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Register a new userCathAI: Fully Automated Interpretation of Coronary Angiograms Using Neural Networks
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Added by
Geoffrey H Tison
Publication date
2021
fields
Informatics Engineering
and research's language is
English
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Coronary heart disease (CHD) is the leading cause of adult death in the United States and worldwide, and for which the coronary angiography procedure is the primary gateway for diagnosis and clinical management decisions. The standard-of-care for interpretation of coronary angiograms depends upon ad-hoc visual assessment by the physician operator. However, ad-hoc visual interpretation of angiograms is poorly reproducible, highly variable and bias prone. Here we show for the first time that fully-automated angiogram interpretation to estimate coronary artery stenosis is possible using a sequence of deep neural network algorithms. The algorithmic pipeline we developed--called CathAI--achieves state-of-the art performance across the sequence of tasks required to accomplish automated interpretation of unselected, real-world angiograms. CathAI (Algorithms 1-2) demonstrated positive predictive value, sensitivity and F1 score of >=90% to identify the projection angle overall and >=93% for left or right coronary artery angiogram detection, the primary anatomic structures of interest. To predict obstructive coronary artery stenosis (>=70% stenosis), CathAI (Algorithm 4) exhibited an area under the receiver operating characteristic curve (AUC) of 0.862 (95% CI: 0.843-0.880). When externally validated in a healthcare system in another country, CathAI AUC was 0.869 (95% CI: 0.830-0.907) to predict obstructive coronary artery stenosis. Our results demonstrate that multiple purpose-built neural networks can function in sequence to accomplish the complex series of tasks required for automated analysis of real-world angiograms. Deployment of CathAI may serve to increase standardization and reproducibility in coronary stenosis assessment, while providing a robust foundation to accomplish future tasks for algorithmic angiographic interpretation.
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Traditional deep neural nets (NNs) have shown the state-of-the-art performance in the task of classification in various applications. However, NNs have not considered any types of uncertainty associated with the class probabilities to minimize risk due to misclassification under uncertainty in real life. Unlike Bayesian neural nets indirectly infering uncertainty through weight uncertainties, evidential neural networks (ENNs) have been recently proposed to support explicit modeling of the uncertainty of class probabilities. It treats predictions of an NN as subjective opinions and learns the function by collecting the evidence leading to these opinions by a deterministic NN from data. However, an ENN is trained as a black box without explicitly considering different types of inherent data uncertainty, such as vacuity (uncertainty due to a lack of evidence) or dissonance (uncertainty due to conflicting evidence). This paper presents a new approach, called a {em regularized ENN}, that learns an ENN based on regularizations related to different characteristics of inherent data uncertainty. Via the experiments with both synthetic and real-world datasets, we demonstrate that the proposed regularized ENN can better learn of an ENN modeling different types of uncertainty in the class probabilities for classification tasks.
XDeep is an open-source Python package developed to interpret deep models for both practitioners and researchers. Overall, XDeep takes a trained deep neural network (DNN) as the input, and generates relevant interpretations as the output with the post-hoc manner. From the functionality perspective, XDeep integrates a wide range of interpretation algorithms from the state-of-the-arts, covering different types of methodologies, and is capable of providing both local explanation and global explanation for DNN when interpreting model behaviours. With the well-documented API designed in XDeep, end-users can easily obtain the interpretations for their deep models at hand with several lines of codes, and compare the results among different algorithms. XDeep is generally compatible with Python 3, and can be installed through Python Package Index (PyPI). The source codes are available at: https://github.com/datamllab/xdeep.
We study how neural networks trained by gradient descent extrapolate, i.e., what they learn outside the support of the training distribution. Previous works report mixed empirical results when extrapolating with neural networks: while feedforward neural networks, a.k.a. multilayer perceptrons (MLPs), do not extrapolate well in certain simple tasks, Graph Neural Networks (GNNs) -- structured networks with MLP modules -- have shown some success in more complex tasks. Working towards a theoretical explanation, we identify conditions under which MLPs and GNNs extrapolate well. First, we quantify the observation that ReLU MLPs quickly converge to linear functions along any direction from the origin, which implies that ReLU MLPs do not extrapolate most nonlinear functions. But, they can provably learn a linear target function when the training distribution is sufficiently diverse. Second, in connection to analyzing the successes and limitations of GNNs, these results suggest a hypothesis for which we provide theoretical and empirical evidence: the success of GNNs in extrapolating algorithmic tasks to new data (e.g., larger graphs or edge weights) relies on encoding task-specific non-linearities in the architecture or features. Our theoretical analysis builds on a connection of over-parameterized networks to the neural tangent kernel. Empirically, our theory holds across different training settings.
Coronary angiography is the gold standard for the diagnosis of coronary heart disease. At present, the methods for detecting coronary artery stenoses and evaluating the degree of it in coronary angiograms are either subjective or not efficient enough. Two vascular stenoses detection methods in coronary angiograms are proposed to assist the diagnosis. The first one is an automatic method, which can automatically segment the entire coronary vessels and mark the stenoses. The second one is an interactive method. With this method, the user only needs to give a start point and an end point to detect the stenoses of a certain vascular segment. We have shown that the proposed tracking methods are robust for angiograms with various vessel structure. The automatic detection method can effectively measure the diameter of the vessel and mark the stenoses in different angiograms. Further investigation proves that the results of interactive detection method can accurately reflect the true stenoses situation. The proposed automatic method and interactive method are effective in various angiograms and can complement each other in clinical practice. The first method can be used for preliminary screening and the second method can be used for further quantitative analysis. It has the potential to improve the level of clinical diagnosis of coronary heart disease.
To make advanced learning machines such as Deep Neural Networks (DNNs) more transparent in decision making, explainable AI (XAI) aims to provide interpretations of DNNs predictions. These interpretations are usually given in the form of heatmaps, each one illustrating relevant patterns regarding the prediction for a given instance. Bayesian approaches such as Bayesian Neural Networks (BNNs) so far have a limited form of transparency (model transparency) already built-in through their prior weight distribution, but notably, they lack explanations of their predictions for given instances. In this work, we bring together these two perspectives of transparency into a holistic explanation framework for explaining BNNs. Within the Bayesian framework, the network weights follow a probability distribution. Hence, the standard (deterministic) prediction strategy of DNNs extends in BNNs to a predictive distribution, and thus the standard explanation extends to an explanation distribution. Exploiting this view, we uncover that BNNs implicitly employ multiple heterogeneous prediction strategies. While some of these are inherited from standard DNNs, others are revealed to us by considering the inherent uncertainty in BNNs. Our quantitative and qualitative experiments on toy/benchmark data and real-world data from pathology show that the proposed approach of explaining BNNs can lead to more effective and insightful explanations.
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