BiRA-Net: Bilinear Attention Net for Diabetic Retinopathy Grading

Diabetic retinopathy (DR) is a common retinal disease that leads to blindness. For diagnosis purposes, DR image grading aims to provide automatic DR grade classification, which is not addressed in conventional research methods of binary DR image classification. Small objects in the eye images, like lesions and microaneurysms, are essential to DR grading in medical imaging, but they could easily be influenced by other objects. To address these challenges, we propose a new deep learning architecture, called BiRA-Net, which combines the attention model for feature extraction and bilinear model for fine-grained classification. Furthermore, in considering the distance between different grades of different DR categories, we propose a new loss function, called grading loss, which leads to improved training convergence of the proposed approach. Experimental results are provided to demonstrate the superior performance of the proposed approach.Comment: Accepted at ICIP 201

Combining Fine- and Coarse-Grained Classifiers for Diabetic Retinopathy Detection

Visual artefacts of early diabetic retinopathy in retinal fundus images are usually small in size, inconspicuous, and scattered all over retina. Detecting diabetic retinopathy requires physicians to look at the whole image and fixate on some specific regions to locate potential biomarkers of the disease. Therefore, getting inspiration from ophthalmologist, we propose to combine coarse-grained classifiers that detect discriminating features from the whole images, with a recent breed of fine-grained classifiers that discover and pay particular attention to pathologically significant regions. To evaluate the performance of this proposed ensemble, we used publicly available EyePACS and Messidor datasets. Extensive experimentation for binary, ternary and quaternary classification shows that this ensemble largely outperforms individual image classifiers as well as most of the published works in most training setups for diabetic retinopathy detection. Furthermore, the performance of fine-grained classifiers is found notably superior than coarse-grained image classifiers encouraging the development of task-oriented fine-grained classifiers modelled after specialist ophthalmologists.Comment: Pages 12, Figures

A Smartphone-Based Tool for Rapid, Portable, and Automated Wide-Field Retinal Imaging.

Purpose:High-quality, wide-field retinal imaging is a valuable method for screening preventable, vision-threatening diseases of the retina. Smartphone-based retinal cameras hold promise for increasing access to retinal imaging, but variable image quality and restricted field of view can limit their utility. We developed and clinically tested a smartphone-based system that addresses these challenges with automation-assisted imaging. Methods:The system was designed to improve smartphone retinal imaging by combining automated fixation guidance, photomontage, and multicolored illumination with optimized optics, user-tested ergonomics, and touch-screen interface. System performance was evaluated from images of ophthalmic patients taken by nonophthalmic personnel. Two masked ophthalmologists evaluated images for abnormalities and disease severity. Results:The system automatically generated 100° retinal photomontages from five overlapping images in under 1 minute at full resolution (52.3 pixels per retinal degree) fully on-phone, revealing numerous retinal abnormalities. Feasibility of the system for diabetic retinopathy (DR) screening using the retinal photomontages was performed in 71 diabetics by masked graders. DR grade matched perfectly with dilated clinical examination in 55.1% of eyes and within 1 severity level for 85.2% of eyes. For referral-warranted DR, average sensitivity was 93.3% and specificity 56.8%. Conclusions:Automation-assisted imaging produced high-quality, wide-field retinal images that demonstrate the potential of smartphone-based retinal cameras to be used for retinal disease screening. Translational Relevance:Enhancement of smartphone-based retinal imaging through automation and software intelligence holds great promise for increasing the accessibility of retinal screening

Weakly-supervised localization of diabetic retinopathy lesions in retinal fundus images

Convolutional neural networks (CNNs) show impressive performance for image classification and detection, extending heavily to the medical image domain. Nevertheless, medical experts are sceptical in these predictions as the nonlinear multilayer structure resulting in a classification outcome is not directly graspable. Recently, approaches have been shown which help the user to understand the discriminative regions within an image which are decisive for the CNN to conclude to a certain class. Although these approaches could help to build trust in the CNNs predictions, they are only slightly shown to work with medical image data which often poses a challenge as the decision for a class relies on different lesion areas scattered around the entire image. Using the DiaretDB1 dataset, we show that on retina images different lesion areas fundamental for diabetic retinopathy are detected on an image level with high accuracy, comparable or exceeding supervised methods. On lesion level, we achieve few false positives with high sensitivity, though, the network is solely trained on image-level labels which do not include information about existing lesions. Classifying between diseased and healthy images, we achieve an AUC of 0.954 on the DiaretDB1.Comment: Accepted in Proc. IEEE International Conference on Image Processing (ICIP), 201

Pathological Evidence Exploration in Deep Retinal Image Diagnosis

Though deep learning has shown successful performance in classifying the label and severity stage of certain disease, most of them give few evidence on how to make prediction. Here, we propose to exploit the interpretability of deep learning application in medical diagnosis. Inspired by Koch's Postulates, a well-known strategy in medical research to identify the property of pathogen, we define a pathological descriptor that can be extracted from the activated neurons of a diabetic retinopathy detector. To visualize the symptom and feature encoded in this descriptor, we propose a GAN based method to synthesize pathological retinal image given the descriptor and a binary vessel segmentation. Besides, with this descriptor, we can arbitrarily manipulate the position and quantity of lesions. As verified by a panel of 5 licensed ophthalmologists, our synthesized images carry the symptoms that are directly related to diabetic retinopathy diagnosis. The panel survey also shows that our generated images is both qualitatively and quantitatively superior to existing methods.Comment: to appear in AAAI (2019). The first two authors contributed equally to the paper. Corresponding Author: Feng L

Supervised machine learning based multi-task artificial intelligence classification of retinopathies

Artificial intelligence (AI) classification holds promise as a novel and affordable screening tool for clinical management of ocular diseases. Rural and underserved areas, which suffer from lack of access to experienced ophthalmologists may particularly benefit from this technology. Quantitative optical coherence tomography angiography (OCTA) imaging provides excellent capability to identify subtle vascular distortions, which are useful for classifying retinovascular diseases. However, application of AI for differentiation and classification of multiple eye diseases is not yet established. In this study, we demonstrate supervised machine learning based multi-task OCTA classification. We sought 1) to differentiate normal from diseased ocular conditions, 2) to differentiate different ocular disease conditions from each other, and 3) to stage the severity of each ocular condition. Quantitative OCTA features, including blood vessel tortuosity (BVT), blood vascular caliber (BVC), vessel perimeter index (VPI), blood vessel density (BVD), foveal avascular zone (FAZ) area (FAZ-A), and FAZ contour irregularity (FAZ-CI) were fully automatically extracted from the OCTA images. A stepwise backward elimination approach was employed to identify sensitive OCTA features and optimal-feature-combinations for the multi-task classification. For proof-of-concept demonstration, diabetic retinopathy (DR) and sickle cell retinopathy (SCR) were used to validate the supervised machine leaning classifier. The presented AI classification methodology is applicable and can be readily extended to other ocular diseases, holding promise to enable a mass-screening platform for clinical deployment and telemedicine.Comment: Supplemental material attached at the en