Towards using Cough for Respiratory Disease Diagnosis by leveraging Artificial Intelligence: A Survey

Cough acoustics contain multitudes of vital information about pathomorphological alterations in the respiratory system. Reliable and accurate detection of cough events by investigating the underlying cough latent features and disease diagnosis can play an indispensable role in revitalizing the healthcare practices. The recent application of Artificial Intelligence (AI) and advances of ubiquitous computing for respiratory disease prediction has created an auspicious trend and myriad of future possibilities in the medical domain. In particular, there is an expeditiously emerging trend of Machine learning (ML) and Deep Learning (DL)-based diagnostic algorithms exploiting cough signatures. The enormous body of literature on cough-based AI algorithms demonstrate that these models can play a significant role for detecting the onset of a specific respiratory disease. However, it is pertinent to collect the information from all relevant studies in an exhaustive manner for the medical experts and AI scientists to analyze the decisive role of AI/ML. This survey offers a comprehensive overview of the cough data-driven ML/DL detection and preliminary diagnosis frameworks, along with a detailed list of significant features. We investigate the mechanism that causes cough and the latent cough features of the respiratory modalities. We also analyze the customized cough monitoring application, and their AI-powered recognition algorithms. Challenges and prospective future research directions to develop practical, robust, and ubiquitous solutions are also discussed in detail.Comment: 30 pages, 12 figures, 9 table

Characterization and processing of novel neck photoplethysmography signals for cardiorespiratory monitoring

Epilepsy is a neurological disorder causing serious brain seizures that severely affect the patients' quality of life. Sudden unexpected death in epilepsy (SUDEP), for which no evident decease reason is found after post-mortem examination, is a common cause of mortality. The mechanisms leading to SUDEP are uncertain, but, centrally mediated apneic respiratory dysfunction, inducing dangerous hypoxemia, plays a key role. Continuous physiological monitoring appears as the only reliable solution for SUDEP prevention. However, current seizure-detection systems do not show enough sensitivity and present a high number of intolerable false alarms. A wearable system capable of measuring several physiological signals from the same body location, could efficiently overcome these limitations. In this framework, a neck wearable apnea detection device (WADD), sensing airflow through tracheal sounds, was designed. Despite the promising performance, it is still necessary to integrate an oximeter sensor into the system, to measure oxygen saturation in blood (SpO2) from neck photoplethysmography (PPG) signals, and hence, support the apnea detection decision. The neck is a novel PPG measurement site that has not yet been thoroughly explored, due to numerous challenges. This research work aims to characterize neck PPG signals, in order to fully exploit this alternative pulse oximetry location, for precise cardiorespiratory biomarkers monitoring. In this thesis, neck PPG signals were recorded, for the first time in literature, in a series of experiments under different artifacts and respiratory conditions. Morphological and spectral characteristics were analyzed in order to identify potential singularities of the signals. The most common neck PPG artifacts critically corrupting the signal quality, and other breathing states of interest, were thoroughly characterized in terms of the most discriminative features. An algorithm was further developed to differentiate artifacts from clean PPG signals. Both, the proposed characterization and classification model can be useful tools for researchers to denoise neck PPG signals and exploit them in a variety of clinical contexts. In addition to that, it was demonstrated that the neck also offered the possibility, unlike other body parts, to extract the Jugular Venous Pulse (JVP) non-invasively. Overall, the thesis showed how the neck could be an optimum location for multi-modal monitoring in the context of diseases affecting respiration, since it not only allows the sensing of airflow related signals, but also, the breathing frequency component of the PPG appeared more prominent than in the standard finger location. In this context, this property enabled the extraction of relevant features to develop a promising algorithm for apnea detection in near-real time. These findings could be of great importance for SUDEP prevention, facilitating the investigation of the mechanisms and risk factors associated to it, and ultimately reduce epilepsy mortality.Open Acces

New Techniques and Optimizations of Short Echo-time 1H MRI with Applications in Murine Lung

Although x-ray computed tomography (CT) is a gold standard for pulmonary imaging, it has high ionizing radiation, which puts patients at greater risk of cancer, particularly in a longitudinal study with cumulative doses. Magnetic resonance imaging (MRI) doesn\u27t involve exposure to ionizing radiation and is especially useful for visualizing soft tissues and organs such as ligaments, cartilage, brain, and heart. Many efforts have been made to apply MRI to study lung function and structure of both humans and animals. However, lung is a unique organ and is very different from other solid organs like the heart and brain due to its complex air-tissue interleaved structure. The magnetic susceptibility differences at the air-tissue interfaces result in very short T2* (~ 1 ms) of lung parenchyma, which is even shorter in small-animal MRI (often at higher field) than in human MRI. Both low proton density and short T2* of lung parenchyma are challenges for pulmonary imaging via MRI because they lead to low signal-to-noise ratio (SNR) in images with traditional Cartesian methods that necessitate longer echo times (≥ 1 ms). This dissertation reports the work of optimizing pulmonary MRI techniques by minimizing the negative effects of low proton density and short T2* of murine lung parenchyma, and the application of these techniques to imaging murine lung. Specifically, echo time (TE) in the Cartesian sequence is minimized, by simultaneous slice select rephasing, phase encoding and read dephasing gradients, in addition to partial Fourier imaging, to reduce signal loss due to T2* relaxation. Radial imaging techniques, often called ultra-short echo-time MRI or UTE MRI, with much shorter time between excitation and data acquisition, were also developed and optimized for pulmonary imaging. Offline reconstruction for UTE data was developed on a Linux system to regrid the non-Cartesian (radial in this dissertation) k-space data for fast Fourier transform. Slabselected UTE was created to fit the field-of-view (FOV) to the imaged lung without fold-in aliasing, which increases TE slightly compared to non-slab-selected UTE. To further reduce TE as well as fit the FOV to the lung without aliasing, UTE with ellipsoidal k-space coverage was developed, which increases resolution and decreases acquisition time. Taking into account T2* effects, point spread function (PSF) analysis was performed to determine the optimal acquisition time for maximal single-voxel SNR. Retrospective self-gating UTE was developed to avoid the use of a ventilator (which may cause lung injury) and to avoid possible prospective gating errors caused by abrupt body motion. Cartesian gradient-recalled-echo imaging (GRE) was first applied to monitor acute cellular rejection in lung transplantation. By repeated imaging in the same animals, both parenchymal signal and lung compliance were measured and were able to detect rejection in the allograft lung. GRE was also used to monitor chronic cellular rejection in a transgenic mouse model after lung transplantation. In addition to parenchymal signal and lung compliance, the percentage of highdensity lung parenchyma was defined and measured to detect chronic rejection. This represents one of the first times quantitative pulmonary MRI has been performed. For 3D radial UTE MRI, 2D golden means (1) were used to determine the direction of radial spokes in k-space, resulting in pseudo-random angular sampling of spherical k-space coverage. Ellipsoidal k-space coverage was generated by expanding spherical coverage to create an ellipsoid in k-space. UTE MRI with ellipsoidal k-space coverage was performed to image healthy mice and phantoms, showing reduced FOV and enhanced in-plane resolution compared to regular UTE. With this modified UTE, T2* of lung parenchyma was measured by an interleaved multi-TE strategy, and T1 of lung parenchyma was measured by a limited flip angle method (2). Retrospective self-gating UTE with ellipsoidal k-space coverage was utilized to monitor the progression of pulmonary fibrosis in a transforming growth factor (TGF)-α transgenic mouse model and compared with histology and pulmonary mechanics. Lung fibrosis progression was not only visualized by MRI images, but also quantified and tracked by the MRIderived lung function parameters like mean lung parenchyma signal, high-density lung volume percentage, and tidal volume. MRI-derived lung function parameters were strongly correlated with the findings of pulmonary mechanics and histology in measuring fibrotic burden. This dissertation demonstrates new techniques and optimizations in GRE and UTE MRI that are employed to minimize TE and image murine lungs to assess lung function and structure and monitor the time course of lung diseases. Importantly, the ability to longitudinally image individual animals by these MRI techniques minimizes the number of animals required in preclinical studies and increases the statistical power of future experiments as each animal can serve at its own control

Trends in Computer-Aided Diagnosis Using Deep 2 Learning Techniques: A Review of Recent Studies on 3 Algorithm Development 4

With recent focus on deep neural network architectures for development of algorithms for computer-aided diagnosis (CAD), we provide a review of studies within the last 3 years (2015-2017) reported in selected top journals and conferences. 29 studies that met our inclusion criteria were reviewed to identify trends in this field and to inform future development. Studies have focused mostly on cancer-related diseases within internal medicine while diseases within gender-/age-focused fields like gynaecology/pediatrics have not received much focus. All reviewed studies employed image datasets, mostly sourced from publicly available databases (55.2%) and few based on data from human subjects (31%) and non-medical datasets (13.8%), while CNN architecture was employed in most (70%) of the studies. Confirmation of the effect of data manipulation on quality of output and adoption of multi-class rather than binary classification also require more focus. Future studies should leverage collaborations with medical experts to aid future with actual clinical testing with reporting based on some generally applicable index to enable comparison. Our next steps on plans for CAD development for osteoarthritis (OA), with plans to consider multi-class classification and comparison across deep learning approaches and unsupervised architectures were also highlighted

Machine Learning based Approaches for Cough Detection From Acceleration

The main goal of this research is to develop a a machine learning based method in order to detect cough from acceleration signals. In this study, two different methods are proposed: a conventional one that uses XGBoost as a classifier and a deep learning which uses CNN-1D as an architecture. We found that these models were able to distinguish between acceleration signals caused by coughing and acceleration signals caused by other activities such as clearing throat, talking, laughing and movements in different directions with high accuracy. This study affirms that cough monitoring based on accelerometer measurements generated by the Hexoskin device is possible, making it a new user-independent tool for cough detection