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Transfer learning with pre-trained neural networks is a common strategy for training classifiers in medical image analysis. Without proper channel selections, this often results in unnecessarily large models that hinder deployment and explainability. In this paper, we propose a novel approach to efficiently build small and well performing networks by introducing the channel-scaling layers. A channel-scaling layer is attached to each frozen convolutional layer, with the trainable scaling weights inferring the importance of the corresponding feature channels. Unlike the fine-tuning approaches, we maintain the weights of the original channels and large datasets are not required. By imposing L1 regularization and thresholding on the scaling weights, this framework iteratively removes unnecessary feature channels from a pre-trained model. Using an ImageNet pre-trained VGG16 model, we demonstrate the capabilities of the proposed framework on classifying opacity from chest X-ray images. The results show that we can reduce the number of parameters by 95% while delivering a superior performance., This paper was accepted by the IEEE International Symposium on Biomedical Imaging (ISBI) 2021

Liver cancer is one of the leading causes of cancer deaths in Asia and Africa. It is caused by the Hepatocellular carcinoma (HCC) in almost 90% of all cases. HCC is a malignant tumor and the most common histological type of the primary liver cancers. The detection and evaluation of viable tumor regions in HCC present an important clinical significance since it is a key step to assess response of chemoradiotherapy and tumor cell proportion in genetic tests. Recent advances in computer vision, digital pathology and microscopy imaging enable automatic histopathology image analysis for cancer diagnosis. In this paper, we present a multi-resolution deep learning model HistoCAE for viable tumor segmentation in whole-slide liver histopathology images. We propose convolutional autoencoder (CAE) based framework with a customized reconstruction loss function for image reconstruction, followed by a classification module to classify each image patch as tumor versus non-tumor. The resulting patch-based prediction results are spatially combined to generate the final segmentation result for each WSI. Additionally, the spatially organized encoded feature map derived from small image patches is used to compress the gigapixel whole-slide images. Our proposed model presents superior performance to other benchmark models with extensive experiments, suggesting its efficacy for viable tumor area segmentation with liver whole-slide images.

Automated diagnostic assistants in healthcare necessitate accurate AI models that can be trained with limited labeled data, can cope with severe class imbalances and can support simultaneous prediction of multiple disease conditions. To this end, we present a deep learning framework that utilizes a number of key components to enable robust modeling in such challenging scenarios. Using an important use-case in chest X-ray classification, we provide several key insights on the effective use of data augmentation, self-training via distillation and confidence tempering for small data learning in medical imaging. Our results show that using 85% lesser labeled data, we can build predictive models that match the performance of classifiers trained in a large-scale data setting.

Deep learning has now become the de facto approach to the recognition of anomalies in medical imaging. Their 'black box' way of classifying medical images into anomaly labels poses problems for their acceptance, particularly with clinicians. Current explainable AI methods offer justifications through visualizations such as heat maps but cannot guarantee that the network is focusing on the relevant image region fully containing the anomaly. In this paper, we develop an approach to explainable AI in which the anomaly is assured to be overlapping the expected location when present. This is made possible by automatically extracting location-specific labels from textual reports and learning the association of expected locations to labels using a hybrid combination of Bi-Directional Long Short-Term Memory Recurrent Neural Networks (Bi-LSTM) and DenseNet-121. Use of this expected location to bias the subsequent attention-guided inference network based on ResNet101 results in the isolation of the anomaly at the expected location when present. The method is evaluated on a large chest X-ray dataset., Comment: 5 pages, Paper presented as a poster at the International Symposium on Biomedical Imaging, 2020, Paper Number 655

A fully automated knee MRI segmentation method to study osteoarthritis (OA) was developed using a novel hierarchical set of random forests (RF) classifiers to learn the appearance of cartilage regions and their boundaries. A neighborhood approximation forest is used first to provide contextual feature to the second-level RF classifier that also considers local features and produces location-specific costs for the layered optimal graph image segmentation of multiple objects and surfaces (LOGISMOS) framework. Double echo steady state (DESS) MRIs used in this work originated from the Osteoarthritis Initiative (OAI) study. Trained on 34 MRIs with varying degrees of OA, the performance of the learning-based method tested on 108 MRIs showed a significant reduction in segmentation errors (\emph{p}$, Comment: IEEE Transactions in Medical Imaging, 11 pages

LOGISMOS (Layered Optimal Graph Image Segmentation for Multiple Objects and Surfaces) is a general approach for optimally segmenting multiple n-D surfaces that mutually interact within individual and/or between object. JEI (Just-Enough Interaction) extension enables the users to intuitively and efficiently guide LOGISMOS to achieve clinically acceptable segmentation that still maintains global optimality, embedded shape, and anatomy knowledge. This chapter is aimed at both the conceptual designers of quantitative medical image analysis methods and developers adopting LOGISMOS-JEI to perform new segmentation tasks. The basic principles and essential techniques of LOGISMOS-JEI are presented. Using three clinical segmentation problems, the process of designing LOGISMOS-JEI applications is described with a focus on choosing proper techniques at all stages of the analysis pipeline. The capability of JEI is demonstrated by reporting the achieved segmentation accuracy and quantifying the levels of human effort involved.

Weakly supervised instance labeling using only image-level labels, in lieu of expensive fine-grained pixel annotations, is crucial in several applications including medical image analysis. In contrast to conventional instance segmentation scenarios in computer vision, the problems that we consider are characterized by a small number of training images and non-local patterns that lead to the diagnosis. In this paper, we explore the use of multiple instance learning (MIL) to design an instance label generator under this weakly supervised setting. Motivated by the observation that an MIL model can handle bags of varying sizes, we propose to repurpose an MIL model originally trained for bag-level classification to produce reliable predictions for single instances, i.e., bags of size $1$. To this end, we introduce a novel regularization strategy based on virtual adversarial training for improving MIL training, and subsequently develop a knowledge distillation technique for repurposing the trained MIL model. Using empirical studies on colon cancer and breast cancer detection from histopathological images, we show that the proposed approach produces high-quality instance-level prediction and significantly outperforms state-of-the MIL methods.

Importance Chest radiography is the most common diagnostic imaging examination performed in emergency departments (EDs). Augmenting clinicians with automated preliminary read assistants could help expedite their workflows, improve accuracy, and reduce the cost of care. Objective To assess the performance of artificial intelligence (AI) algorithms in realistic radiology workflows by performing an objective comparative evaluation of the preliminary reads of anteroposterior (AP) frontal chest radiographs performed by an AI algorithm and radiology residents. Design, Setting, and Participants This diagnostic study included a set of 72 findings assembled by clinical experts to constitute a full-fledged preliminary read of AP frontal chest radiographs. A novel deep learning architecture was designed for an AI algorithm to estimate the findings per image. The AI algorithm was trained using a multihospital training data set of 342 126 frontal chest radiographs captured in ED and urgent care settings. The training data were labeled from their associated reports. Image-based F1 score was chosen to optimize the operating point on the receiver operating characteristics (ROC) curve so as to minimize the number of missed findings and overcalls per image read. The performance of the model was compared with that of 5 radiology residents recruited from multiple institutions in the US in an objective study in which a separate data set of 1998 AP frontal chest radiographs was drawn from a hospital source representative of realistic preliminary reads in inpatient and ED settings. A triple consensus with adjudication process was used to derive the ground truth labels for the study data set. The performance of AI algorithm and radiology residents was assessed by comparing their reads with ground truth findings. All studies were conducted through a web-based clinical study application system. The triple consensus data set was collected between February and October 2018. The comparison study was preformed between January and October 2019. Data were analyzed from October to February 2020. After the first round of reviews, further analysis of the data was performed from March to July 2020. Main Outcomes and Measures The learning performance of the AI algorithm was judged using the conventional ROC curve and the area under the curve (AUC) during training and field testing on the study data set. For the AI algorithm and radiology residents, the individual finding label performance was measured using the conventional measures of label-based sensitivity, specificity, and positive predictive value (PPV). In addition, the agreement with the ground truth on the assignment of findings to images was measured using the pooled κ statistic. The preliminary read performance was recorded for AI algorithm and radiology residents using new measures of mean image-based sensitivity, specificity, and PPV designed for recording the fraction of misses and overcalls on a per image basis. The 1-sided analysis of variance test was used to compare the means of each group (AI algorithm vs radiology residents) using the F distribution, and the null hypothesis was that the groups would have similar means. Results The trained AI algorithm achieved a mean AUC across labels of 0.807 (weighted mean AUC, 0.841) after training. On the study data set, which had a different prevalence distribution, the mean AUC achieved was 0.772 (weighted mean AUC, 0.865). The interrater agreement with ground truth finding labels for AI algorithm predictions had pooled κ value of 0.544, and the pooled κ for radiology residents was 0.585. For the preliminary read performance, the analysis of variance test was used to compare the distributions of AI algorithm and radiology residents' mean image-based sensitivity, PPV, and specificity. The mean image-based sensitivity for AI algorithm was 0.716 (95% CI, 0.704-0.729) and for radiology residents was 0.720 (95% CI, 0.709-0.732) (P = .66), while the PPV was 0.730 (95% CI, 0.718-0.742) for the AI algorithm and 0.682 (95% CI, 0.670-0.694) for the radiology residents (P

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-ray benchmark database of 73 rich sentence-level descriptors of findings seen in AP chest X-rays. We describe our method of obtaining these findings through a semi-automated ground truth generation process from crowdsourcing of clinician annotations. We also present results of building classifiers for these findings that show that such higher granularity labels can also be learned through the framework of deep learning classifiers., Comment: This paper was accepted by the IEEE International Symposium on Biomedical Imaging (ISBI) 2019

We present a fully automated learning-based approach for segmenting knee cartilage in the presence of osteoarthritis (OA). The algorithm employs a hierarchical set of two random forest classifiers. The first is a neighborhood approximation forest, the output probability map of which is utilized as a feature set for the second random forest (RF) classifier. The output probabilities of the hierarchical approach are used as cost functions in a Layered Optimal Graph Segmentation of Multiple Objects and Surfaces (LOGISMOS). In this work, we highlight a novel post-processing interaction called just-enough interaction (JEI) which enables quick and accurate generation of a large set of training examples. Disjoint sets of 15 and 13 subjects were used for training and tested on another disjoint set of 53 knee datasets. All images were acquired using a double echo steady state (DESS) MRI sequence and are from the osteoarthritis initiative (OAI) database. Segmentation performance using the learning-based cost function showed significant reduction in segmentation errors ($p< 0.05$) in comparison with conventional gradient-based cost functions., KEYWORDS: Graph based segmentation; Just enough interaction; LOGISMOS; Neighborhood approximation forests; Osteoarthritis; Random forest classifier; knee MRI PMID: 28626842 PMCID: PMC5471813