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Register a new userTele-operative Robotic Lung Ultrasound Scanning Platform for Triage of COVID-19 Patients
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Added by
Ryosuke Tsumura
Publication date
2020
fields
Informatics Engineering
and research's language is
English
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Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic of epic proportions and a global response to prepare health systems worldwide is of utmost importance. In addition to its cost-effectiveness in a resources-limited setting, lung ultrasound (LUS) has emerged as a rapid noninvasive imaging tool for the diagnosis of COVID-19 infected patients. Concerns surrounding LUS include the disparity of infected patients and healthcare providers, relatively small number of physicians and sonographers capable of performing LUS, and most importantly, the requirement for substantial physical contact between the patient and operator, increasing the risk of transmission. Mitigation of the spread of the virus is of paramount importance. A 2-dimensional (2D) tele-operative robotic platform capable of performing LUS in for COVID-19 infected patients may be of significant benefit. The authors address the aforementioned issues surrounding the use of LUS in the application of COVID- 19 infected patients. In addition, first time application, feasibility and safety were validated in three healthy subjects, along with 2D image optimization and comparison for overall accuracy. Preliminary results demonstrate that the proposed platform allows for successful acquisition and application of LUS in humans.
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Ultrasound (US) is a non-invasive yet effective medical diagnostic imaging technique for the COVID-19 global pandemic. However, due to complex feature behaviors and expensive annotations of US images, it is difficult to apply Artificial Intelligence (AI) assisting approaches for lungs multi-symptom (multi-label) classification. To overcome these difficulties, we propose a novel semi-supervised Two-Stream Active Learning (TSAL) method to model complicated features and reduce labeling costs in an iterative procedure. The core component of TSAL is the multi-label learning mechanism, in which label correlations information is used to design multi-label margin (MLM) strategy and confidence validation for automatically selecting informative samples and confident labels. On this basis, a multi-symptom multi-label (MSML) classification network is proposed to learn discriminative features of lung symptoms, and a human-machine interaction is exploited to confirm the final annotations that are used to fine-tune MSML with progressively labeled data. Moreover, a novel lung US dataset named COVID19-LUSMS is built, currently containing 71 clinical patients with 6,836 images sampled from 678 videos. Experimental evaluations show that TSAL using only 20% data can achieve superior performance to the baseline and the state-of-the-art. Qualitatively, visualization of both attention map and sample distribution confirms the good consistency with the clinic knowledge.
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.
Lung ultrasound imaging has been shown effective in detecting typical patterns for interstitial pneumonia, as a point-of-care tool for both patients with COVID-19 and other community-acquired pneumonia (CAP). In this work, we focus on the hyperechoic B-line segmentation task. Using deep neural networks, we automatically outline the regions that are indicative of pathology-sensitive artifacts and their associated sonographic patterns. With a real-world data-scarce scenario, we investigate approaches to utilize both COVID-19 and CAP lung ultrasound data to train the networks; comparing fine-tuning and unsupervised domain adaptation. Segmenting either type of lung condition at inference may support a range of clinical applications during evolving epidemic stages, but also demonstrates value in resource-constrained clinical scenarios. Adapting real clinical data acquired from COVID-19 patients to those from CAP patients significantly improved Dice scores from 0.60 to 0.87 (p < 0.001) and from 0.43 to 0.71 (p < 0.001), on independent COVID-19 and CAP test cases, respectively. It is of practical value that the improvement was demonstrated with only a small amount of data in both training and adaptation data sets, a common constraint for deploying machine learning models in clinical practice. Interestingly, we also report that the inverse adaptation, from labelled CAP data to unlabeled COVID-19 data, did not demonstrate an improvement when tested on either condition. Furthermore, we offer a possible explanation that correlates the segmentation performance to label consistency and data domain diversity in this point-of-care lung ultrasound application.
As the second wave in India mitigates, COVID-19 has now infected about 29 million patients countrywide, leading to more than 350 thousand people dead. As the infections surged, the strain on the medical infrastructure in the country became apparent. While the country vaccinates its population, opening up the economy may lead to an increase in infection rates. In this scenario, it is essential to effectively utilize the limited hospital resources by an informed patient triaging system based on clinical parameters. Here, we present two interpretable machine learning models predicting the clinical outcomes, severity, and mortality, of the patients based on routine non-invasive surveillance of blood parameters from one of the largest cohorts of Indian patients at the day of admission. Patient severity and mortality prediction models achieved 86.3% and 88.06% accuracy, respectively, with an AUC-ROC of 0.91 and 0.92. We have integrated both the models in a user-friendly web app calculator, https://triage-COVID-19.herokuapp.com/, to showcase the potential deployment of such efforts at scale.
During the coronavirus disease 2019 (COVID-19) pandemic, rapid and accurate triage of patients at the emergency department is critical to inform decision-making. We propose a data-driven approach for automatic prediction of deterioration risk using a deep neural network that learns from chest X-ray images and a gradient boosting model that learns from routine clinical variables. Our AI prognosis system, trained using data from 3,661 patients, achieves an area under the receiver operating characteristic curve (AUC) of 0.786 (95% CI: 0.745-0.830) when predicting deterioration within 96 hours. The deep neural network extracts informative areas of chest X-ray images to assist clinicians in interpreting the predictions and performs comparably to two radiologists in a reader study. In order to verify performance in a real clinical setting, we silently deployed a preliminary version of the deep neural network at New York University Langone Health during the first wave of the pandemic, which produced accurate predictions in real-time. In summary, our findings demonstrate the potential of the proposed system for assisting front-line physicians in the triage of COVID-19 patients.
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