Mehdi Moradi

Gaurang Karwande, Amarachi Mbakawe, Joy T. Wu et al. · ibm-research

Despite the progress in utilizing deep learning to automate chest radiograph interpretation and disease diagnosis tasks, change between sequential Chest X-rays (CXRs) has received limited attention. Monitoring the progression of pathologies that are visualized through chest imaging poses several challenges in anatomical motion estimation and image registration, i.e., spatially aligning the two images and modeling temporal dynamics in change detection. In this work, we propose CheXRelNet, a neural model that can track longitudinal pathology change relations between two CXRs. CheXRelNet incorporates local and global visual features, utilizes inter-image and intra-image anatomical information, and learns dependencies between anatomical region attributes, to accurately predict disease change for a pair of CXRs. Experimental results on the Chest ImaGenome dataset show increased downstream performance compared to baselines. Code is available at https://github.com/PLAN-Lab/ChexRelNet

Ashutosh Jadhav, Satyananda Kashyap, Hakan Bulu et al. · ibm-research

Intrasaccular flow disruptors treat cerebral aneurysms by diverting the blood flow from the aneurysm sac. Residual flow into the sac after the intervention is a failure that could be due to the use of an undersized device, or to vascular anatomy and clinical condition of the patient. We report a machine learning model based on over 100 clinical and imaging features that predict the outcome of wide-neck bifurcation aneurysm treatment with an intravascular embolization device. We combine clinical features with a diverse set of common and novel imaging measurements within a random forest model. We also develop neural network segmentation algorithms in 2D and 3D to contour the sac in angiographic images and automatically calculate the imaging features. These deliver 90% overlap with manual contouring in 2D and 83% in 3D. Our predictive model classifies complete vs. partial occlusion outcomes with an accuracy of 75.31%, and weighted F1-score of 0.74.

Tanveer Syeda-Mahmood, Hassan M. Ahmad, Nadeem Ansari et al.

Chest X-rays are the most common diagnostic exams in emergency rooms and hospitals. There has been a surge of work on automatic interpretation of chest X-rays using deep learning approaches after the availability of large open source chest X-ray dataset from NIH. However, the labels are not sufficiently rich and descriptive for training classification tools. Further, it does not adequately address the findings seen in Chest X-rays taken in anterior-posterior (AP) view which also depict the placement of devices such as central vascular lines and tubes. In this paper, we present a new chest X-ray benchmark database of 73 rich sentence-level descriptors of findings seen in AP chest X-rays. We describe our method of obtaining these findings through a semi-automated ground truth generation process from crowdsourcing of clinician annotations. We also present results of building classifiers for these findings that show that such higher granularity labels can also be learned through the framework of deep learning classifiers.

Ken C. L. Wong, Mehdi Moradi

The convolutional layer and loss function are two fundamental components in deep learning. Because of the success of conventional deep learning kernels, the less versatile Gabor kernels become less popular despite the fact that they can provide abundant features at different frequencies, orientations, and scales with much fewer parameters. For existing loss functions for multi-class image segmentation, there is usually a tradeoff among accuracy, robustness to hyperparameters, and manual weight selections for combining different losses. Therefore, to gain the benefits of using Gabor kernels while keeping the advantage of automatic feature generation in deep learning, we propose a fully trainable Gabor-based convolutional layer where all Gabor parameters are trainable through backpropagation. Furthermore, we propose a loss function based on the Pearson's correlation coefficient, which is accurate, robust to learning rates, and does not require manual weight selections. Experiments on 43 3D brain magnetic resonance images with 19 anatomical structures show that, using the proposed loss function with a proper combination of conventional and Gabor-based kernels, we can train a network with only 1.6 million parameters to achieve an average Dice coefficient of 83%. This size is 44 times smaller than the original V-Net which has 71 million parameters. This paper demonstrates the potentials of using learnable parametric kernels in deep learning for 3D segmentation.

Ken C. L. Wong, Satyananda Kashyap, Mehdi Moradi

Network-based transfer learning allows the reuse of deep learning features with limited data, but the resulting models can be unnecessarily large. Although network pruning can improve inference efficiency, existing algorithms usually require fine-tuning that may not be suitable for small datasets. In this paper, using the singular value decomposition, we decompose a convolutional layer into two layers: a convolutional layer with the orthonormal basis vectors as the filters, and a "BasisScalingConv" layer which is responsible for rescaling the features and transforming them back to the original space. As the filters in each decomposed layer are linearly independent, when using the proposed basis scaling factors with the Taylor approximation of importance, pruning can be more effective and fine-tuning individual weights is unnecessary. Furthermore, as the numbers of input and output channels of the original convolutional layer remain unchanged after basis pruning, it is applicable to virtually all architectures and can be combined with existing pruning algorithms for double pruning to further increase the pruning capability. When transferring knowledge from ImageNet pre-trained models to different target domains, with less than 1% reduction in classification accuracies, we can achieve pruning ratios up to 74.6% for CIFAR-10 and 98.9% for MNIST in model parameters.

Joy T. Wu, Nkechinyere N. Agu, Ismini Lourentzou et al.

Despite the progress in automatic detection of radiologic findings from chest X-ray (CXR) images in recent years, a quantitative evaluation of the explainability of these models is hampered by the lack of locally labeled datasets for different findings. With the exception of a few expert-labeled small-scale datasets for specific findings, such as pneumonia and pneumothorax, most of the CXR deep learning models to date are trained on global "weak" labels extracted from text reports, or trained via a joint image and unstructured text learning strategy. Inspired by the Visual Genome effort in the computer vision community, we constructed the first Chest ImaGenome dataset with a scene graph data structure to describe $242,072$ images. Local annotations are automatically produced using a joint rule-based natural language processing (NLP) and atlas-based bounding box detection pipeline. Through a radiologist constructed CXR ontology, the annotations for each CXR are connected as an anatomy-centered scene graph, useful for image-level reasoning and multimodal fusion applications. Overall, we provide: i) $1,256$ combinations of relation annotations between $29$ CXR anatomical locations (objects with bounding box coordinates) and their attributes, structured as a scene graph per image, ii) over $670,000$ localized comparison relations (for improved, worsened, or no change) between the anatomical locations across sequential exams, as well as ii) a manually annotated gold standard scene graph dataset from $500$ unique patients.

Nkechinyere N. Agu, Joy T. Wu, Hanqing Chao et al.

Radiologists usually observe anatomical regions of chest X-ray images as well as the overall image before making a decision. However, most existing deep learning models only look at the entire X-ray image for classification, failing to utilize important anatomical information. In this paper, we propose a novel multi-label chest X-ray classification model that accurately classifies the image finding and also localizes the findings to their correct anatomical regions. Specifically, our model consists of two modules, the detection module and the anatomical dependency module. The latter utilizes graph convolutional networks, which enable our model to learn not only the label dependency but also the relationship between the anatomical regions in the chest X-ray. We further utilize a method to efficiently create an adjacency matrix for the anatomical regions using the correlation of the label across the different regions. Detailed experiments and analysis of our results show the effectiveness of our method when compared to the current state-of-the-art multi-label chest X-ray image classification methods while also providing accurate location information.

Ken C. L. Wong, Satyananda Kashyap, Mehdi Moradi

Transfer learning with pre-trained neural networks is a common strategy for training classifiers in medical image analysis. Without proper channel selections, this often results in unnecessarily large models that hinder deployment and explainability. In this paper, we propose a novel approach to efficiently build small and well performing networks by introducing the channel-scaling layers. A channel-scaling layer is attached to each frozen convolutional layer, with the trainable scaling weights inferring the importance of the corresponding feature channels. Unlike the fine-tuning approaches, we maintain the weights of the original channels and large datasets are not required. By imposing L1 regularization and thresholding on the scaling weights, this framework iteratively removes unnecessary feature channels from a pre-trained model. Using an ImageNet pre-trained VGG16 model, we demonstrate the capabilities of the proposed framework on classifying opacity from chest X-ray images. The results show that we can reduce the number of parameters by 95% while delivering a superior performance.

Ottmar Cronie, Mehdi Moradi, Christophe A. N. Biscio

This paper presents the first general (supervised) statistical learning framework for point processes in general spaces. Our approach is based on the combination of two new concepts, which we define in the paper: i) bivariate innovations, which are measures of discrepancy/prediction-accuracy between two point processes, and ii) point process cross-validation (CV), which we here define through point process thinning. The general idea is to carry out the fitting by predicting CV-generated validation sets using the corresponding training sets; the prediction error, which we minimise, is measured by means of bivariate innovations. Having established various theoretical properties of our bivariate innovations, we study in detail the case where the CV procedure is obtained through independent thinning and we apply our statistical learning methodology to three typical spatial statistical settings, namely parametric intensity estimation, non-parametric intensity estimation and Papangelou conditional intensity fitting. Aside from deriving theoretical properties related to these cases, in each of them we numerically show that our statistical learning approach outperforms the state of the art in terms of mean (integrated) squared error.

Alexandros Karargyris, Satyananda Kashyap, Ismini Lourentzou et al.

We developed a rich dataset of Chest X-Ray (CXR) images to assist investigators in artificial intelligence. The data were collected using an eye tracking system while a radiologist reviewed and reported on 1,083 CXR images. The dataset contains the following aligned data: CXR image, transcribed radiology report text, radiologist's dictation audio and eye gaze coordinates data. We hope this dataset can contribute to various areas of research particularly towards explainable and multimodal deep learning / machine learning methods. Furthermore, investigators in disease classification and localization, automated radiology report generation, and human-machine interaction can benefit from these data. We report deep learning experiments that utilize the attention maps produced by eye gaze dataset to show the potential utility of this data.

Sandesh Ghimire, Satyananda Kashyap, Joy T. Wu et al.

Chest radiography is the most common medical image examination for screening and diagnosis in hospitals. Automatic interpretation of chest X-rays at the level of an entry-level radiologist can greatly benefit work prioritization and assist in analyzing a larger population. Subsequently, several datasets and deep learning-based solutions have been proposed to identify diseases based on chest X-ray images. However, these methods are shown to be vulnerable to shift in the source of data: a deep learning model performing well when tested on the same dataset as training data, starts to perform poorly when it is tested on a dataset from a different source. In this work, we address this challenge of generalization to a new source by forcing the network to learn a source-invariant representation. By employing an adversarial training strategy, we show that a network can be forced to learn a source-invariant representation. Through pneumonia-classification experiments on multi-source chest X-ray datasets, we show that this algorithm helps in improving classification accuracy on a new source of X-ray dataset.

Satyananda Kashyap, Alexandros Karargyris, Joy Wu et al.

Deep learning has now become the de facto approach to the recognition of anomalies in medical imaging. Their 'black box' way of classifying medical images into anomaly labels poses problems for their acceptance, particularly with clinicians. Current explainable AI methods offer justifications through visualizations such as heat maps but cannot guarantee that the network is focusing on the relevant image region fully containing the anomaly. In this paper, we develop an approach to explainable AI in which the anomaly is assured to be overlapping the expected location when present. This is made possible by automatically extracting location-specific labels from textual reports and learning the association of expected locations to labels using a hybrid combination of Bi-Directional Long Short-Term Memory Recurrent Neural Networks (Bi-LSTM) and DenseNet-121. Use of this expected location to bias the subsequent attention-guided inference network based on ResNet101 results in the isolation of the anomaly at the expected location when present. The method is evaluated on a large chest X-ray dataset.

Tanveer Syeda-Mahmood, Ken C. L. Wong, Yaniv Gur et al.

Obtaining automated preliminary read reports for common exams such as chest X-rays will expedite clinical workflows and improve operational efficiencies in hospitals. However, the quality of reports generated by current automated approaches is not yet clinically acceptable as they cannot ensure the correct detection of a broad spectrum of radiographic findings nor describe them accurately in terms of laterality, anatomical location, severity, etc. In this work, we present a domain-aware automatic chest X-ray radiology report generation algorithm that learns fine-grained description of findings from images and uses their pattern of occurrences to retrieve and customize similar reports from a large report database. We also develop an automatic labeling algorithm for assigning such descriptors to images and build a novel deep learning network that recognizes both coarse and fine-grained descriptions of findings. The resulting report generation algorithm significantly outperforms the state of the art using established score metrics.

Ken C. L. Wong, Mehdi Moradi

Deep learning has largely reduced the need for manual feature selection in image segmentation. Nevertheless, network architecture optimization and hyperparameter tuning are mostly manual and time consuming. Although there are increasing research efforts on network architecture search in computer vision, most works concentrate on image classification but not segmentation, and there are very limited efforts on medical image segmentation especially in 3D. To remedy this, here we propose a framework, SegNAS3D, for network architecture search of 3D image segmentation. In this framework, a network architecture comprises interconnected building blocks that consist of operations such as convolution and skip connection. By representing the block structure as a learnable directed acyclic graph, hyperparameters such as the number of feature channels and the option of using deep supervision can be learned together through derivative-free global optimization. Experiments on 43 3D brain magnetic resonance images with 19 structures achieved an average Dice coefficient of 82%. Each architecture search required less than three days on three GPUs and produced architectures that were much smaller than the state-of-the-art manually created architectures.

Alexandros Karargyris, Ken C. L. Wong, Joy T. Wu et al.

In many screening applications, the primary goal of a radiologist or assisting artificial intelligence is to rule out certain findings. The classifiers built for such applications are often trained on large datasets that derive labels from clinical notes written for patients. While the quality of the positive findings described in these notes is often reliable, lack of the mention of a finding does not always rule out the presence of it. This happens because radiologists comment on the patient in the context of the exam, for example focusing on trauma as opposed to chronic disease at emergency rooms. However, this disease finding ambiguity can affect the performance of algorithms. Hence it is critical to model the ambiguity during training. We propose a scheme to apply reasonable class weight modifiers to our loss function for the no mention cases during training. We experiment with two different deep neural network architectures and show that the proposed method results in a large improvement in the performance of the classifiers, specially on negated findings. The baseline performance of a custom-made dilated block network proposed in this paper shows an improvement in comparison with baseline DenseNet-201, while both architectures benefit from the new proposed loss function weighting scheme. Over 200,000 chest X-ray images and three highly common diseases, along with their negated counterparts, are included in this study.

Ken C. L. Wong, Mehdi Moradi, Joy Wu et al.

Chest X-rays (CXRs) are among the most commonly used medical image modalities. They are mostly used for screening, and an indication of disease typically results in subsequent tests. As this is mostly a screening test used to rule out chest abnormalities, the requesting clinicians are often interested in whether a CXR is normal or not. A machine learning algorithm that can accurately screen out even a small proportion of the "real normal" exams out of all requested CXRs would be highly beneficial in reducing the workload for radiologists. In this work, we report a deep neural network trained for classifying CXRs with the goal of identifying a large number of normal (disease-free) images without risking the discharge of sick patients. We use an ImageNet-pretrained Inception-ResNet-v2 model to provide the image features, which are further used to train a model on CXRs labelled by expert radiologists. The probability threshold for classification is optimized for 100% precision for the normal class, ensuring no sick patients are released. At this threshold we report an average recall of 50%. This means that the proposed solution has the potential to cut in half the number of disease-free CXRs examined by radiologists, without risking the discharge of sick patients.

Alexandros Karargyris, Satyananda Kashyap, Joy T Wu et al.

Age prediction based on appearances of different anatomies in medical images has been clinically explored for many decades. In this paper, we used deep learning to predict a persons age on Chest X-Rays. Specifically, we trained a CNN in regression fashion on a large publicly available dataset. Moreover, for interpretability, we explored activation maps to identify which areas of a CXR image are important for the machine (i.e. CNN) to predict a patients age, offering insight. Overall, amongst correctly predicted CXRs, we see areas near the clavicles, shoulders, spine, and mediastinum being most activated for age prediction, as one would expect biologically. Amongst incorrectly predicted CXRs, we have qualitatively identified disease patterns that could possibly make the anatomies appear older or younger than expected. A further technical and clinical evaluation would improve this work. As CXR is the most commonly requested imaging exam, a potential use case for estimating age may be found in the preventative counseling of patient health status compared to their age-expected average, particularly when there is a large discrepancy between predicted age and the real patient age.

Mehdi Moradi, Ali Madani, Yaniv Gur et al.

Medical image analysis practitioners have embraced big data methodologies. This has created a need for large annotated datasets. The source of big data is typically large image collections and clinical reports recorded for these images. In many cases, however, building algorithms aimed at segmentation and detection of disease requires a training dataset with markings of the areas of interest on the image that match with the described anomalies. This process of annotation is expensive and needs the involvement of clinicians. In this work we propose two separate deep neural network architectures for automatic marking of a region of interest (ROI) on the image best representing a finding location, given a textual report or a set of keywords. One architecture consists of LSTM and CNN components and is trained end to end with images, matching text, and markings of ROIs for those images. The output layer estimates the coordinates of the vertices of a polygonal region. The second architecture uses a network pre-trained on a large dataset of the same image types for learning feature representations of the findings of interest. We show that for a variety of findings from chest X-ray images, both proposed architectures learn to estimate the ROI, as validated by clinical annotations. There is a clear advantage obtained from the architecture with pre-trained imaging network. The centroids of the ROIs marked by this network were on average at a distance equivalent to 5.1% of the image width from the centroids of the ground truth ROIs.

Ken C. L. Wong, Mehdi Moradi, Hui Tang et al.

With the introduction of fully convolutional neural networks, deep learning has raised the benchmark for medical image segmentation on both speed and accuracy, and different networks have been proposed for 2D and 3D segmentation with promising results. Nevertheless, most networks only handle relatively small numbers of labels (<10), and there are very limited works on handling highly unbalanced object sizes especially in 3D segmentation. In this paper, we propose a network architecture and the corresponding loss function which improve segmentation of very small structures. By combining skip connections and deep supervision with respect to the computational feasibility of 3D segmentation, we propose a fast converging and computationally efficient network architecture for accurate segmentation. Furthermore, inspired by the concept of focal loss, we propose an exponential logarithmic loss which balances the labels not only by their relative sizes but also by their segmentation difficulties. We achieve an average Dice coefficient of 82% on brain segmentation with 20 labels, with the ratio of the smallest to largest object sizes as 0.14%. Less than 100 epochs are required to reach such accuracy, and segmenting a 128x128x128 volume only takes around 0.4 s.

Ken C. L. Wong, Tanveer Syeda-Mahmood, Mehdi Moradi

Deep learning has shown promising results in medical image analysis, however, the lack of very large annotated datasets confines its full potential. Although transfer learning with ImageNet pre-trained classification models can alleviate the problem, constrained image sizes and model complexities can lead to unnecessary increase in computational cost and decrease in performance. As many common morphological features are usually shared by different classification tasks of an organ, it is greatly beneficial if we can extract such features to improve classification with limited samples. Therefore, inspired by the idea of curriculum learning, we propose a strategy for building medical image classifiers using features from segmentation networks. By using a segmentation network pre-trained on similar data as the classification task, the machine can first learn the simpler shape and structural concepts before tackling the actual classification problem which usually involves more complicated concepts. Using our proposed framework on a 3D three-class brain tumor type classification problem, we achieved 82% accuracy on 191 testing samples with 91 training samples. When applying to a 2D nine-class cardiac semantic level classification problem, we achieved 86% accuracy on 263 testing samples with 108 training samples. Comparisons with ImageNet pre-trained classifiers and classifiers trained from scratch are presented.

Ken C. L. Wong, Alexandros Karargyris, Tanveer Syeda-Mahmood et al.

Although deep learning can provide promising results in medical image analysis, the lack of very large annotated datasets confines its full potential. Furthermore, limited positive samples also create unbalanced datasets which limit the true positive rates of trained models. As unbalanced datasets are mostly unavoidable, it is greatly beneficial if we can extract useful knowledge from negative samples to improve classification accuracy on limited positive samples. To this end, we propose a new strategy for building medical image analysis pipelines that target disease detection. We train a discriminative segmentation model only on normal images to provide a source of knowledge to be transferred to a disease detection classifier. We show that using the feature maps of a trained segmentation network, deviations from normal anatomy can be learned by a two-class classification network on an extremely unbalanced training dataset with as little as one positive for 17 negative samples. We demonstrate that even though the segmentation network is only trained on normal cardiac computed tomography images, the resulting feature maps can be used to detect pericardial effusion and cardiac septal defects with two-class convolutional classification networks.