve the average precision by 20+% in comparison with the common baseline that detects lung nodules from original projections using a popular detection network. Potentially, this approach could help re-design the current X-ray imaging protocols and workflows and improve the diagnostic performance of chest radiographs in lung diseases.

Deep Interactive Denoiser (DID) for X-Ray Computed Tomography

Low dose computed tomography (LDCT) is desirable for both diagnostic imaging and image guided interventions. Denoisers are openly used to improve the quality of LDCT. Deep learning (DL)-based denoisers have shown state-of-the-art performance and are becoming one of the mainstream methods. However, there exists two challenges regarding the DL-based denoisers: 1) a trained model typically does not generate different image candidates with different noise-resolution tradeoffs which sometimes are needed for different clinical tasks; 2) the model generalizability might be an issue when the noise level in the testing images is different from that in the training dataset. To address these two challenges, in this work, we introduce a lightweight optimization process at the testing phase on top of any existing DL-based denoisers to generate multiple image candidates with different noise-resolution tradeoffs suitable for different clinical tasks in real-time. Consequently, our method allows the users to interact with the denoiser to efficiently review various image candidates and quickly pick up the desired one, and thereby was termed as deep interactive denoiser (DID). Experimental results demonstrated that DID can deliver multiple image candidates with different noise-resolution tradeoffs, and shows great generalizability regarding various network architectures, as well as training and testing datasets with various noise levels.

Deep Metric Learning-based Image Retrieval System for Chest Radiograph and its Clinical Applications in COVID-19

In recent years, deep learning-based image analysis methods have been widely applied in computer-aided detection, diagnosis and prognosis, and has shown its value during the public health crisis of the novel coronavirus disease 2019 (COVID-19) pandemic. Chest radiograph (CXR) has been playing a crucial role in COVID-19 patient triaging, diagnosing and monitoring, particularly in the United States. Considering the mixed and unspecific signals in CXR, an image retrieval model of CXR that provides both similar images and associated clinical information can be more clinically meaningful than a direct image diagnostic model. In this work we develop a novel CXR image retrieval model based on deep metric learning. Unlike traditional diagnostic models which aims at learning the direct mapping from images to labels, the proposed model aims at learning the optimized embedding space of images, where images with the same labels and similar contents are pulled together. It utilizes multi-similarity loss with hard-mining sampling strategy and attention mechanism to learn the optimized embedding space, and provides similar images to the query image. The model is trained and validated on an international multi-site COVID-19 dataset collected from 3 different sources. Experimental results of COVID-19 image retrieval and diagnosis tasks show that the proposed model can serve as a robust solution for CXR analysis and patient management for COVID-19. The model is also tested on its transferability on a different clinical decision support task, where the pre-trained model is applied to extract image features from a new dataset without any further training. These results demonstrate our deep metric learning based image retrieval model is highly efficient in the CXR retrieval, diagnosis and prognosis, and thus has great clinical value for the treatment and management of COVID-19 patients.

Deep Learning-based Four-region Lung Segmentation in Chest Radiography for COVID-19 Diagnosis

Purpose. Imaging plays an important role in assessing severity of COVID 19 pneumonia. However, semantic interpretation of chest radiography (CXR) findings does not include quantitative description of radiographic opacities. Most current AI assisted CXR image analysis framework do not quantify for regional variations of disease. To address these, we proposed a four region lung segmentation method to assist accurate quantification of COVID 19 pneumonia. Methods. A segmentation model to separate left and right lung is firstly applied, and then a carina and left hilum detection network is used, which are the clinical landmarks to separate the upper and lower lungs. To improve the segmentation performance of COVID 19 images, ensemble strategy incorporating five models is exploited. Using each region, we evaluated the clinical relevance of the proposed method with the Radiographic Assessment of the Quality of Lung Edema (RALE). Results. The proposed ensemble strategy showed dice score of 0.900, which is significantly higher than conventional methods (0.854 0.889). Mean intensities of segmented four regions indicate positive correlation to the extent and density scores of pulmonary opacities under the RALE framework. Conclusion. A deep learning based model in CXR can accurately segment and quantify regional distribution of pulmonary opacities in patients with COVID 19 pneumonia.

Deep Learning Predicts Cardiovascular Disease Risks from Lung Cancer Screening Low Dose Computed Tomography

The high risk population of cardiovascular disease (CVD) is simultaneously at high risk of lung cancer. Given the dominance of low dose computed tomography (LDCT) for lung cancer screening, the feasibility of extracting information on CVD from the same LDCT scan would add major value to patients at no additional radiation dose. However, with strong noise in LDCT images and without electrocardiogram (ECG) gating, CVD risk analysis from LDCT is highly challenging. Here we present an innovative deep learning model to address this challenge. Our deep model was trained with 30,286 LDCT volumes and achieved the state-of-the-art performance (area under the curve (AUC) of 0.869) on 2,085 National Lung Cancer Screening Trial (NLST) subjects, and effectively identified patients with high CVD mortality risks (AUC of 0.768). Our deep model was further calibrated against the clinical gold standard CVD risk scores from ECG-gated dedicated cardiac CT, including coronary artery calcification (CAC) score, CAD-RADS score and MESA 10-year CHD risk score from an independent dataset of 106 subjects. In this validation study, our model achieved AUC of 0.942, 0.809 and 0.817 for CAC, CAD-RADS and MESA scores, respectively. Our deep learning model has the potential to convert LDCT for lung cancer screening into dual-screening quantitative tool for CVD risk estimation.

Integrative Analysis for COVID-19 Patient Outcome Prediction

While image analysis of chest computed tomography (CT) for COVID-19 diagnosis has been intensively studied, little work has been performed for image-based patient outcome prediction. Management of high-risk patients with early intervention is a key to lower the fatality rate of COVID-19 pneumonia, as a majority of patients recover naturally. Therefore, an accurate prediction of disease progression with baseline imaging at the time of the initial presentation can help in patient management. In lieu of only size and volume information of pulmonary abnormalities and features through deep learning based image segmentation, here we combine radiomics of lung opacities and non-imaging features from demographic data, vital signs, and laboratory findings to predict need for intensive care unit (ICU) admission. To our knowledge, this is the first study that uses holistic information of a patient including both imaging and non-imaging data for outcome prediction. The proposed methods were thoroughly evaluated on datasets separately collected from three hospitals, one in the United States, one in Iran, and another in Italy, with a total 295 patients with reverse transcription polymerase chain reaction (RT-PCR) assay positive COVID-19 pneumonia. Our experimental results demonstrate that adding non-imaging features can significantly improve the performance of prediction to achieve AUC up to 0.884 and sensitivity as high as 96.1%, which can be valuable to provide clinical decision support in managing COVID-19 patients. Our methods may also be applied to other lung diseases including but not limited to community acquired pneumonia.

Quantifying and Leveraging Predictive Uncertainty for Medical Image Assessment

The interpretation of medical images is a challenging task, often complicated by the presence of artifacts, occlusions, limited contrast and more. Most notable is the case of chest radiography, where there is a high inter-rater variability in the detection and classification of abnormalities. This is largely due to inconclusive evidence in the data or subjective definitions of disease appearance. An additional example is the classification of anatomical views based on 2D Ultrasound images. Often, the anatomical context captured in a frame is not sufficient to recognize the underlying anatomy. Current machine learning solutions for these problems are typically limited to providing probabilistic predictions, relying on the capacity of underlying models to adapt to limited information and the high degree of label noise. In practice, however, this leads to overconfident systems with poor generalization on unseen data. To account for this, we propose a system that learns not only the probabilistic estimate for classification, but also an explicit uncertainty measure which captures the confidence of the system in the predicted output. We argue that this approach is essential to account for the inherent ambiguity characteristic of medical images from different radiologic exams including computed radiography, ultrasonography and magnetic resonance imaging. In our experiments we demonstrate that sample rejection based on the predicted uncertainty can significantly improve the ROC-AUC for various tasks, e.g., by 8% to 0.91 with an expected rejection rate of under 25% for the classification of different abnormalities in chest radiographs. In addition, we show that using uncertainty-driven bootstrapping to filter the training data, one can achieve a significant increase in robustness and accuracy.

CovidCTNet: An Open-Source Deep Learning Approach to Identify Covid-19 Using CT Image

Coronavirus disease 2019 (Covid-19) is highly contagious with limited treatment options. Early and accurate diagnosis of Covid-19 is crucial in reducing the spread of the disease and its accompanied mortality. Currently, detection by reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard of outpatient and inpatient detection of Covid-19. RT-PCR is a rapid method, however, its accuracy in detection is only ~70-75%. Another approved strategy is computed tomography (CT) imaging. CT imaging has a much higher sensitivity of ~80-98%, but similar accuracy of 70%. To enhance the accuracy of CT imaging detection, we developed an open-source set of algorithms called CovidCTNet that successfully differentiates Covid-19 from community-acquired pneumonia (CAP) and other lung diseases. CovidCTNet increases the accuracy of CT imaging detection to 90% compared to radiologists (70%). The model is designed to work with heterogeneous and small sample sizes independent of the CT imaging hardware. In order to facilitate the detection of Covid-19 globally and assist radiologists and physicians in the screening process, we are releasing all algorithms and parametric details in an open-source format. Open-source sharing of our CovidCTNet enables developers to rapidly improve and optimize services, while preserving user privacy and data ownership.