Artificial Intelligence in Image-Based Screening, Diagnostics, and Clinical Care of Cardiopulmonary Diseases

Cardiothoracic and pulmonary diseases are a significant cause of mortality and morbidity worldwide. The COVID-19 pandemic has highlighted the lack of access to clinical care, the overburdened medical system, and the potential of artificial intelligence (AI) in improving medicine. There are a variety of diseases affecting the cardiopulmonary system including lung cancers, heart disease, tuberculosis (TB), etc., in addition to COVID-19-related diseases. Screening, diagnosis, and management of cardiopulmonary diseases has become difficult owing to the limited availability of diagnostic tools and experts, particularly in resource-limited regions. Early screening, accurate diagnosis and staging of these diseases could play a crucial role in treatment and care, and potentially aid in reducing mortality. Radiographic imaging methods such as computed tomography (CT), chest X-rays (CXRs), and echo ultrasound (US) are widely used in screening and diagnosis. Research on using image-based AI and machine learning (ML) methods can help in rapid assessment, serve as surrogates for expert assessment, and reduce variability in human performance. In this Special Issue, “Artificial Intelligence in Image-Based Screening, Diagnostics, and Clinical Care of Cardiopulmonary Diseases”, we have highlighted exemplary primary research studies and literature reviews focusing on novel AI/ML methods and their application in image-based screening, diagnosis, and clinical management of cardiopulmonary diseases. We hope that these articles will help establish the advancements in AI

Synthetic data generation method for hybrid image-tabular data using two generative adversarial networks

The generation of synthetic medical records using generative adversarial networks (GANs) has become increasingly important for addressing privacy concerns and promoting data sharing in the medical field. In this paper, we propose a novel method for generating synthetic hybrid medical records consisting of chest X-ray images (CXRs) and structured tabular data (including anthropometric data and laboratory tests) using an auto-encoding GAN ({\alpha}GAN) and a conditional tabular GAN (CTGAN). Our approach involves training a {\alpha}GAN model on a large public database (pDB) to reduce the dimensionality of CXRs. We then applied the trained encoder of the GAN model to the images in original database (oDB) to obtain the latent vectors. These latent vectors were combined with tabular data in oDB, and these joint data were used to train the CTGAN model. We successfully generated diverse synthetic records of hybrid CXR and tabular data, maintaining correspondence between them. We evaluated this synthetic database (sDB) through visual assessment, distribution of interrecord distances, and classification tasks. Our evaluation results showed that the sDB captured the features of the oDB while maintaining the correspondence between the images and tabular data. Although our approach relies on the availability of a large-scale pDB containing a substantial number of images with the same modality and imaging region as those in the oDB, this method has the potential for the public release of synthetic datasets without compromising the secondary use of data.Comment: 14 page

Enhancing Radiology Diagnosis through Convolutional Neural Networks for Computer Vision in Healthcare

The transformative power of Convolutional Neural Networks (CNNs) in radiology diagnostics is examined in this study, with a focus on interpretability, effectiveness, and ethical issues. With an altered DenseNet architecture, the CNN performs admirably in terms of particularity, sensitivity, as well as accuracy. Its superiority over conventional methods is validated by comparative analyses, which highlight efficiency gains. Nonetheless, interpretability issues highlight the necessity of sophisticated methods in addition to continuous model improvement. Integration issues like interoperability and radiologists' training lead to suggestions for teamwork. Systematic consideration of the ethical implications is carried out, necessitating extensive frameworks. Refinement of architectures, interpretability, alongside ethical considerations need to be prioritized in future work for responsible CNN deployment in radiology diagnostics

Towards Generalist Biomedical AI

Medicine is inherently multimodal, with rich data modalities spanning text, imaging, genomics, and more. Generalist biomedical artificial intelligence (AI) systems that flexibly encode, integrate, and interpret this data at scale can potentially enable impactful applications ranging from scientific discovery to care delivery. To enable the development of these models, we first curate MultiMedBench, a new multimodal biomedical benchmark. MultiMedBench encompasses 14 diverse tasks such as medical question answering, mammography and dermatology image interpretation, radiology report generation and summarization, and genomic variant calling. We then introduce Med-PaLM Multimodal (Med-PaLM M), our proof of concept for a generalist biomedical AI system. Med-PaLM M is a large multimodal generative model that flexibly encodes and interprets biomedical data including clinical language, imaging, and genomics with the same set of model weights. Med-PaLM M reaches performance competitive with or exceeding the state of the art on all MultiMedBench tasks, often surpassing specialist models by a wide margin. We also report examples of zero-shot generalization to novel medical concepts and tasks, positive transfer learning across tasks, and emergent zero-shot medical reasoning. To further probe the capabilities and limitations of Med-PaLM M, we conduct a radiologist evaluation of model-generated (and human) chest X-ray reports and observe encouraging performance across model scales. In a side-by-side ranking on 246 retrospective chest X-rays, clinicians express a pairwise preference for Med-PaLM M reports over those produced by radiologists in up to 40.50% of cases, suggesting potential clinical utility. While considerable work is needed to validate these models in real-world use cases, our results represent a milestone towards the development of generalist biomedical AI systems

This is not a real image:Generative artificial intelligence to enhance radiology education

Radiologists fulfill a critical role in our healthcare system, but their workload has increased substantially over time. Although algorithmic tools have been proposed to support the diagnostic process, the workload is not efficiently decreased in this manner. However, another possibility is to decrease workload in a different area. The main topic of this thesis is concerned with investigating how simulation training can be realized to aid in the image interpretation skills training of the radiology resident. To realize simulated training it is necessary to know (1) how we can create realistic artificial medical images, subsequently (2) How we can control their variety and (3) how we can adjust their difficulty.Firstly, it is shown that artificial medical images can blend in with original ones. For this purpose a GAN model is used to create 2-dimensional artificial medical images. The created artificial images are assessed both quantitatively and qualitatively in terms of their realism. Secondly, to better control the variety of the artificial medical images a diffusion model is used to guide both coarse- and fine-features. The results show that the model was able to adjust fine-feature characteristics of the pathology type according to the feedback of the independent classifier. Thirdly, a method is presented to describe the detection difficulty of an (artificial) medical image using quantitative pathology and image characteristics. Results show that it is possible to describe almost two thirds of the variation in difficulty using these quantitative characteristics and as such describe images as having lower or higher detection difficulty. Finally, the responsible implementation of the medical image simulator to assist in image interpretation skills is investigated. Combining the results of this thesis resulted in a prototype of a 'medical image simulator'. This simulator can take over part of the workload of the supervising radiologists, by providing a means for independent repetitive practice for the resident. The realistic artificial medical images can be varied in terms of their content and their difficulty. This can enable a personalized experience that can enhance training of image interpretation skills and make it more efficient

Object Detection in medical imaging

A thesis submitted in partial fulfillment of the requirements for the degree of Doctor in Information Management, specialization in Information and Decision SystemsArtificial Intelligence, assisted by deep learning, has emerged in various fields of our society. These systems allow the automation and the improvement of several tasks, even surpassing, in some cases, human capability. Object detection methods are used nowadays in several areas, including medical imaging analysis. However, these methods are susceptible to errors, and there is a lack of a universally accepted method that can be applied across all types of applications with the needed precision in the medical field. Additionally, the application of object detectors in medical imaging analysis has yet to be thoroughly analyzed to achieve a richer understanding of the state of the art. To tackle these shortcomings, we present three studies with distinct goals. First, a quantitative and qualitative analysis of academic research was conducted to gather a perception of which object detectors are employed, the modality of medical imaging used, and the particular body parts under investigation. Secondly, we propose an optimized version of a widely used algorithm to overcome limitations commonly addressed in medical imaging by fine-tuning several hyperparameters. Thirdly, we develop a novel stacking approach to augment the precision of detections on medical imaging analysis. The findings show that despite the late arrival of object detection in medical imaging analysis, the number of publications has increased in recent years, demonstrating the significant potential for growth. Additionally, we establish that it is possible to address some constraints on the data through an exhaustive optimization of the algorithm. Finally, our last study highlights that there is still room for improvement in these advanced techniques, using, as an example, stacking approaches. The contributions of this dissertation are several, as it puts forward a deeper overview of the state-of-the-art applications of object detection algorithms in the medical field and presents strategies for addressing typical constraints in this area.A Inteligência Artificial, auxiliada pelo deep learning, tem emergido em diversas áreas da nossa sociedade. Estes sistemas permitem a automatização e a melhoria de diversas tarefas, superando mesmo, em alguns casos, a capacidade humana. Os métodos de detecção de objetos são utilizados atualmente em diversas áreas, inclusive na análise de imagens médicas. No entanto, esses métodos são suscetíveis a erros e falta um método universalmente aceite que possa ser aplicado em todos os tipos de aplicações com a precisão necessária na área médica. Além disso, a aplicação de detectores de objetos na análise de imagens médicas ainda precisa ser analisada minuciosamente para alcançar uma compreensão mais rica do estado da arte. Para enfrentar essas limitações, apresentamos três estudos com objetivos distintos. Inicialmente, uma análise quantitativa e qualitativa da pesquisa acadêmica foi realizada para obter uma percepção de quais detectores de objetos são empregues, a modalidade de imagem médica usada e as partes específicas do corpo sob investigação. Num segundo estudo, propomos uma versão otimizada de um algoritmo amplamente utilizado para superar limitações comumente abordadas em imagens médicas por meio do ajuste fino de vários hiperparâmetros. Em terceiro lugar, desenvolvemos uma nova abordagem de stacking para aumentar a precisão das detecções na análise de imagens médicas. Os resultados demostram que, apesar da chegada tardia da detecção de objetos na análise de imagens médicas, o número de publicações aumentou nos últimos anos, evidenciando o significativo potencial de crescimento. Adicionalmente, estabelecemos que é possível resolver algumas restrições nos dados por meio de uma otimização exaustiva do algoritmo. Finalmente, o nosso último estudo destaca que ainda há espaço para melhorias nessas técnicas avançadas, usando, como exemplo, abordagens de stacking. As contribuições desta dissertação são várias, apresentando uma visão geral em maior detalhe das aplicações de ponta dos algoritmos de detecção de objetos na área médica e apresenta estratégias para lidar com restrições típicas nesta área

From Fully-Supervised, Single-Task to Scarcely-Supervised, Multi-Task Deep Learning for Medical Image Analysis

Image analysis based on machine learning has gained prominence with the advent of deep learning, particularly in medical imaging. To be effective in addressing challenging image analysis tasks, however, conventional deep neural networks require large corpora of annotated training data, which are unfortunately scarce in the medical domain, thus often rendering fully-supervised learning strategies ineffective.This thesis devises for use in a variety of medical image analysis applications a series of novel deep learning methods, ranging from fully-supervised, single-task learning to scarcely-supervised, multi-task learning that makes efficient use of annotated training data. Specifically, its main contributions include (1) fully-supervised, single-task learning for the segmentation of pulmonary lobes from chest CT scans and the analysis of scoliosis from spine X-ray images; (2) supervised, single-task, domain-generalized pulmonary segmentation in chest X-ray images and retinal vasculature segmentation in fundoscopic images; (3) largely-unsupervised, multiple-task learning via deep generative modeling for the joint synthesis and classification of medical image data; and (4) partly-supervised, multiple-task learning for the combined segmentation and classification of chest and spine X-ray images