Discriminative models that require full supervision are inefficacious in the medical imaging domain when large labeled datasets are unavailable. By contrast, generative modeling---i.e., learning data generation and classification---facilitates semi-supervised training with limited labeled data. Moreover, generative modeling can be advantageous in accomplishing multiple objectives for better generalization. We propose a novel multi-task learning model for jointly learning a classifier and a segmentor, from chest X-ray images, through semi-supervised learning. In addition, we propose a new loss function that combines absolute KL divergence with Tversky loss (KLTV) to yield faster convergence and better segmentation performance. Based on our experimental results using a novel segmentation model, an Adversarial Pyramid Progressive Attention U-Net (APPAU-Net), we hypothesize that KLTV can be more effective for generalizing multi-tasking models while being competitive in segmentation-only tasks.
Deep learning technologies have already demonstrated a high potential to build diagnosis support systems from medical imaging data, such as Chest X-Ray images. However, the shortage of labeled data in the medical field represents one key obstacle to narrow down the performance gap with respect to applications in other image domains. In this work, we investigate the benefits of a curricular Self-Supervised Learning (SSL) pretraining scheme with respect to fully-supervised training regimes for pneumonia recognition on Chest X-Ray images of Covid-19 patients. We show that curricular SSL pretraini…
UT Austin（得克萨斯大学奥斯汀分校）；MIS, Germany（德国曼海姆应用科学大学）；Weill Cornell Medicine（威尔康奈尔医学院）
Computer-aided diagnosis plays a salient role in more accessible and accurate cardiopulmonary diseases classification and localization on chest radiography. Millions of people get affected and die due to these diseases without an accurate and timely diagnosis. Recently proposed contrastive learning heavily relies on data augmentation, especially positive data augmentation. However, generating clinically-accurate data augmentations for medical images is extremely difficult because the common data augmentation methods in computer vision, such as sharp, blur, and crop operations, can severely alt…
Technical University of Kosice（科希策技术大学）；Pavol Jozef Safarik University（帕沃尔·约瑟夫·沙法里克大学）；Louis Pasteur University Hospital（路易·巴斯德大学医院）
Chest radiography is a relatively cheap, widely available medical procedure that conveys key information for making diagnostic decisions. Chest X-rays are almost always used in the diagnosis of respiratory diseases such as pneumonia or the recent COVID-19. In this paper, we propose a self-supervised deep neural network that is pretrained on an unlabeled chest X-ray dataset. The learned representations are transferred to downstream task - the classification of respiratory diseases. The results obtained on four public datasets show that our approach yields competitive results without requiring l…
Saratoga High School（萨拉托加高中）；Stanford University（斯坦福大学）
Chest X-rays of coronavirus disease 2019 (COVID-19) patients are frequently obtained to determine the extent of lung disease and are a valuable source of data for creating artificial intelligence models. Most work to date assessing disease severity on chest imaging has focused on segmenting computed tomography (CT) images; however, given that CTs are performed much less frequently than chest X-rays for COVID-19 patients, automated lung lesion segmentation on chest X-rays could be clinically valuable. There currently exists a universal shortage of chest X-rays with ground truth COVID-19 lung le…
Semi-supervised learning (SSL) leverages both labeled and unlabeled data for training models when the labeled data is limited and the unlabeled data is vast. Frequently, the unlabeled data is more widely available than the labeled data, hence this data is used to improve the level of generalization of a model when the labeled data is scarce. However, in real-world settings unlabeled data might depict a different distribution than the labeled dataset distribution. This is known as distribution mismatch. Such problem generally occurs when the source of unlabeled data is different from the labele…
Beth Israel Deaconess Medical Center（贝斯以色列女执事医疗中心）；Harvard Medical School（哈佛医学院）；Massachusetts Institute of Technology（麻省理工学院）；Philips Research（飞利浦研究院）
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 conges…
Weakly Supervised Anomaly Detection for Chest X-Ray Image
School of Artificial Intelligence, Beijing University of Posts and Telecommunications（北京邮电大学人工智能学院）；College of Information and Engineering, Capital Normal University（首都师范大学信息与工程学院）；Peking University Third Hospital（北京大学第三医院）
HIDSS4Health - Helmholtz Information and Data Science School for Health（HIDSS4Health——亥姆霍兹健康信息与数据科学学院）；Karlsruhe Institute of Technology（卡尔斯鲁厄理工学院）；German Cancer Research Center Heidelberg（海德堡德国癌症研究中心）
The lack of fine-grained annotations hinders the deployment of automated diagnosis systems, which require human-interpretable justification for their decision process. In this paper, we address the problem of weakly supervised identification and localization of abnormalities in chest radiographs. To that end, we introduce a novel loss function for training convolutional neural networks increasing the \emph{localization confidence} and assisting the overall \emph{disease identification}. The loss leverages both image- and patch-level predictions to generate auxiliary supervision. Rather than fo…
The University of Texas at Arlington（德克萨斯大学阿灵顿分校）；Tencent AI Lab（腾讯人工智能实验室）
Chest X-rays is one of the most commonly available and affordable radiological examinations in clinical practice. While detecting thoracic diseases on chest X-rays is still a challenging task for machine intelligence, due to 1) the highly varied appearance of lesion areas on X-rays from patients of different thoracic disease and 2) the shortage of accurate pixel-level annotations by radiologists for model training. Existing machine learning methods are unable to deal with the challenge that thoracic diseases usually happen in localized disease-specific areas. In this article, we propose a weak…
Deep Convolutional Neural Networks have proven effective in solving the task of semantic segmentation. However, their efficiency heavily relies on the pixel-level annotations that are expensive to get and often require domain expertise, especially in medical imaging. Weakly supervised semantic segmentation helps to overcome these issues and also provides explainable deep learning models. In this paper, we propose a novel approach to the semantic segmentation of medical chest X-ray images with only image-level class labels as supervision. We improve the disease localization accuracy by combinin…
University of Adelaide（阿德莱德大学）；Universidade Federal Rural de Pernambuco（伯南布哥联邦农村大学）；Universität Ulm（乌尔姆大学）；South Australian Health and Medical Research Institute（南澳大利亚健康与医学研究所）
The training of deep learning models generally requires a large amount of annotated data for effective convergence and generalisation. However, obtaining high-quality annotations is a laboursome and expensive process due to the need of expert radiologists for the labelling task. The study of semi-supervised learning in medical image analysis is then of crucial importance given that it is much less expensive to obtain unlabelled images than to acquire images labelled by expert radiologists. Essentially, semi-supervised methods leverage large sets of unlabelled data to enable better training con…
National Research Council Canada（加拿大国家研究委员会）；University of Waterloo（滑铁卢大学）
Effective representation learning is the key in improving model performance for medical image analysis. In training deep learning models, a compromise often must be made between performance and trust, both of which are essential for medical applications. Moreover, models optimized with cross-entropy loss tend to suffer from unwarranted overconfidence in the majority class and over-cautiousness in the minority class. In this work, we integrate a new surrogate loss with self-supervised learning for computer-aided screening of COVID-19 patients using radiography images. In addition, we adopt a ne…
Purpose: Considering several patients screened due to COVID-19 pandemic, computer-aided detection has strong potential in assisting clinical workflow efficiency and reducing the incidence of infections among radiologists and healthcare providers. Since many confirmed COVID-19 cases present radiological findings of pneumonia, radiologic examinations can be useful for fast detection. Therefore, chest radiography can be used to fast screen COVID-19 during the patient triage, thereby determining the priority of patient's care to help saturated medical facilities in a pandemic situation. Methods: I…
Massachusetts Institute of Technology（麻省理工学院）；Philips Research North America（飞利浦北美研究院）；Beth Israel Deaconess Medical Center（贝斯以色列女执事医疗中心）；Harvard Medical School（哈佛医学院）；Brigham and Women’s Hospital（布莱根妇女医院）
We propose and demonstrate machine learning algorithms to assess the severity of pulmonary edema in chest x-ray images of congestive heart failure patients. Accurate assessment of pulmonary edema in heart failure is critical when making treatment and disposition decisions. Our work is grounded in a large-scale clinical dataset of over 300,000 x-ray images with associated radiology reports. While edema severity labels can be extracted unambiguously from a small fraction of the radiology reports, accurate annotation is challenging in most cases. To take advantage of the unlabeled images, we deve…
University of Alicante（阿利坎特大学）；Hospital San Juan de Alicante（阿利坎特圣胡安医院）；Regional Ministry of Health, Valencia（瓦伦西亚地区卫生部）
We present a labeled large-scale, high resolution chest x-ray dataset for the automated exploration of medical images along with their associated reports. This dataset includes more than 160,000 images obtained from 67,000 patients that were interpreted and reported by radiologists at Hospital San Juan Hospital (Spain) from 2009 to 2017, covering six different position views and additional information on image acquisition and patient demography. The reports were labeled with 174 different radiographic findings, 19 differential diagnoses and 104 anatomic locations organized as a hierarchical ta…
We consider the problem of abnormality localization for clinical applications. While deep learning has driven much recent progress in medical imaging, many clinical challenges are not fully addressed, limiting its broader usage. While recent methods report high diagnostic accuracies, physicians have concerns trusting these algorithm results for diagnostic decision-making purposes because of a general lack of algorithm decision reasoning and interpretability. One potential way to address this problem is to further train these models to localize abnormalities in addition to just classifying them…
Anatomy-Structured Hierarchical MIL for Weakly-Supervised Thoracic Disease Detection in Chest X-rays
Ewha Womans University（梨花女子大学）；Ewha Medical Artificial Intelligence Research Institute（梨花女子大学医学人工智能研究所）；REMEDI Inc.（瑞美迪公司）；Ewha Womans University Seoul Hospital（梨花女子大学首尔医院）
Osaka University Graduate School of Medicine（大阪大学医学研究生院）
Large numbers of labeled medical images are essential for the accurate detection of anomalies, but manual annotation is labor-intensive and time-consuming. Self-supervised learning (SSL) is a training method to learn data-specific features without manual annotation. Several SSL-based models have been employed in medical image anomaly detection. These SSL methods effectively learn representations in several field-specific images, such as natural and industrial product images. However, owing to the requirement of medical expertise, typical SSL-based models are inefficient in medical image anomal…
Feature-level Site Leakage Reduction for Cross-Hospital Chest X-ray Transfer via Self-Supervised Learning
University of Mentouri Brothers Constantine 1（君士坦丁兄弟门图里大学）；LRIA Laboratory, University of Science and Technology Houari Boumediene (USTHB)（LRIA实验室，胡阿里·布迈丁科技大学）；LSIACIO Laboratory, University of Mentouri Brothers Constantine 1（LSIACIO实验室，君士坦丁兄弟门图里大学）；University of Paris-VIII-Vincennes-Saint-Denis（巴黎第八大学）
The Chinese University of Hong Kong（香港中文大学）；The Hong Kong University of Science and Technology（香港科技大学）；Imsight AI Research Lab（Imsight人工智能研究实验室）；Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences（中国科学院深圳先进技术研究院）
Chest X-ray (CXR) is the most typical diagnostic X-ray examination for screening various thoracic diseases. Automatically localizing lesions from CXR is promising for alleviating radiologists' reading burden. However, CXR datasets are often with massive image-level annotations and scarce lesion-level annotations, and more often, without annotations. Thus far, unifying different supervision granularities to develop thoracic disease detection algorithms has not been comprehensively addressed. In this paper, we present OXnet, the first deep omni-supervised thoracic disease detection network to ou…
National Institutes of Health, Clinical Center（美国国立卫生研究院临床中心）；Ping An Technology Co., Ltd.（平安科技有限公司）
In this work, we exploit the task of joint classification and weakly supervised localization of thoracic diseases from chest radiographs, with only image-level disease labels coupled with disease severity-level (DSL) information of a subset. A convolutional neural network (CNN) based attention-guided curriculum learning (AGCL) framework is presented, which leverages the severity-level attributes mined from radiology reports. Images in order of difficulty (grouped by different severity-levels) are fed to CNN to boost the learning gradually. In addition, highly confident samples (measured by cla…
MILA（蒙特利尔学习算法研究所）；Université de Montréal（蒙特利尔大学）；Imagia Inc.（Imagia公司）；School of Computing Science, Simon Fraser University（西蒙弗雷泽大学计算科学学院）
The scarcity of richly annotated medical images is limiting supervised deep learning based solutions to medical image analysis tasks, such as localizing discriminatory radiomic disease signatures. Therefore, it is desirable to leverage unsupervised and weakly supervised models. Most recent weakly supervised localization methods apply attention maps or region proposals in a multiple instance learning formulation. While attention maps can be noisy, leading to erroneously highlighted regions, it is not simple to decide on an optimal window/bag size for multiple instance learning approaches. In th…
EVA-X: A Foundation Model for General Chest X-ray Analysis with Self-supervised Learning
School of Electronic Information and Communications, Huazhong University of Science and Technology（华中科技大学电子信息与通信学院）；Union Hospital, Tongji Medical College, Huazhong University of Science and Technology（华中科技大学同济医学院附属协和医院）；Peter Munk Cardiac Centre, University Health Network（多伦多大学健康网络彼得·芒克心脏中心）；University of Toronto（多伦多大学）；Vector Institute for Artificial Intelligence（向量人工智能研究所）
本文提出 EVA-X 自监督胸部 X 光基础模型，可同时学习语义与几何表示，在 20 多种疾病和 11 项检测任务上取得领先性能，并降低标注需求。
The University of Texas at Austin（德克萨斯大学奥斯汀分校）；Weill Cornell Medical College（威尔康奈尔医学院）
Before the recent success of deep learning methods for automated medical image analysis, practitioners used handcrafted radiomic features to quantitatively describe local patches of medical images. However, extracting discriminative radiomic features relies on accurate pathology localization, which is difficult to acquire in real-world settings. Despite advances in disease classification and localization from chest X-rays, many approaches fail to incorporate clinically-informed domain knowledge. For these reasons, we propose a Radiomics-Guided Transformer (RGT) that fuses \textit{global} image…
Centre for Computational Intelligence (CCI), De Montfort University（德蒙福特大学计算智能中心）；School of Computer Science, University of Nottingham（诺丁汉大学计算机科学学院）
In the context of the global coronavirus pandemic, different deep learning solutions for infected subject detection using chest X-ray images have been proposed. However, deep learning models usually need large labelled datasets to be effective. Semi-supervised deep learning is an attractive alternative, where unlabelled data is leveraged to improve the overall model's accuracy. However, in real-world usage settings, an unlabelled dataset might present a different distribution than the labelled dataset (i.e. the labelled dataset was sampled from a target clinic and the unlabelled dataset from a…
Pre-trained models, e.g., from ImageNet, have proven to be effective in boosting the performance of many downstream applications. It is too demanding to acquire large-scale annotations to build such models for medical imaging. Meanwhile, there are numerous clinical data (in the form of images and text reports) stored in the hospital information systems. The paired image-text data from the same patient study could be utilized for the pre-training task in a weakly supervised manner. However, the integrity, accessibility, and amount of such raw data vary across different institutes, e.g., paired …
Given image labels as the only supervisory signal, we focus on harvesting, or mining, thoracic disease localizations from chest X-ray images. Harvesting such localizations from existing datasets allows for the creation of improved data sources for computer-aided diagnosis and retrospective analyses. We train a convolutional neural network (CNN) for image classification and propose an attention mining (AM) strategy to improve the model's sensitivity or saliency to disease patterns. The intuition of AM is that once the most salient disease area is blocked or hidden from the CNN model, it will pa…
Hospital Italiano de Buenos Aires（布宜诺斯艾利斯意大利医院）；Universidad Tecnológica Nacional（国家技术大学）
BACKGROUND AND OBJECTIVES: The multiple chest x-ray datasets released in the last years have ground-truth labels intended for different computer vision tasks, suggesting that performance in automated chest-xray interpretation might improve by using a method that can exploit diverse types of annotations. This work presents a Deep Learning method based on the late fusion of different convolutional architectures, that allows training with heterogeneous data with a simple implementation, and evaluates its performance on independent test data. We focused on obtaining a clinically useful tool that c…
Carnegie Mellon University（卡内基梅隆大学）；University of Pennsylvania（宾夕法尼亚大学）
We present a weakly supervised deep learning model for classifying thoracic diseases and identifying abnormalities in chest radiography. In this work, instead of learning from medical imaging data with region-level annotations, our model was merely trained on imaging data with image-level labels to classify diseases, and is able to identify abnormal image regions simultaneously. Our model consists of a customized pooling structure and an adaptive DenseNet front-end, which can effectively recognize possible disease features for classification and localization tasks. Our method has been validate…
In this paper, we present a deep learning-based image processing technique for extraction of bone structures in chest radiographs using a U-Net FCNN. The U-Net was trained to accomplish the task in a fully supervised setting. To create the training image pairs, we employed simulated X-Ray or Digitally Reconstructed Radiographs (DRR), derived from 664 CT scans belonging to the LIDC-IDRI dataset. Using HU based segmentation of bone structures in the CT domain, a synthetic 2D "Bone x-ray" DRR is produced and used for training the network. For the reconstruction loss, we utilize two loss functions…
Nanjing University（南京大学）；Drum Tower Hospital, Nanjing University（南京大学医学院附属鼓楼医院）；Chinese Academy of Medical Sciences and Peking Union Medical College（中国医学科学院北京协和医学院）
The chest X-Ray (CXR) is the one of the most common clinical exam used to diagnose thoracic diseases and abnormalities. The volume of CXR scans generated daily in hospitals is huge. Therefore, an automated diagnosis system able to save the effort of doctors is of great value. At present, the applications of artificial intelligence in CXR diagnosis usually use pattern recognition to classify the scans. However, such methods rely on labeled databases, which are costly and usually have large error rates. In this work, we built a database containing more than 12,000 CXR scans and radiological repo…
Universite de Bordeaux（波尔多大学）；National University of Singapore（新加坡国立大学）；University of Cambridge（剑桥大学）；Stanford University（斯坦福大学）；Yale-NUS College（耶鲁-新加坡国立大学学院）
The task of classifying X-ray data is a problem of both theoretical and clinical interest. Whilst supervised deep learning methods rely upon huge amounts of labelled data, the critical problem of achieving a good classification accuracy when an extremely small amount of labelled data is available has yet to be tackled. In this work, we introduce a novel semi-supervised framework for X-ray classification which is based on a graph-based optimisation model. To the best of our knowledge, this is the first method that exploits graph-based semi-supervised learning for X-ray data classification. Furt…
University of Cambridge（剑桥大学）；Université de Bordeaux（波尔多大学）；Bordeaux INP（波尔多国立理工学院）；CNRS（法国国家科学研究中心）
Can one learn to diagnose COVID-19 under extreme minimal supervision? Since the outbreak of the novel COVID-19 there has been a rush for developing Artificial Intelligence techniques for expert-level disease identification on Chest X-ray data. In particular, the use of deep supervised learning has become the go-to paradigm. However, the performance of such models is heavily dependent on the availability of a large and representative labelled dataset. The creation of which is a heavily expensive and time consuming task, and especially imposes a great challenge for a novel disease. Semi-supervis…
University of Pittsburgh（匹兹堡大学）；University of Pittsburgh Medical Center（匹兹堡大学医学中心）
Creating a large-scale dataset of abnormality annotation on medical images is a labor-intensive and costly task. Leveraging weak supervision from readily available data such as radiology reports can compensate lack of large-scale data for anomaly detection methods. However, most of the current methods only use image-level pathological observations, failing to utilize the relevant anatomy mentions in reports. Furthermore, Natural Language Processing (NLP)-mined weak labels are noisy due to label sparsity and linguistic ambiguity. We propose an Anatomy-Guided chest X-ray Network (AGXNet) to addr…
A foundation model for generalizable disease diagnosis in chest X-ray images
Centre for Perceptual and Interactive Intelligence, the Chinese University of Hong Kong（香港中文大学感知与交互智能中心）；Shanghai Artificial Intelligence Laboratory（上海人工智能实验室）；SenseTime Research（商汤科技研究院）；Department of Electronic Engineering, the Chinese University of Hong Kong（香港中文大学电子工程系）
Suppression of thoracic bone shadows on chest X-rays (CXRs) has been indicated to improve the diagnosis of pulmonary disease. Previous approaches can be categorized as unsupervised physical and supervised deep learning models. Nevertheless, with physical models able to preserve morphological details but at the cost of extremely long processing time, existing DL methods face challenges of gathering sufficient/qualitative ground truth (GT) for robust training, thus leading to failure in maintaining clinically acceptable false positive rates. We hereby propose a generalizable yet efficient workfl…
Self-supervised pretraining followed by supervised fine-tuning has seen success in image recognition, especially when labeled examples are scarce, but has received limited attention in medical image analysis. This paper studies the effectiveness of self-supervised learning as a pretraining strategy for medical image classification. We conduct experiments on two distinct tasks: dermatology skin condition classification from digital camera images and multi-label chest X-ray classification, and demonstrate that self-supervised learning on ImageNet, followed by additional self-supervised learning …
VUNO Inc.（VUNO公司）；Imperial College London（帝国理工学院）；Asan Medical Center（峨山医疗中心）；University of Ulsan（蔚山大学）
Generating large quantities of quality labeled data in medical imaging is very time consuming and expensive. The performance of supervised algorithms for various tasks on imaging has improved drastically over the years, however the availability of data to train these algorithms have become one of the main bottlenecks for implementation. To address this, we propose a semi-supervised learning method where pseudo-negative labels from unlabeled data are used to further refine the performance of a pulmonary nodule detection network in chest radiographs. After training with the proposed network, the…
Deep Omni-supervised Learning for Rib Fracture Detection from Chest Radiology Images
Imsight AI Research Lab（Imsight AI 研究实验室）；The Hong Kong University of Science and Technology（香港科技大学）；HKUST Shenzhen-Hong Kong Collaborative Innovation Research Institute（香港科技大学深圳-香港协同创新研究院）；The Chinese University of Hong Kong（香港中文大学）
University of Assiut（艾斯尤特大学）；Birmingham City University（伯明翰城市大学）
Due to the high availability of large-scale annotated image datasets, knowledge transfer from pre-trained models showed outstanding performance in medical image classification. However, building a robust image classification model for datasets with data irregularity or imbalanced classes can be a very challenging task, especially in the medical imaging domain. In this paper, we propose a novel deep convolutional neural network, we called Self Supervised Super Sample Decomposition for Transfer learning (4S-DT) model. 4S-DT encourages a coarse-to-fine transfer learning from large-scale image rec…
Boosting multi-demographic federated learning for chest radiograph analysis using general-purpose self-supervised representations
University Hospital RWTH Aachen（亚琛工业大学附属医院）；Hamedan University of Technology（哈马丹理工大学）；Friedrich-Alexander-Universität Erlangen-Nürnberg（埃尔朗根-纽伦堡大学）；Stanford University（斯坦福大学）
Mohamed bin Zayed University of Artificial Intelligence（穆罕默德·本·扎耶德人工智能大学）
Quick and accurate diagnosis is of paramount importance to mitigate the effects of COVID-19 infection, particularly for severe cases. Enormous effort has been put towards developing deep learning methods to classify and detect COVID-19 infections from chest radiography images. However, recently some questions have been raised surrounding the clinical viability and effectiveness of such methods. In this work, we investigate the impact of multi-task learning (classification and segmentation) on the ability of CNNs to differentiate between various appearances of COVID-19 infections in the lung. W…
The increased availability and accuracy of eye-gaze tracking technology has sparked attention-related research in psychology, neuroscience, and, more recently, computer vision and artificial intelligence. The attention mechanism in artificial neural networks is known to improve learning tasks. However, no previous research has combined the network attention and human attention. This paper describes a gaze-guided class activation mapping (GG-CAM) method to directly regulate the formation of network attention based on expert radiologists' visual attention for the chest X-ray pathology classifica…
