Wound Segmentation with Dynamic Illumination Correction and Dual-view Semantic Fusion

Wound image segmentation is a critical component for the clinical diagnosis and in-time treatment of wounds. Recently, deep learning has become the mainstream methodology for wound image segmentation. However, the pre-processing of the wound image, such as the illumination correction, is required before the training phase as the performance can be greatly improved. The correction procedure and the training of deep models are independent of each other, which leads to sub-optimal segmentation performance as the fixed illumination correction may not be suitable for all images. To address aforementioned issues, an end-to-end dual-view segmentation approach was proposed in this paper, by incorporating a learn-able illumination correction module into the deep segmentation models. The parameters of the module can be learned and updated during the training stage automatically, while the dual-view fusion can fully employ the features from both the raw images and the enhanced ones. To demonstrate the effectiveness and robustness of the proposed framework, the extensive experiments are conducted on the benchmark datasets. The encouraging results suggest that our framework can significantly improve the segmentation performance, compared to the state-of-the-art methods

Risk prediction analysis for post-surgical complications in cardiothoracic surgery

Cardiothoracic surgery patients have the risk of developing surgical site infections (SSIs), which causes hospital readmissions, increases healthcare costs and may lead to mortality. The first 30 days after hospital discharge are crucial for preventing these kind of infections. As an alternative to a hospital-based diagnosis, an automatic digital monitoring system can help with the early detection of SSIs by analyzing daily images of patient’s wounds. However, analyzing a wound automatically is one of the biggest challenges in medical image analysis. The proposed system is integrated into a research project called CardioFollowAI, which developed a digital telemonitoring service to follow-up the recovery of cardiothoracic surgery patients. This present work aims to tackle the problem of SSIs by predicting the existence of worrying alterations in wound images taken by patients, with the help of machine learning and deep learning algorithms. The developed system is divided into a segmentation model which detects the wound region area and categorizes the wound type, and a classification model which predicts the occurrence of alterations in the wounds. The dataset consists of 1337 images with chest wounds (WC), drainage wounds (WD) and leg wounds (WL) from 34 cardiothoracic surgery patients. For segmenting the images, an architecture with a Mobilenet encoder and an Unet decoder was used to obtain the regions of interest (ROI) and attribute the wound class. The following model was divided into three sub-classifiers for each wound type, in order to improve the model’s performance. Color and textural features were extracted from the wound’s ROIs to feed one of the three machine learning classifiers (random Forest, support vector machine and K-nearest neighbors), that predict the final output. The segmentation model achieved a final mean IoU of 89.9%, a dice coefficient of 94.6% and a mean average precision of 90.1%, showing good results. As for the algorithms that performed classification, the WL classifier exhibited the best results with a 87.6% recall and 52.6% precision, while WC classifier achieved a 71.4% recall and 36.0% precision. The WD had the worst performance with a 68.4% recall and 33.2% precision. The obtained results demonstrate the feasibility of this solution, which can be a start for preventing SSIs through image analysis with artificial intelligence.Os pacientes submetidos a uma cirurgia cardiotorácica tem o risco de desenvolver infeções no local da ferida cirúrgica, o que pode consequentemente levar a readmissões hospitalares, ao aumento dos custos na saúde e à mortalidade. Os primeiros 30 dias após a alta hospitalar são cruciais na prevenção destas infecções. Assim, como alternativa ao diagnóstico no hospital, a utilização diária de um sistema digital e automático de monotorização em imagens de feridas cirúrgicas pode ajudar na precoce deteção destas infeções. No entanto, a análise automática de feridas é um dos grandes desafios em análise de imagens médicas. O sistema proposto integra um projeto de investigação designado CardioFollow.AI, que desenvolveu um serviço digital de telemonitorização para realizar o follow-up da recuperação dos pacientes de cirurgia cardiotorácica. Neste trabalho, o problema da infeção de feridas cirúrgicas é abordado, através da deteção de alterações preocupantes na ferida com ajuda de algoritmos de aprendizagem automática. O sistema desenvolvido divide-se num modelo de segmentação, que deteta a região da ferida e a categoriza consoante o seu tipo, e num modelo de classificação que prevê a existência de alterações na ferida. O conjunto de dados consistiu em 1337 imagens de feridas do peito (WC), feridas dos tubos de drenagem (WD) e feridas da perna (WL), provenientes de 34 pacientes de cirurgia cardiotorácica. A segmentação de imagem foi realizada através da combinação de Mobilenet como codificador e Unet como decodificador, de forma a obter-se as regiões de interesse e atribuir a classe da ferida. O modelo seguinte foi dividido em três subclassificadores para cada tipo de ferida, de forma a melhorar a performance do modelo. Caraterísticas de cor e textura foram extraídas da região da ferida para serem introduzidas num dos modelos de aprendizagem automática de forma a prever a classificação final (Random Forest, Support Vector Machine and K-Nearest Neighbors). O modelo de segmentação demonstrou bons resultados ao obter um IoU médio final de 89.9%, um dice de 94.6% e uma média de precisão de 90.1%. Relativamente aos algoritmos que realizaram a classificação, o classificador WL exibiu os melhores resultados com 87.6% de recall e 62.6% de precisão, enquanto o classificador das WC conseguiu um recall de 71.4% e 36.0% de precisão. Por fim, o classificador das WD teve a pior performance com um recall de 68.4% e 33.2% de precisão. Os resultados obtidos demonstram a viabilidade desta solução, que constitui o início da prevenção de infeções em feridas cirúrgica a partir da análise de imagem, com recurso a inteligência artificial

Image Analysis System for Early Detection of Cardiothoracic Surgery Wound Alterations Based on Artificial Intelligence Models

Funding Information: This work is part of a research project funded by Fundação para a Ciência e Tecnologia, which aims to design and implement a post-surgical digital telemonitoring service for cardiothoracic surgery patients. The main goals of the research project are: to study the impact of daily telemonitoring on early diagnosis, to reduce hospital readmissions, and to improve patient safety, during the 30-day period after hospital discharge. This remote follow-up involves a digital remote patient monitoring kit which includes a sphygmomanometer, a scale, a smartwatch, and a smartphone, allowing daily patient data collection. One of the daily outcomes was the daily photographs taken by patients regarding surgical wounds. Every day, the clinical team had to analyze the image of each patient, which could take a long time. The automatic analysis of these images would allow implementing an alert related to the detection of wound modifications that could represent a risk of infection. Such an alert would spare time for the clinical team in follow-up care. Funding Information: This research has been supported by Fundação para a Ciência e Tecnologia (FCT) under CardioFollow.AI project (DSAIPA/AI/0094/2020), Lisboa-05-3559-FSE-000003 and UIDB/04559/2020. Publisher Copyright: © 2023 by the authors.Cardiothoracic surgery patients have the risk of developing surgical site infections which cause hospital readmissions, increase healthcare costs, and may lead to mortality. This work aims to tackle the problem of surgical site infections by predicting the existence of worrying alterations in wound images with a wound image analysis system based on artificial intelligence. The developed system comprises a deep learning segmentation model (MobileNet-Unet), which detects the wound region area and categorizes the wound type (chest, drain, and leg), and a machine learning classification model, which predicts the occurrence of wound alterations (random forest, support vector machine and k-nearest neighbors for chest, drain, and leg, respectively). The deep learning model segments the image and assigns the wound type. Then, the machine learning models classify the images from a group of color and textural features extracted from the output region of interest to feed one of the three wound-type classifiers that reach the final binary decision of wound alteration. The segmentation model achieved a mean Intersection over Union of 89.9% and a mean average precision of 90.1%. Separating the final classification into different classifiers was more effective than a single classifier for all the wound types. The leg wound classifier exhibited the best results with an 87.6% recall and 52.6% precision.publishersversionpublishe

Simultaneous Wound Border Segmentation and Tissue Classification Using a Conditional Generative Adversarial Network

Generative adversarial network (GAN) applications on medical image synthesis have the potential to assist caregivers in deciding a proper chronic wound treatment plan by understanding the border segmentation and the wound tissue classification visually. This study proposes a hybrid wound border segmentation and tissue classification method utilising conditional GAN, which can mimic real data without expert knowledge. We trained the network on chronic wound datasets with different sizes. The performance of the GAN algorithm is evaluated through the mean squared error, Dice coefficient metrics and visual inspection of generated images. This study also analyses the optimum number of training images as well as the number of epochs using GAN for wound border segmentation and tissue classification. The results show that the proposed GAN model performs efficiently for wound border segmentation and tissue classification tasks with a set of 2000 images at 200 epochs

Imparting 3D representations to artificial intelligence for a full assessment of pressure injuries.

During recent decades, researches have shown great interest to machine learning techniques in order to extract meaningful information from the large amount of data being collected each day. Especially in the medical field, images play a significant role in the detection of several health issues. Hence, medical image analysis remarkably participates in the diagnosis process and it is considered a suitable environment to interact with the technology of intelligent systems. Deep Learning (DL) has recently captured the interest of researchers as it has proven to be efficient in detecting underlying features in the data and outperformed the classical machine learning methods. The main objective of this dissertation is to prove the efficiency of Deep Learning techniques in tackling one of the important health issues we are facing in our society, through medical imaging. Pressure injuries are a dermatology related health issue associated with increased morbidity and health care costs. Managing pressure injuries appropriately is increasingly important for all the professionals in wound care. Using 2D photographs and 3D meshes of these wounds, collected from collaborating hospitals, our mission is to create intelligent systems for a full non-intrusive assessment of these wounds. Five main tasks have been achieved in this study: a literature review of wound imaging methods using machine learning techniques, the classification and segmentation of the tissue types inside the pressure injury, the segmentation of these wounds and the design of an end-to-end system which measures all the necessary quantitative information from 3D meshes for an efficient assessment of PIs, and the integration of the assessment imaging techniques in a web-based application

A Survey on Deep Learning in Medical Image Analysis

Deep learning algorithms, in particular convolutional networks, have rapidly become a methodology of choice for analyzing medical images. This paper reviews the major deep learning concepts pertinent to medical image analysis and summarizes over 300 contributions to the field, most of which appeared in the last year. We survey the use of deep learning for image classification, object detection, segmentation, registration, and other tasks and provide concise overviews of studies per application area. Open challenges and directions for future research are discussed.Comment: Revised survey includes expanded discussion section and reworked introductory section on common deep architectures. Added missed papers from before Feb 1st 201

Nuclei & Glands Instance Segmentation in Histology Images: A Narrative Review

Instance segmentation of nuclei and glands in the histology images is an important step in computational pathology workflow for cancer diagnosis, treatment planning and survival analysis. With the advent of modern hardware, the recent availability of large-scale quality public datasets and the community organized grand challenges have seen a surge in automated methods focusing on domain specific challenges, which is pivotal for technology advancements and clinical translation. In this survey, 126 papers illustrating the AI based methods for nuclei and glands instance segmentation published in the last five years (2017-2022) are deeply analyzed, the limitations of current approaches and the open challenges are discussed. Moreover, the potential future research direction is presented and the contribution of state-of-the-art methods is summarized. Further, a generalized summary of publicly available datasets and a detailed insights on the grand challenges illustrating the top performing methods specific to each challenge is also provided. Besides, we intended to give the reader current state of existing research and pointers to the future directions in developing methods that can be used in clinical practice enabling improved diagnosis, grading, prognosis, and treatment planning of cancer. To the best of our knowledge, no previous work has reviewed the instance segmentation in histology images focusing towards this direction.Comment: 60 pages, 14 figure

Bimodal automated carotid ultrasound segmentation using geometrically constrained deep neural networks

For asymptomatic patients suffering from carotid stenosis, the assessment of plaque morphology is an important clinical task which allows monitoring of the risk of plaque rupture and future incidents of stroke. Ultrasound Imaging provides a safe and non-invasive modality for this, and the segmentation of media-adventitia boundaries and lumen-intima boundaries of the Carotid artery form an essential part in this monitoring process. In this paper, we propose a novel Deep Neural Network as a fully automated segmentation tool, and its application in delineating both the media-adventitia boundary and the lumen-intima boundary. We develop a new geometrically constrained objective function as part of the Network's Stochastic Gradient Descent optimisation, thus tuning it to the problem at hand. Furthermore, we also apply a bimodal fusion of amplitude and phase congruency data proposed by us in previous work, as an input to the network, as the latter provides an intensity-invariant data source to the network. We finally report the segmentation performance of the network on transverse sections of the carotid. Tests are carried out on an augmented dataset of 81,000 images, and the results are compared to other studies by reporting the DICE coefficient of similarity, modified Hausdorff Distance, sensitivity and specificity. Our proposed modification is shown to yield improved results on the standard network over this larger dataset, with the advantage of it being fully automated. We conclude that Deep Neural Networks provide a reliable trained manner in which carotid ultrasound images may be automatically segmented, using amplitude data and intensity invariant phase congruency maps as a data source