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Register a new userCheXpedition: Investigating Generalization Challenges for Translation of Chest X-Ray Algorithms to the Clinical Setting
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Although there have been several recent advances in the application of deep learning algorithms to chest x-ray interpretation, we identify three major challenges for the translation of chest x-ray algorithms to the clinical setting. We examine the performance of the top 10 performing models on the CheXpert challenge leaderboard on three tasks: (1) TB detection, (2) pathology detection on photos of chest x-rays, and (3) pathology detection on data from an external institution. First, we find that the top 10 chest x-ray models on the CheXpert competition achieve an average AUC of 0.851 on the task of detecting TB on two public TB datasets without fine-tuning or including the TB labels in training data. Second, we find that the average performance of the models on photos of x-rays (AUC = 0.916) is similar to their performance on the original chest x-ray images (AUC = 0.924). Third, we find that the models tested on an external dataset either perform comparably to or exceed the average performance of radiologists. We believe that our investigation will inform rapid translation of deep learning algorithms to safe and effective clinical decision support tools that can be validated prospectively with large impact studies and clinical trials.
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Recent advances in training deep learning models have demonstrated the potential to provide accurate chest X-ray interpretation and increase access to radiology expertise. However, poor generalization due to data distribution shifts in clinical settings is a key barrier to implementation. In this study, we measured the diagnostic performance for 8 different chest X-ray models when applied to (1) smartphone photos of chest X-rays and (2) external datasets without any finetuning. All models were developed by different groups and submitted to the CheXpert challenge, and re-applied to test datasets without further tuning. We found that (1) on photos of chest X-rays, all 8 models experienced a statistically significant drop in task performance, but only 3 performed significantly worse than radiologists on average, and (2) on the external set, none of the models performed statistically significantly worse than radiologists, and five models performed statistically significantly better than radiologists. Our results demonstrate that some chest X-ray models, under clinically relevant distribution shifts, were comparable to radiologists while other models were not. Future work should investigate aspects of model training procedures and dataset collection that influence generalization in the presence of data distribution shifts.
The use of smartphones to take photographs of chest x-rays represents an appealing solution for scaled deployment of deep learning models for chest x-ray interpretation. However, the performance of chest x-ray algorithms on photos of chest x-rays has not been thoroughly investigated. In this study, we measured the diagnostic performance for 8 different chest x-ray models when applied to photos of chest x-rays. All models were developed by different groups and submitted to the CheXpert challenge, and re-applied to smartphone photos of x-rays in the CheXphoto dataset without further tuning. We found that several models had a drop in performance when applied to photos of chest x-rays, but even with this drop, some models still performed comparably to radiologists. Further investigation could be directed towards understanding how different model training procedures may affect model generalization to photos of chest x-rays.
Recent works show that Generative Adversarial Networks (GANs) can be successfully applied to chest X-ray data augmentation for lung disease recognition. However, the implausible and distorted pathology features generated from the less than perfect generator may lead to wrong clinical decisions. Why not keep the original pathology region? We proposed a novel approach that allows our generative model to generate high quality plausible images that contain undistorted pathology areas. The main idea is to design a training scheme based on an image-to-image translation network to introduce variations of new lung features around the pathology ground-truth area. Moreover, our model is able to leverage both annotated disease images and unannotated healthy lung images for the purpose of generation. We demonstrate the effectiveness of our model on two tasks: (i) we invite certified radiologists to assess the quality of the generated synthetic images against real and other state-of-the-art generative models, and (ii) data augmentation to improve the performance of disease localisation.
AI plays an important role in COVID-19 identification. Computer vision and deep learning techniques can assist in determining COVID-19 infection with Chest X-ray Images. However, for the protection and respect of the privacy of patients, the hospitals specific medical-related data did not allow leakage and sharing without permission. Collecting such training data was a major challenge. To a certain extent, this has caused a lack of sufficient data samples when performing deep learning approaches to detect COVID-19. Federated Learning is an available way to address this issue. It can effectively address the issue of data silos and get a shared model without obtaining local data. In the work, we propose the use of federated learning for COVID-19 data training and deploy experiments to verify the effectiveness. And we also compare performances of four popular models (MobileNet, ResNet18, MoblieNet, and COVID-Net) with the federated learning framework and without the framework. This work aims to inspire more researches on federated learning about COVID-19.
Recent epidemiological data report that worldwide more than 53 million people have been infected by SARS-CoV-2, resulting in 1.3 million deaths. The disease has been spreading very rapidly and few months after the identification of the first infected, shortage of hospital resources quickly became a problem. In this work we investigate whether chest X-ray (CXR) can be used as a possible tool for the early identification of patients at risk of severe outcome, like intensive care or death. CXR is a radiological technique that compared to computed tomography (CT) it is simpler, faster, more widespread and it induces lower radiation dose. We present a dataset including data collected from 820 patients by six Italian hospitals in spring 2020 during the first COVID-19 emergency. The dataset includes CXR images, several clinical attributes and clinical outcomes. We investigate the potential of artificial intelligence to predict the prognosis of such patients, distinguishing between severe and mild cases, thus offering a baseline reference for other researchers and practitioners. To this goal, we present three approaches that use features extracted from CXR images, either handcrafted or automatically by convolutional neuronal networks, which are then integrated with the clinical data. Exhaustive evaluation shows promising performance both in 10-fold and leave-one-centre-out cross-validation, implying that clinical data and images have the potential to provide useful information for the management of patients and hospital resources.
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