The latest threat to global health is the COVID-19 outbreak. Although there exist large datasets of chest X-rays (CXR) and computed tomography (CT) scans, few COVID-19 image collections are currently available due to patient privacy. At the same time, there is a rapid growth of COVID-19-relevant articles in the biomedical literature. Here, we present COVID-19-CT-CXR, a public database of COVID-19 CXR and CT images, which are automatically extracted from COVID-19-relevant articles from the PubMed Central Open Access (PMC-OA) Subset. We extracted figures, associated captions, and relevant figure descriptions in the article and separated compound figures into subfigures. We also designed a deep-learning model to distinguish them from other figure types and to classify them accordingly. The final database includes 1,327 CT and 263 CXR images (as of May 9, 2020) with their relevant text. To demonstrate the utility of COVID-19-CT-CXR, we conducted four case studies. (1) We show that COVID-19-CT-CXR, when used as additional training data, is able to contribute to improved DL performance for the classification of COVID-19 and non-COVID-19 CT. (2) We collected CT images of influenza and trained a DL baseline to distinguish a diagnosis of COVID-19, influenza, or normal or other types of diseases on CT. (3) We trained an unsupervised one-class classifier from non-COVID-19 CXR and performed anomaly detection to detect COVID-19 CXR. (4) From text-mined captions and figure descriptions, we compared clinical symptoms and clinical findings of COVID-19 vs. those of influenza to demonstrate the disease differences in the scientific publications. We believe that our work is complementary to existing resources and hope that it will contribute to medical image analysis of the COVID-19 pandemic. The dataset, code, and DL models are publicly available at https://github.com/ncbi-nlp/COVID-19-CT-CXR.
Calcified plaque in the aorta and pelvic arteries is associated with coronary artery calcification and is a strong predictor of heart attack. Current calcified plaque detection models show poor generalizability to different domains (ie. pre-contrast vs. post-contrast CT scans). Many recent works have shown how cross domain object detection can be improved using an image translation model which translates between domains using a single shared latent space. However, while current image translation models do a good job preserving global/intermediate level structures they often have trouble preserving tiny structures. In medical imaging applications, preserving small structures is important since these structures can carry information which is highly relevant for disease diagnosis. Recent works on image reconstruction show that complex real-world images are better reconstructed using a union of subspaces approach. Since small image patches are used to train the image translation model, it makes sense to enforce that each patch be represented by a linear combination of subspaces which may correspond to the different parts of the body present in that patch. Motivated by this, we propose an image translation network using a shared union of subspaces constraint and show our approach preserves subtle structures (plaques) better than the conventional method. We further applied our method to a cross domain plaque detection task and show significant improvement compared to the state-of-the art method.
Data-driven Machine Learning has emerged as a promising approach for building accurate and robust statistical models from medical data, which is collected in huge volumes by modern healthcare systems. Existing medical data is not fully exploited by ML primarily because it sits in data silos and privacy concerns restrict access to this data. However, without access to sufficient data, ML will be prevented from reaching its full potential and, ultimately, from making the transition from research to clinical practice. This paper considers key factors contributing to this issue, explores how Federated Learning (FL) may provide a solution for the future of digital health and highlights the challenges and considerations that need to be addressed.
Dual-energy (DE) chest radiography provides the capability of selectively imaging two clinically relevant materials, namely soft tissues, and osseous structures, to better characterize a wide variety of thoracic pathology and potentially improve diagnosis in posteroanterior (PA) chest radiographs. However, DE imaging requires specialized hardware and a higher radiation dose than conventional radiography, and motion artifacts sometimes happen due to involuntary patient motion. In this work, we learn the mapping between conventional radiographs and bone suppressed radiographs. Specifically, we propose to utilize two variations of generative adversarial networks (GANs) for image-to-image translation between conventional and bone suppressed radiographs obtained by DE imaging technique. We compare the effectiveness of training with patient-wisely paired and unpaired radiographs. Experiments show both training strategies yield "radio-realistic'' radiographs with suppressed bony structures and few motion artifacts on a hold-out test set. While training with paired images yields slightly better performance than that of unpaired images when measuring with two objective image quality metrics, namely Structural Similarity Index (SSIM) and Peak Signal-to-Noise Ratio (PSNR), training with unpaired images demonstrates better generalization ability on unseen anteroposterior (AP) radiographs than paired training.
The vertebral levels of the spine provide a useful coordinate system when making measurements of plaque, muscle, fat, and bone mineral density. Correctly classifying vertebral levels with high accuracy is challenging due to the similar appearance of each vertebra, the curvature of the spine, and the possibility of anomalies such as fractured vertebrae, implants, lumbarization of the sacrum, and sacralization of L5. The goal of this work is to develop a system that can accurately and robustly identify the L1 level in large heterogeneous datasets. The first approach we study is using a 3D U-Net to segment the L1 vertebra directly using the entire scan volume to provide context. We also tested models for two class segmentation of L1 and T12 and a three class segmentation of L1, T12 and the rib attached to T12. By increasing the number of training examples to 249 scans using pseudo-segmentations from an in-house segmentation tool we were able to achieve 98% accuracy with respect to identifying the L1 vertebra, with an average error of 4.5 mm in the craniocaudal level. We next developed an algorithm which performs iterative instance segmentation and classification of the entire spine with a 3D U-Net. We found the instance based approach was able to yield better segmentations of nearly the entire spine, but had lower classification accuracy for L1.
Lesion segmentation in medical imaging serves as an effective tool for assessing tumor sizes and monitoring changes in growth. However, not only is manual lesion segmentation time-consuming, but it is also expensive and requires expert radiologist knowledge. Therefore many hospitals rely on a loose substitute called response evaluation criteria in solid tumors (RECIST). Although these annotations are far from precise, they are widely used throughout hospitals and are found in their picture archiving and communication systems (PACS). Therefore, these annotations have the potential to serve as a robust yet challenging means of weak supervision for training full lesion segmentation models. In this work, we propose a weakly-supervised co-segmentation model that first generates pseudo-masks from the RECIST slices and uses these as training labels for an attention-based convolutional neural network capable of segmenting common lesions from a pair of CT scans. To validate and test the model, we utilize the DeepLesion dataset, an extensive CT-scan lesion dataset that contains 32,735 PACS bookmarked images. Extensive experimental results demonstrate the efficacy of our co-segmentation approach for lesion segmentation with a mean Dice coefficient of 90.3%.
Lesion segmentation on computed tomography (CT) scans is an important step for precisely monitoring changes in lesion/tumor growth. This task, however, is very challenging since manual segmentation is prohibitively time-consuming, expensive, and requires professional knowledge. Current practices rely on an imprecise substitute called response evaluation criteria in solid tumors (RECIST). Although these markers lack detailed information about the lesion regions, they are commonly found in hospitals' picture archiving and communication systems (PACS). Thus, these markers have the potential to serve as a powerful source of weak-supervision for 2D lesion segmentation. To approach this problem, this paper proposes a convolutional neural network (CNN) based weakly-supervised lesion segmentation method, which first generates the initial lesion masks from the RECIST measurements and then utilizes co-segmentation to leverage lesion similarities and refine the initial masks. In this work, an attention-based co-segmentation model is adopted due to its ability to learn more discriminative features from a pair of images. Experimental results on the NIH DeepLesion dataset demonstrate that the proposed co-segmentation approach significantly improves lesion segmentation performance, e.g the Dice score increases about 4.0% (from 85.8% to 89.8%).
Purpose: To systematically investigate the influence of various data consistency layers, (semi-)supervised learning and ensembling strategies, defined in a $\Sigma$-net, for accelerated parallel MR image reconstruction using deep learning. Theory and Methods: MR image reconstruction is formulated as learned unrolled optimization scheme with a Down-Up network as regularization and varying data consistency layers. The different architectures are split into sensitivity networks, which rely on explicit coil sensitivity maps, and parallel coil networks, which learn the combination of coils implicitly. Different content and adversarial losses, a semi-supervised fine-tuning scheme and model ensembling are investigated. Results: Evaluated on the fastMRI multicoil validation set, architectures involving raw k-space data outperform image enhancement methods significantly. Semi-supervised fine-tuning adapts to new k-space data and provides, together with reconstructions based on adversarial training, the visually most appealing results although quantitative quality metrics are reduced. The $\Sigma$-net ensembles the benefits from different models and achieves similar scores compared to the single state-of-the-art approaches. Conclusion: This work provides an open-source framework to perform a systematic wide-range comparison of state-of-the-art reconstruction approaches for parallel MR image reconstruction on the fastMRI knee dataset and explores the importance of data consistency. A suitable trade-off between perceptual image quality and quantitative scores are achieved with the ensembled $\Sigma$-net.
We explore an ensembled $\Sigma$-net for fast parallel MR imaging, including parallel coil networks, which perform implicit coil weighting, and sensitivity networks, involving explicit sensitivity maps. The networks in $\Sigma$-net are trained in a supervised way, including content and GAN losses, and with various ways of data consistency, i.e., proximal mappings, gradient descent and variable splitting. A semi-supervised finetuning scheme allows us to adapt to the k-space data at test time, which, however, decreases the quantitative metrics, although generating the visually most textured and sharp images. For this challenge, we focused on robust and high SSIM scores, which we achieved by ensembling all models to a $\Sigma$-net.
In this work, we exploit the unsupervised domain adaptation problem for radiology image interpretation across domains. Specifically, we study how to adapt the disease recognition model from a labeled source domain to an unlabeled target domain, so as to reduce the effort of labeling each new dataset. To address the shortcoming of cross-domain, unpaired image-to-image translation methods which typically ignore class-specific semantics, we propose a task-driven, discriminatively trained, cycle-consistent generative adversarial network, termed TUNA-Net. It is able to preserve 1) low-level details, 2) high-level semantic information and 3) mid-level feature representation during the image-to-image translation process, to favor the target disease recognition task. The TUNA-Net framework is general and can be readily adapted to other learning tasks. We evaluate the proposed framework on two public chest X-ray datasets for pneumonia recognition. The TUNA-Net model can adapt labeled adult chest X-rays in the source domain such that they appear as if they were drawn from pediatric X-rays in the unlabeled target domain, while preserving the disease semantics. Extensive experiments show the superiority of the proposed method as compared to state-of-the-art unsupervised domain adaptation approaches. Notably, TUNA-Net achieves an AUC of 96.3% for pediatric pneumonia classification, which is very close to that of the supervised approach (98.1%), but without the need for labels on the target domain.