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Automated diagnosis of COVID-19 with limited posteroanterior chest X-ray images using fine-tuned deep neural networks

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 Added by Narinder Punn
 Publication date 2020
and research's language is English




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The novel coronavirus 2019 (COVID-19) is a respiratory syndrome that resembles pneumonia. The current diagnostic procedure of COVID-19 follows reverse-transcriptase polymerase chain reaction (RT-PCR) based approach which however is less sensitive to identify the virus at the initial stage. Hence, a more robust and alternate diagnosis technique is desirable. Recently, with the release of publicly available datasets of corona positive patients comprising of computed tomography (CT) and chest X-ray (CXR) imaging; scientists, researchers and healthcare experts are contributing for faster and automated diagnosis of COVID-19 by identifying pulmonary infections using deep learning approaches to achieve better cure and treatment. These datasets have limited samples concerned with the positive COVID-19 cases, which raise the challenge for unbiased learning. Following from this context, this article presents the random oversampling and weighted class loss function approach for unbiased fine-tuned learning (transfer learning) in various state-of-the-art deep learning approaches such as baseline ResNet, Inception-v3, Inception ResNet-v2, DenseNet169, and NASNetLarge to perform binary classification (as normal and COVID-19 cases) and also multi-class classification (as COVID-19, pneumonia, and normal case) of posteroanterior CXR images. Accuracy, precision, recall, loss, and area under the curve (AUC) are utilized to evaluate the performance of the models. Considering the experimental results, the performance of each model is scenario dependent; however, NASNetLarge displayed better scores in contrast to other architectures, which is further compared with other recently proposed approaches. This article also added the visual explanation to illustrate the basis of model classification and perception of COVID-19 in CXR images.



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The infection of respiratory coronavirus disease 2019 (COVID-19) starts with the upper respiratory tract and as the virus grows, the infection can progress to lungs and develop pneumonia. The conventional way of COVID-19 diagnosis is reverse transcription polymerase chain reaction (RT-PCR), which is less sensitive during early stages; especially if the patient is asymptomatic, which may further cause more severe pneumonia. In this context, several deep learning models have been proposed to identify pulmonary infections using publicly available chest X-ray (CXR) image datasets for early diagnosis, better treatment and quick cure. In these datasets, presence of less number of COVID-19 positive samples compared to other classes (normal, pneumonia and Tuberculosis) raises the challenge for unbiased learning of deep learning models. All deep learning models opted class balancing techniques to solve this issue; which however should be avoided in any medical diagnosis process. Moreover, the deep learning models are also data hungry and need massive computation resources. Therefore for quicker diagnosis, this research proposes a novel pinball loss function based one-class support vector machine (PB-OCSVM), that can work in presence of limited COVID-19 positive CXR samples with objectives to maximize the learning efficiency and to minimize the false predictions. The performance of the proposed model is compared with conventional OCSVM and existing deep learning models, and the experimental results prove that the proposed model outperformed over state-of-the-art methods. To validate the robustness of the proposed model, experiments are also performed with noisy CXR images and UCI benchmark datasets.
With a Coronavirus disease (COVID-19) case count exceeding 10 million worldwide, there is an increased need for a diagnostic capability. The main variables in increasing diagnostic capability are reduced cost, turnaround or diagnosis time, and upfront equipment cost and accessibility. Two candidates for machine learning COVID-19 diagnosis are Computed Tomography (CT) scans and plain chest X-rays. While CT scans score higher in sensitivity, they have a higher cost, maintenance requirement, and turnaround time as compared to plain chest X-rays. The use of portable chest X-radiograph (CXR) is recommended by the American College of Radiology (ACR) since using CT places a massive burden on radiology services. Therefore, X-ray imagery paired with machine learning techniques is proposed a first-line triage tool for COVID-19 diagnostics. In this paper we propose a computer-aided diagnosis (CAD) to accurately classify chest X-ray scans of COVID-19 and normal subjects by fine-tuning several neural networks (ResNet18, ResNet50, DenseNet201) pre-trained on the ImageNet dataset. These neural networks are fused in a parallel architecture and the voting criteria are applied in the final classification decision between the candidate object classes where the output of each neural network is representing a single vote. Several experiments are conducted on the weakly labeled COVID-19-CT-CXR dataset consisting of 263 COVID-19 CXR images extracted from PubMed Central Open Access subsets combined with 25 normal classification CXR images. These experiments show an optimistic result and a capability of the proposed model to outperforming many state-of-the-art algorithms on several measures. Using k-fold cross-validation and a bagging classifier ensemble, we achieve an accuracy of 99.7% and a sensitivity of 100%.
Coronavirus disease 2019 (COVID-19) has emerged the need for computer-aided diagnosis with automatic, accurate, and fast algorithms. Recent studies have applied Machine Learning algorithms for COVID-19 diagnosis over chest X-ray (CXR) images. However, the data scarcity in these studies prevents a reliable evaluation with the potential of overfitting and limits the performance of deep networks. Moreover, these networks can discriminate COVID-19 pneumonia usually from healthy subjects only or occasionally, from limited pneumonia types. Thus, there is a need for a robust and accurate COVID-19 detector evaluated over a large CXR dataset. To address this need, in this study, we propose a reliable COVID-19 detection network: ReCovNet, which can discriminate COVID-19 pneumonia from 14 different thoracic diseases and healthy subjects. To accomplish this, we have compiled the largest COVID-19 CXR dataset: QaTa-COV19 with 124,616 images including 4603 COVID-19 samples. The proposed ReCovNet achieved a detection performance with 98.57% sensitivity and 99.77% specificity.
The current COVID-19 pandemic has motivated the researchers to use artificial intelligence techniques for a potential alternative to reverse transcription-polymerase chain reaction (RT-PCR) due to the limited scale of testing. The chest X-ray (CXR) is one of the alternatives to achieve fast diagnosis but the unavailability of large-scale annotated data makes the clinical implementation of machine learning-based COVID detection difficult. Another issue is the usage of ImageNet pre-trained networks which does not extract reliable feature representations from medical images. In this paper, we propose the use of hierarchical convolutional network (HCN) architecture to naturally augment the data along with diversified features. The HCN uses the first convolution layer from COVIDNet followed by the convolutional layers from well-known pre-trained networks to extract the features. The use of the convolution layer from COVIDNet ensures the extraction of representations relevant to the CXR modality. We also propose the use of ECOC for encoding multiclass problems to binary classification for improving the recognition performance. Experimental results show that HCN architecture is capable of achieving better results in comparison to the existing studies. The proposed method can accurately triage potential COVID-19 patients through CXR images for sharing the testing load and increasing the testing capacity.
The exponential increase in COVID-19 patients is overwhelming healthcare systems across the world. With limited testing kits, it is impossible for every patient with respiratory illness to be tested using conventional techniques (RT-PCR). The tests also have long turn-around time, and limited sensitivity. Detecting possible COVID-19 infections on Chest X-Ray may help quarantine high risk patients while test results are awaited. X-Ray machines are already available in most healthcare systems, and with most modern X-Ray systems already digitized, there is no transportation time involved for the samples either. In this work we propose the use of chest X-Ray to prioritize the selection of patients for further RT-PCR testing. This may be useful in an inpatient setting where the present systems are struggling to decide whether to keep the patient in the ward along with other patients or isolate them in COVID-19 areas. It would also help in identifying patients with high likelihood of COVID with a false negative RT-PCR who would need repeat testing. Further, we propose the use of modern AI techniques to detect the COVID-19 patients using X-Ray images in an automated manner, particularly in settings where radiologists are not available, and help make the proposed testing technology scalable. We present CovidAID: COVID-19 AI Detector, a novel deep neural network based model to triage patients for appropriate testing. On the publicly available covid-chestxray-dataset [2], our model gives 90.5% accuracy with 100% sensitivity (recall) for the COVID-19 infection. We significantly improve upon the results of Covid-Net [10] on the same dataset.

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