Collaborative Artificial Intelligence Algorithms for Medical Imaging Applications

In this dissertation, we propose novel machine learning algorithms for high-risk medical imaging applications. Specifically, we tackle current challenges in radiology screening process and introduce cutting-edge methods for image-based diagnosis, detection and segmentation. We incorporate expert knowledge through eye-tracking, making the whole process human-centered. This dissertation contributes to machine learning, computer vision, and medical imaging research by: 1) introducing a mathematical formulation of radiologists level of attention, and sparsifying their gaze data for a better extraction and comparison of search patterns. 2) proposing novel, local and global, image analysis algorithms. Imaging based diagnosis and pattern analysis are high-risk Artificial Intelligence applications. A standard radiology screening procedure includes detection, diagnosis and measurement (often done with segmentation) of abnormalities. We hypothesize that having a true collaboration is essential for a better control mechanism, in such applications. In this regard, we propose to form a collaboration medium between radiologists and machine learning algorithms through eye-tracking. Further, we build a generic platform consisting of novel machine learning algorithms for each of these tasks. Our collaborative algorithm utilizes eye tracking and includes an attention model and gaze-pattern analysis, based on data clustering and graph sparsification. Then, we present a semi-supervised multi-task network for local analysis of image in radiologists\u27 ROIs, extracted in the previous step. To address missing tumors and analyze regions that are completely missed by radiologists during screening, we introduce a detection framework, S4ND: Single Shot Single Scale Lung Nodule Detection. Our proposed detection algorithm is specifically designed to handle tiny abnormalities in lungs, which are easy to miss by radiologists. Finally, we introduce a novel projective adversarial framework, PAN: Projective Adversarial Network for Medical Image Segmentation, for segmenting complex 3D structures/organs, which can be beneficial in the screening process by guiding radiologists search areas through segmentation of desired structure/organ

This is not a real image:Generative artificial intelligence to enhance radiology education

Radiologists fulfill a critical role in our healthcare system, but their workload has increased substantially over time. Although algorithmic tools have been proposed to support the diagnostic process, the workload is not efficiently decreased in this manner. However, another possibility is to decrease workload in a different area. The main topic of this thesis is concerned with investigating how simulation training can be realized to aid in the image interpretation skills training of the radiology resident. To realize simulated training it is necessary to know (1) how we can create realistic artificial medical images, subsequently (2) How we can control their variety and (3) how we can adjust their difficulty.Firstly, it is shown that artificial medical images can blend in with original ones. For this purpose a GAN model is used to create 2-dimensional artificial medical images. The created artificial images are assessed both quantitatively and qualitatively in terms of their realism. Secondly, to better control the variety of the artificial medical images a diffusion model is used to guide both coarse- and fine-features. The results show that the model was able to adjust fine-feature characteristics of the pathology type according to the feedback of the independent classifier. Thirdly, a method is presented to describe the detection difficulty of an (artificial) medical image using quantitative pathology and image characteristics. Results show that it is possible to describe almost two thirds of the variation in difficulty using these quantitative characteristics and as such describe images as having lower or higher detection difficulty. Finally, the responsible implementation of the medical image simulator to assist in image interpretation skills is investigated. Combining the results of this thesis resulted in a prototype of a 'medical image simulator'. This simulator can take over part of the workload of the supervising radiologists, by providing a means for independent repetitive practice for the resident. The realistic artificial medical images can be varied in terms of their content and their difficulty. This can enable a personalized experience that can enhance training of image interpretation skills and make it more efficient

Eye-tracking the moving medical image: Development and investigation of a novel investigational tool for CT Colonography

Colorectal cancer remains the third most common cancer in the UK but the second leading cause of cancer death with >16,000 dying per year. Many advances have been made in recent years in all areas of investigation for colorectal cancer, one of the more notable being the widespread introduction of CT Colonography (CTC). CTC has rapidly established itself as a cornerstone of diagnosis for colonic neoplasia and much work has been done to standardise and assure quality in practice in both the acquisition and interpretation of the technique. A novel feature of CTC is the presentation of imaging in both traditional 2D and the ‘virtual’ 3D endoluminal formats. This thesis looks at expanding our understanding of and improving our performance in utilizing the endoluminal 3D view. We present and develop novel metrics applicable to eye-tracking the moving image, so that the complex dynamic nature of 3D endoluminal fly-through interpretation can be captured. These metrics are then applied to assess the effect of important elements of image interpretation, namely, reader experience, the effect of the use Computer Aided Detection (CAD) and the influence of the expected prevalence of abnormality. We review our findings with reference to the literature of eye tracking within medical imaging. In the co-registration section we apply our validated computer-assisted registration algorithm to the matching of 3D endoluminal colonic locations between temporally separate datasets, assessing its accuracy as an aid to colonic polyp surveillance with CTC

Facilitating Colorectal Cancer Diagnosis with Computed Tomographic Colonography

Computed tomographic colonography (CTC) is a diagnostic technique involving helical volume acquisition of the cleansed, distended colorectum to detect colorectal cancer or potentially premalignant polyps. This Thesis summarises the evidence base, identifies areas in need of further research, quantifies sources of bias and presents novel techniques to facilitate colorectal cancer diagnosis using CTC. CTC literature is reviewed to justify the rationale for current implementation and to identify fruitful areas for research. This confirms excellent diagnostic performance can be attained providing CTC is interpreted by trained, experienced observers employing state-of-the-art implementation. The technique is superior to barium enema and consequently, it has been embraced by radiologists, clinicians and health policy-makers. Factors influencing generalisability of CTC research are investigated, firstly with a survey of European educational workshop participants which revealed limited CTC experience and training, followed by a systematic review exploring bias in research studies of diagnostic test accuracy which established that studies focussing on these aspects were lacking. Experiments to address these sources of bias are presented, using novel methodology: Conjoint analysis is used to ascertain patients‘ and clinicians’ attitudes to false-positive screening diagnoses, showing that both groups overwhelmingly value sensitivity over specificity. The results inform a weighted statistical analysis for CAD which is applied to the results of two previous studies showing the incremental benefit is significantly higher for novices than experienced readers. We have employed eye-tracking technology to establish the visual search patterns of observers reading CTC, demonstrated feasibility and developed metrics for analysis. We also describe development and validation of computer software to register prone and supine endoluminal surface locations demonstrating accurate matching of corresponding points when applied to a phantom and a generalisable, publically available, CTC database. Finally, areas in need of future development are suggested