Symbiotic deep learning for medical image analysis with applications in real-time diagnosis for fetal ultrasound screening

The last hundred years have seen a monumental rise in the power and capability of machines to perform intelligent tasks in the stead of previously human operators. This rise is not expected to slow down any time soon and what this means for society and humanity as a whole remains to be seen. The overwhelming notion is that with the right goals in mind, the growing influence of machines on our every day tasks will enable humanity to give more attention to the truly groundbreaking challenges that we all face together. This will usher in a new age of human machine collaboration in which humans and machines may work side by side to achieve greater heights for all of humanity. Intelligent systems are useful in isolation, but the true benefits of intelligent systems come to the fore in complex systems where the interaction between humans and machines can be made seamless, and it is this goal of symbiosis between human and machine that may democratise complex knowledge, which motivates this thesis. In the recent past, datadriven methods have come to the fore and now represent the state-of-the-art in many different fields. Alongside the shift from rule-based towards data-driven methods we have also seen a shift in how humans interact with these technologies. Human computer interaction is changing in response to data-driven methods and new techniques must be developed to enable the same symbiosis between man and machine for data-driven methods as for previous formula-driven technology. We address five key challenges which need to be overcome for data-driven human-in-the-loop computing to reach maturity. These are (1) the ’Categorisation Challenge’ where we examine existing work and form a taxonomy of the different methods being utilised for data-driven human-in-the-loop computing; (2) the ’Confidence Challenge’, where data-driven methods must communicate interpretable beliefs in how confident their predictions are; (3) the ’Complexity Challenge’ where the aim of reasoned communication becomes increasingly important as the complexity of tasks and methods to solve also increases; (4) the ’Classification Challenge’ in which we look at how complex methods can be separated in order to provide greater reasoning in complex classification tasks; and finally (5) the ’Curation Challenge’ where we challenge the assumptions around bottleneck creation for the development of supervised learning methods.Open Acces

Motion robust acquisition and reconstruction of quantitative T2* maps in the developing brain

The goal of the research presented in this thesis was to develop methods for quantitative T2* mapping of the developing brain. Brain maturation in the early period of life involves complex structural and physiological changes caused by synaptogenesis, myelination and growth of cells. Molecular structures and biological processes give rise to varying levels of T2* relaxation time, which is an inherent contrast mechanism in magnetic resonance imaging. The knowledge of T2* relaxation times in the brain can thus help with evaluation of pathology by establishing its normative values in the key areas of the brain. T2* relaxation values are a valuable biomarker for myelin microstructure and iron concentration, as well as an important guide towards achievement of optimal fMRI contrast. However, fetal MR imaging is a significant step up from neonatal or adult MR imaging due to the complexity of the acquisition and reconstruction techniques that are required to provide high quality artifact-free images in the presence of maternal respiration and unpredictable fetal motion. The first contribution of this thesis, described in Chapter 4, presents a novel acquisition method for measurement of fetal brain T2* values. At the time of publication, this was the first study of fetal brain T2* values. Single shot multi-echo gradient echo EPI was proposed as a rapid method for measuring fetal T2* values by effectively freezing intra-slice motion. The study concluded that fetal T2* values are higher than those previously reported for pre-term neonates and decline with a consistent trend across gestational age. The data also suggested that longer than usual echo times or direct T2* measurement should be considered when performing fetal fMRI in order to reach optimal BOLD sensitivity. For the second contribution, described in Chapter 5, measurements were extended to a higher field strength of 3T and reported, for the first time, both for fetal and neonatal subjects at this field strength. The technical contribution of this work is a fully automatic segmentation framework that propagates brain tissue labels onto the acquired T2* maps without the need for manual intervention. The third contribution, described in Chapter 6, proposed a new method for performing 3D fetal brain reconstruction where the available data is sparse and is therefore limited in the use of current state of the art techniques for 3D brain reconstruction in the presence of motion. To enable a high resolution reconstruction, a generative adversarial network was trained to perform image to image translation between T2 weighted and T2* weighted data. Translated images could then be served as a prior for slice alignment and super resolution reconstruction of 3D brain image.Open Acces

Going Deep in Medical Image Analysis: Concepts, Methods, Challenges and Future Directions

Medical Image Analysis is currently experiencing a paradigm shift due to Deep Learning. This technology has recently attracted so much interest of the Medical Imaging community that it led to a specialized conference in `Medical Imaging with Deep Learning' in the year 2018. This article surveys the recent developments in this direction, and provides a critical review of the related major aspects. We organize the reviewed literature according to the underlying Pattern Recognition tasks, and further sub-categorize it following a taxonomy based on human anatomy. This article does not assume prior knowledge of Deep Learning and makes a significant contribution in explaining the core Deep Learning concepts to the non-experts in the Medical community. Unique to this study is the Computer Vision/Machine Learning perspective taken on the advances of Deep Learning in Medical Imaging. This enables us to single out `lack of appropriately annotated large-scale datasets' as the core challenge (among other challenges) in this research direction. We draw on the insights from the sister research fields of Computer Vision, Pattern Recognition and Machine Learning etc.; where the techniques of dealing with such challenges have already matured, to provide promising directions for the Medical Imaging community to fully harness Deep Learning in the future

Advanced Sensing and Image Processing Techniques for Healthcare Applications

This Special Issue aims to attract the latest research and findings in the design, development and experimentation of healthcare-related technologies. This includes, but is not limited to, using novel sensing, imaging, data processing, machine learning, and artificially intelligent devices and algorithms to assist/monitor the elderly, patients, and the disabled population

Online Super-Resolution For Fibre-Bundle-Based Confocal Laser Endomicroscopy

Probe-based Confocal Laser Endomicroscopy (pCLE) produces microscopic images enabling real-time in vivo optical biopsy. However, the miniaturisation of the optical hardware, specifically the reliance on an optical fibre bundle as an imaging guide, fundamentally limits image quality by producing artefacts, noise, and relatively low contrast and resolution. The reconstruction approaches in clinical pCLE products do not fully alleviate these problems. Consequently, image quality remains a barrier that curbs the full potential of pCLE. Enhancing the image quality of pCLE in real-time remains a challenge. The research in this thesis is a response to this need. I have developed dedicated online super-resolution methods that account for the physics of the image acquisition process. These methods have the potential to replace existing reconstruction algorithms without interfering with the fibre design or the hardware of the device. In this thesis, novel processing pipelines are proposed for enhancing the image quality of pCLE. First, I explored a learning-based super-resolution method that relies on mapping from the low to the high-resolution space. Due to the lack of high-resolution pCLE, I proposed to simulate high-resolution data and use it as a ground truth model that is based on the pCLE acquisition physics. However, pCLE images are reconstructed from irregularly distributed fibre signals, and grid-based Convolutional Neural Networks are not designed to take irregular data as input. To alleviate this problem, I designed a new trainable layer that embeds Nadaraya- Watson regression. Finally, I proposed a novel blind super-resolution approach by deploying unsupervised zero-shot learning accompanied by a down-sampling kernel crafted for pCLE. I evaluated these new methods in two ways: a robust image quality assessment and a perceptual quality test assessed by clinical experts. The results demonstrate that the proposed super-resolution pipelines are superior to the current reconstruction algorithm in terms of image quality and clinician preference

Generative Adversarial Network (GAN) for Medical Image Synthesis and Augmentation

Medical image processing aided by artificial intelligence (AI) and machine learning (ML) significantly improves medical diagnosis and decision making. However, the difficulty to access well-annotated medical images becomes one of the main constraints on further improving this technology. Generative adversarial network (GAN) is a DNN framework for data synthetization, which provides a practical solution for medical image augmentation and translation. In this study, we first perform a quantitative survey on the published studies on GAN for medical image processing since 2017. Then a novel adaptive cycle-consistent adversarial network (Ad CycleGAN) is proposed. We respectively use a malaria blood cell dataset (19,578 images) and a COVID-19 chest X-ray dataset (2,347 images) to test the new Ad CycleGAN. The quantitative metrics include mean squared error (MSE), root mean squared error (RMSE), peak signal-to-noise ratio (PSNR), universal image quality index (UIQI), spatial correlation coefficient (SCC), spectral angle mapper (SAM), visual information fidelity (VIF), Frechet inception distance (FID), and the classification accuracy of the synthetic images. The CycleGAN and variant autoencoder (VAE) are also implemented and evaluated as comparison. The experiment results on malaria blood cell images indicate that the Ad CycleGAN generates more valid images compared to CycleGAN or VAE. The synthetic images by Ad CycleGAN or CycleGAN have better quality than those by VAE. The synthetic images by Ad CycleGAN have the highest accuracy of 99.61%. In the experiment on COVID-19 chest X-ray, the synthetic images by Ad CycleGAN or CycleGAN have higher quality than those generated by variant autoencoder (VAE). However, the synthetic images generated through the homogenous image augmentation process have better quality than those synthesized through the image translation process. The synthetic images by Ad CycleGAN have higher accuracy of 95.31% compared to the accuracy of the images by CycleGAN of 93.75%. In conclusion, the proposed Ad CycleGAN provides a new path to synthesize medical images with desired diagnostic or pathological patterns. It is considered a new approach of conditional GAN with effective control power upon the synthetic image domain. The findings offer a new path to improve the deep neural network performance in medical image processing

A novel approach to monitor tissue oxygen saturation with broadband near-infrared spectroscopy

Cerebral oximetry is the measurement of tissue oxygen saturation, StO2, with near-infrared spectroscopy (NIRS). The technique offers a non-invasive assessment of cerebral oxygenation and has potential to be used as a biomarker in neonatal critical care, particularly hypoxic-ischaemic-encephalopathy (HIE). HIE is a major cause of neonatal mortality and affected neonates need continuous cerebral monitoring to guide treatment and improve patient outcome. While multiple algorithms to recover StO2 have been published, issues with low measurement accuracy or extracranial tissue signal contamination remain. This thesis is focused on the exploration of recovering StO2 from continuous-wave broadband NIRS measurements with the aim to develop a novel algorithm to recover StO2 with increased dynamic range and depth resolution. The novel algorithm, broadband multidistance oximetry (BRUNO), recovers StO2 from a broadband multidistance measurement of the attenuation slope against distance. BRUNO combines and expands two other StO2 algorithms, spatially resolved spectroscopy (SRS) and broadband fitting (BF). The evaluation of algorithm performance was done in data obtained in computational simulations and phantoms. The median error of brain StO2 recovered in simulations of brain and extracerebral tissue oxygenation changes was 1.1% with BRUNO, 2.3% with BF and 3.8% with SRS. Measurements during full oxygenation-deoxygenation cycles in a homogeneous blood phantom showed differences in the dynamic range of the algorithms; BRUNO recovered StO2 over 0–100%, BF over 0–90% and SRS over 40–80%. These results show higher accuracy of BRUNO StO2, higher sensitivity to brain oxygenation and wider dynamic range. Measurements of StO2 in one neonate with HIE showed that the StO2 algorithms led to different baseline values. Including an automated data assessment step in BRUNO to evaluate the suitability of collected spectra for analysis ensured BRUNO reliability. These findings highlight the effect of StO2 algorithm selection on oxygenation recovery; applying BRUNO in the clinical care setting could reveal further insight into complex oxygenation processes occurring during neonatal brain injury