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Register a new userDescribing the Structural Phenotype of the Glaucomatous Optic Nerve Head Using Artificial Intelligence
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The optic nerve head (ONH) typically experiences complex neural- and connective-tissue structural changes with the development and progression of glaucoma, and monitoring these changes could be critical for improved diagnosis and prognosis in the glaucoma clinic. The gold-standard technique to assess structural changes of the ONH clinically is optical coherence tomography (OCT). However, OCT is limited to the measurement of a few hand-engineered parameters, such as the thickness of the retinal nerve fiber layer (RNFL), and has not yet been qualified as a stand-alone device for glaucoma diagnosis and prognosis applications. We argue this is because the vast amount of information available in a 3D OCT scan of the ONH has not been fully exploited. In this study we propose a deep learning approach that can: textbf{(1)} fully exploit information from an OCT scan of the ONH; textbf{(2)} describe the structural phenotype of the glaucomatous ONH; and that can textbf{(3)} be used as a robust glaucoma diagnosis tool. Specifically, the structural features identified by our algorithm were found to be related to clinical observations of glaucoma. The diagnostic accuracy from these structural features was $92.0 pm 2.3 %$ with a sensitivity of $90.0 pm 2.4 % $ (at $95 %$ specificity). By changing their magnitudes in steps, we were able to reveal how the morphology of the ONH changes as one transitions from a `non-glaucoma to a `glaucoma condition. We believe our work may have strong clinical implication for our understanding of glaucoma pathogenesis, and could be improved in the future to also predict future loss of vision.
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Since the introduction of optical coherence tomography (OCT), it has been possible to study the complex 3D morphological changes of the optic nerve head (ONH) tissues that occur along with the progression of glaucoma. Although several deep learning (DL) techniques have been recently proposed for the automated extraction (segmentation) and quantification of these morphological changes, the device specific nature and the difficulty in preparing manual segmentations (training data) limit their clinical adoption. With several new manufacturers and next-generation OCT devices entering the market, the complexity in deploying DL algorithms clinically is only increasing. To address this, we propose a DL based 3D segmentation framework that is easily translatable across OCT devices in a label-free manner (i.e. without the need to manually re-segment data for each device). Specifically, we developed 2 sets of DL networks. The first (referred to as the enhancer) was able to enhance OCT image quality from 3 OCT devices, and harmonized image-characteristics across these devices. The second performed 3D segmentation of 6 important ONH tissue layers. We found that the use of the enhancer was critical for our segmentation network to achieve device independency. In other words, our 3D segmentation network trained on any of 3 devices successfully segmented ONH tissue layers from the other two devices with high performance (Dice coefficients > 0.92). With such an approach, we could automatically segment images from new OCT devices without ever needing manual segmentation data from such devices.
The emergence of digital pathology has opened new horizons for histopathology and cytology. Artificial-intelligence algorithms are able to operate on digitized slides to assist pathologists with diagnostic tasks. Whereas machine learning involving classification and segmentation methods have obvious benefits for image analysis in pathology, image search represents a fundamental shift in computational pathology. Matching the pathology of new patients with already diagnosed and curated cases offers pathologist a novel approach to improve diagnostic accuracy through visual inspection of similar cases and computational majority vote for consensus building. In this study, we report the results from searching the largest public repository (The Cancer Genome Atlas [TCGA] program by National Cancer Institute, USA) of whole slide images from almost 11,000 patients depicting different types of malignancies. For the first time, we successfully indexed and searched almost 30,000 high-resolution digitized slides constituting 16 terabytes of data comprised of 20 million 1000x1000 pixels image patches. The TCGA image database covers 25 anatomic sites and contains 32 cancer subtypes. High-performance storage and GPU power were employed for experimentation. The results were assessed with conservative majority voting to build consensus for subtype diagnosis through vertical search and demonstrated high accuracy values for both frozen sections slides (e.g., bladder urothelial carcinoma 93%, kidney renal clear cell carcinoma 97%, and ovarian serous cystadenocarcinoma 99%) and permanent histopathology slides (e.g., prostate adenocarcinoma 98%, skin cutaneous melanoma 99%, and thymoma 100%). The key finding of this validation study was that computational consensus appears to be possible for rendering diagnoses if a sufficiently large number of searchable cases are available for each cancer subtype.
Coronavirus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2). The virus transmits rapidly; it has a basic reproductive number R of 2.2-2.7. In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. COVID-19 is currently affecting more than 200 countries with 6M active cases. An effective testing strategy for COVID-19 is crucial to controlling the outbreak but the demand for testing surpasses the availability of test kits that use Reverse Transcription Polymerase Chain Reaction (RT-PCR). In this paper, we present a technique to screen for COVID-19 using artificial intelligence. Our technique takes only seconds to screen for the presence of the virus in a patient. We collected a dataset of chest X-ray images and trained several popular deep convolution neural network-based models (VGG, MobileNet, Xception, DenseNet, InceptionResNet) to classify the chest X-rays. Unsatisfied with these models, we then designed and built a Residual Attention Network that was able to screen COVID-19 with a testing accuracy of 98% and a validation accuracy of 100%. A feature maps visual of our model show areas in a chest X-ray which are important for classification. Our work can help to increase the adaptation of AI-assisted applications in clinical practice. The code and dataset used in this project are available at https://github.com/vishalshar/covid-19-screening-using-RAN-on-X-ray-images.
The COVID-19 pandemic continues to spread and impact the well-being of the global population. The front-line modalities including computed tomography (CT) and X-ray play an important role for triaging COVID patients. Considering the limited access of resources (both hardware and trained personnel) and decontamination considerations, CT may not be ideal for triaging suspected subjects. Artificial intelligence (AI) assisted X-ray based applications for triaging and monitoring require experienced radiologists to identify COVID patients in a timely manner and to further delineate the disease region boundary are seen as a promising solution. Our proposed solution differs from existing solutions by industry and academic communities, and demonstrates a functional AI model to triage by inferencing using a single x-ray image, while the deep-learning model is trained using both X-ray and CT data. We report on how such a multi-modal training improves the solution compared to X-ray only training. The multi-modal solution increases the AUC (area under the receiver operating characteristic curve) from 0.89 to 0.93 and also positively impacts the Dice coefficient (0.59 to 0.62) for localizing the pathology. To the best our knowledge, it is the first X-ray solution by leveraging multi-modal information for the development.
Breast density is an important risk factor for breast cancer that also affects the specificity and sensitivity of screening mammography. Current federal legislation mandates reporting of breast density for all women undergoing breast screening. Clinically, breast density is assessed visually using the American College of Radiology Breast Imaging Reporting And Data System (BI-RADS) scale. Here, we introduce an artificial intelligence (AI) method to estimate breast percentage density (PD) from digital mammograms. Our method leverages deep learning (DL) using two convolutional neural network architectures to accurately segment the breast area. A machine-learning algorithm combining superpixel generation, texture feature analysis, and support vector machine is then applied to differentiate dense from non-dense tissue regions, from which PD is estimated. Our method has been trained and validated on a multi-ethnic, multi-institutional dataset of 15,661 images (4,437 women), and then tested on an independent dataset of 6,368 digital mammograms (1,702 women; cases=414) for both PD estimation and discrimination of breast cancer. On the independent dataset, PD estimates from Deep-LIBRA and an expert reader were strongly correlated (Spearman correlation coefficient = 0.90). Moreover, Deep-LIBRA yielded a higher breast cancer discrimination performance (area under the ROC curve, AUC = 0.611 [95% confidence interval (CI): 0.583, 0.639]) compared to four other widely-used research and commercial PD assessment methods (AUCs = 0.528 to 0.588). Our results suggest a strong agreement of PD estimates between Deep-LIBRA and gold-standard assessment by an expert reader, as well as improved performance in breast cancer risk assessment over state-of-the-art open-source and commercial methods.
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