PadChest: A large chest x-ray image dataset with multi-label annotated reports

We present a labeled large-scale, high resolution chest x-ray dataset for the automated exploration of medical images along with their associated reports. This dataset includes more than 160,000 images obtained from 67,000 patients that were interpreted and reported by radiologists at Hospital San Juan Hospital (Spain) from 2009 to 2017, covering six different position views and additional information on image acquisition and patient demography. The reports were labeled with 174 different radiographic findings, 19 differential diagnoses and 104 anatomic locations organized as a hierarchical taxonomy and mapped onto standard Unified Medical Language System (UMLS) terminology. Of these reports, 27% were manually annotated by trained physicians and the remaining set was labeled using a supervised method based on a recurrent neural network with attention mechanisms. The labels generated were then validated in an independent test set achieving a 0.93 Micro-F1 score. To the best of our knowledge, this is one of the largest public chest x-ray database suitable for training supervised models concerning radiographs, and the first to contain radiographic reports in Spanish. The PadChest dataset can be downloaded from http://bimcv.cipf.es/bimcv-projects/padchest/

Knowledge graph-based method for solutions detection and evaluation in an online problem-solving community

Online communities are a real medium for human experiences sharing. They contain rich knowledge of lived situations and experiences that can be used to support decision-making process and problem-solving. This work presents an approach for extracting, representing, and evaluating components of problem-solving knowledge shared in online communities. Few studies have tackled the issue of knowledge extraction and its usefulness evaluation in online communities. In this study, we propose a new approach to detect and evaluate best solutions to problems discussed by members of online communities. Our approach is based on knowledge graph technology and graphs theory enabling the representation of knowledge shared by the community and facilitating its reuse. Our process of problem-solving knowledge extraction in online communities (PSKEOC) consists of three phases: problems and solutions detection and classification, knowledge graph constitution and finally best solutions evaluation. The experimental results are compared to the World Health Organization (WHO) model chapter about Infant and young child feeding and show that our approach succeed to extract and reveal important problem-solving knowledge contained in online community’s conversations. Our proposed approach leads to the construction of an experiential knowledge graph as a representation of the constructed knowledge base in the community studied in this paper

Computer-aided image quality assessment in automated 3D breast ultrasound images

Automated 3D breast ultrasound (ABUS) is a valuable, non-ionising adjunct to X-ray mammography for breast cancer screening and diagnosis for women with dense breasts. High image quality is an important prerequisite for diagnosis and has to be guaranteed at the time of acquisition. The high throughput of images in a screening scenario demands for automated solutions. In this work, an automated image quality assessment system rating ABUS scans at the time of acquisition was designed and implemented. Quality assessment of present diagnostic ultrasound images has rarely been performed demanding thorough analysis of potential image quality aspects in ABUS. Therefore, a reader study was initiated, making two clinicians rate the quality of clinical ABUS images. The frequency of specific quality aspects was evaluated revealing that incorrect positioning and insufficiently applied contact fluid caused the most relevant image quality issues. The relative position of the nipple in the image, the acoustic shadow caused by the nipple as well as the shape of the breast contour reflect patient positioning and ultrasound transducer handling. Morphological and histogram-based features utilized for machine learning to reproduce the manual classification as provided by the clinicians. At 97 % specificity, the automatic classification achieved sensitivities of 59 %, 45 %, and 46 % for the three aforementioned aspects, respectively. The nipple is an important landmark in breast imaging, which is generally---but not always correctly---pinpointed by the technicians. An existing nipple detection algorithm was extended by probabilistic atlases and exploited for automatic detection of incorrectly annotated nipple marks. The nipple detection rate was increased from 82 % to 85 % and the classification achieved 90 % sensitivity at 89 % specificity. A lack of contact fluid between transducer and skin can induce reverberation patterns and acoustic shadows, which can possibly obscure lesions. Parameter maps were computed in order to localize these artefact regions and yielded a detection rate of 83 % at 2.6 false positives per image. Parts of the presented work were integrated to clinical workflow making up a novel image quality assessment system that supported technicians in their daily routine by detecting images of insufficient quality and indicating potential improvements for a repeated scan while the patient was still in the examination room. First evaluations showed that the proposed method sensitises technicians for the radiologists' demands on diagnostically valuable images

Breast Cancer : automatic detection and risk analysis through machine learning algorithms, using mammograms

Tese de Mestrado Integrado, Engenharia Biomédica e Biofísica (Engenharia Clínica e Instrumentação Médica), 2021, Universidade de Lisboa, Faculdade de CiênciasCom 2.3 milhões de casos diagnosticados em todo o Mundo, durante o ano de 2020, o cancro da mama tornou-se aquele com maior incidência, nesse mesmo ano, considerando ambos os sexos. Anualmente, em Portugal, são diagnosticados aproximadamente sete mil (7000) novos casos de cancro da mama, com mil oitocentas (1800) mulheres a morrerem, todos os anos, devido a esta doença - indicando uma taxa de mortalidade de aproximadamente 5 mulheres por dia. A maior parte dos diagnósticos de cancro da mama ocorrem ao nível de programas de rastreio, que utilizam mamografia. Esta técnica de imagem apresenta alguns problemas: o facto de ser uma imagem a duas dimensões leva a que haja sobreposição de tecidos, o que pode mascarar a presença de tumores; e a fraca sensibilidade a mamas mais densas, sendo estas caraterísticas de mulheres com risco de cancro da mama mais elevado. Como estes dois problemas dificultam a leitura das mamografias, grande parte deste trabalhou focou-se na verificação do desempenho de métodos computacionais na tarefa de classificar mamografias em duas classes: cancro e não-cancro. No que diz respeito à classe “não cancro” (N = 159), esta foi constituída por mamografias saudáveis (N=84), e por mamografias que continham lesões benignas (N=75). Já a classe “cancro” continha apenas mamografias com lesões malignas (N = 73). A discriminação entre estas duas classes foi feita com recurso a algoritmos de aprendizagem automática. Múltiplos classificadores foram otimizados e treinados (Ntreino=162, Nteste = 70), recorrendo a um conjunto de características previamente selecionado, que descreve a textura de toda a mamografia, em vez de apenas uma única Região de Interesse. Estas características de textura baseiam-se na procura de padrões: sequências de pixéis com a mesma intensidade, ou pares específicos de pixéis. O classificador que apresentou uma performance mais elevada foi um dos Support Vector Machine (SVM) treinados – AUC= 0.875, o que indica um desempenho entre o bom e o excelente. A Percent Mammographic Density (%PD) é um importante fator de risco no que diz respeito ao desenvolvimento da doença, pelo que foi estudado se a sua adição ao set de features selecionado resultaria numa melhor performance dos classificadores. O classificador, treinado e otimizado utilizando as features de textura e os cálculos de %PD, com maior capacidade discriminativa foi um Linear Discriminant Analysis (LDA) – AUC = 0.875. Uma vez que a performance é igual à obtida com o classificador que utiliza apenas features de textura, conclui-se que a %PD parece não contribuir com informação relevante. Tal pode ocorrer porque as próprias características de textura já têm informação sobre a densidade da mama. De forma a estudar-se de que modo o desempenho destes métodos computacionais pode ser afetado por piores condições de aquisição de imagem, foi simulado ruído gaussiano, e adicionado ao set de imagens utilizado para testagem. Este ruído, adicionado a cada imagem com quatro magnitudes diferentes, resultou numa AUC de 0.765 para o valor mais baixo de ruído, e numa AUC de 0.5 para o valor de ruído mais elevado. Tais resultados indicam que, para níveis de ruído mais baixo, o classificador consegue, ainda assim, manter uma performance satisfatória – o que deixa de se verificar para valores mais elevados de ruído. Estudou-se, também, se a aplicação de técnicas de filtragem – com um filtro mediana – poderia ajudar a recuperar informação perdida aquando da adição de ruído. A aplicação do filtro a todas as imagens ruidosas resultou numa AUC de 0.754 para o valor mais elevado de ruído, atingindo assim um desempenho similar ao set de imagens menos ruidosas, antes do processo de filtragem (AUC=0.765). Este resultados parecem indicar que, na presença de más condições de aquisição, a aplicação de um filtro mediana pode ajudar a recuperar informação, conduzindo assim a um melhor desempenho dos métodos computacionais. No entanto, esta mesma conclusão parece não se verificar para valores de ruído mais baixo onde a AUC após filtragem acaba por ser mais reduzida. Tal resultado poderá indicar que, em situações onde o nível de ruído é mais baixo, a técnica de filtragem não só remove o ruído, como acaba também por, ela própria, remover informação ao nível da textura da imagem. De modo a verificar se mamas com diferentes densidades afetavam a performance do classificador, foram criados três sets de teste diferentes, cada um deles contendo imagens de mamas com a mesma densidade (1, 2, e 3). Os resultados obtidos indicam-nos que um aumento na densidade das mamas analisadas não resulta, necessariamente, numa diminuição da capacidade em discriminar as classes definidas (AUC = 0.864, AUC = 0.927, AUC= 0.905; para as classes 1, 2, e 3 respetivamente). A utilização da imagem integral para analisar de textura, e a utilização de imagens de datasets diferentes (com dimensões de imagem diferentes), poderiam introduzir um viés na classificação, especialmente no que diz respeito às diferentes áreas da mama. Para verificar isso mesmo, utilizando o coeficiente de correlação de Pearson, ρ = 0.3, verificou-se que a área da mama (e a percentagem de ocupação) tem uma fraca correlação com a classificação dada a cada imagem. A construção do classificador, para além de servir de base a todos os testes apresentados, serviu também o propósito de criar uma interface interativa, passível de ser utilizada como ficheiro executável, sem necessidade de instalação de nenhum software. Esta aplicação permite que o utilizador carregue imagens de mamografia, exclua background desnecessário para a análise da imagem, extraia features, teste o classificador construído e dê como output, no ecrã, a classe correspondente à imagem carregada. A análise de risco de desenvolvimento da doença foi conseguida através da análise visual da variação dos valores das features de textura ao longo dos anos para um pequeno set (N=11) de mulheres. Esta mesma análise permitiu descortinar aquilo que parece ser uma tendência apresentada apenas por mulheres doentes, na mamografia imediatamente anterior ao diagnóstico da doença. Todos os resultados obtidos são descritos profundamente ao longo deste documento, onde se faz, também, uma referência pormenorizada a todos os métodos utilizados para os obter. O resultado da classificação feita apenas com as features de textura encontra-se dentro dos valores referenciados no estado-da-arte, indicando que o uso de features de textura, por si só, demonstrou ser profícuo. Para além disso, tal resultado serve também de indicação que o recurso a toda a imagem de mamografia, sem o trabalho árduo de definição de uma Região de Interesse, poderá ser utilizado com relativa segurança. Os resultados provenientes da análise do efeito da densidade e da área da mama, dão também confiança no uso do classificador. A interface interativa que resultou desta primeira fase de trabalho tem, potencialmente, um diferenciado conjunto de aplicações: no campo médico, poderá servir de auxiliar de diagnóstico ao médico; já no campo da análise computacional, poderá servir para a definição da ground truth de potenciais datasets que não tenham legendas definidas. No que diz respeito à análise de risco, a utilização de um dataset de dimensões reduzidas permitiu, ainda assim, compreender que existem tendências nas variações das features ao longo dos anos, que são especificas de mulheres que desenvolveram a doença. Os resultados obtidos servem, então, de indicação que a continuação desta linha de trabalho, procurando avaliar/predizer o risco, deverá ser seguida, com recurso não só a datasets mais completos, como também a métodos computacionais de aprendizagem automática.Two million and three hundred thousand Breast Cancer (BC) cases were diagnosed in 2020, making it the type of cancer with the highest incidence that year, considering both sexes. Breast Cancer diagnosis usually occurs during screening programs using mammography, which has some downsides: the masking effect due to its 2-D nature, and its poor sensitivity concerning dense breasts. Since these issues result in difficulties reading mammograms, the main part of this work aimed to verify how a computer vision method would perform in classifying mammograms into two classes: cancer and non-cancer. The ‘non-cancer group’ (N=159) was composed by images with healthy tissue (N=84) and images with benign lesions (N=75), while the cancer group (N=73) contained malignant lesions. To achieve this, multiple classifiers were optimized and trained (Ntrain = 162, Ntest = 70) with a previously selected ideal sub-set of features that describe the texture of the entire image, instead of just one small Region of Interest (ROI). The classifier with the best performance was Support Vector Machine (SVM), (AUC = 0.875), which indicates a good-to-excellent capability discriminating the two defined groups. To assess if Percent Mammographic Density (%PD), an important risk factor, added important information, a new classifier was optimized and trained using the selected sub-set of texture features plus the %PD calculation. The classifier with the best performance was a Linear Discriminant Analysis (LDA), (AUC=0.875), which seems to indicate, once it achieves the same performance as the classifier using only texture features, that there is no relevant information added from %PD calculations. This happens because texture already includes information on breast density. To understand how the classifier would perform in worst image acquisition conditions, gaussian noise was added to the test images (N=70), with four different magnitudes (AUC= 0.765 for the lowest noise value vs. AUC ≈ 0.5 for the highest). A median filter was applied to the noised images towards evaluating if information could be recovered. For the highest noise value, after filtering, the AUC was very close to the one obtained for the lowest noise value before filtering (0.754 vs 0.765), which indicates information recovery. The effect of density in classifier performance was evaluated by constructing three different test sets, each containing images from a density class (1,2,3). It was seen that an increase in density did not necessarily resulted in a decrease in performance, which indicates that the classifier is robust to density variation (AUC = 0.864, AUC= 0.927, AUC= 0.905 ; for class 1, 2, and 3 respectively). Since the entire image is being analyzed, and images come from different datasets, it was verified if breast area was adding bias to classification. Pearson correlation coefficient provided an output of ρ = 0.22, showing that there is a weak correlation between these two variables. Finally, breast cancer risk was assessed by visual texture feature analysis through the years, for a small set of women (N=11). This visual analysis allowed to unveil what seems to be a pattern amongst women who developed the disease, in the mammogram immediately before diagnosis. The details of each phase, as well as the associated final results are deeply described throughout this document. The work done in the first classification task resulted in a state-of-the-art performance, which may serve as foundation for new research in the area, without the laborious work of ROI definition. Besides that, the use of texture features alone proved to be fruitful. Results concerning risk may serve as basis for future work in the area, with larger datasets and the incorporation of Computer Vision methods

Studies on deep learning approach in breast lesions detection and cancer diagnosis in mammograms

Breast cancer accounts for the largest proportion of newly diagnosed cancers in women recently. Early diagnosis of breast cancer can improve treatment outcomes and reduce mortality. Mammography is convenient and reliable, which is the most commonly used method for breast cancer screening. However, manual examinations are limited by the cost and experience of radiologists, which introduce a high false positive rate and false examination. Therefore, a high-performance computer-aided diagnosis (CAD) system is significant for lesions detection and cancer diagnosis. Traditional CADs for cancer diagnosis require a large number of features selected manually and remain a high false positive rate. The methods based on deep learning can automatically extract image features through the network, but their performance is limited by the problems of multicenter data biases, the complexity of lesion features, and the high cost of annotations. Therefore, it is necessary to propose a CAD system to improve the ability of lesion detection and cancer diagnosis, which is optimized for the above problems. This thesis aims to utilize deep learning methods to improve the CADs' performance and effectiveness of lesion detection and cancer diagnosis. Starting from the detection of multi-type lesions using deep learning methods based on full consideration of characteristics of mammography, this thesis explores the detection method of microcalcification based on multiscale feature fusion and the detection method of mass based on multi-view enhancing. Then, a classification method based on multi-instance learning is developed, which integrates the detection results from the above methods, to realize the precise lesions detection and cancer diagnosis in mammography. For the detection of microcalcification, a microcalcification detection network named MCDNet is proposed to overcome the problems of multicenter data biases, the low resolution of network inputs, and scale differences between microcalcifications. In MCDNet, Adaptive Image Adjustment mitigates the impact of multicenter biases and maximizes the input effective pixels. Then, the proposed pyramid network with shortcut connections ensures that the feature maps for detection contain more precise localization and classification information about multiscale objects. In the structure, trainable Weighted Feature Fusion is proposed to improve the detection performance of both scale objects by learning the contribution of feature maps in different stages. The experiments show that MCDNet outperforms other methods on robustness and precision. In case the average number of false positives per image is 1, the recall rates of benign and malignant microcalcification are 96.8% and 98.9%, respectively. MCDNet can effectively help radiologists detect microcalcifications in clinical applications. For the detection of breast masses, a weakly supervised multi-view enhancing mass detection network named MVMDNet is proposed to solve the lack of lesion-level labels. MVMDNet can be trained on the image-level labeled dataset and extract the extra localization information by exploring the geometric relation between multi-view mammograms. In Multi-view Enhancing, Spatial Correlation Attention is proposed to extract correspondent location information between different views while Sigmoid Weighted Fusion module fuse diagnostic and auxiliary features to improve the precision of localization. CAM-based Detection module is proposed to provide detections for mass through the classification labels. The results of experiments on both in-house dataset and public dataset, [email protected] and [email protected] (recall rate@average number of false positive per image), demonstrate MVMDNet achieves state-of-art performances among weakly supervised methods and has robust generalization ability to alleviate the multicenter biases. In the study of cancer diagnosis, a breast cancer classification network named CancerDNet based on Multi-instance Learning is proposed. CancerDNet successfully solves the problem that the features of lesions are complex in whole image classification utilizing the lesion detection results from the previous chapters. Whole Case Bag Learning is proposed to combined the features extracted from four-view, which works like a radiologist to realize the classification of each case. Low-capacity Instance Learning and High-capacity Instance Learning successfully integrate the detections of multi-type lesions into the CancerDNet, so that the model can fully consider lesions with complex features in the classification task. CancerDNet achieves the AUC of 0.907 and AUC of 0.925 on the in-house and the public datasets, respectively, which is better than current methods. The results show that CancerDNet achieves a high-performance cancer diagnosis. In the works of the above three parts, this thesis fully considers the characteristics of mammograms and proposes methods based on deep learning for lesions detection and cancer diagnosis. The results of experiments on in-house and public datasets show that the methods proposed in this thesis achieve the state-of-the-art in the microcalcifications detection, masses detection, and the case-level classification of cancer and have a strong ability of multicenter generalization. The results also prove that the methods proposed in this thesis can effectively assist radiologists in making the diagnosis while saving labor costs

Comparative Analysis of Segment Anything Model and U-Net for Breast Tumor Detection in Ultrasound and Mammography Images

In this study, the main objective is to develop an algorithm capable of identifying and delineating tumor regions in breast ultrasound (BUS) and mammographic images. The technique employs two advanced deep learning architectures, namely U-Net and pretrained SAM, for tumor segmentation. The U-Net model is specifically designed for medical image segmentation and leverages its deep convolutional neural network framework to extract meaningful features from input images. On the other hand, the pretrained SAM architecture incorporates a mechanism to capture spatial dependencies and generate segmentation results. Evaluation is conducted on a diverse dataset containing annotated tumor regions in BUS and mammographic images, covering both benign and malignant tumors. This dataset enables a comprehensive assessment of the algorithm's performance across different tumor types. Results demonstrate that the U-Net model outperforms the pretrained SAM architecture in accurately identifying and segmenting tumor regions in both BUS and mammographic images. The U-Net exhibits superior performance in challenging cases involving irregular shapes, indistinct boundaries, and high tumor heterogeneity. In contrast, the pretrained SAM architecture exhibits limitations in accurately identifying tumor areas, particularly for malignant tumors and objects with weak boundaries or complex shapes. These findings highlight the importance of selecting appropriate deep learning architectures tailored for medical image segmentation. The U-Net model showcases its potential as a robust and accurate tool for tumor detection, while the pretrained SAM architecture suggests the need for further improvements to enhance segmentation performance

Olfaction scaffolds the developing human from neonate to adolescent and beyond

The impact of the olfactory sense is regularly apparent across development. The foetus is bathed in amniotic fluid that conveys the mother’s chemical ecology. Transnatal olfactory continuity between the odours of amniotic fluid and milk assists in the transition to nursing. At the same time, odours emanating from the mammary areas provoke appetitive responses in newborns. Odours experienced from the mother’s diet during breastfeeding, and from practices such as pre-mastication, may assist in the dietary transition at weaning. In parallel, infants are attracted to and recognise their mother’s odours; later, children are able to recognise other kin and peers based on their odours. Familiar odours, such as those of the mother, regulate the child’s emotions, and scaffold perception and learning through non-olfactory senses. During adolescence, individuals become more sensitive to some bodily odours, while the timing of adolescence itself has been speculated to draw from the chemical ecology of the family unit. Odours learnt early in life and within the family niche continue to influence preferences as mate choice becomes relevant. Olfaction thus appears significant in turning on, sustaining and, in cases when mother odour is altered, disturbing adaptive reciprocity between offspring and caregiver during the multiple transitions of development between birth and adolescence