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

A proposed methodology for detecting the malignant potential of pulmonary nodules in sarcoma using computed tomographic imaging and artificial intelligence-based models

The presence of lung metastases in patients with primary malignancies is an important criterion for treatment management and prognostication. Computed tomography (CT) of the chest is the preferred method to detect lung metastasis. However, CT has limited efficacy in differentiating metastatic nodules from benign nodules (e.g., granulomas due to tuberculosis) especially at early stages (<5 mm). There is also a significant subjectivity associated in making this distinction, leading to frequent CT follow-ups and additional radiation exposure along with financial and emotional burden to the patients and family. Even 18F-fluoro-deoxyglucose positron emission technology-computed tomography (18F-FDG PET-CT) is not always confirmatory for this clinical problem. While pathological biopsy is the gold standard to demonstrate malignancy, invasive sampling of small lung nodules is often not clinically feasible. Currently, there is no non-invasive imaging technique that can reliably characterize lung metastases. The lung is one of the favored sites of metastasis in sarcomas. Hence, patients with sarcomas, especially from tuberculosis prevalent developing countries, can provide an ideal platform to develop a model to differentiate lung metastases from benign nodules. To overcome the lack of optimal specificity of CT scan in detecting pulmonary metastasis, a novel artificial intelligence (AI)-based protocol is proposed utilizing a combination of radiological and clinical biomarkers to identify lung nodules and characterize it as benign or metastasis. This protocol includes a retrospective cohort of nearly 2,000–2,250 sample nodules (from at least 450 patients) for training and testing and an ambispective cohort of nearly 500 nodules (from 100 patients; 50 patients each from the retrospective and prospective cohort) for validation. Ground-truth annotation of lung nodules will be performed using an in-house-built segmentation tool. Ground-truth labeling of lung nodules (metastatic/benign) will be performed based on histopathological results or baseline and/or follow-up radiological findings along with clinical outcome of the patient. Optimal methods for data handling and statistical analysis are included to develop a robust protocol for early detection and classification of pulmonary metastasis at baseline and at follow-up and identification of associated potential clinical and radiological markers

Efficient Feature Selection and ML Algorithm for Accurate Diagnostics

Machine learning algorithms have been deployed in numerous optimization, prediction and classification problems. This has endeared them for application in fields such as computer networks and medical diagnosis. Although these machine learning algorithms achieve convincing results in these fields, they face numerous challenges when deployed on imbalanced dataset. Consequently, these algorithms are often biased towards majority class, hence unable to generalize the learning process. In addition, they are unable to effectively deal with high-dimensional datasets. Moreover, the utilization of conventional feature selection techniques from a dataset based on attribute significance render them ineffective for majority of the diagnosis applications. In this paper, feature selection is executed using the more effective Neighbour Components Analysis (NCA). During the classification process, an ensemble classifier comprising of K-Nearest Neighbours (KNN), Naive Bayes (NB), Decision Tree (DT) and Support Vector Machine (SVM) is built, trained and tested. Finally, cross validation is carried out to evaluate the developed ensemble model. The results shows that the proposed classifier has the best performance in terms of precision, recall, F-measure and classification accuracy

Learning Algorithms for Fat Quantification and Tumor Characterization

Obesity is one of the most prevalent health conditions. About 30% of the world\u27s and over 70% of the United States\u27 adult populations are either overweight or obese, causing an increased risk for cardiovascular diseases, diabetes, and certain types of cancer. Among all cancers, lung cancer is the leading cause of death, whereas pancreatic cancer has the poorest prognosis among all major cancers. Early diagnosis of these cancers can save lives. This dissertation contributes towards the development of computer-aided diagnosis tools in order to aid clinicians in establishing the quantitative relationship between obesity and cancers. With respect to obesity and metabolism, in the first part of the dissertation, we specifically focus on the segmentation and quantification of white and brown adipose tissue. For cancer diagnosis, we perform analysis on two important cases: lung cancer and Intraductal Papillary Mucinous Neoplasm (IPMN), a precursor to pancreatic cancer. This dissertation proposes an automatic body region detection method trained with only a single example. Then a new fat quantification approach is proposed which is based on geometric and appearance characteristics. For the segmentation of brown fat, a PET-guided CT co-segmentation method is presented. With different variants of Convolutional Neural Networks (CNN), supervised learning strategies are proposed for the automatic diagnosis of lung nodules and IPMN. In order to address the unavailability of a large number of labeled examples required for training, unsupervised learning approaches for cancer diagnosis without explicit labeling are proposed. We evaluate our proposed approaches (both supervised and unsupervised) on two different tumor diagnosis challenges: lung and pancreas with 1018 CT and 171 MRI scans respectively. The proposed segmentation, quantification and diagnosis approaches explore the important adiposity-cancer association and help pave the way towards improved diagnostic decision making in routine clinical practice

Capsule Network-based Radiomics: From Diagnosis to Treatment

Recent advancements in signal processing and machine learning coupled with developments of electronic medical record keeping in hospitals have resulted in a surge of significant interest in ``radiomics". Radiomics is an emerging and relatively new research field, which refers to semi-quantitative and/or quantitative features extracted from medical images with the goal of developing predictive and/or prognostic models. Radiomics is expected to become a critical component for integration of image-derived information for personalized treatment in the near future. The conventional radiomics workflow is, typically, based on extracting pre-designed features (also referred to as hand-crafted or engineered features) from a segmented region of interest. Clinical application of hand-crafted radiomics is, however, limited by the fact that features are pre-defined and extracted without taking the desired outcome into account. The aforementioned drawback has motivated trends towards development of deep learning-based radiomics (also referred to as discovery radiomics). Discovery radiomics has the advantage of learning the desired features on its own in an end-to-end fashion. Discovery radiomics has several applications in disease prediction/ diagnosis. Through this Ph.D. thesis, we develop deep learning-based architectures to address the following critical challenges identified within the radiomics domain. First, we cover the tumor type classification problem, which is of high importance for treatment selection. We address this problem, by designing a Capsule network-based architecture that has several advantages over existing solutions such as eliminating the need for access to a huge amount of training data, and its capability to learn input transformations on its own. We apply different modifications to the Capsule network architecture to make it more suitable for radiomics. At one hand, we equip the proposed architecture with access to the tumor boundary box, and on the other hand, a multi-scale Capsule network architecture is designed. Furthermore, capitalizing on the advantages of ensemble learning paradigms, we design a boosting and also a mixture of experts capsule network. A Bayesian capsule network is also developed to capture the uncertainty of the tumor classification. Beside knowing the tumor type (through classification), predicting the patient's response to treatment plays an important role in treatment design. Predicting patient's response, including survival and tumor recurrence, is another goal of this thesis, which we address by designing a deep learning-based model that takes not only the medical images, but also different clinical factors (such as age and gender) as inputs. Finally, COVID-19 diagnosis, another challenging and crucial problem within the radiomics domain, is dealt with using both X-ray and Computed Tomography (CT) images (in particular low-dose ones), where two in-house datasets are collected for the latter and different capsule network-based models are developed for COVID-19 diagnosis

EGFR and KRAS mutation prediction on lung cancer through medical image processing and artificial intelligence

Lung cancer causes more deaths globally than any other type of cancer. To determine the best treatment, detecting EGFR and KRAS mutations is of interest. However, non-invasive ways to obtain this information are not available. In this study, an ensemble approach is applied to increase the performance of EGFR and KRAS mutation prediction from CT images using a small dataset. A new voting scheme, Selective Class Average Voting (SCAV) is proposed and its performance is assessed both for machine learning models and Convolutional Neural Networks (CNNs). For the EGFR mutation, in the machine learning approach, there was an increase in the Sensitivity from 0.66 to 0.75, and an increase in AUC from 0.68 to 0.70. With the deep learning approach an AUC of 0.846 was obtained with custom CNNs, and with SCAV the Accuracy of the model was increased from 0.80 to 0.857. Finally, when combining the best Custom and Pre-trained CNNs using SCAV an AUC of 0.914 was obtained. For the KRAS mutation both in the machine learning models (0.65 to 0.71 AUC) and the deep learning models (0.739 to 0.778 AUC) a significant increase in performance was found. This increase was even greater with Ensembles of Pre-trained CNNs (0.809 AUC). The results obtained in this work show how to effectively learn from small image datasets to predict EGFR and KRAS mutations, and that using ensembles with SCAV increases the performance of machine learning classifiers and CNNs.DoctoradoDoctor en Ingeniería de Sistemas y Computació

Ensemble Methods for Lung Cancer Gene Mutation Prediction

Previous results from the project "Lung Cancer Screening - A non-invasive methodology for early diagnosis" and literature suggest that the most relevant information to predict the mutation status in lung cancer might be the combination of features from the nodule and other lung structures. Quantitative features extracted from cancer nodules have been used to create predictive models for gene mutation status and screening. Novel ensemble methods will be developed in order to use quantitative features from external structures to the nodule with traditional features from the nodule. The combination of relevant information by the learning models should improve the accuracy of diagnosis