Intraoperative margin assessment of human breast tissue in optical coherence tomography images using deep neural networks

Objective: In this work, we perform margin assessment of human breast tissue from optical coherence tomography (OCT) images using deep neural networks (DNNs). This work simulates an intraoperative setting for breast cancer lumpectomy. Methods: To train the DNNs, we use both the state-of-the-art methods (Weight Decay and DropOut) and a newly introduced regularization method based on function norms. Commonly used methods can fail when only a small database is available. The use of a function norm introduces a direct control over the complexity of the function with the aim of diminishing the risk of overfitting. Results: As neither the code nor the data of previous results are publicly available, the obtained results are compared with reported results in the literature for a conservative comparison. Moreover, our method is applied to locally collected data on several data configurations. The reported results are the average over the different trials. Conclusion: The experimental results show that the use of DNNs yields significantly better results than other techniques when evaluated in terms of sensitivity, specificity, F1 score, G-mean and Matthews correlation coefficient. Function norm regularization yielded higher and more robust results than competing methods. Significance: We have demonstrated a system that shows high promise for (partially) automated margin assessment of human breast tissue, Equal error rate (EER) is reduced from approximately 12\% (the lowest reported in the literature) to 5\%\,--\,a 58\% reduction. The method is computationally feasible for intraoperative application (less than 2 seconds per image).Comment: 16 pages, 9 figure

An automated system for lung nodule detection in low-dose computed tomography

A computer-aided detection (CAD) system for the identification of pulmonary nodules in low-dose multi-detector helical Computed Tomography (CT) images was developed in the framework of the MAGIC-5 Italian project. One of the main goals of this project is to build a distributed database of lung CT scans in order to enable automated image analysis through a data and cpu GRID infrastructure. The basic modules of our lung-CAD system, a dot-enhancement filter for nodule candidate selection and a neural classifier for false-positive finding reduction, are described. The system was designed and tested for both internal and sub-pleural nodules. The results obtained on the collected database of low-dose thin-slice CT scans are shown in terms of free response receiver operating characteristic (FROC) curves and discussed.Comment: 9 pages, 9 figures; Proceedings of the SPIE Medical Imaging Conference, 17-22 February 2007, San Diego, California, USA, Vol. 6514, 65143

Segmentation of the Proximal Femur from MR Images using Deep Convolutional Neural Networks

Magnetic resonance imaging (MRI) has been proposed as a complimentary method to measure bone quality and assess fracture risk. However, manual segmentation of MR images of bone is time-consuming, limiting the use of MRI measurements in the clinical practice. The purpose of this paper is to present an automatic proximal femur segmentation method that is based on deep convolutional neural networks (CNNs). This study had institutional review board approval and written informed consent was obtained from all subjects. A dataset of volumetric structural MR images of the proximal femur from 86 subject were manually-segmented by an expert. We performed experiments by training two different CNN architectures with multiple number of initial feature maps and layers, and tested their segmentation performance against the gold standard of manual segmentations using four-fold cross-validation. Automatic segmentation of the proximal femur achieved a high dice similarity score of 0.94$\pm$0.05 with precision = 0.95$\pm$0.02, and recall = 0.94$\pm$0.08 using a CNN architecture based on 3D convolution exceeding the performance of 2D CNNs. The high segmentation accuracy provided by CNNs has the potential to help bring the use of structural MRI measurements of bone quality into clinical practice for management of osteoporosis.Comment: This is a pre-print of an article published in Scientific Reports. The final authenticated version is available online at: https://doi.org/10.1038/s41598-018-34817-

Fast Enhanced CT Metal Artifact Reduction using Data Domain Deep Learning

Filtered back projection (FBP) is the most widely used method for image reconstruction in X-ray computed tomography (CT) scanners. The presence of hyper-dense materials in a scene, such as metals, can strongly attenuate X-rays, producing severe streaking artifacts in the reconstruction. These metal artifacts can greatly limit subsequent object delineation and information extraction from the images, restricting their diagnostic value. This problem is particularly acute in the security domain, where there is great heterogeneity in the objects that can appear in a scene, highly accurate decisions must be made quickly. The standard practical approaches to reducing metal artifacts in CT imagery are either simplistic non-adaptive interpolation-based projection data completion methods or direct image post-processing methods. These standard approaches have had limited success. Motivated primarily by security applications, we present a new deep-learning-based metal artifact reduction (MAR) approach that tackles the problem in the projection data domain. We treat the projection data corresponding to metal objects as missing data and train an adversarial deep network to complete the missing data in the projection domain. The subsequent complete projection data is then used with FBP to reconstruct image intended to be free of artifacts. This new approach results in an end-to-end MAR algorithm that is computationally efficient so practical and fits well into existing CT workflows allowing easy adoption in existing scanners. Training deep networks can be challenging, and another contribution of our work is to demonstrate that training data generated using an accurate X-ray simulation can be used to successfully train the deep network when combined with transfer learning using limited real data sets. We demonstrate the effectiveness and potential of our algorithm on simulated and real examples.Comment: Accepted for publication in IEEE Transactions on Computational Imagin

Convolutional Sparse Coding for Compressed Sensing CT Reconstruction

Over the past few years, dictionary learning (DL)-based methods have been successfully used in various image reconstruction problems. However, traditional DL-based computed tomography (CT) reconstruction methods are patch-based and ignore the consistency of pixels in overlapped patches. In addition, the features learned by these methods always contain shifted versions of the same features. In recent years, convolutional sparse coding (CSC) has been developed to address these problems. In this paper, inspired by several successful applications of CSC in the field of signal processing, we explore the potential of CSC in sparse-view CT reconstruction. By directly working on the whole image, without the necessity of dividing the image into overlapped patches in DL-based methods, the proposed methods can maintain more details and avoid artifacts caused by patch aggregation. With predetermined filters, an alternating scheme is developed to optimize the objective function. Extensive experiments with simulated and real CT data were performed to validate the effectiveness of the proposed methods. Qualitative and quantitative results demonstrate that the proposed methods achieve better performance than several existing state-of-the-art methods.Comment: Accepted by IEEE TM

Evaluation of Transfer Learning for Classification of: (1) Diabetic Retinopathy by Digital Fundus Photography and (2) Diabetic Macular Edema, Choroidal Neovascularization and Drusen by Optical Coherence Tomography

Deep learning has been successfully applied to a variety of image classification tasks. There has been keen interest to apply deep learning in the medical domain, particularly specialties that heavily utilize imaging, such as ophthalmology. One issue that may hinder application of deep learning to the medical domain is the vast amount of data necessary to train deep neural networks (DNNs). Because of regulatory and privacy issues associated with medicine, and the generally proprietary nature of data in medical domains, obtaining large datasets to train DNNs is a challenge, particularly in the ophthalmology domain. Transfer learning is a technique developed to address the issue of applying DNNs for domains with limited data. Prior reports on transfer learning have examined custom networks to fully train or used a particular DNN for transfer learning. However, to the best of my knowledge, no work has systematically examined a suite of DNNs for transfer learning for classification of diabetic retinopathy, diabetic macular edema, and two key features of age-related macular degeneration. This work attempts to investigate transfer learning for classification of these ophthalmic conditions. Part I gives a condensed overview of neural networks and the DNNs under evaluation. Part II gives the reader the necessary background concerning diabetic retinopathy and prior work on classification using retinal fundus photographs. The methodology and results of transfer learning for diabetic retinopathy classification are presented, showing that transfer learning towards this domain is feasible, with promising accuracy. Part III gives an overview of diabetic macular edema, choroidal neovascularization and drusen (features associated with age-related macular degeneration), and presents results for transfer learning evaluation using optical coherence tomography to classify these entities

Deep Learning in Cardiology

The medical field is creating large amount of data that physicians are unable to decipher and use efficiently. Moreover, rule-based expert systems are inefficient in solving complicated medical tasks or for creating insights using big data. Deep learning has emerged as a more accurate and effective technology in a wide range of medical problems such as diagnosis, prediction and intervention. Deep learning is a representation learning method that consists of layers that transform the data non-linearly, thus, revealing hierarchical relationships and structures. In this review we survey deep learning application papers that use structured data, signal and imaging modalities from cardiology. We discuss the advantages and limitations of applying deep learning in cardiology that also apply in medicine in general, while proposing certain directions as the most viable for clinical use.Comment: 27 pages, 2 figures, 10 table

Deep learning to achieve clinically applicable segmentation of head and neck anatomy for radiotherapy

Over half a million individuals are diagnosed with head and neck cancer each year worldwide. Radiotherapy is an important curative treatment for this disease, but it requires manual time consuming delineation of radio-sensitive organs at risk (OARs). This planning process can delay treatment, while also introducing inter-operator variability with resulting downstream radiation dose differences. While auto-segmentation algorithms offer a potentially time-saving solution, the challenges in defining, quantifying and achieving expert performance remain. Adopting a deep learning approach, we demonstrate a 3D U-Net architecture that achieves expert-level performance in delineating 21 distinct head and neck OARs commonly segmented in clinical practice. The model was trained on a dataset of 663 deidentified computed tomography (CT) scans acquired in routine clinical practice and with both segmentations taken from clinical practice and segmentations created by experienced radiographers as part of this research, all in accordance with consensus OAR definitions. We demonstrate the model's clinical applicability by assessing its performance on a test set of 21 CT scans from clinical practice, each with the 21 OARs segmented by two independent experts. We also introduce surface Dice similarity coefficient (surface DSC), a new metric for the comparison of organ delineation, to quantify deviation between OAR surface contours rather than volumes, better reflecting the clinical task of correcting errors in the automated organ segmentations. The model's generalisability is then demonstrated on two distinct open source datasets, reflecting different centres and countries to model training. With appropriate validation studies and regulatory approvals, this system could improve the efficiency, consistency, and safety of radiotherapy pathways

Accuracy of automated 3D cephalometric landmarks by deep learning algorithms: systematic review and meta-analysis

Objectives The aim of the present systematic review and meta-analysis is to assess the accuracy of automated landmarking using deep learning in comparison with manual tracing for cephalometric analysis of 3D medical images. Methods PubMed/Medline, IEEE Xplore, Scopus and ArXiv electronic databases were searched. Selection criteria were: ex vivo and in vivo volumetric data images suitable for 3D landmarking (Problem), a minimum of five automated landmarking performed by deep learning method (Intervention), manual landmarking (Comparison), and mean accuracy, in mm, between manual and automated landmarking (Outcome). QUADAS-2 was adapted for quality analysis. Meta-analysis was performed on studies that reported as outcome mean values and standard deviation of the difference (error) between manual and automated landmarking. Linear regression plots were used to analyze correlations between mean accuracy and year of publication. Results The initial electronic screening yielded 252 papers published between 2020 and 2022. A total of 15 studies were included for the qualitative synthesis, whereas 11 studies were used for the meta-analysis. Overall random effect model revealed a mean value of 2.44 mm, with a high heterogeneity (I-2 = 98.13%, tau(2) = 1.018, p-value < 0.001); risk of bias was high due to the presence of issues for several domains per study. Meta-regression indicated a significant relation between mean error and year of publication (p value = 0.012). Conclusion Deep learning algorithms showed an excellent accuracy for automated 3D cephalometric landmarking. In the last two years promising algorithms have been developed and improvements in landmarks annotation accuracy have been done