Operationalizing fairness in medical AI adoption: Detection of early Alzheimer’s Disease with 2D CNN

Objectives: To operationalize fairness in the adoption of medical artificial intelligence (AI) algorithms in terms of access to computational resources, the proposed approach is based on a two-dimensional (2D) Convolutional Neural Networks (CNN), which provides a faster, cheaper, and accurate-enough detection of early Alzheimer’s Disease (AD) and Mild Cognitive Impairment (MCI), without the need for use of large training datasets or costly high-performance computing (HPC) infrastructures. Methods: The standardized ADNI datasets are used for the proposed model, with additional skull stripping, using the BET2 approach. The 2D CNN architecture is based on LeNet-5, the LReLU activation function and a Sigmoid function were used, and batch normalization was added after every convolutional layer to stabilize the learning process. The model was optimized by manually tuning all its hyperparameters. Results: The model was evaluated in terms of accuracy, recall, precision, and f1-score. The results demonstrate that the model predicted MCI with an accuracy of .735, passing the random guessing baseline of .521, and predicted AD with an accuracy of .837, passing the random guessing baseline of .536. Discussion: The proposed approach can assist clinicians in the early diagnosis of AD and MCI, with high-enough accuracy, based on relatively smaller datasets, and without the need of HPC infrastructures. Such an approach can alleviate disparities and operationalize fairness in the adoption of medical algorithms. Conclusion: Medical AI algorithms should not be focused solely on accuracy but should also be evaluated with respect to how they might impact disparities and operationalize fairness in their adoption

Early Diagnosis of Mild Cognitive Impairment with 2-Dimensional Convolutional Neural Network Classification of Magnetic Resonance Images

We motivate and implement an Artificial Intelligence (AI) Computer Aided Diagnosis (CAD) framework, to assist clinicians in the early diagnosis of Mild Cognitive Impairment (MCI) and Alzheimer’s Disease (AD). Our framework is based on a Convolutional Neural Network (CNN) trained and tested on functional Magnetic Resonance Images datasets. We contribute to the literature on AI-CAD frameworks for AD by using a 2D CNN for early diagnosis of MCI. Contrary to current efforts, we do not attempt to provide an AI-CAD framework that will replace clinicians, but one that can work in synergy with them. Our framework is cheaper and faster as it relies on small datasets without the need of high-performance computing infrastructures. Our work contributes to the literature on digital transformation of healthcare, health Information Systems, and NeuroIS, while it opens novel avenues for further research on the topic

Towards Practical Application of Deep Learning in Diagnosis of Alzheimer's Disease

Accurate diagnosis of Alzheimer's disease (AD) is both challenging and time consuming. With a systematic approach for early detection and diagnosis of AD, steps can be taken towards the treatment and prevention of the disease. This study explores the practical application of deep learning models for diagnosis of AD. Due to computational complexity, large training times and limited availability of labelled dataset, a 3D full brain CNN (convolutional neural network) is not commonly used, and researchers often prefer 2D CNN variants. In this study, full brain 3D version of well-known 2D CNNs were designed, trained and tested for diagnosis of various stages of AD. Deep learning approach shows good performance in differentiating various stages of AD for more than 1500 full brain volumes. Along with classification, the deep learning model is capable of extracting features which are key in differentiating the various categories. The extracted features align with meaningful anatomical landmarks, that are currently considered important in identification of AD by experts. An ensemble of all the algorithm was also tested and the performance of the ensemble algorithm was superior to any individual algorithm, further improving diagnosis ability. The 3D versions of the trained CNNs and their ensemble have the potential to be incorporated in software packages that can be used by physicians/radiologists to assist them in better diagnosis of AD.Comment: 18 pages, 8 figure

Biomedical Data Classification with Improvised Deep Learning Architectures

With the rise of very powerful hardware and evolution of deep learning architectures, healthcare data analysis and its applications have been drastically transformed. These transformations mainly aim to aid a healthcare personnel with diagnosis and prognosis of a disease or abnormality at any given point of healthcare routine workflow. For instance, many of the cancer metastases detection depends on pathological tissue procedures and pathologist reviews. The reports of severity classification vary amongst different pathologist, which then leads to different treatment options for a patient. This labor-intensive work can lead to errors or mistreatments resulting in high cost of healthcare. With the help of machine learning and deep learning modules, some of these traditional diagnosis techniques can be improved and aid a doctor in decision making with an unbiased view. Some of such modules can help reduce the cost, shortage of an expertise, and time in identifying the disease. However, there are many other datapoints that are available with medical images, such as omics data, biomarker calculations, patient demographics and history. All these datapoints can enhance disease classification or prediction of progression with the help of machine learning/deep learning modules. However, it is very difficult to find a comprehensive dataset with all different modalities and features in healthcare setting due to privacy regulations. Hence in this thesis, we explore both medical imaging data with clinical datapoints as well as genomics datasets separately for classification tasks using combinational deep learning architectures. We use deep neural networks with 3D volumetric structural magnetic resonance images of Alzheimer Disease dataset for classification of disease. A separate study is implemented to understand classification based on clinical datapoints achieved by machine learning algorithms. For bioinformatics applications, sequence classification task is a crucial step for many metagenomics applications, however, requires a lot of preprocessing that requires sequence assembly or sequence alignment before making use of raw whole genome sequencing data, hence time consuming especially in bacterial taxonomy classification. There are only a few approaches for sequence classification tasks that mainly involve some convolutions and deep neural network. A novel method is developed using an intrinsic nature of recurrent neural networks for 16s rRNA sequence classification which can be adapted to utilize read sequences directly. For this classification task, the accuracy is improved using optimization techniques with a hybrid neural network

3D Deep Learning on Medical Images: A Review

The rapid advancements in machine learning, graphics processing technologies and availability of medical imaging data has led to a rapid increase in use of deep learning models in the medical domain. This was exacerbated by the rapid advancements in convolutional neural network (CNN) based architectures, which were adopted by the medical imaging community to assist clinicians in disease diagnosis. Since the grand success of AlexNet in 2012, CNNs have been increasingly used in medical image analysis to improve the efficiency of human clinicians. In recent years, three-dimensional (3D) CNNs have been employed for analysis of medical images. In this paper, we trace the history of how the 3D CNN was developed from its machine learning roots, give a brief mathematical description of 3D CNN and the preprocessing steps required for medical images before feeding them to 3D CNNs. We review the significant research in the field of 3D medical imaging analysis using 3D CNNs (and its variants) in different medical areas such as classification, segmentation, detection, and localization. We conclude by discussing the challenges associated with the use of 3D CNNs in the medical imaging domain (and the use of deep learning models, in general) and possible future trends in the field.Comment: 13 pages, 4 figures, 2 table

Development and characterization of deep learning techniques for neuroimaging data

Deep learning methods are extremely promising machine learning tools to analyze neuroimaging data. However, their potential use in clinical settings is limited because of the existing challenges of applying these methods to neuroimaging data. In this study, first a data leakage type caused by slice-level data split that is introduced during training and validation of a 2D CNN is surveyed and a quantitative assessment of the model’s performance overestimation is presented. Second, an interpretable, leakage-fee deep learning software written in a python language with a wide range of options has been developed to conduct both classification and regression analysis. The software was applied to the study of mild cognitive impairment (MCI) in patients with small vessel disease (SVD) using multi-parametric MRI data where the cognitive performance of 58 patients measured by five neuropsychological tests is predicted using a multi-input CNN model taking brain image and demographic data. Each of the cognitive test scores was predicted using different MRI-derived features. As MCI due to SVD has been hypothesized to be the effect of white matter damage, DTI-derived features MD and FA produced the best prediction outcome of the TMT-A score which is consistent with the existing literature. In a second study, an interpretable deep learning system aimed at 1) classifying Alzheimer disease and healthy subjects 2) examining the neural correlates of the disease that causes a cognitive decline in AD patients using CNN visualization tools and 3) highlighting the potential of interpretability techniques to capture a biased deep learning model is developed. Structural magnetic resonance imaging (MRI) data of 200 subjects was used by the proposed CNN model which was trained using a transfer learning-based approach producing a balanced accuracy of 71.6%. Brain regions in the frontal and parietal lobe showing the cerebral cortex atrophy were highlighted by the visualization tools

Deep learning of brain asymmetry digital biomarkers to support early diagnosis of cognitive decline and dementia

Early identification of degenerative processes in the human brain is essential for proper care and treatment. This may involve different instrumental diagnostic methods, including the most popular computer tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) scans. These technologies provide detailed information about the shape, size, and function of the human brain. Structural and functional cerebral changes can be detected by computational algorithms and used to diagnose dementia and its stages (amnestic early mild cognitive impairment - EMCI, Alzheimer’s Disease - AD). They can help monitor the progress of the disease. Transformation shifts in the degree of asymmetry between the left and right hemispheres illustrate the initialization or development of a pathological process in the brain. In this vein, this study proposes a new digital biomarker for the diagnosis of early dementia based on the detection of image asymmetries and crosssectional comparison of NC (normal cognitively), EMCI and AD subjects. Features of brain asymmetries extracted from MRI of the ADNI and OASIS databases are used to analyze structural brain changes and machine learning classification of the pathology. The experimental part of the study includes results of supervised machine learning algorithms and transfer learning architectures of convolutional neural networks for distinguishing between cognitively normal subjects and patients with early or progressive dementia. The proposed pipeline offers a low-cost imaging biomarker for the classification of dementia. It can be potentially helpful to other brain degenerative disorders accompanied by changes in brain asymmetries

Applications of Machine Learning in Medical Prognosis Using Electronic Medical Records

Approximately 84 % of hospitals are adopting electronic medical records (EMR) In the United States. EMR is a vital resource to help clinicians diagnose the onset or predict the future condition of a specific disease. With machine learning advances, many research projects attempt to extract medically relevant and actionable data from massive EMR databases using machine learning algorithms. However, collecting patients\u27 prognosis factors from Electronic EMR is challenging due to privacy, sensitivity, and confidentiality. In this study, we developed medical generative adversarial networks (GANs) to generate synthetic EMR prognosis factors using minimal information collected during routine care in specialized healthcare facilities. The generated prognosis variables used in developing predictive models for (1) chronic wound healing in patients diagnosed with Venous Leg Ulcers (VLUs) and (2) antibiotic resistance in patients diagnosed with Skin and soft tissue infections (SSTIs). Our proposed medical GANs, EMR-TCWGAN and DermaGAN, can produce both continuous and categorical features from EMR. We utilized conditional training strategies to enhance training and generate classified data regarding healing vs. non-healing in EMR-TCWGAN and susceptibility vs. resistance in DermGAN. The ability of the proposed GAN models to generate realistic EMR data was evaluated by TSTR (test on the synthetic, train on the real), discriminative accuracy, and visualization. We analyzed the synthetic data augmentation technique\u27s practicality in improving the wound healing prognostic model and antibiotic resistance classifier. We achieved the area under the curve (AUC) of 0.875 in the wound healing prognosis model and an average AUC of 0.830 in the antibiotic resistance classifier by using the synthetic samples generated by GANs in the training process. These results suggest that GANs can be considered a data augmentation method to generate realistic EMR data

Machine Learning for Multiclass Classification and Prediction of Alzheimer\u27s Disease

Alzheimer\u27s disease (AD) is an irreversible neurodegenerative disorder and a common form of dementia. This research aims to develop machine learning algorithms that diagnose and predict the progression of AD from multimodal heterogonous biomarkers with a focus placed on the early diagnosis. To meet this goal, several machine learning-based methods with their unique characteristics for feature extraction and automated classification, prediction, and visualization have been developed to discern subtle progression trends and predict the trajectory of disease progression. The methodology envisioned aims to enhance both the multiclass classification accuracy and prediction outcomes by effectively modeling the interplay between the multimodal biomarkers, handle the missing data challenge, and adequately extract all the relevant features that will be fed into the machine learning framework, all in order to understand the subtle changes that happen in the different stages of the disease. This research will also investigate the notion of multitasking to discover how the two processes of multiclass classification and prediction relate to one another in terms of the features they share and whether they could learn from one another for optimizing multiclass classification and prediction accuracy. This research work also delves into predicting cognitive scores of specific tests over time, using multimodal longitudinal data. The intent is to augment our prospects for analyzing the interplay between the different multimodal features used in the input space to the predicted cognitive scores. Moreover, the power of modality fusion, kernelization, and tensorization have also been investigated to efficiently extract important features hidden in the lower-dimensional feature space without being distracted by those deemed as irrelevant. With the adage that a picture is worth a thousand words, this dissertation introduces a unique color-coded visualization system with a fully integrated machine learning model for the enhanced diagnosis and prognosis of Alzheimer\u27s disease. The incentive here is to show that through visualization, the challenges imposed by both the variability and interrelatedness of the multimodal features could be overcome. Ultimately, this form of visualization via machine learning informs on the challenges faced with multiclass classification and adds insight into the decision-making process for a diagnosis and prognosis