Supervised cnn strategies for optical image segmentation and classification in interventional medicine

The analysis of interventional images is a topic of high interest for the medical-image analysis community. Such an analysis may provide interventional-medicine professionals with both decision support and context awareness, with the final goal of improving patient safety. The aim of this chapter is to give an overview of some of the most recent approaches (up to 2018) in the field, with a focus on Convolutional Neural Networks (CNNs) for both segmentation and classification tasks. For each approach, summary tables are presented reporting the used dataset, involved anatomical region and achieved performance. Benefits and disadvantages of each approach are highlighted and discussed. Available datasets for algorithm training and testing and commonly used performance metrics are summarized to offer a source of information for researchers that are approaching the field of interventional-image analysis. The advancements in deep learning for medical-image analysis are involving more and more the interventional-medicine field. However, these advancements are undeniably slower than in other fields (e.g. preoperative-image analysis) and considerable work still needs to be done in order to provide clinicians with all possible support during interventional-medicine procedures

Agreement Between Experts and an Untrained Crowd for Identifying Dermoscopic Features Using a Gamified App: Reader Feasibility Study

Background Dermoscopy is commonly used for the evaluation of pigmented lesions, but agreement between experts for identification of dermoscopic structures is known to be relatively poor. Expert labeling of medical data is a bottleneck in the development of machine learning (ML) tools, and crowdsourcing has been demonstrated as a cost- and time-efficient method for the annotation of medical images. Objective The aim of this study is to demonstrate that crowdsourcing can be used to label basic dermoscopic structures from images of pigmented lesions with similar reliability to a group of experts. Methods First, we obtained labels of 248 images of melanocytic lesions with 31 dermoscopic “subfeatures” labeled by 20 dermoscopy experts. These were then collapsed into 6 dermoscopic “superfeatures” based on structural similarity, due to low interrater reliability (IRR): dots, globules, lines, network structures, regression structures, and vessels. These images were then used as the gold standard for the crowd study. The commercial platform DiagnosUs was used to obtain annotations from a nonexpert crowd for the presence or absence of the 6 superfeatures in each of the 248 images. We replicated this methodology with a group of 7 dermatologists to allow direct comparison with the nonexpert crowd. The Cohen κ value was used to measure agreement across raters. Results In total, we obtained 139,731 ratings of the 6 dermoscopic superfeatures from the crowd. There was relatively lower agreement for the identification of dots and globules (the median κ values were 0.526 and 0.395, respectively), whereas network structures and vessels showed the highest agreement (the median κ values were 0.581 and 0.798, respectively). This pattern was also seen among the expert raters, who had median κ values of 0.483 and 0.517 for dots and globules, respectively, and 0.758 and 0.790 for network structures and vessels. The median κ values between nonexperts and thresholded average–expert readers were 0.709 for dots, 0.719 for globules, 0.714 for lines, 0.838 for network structures, 0.818 for regression structures, and 0.728 for vessels. Conclusions This study confirmed that IRR for different dermoscopic features varied among a group of experts; a similar pattern was observed in a nonexpert crowd. There was good or excellent agreement for each of the 6 superfeatures between the crowd and the experts, highlighting the similar reliability of the crowd for labeling dermoscopic images. This confirms the feasibility and dependability of using crowdsourcing as a scalable solution to annotate large sets of dermoscopic images, with several potential clinical and educational applications, including the development of novel, explainable ML tools

Large-scale medical image annotation with quality-controlled crowdsourcing

Accurate annotations of medical images are essential for various clinical applications. The remarkable advances in machine learning, especially deep learning based techniques, show great potential for automatic image segmentation. However, these solutions require a huge amount of accurately annotated reference data for training. Especially in the domain of medical image analysis, the availability of domain experts for reference data generation is becoming a major bottleneck for machine learning applications. In this context, crowdsourcing has gained increasing attention as a tool for low-cost and large-scale data annotation. As a method to outsource cognitive tasks to anonymous non-expert workers over the internet, it has evolved into a valuable tool for data annotation in various research fields. Major challenges in crowdsourcing remain the high variance in the annotation quality as well as the lack of domain specific knowledge of the individual workers. Current state-of-the-art methods for quality control usually induce further costs, as they rely on a redundant distribution of tasks or perform additional annotations on tasks with already known reference outcome. Aim of this thesis is to apply common crowdsourcing techniques for large-scale medical image annotation and create a cost effective quality control method for crowd-sourced image annotation. The problem of large-scale medical image annotation is addressed by introducing a hybrid crowd-algorithm approach that allowed expert-level organ segmentation in CT scans. A pilot study performed on the case of liver segmentation in abdominal CT scans showed that the proposed approach is able to create organ segmentations matching the quality of those create by medical experts. Recording the behavior of individual non-expert online workers during the annotation process in clickstreams enabled the derivation of an annotation quality measure that could successfully be used to merge crowd-sourced segmentations. A comprehensive validation study performed with various object classes from publicly available data sets demonstrated that the presented quality control measure generalizes well over different object classes and clearly outperforms state-of-the-art methods in terms of costs and segmentation quality. In conclusion, the methods introduced in this thesis are an essential contribution to reduce the annotation costs and further improve the quality of crowd-sourced image segmentation