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Register a new userDeep learning for detecting pulmonary tuberculosis via chest radiography: an international study across 10 countries
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Tuberculosis (TB) is a top-10 cause of death worldwide. Though the WHO recommends chest radiographs (CXRs) for TB screening, the limited availability of CXR interpretation is a barrier. We trained a deep learning system (DLS) to detect active pulmonary TB using CXRs from 9 countries across Africa, Asia, and Europe, and utilized large-scale CXR pretraining, attention pooling, and noisy student semi-supervised learning. Evaluation was on (1) a combined test set spanning China, India, US, and Zambia, and (2) an independent mining population in South Africa. Given WHO targets of 90% sensitivity and 70% specificity, the DLSs operating point was prespecified to favor sensitivity over specificity. On the combined test set, the DLSs ROC curve was above all 9 India-based radiologists, with an AUC of 0.90 (95%CI 0.87-0.92). The DLSs sensitivity (88%) was higher than the India-based radiologists (75% mean sensitivity), p<0.001 for superiority; and its specificity (79%) was non-inferior to the radiologists (84% mean specificity), p=0.004. Similar trends were observed within HIV positive and sputum smear positive sub-groups, and in the South Africa test set. We found that 5 US-based radiologists (where TB isnt endemic) were more sensitive and less specific than the India-based radiologists (where TB is endemic). The DLS also remained non-inferior to the US-based radiologists. In simulations, using the DLS as a prioritization tool for confirmatory testing reduced the cost per positive case detected by 40-80% compared to using confirmatory testing alone. To conclude, our DLS generalized to 5 countries, and merits prospective evaluation to assist cost-effective screening efforts in radiologist-limited settings. Operating point flexibility may permit customization of the DLS to account for site-specific factors such as TB prevalence, demographics, clinical resources, and customary practice patterns.
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We developed a deep learning model-based system to automatically generate a quantitative Computed Tomography (CT) diagnostic report for Pulmonary Tuberculosis (PTB) cases.501 CT imaging datasets from 223 patients with active PTB were collected, and another 501 cases from a healthy population served as negative samples.2884 lesions of PTB were carefully labeled and classified manually by professional radiologists.Three state-of-the-art 3D convolution neural network (CNN) models were trained and evaluated in the inspection of PTB CT images. Transfer learning method was also utilized during this process. The best model was selected to annotate the spatial location of lesions and classify them into miliary, infiltrative, caseous, tuberculoma and cavitary types simultaneously.Then the Noisy-Or Bayesian function was used to generate an overall infection probability.Finally, a quantitative diagnostic report was exported.The results showed that the recall and precision rates, from the perspective of a single lesion region of PTB, were 85.9% and 89.2% respectively. The overall recall and precision rates,from the perspective of one PTB case, were 98.7% and 93.7%, respectively. Moreover, the precision rate of the PTB lesion type classification was 90.9%.The new method might serve as an effective reference for decision making by clinical doctors.
Purpose: To develop a machine learning model to classify the severity grades of pulmonary edema on chest radiographs. Materials and Methods: In this retrospective study, 369,071 chest radiographs and associated radiology reports from 64,581 (mean age, 51.71; 54.51% women) patients from the MIMIC-CXR chest radiograph dataset were included. This dataset was split into patients with and without congestive heart failure (CHF). Pulmonary edema severity labels from the associated radiology reports were extracted from patients with CHF as four different ordinal levels: 0, no edema; 1, vascular congestion; 2, interstitial edema; and 3, alveolar edema. Deep learning models were developed using two approaches: a semi-supervised model using a variational autoencoder and a pre-trained supervised learning model using a dense neural network. Receiver operating characteristic curve analysis was performed on both models. Results: The area under the receiver operating characteristic curve (AUC) for differentiating alveolar edema from no edema was 0.99 for the semi-supervised model and 0.87 for the pre-trained models. Performance of the algorithm was inversely related to the difficulty in categorizing milder states of pulmonary edema (shown as AUCs for semi-supervised model and pre-trained model, respectively): 2 versus 0, 0.88 and 0.81; 1 versus 0, 0.79 and 0.66; 3 versus 1, 0.93 and 0.82; 2 versus 1, 0.69 and 0.73; and, 3 versus 2, 0.88 and 0.63. Conclusion: Deep learning models were trained on a large chest radiograph dataset and could grade the severity of pulmonary edema on chest radiographs with high performance.
Purpose. Imaging plays an important role in assessing severity of COVID 19 pneumonia. However, semantic interpretation of chest radiography (CXR) findings does not include quantitative description of radiographic opacities. Most current AI assisted CXR image analysis framework do not quantify for regional variations of disease. To address these, we proposed a four region lung segmentation method to assist accurate quantification of COVID 19 pneumonia. Methods. A segmentation model to separate left and right lung is firstly applied, and then a carina and left hilum detection network is used, which are the clinical landmarks to separate the upper and lower lungs. To improve the segmentation performance of COVID 19 images, ensemble strategy incorporating five models is exploited. Using each region, we evaluated the clinical relevance of the proposed method with the Radiographic Assessment of the Quality of Lung Edema (RALE). Results. The proposed ensemble strategy showed dice score of 0.900, which is significantly higher than conventional methods (0.854 0.889). Mean intensities of segmented four regions indicate positive correlation to the extent and density scores of pulmonary opacities under the RALE framework. Conclusion. A deep learning based model in CXR can accurately segment and quantify regional distribution of pulmonary opacities in patients with COVID 19 pneumonia.
Tuberculosis (TB) is a chronic lung disease that occurs due to bacterial infection and is one of the top 10 leading causes of death. Accurate and early detection of TB is very important, otherwise, it could be life-threatening. In this work, we have detected TB reliably from the chest X-ray images using image pre-processing, data augmentation, image segmentation, and deep-learning classification techniques. Several public databases were used to create a database of 700 TB infected and 3500 normal chest X-ray images for this study. Nine different deep CNNs (ResNet18, ResNet50, ResNet101, ChexNet, InceptionV3, Vgg19, DenseNet201, SqueezeNet, and MobileNet), which were used for transfer learning from their pre-trained initial weights and trained, validated and tested for classifying TB and non-TB normal cases. Three different experiments were carried out in this work: segmentation of X-ray images using two different U-net models, classification using X-ray images, and segmented lung images. The accuracy, precision, sensitivity, F1-score, specificity in the detection of tuberculosis using X-ray images were 97.07 %, 97.34 %, 97.07 %, 97.14 % and 97.36 % respectively. However, segmented lungs for the classification outperformed than whole X-ray image-based classification and accuracy, precision, sensitivity, F1-score, specificity were 99.9 %, 99.91 %, 99.9 %, 99.9 %, and 99.52 % respectively. The paper also used a visualization technique to confirm that CNN learns dominantly from the segmented lung regions results in higher detection accuracy. The proposed method with state-of-the-art performance can be useful in the computer-aided faster diagnosis of tuberculosis.
Objective: We propose an end-to-end CNN-based locating model for pulmonary tuberculosis (TB) diagnosis in radiographs. This model makes full use of chest radiograph (X-ray) for its improved accessibility, reduced cost and high accuracy for TB disease. Methods: Several specialized improvements are proposed for detection task in medical field. A false positive (FP) restrictor head is introduced for FP reduction. Anchor-oriented network heads is proposed in the position regression section. An optimization of loss function is designed for hard example mining. Results: The experimental results show that when the threshold of intersection over union (IoU) is set to 0.3, the average precision (AP) of two test data sets provided by different hospitals reaches 0.9023 and 0.9332. Ablation experiments shows that hard example mining and change of regressor heads contribute most in this work, but FP restriction is necessary in a CAD diagnose system. Conclusion: The results prove the high precision and good generalization ability of our proposed model comparing to previous works. Significance: We first make full use of the feature extraction ability of CNNs in TB diagnostic field and make exploration in localization of TB, when the previous works focus on the weaker task of healthy-sick subject classification.
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