Automatic Segmentation of Brachial Artery based on Fuzzy C-Means Pixel Clustering from Ultrasound Images

Automatic extraction of brachial artery and measuring associated indices such as flow-mediated dilatation and Intima-media thickness are important for early detection of cardiovascular disease and other vascular endothelial malfunctions. In this paper, we propose the basic but important component of such decision-assisting medical software development – noise tolerant fully automatic segmentation of brachial artery from ultrasound images. Pixel clustering with Fuzzy C-Means algorithm in the quantization process is the key component of that segmentation with various image processing algorithms involved. This algorithm could be an alternative choice of segmentation process that can replace speckle noise-suffering edge detection procedures in this application domain

Automatic analysis and classification of cardiac acoustic signals for long term monitoring

Objective: Cardiovascular diseases are the leading cause of death worldwide resulting in over 17.9 million deaths each year. Most of these diseases are preventable and treatable, but their progression and outcomes are significantly more positive with early-stage diagnosis and proper disease management. Among the approaches available to assist with the task of early-stage diagnosis and management of cardiac conditions, automatic analysis of auscultatory recordings is one of the most promising ones, since it could be particularly suitable for ambulatory/wearable monitoring. Thus, proper investigation of abnormalities present in cardiac acoustic signals can provide vital clinical information to assist long term monitoring. Cardiac acoustic signals, however, are very susceptible to noise and artifacts, and their characteristics vary largely with the recording conditions which makes the analysis challenging. Additionally, there are challenges in the steps used for automatic analysis and classification of cardiac acoustic signals. Broadly, these steps are the segmentation, feature extraction and subsequent classification of recorded signals using selected features. This thesis presents approaches using novel features with the aim to assist the automatic early-stage detection of cardiovascular diseases with improved performance, using cardiac acoustic signals collected in real-world conditions. Methods: Cardiac auscultatory recordings were studied to identify potential features to help in the classification of recordings from subjects with and without cardiac diseases. The diseases considered in this study for the identification of the symptoms and characteristics are the valvular heart diseases due to stenosis and regurgitation, atrial fibrillation, and splitting of fundamental heart sounds leading to additional lub/dub sounds in the systole or diastole interval of a cardiac cycle. The localisation of cardiac sounds of interest was performed using an adaptive wavelet-based filtering in combination with the Shannon energy envelope and prior information of fundamental heart sounds. This is a prerequisite step for the feature extraction and subsequent classification of recordings, leading to a more precise diagnosis. Localised segments of S1 and S2 sounds, and artifacts, were used to extract a set of perceptual and statistical features using wavelet transform, homomorphic filtering, Hilbert transform and mel-scale filtering, which were then fed to train an ensemble classifier to interpret S1 and S2 sounds. Once sound peaks of interest were identified, features extracted from these peaks, together with the features used for the identification of S1 and S2 sounds, were used to develop an algorithm to classify recorded signals. Overall, 99 features were extracted and statistically analysed using neighborhood component analysis (NCA) to identify the features which showed the greatest ability in classifying recordings. Selected features were then fed to train an ensemble classifier to classify abnormal recordings, and hyperparameters were optimized to evaluate the performance of the trained classifier. Thus, a machine learning-based approach for the automatic identification and classification of S1 and S2, and normal and abnormal recordings, in real-world noisy recordings using a novel feature set is presented. The validity of the proposed algorithm was tested using acoustic signals recorded in real-world, non-controlled environments at four auscultation sites (aortic valve, tricuspid valve, mitral valve, and pulmonary valve), from the subjects with and without cardiac diseases; together with recordings from the three large public databases. The performance metrics of the methodology in relation to classification accuracy (CA), sensitivity (SE), precision (P+), and F1 score, were evaluated. Results: This thesis proposes four different algorithms to automatically classify fundamental heart sounds – S1 and S2; normal fundamental sounds and abnormal additional lub/dub sounds recordings; normal and abnormal recordings; and recordings with heart valve disorders, namely the mitral stenosis (MS), mitral regurgitation (MR), mitral valve prolapse (MVP), aortic stenosis (AS) and murmurs, using cardiac acoustic signals. The results obtained from these algorithms were as follows: • The algorithm to classify S1 and S2 sounds achieved an average SE of 91.59% and 89.78%, and F1 score of 90.65% and 89.42%, in classifying S1 and S2, respectively. 87 features were extracted and statistically studied to identify the top 14 features which showed the best capabilities in classifying S1 and S2, and artifacts. The analysis showed that the most relevant features were those extracted using Maximum Overlap Discrete Wavelet Transform (MODWT) and Hilbert transform. • The algorithm to classify normal fundamental heart sounds and abnormal additional lub/dub sounds in the systole or diastole intervals of a cardiac cycle, achieved an average SE of 89.15%, P+ of 89.71%, F1 of 89.41%, and CA of 95.11% using the test dataset from the PASCAL database. The top 10 features that achieved the highest weights in classifying these recordings were also identified. • Normal and abnormal classification of recordings using the proposed algorithm achieved a mean CA of 94.172%, and SE of 92.38%, in classifying recordings from the different databases. Among the top 10 acoustic features identified, the deterministic energy of the sound peaks of interest and the instantaneous frequency extracted using the Hilbert Huang-transform, achieved the highest weights. • The machine learning-based approach proposed to classify recordings of heart valve disorders (AS, MS, MR, and MVP) achieved an average CA of 98.26% and SE of 95.83%. 99 acoustic features were extracted and their abilities to differentiate these abnormalities were examined using weights obtained from the neighborhood component analysis (NCA). The top 10 features which showed the greatest abilities in classifying these abnormalities using recordings from the different databases were also identified. The achieved results demonstrate the ability of the algorithms to automatically identify and classify cardiac sounds. This work provides the basis for measurements of many useful clinical attributes of cardiac acoustic signals and can potentially help in monitoring the overall cardiac health for longer duration. The work presented in this thesis is the first-of-its-kind to validate the results using both, normal and pathological cardiac acoustic signals, recorded for a long continuous duration of 5 minutes at four different auscultation sites in non-controlled real-world conditions.Open Acces

An open access database for the evaluation of heart sound algorithms

This is an author-created, un-copyedited version of an article published in Physiological Measurement. IOP Publishing Ltd is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at https://doi.org/10.1088/0967-3334/37/12/2181In the past few decades, analysis of heart sound signals (i.e. the phonocardiogram or PCG), especially for automated heart sound segmentation and classification, has been widely studied and has been reported to have the potential value to detect pathology accurately in clinical applications. However, comparative analyses of algorithms in the literature have been hindered by the lack of high-quality, rigorously validated, and standardized open databases of heart sound recordings. This paper describes a public heart sound database, assembled for an international competition, the PhysioNet/Computing in Cardiology (CinC) Challenge 2016. The archive comprises nine different heart sound databases sourced from multiple research groups around the world. It includes 2435 heart sound recordings in total collected from 1297 healthy subjects and patients with a variety of conditions, including heart valve disease and coronary artery disease. The recordings were collected from a variety of clinical or nonclinical (such as in-home visits) environments and equipment. The length of recording varied from several seconds to several minutes. This article reports detailed information about the subjects/patients including demographics (number, age, gender), recordings (number, location, state and time length), associated synchronously recorded signals, sampling frequency and sensor type used. We also provide a brief summary of the commonly used heart sound segmentation and classification methods, including open source code provided concurrently for the Challenge. A description of the PhysioNet/CinC Challenge 2016, including the main aims, the training and test sets, the hand corrected annotations for different heart sound states, the scoring mechanism, and associated open source code are provided. In addition, several potential benefits from the public heart sound database are discussed.This work was supported by the National Institutes of Health (NIH) grant R01-EB001659 from the National Institute of Biomedical Imaging and Bioengineering (NIBIB) and R01GM104987 from the National Institute of General Medical Sciences.Liu, C.; Springer, DC.; Li, Q.; Moody, B.; Abad Juan, RC.; Li, Q.; Moody, B.... (2016). An open access database for the evaluation of heart sound algorithms. Physiological Measurement. 37(12):2181-2213. doi:10.1088/0967-3334/37/12/2181S21812213371

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

Documenting and predicting topic changes in Computers in Biology and Medicine: A bibliometric keyword analysis from 1990 to 2017

The Computers in Biology and Medicine (CBM) journal promotes the use of com-puting machinery in the fields of bioscience and medicine. Since the first volume in 1970, the importance of computers in these fields has grown dramatically, this is evident in the diversification of topics and an increase in the publication rate. In this study, we quantify both change and diversification of topics covered in CBM. This is done by analysing the author supplied keywords, since they were electronically captured in 1990. The analysis starts by selecting 40 keywords, related to Medical (M) (7), Data (D)(10), Feature (F) (17) and Artificial Intelligence (AI) (6) methods. Automated keyword clustering shows the statistical connection between the selected keywords. We found that the three most popular topics in CBM are: Support Vector Machine (SVM), Elec-troencephalography (EEG) and IMAGE PROCESSING. In a separate analysis step, we bagged the selected keywords into sequential one year time slices and calculated the normalized appearance. The results were visualised with graphs that indicate the CBM topic changes. These graphs show that there was a transition from Artificial Neural Network (ANN) to SVM. In 2006 SVM replaced ANN as the most important AI algo-rithm. Our investigation helps the editorial board to manage and embrace topic change. Furthermore, our analysis is interesting for the general reader, as the results can help them to adjust their research directions

Impact of GAN-based Lesion-Focused Medical Image Super-Resolution on Radiomic Feature Robustness

Dissertation presented as the partial requirement for obtaining a Master's degree in Data Science and Advanced Analytics, specialization in Data ScienceRobust machine learning models based on radiomic features might allow for accurate diagnosis, prognosis, and medical decision-making. Unfortunately, the lack of standardized radiomic feature extraction has hampered their clinical use. Since the radiomic features tend to be affected by low voxel statistics in regions of interest, increasing the sample size would improve their robustness in clinical studies. Therefore, we propose a Generative Adversarial Network (GAN)-based lesion-focused framework for Computed Tomography (CT) image Super-Resolution (SR); for the lesion (i.e., cancer) patch-focused training, we incorporate Spatial Pyramid Pooling (SPP) into GANConstrained by the Identical, Residual, and Cycle Learning Ensemble (GAN-CIRCLE). At 2× SR, the proposed model achieved better perceptual quality with less blurring than the other considered state-of-the-art SR methods, while producing comparable results at 4× SR. We also evaluated the robustness of our model’s radiomic feature in terms of quantization on a different lung cancer CT dataset using Principal Component Analysis (PCA). Intriguingly, the most important radiomic features in our PCAbased analysis were the most robust features extracted on the GAN-super-resolved images. These achievements pave the way for the application of GAN-based image Super-Resolution techniques for studies of radiomics for robust biomarker discoveryModelos de machine learning robustos baseados em atributos radiômicos possibilitam diagnósticos e decisões médicas mais precisas. Infelizmente, por causa da falta de padronização na extração de atributos radiômicos, sua utilização em contextos clínicos tem sido restrita. Considerando que atributos radiômics tendem a ser afetados pelas estatítiscas de voxels de baixo volume nas regiões de interesse, o aumento to tamanho da amostra tem o potencial de melhorar a robustez desses atributos em estudos clínicos. Portanto, esse trabalho propões um framework baseado numa rede neural generativa (GAN) focada na região de interesse para a super-resolução de imagens de Tomografia Computadorizada (CT). Para treinar a rede de forma concentrada na lesão (i.e. cancer), incorporamos a tecnica de Spatial Pyramid Pooling no framework da GAN-CIRCLE. Nos experimentos de super-resolução 2×, o modelo proposto alcançou melhor qualidade perceptual com menos embaçamento do que outros métodos estado-da-arte considerados. A robustez dos atributos radiômics das imagens super-resolvidas geradas pelo modelo também foram analizadas em termos de quantização em um banco de imagens diferente, contendo imagens de tomografia computadorizada de câncer de pulmão, usando anaálise de componentes principaiss (PCA). Intrigantemente, os atributos radiômicos mais importantes nessa análise foram também os atributos mais robustos extraídos das imagens super-resolvidas pelo método proposto. Esses resultados abrem caminho para a aplicação de técnicas de super-resolução baseadas em redes neurais generativas aplicadas a estudos de radômica para a descoberta de biomarcadores robustos.This work was partially supported by The Mark Foundation for Cancer Research and Cancer Research UK Cambridge Centre [C9685/A25177], the Wellcome Trust Innovator Award, UK [215733/Z/19/Z] and the CRUK National Cancer Imaging Translational Accelerator (NCITA) [C42780/A27066]. Additional support was also provided by the National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre (BRC-1215-20014). This works was also finantially supported by national funds through the FCT (Fundação para a Ciência e a Tecnologia) by the projects GADgET (DSAIPA/DS/0022/2018) and the Slovenian Research Agency (research core funding no. P5-0410).This work was partially supported by The Mark Foundation for Cancer Research and Cancer Research UK Cambridge Centre [C9685/A25177], the Wellcome Trust Innovator Award, UK [215733/Z/19/Z] and the CRUK National Cancer Imaging Translational Accelerator (NCITA) [C42780/A27066]. Additional support was also provided by the National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre (BRC-1215-20014). This works was also finantially supported by national funds through the FCT (Fundação para a Ciência e a Tecnologia) by the projects GADgET (DSAIPA/DS/0022/2018) and the Slovenian Research Agency (research core funding no. P5-0410)

A Deep Learning Framework for the Detection of Abnormality in Cerebral Blood Flow Velocity Using Transcranial Doppler Ultrasound

Transcranial doppler (TCD) ultrasound is a non-invasive imaging technique that can be used for continuous monitoring of blood flow in the brain through the major cerebral arteries by calculating the cerebral blood flow velocity (CBFV). Since the brain requires a consistent supply of blood to function properly and meet its metabolic demand, a change in CBVF can be an indication of neurological diseases. Depending on the severity of the disease, the symptoms may appear immediately or may appear weeks later. For the early detection of neurological diseases, a classification model is proposed in this study, with the ability to distinguish healthy subjects from critically ill subjects. The TCD ultrasound database used in this study contains signals from the middle cerebral artery (MCA) of 6 healthy subjects and 12 subjects with known neurocritical diseases. The classification model works based on the maximal blood flow velocity waveforms extracted from the TCD ultrasound. Since the signal quality of the recorded TCD ultrasound is highly dependent on the operator's skillset, a noisy and corrupted signal can exist and can add biases to the classifier. Therefore, a deep learning classifier, trained on a curated and clean biomedical signal can reliably detect neurological diseases. For signal classification, this study proposes a Self-organized Operational Neural Network (Self-ONN)-based deep learning model Self-ResAttentioNet18, which achieves classification accuracy of 96.05% with precision, recall, f1 score, and specificity of 96.06%, 96.05%, 96.06%, and 96.09%, respectively. With an area under the ROC curve of 0.99, the model proves its feasibility to confidently classify middle cerebral artery (MCA) waveforms in near real-time.This work was made possible by the High Impact grant of Qatar University # QUHI-CENG-22_23-548 and student grant: QUST-1-CENG-2023-796. The statements made herein are solely the responsibility of the authors.Scopu