Chest x-ray imaging is widely used for the diagnosis of pneumothorax and there has been significant interest in developing automated methods to assist in image interpretation. We present an image classification pipeline which detects pneumothorax as well as the various types of chest tubes that are commonly used to treat pneumothorax. Our multi-stage algorithm is based on lung segmentation followed by pneumothorax classification, including classification of patches that are most likely to contain pneumothorax. This algorithm achieves state of the art performance for pneumothorax classification on an open-source benchmark dataset. Unlike previous work, this algorithm shows comparable performance on data with and without chest tubes and thus has an improved clinical utility. To evaluate these algorithms in a realistic clinical scenario, we demonstrate the ability to identify real cases of missed pneumothorax in a large dataset of chest x-ray studies.
National University of Sciences and Technology (NUST)（国立科技大学）
Among various medical imaging tools, chest radiographs are the most important and widely used diagnostic tool for detection of thoracic pathologies. Research is being carried out in order to propose robust automatic diagnostic tool for detection of pathologies from chest radiographs. Artificial Intelligence techniques especially deep learning methodologies have found to be giving promising results in automating the field of medicine. Lot of research has been done for automatic and fast detection of pneumothorax from chest radiographs while proposing several frameworks based on artificial intel…
Jordan University of Science and Technology（约旦科技大学）；Staffordshire University（斯塔福德郡大学）
Pneumothorax, also called a collapsed lung, refers to the presence of the air in the pleural space between the lung and chest wall. It can be small (no need for treatment), or large and causes death if it is not identified and treated on time. It is easily seen and identified by experts using a chest X-ray. Although this method is mostly error-free, it is time-consuming and needs expert radiologists. Recently, Computer Vision has been providing great assistance in detecting and segmenting pneumothorax. In this paper, we propose a 2-Stage Training system (2ST-UNet) to segment images with pneumo…
University of Waterloo（滑铁卢大学）；Vector Institute（向量研究所）
Pneumothorax, a collapsed or dropped lung, is a fatal condition typically detected on a chest X-ray by an experienced radiologist. Due to shortage of such experts, automated detection systems based on deep neural networks have been developed. Nevertheless, applying such systems in practice remains a challenge. These systems, mostly compute a single probability as output, may not be enough for diagnosis. On the contrary, content-based medical image retrieval (CBIR) systems, such as image search, can assist clinicians for diagnostic purposes by enabling them to compare the case they are examinin…
Pneumothorax is a relatively common disease, but in some cases, it may be difficult to find with chest radiography. In this paper, we propose a novel method of detecting pneumothorax in chest radiography. We propose an ensemble model of identical convolutional neural networks (CNN) with three different sizes of radiography images. Conventional methods may not properly characterize lost features while resizing large size images into 256 x 256 or 224 x 224 sizes. Our model is evaluated with ChestX-ray dataset which contains over 100,000 chest radiography images. As a result of the experiment, th…
Philips Research（飞利浦研究院）；Hamburg University of Technology（汉堡工业大学）；Philips Healthcare（飞利浦医疗）；University of Washington Medical Center（华盛顿大学医学中心）
Pneumothorax is a critical condition that requires timely communication and immediate action. In order to prevent significant morbidity or patient death, early detection is crucial. For the task of pneumothorax detection, we study the characteristics of three different deep learning techniques: (i) convolutional neural networks, (ii) multiple-instance learning, and (iii) fully convolutional networks. We perform a five-fold cross-validation on a dataset consisting of 1003 chest X-ray images. ROC analysis yields AUCs of 0.96, 0.93, and 0.92 for the three methods, respectively. We review the clas…
University of Waterloo（滑铁卢大学）；Vector Institute（向量研究所）
Fast diagnosis and treatment of pneumothorax, a collapsed or dropped lung, is crucial to avoid fatalities. Pneumothorax is typically detected on a chest X-ray image through visual inspection by experienced radiologists. However, the detection rate is quite low. Therefore, there is a strong need for automated detection systems to assist radiologists. Despite the high accuracy levels generally reported for deep learning classifiers in many applications, they may not be useful in clinical practice due to the lack of large number of high-quality labelled images as well as a lack of interpretation …
Leveraging Anatomical Constraints with Uncertainty for Pneumothorax Segmentation
Duke-NUS Medical School（杜克-新加坡国立大学医学院）；Duke University（杜克大学）；Singapore General Hospital（新加坡中央医院）；Institute of High Performance Computing, Agency for Science, Technology and Research（新加坡科技研究局高性能计算研究所）；Institute of Data Science, National University of Singapore（新加坡国立大学数据科学研究院）
National University of Sciences and Technology (NUST)（国家科技大学（NUST））；Jeju National University（济州国立大学）
Pneumothorax, a life threatening disease, needs to be diagnosed immediately and efficiently. The prognosis in this case is not only time consuming but also prone to human errors. So an automatic way of accurate diagnosis using chest X-rays is the utmost requirement. To-date, most of the available medical images datasets have class-imbalance issue. The main theme of this study is to solve this problem along with proposing an automated way of detecting pneumothorax. We first compare the existing approaches to tackle the class-imbalance issue and find that data-level-ensemble (i.e. ensemble of su…
Attention-based Saliency Maps Improve Interpretability of Pneumothorax Classification
Munich Institute of Biomedical Engineering, Technical University of Munich（慕尼黑工业大学慕尼黑生物医学工程研究所）；Technical University of Munich（慕尼黑工业大学）；University Hospital LMU（慕尼黑大学附属医院）；Munich School of Technology in Society, Technical University of Munich（慕尼黑工业大学慕尼黑技术与社会学院）
University of Maryland School of Medicine（马里兰大学医学院）；Johns Hopkins University（约翰斯·霍普金斯大学）
Chest X-ray (CXR) datasets hosted on Kaggle, though useful from a data science competition standpoint, have limited utility in clinical use because of their narrow focus on diagnosing one specific disease. In real-world clinical use, multiple diseases need to be considered since they can co-exist in the same patient. In this work, we demonstrate how federated learning (FL) can be used to make these toy CXR datasets from Kaggle clinically useful. Specifically, we train a single FL classification model (`global`) using two separate CXR datasets -- one annotated for presence of pneumonia and the …
Philips Research North America（飞利浦北美研究院）；Philips Research（飞利浦研究院）
The automatic detection of critical findings in chest X-rays (CXR), such as pneumothorax, is important for assisting radiologists in their clinical workflow like triaging time-sensitive cases and screening for incidental findings. While deep learning (DL) models has become a promising predictive technology with near-human accuracy, they commonly suffer from a lack of explainability, which is an important aspect for clinical deployment of DL models in the highly regulated healthcare industry. For example, localizing critical findings in an image is useful for explaining the predictions of DL cl…
The image captioning task is increasingly prevalent in artificial intelligence applications for medicine. One important application is clinical report generation from chest radiographs. The clinical writing of unstructured reports is time consuming and error-prone. An automated system would improve standardization, error reduction, time consumption, and medical accessibility. In this paper we demonstrate the importance of domain specific pre-training and propose a modified transformer architecture for the medical image captioning task. To accomplish this, we train a series of modified transfor…
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…
Lung nodules can be an alarming precursor to potential lung cancer. Missed nodule detections during chest radiograph analysis remains a common challenge among thoracic radiologists. In this work, we present a multi-task lung nodule detection algorithm for chest radiograph analysis. Unlike past approaches, our algorithm predicts a global-level label indicating nodule presence along with local-level labels predicting nodule locations using a Dual Head Network (DHN). We demonstrate the favorable nodule detection performance that our multi-task formulation yields in comparison to conventional meth…
Machine learning models for radiology benefit from large-scale data sets with high quality labels for abnormalities. We curated and analyzed a chest computed tomography (CT) data set of 36,316 volumes from 19,993 unique patients. This is the largest multiply-annotated volumetric medical imaging data set reported. To annotate this data set, we developed a rule-based method for automatically extracting abnormality labels from free-text radiology reports with an average F-score of 0.976 (min 0.941, max 1.0). We also developed a model for multi-organ, multi-disease classification of chest CT volum…
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 Rochester（罗切斯特大学）；Ludwig Maximilian University（路德维希马克西米利安大学）
Chest x-rays are the most common radiology studies for diagnosing lung and heart disease. Hence, a system for automated pre-reporting of pathologic findings on chest x-rays would greatly enhance radiologists' productivity. To this end, we investigate a deep-learning framework with novel training schemes for classification of different thoracic pathology labels from chest x-rays. We use the currently largest publicly available annotated dataset ChestX-ray14 of 112,120 chest radiographs of 30,805 patients. Each image was annotated with either a 'NoFinding' class, or one or more of 14 thoracic pa…
A major obstacle to the integration of deep learning models for chest x-ray interpretation into clinical settings is the lack of understanding of their failure modes. In this work, we first investigate whether there are patient subgroups that chest x-ray models are likely to misclassify. We find that patient age and the radiographic finding of lung lesion, pneumothorax or support devices are statistically relevant features for predicting misclassification for some chest x-ray models. Second, we develop misclassification predictors on chest x-ray models using their outputs and clinical features…
Objectives: To compare artificial intelligence (AI) as a second reader in detecting lung nodules on chest X-rays (CXR) versus radiologists of two binational institutions, and to evaluate AI performance when using two different modes: automated versus assisted (additional remote radiologist review). Methods: The CXR public database (n = 247) of the Japanese Society of Radiological Technology with various types and sizes of lung nodules was analyzed. Eight radiologists evaluated the CXR images with regard to the presence of lung nodules and nodule conspicuity. After radiologist review, the AI so…
Who Gets Missed in the Tail? Thresholded Subgroup Underdiagnosis in Long-Tailed Chest X-ray Classification
University of Science, Ho Chi Minh City（胡志明市科学大学）；Vietnam National University, Ho Chi Minh City（胡志明市越南国立大学）；VinUni-Illinois Smart Health Center, VinUniversity（VinUni-伊利诺伊智能健康中心，Vin大学）；Carnegie Mellon University（卡内基梅隆大学）；Northwestern University（西北大学）；College of Engineering & Computer Science, VinUniversity（Vin大学工程与计算机科学学院）
National Cheng Kung University（台湾成功大学）；Kun Shan University（昆山科技大学）；National Cheng Kung University Hospital（台湾成功大学医院）
In recent years, convolutional neural networks (CNNs) have been successfully implemented to various image recognition applications, such as medical image analysis, object detection, and image segmentation. Many studies and applications have been working on improving the performance of CNN algorithms and models. The strategies that aim to improve the performance of CNNs can be grouped into three major approaches: (1) deeper and wider network architecture, (2) automatic architecture search, and (3) convolutional attention block. Unlike approaches (1) and (2), the convolutional attention block ap…
University of Oulu（奥卢大学）；Oulu University Hospital（奥卢大学医院）；Oxipit UAB
Objectives: To assess the use of artificial intelligence-based software in ruling out chest X-ray cases, with no significant findings in a primary health care setting. Methods: In this retrospective study, a commercially available artificial intelligence (AI) software was used to analyse 10 000 chest X-rays of Finnish primary health care patients. In studies with a mismatch between an AI normal report and the original radiologist report, a consensus read by two board-certified radiologists was conducted to make the final diagnosis. Results: After the exclusion of cases not meeting the study cr…
Multilabel Classification for Lung Disease Detection: Integrating Deep Learning and Natural Language Processing
Mechanical Engineering Staten Island Tech High School（Staten Island Tech High School机械工程系）；Computer Science Monta Vista High School（Monta Vista High School计算机科学系）；Computer Science Lambert High School（Lambert High School计算机科学系）；Electrical Engineering Edison Academy Magnet School（Edison Academy Magnet School电气工程系）
Stanford AIMI（斯坦福大学医学人工智能实验室）；Stanford University（斯坦福大学）；University of California, Davis（加州大学戴维斯分校）；Stability AI
Multimodal models trained on large natural image-text pair datasets have exhibited astounding abilities in generating high-quality images. Medical imaging data is fundamentally different to natural images, and the language used to succinctly capture relevant details in medical data uses a different, narrow but semantically rich, domain-specific vocabulary. Not surprisingly, multi-modal models trained on natural image-text pairs do not tend to generalize well to the medical domain. Developing generative imaging models faithfully representing medical concepts while providing compositional divers…
University Medical Center Hamburg-Eppendorf（汉堡-埃彭多夫大学医学中心）；Hamburg University of Technology（汉堡工业大学）；Forschungszentrum Medizintechnik Hamburg（汉堡医学技术研究中心）；Philips Research（飞利浦研究院）
The aim is to evaluate whether smart worklist prioritization by artificial intelligence (AI) can optimize the radiology workflow and reduce report turnaround times (RTAT) for critical findings in chest radiographs (CXRs). Furthermore, we investigate a method to counteract the effect of false negative predictions by AI -- resulting in an extremely and dangerously long RTAT, as CXRs are sorted to the end of the worklist. We developed a simulation framework that models the current workflow at a university hospital by incorporating hospital specific CXR generation rates, reporting rates and pathol…
Beyond the First Read: AI-Assisted Perceptual Error Detection in Chest Radiography Accounting for Interobserver Variability
High School Student（高中学生）；PhD Candidate（博士生）；Department of Electrical and Computer Engineering University of Houston（电气与计算机工程系，休斯顿大学）；Department of Computer Science Emory University（计算机科学系，埃默里大学）；Department of Thoracic Imaging, Division of Diagnostic Imaging The University of Texas MD Anderson Cancer Center, Houston, TX（胸腔成像部，诊断影像学分会，德克萨斯大学MD安德森癌症中心，休斯顿，TX）
Can Deep Learning Reliably Recognize Abnormality Patterns on Chest X-rays? A Multi-Reader Study Examining One Month of AI Implementation in Everyday Radiology Clinical Practice
Carebot s.r.o.（Carebot有限责任公司）；Masaryk University（马萨里克大学）；Institute of Biostatistics and Analysis, s.r.o.（生物统计与分析所有限责任公司）；Havířov Hospital and Clinic（哈维若夫医院与诊所）；Charles University（查理大学）；Czech Technical University（捷克技术大学）
本研究开发 Carebot AI CXR 检测七种胸片异常，并基于 956 张图像与六名放射科医生比较，证明其灵敏度高，可辅助降低初中级医生漏诊率。
NVIDIA（英伟达）；National Institute of Health Clinical Center（美国国立卫生研究院临床中心）
Detecting clinically relevant objects in medical images is a challenge despite large datasets due to the lack of detailed labels. To address the label issue, we utilize the scene-level labels with a detection architecture that incorporates natural language information. We present a challenging new set of radiologist paired bounding box and natural language annotations on the publicly available MIMIC-CXR dataset especially focussed on pneumonia and pneumothorax. Along with the dataset, we present a joint vision language weakly supervised transformer layer-selected one-stage dual head detection …
KAIST（韩国科学技术院）；Asan Medical Center（峨山医学中心）；University of Ulsan College of Medicine（蔚山大学医学院）；Yeungnam University（岭南大学）；Kyungpook National University（庆北国立大学）；Seoul National University（首尔国立大学）
Although deep learning-based computer-aided diagnosis systems have recently achieved expert-level performance, developing a robust deep learning model requires large, high-quality data with manual annotation, which is expensive to obtain. This situation poses the problem that the chest x-rays collected annually in hospitals cannot be used due to the lack of manual labeling by experts, especially in deprived areas. To address this, here we present a novel deep learning framework that uses knowledge distillation through self-supervised learning and self-training, which shows that the performance…
Lung nodules are commonly missed in chest radiographs. We propose and evaluate P-AnoGAN, an unsupervised anomaly detection approach for lung nodules in radiographs. P-AnoGAN modifies the fast anomaly detection generative adversarial network (f-AnoGAN) by utilizing a progressive GAN and a convolutional encoder-decoder-encoder pipeline. Model training uses only unlabelled healthy lung patches extracted from the Indiana University Chest X-Ray Collection. External validation and testing are performed using healthy and unhealthy patches extracted from the ChestX-ray14 and Japanese Society for Radio…
Shanghai Jiao Tong University（上海交通大学）；Shanghai United Imaging Intelligence Co., Ltd.（上海联影智能医疗科技有限公司）；ShanghaiTech University（上海科技大学）
Lung nodule detection in chest X-ray (CXR) images is common to early screening of lung cancers. Deep-learning-based Computer-Assisted Diagnosis (CAD) systems can support radiologists for nodule screening in CXR. However, it requires large-scale and diverse medical data with high-quality annotations to train such robust and accurate CADs. To alleviate the limited availability of such datasets, lung nodule synthesis methods are proposed for the sake of data augmentation. Nevertheless, previous methods lack the ability to generate nodules that are realistic with the size attribute desired by the …
Radboud University Medical Center（拉德堡德大学医学中心）；Polytechnic University of Turin（都灵理工大学）；Istituto Nazionale di Fisica Nucleare（国家核物理研究院）；Radboud University Nijmegen（拉德堡德大学）；Radboud University（拉德堡德大学）；The Chinese University of Hong Kong（香港中文大学）；University of Pisa（比萨大学）
Automatic detection of pulmonary nodules in thoracic computed tomography (CT) scans has been an active area of research for the last two decades. However, there have only been few studies that provide a comparative performance evaluation of different systems on a common database. We have therefore set up the LUNA16 challenge, an objective evaluation framework for automatic nodule detection algorithms using the largest publicly available reference database of chest CT scans, the LIDC-IDRI data set. In LUNA16, participants develop their algorithm and upload their predictions on 888 CT scans in o…
Evaluating the Impact of Radiographic Noise on Chest X-ray Semantic Segmentation and Disease Classification Using a Scalable Noise Injection Framework
The University of Texas Health Science Center at Houston（德克萨斯大学休斯顿健康科学中心）；Stanford University School of Medicine（斯坦福大学医学院）；Algoverse AI Research（Algoverse AI 研究院）
Cleveland Clinic London Hospital（伦敦克利夫兰诊所医院）；Mid South Essex NHS Foundation Trust（中埃塞克斯南部国民保健服务基金会信托）；King’s College Hospital NHS Foundation Trust（国王学院医院国民保健服务基金会信托）；London South Bank University（伦敦南岸大学）
Objectives: The present study evaluated the impact of a commercially available explainable AI algorithm in augmenting the ability of clinicians to identify lung cancer on chest X-rays (CXR). Design: This retrospective study evaluated the performance of 11 clinicians for detecting lung cancer from chest radiographs, with and without assistance from a commercially available AI algorithm (red dot, Behold.ai) that predicts suspected lung cancer from CXRs. Clinician performance was evaluated against clinically confirmed diagnoses. Setting: The study analysed anonymised patient data from an NHS hosp…
