198 research outputs found
Deep learning for unsupervised domain adaptation in medical imaging: Recent advancements and future perspectives
Deep learning has demonstrated remarkable performance across various tasks in
medical imaging. However, these approaches primarily focus on supervised
learning, assuming that the training and testing data are drawn from the same
distribution. Unfortunately, this assumption may not always hold true in
practice. To address these issues, unsupervised domain adaptation (UDA)
techniques have been developed to transfer knowledge from a labeled domain to a
related but unlabeled domain. In recent years, significant advancements have
been made in UDA, resulting in a wide range of methodologies, including feature
alignment, image translation, self-supervision, and disentangled representation
methods, among others. In this paper, we provide a comprehensive literature
review of recent deep UDA approaches in medical imaging from a technical
perspective. Specifically, we categorize current UDA research in medical
imaging into six groups and further divide them into finer subcategories based
on the different tasks they perform. We also discuss the respective datasets
used in the studies to assess the divergence between the different domains.
Finally, we discuss emerging areas and provide insights and discussions on
future research directions to conclude this survey.Comment: Under Revie
Artificial intelligence and automation in endoscopy and surgery
Modern endoscopy relies on digital technology, from high-resolution imaging sensors and displays to electronics connecting configurable illumination and actuation systems for robotic articulation. In addition to enabling more effective diagnostic and therapeutic interventions, the digitization of the procedural toolset enables video data capture of the internal human anatomy at unprecedented levels. Interventional video data encapsulate functional and structural information about a patient’s anatomy as well as events, activity and action logs about the surgical process. This detailed but difficult-to-interpret record from endoscopic procedures can be linked to preoperative and postoperative records or patient imaging information. Rapid advances in artificial intelligence, especially in supervised deep learning, can utilize data from endoscopic procedures to develop systems for assisting procedures leading to computer-assisted interventions that can enable better navigation during procedures, automation of image interpretation and robotically assisted tool manipulation. In this Perspective, we summarize state-of-the-art artificial intelligence for computer-assisted interventions in gastroenterology and surgery
Advanced endoscopic techniques and optical diagnosis in the lower gastrointestinal tract
Inflammatory bowel disease describes debilitating chronic diseases (Ulcerative colitis and Crohn’s Disease) of the gastrointestinal tract that requires many patients to take long term medications, have an increased risk of malignancy and can often lead to major abdominal surgery. With the advent of modern therapies, in particular biological therapies, clinicians and patients can increasingly achieve mucosal healing. Mucosal healing is associated with favourable outcomes such as reduced hospitalisation, colectomy and fewer courses of steroids. However, the definition of mucosal healing was based on endoscopic scoring systems developed in a previous generation of endoscopic technology. Novel endoscopic technology, such as Virtual Electronic Chromoendoscopy, can gain more accurate assessments of inflammatory activity, closing the gap to histological activity. The term optical diagnosis refers to the ability of an endoscopist to accurately predict the histology of an endoscopic finding, albeit in predicting inflammatory activity in inflammatory bowel disease or in predicting the histology of a colorectal polyp. With ever improving endoscopic technology successful optical diagnosis is increasingly possible.
The PICaSSO score is a score that was developed using Virtual Electronic Chromoendoscopy and is the first to define endoscopic features in keeping with mucosal healing. This thesis includes a large multicentre international prospective study which investigates the correlation of the PICaSSO score and other established endoscopic scores (MES and UCEIS) against multiple histological indices (RHI, NHI, ECAP, Geboes, and Villanacci) and prospectively assessed outcomes at 6 and 12 months. There was strong correlation between PICaSSO and histology scores, significantly superior to correlation coefficients of MES and UCEIS with histology scores. A PICaSSO score of ≤3 detected histologic remission by RHI with AUROC 0.90 (95% CI 0.86-0.94). PICaSSO score ≤3 predicted better outcomes than PICaSSO >3.
The next study moves from optical characterisation to molecular characterisation of inflammatory activity using Raman Spectroscopy. Raman Spectroscopy (RS) describes the scattering of inelastic light giving spectra that are highly specific for individual molecules. This study aimed to establish spectral changes before and after treatment and whether Raman Spectroscopy can accurately differentiate between inflammation and MH. Reductions in intensity at 1003cm-1 and 1252cm-1 when a reduction in inflammation was seen post-treatment and when MH was present. MH was associated with an increase in intensity at 1304cm-1. A trained neural network differentiated MH from active inflammation with high sensitivity, specificity, PPV, NPV and accuracy in UC and CD. Raman Spectroscopy may represent an additional tool in the assessment of mucosal healing in IBD.
To implement optical diagnosis in practice there needs to be robust training. The next study presents a randomised controlled study comparing the performance of self-training vs. didactic training on the diagnostic accuracy of diminutive/small colonic polyp histological prediction by trainees using established polyp classification tools. The study showed self-learning can achieve results similar to didactic training which, could enable widespread implementation of optical diagnosis in clinical practice. Following this study, I present a meta-analysis and systematic review of optical diagnosis training in small/diminutive colorectal polyps. Optical diagnosis training is effective in improving accuracy of histology prediction in colorectal polyps and didactic and computer-based training show comparable effectiveness in improving diagnostic accuracy. The final study presented is implementing optical diagnosis training and setting quality standards in IBD surveillance endoscopy. A significant improvement in quality was seen in the proportion of procedures using dye-based chromoendoscopy, use of polyp classification tools and an increase lesion detection
Deep Learning-based Solutions to Improve Diagnosis in Wireless Capsule Endoscopy
[eng] Deep Learning (DL) models have gained extensive attention due to their remarkable performance in a wide range of real-world applications, particularly in computer vision. This achievement, combined with the increase in available medical records, has made it possible to open up new opportunities for analyzing and interpreting healthcare data. This symbiotic relationship can enhance the diagnostic process by identifying abnormalities, patterns, and trends, resulting in more precise, personalized, and effective healthcare for patients.
Wireless Capsule Endoscopy (WCE) is a non-invasive medical imaging technique used to visualize the entire Gastrointestinal (GI) tract. Up to this moment, physicians meticulously review the captured frames to identify pathologies and diagnose patients. This manual process is time- consuming and prone to errors due to the challenges of interpreting the complex nature of WCE procedures. Thus, it demands a high level of attention, expertise, and experience. To overcome these drawbacks, shorten the screening process, and improve the diagnosis, efficient and accurate DL methods are required.
This thesis proposes DL solutions to the following problems encountered in the analysis of WCE studies: pathology detection, anatomical landmark identification, and Out-of-Distribution (OOD) sample handling. These solutions aim to achieve robust systems that minimize the duration of the video analysis and reduce the number of undetected lesions.
Throughout their development, several DL drawbacks have appeared, including small and imbalanced datasets. These limitations have also been addressed, ensuring that they do not hinder the generalization of neural networks, leading to suboptimal performance and overfitting.
To address the previous WCE problems and overcome the DL challenges, the proposed systems adopt various strategies that utilize the power advantage of Triplet Loss (TL) and Self-Supervised Learning (SSL) techniques. Mainly, TL has been used to improve the generalization of the models, while SSL methods have been employed to leverage the unlabeled data to obtain useful representations. The presented methods achieve State-of-the-art results in the aforementioned medical problems and contribute to the ongoing research to improve the diagnostic of WCE studies.[cat] Els models d’aprenentatge profund (AP) han acaparat molta atenció a causa del seu rendiment en una à mplia gamma d'aplicacions del món real, especialment en visió per ordinador. Aquest fet, combinat amb l'increment de registres mèdics disponibles, ha permès obrir noves oportunitats per analitzar i interpretar les dades sanità ries. Aquesta relació simbiòtica pot millorar el procés de diagnòstic identificant anomalies, patrons i tendències, amb la conseqüent obtenció de diagnòstics sanitaris més precisos, personalitzats i eficients per als pacients.
La Capsula endoscòpica (WCE) és una tècnica d'imatge mèdica no invasiva utilitzada per visualitzar tot el tracte gastrointestinal (GI). Fins ara, els metges revisen minuciosament els fotogrames capturats per identificar patologies i diagnosticar pacients. Aquest procés manual requereix temps i és propens a errors. Per tant, exigeix un alt nivell d'atenció, experiència i especialització. Per superar aquests inconvenients, reduir la durada del procés de detecció i millorar el diagnòstic, es requereixen mètodes eficients i precisos d’AP.
Aquesta tesi proposa solucions que utilitzen AP per als següents problemes trobats en l'anà lisi dels estudis de WCE: detecció de patologies, identificació de punts de referència anatòmics i gestió de mostres que pertanyen fora del domini. Aquestes solucions tenen com a objectiu aconseguir sistemes robustos que minimitzin la durada de l'anà lisi del vÃdeo i redueixin el nombre de lesions no detectades. Durant el seu desenvolupament, han sorgit diversos inconvenients relacionats amb l’AP, com ara conjunts de dades petits i desequilibrats. Aquestes limitacions també s'han abordat per assegurar que no obstaculitzin la generalització de les xarxes neuronals, evitant un rendiment subòptim.
Per abordar els problemes anteriors de WCE i superar els reptes d’AP, els sistemes proposats adopten diverses estratègies que aprofiten l'avantatge de la Triplet Loss (TL) i les tècniques d’auto-aprenentatge. Principalment, s'ha utilitzat TL per millorar la generalització dels models, mentre que els mètodes d’autoaprenentatge s'han emprat per aprofitar les dades sense etiquetar i obtenir representacions útils. Els mètodes presentats aconsegueixen bons resultats en els problemes mèdics esmentats i contribueixen a la investigació en curs per millorar el diagnòstic dels estudis de WCE
Uncertainty, interpretability and dataset limitations in Deep Learning
[eng] Deep Learning (DL) has gained traction in the last years thanks to the exponential increase in compute power. New techniques and methods are published at a daily basis, and records are being set across multiple disciplines. Undeniably, DL has brought a revolution to the machine learning field and to our lives. However, not everything has been resolved and some considerations must be taken into account.
For instance, obtaining uncertainty measures and bounds is still an open problem. Models should be able to capture and express the confidence they have in their decisions, and Artificial Neural Networks (ANN) are known to lack in this regard. Be it through out of distribution samples, adversarial attacks, or simply unrelated or nonsensical inputs, ANN models demonstrate an unfounded and incorrect tendency to still output high probabilities. Likewise, interpretability remains an unresolved question. Some fields not only need but rely on being able to provide human interpretations of the thought process of models. ANNs, and specially deep models trained with DL, are hard to reason about. Last but not least, there is a tendency that indicates that models are getting deeper and more complex. At the same time, to cope with the increasing number of parameters, datasets are required to be of higher quality and, usually, larger. Not all research, and even less real world applications, can keep with the increasing demands.
Therefore, taking into account the previous issues, the main aim of this thesis is to provide methods and frameworks to tackle each of them. These approaches should be applicable to any suitable field and dataset, and are employed with real world datasets as proof of concept.
First, we propose a method that provides interpretability with respect to the results through uncertainty measures. The model in question is capable of reasoning about the uncertainty inherent in data and leverages that information to progressively refine its outputs. In particular, the method is applied to land cover segmentation, a classification task that aims to assign a type of land to each pixel in satellite images. The dataset and application serve to prove that the final uncertainty bound enables the end-user to reason about the possible errors in the segmentation result.
Second, Recurrent Neural Networks are used as a method to create robust models towards lacking datasets, both in terms of size and class balance. We apply them to two different fields, road extraction in satellite images and Wireless Capsule Endoscopy (WCE). The former demonstrates that contextual information in the temporal axis of data can be used to create models that achieve
comparable results to state-of-the-art while being less complex. The latter, in turn, proves that contextual information for polyp detection can be crucial to obtain models that generalize better and obtain higher performance.
Last, we propose two methods to leverage unlabeled data in the model creation process. Often datasets are easier to obtain than to label, which results in many wasted opportunities with traditional classification approaches. Our approaches based on self-supervised learning result in a novel contrastive loss that is capable of extracting meaningful information out of pseudo-labeled data. Applying both methods to WCE data proves that the extracted inherent knowledge creates models that perform better in extremely unbalanced datasets and with lack of data.
To summarize, this thesis demonstrates potential solutions to obtain uncertainty bounds, provide reasonable explanations of the outputs, and to combat lack of data or unbalanced datasets. Overall, the presented methods have a positive impact on the DL field and could have a real and tangible effect for the society.[cat] És innegable que el Deep Learning ha causat una revolució en molts aspectes no solament de l’aprenentatge automà tic però també de les nostres vides dià ries. Tot i aixÃ, encara queden aspectes a millorar. Les xarxes neuronals tenen problemes per estimar la seva confiança en les prediccions, i sovint reporten probabilitats altes en casos que no tenen relació amb el model o que directament no tenen sentit. De la mateixa forma, interpretar els resultats d’un model profund i complex resulta una tasca extremadament complicada. Aquests mateixos models, cada cop amb més parà metres i més potents, requereixen també de dades més ben etiquetades i més completes.
Tenint en compte aquestes limitacions, l’objectiu principal és el de buscar mètodes i algoritmes per trobar-ne solució. Primerament, es proposa la creació d’un mètode capaç d’obtenir incertesa en imatges satèl·lit i d’utilitzar-la per crear models més robustos i resultats interpretables. En segon lloc, s’utilitzen Recurrent Neural Networks (RNN) per combatre la falta de dades mitjançant l’obtenció d’informació contextual de dades temporals. Aquestes s’apliquen per l’extracció de carreteres d’imatges satèl·lit i per la classificació de pòlips en imatges obtingudes amb Wireless Capsule Endoscopy (WCE). Finalment, es plantegen dos mètodes per tractar amb la falta de dades etiquetades i desbalancejos en les classes amb l’ús de Self-supervised Learning (SSL). Seqüències no etiquetades d’imatges d’intestins s’incorporen en el models en una fase prèvia a la classificació tradicional.
Aquesta tesi demostra que les solucions proposades per obtenir mesures d’incertesa són efectives per donar explicacions raonables i interpretables sobre els resultats. Igualment, es prova que el context en dades de carà cter temporal, obtingut amb RNNs, serveix per obtenir models més simples que poden arribar a solucionar els problemes derivats de la falta de dades. Per últim, es mostra que SSL serveix per combatre de forma efectiva els problemes de generalització degut a dades no balancejades en diversos dominis de WCE.
Concloem que aquesta tesi presenta mètodes amb un impacte real en diversos aspectes de DL a la vegada que demostra la capacitat de tenir un impacte positiu en la societat
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 suscetÃveis 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 especÃficas 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 possÃvel 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 tÃpicas nesta área
Low value care in surgery
Background
Value has been defined as the ratio of quality outcomes to cost. Perfect value would represent infinitely beneficial outcomes associated with minimal costs. Of interest to the present study are interventions where outcomes are minimal, and costs may be high as they may provide an opportunity for disinvestment, improving the overall value of care whilst providing efficiency gains.
Methods
A Scoping Narrative Review was performed in order to understand incumbent approaches towards dealing with low value care. International lessons from different processes were identified and encompassed into a conceptual logic orientated framework for de-adoption. To identify low value care in surgery a Systematic review of peer reviewed high-level literature was performed to identify candidate interventions for de-adoption. Subsequently a granular assessment of the behaviour of passive de-adoption was performed through a retrospective longitudinal observational study based upon administrative hospital data.
Results
A comprehensive conceptual model that takes an integrated approach to de-adoption was assembled from lessons learnt when dealing with low value care previously. It identified three stages in the de-adoption cycle which are necessary for success: identification, implementation and re-evaluation. Each process should be performed at multiple planes: national (macro), local (meso) and provider / patient (micro) levels in order to have a holistic effect. The identification of low value interventions may be from exploring peer reviewed literature, as demonstrated from the systematic review or exploring geographical variation of care. Said review identified 71 low value procedures, of which 5 interventions which carried the highest economic burden were postulated to cost the health system £135 million per annum. Subsequent granular review identified that passive levers have not resulted in de-adoption of a surgical low value interventions – e.g. delayed cholecystectomy. This is due to the presence of exnovator providers whom are concurrently de-adopting innovative interventions as other providers are adopting them.
Conclusions
Low value care represents a significant burden in the current health service. This thesis has evaluated its incidence and economic burden in general surgery. Service transformation is necessary and may be achieved through the holistic integrated approach recommended here. Policy makers have already sought this novel information and encompassed it into national policy, with the objective of achieving higher value care through effective de-adoption.Open Acces
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