Elicitation and representation of expert knowledge for computer aided diagnosis in mammography

To study how professional radiologists describe, interpret and make decisions about micro-calcifications in mammograms. The purpose was to develop a model of the radiologists' decision making for use in CADMIUM II, a computerized aid for mammogram interpretation that combines symbolic reasoning with image processing

Histopathological image analysis : a review

Over the past decade, dramatic increases in computational power and improvement in image analysis algorithms have allowed the development of powerful computer-assisted analytical approaches to radiological data. With the recent advent of whole slide digital scanners, tissue histopathology slides can now be digitized and stored in digital image form. Consequently, digitized tissue histopathology has now become amenable to the application of computerized image analysis and machine learning techniques. Analogous to the role of computer-assisted diagnosis (CAD) algorithms in medical imaging to complement the opinion of a radiologist, CAD algorithms have begun to be developed for disease detection, diagnosis, and prognosis prediction to complement the opinion of the pathologist. In this paper, we review the recent state of the art CAD technology for digitized histopathology. This paper also briefly describes the development and application of novel image analysis technology for a few specific histopathology related problems being pursued in the United States and Europe

Bayesian networks for disease diagnosis: What are they, who has used them and how?

A Bayesian network (BN) is a probabilistic graph based on Bayes' theorem, used to show dependencies or cause-and-effect relationships between variables. They are widely applied in diagnostic processes since they allow the incorporation of medical knowledge to the model while expressing uncertainty in terms of probability. This systematic review presents the state of the art in the applications of BNs in medicine in general and in the diagnosis and prognosis of diseases in particular. Indexed articles from the last 40 years were included. The studies generally used the typical measures of diagnostic and prognostic accuracy: sensitivity, specificity, accuracy, precision, and the area under the ROC curve. Overall, we found that disease diagnosis and prognosis based on BNs can be successfully used to model complex medical problems that require reasoning under conditions of uncertainty.Comment: 22 pages, 5 figures, 1 table, Student PhD first pape

Quantitative analysis of breast cancer diagnosis using a probabilistic modelling approach

Background:Breast cancer is the most prevalent cancer in women in most countries of the world. Many computer aided diagnostic methods have been proposed, but there are few studies on quantitative discovery of probabilistic dependencies among breast cancer data features and identification of the contribution of each feature to breast cancer diagnosis. Methods:This study aims to fill this void by utilizing a Bayesian network (BN) modelling approach. A K2 learning algorithm and statistical computation methods are used to construct BN structure and assess the obtained BN model. The data used in this study were collected from a clinical ultrasound dataset derived from a Chinese local hospital and a fine-needle aspiration cytology (FNAC) dataset from UCI machine learning repository. Results: Our study suggested that, in terms of ultrasound data, cell shape is the most significant feature for breast cancer diagnosis, and the resistance index presents a strong probabilistic dependency on blood signals. With respect to FNAC data, bare nuclei are the most important discriminating feature of malignant and benign breast tumours, and uniformity of both cell size and cell shape are tightly interdependent. Contributions: The BN modelling approach can support clinicians in making diagnostic decisions based on the significant features identified by the model, especially when some other features are missing for specific patients. The approach is also applicable to other healthcare data analytics and data modelling for disease diagnosis

Pattern recognition systems design on parallel GPU architectures for breast lesions characterisation employing multimodality images

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University London.The aim of this research was to address the computational complexity in designing multimodality Computer-Aided Diagnosis (CAD) systems for characterising breast lesions, by harnessing the general purpose computational potential of consumer-level Graphics Processing Units (GPUs) through parallel programming methods. The complexity in designing such systems lies on the increased dimensionality of the problem, due to the multiple imaging modalities involved, on the inherent complexity of optimal design methods for securing high precision, and on assessing the performance of the design prior to deployment in a clinical environment, employing unbiased system evaluation methods. For the purposes of this research, a Pattern Recognition (PR)-system was designed to provide highest possible precision by programming in parallel the multiprocessors of the NVIDIA’s GPU-cards, GeForce 8800GT or 580GTX, and using the CUDA programming framework and C++. The PR-system was built around the Probabilistic Neural Network classifier and its performance was evaluated by a re-substitution method, for estimating the system’s highest accuracy, and by the external cross validation method, for assessing the PR-system’s unbiased accuracy to new, “unseen” by the system, data. Data comprised images of patients with histologically verified (benign or malignant) breast lesions, who underwent both ultrasound (US) and digital mammography (DM). Lesions were outlined on the images by an experienced radiologist, and textural features were calculated. Regarding breast lesion classification, the accuracies for discriminating malignant from benign lesions were, 85.5% using US-features alone, 82.3% employing DM-features alone, and 93.5% combining US and DM features. Mean accuracy to new “unseen” data for the combined US and DM features was 81%. Those classification accuracies were about 10% higher than accuracies achieved on a single CPU, using sequential programming methods, and 150-fold faster. In addition, benign lesions were found smoother, more homogeneous, and containing larger structures. Additionally, the PR-system design was adapted for tackling other medical problems, as a proof of its generalisation. These included classification of rare brain tumours, (achieving 78.6% for overall accuracy (OA) and 73.8% for estimated generalisation accuracy (GA), and accelerating system design 267 times), discrimination of patients with micro-ischemic and multiple sclerosis lesions (90.2% OA and 80% GA with 32-fold design acceleration), classification of normal and pathological knee cartilages (93.2% OA and 89% GA with 257-fold design acceleration), and separation of low from high grade laryngeal cancer cases (93.2% OA and 89% GA, with 130-fold design acceleration). The proposed PR-system improves breast-lesion discrimination accuracy, it may be redesigned on site when new verified data are incorporated in its depository, and it may serve as a second opinion tool in a clinical environment

The use of knowledge discovery databases in the identification of patients with colorectal cancer

Colorectal cancer is one of the most common forms of malignancy with 35,000 new patients diagnosed annually within the UK. Survival figures show that outcomes are less favourable within the UK when compared with the USA and Europe with 1 in 4 patients having incurable disease at presentation as of data from 2000.Epidemiologists have demonstrated that the incidence of colorectal cancer is highest on the industrialised western world with numerous contributory factors. These range from a genetic component to concurrent medical conditions and personal lifestyle. In addition, data also demonstrates that environmental changes play a significant role with immigrants rapidly reaching the incidence rates of the host country.Detection of colorectal cancer remains an important and evolving aspect of healthcare with the aim of improving outcomes by earlier diagnosis. This process was initially revolutionised within the UK in 2002 with the ACPGBI 2 week wait guidelines to facilitate referrals form primary care and has subsequently seen other schemes such as bowel cancer screening introduced to augment earlier detection rates. Whereas the national screening programme is dependent on FOBT the standard referral practice is dependent upon a number of trigger symptoms that qualify for an urgent referral to a specialist for further investigations. This process only identifies 25-30% of those with colorectal cancer and remains a labour intensive process with only 10% of those seen in the 2 week wait clinics having colorectal cancer.This thesis hypothesises whether using a patient symptom questionnaire in conjunction with knowledge discovery techniques such as data mining and artificial neural networks could identify patients at risk of colorectal cancer and therefore warrant urgent further assessment. Artificial neural networks and data mining methods are used widely in industry to detect consumer patterns by an inbuilt ability to learn from previous examples within a dataset and model often complex, non-linear patterns. Within medicine these methods have been utilised in a host of diagnostic techniques from myocardial infarcts to its use in the Papnet cervical smear programme for cervical cancer detection.A linkert based questionnaire of those attending the 2 week wait fast track colorectal clinic was used to produce a ‘symptoms’ database. This was then correlated with individual patient diagnoses upon completion of their clinical assessment. A total of 777 patients were included in the study and their diagnosis categorised into a dichotomous variable to create a selection of datasets for analysis. These data sets were then taken by the author and used to create a total of four primary databases based on all questions, 2 week wait trigger symptoms, Best knowledge questions and symptoms identified in Univariate analysis as significant. Each of these databases were entered into an artificial neural network programme, altering the number of hidden units and layers to obtain a selection of outcome models that could be further tested based on a selection of set dichotomous outcomes. Outcome models were compared for sensitivity, specificity and risk. Further experiments were carried out with data mining techniques and the WEKA package to identify the most accurate model. Both would then be compared with the accuracy of a colorectal specialist and GP.Analysis of the data identified that 24% of those referred on the 2 week wait referral pathway failed to meet referral criteria as set out by the ACPGBI. The incidence of those with colorectal cancer was 9.5% (74) which is in keeping with other studies and the main symptoms were rectal bleeding, change in bowel habit and abdominal pain. The optimal knowledge discovery database model was a back propagation ANN using all variables for outcomes cancer/not cancer with sensitivity of 0.9, specificity of 0.97 and LR 35.8. Artificial neural networks remained the more accurate modelling method for all the dichotomous outcomes.The comparison of GP’s and colorectal specialists at predicting outcome demonstrated that the colorectal specialists were the more accurate predictors of cancer/not cancer with sensitivity 0.27 and specificity 0.97, (95% CI 0.6-0.97, PPV 0.75, NPV 0.83) and LR 10.6. When compared to the KDD models for predicting the same outcome, once again the ANN models were more accurate with the optimal model having sensitivity 0.63, specificity 0.98 (95% CI 0.58-1, PPV 0.71, NPV 0.96) and LR 28.7.The results demonstrate that diagnosis colorectal cancer remains a challenging process, both for clinicians and also for computation models. KDD models have been shown to be consistently more accurate in the prediction of those with colorectal cancer than clinicians alone when used solely in conjunction with a questionnaire. It would be ill conceived to suggest that KDD models could be used as a replacement to clinician- patient interaction but they may aid in the acceleration of some patients for further investigations or ‘straight to test’ if used on those referred as routine patients