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A Cascaded Learning Strategy for Robust COVID-19 Pneumonia Chest X-Ray Screening

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 Added by Tyng-Luh Liu
 Publication date 2020
and research's language is English




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We introduce a comprehensive screening platform for the COVID-19 (a.k.a., SARS-CoV-2) pneumonia. The proposed AI-based system works on chest x-ray (CXR) images to predict whether a patient is infected with the COVID-19 disease. Although the recent international joint effort on making the availability of all sorts of open data, the public collection of CXR images is still relatively small for reliably training a deep neural network (DNN) to carry out COVID-19 prediction. To better address such inefficiency, we design a cascaded learning strategy to improve both the sensitivity and the specificity of the resulting DNN classification model. Our approach leverages a large CXR image dataset of non-COVID-19 pneumonia to generalize the original well-trained classification model via a cascaded learning scheme. The resulting screening system is shown to achieve good classification performance on the expanded dataset, including those newly added COVID-19 CXR images.



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This paper addresses the new problem of automated screening of coronavirus disease 2019 (COVID-19) based on chest X-rays, which is urgently demanded toward fast stopping the pandemic. However, robust and accurate screening of COVID-19 from chest X-rays is still a globally recognized challenge because of two bottlenecks: 1) imaging features of COVID-19 share some similarities with other pneumonia on chest X-rays, and 2) the misdiagnosis rate of COVID-19 is very high, and the misdiagnosis cost is expensive. While a few pioneering works have made much progress, they underestimate both crucial bottlenecks. In this paper, we report our solution, discriminative cost-sensitive learning (DCSL), which should be the choice if the clinical needs the assisted screening of COVID-19 from chest X-rays. DCSL combines both advantages from fine-grained classification and cost-sensitive learning. Firstly, DCSL develops a conditional center loss that learns deep discriminative representation. Secondly, DCSL establishes score-level cost-sensitive learning that can adaptively enlarge the cost of misclassifying COVID-19 examples into other classes. DCSL is so flexible that it can apply in any deep neural network. We collected a large-scale multi-class dataset comprised of 2,239 chest X-ray examples: 239 examples from confirmed COVID-19 cases, 1,000 examples with confirmed bacterial or viral pneumonia cases, and 1,000 examples of healthy people. Extensive experiments on the three-class classification show that our algorithm remarkably outperforms state-of-the-art algorithms. It achieves an accuracy of 97.01%, a precision of 97%, a sensitivity of 97.09%, and an F1-score of 96.98%. These results endow our algorithm as an efficient tool for the fast large-scale screening of COVID-19.
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.
Coronavirus disease 2019 (COVID-19) is an infectious disease with first symptoms similar to the flu. COVID-19 appeared first in China and very quickly spreads to the rest of the world, causing then the 2019-20 coronavirus pandemic. In many cases, this disease causes pneumonia. Since pulmonary infections can be observed through radiography images, this paper investigates deep learning methods for automatically analyzing query chest X-ray images with the hope to bring precision tools to health professionals towards screening the COVID-19 and diagnosing confirmed patients. In this context, training datasets, deep learning architectures and analysis strategies have been experimented from publicly open sets of chest X-ray images. Tailored deep learning models are proposed to detect pneumonia infection cases, notably viral cases. It is assumed that viral pneumonia cases detected during an epidemic COVID-19 context have a high probability to presume COVID-19 infections. Moreover, easy-to-apply health indicators are proposed for estimating infection status and predicting patient status from the detected pneumonia cases. Experimental results show possibilities of training deep learning models over publicly open sets of chest X-ray images towards screening viral pneumonia. Chest X-ray test images of COVID-19 infected patients are successfully diagnosed through detection models retained for their performances. The efficiency of proposed health indicators is highlighted through simulated scenarios of patients presenting infections and health problems by combining real and synthetic health data.
Purpose: The need to streamline patient management for COVID-19 has become more pressing than ever. Chest X-rays provide a non-invasive (potentially bedside) tool to monitor the progression of the disease. In this study, we present a severity score prediction model for COVID-19 pneumonia for frontal chest X-ray images. Such a tool can gauge severity of COVID-19 lung infections (and pneumonia in general) that can be used for escalation or de-escalation of care as well as monitoring treatment efficacy, especially in the ICU. Methods: Images from a public COVID-19 database were scored retrospectively by three blinded experts in terms of the extent of lung involvement as well as the degree of opacity. A neural network model that was pre-trained on large (non-COVID-19) chest X-ray datasets is used to construct features for COVID-19 images which are predictive for our task. Results: This study finds that training a regression model on a subset of the outputs from an this pre-trained chest X-ray model predicts our geographic extent score (range 0-8) with 1.14 mean absolute error (MAE) and our lung opacity score (range 0-6) with 0.78 MAE. Conclusions: These results indicate that our models ability to gauge severity of COVID-19 lung infections could be used for escalation or de-escalation of care as well as monitoring treatment efficacy, especially in the intensive care unit (ICU). A proper clinical trial is needed to evaluate efficacy. To enable this we make our code, labels, and data available online at https://github.com/mlmed/torchxrayvision/tree/master/scripts/covid-severity and https://github.com/ieee8023/covid-chestxray-dataset
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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