We systematically evaluate the performance of deep learning models in the presence of diseases not labeled for or present during training. First, we evaluate whether deep learning models trained on a subset of diseases (seen diseases) can detect the presence of any one of a larger set of diseases. We find that models tend to falsely classify diseases outside of the subset (unseen diseases) as "no disease". Second, we evaluate whether models trained on seen diseases can detect seen diseases when co-occurring with diseases outside the subset (unseen diseases). We find that models are still able to detect seen diseases even when co-occurring with unseen diseases. Third, we evaluate whether feature representations learned by models may be used to detect the presence of unseen diseases given a small labeled set of unseen diseases. We find that the penultimate layer of the deep neural network provides useful features for unseen disease detection. Our results can inform the safe clinical deployment of deep learning models trained on a non-exhaustive set of disease classes.
The use of smartphones to take photographs of chest x-rays represents an appealing solution for scaled deployment of deep learning models for chest x-ray interpretation. However, the performance of chest x-ray algorithms on photos of chest x-rays has not been thoroughly investigated. In this study, we measured the diagnostic performance for 8 different chest x-ray models when applied to photos of chest x-rays. All models were developed by different groups and submitted to the CheXpert challenge, and re-applied to smartphone photos of x-rays in the CheXphoto dataset without further tuning. We f…
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…
COVID-19 is a global pandemic, and detecting them is a momentous task for medical professionals today due to its rapid mutations. Current methods of examining chest X-rays and CT scan requires profound knowledge and are time consuming, which suggests that it shrinks the precious time of medical practitioners when people's lives are at stake. This study tries to assist this process by achieving state-of-the-art performance in classifying chest X-rays by fine-tuning Vision Transformer(ViT). The proposed approach uses pretrained models, fine-tuned for detecting the presence of COVID-19 disease on…
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…
We develop an algorithm that can detect pneumonia from chest X-rays at a level exceeding practicing radiologists. Our algorithm, CheXNet, is a 121-layer convolutional neural network trained on ChestX-ray14, currently the largest publicly available chest X-ray dataset, containing over 100,000 frontal-view X-ray images with 14 diseases. Four practicing academic radiologists annotate a test set, on which we compare the performance of CheXNet to that of radiologists. We find that CheXNet exceeds average radiologist performance on the F1 metric. We extend CheXNet to detect all 14 diseases in ChestX…
Virginia Tech（弗吉尼亚理工大学）；IBM Research（IBM研究院）；Institute for Medical Engineering and Science, Massachusetts Institute of Technology（麻省理工学院医学工程与科学研究所）；Beth Israel Deaconess Medical Center（贝斯以色列女执事医疗中心）；Harvard T.H. Chan School of Public Health（哈佛陈曾熙公共卫生学院）；University of British Columbia（不列颠哥伦比亚大学）
Despite the progress in utilizing deep learning to automate chest radiograph interpretation and disease diagnosis tasks, change between sequential Chest X-rays (CXRs) has received limited attention. Monitoring the progression of pathologies that are visualized through chest imaging poses several challenges in anatomical motion estimation and image registration, i.e., spatially aligning the two images and modeling temporal dynamics in change detection. In this work, we propose CheXRelNet, a neural model that can track longitudinal pathology change relations between two CXRs. CheXRelNet incorpor…
Recent advances in training deep learning models have demonstrated the potential to provide accurate chest X-ray interpretation and increase access to radiology expertise. However, poor generalization due to data distribution shifts in clinical settings is a key barrier to implementation. In this study, we measured the diagnostic performance for 8 different chest X-ray models when applied to (1) smartphone photos of chest X-rays and (2) external datasets without any finetuning. All models were developed by different groups and submitted to the CheXpert challenge, and re-applied to test dataset…
Seoul National University（首尔国立大学）；Hankuk University of Foreign Studies（韩国外国语大学）
Suppressing bones on chest X-rays such as ribs and clavicle is often expected to improve pathologies classification. These bones can interfere with a broad range of diagnostic tasks on pulmonary disease except for musculoskeletal system. Current conventional method for acquisition of bone suppressed X-rays is dual energy imaging, which captures two radiographs at a very short interval with different energy levels; however, the patient is exposed to radiation twice and the artifacts arise due to heartbeats between two shots. In this paper, we introduce a deep generative model trained to predict…
University of Michigan（密歇根大学）；Institute for Healthcare Policy & Innovation（医疗政策与创新研究所）；Department of Electrical Engineering and Computer Science（电气工程与计算机科学系）；Department of Radiology（放射科）；Department of Internal Medicine（内科）
While deep learning has shown promise in improving the automated diagnosis of disease based on chest X-rays, deep networks may exhibit undesirable behavior related to shortcuts. This paper studies the case of spurious class skew in which patients with a particular attribute are spuriously more likely to have the outcome of interest. For instance, clinical protocols might lead to a dataset in which patients with pacemakers are disproportionately likely to have congestive heart failure. This skew can lead to models that take shortcuts by heavily relying on the biased attribute. We explore this p…
X-rays are commonly performed imaging tests that use small amounts of radiation to produce pictures of the organs, tissues, and bones of the body. X-rays of the chest are used to detect abnormalities or diseases of the airways, blood vessels, bones, heart, and lungs. In this work we present a stochastic attention-based model that is capable of learning what regions within a chest X-ray scan should be visually explored in order to conclude that the scan contains a specific radiological abnormality. The proposed model is a recurrent neural network (RNN) that learns to sequentially sample the ent…
Chest X-rays are the most common diagnostic exams in emergency rooms and hospitals. There has been a surge of work on automatic interpretation of chest X-rays using deep learning approaches after the availability of large open source chest X-ray dataset from NIH. However, the labels are not sufficiently rich and descriptive for training classification tools. Further, it does not adequately address the findings seen in Chest X-rays taken in anterior-posterior (AP) view which also depict the placement of devices such as central vascular lines and tubes. In this paper, we present a new chest X-ra…
Clinically-Inspired Hierarchical Multi-Label Classification of Chest X-rays with a Penalty-Based Loss Function
Gina Cody School of Engineering and Computer Science, Concordia University（康考迪亚大学吉娜·科迪工程与计算机科学学院）；YULCOM Technologies（YULCOM科技公司）；Division of Radiation Oncology, McGill University Health Centre（麦吉尔大学健康中心放射肿瘤科）
G.B. Pant Government Engineering College（G.B. Pant政府工程学院）
Coronavirus is a large virus family consisting of diverse viruses, some of which disseminate among mammals and others cause sickness among humans. COVID-19 is highly contagious and is rapidly spreading, rendering its early diagnosis of preeminent status. Researchers, medical specialists and organizations all over the globe have been working tirelessly to combat this virus and help in its containment. In this paper, a novel neural network called WisdomNet has been proposed, for the diagnosis of COVID-19 using chest X-rays. The WisdomNet uses the concept of Wisdom of Crowds as its founding idea.…
University of South Florida（南佛罗里达大学）；University of California, San Francisco（加利福尼亚大学旧金山分校）
Testing for COVID-19 has been unable to keep up with the demand. Further, the false negative rate is projected to be as high as 30% and test results can take some time to obtain. X-ray machines are widely available and provide images for diagnosis quickly. This paper explores how useful chest X-ray images can be in diagnosing COVID-19 disease. We have obtained 122 chest X-rays of COVID-19 and over 4,000 chest X-rays of viral and bacterial pneumonia. A pretrained deep convolutional neural network has been tuned on 102 COVID-19 cases and 102 other pneumonia cases in a 10-fold cross validation. T…
University of Chittagong（吉大港大学）；Charles Sturt University（查尔斯特大学）
This paper proposed an ensemble of deep convolutional neural networks (CNN) based on EfficientNet, named ECOVNet, to detect COVID-19 using a large chest X-ray data set. At first, the open-access large chest X-ray collection is augmented, and then ImageNet pre-trained weights for EfficientNet is transferred with some customized fine-tuning top layers that are trained, followed by an ensemble of model snapshots to classify chest X-rays corresponding to COVID-19, normal, and pneumonia. The predictions of the model snapshots, which are created during a single training, are combined through two ens…
Stanford University（斯坦福大学）；University of California, Berkeley（加州大学伯克利分校）；IBM Almaden Research Center（IBM阿尔马登研究中心）
Chest X-rays have become the focus of vigorous deep learning research in recent years due to the availability of large labeled datasets. While classification of anomalous findings is now possible, ensuring that they are correctly localized still remains challenging, as this requires recognition of anomalies within anatomical regions. Existing deep learning networks for fine-grained anomaly classification learn location-specific findings using architectures where the location and spatial contiguity information is lost during the flattening step before classification. In this paper, we present a…
Sierra Research S.L（塞拉研究有限公司）；Universidad de Alicante（阿利坎特大学）；Medbravo（Medbravo医疗公司）；Fundación para el Fomento de la Investigación Sanitario y Biomédica de la Comunidad Valenciana（瓦伦西亚自治区卫生与生物医学研究促进基金会）；Hospital San Juan de Alicante（阿利坎特圣胡安医院）；Universidad Miguel Hernández（米格尔·埃尔南德斯大学）
In this work we present a method for the detection of radiological findings, their location and differential diagnoses from chest x-rays. Unlike prior works that focus on the detection of few pathologies, we use a hierarchical taxonomy mapped to the Unified Medical Language System (UMLS) terminology to identify 189 radiological findings, 22 differential diagnosis and 122 anatomic locations, including ground glass opacities, infiltrates, consolidations and other radiological findings compatible with COVID-19. We train the system on one large database of 92,594 frontal chest x-rays (AP or PA, st…
University of Amsterdam（阿姆斯特丹大学）；Radboud University Medical Center（拉德堡德大学医学中心）
Chest X-rays are one of the most commonly used technologies for medical diagnosis. Many deep learning models have been proposed to improve and automate the abnormality detection task on this type of data. In this paper, we propose a different approach based on image inpainting under adversarial training first introduced by Goodfellow et al. We configure the context encoder model for this task and train it over 1.1M 128x128 images from healthy X-rays. The goal of our model is to reconstruct the missing central 64x64 patch. Once the model has learned how to inpaint healthy tissue, we test its pe…
Technical University of Munich（慕尼黑工业大学）；Klinikum rechts der Isar（伊萨尔河畔临床教学中心）
Deep learning models used in medical image analysis are prone to raising reliability concerns due to their black-box nature. To shed light on these black-box models, previous works predominantly focus on identifying the contribution of input features to the diagnosis, i.e., feature attribution. In this work, we explore counterfactual explanations to identify what patterns the models rely on for diagnosis. Specifically, we investigate the effect of changing features within chest X-rays on the classifier's output to understand its decision mechanism. We leverage a StyleGAN-based approach (StyleE…
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…
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…
IBM Watson Health Imaging（IBM沃森健康影像）；Baptist Health South Florida（南佛罗里达浸信会健康）；Brigham and Women’s Hospital（布莱根妇女医院）
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…
University of Leeds（利兹大学）；Leeds Teaching Hospitals NHS Trust（利兹教学医院 NHS 信托基金）
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 classifyin…
Purpose: We present image classifiers based on Dense Convolutional Networks and transfer learning to classify chest X-ray images according to three labels: COVID-19, pneumonia and normal. Methods: We fine-tuned neural networks pretrained on ImageNet and applied a twice transfer learning approach, using NIH ChestX-ray14 dataset as an intermediate step. We also suggested a novelty called output neuron keeping, which changes the twice transfer learning technique. In order to clarify the modus operandi of the models, we used Layer-wise Relevance Propagation (LRP) to generate heatmaps. Results: We …
Background: Chest X-rays are the most commonly performed, cost-effective diagnostic imaging tests ordered by physicians. A clinically validated AI system that can reliably separate normals from abnormals can be invaluble particularly in low-resource settings. The aim of this study was to develop and validate a deep learning system to detect various abnormalities seen on a chest X-ray. Methods: A deep learning system was trained on 2.3 million chest X-rays and their corresponding radiology reports to identify various abnormalities seen on a Chest X-ray. The system was tested against - 1. A thre…
Image representation is a fundamental task in computer vision. However, most of the existing approaches for image representation ignore the relations between images and consider each input image independently. Intuitively, relations between images can help to understand the images and maintain model consistency over related images, leading to better explainability. In this paper, we consider modeling the image-level relations to generate more informative image representations, and propose ImageGCN, an end-to-end graph convolutional network framework for inductive multi-relational image modelin…
The potential of deep learning, especially in medical imaging, initiated astonishing results and improved the methodologies after every passing day. Deep learning in radiology provides the opportunity to classify, detect and segment different diseases automatically. In the proposed study, we worked on a non-trivial aspect of medical imaging where we classified and localized the X-Rays affected by bullets. We tested Images on different classification and localization models to get considerable accuracy. The replicated data set used in the study was replicated on different images of chest X-Rays…
Chest X-ray is the most common medical imaging exam used to assess multiple pathologies. Automated algorithms and tools have the potential to support the reading workflow, improve efficiency, and reduce reading errors. With the availability of large scale data sets, several methods have been proposed to classify pathologies on chest X-ray images. However, most methods report performance based on random image based splitting, ignoring the high probability of the same patient appearing in both training and test set. In addition, most methods fail to explicitly incorporate the spatial information…
University of Michigan（密歇根大学）；University of Michigan Medical School（密歇根大学医学院）
Objective: When patients develop acute respiratory failure, accurately identifying the underlying etiology is essential for determining the best treatment. However, differentiating between common medical diagnoses can be challenging in clinical practice. Machine learning models could improve medical diagnosis by aiding in the diagnostic evaluation of these patients. Materials and Methods: Machine learning models were trained to predict the common causes of acute respiratory failure (pneumonia, heart failure, and/or COPD). Models were trained using chest radiographs and clinical data from the e…
Acute Care Solutions（急性护理解决方案）；Philips Research North America（飞利浦北美研究院）
The MIMIC-CXR dataset is (to date) the largest released chest x-ray dataset consisting of 473,064 chest x-rays and 206,574 radiology reports collected from 63,478 patients. We present the results of training and evaluating a collection of deep convolutional neural networks on this dataset to recognize multiple common thorax diseases. To the best of our knowledge, this is the first work that trains CNNs for this task on such a large collection of chest x-ray images, which is over four times the size of the largest previously released chest x-ray corpus (ChestX-Ray14). We describe and evaluate i…
Mila, Quebec Artificial Intelligence Institute（米拉-魁北克人工智能研究所）；Université de Montréal（蒙特利尔大学）
Most deep learning models in chest X-ray prediction utilize the posteroanterior (PA) view due to the lack of other views available. PadChest is a large-scale chest X-ray dataset that has almost 200 labels and multiple views available. In this work, we use PadChest to explore multiple approaches to merging the PA and lateral views for predicting the radiological labels associated with the X-ray image. We find that different methods of merging the model utilize the lateral view differently. We also find that including the lateral view increases performance for 32 labels in the dataset, while bei…
Department of Radiology and Imaging Sciences, Clinical Center（临床中心放射与影像科学系）
Chest X-rays are one of the most common radiological examinations in daily clinical routines. Reporting thorax diseases using chest X-rays is often an entry-level task for radiologist trainees. Yet, reading a chest X-ray image remains a challenging job for learning-oriented machine intelligence, due to (1) shortage of large-scale machine-learnable medical image datasets, and (2) lack of techniques that can mimic the high-level reasoning of human radiologists that requires years of knowledge accumulation and professional training. In this paper, we show the clinical free-text radiological repor…
Wayne State Univ.（韦恩州立大学）；NanoBioScience Institute, Wayne State Univ.（韦恩州立大学纳米生物科学研究所）；University of Michigan（密歇根大学）；Henry Ford Health System（亨利福特医疗系统）
Deep Neural Networks (DNN) are widely used to carry out segmentation tasks in biomedical images. Most DNNs developed for this purpose are based on some variation of the encoder-decoder U-Net architecture. Here we show that Res-CR-Net, a new type of fully convolutional neural network, which was originally developed for the semantic segmentation of microscopy images, and which does not adopt a U-Net architecture, is very effective at segmenting the lung fields in chest X-rays from either healthy patients or patients with a variety of lung pathologies.
Tuberculosis (TB) is a contagious bacterial airborne disease, and is one of the top 10 causes of death worldwide. According to the World Health Organization (WHO), around 1.8 billion people are infected with TB and 1.6 million deaths were reported in 2018. More importantly,95% of cases and deaths were from developing countries. Yet, TB is a completely curable disease through early diagnosis. To achieve this goal one of the key requirements is efficient utilization of existing diagnostic technologies, among which chest X-ray is the first line of diagnostic tool used for screening for active TB.…
University of Warwick（华威大学）；Guy’s and St Thomas’ NHS Foundation Trust（盖伊和圣托马斯国民保健服务基金会信托）；University Hospitals Coventry and Warwickshire NHS Trust（考文垂与沃里克郡大学医院国民保健服务信托）；Guy’s and St Thomas’ NHS Trust（盖伊和圣托马斯国民保健服务信托）；King’s College London（伦敦国王学院）；The Alan Turing Institute（艾伦·图灵研究所）
Understanding the internal physiological changes accompanying the aging process is an important aspect of medical image interpretation, with the expected changes acting as a baseline when reporting abnormal findings. Deep learning has recently been demonstrated to allow the accurate estimation of patient age from chest X-rays, and shows potential as a health indicator and mortality predictor. In this paper we present a novel comparative study of the relative performance of radiologists versus state-of-the-art deep learning models on two tasks: (a) patient age estimation from a single chest X-r…
The University of Texas at Austin（德克萨斯大学奥斯汀分校）；Weill Cornell Medicine（威尔康奈尔医学院）
Chest X-ray becomes one of the most common medical diagnoses due to its noninvasiveness. The number of chest X-ray images has skyrocketed, but reading chest X-rays still have been manually performed by radiologists, which creates huge burnouts and delays. Traditionally, radiomics, as a subfield of radiology that can extract a large number of quantitative features from medical images, demonstrates its potential to facilitate medical imaging diagnosis before the deep learning era. In this paper, we develop an end-to-end framework, ChexRadiNet, that can utilize the radiomics features to improve t…
Toronto Rehabilitation Institute, University Health Network（多伦多康复研究所，大学健康网络）；University of Toronto（多伦多大学）；University of Manitoba（曼尼托巴大学）
The current COVID-19 pandemic is now getting contained, albeit at the cost of morethan2.3million human lives. A critical phase in any pandemic is the early detection of cases to develop preventive treatments and strategies. In the case of COVID-19,several studies have indicated that chest radiography images of the infected patients show characteristic abnormalities. However, at the onset of a given pandemic, such asCOVID-19, there may not be sufficient data for the affected cases to train models for their robust detection. Hence, supervised classification is ill-posed for this problem because …
MetaChest: Generalized few-shot learning of pathologies from chest X-rays
Posgrado en Ciencia e Ingeniería de la Computación（计算机科学与工程研究生院）；Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas（应用数学与系统研究所）；Universidad Nacional Autónoma de México（墨西哥国立自治大学）
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…
The University of Texas at Austin（德克萨斯大学奥斯汀分校）；Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院）；Weill Cornell Medicine（威尔康奈尔医学院）
Building a highly accurate predictive model for classification and localization of abnormalities in chest X-rays usually requires a large number of manually annotated labels and pixel regions (bounding boxes) of abnormalities. However, it is expensive to acquire such annotations, especially the bounding boxes. Recently, contrastive learning has shown strong promise in leveraging unlabeled natural images to produce highly generalizable and discriminative features. However, extending its power to the medical image domain is under-explored and highly non-trivial, since medical images are much les…
Bauman Moscow State Technical University（鲍曼莫斯科国立技术大学）
The possibility of high-precision and rapid detection of pathologies on chest X-rays makes it possible to detect the development of pneumonia at an early stage and begin immediate treatment. Artificial intelligence can speed up and qualitatively improve the procedure of X-ray analysis and give recommendations to the doctor for additional consideration of suspicious images. The purpose of this study is to determine the best models and implementations of the transfer learning method in the binary classification problem in the presence of a small amount of training data. In this article, various …
