Michael J. Horry

Michael J. Horry, Subrata Chakraborty, Biswajeet Pradhan et al.

The COVID-19 pandemic has inspired unprecedented data collection and computer vision modelling efforts worldwide, focusing on diagnosis and stratification of COVID-19 from medical images. Despite this large-scale research effort, these models have found limited practical application due in part to unproven generalization of these models beyond their source study. This study investigates the generalizability of key published models using the publicly available COVID-19 Computed Tomography data through cross dataset validation. We then assess the predictive ability of these models for COVID-19 severity using an independent new dataset that is stratified for COVID-19 lung involvement. Each inter-dataset study is performed using histogram equalization, and contrast limited adaptive histogram equalization with and without a learning Gabor filter. The study shows high variability in the generalization of models trained on these datasets due to varied sample image provenances and acquisition processes amongst other factors. We show that under certain conditions, an internally consistent dataset can generalize well to an external dataset despite structural differences between these datasets with f1 scores up to 86%. Our best performing model shows high predictive accuracy for lung involvement score for an independent dataset for which expertly labelled lung involvement stratification is available. Creating an ensemble of our best model for disease positive prediction with our best model for disease negative prediction using a min-max function resulted in a superior model for lung involvement prediction with average predictive accuracy of 75% for zero lung involvement and 96% for 75-100% lung involvement with almost linear relationship between these stratifications.

Michael J. Horry, Subrata Chakraborty, Biswajeet Pradhan et al.

Lung cancer is the leading cause of cancer death and morbidity worldwide. Many studies have shown machine learning models to be effective at detecting lung nodules from chest X-ray images. However, these techniques have yet to be embraced by the medical community due to several practical, ethical, and regulatory constraints stemming from the black-box nature of deep learning models. Additionally, most lung nodules visible on chest X-ray are benign; therefore, the narrow task of computer vision-based lung nodule detection cannot be equated to automated lung cancer detection. Addressing both concerns, this study introduces a novel hybrid deep learning and decision tree-based computer vision model which presents lung cancer malignancy predictions as interpretable decision trees. The deep learning component of this process is trained using a large publicly available dataset on pathological biomarkers associated with lung cancer. These models are then used to inference biomarker scores for chest X-ray images from two, independent data sets for which malignancy metadata is available. We mine multi-variate predictive models by fitting shallow decision trees to the malignancy stratified datasets and interrogate a range of metrics to determine the best model. Our best decision tree model achieves sensitivity and specificity of 86.7% and 80.0% respectively with a positive predictive value of 92.9%. Decision trees mined using this method may be considered as a starting point for refinement into clinically useful multi-variate lung cancer malignancy models for implementation as a workflow augmentation tool to improve the efficiency of human radiologists.

Douglas P. S. Gomes, Michael J. Horry, Anwaar Ulhaq et al.

The application of computer vision for COVID-19 diagnosis is complex and challenging, given the risks associated with patient misclassifications. Arguably, the primary value of medical imaging for COVID-19 lies rather on patient prognosis. Radiological images can guide physicians assessing the severity of the disease, and a series of images from the same patient at different stages can help to gauge disease progression. Hence, a simple method based on lung-pathology interpretable features for scoring disease severity from Chest X-rays is proposed here. As the primary contribution, this method correlates well to patient severity in different stages of disease progression with competitive results compared to other existing, more complex methods. An original data selection approach is also proposed, allowing the simple model to learn the severity-related features. It is hypothesized that the resulting competitive performance presented here is related to the method being feature-based rather than reliant on lung involvement or opacity as others in the literature. A second contribution comes from the validation of the results, conceptualized as the scoring of patients groups from different stages of the disease. Besides performing such validation on an independent data set, the results were also compared with other proposed scoring methods in the literature. The results show that there is a significant correlation between the scoring system (MAVIDH) and patient outcome, which could potentially help physicians rating and following disease progression in COVID-19 patients.

Douglas P. S. Gomes, Anwaar Ulhaq, Manoranjan Paul et al.

X-ray images may present non-trivial features with predictive information of patients that develop severe symptoms of COVID-19. If true, this hypothesis may have practical value in allocating resources to particular patients while using a relatively inexpensive imaging technique. The difficulty of testing such a hypothesis comes from the need for large sets of labelled data, which need to be well-annotated and should contemplate the post-imaging severity outcome. This paper presents an original methodology for extracting semantic features that correlate to severity from a data set with patient ICU admission labels through interpretable models. The methodology employs a neural network trained to recognise lung pathologies to extract the semantic features, which are then analysed with low-complexity models to limit overfitting while increasing interpretability. This analysis points out that only a few features explain most of the variance between patients that developed severe symptoms. When applied to an unrelated larger data set with pathology-related clinical notes, the method has shown to be capable of selecting images for the learned features, which could translate some information about their common locations in the lung. Besides attesting separability on patients that eventually develop severe symptoms, the proposed methods represent a statistical approach highlighting the importance of features related to ICU admission that may have been only qualitatively reported. While handling limited data sets, notable methodological aspects are adopted, such as presenting a state-of-the-art lung segmentation network and the use of low-complexity models to avoid overfitting. The code for methodology and experiments is also available.