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Register a new userCommon pitfalls and recommendations for using machine learning to detect and prognosticate for COVID-19 using chest radiographs and CT scans
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Added by
Michael Roberts
Publication date
2020
fields
Informatics Engineering
and research's language is
English
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Machine learning methods offer great promise for fast and accurate detection and prognostication of COVID-19 from standard-of-care chest radiographs (CXR) and computed tomography (CT) images. Many articles have been published in 2020 describing new machine learning-based models for both of these tasks, but it is unclear which are of potential clinical utility. In this systematic review, we search EMBASE via OVID, MEDLINE via PubMed, bioRxiv, medRxiv and arXiv for published papers and preprints uploaded from January 1, 2020 to October 3, 2020 which describe new machine learning models for the diagnosis or prognosis of COVID-19 from CXR or CT images. Our search identified 2,212 studies, of which 415 were included after initial screening and, after quality screening, 61 studies were included in this systematic review. Our review finds that none of the models identified are of potential clinical use due to methodological flaws and/or underlying biases. This is a major weakness, given the urgency with which validated COVID-19 models are needed. To address this, we give many recommendations which, if followed, will solve these issues and lead to higher quality model development and well documented manuscripts.
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Since the emergence of COVID-19, deep learning models have been developed to identify COVID-19 from chest X-rays. With little to no direct access to hospital data, the AI community relies heavily on public data comprising numerous data sources. Model performance results have been exceptional when training and testing on open-source data, surpassing the reported capabilities of AI in pneumonia-detection prior to the COVID-19 outbreak. In this study impactful models are trained on a widely used open-source data and tested on an external test set and a hospital dataset, for the task of classifying chest X-rays into one of three classes: COVID-19, non-COVID pneumonia and no-pneumonia. Classification performance of the models investigated is evaluated through ROC curves, confusion matrices and standard classification metrics. Explainability modules are implemented to explore the image features most important to classification. Data analysis and model evaluations show that the popular open-source dataset COVIDx is not representative of the real clinical problem and that results from testing on this are inflated. Dependence on open-source data can leave models vulnerable to bias and confounding variables, requiring careful analysis to develop clinically useful/viable AI tools for COVID-19 detection in chest X-rays.
The novel corona-virus disease (COVID-19) pandemic has caused a major outbreak in more than 200 countries around the world, leading to a severe impact on the health and life of many people globally. As of Aug 25th of 2020, more than 20 million people are infected, and more than 800,000 death are reported. Computed Tomography (CT) images can be used as a as an alternative to the time-consuming reverse transcription polymerase chain reaction (RT-PCR) test, to detect COVID-19. In this work we developed a deep learning framework to predict COVID-19 from CT images. We propose to use an attentional convolution network, which can focus on the infected areas of chest, enabling it to perform a more accurate prediction. We trained our model on a dataset of more than 2000 CT images, and report its performance in terms of various popular metrics, such as sensitivity, specificity, area under the curve, and also precision-recall curve, and achieve very promising results. We also provide a visualization of the attention maps of the model for several test images, and show that our model is attending to the infected regions as intended. In addition to developing a machine learning modeling framework, we also provide the manual annotation of the potentionally infected regions of chest, with the help of a board-certified radiologist, and make that publicly available for other researchers.
The novel COVID-19 is a global pandemic disease overgrowing worldwide. Computer-aided screening tools with greater sensitivity is imperative for disease diagnosis and prognosis as early as possible. It also can be a helpful tool in triage for testing and clinical supervision of COVID-19 patients. However, designing such an automated tool from non-invasive radiographic images is challenging as many manually annotated datasets are not publicly available yet, which is the essential core requirement of supervised learning schemes. This article proposes a 3D Convolutional Neural Network (CNN)-based classification approach considering both the inter- and intra-slice spatial voxel information. The proposed system is trained in an end-to-end manner on the 3D patches from the whole volumetric CT images to enlarge the number of training samples, performing the ablation studies on patch size determination. We integrate progressive resizing, segmentation, augmentations, and class-rebalancing to our 3D network. The segmentation is a critical prerequisite step for COVID-19 diagnosis enabling the classifier to learn prominent lung features while excluding the outer lung regions of the CT scans. We evaluate all the extensive experiments on a publicly available dataset, named MosMed, having binary- and multi-class chest CT image partitions. Our experimental results are very encouraging, yielding areas under the ROC curve of 0.914 and 0.893 for the binary- and multi-class tasks, respectively, applying 5-fold cross-validations. Our methods promising results delegate it as a favorable aiding tool for clinical practitioners and radiologists to assess COVID-19.
The health and socioeconomic difficulties caused by the COVID-19 pandemic continues to cause enormous tensions around the world. In particular, this extraordinary surge in the number of cases has put considerable strain on health care systems around the world. A critical step in the treatment and management of COVID-19 positive patients is severity assessment, which is challenging even for expert radiologists given the subtleties at different stages of lung disease severity. Motivated by this challenge, we introduce COVID-Net CT-S, a suite of deep convolutional neural networks for predicting lung disease severity due to COVID-19 infection. More specifically, a 3D residual architecture design is leveraged to learn volumetric visual indicators characterizing the degree of COVID-19 lung disease severity. Experimental results using the patient cohort collected by the China National Center for Bioinformation (CNCB) showed that the proposed COVID-Net CT-S networks, by leveraging volumetric features, can achieve significantly improved severity assessment performance when compared to traditional severity assessment networks that learn and leverage 2D visual features to characterize COVID-19 severity.
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has rapidly spread into a global pandemic. A form of pneumonia, presenting as opacities with in a patients lungs, is the most common presentation associated with this virus, and great attention has gone into how these changes relate to patient morbidity and mortality. In this work we provide open source models for the segmentation of patterns of pulmonary opacification on chest Computed Tomography (CT) scans which have been correlated with various stages and severities of infection. We have collected 663 chest CT scans of COVID-19 patients from healthcare centers around the world, and created pixel wise segmentation labels for nearly 25,000 slices that segment 6 different patterns of pulmonary opacification. We provide open source implementations and pre-trained weights for multiple segmentation models trained on our dataset. Our best model achieves an opacity Intersection-Over-Union score of 0.76 on our test set, demonstrates successful domain adaptation, and predicts the volume of opacification within 1.7% of expert radiologists. Additionally, we present an analysis of the inter-observer variability inherent to this task, and propose methods for appropriate probabilistic approaches.
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