Muhammad E. H. Chowdhury

Promit Basak, A. H. M Nazmus Sakib, Muhammad E. H. Chowdhury et al.

Monitoring the electrical pulse of fetal heart through a non-invasive fetal electrocardiogram (fECG) can easily detect abnormalities in the developing heart to significantly reduce the infant mortality rate and post-natal complications. Due to the overlapping of maternal and fetal R-peaks, the low amplitude of the fECG, systematic and ambient noises, typical signal extraction methods, such as adaptive filters, independent component analysis, empirical mode decomposition, etc., are unable to produce satisfactory fECG. While some techniques can produce accurate QRS waves, they often ignore other important aspects of the ECG. Our approach, which is based on 1D CycleGAN, can reconstruct the fECG signal from the mECG signal while maintaining the morphology due to extensive preprocessing and appropriate framework. The performance of our solution was evaluated by combining two available datasets from Physionet, "Abdominal and Direct Fetal ECG Database" and "Fetal electrocardiograms, direct and abdominal with reference heartbeat annotations", where it achieved an average PCC and Spectral-Correlation score of 88.4% and 89.4%, respectively. It detects the fQRS of the signal with accuracy, precision, recall and F1 score of 92.6%, 97.6%, 94.8% and 96.4%, respectively. It can also accurately produce the estimation of fetal heart rate and R-R interval with an error of 0.25% and 0.27%, respectively. The main contribution of our work is that, unlike similar studies, it can retain the morphology of the ECG signal with high fidelity. The accuracy of our solution for fetal heart rate and R-R interval length is comparable to existing state-of-the-art techniques. This makes it a highly effective tool for early diagnosis of fetal heart diseases and regular health checkups of the fetus.

Md Shafayet Hossain, Muhammad E. H. Chowdhury, Mamun Bin Ibne Reaz et al.

The electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) signals, highly non-stationary in nature, greatly suffers from motion artifacts while recorded using wearable sensors. This paper proposes two robust methods: i) Wavelet packet decomposition (WPD), and ii) WPD in combination with canonical correlation analysis (WPD-CCA), for motion artifact correction from single-channel EEG and fNIRS signals. The efficacy of these proposed techniques is tested using a benchmark dataset and the performance of the proposed methods is measured using two well-established performance matrices: i) Difference in the signal to noise ratio (ΔSNR) and ii) Percentage reduction in motion artifacts (η). The proposed WPD-based single-stage motion artifacts correction technique produces the highest average ΔSNR (29.44 dB) when db2 wavelet packet is incorporated whereas the greatest average η (53.48%) is obtained using db1 wavelet packet for all the available 23 EEG recordings. Our proposed two-stage motion artifacts correction technique i.e. the WPD-CCA method utilizing db1 wavelet packet has shown the best denoising performance producing an average ΔSNR and η values of 30.76 dB and 59.51%, respectively for all the EEG recordings. On the other hand, the two-stage motion artifacts removal technique i.e. WPD-CCA has produced the best average ΔSNR (16.55 dB, utilizing db1 wavelet packet) and largest average η (41.40%, using fk8 wavelet packet). The highest average ΔSNR and η using single-stage artifacts removal techniques (WPD) are found as 16.11 dB and 26.40%, respectively for all the fNIRS signals using fk4 wavelet packet. In both EEG and fNIRS modalities, the percentage reduction in motion artifacts increases by 11.28% and 56.82%, respectively when two-stage WPD-CCA techniques are employed.

Tawsifur Rahman, Muhammad E. H. Chowdhury, Amith Khandakar et al.

Fast and accurate detection of the disease can significantly help in reducing the strain on the healthcare facility of any country to reduce the mortality during any pandemic. The goal of this work is to create a multimodal system using a novel machine learning framework that uses both Chest X-ray (CXR) images and clinical data to predict severity in COVID-19 patients. In addition, the study presents a nomogram-based scoring technique for predicting the likelihood of death in high-risk patients. This study uses 25 biomarkers and CXR images in predicting the risk in 930 COVID-19 patients admitted during the first wave of COVID-19 (March-June 2020) in Italy. The proposed multimodal stacking technique produced the precision, sensitivity, and F1-score, of 89.03%, 90.44%, and 89.03%, respectively to identify low or high-risk patients. This multimodal approach improved the accuracy by 6% in comparison to the CXR image or clinical data alone. Finally, nomogram scoring system using multivariate logistic regression -- was used to stratify the mortality risk among the high-risk patients identified in the first stage. Lactate Dehydrogenase (LDH), O2 percentage, White Blood Cells (WBC) Count, Age, and C-reactive protein (CRP) were identified as useful predictor using random forest feature selection model. Five predictors parameters and a CXR image based nomogram score was developed for quantifying the probability of death and categorizing them into two risk groups: survived (<50%), and death (>=50%), respectively. The multi-modal technique was able to predict the death probability of high-risk patients with an F1 score of 92.88 %. The area under the curves for the development and validation cohorts are 0.981 and 0.939, respectively.

Fahmida Haque, Mamun B. I. Reaz, Muhammad E. H. Chowdhury et al.

Background: Diabetic Sensorimotor polyneuropathy (DSPN) is a major long-term complication in diabetic patients associated with painful neuropathy, foot ulceration and amputation. The Michigan neuropathy screening instrument (MNSI) is one of the most common screening techniques for DSPN, however, it does not provide any direct severity grading system. Method: For designing and modelling the DSPN severity grading systems for MNSI, 19 years of data from Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials were used. MNSI variables and patient outcomes were investigated using machine learning tools to identify the features having higher association in DSPN identification. A multivariable logistic regression-based nomogram was generated and validated for DSPN severity grading. Results: The top-7 ranked features from MNSI: 10-gm filament, Vibration perception (R), Vibration perception (L), previous diabetic neuropathy, the appearance of deformities, appearance of callus and appearance of fissure were identified as key features for identifying DSPN using the extra tree model. The area under the curve (AUC) of the nomogram for the internal and external datasets were 0.9421 and 0.946, respectively. From the developed nomogram, the probability of having DSPN was predicted and a DSPN severity scoring system for MNSI was developed from the probability score. The model performance was validated on an independent dataset. Patients were stratified into four severity levels: absent, mild, moderate, and severe using a cut-off value of 10.5, 12.7 and 15 for a DSPN probability less than 50%, 75% to 90%, and above 90%, respectively. Conclusions: This study provides a simple, easy-to-use and reliable algorithm for defining the prognosis and management of patients with DSPN.

Turker Ince, Serkan Kiranyaz, Ozer Can Devecioglu et al.

Objective: Despite numerous studies proposed for audio restoration in the literature, most of them focus on an isolated restoration problem such as denoising or dereverberation, ignoring other artifacts. Moreover, assuming a noisy or reverberant environment with limited number of fixed signal-to-distortion ratio (SDR) levels is a common practice. However, real-world audio is often corrupted by a blend of artifacts such as reverberation, sensor noise, and background audio mixture with varying types, severities, and duration. In this study, we propose a novel approach for blind restoration of real-world audio signals by Operational Generative Adversarial Networks (Op-GANs) with temporal and spectral objective metrics to enhance the quality of restored audio signal regardless of the type and severity of each artifact corrupting it. Methods: 1D Operational-GANs are used with generative neuron model optimized for blind restoration of any corrupted audio signal. Results: The proposed approach has been evaluated extensively over the benchmark TIMIT-RAR (speech) and GTZAN-RAR (non-speech) datasets corrupted with a random blend of artifacts each with a random severity to mimic real-world audio signals. Average SDR improvements of over 7.2 dB and 4.9 dB are achieved, respectively, which are substantial when compared with the baseline methods. Significance: This is a pioneer study in blind audio restoration with the unique capability of direct (time-domain) restoration of real-world audio whilst achieving an unprecedented level of performance for a wide SDR range and artifact types. Conclusion: 1D Op-GANs can achieve robust and computationally effective real-world audio restoration with significantly improved performance. The source codes and the generated real-world audio datasets are shared publicly with the research community in a dedicated GitHub repository1.

Fahmida Haque, Mamun Bin Ibne Reaz, Muhammad Enamul Hoque Chowdhury et al.

Diabetic sensorimotor polyneuropathy (DSPN) is one of the prevalent forms of neuropathy affected by diabetic patients that involves alterations in biomechanical changes in human gait. In literature, for the last 50 years, researchers are trying to observe the biomechanical changes due to DSPN by studying muscle electromyography (EMG), and ground reaction forces (GRF). However, the literature is contradictory. In such a scenario, we are proposing to use Machine learning techniques to identify DSPN patients by using EMG, and GRF data. We have collected a dataset consists of three lower limb muscles EMG (tibialis anterior (TA), vastus lateralis (VL), gastrocnemius medialis (GM) and 3-dimensional GRF components (GRFx, GRFy, and GRFz). Raw EMG and GRF signals were preprocessed, and a newly proposed feature extraction technique scheme from literature was applied to extract the best features from the signals. The extracted feature list was ranked using Relief feature ranking techniques, and highly correlated features were removed. We have trained different ML models to find out the best-performing model and optimized that model. We trained the optimized ML models for different combinations of muscles and GRF components features, and the performance matrix was evaluated. This study has found ensemble classifier model was performing in identifying DSPN Severity, and we optimized it before training. For EMG analysis, we have found the best accuracy of 92.89% using the Top 14 features for features from GL, VL and TA muscles combined. In the GRF analysis, the model showed 94.78% accuracy by using the Top 15 features for the feature combinations extracted from GRFx, GRFy and GRFz signals. The performance of ML-based DSPN severity classification models, improved significantly, indicating their reliability in DSPN severity classification, for biomechanical data.

Sayed Ahmed, Muhammad Ashad Kabir, Muhammad E. H. Chowdhury et al.

Diabetes-related foot ulcers and complications are a significant concern for individuals with diabetes, leading to severe health implications such as lower-limb amputation and reduced quality of life. This chapter discusses applying AI-driven personalised offloading device prescriptions as an advanced solution for preventing such conditions. By harnessing the capabilities of artificial intelligence, this cutting-edge approach enables the prescription of offloading devices tailored to each patient's specific requirements. This includes the patient's preferences on offloading devices such as footwear and foot orthotics and their adaptations that suit the patient's intention of use and lifestyle. Through a series of studies, real-world data analysis and machine learning algorithms, high-risk areas can be identified, facilitating the recommendation of precise offloading strategies, including custom orthotic insoles, shoe adaptations, or specialised footwear. By including patient-specific factors to promote adherence, proactively addressing pressure points and promoting optimal foot mechanics, these personalised offloading devices have the potential to minimise the occurrence of foot ulcers and associated complications. This chapter proposes an AI-powered Clinical Decision Support System (CDSS) to recommend personalised prescriptions of offloading devices (footwear and insoles) for patients with diabetes who are at risk of foot complications. This innovative approach signifies a transformative leap in diabetic foot care, offering promising opportunities for preventive healthcare interventions.

Alvee Hassan, Rusab Sarmun, Muhammad E. H. Chowdhury et al.

Early detection of coronary artery disease (CAD) is critical for reducing mortality and improving patient treatment planning. While angiographic image analysis from X-rays is a common and cost-effective method for identifying cardiac abnormalities, including stenotic coronary arteries, poor image quality can significantly impede clinical diagnosis. We present the Coronary Artery Segmentation and Refinement Network (CASR-Net), a three-stage pipeline comprising image preprocessing, segmentation, and refinement. A novel multichannel preprocessing strategy combining CLAHE and an improved Ben Graham method provides incremental gains, increasing Dice Score Coefficient (DSC) by 0.31-0.89% and Intersection over Union (IoU) by 0.40-1.16% compared with using the techniques individually. The core innovation is a segmentation network built on a UNet with a DenseNet121 encoder and a Self-organized Operational Neural Network (Self-ONN) based decoder, which preserves the continuity of narrow and stenotic vessel branches. A final contour refinement module further suppresses false positives. Evaluated with 5-fold cross-validation on a combination of two public datasets that contain both healthy and stenotic arteries, CASR-Net outperformed several state-of-the-art models, achieving an IoU of 61.43%, a DSC of 76.10%, and clDice of 79.36%. These results highlight a robust approach to automated coronary artery segmentation, offering a valuable tool to support clinicians in diagnosis and treatment planning.

Fabiha Bushra, Muhammad E. H. Chowdhury, Rusab Sarmun et al.

The increasing reliance on Computed Tomography Pulmonary Angiography (CTPA) for Pulmonary Embolism (PE) diagnosis presents challenges and a pressing need for improved diagnostic solutions. The primary objective of this study is to leverage deep learning techniques to enhance the Computer Assisted Diagnosis (CAD) of PE. With this aim, we propose a classifier-guided detection approach that effectively leverages the classifier's probabilistic inference to direct the detection predictions, marking a novel contribution in the domain of automated PE diagnosis. Our classification system includes an Attention-Guided Convolutional Neural Network (AG-CNN) that uses local context by employing an attention mechanism. This approach emulates a human expert's attention by looking at both global appearances and local lesion regions before making a decision. The classifier demonstrates robust performance on the FUMPE dataset, achieving an AUROC of 0.927, sensitivity of 0.862, specificity of 0.879, and an F1-score of 0.805 with the Inception-v3 backbone architecture. Moreover, AG-CNN outperforms the baseline DenseNet-121 model, achieving an 8.1% AUROC gain. While previous research has mostly focused on finding PE in the main arteries, our use of cutting-edge object detection models and ensembling techniques greatly improves the accuracy of detecting small embolisms in the peripheral arteries. Finally, our proposed classifier-guided detection approach further refines the detection metrics, contributing new state-of-the-art to the community: mAP$_{50}$, sensitivity, and F1-score of 0.846, 0.901, and 0.779, respectively, outperforming the former benchmark with a significant 3.7% improvement in mAP$_{50}$. Our research aims to elevate PE patient care by integrating AI solutions into clinical workflows, highlighting the potential of human-AI collaboration in medical diagnostics.

Tariq O. Abbas, Mohamed AbdelMoniem, Ibrahim Khalil et al.

Objectives: To explore the capacity of deep learning algorithm to further streamline and optimize urethral plate (UP) quality appraisal on 2D images using the plate objective scoring tool (POST), aiming to increase the objectivity and reproducibility of UP appraisal in hypospadias repair. Methods: The five key POST landmarks were marked by specialists in a 691-image dataset of prepubertal boys undergoing primary hypospadias repair. This dataset was then used to develop and validate a deep learning-based landmark detection model. The proposed framework begins with glans localization and detection, where the input image is cropped using the predicted bounding box. Next, a deep convolutional neural network (CNN) architecture is used to predict the coordinates of the five POST landmarks. These predicted landmarks are then used to assess UP quality in distal hypospadias. Results: The proposed model accurately localized the glans area, with a mean average precision (mAP) of 99.5% and an overall sensitivity of 99.1%. A normalized mean error (NME) of 0.07152 was achieved in predicting the coordinates of the landmarks, with a mean squared error (MSE) of 0.001 and a 20.2% failure rate at a threshold of 0.1 NME. Conclusions: This deep learning application shows robustness and high precision in using POST to appraise UP quality. Further assessment using international multi-centre image-based databases is ongoing. External validation could benefit deep learning algorithms and lead to better assessments, decision-making and predictions for surgical outcomes.

Md. Shaheenur Islam Sumon, Md. Sakib Bin Islam, Md. Sohanur Rahman et al.

The early detection and prediction of cardiovascular diseases are crucial for reducing the severe morbidity and mortality associated with these conditions worldwide. A multi-headed self-attention mechanism, widely used in natural language processing (NLP), is operated by Transformers to understand feature interactions in feature spaces. However, the relationships between various features within biological systems remain ambiguous in these spaces, highlighting the necessity of early detection and prediction of cardiovascular diseases to reduce the severe morbidity and mortality with these conditions worldwide. We handle this issue with CardioTabNet, which exploits the strength of tab transformer to extract feature space which carries strong understanding of clinical cardiovascular data and its feature ranking. As a result, performance of downstream classical models significantly showed outstanding result. Our study utilizes the open-source dataset for heart disease prediction with 1190 instances and 11 features. In total, 11 features are divided into numerical (age, resting blood pressure, cholesterol, maximum heart rate, old peak, weight, and fasting blood sugar) and categorical (resting ECG, exercise angina, and ST slope). Tab transformer was used to extract important features and ranked them using random forest (RF) feature ranking algorithm. Ten machine-learning models were used to predict heart disease using selected features. After extracting high-quality features, the top downstream model (a hyper-tuned ExtraTree classifier) achieved an average accuracy rate of 94.1% and an average Area Under Curve (AUC) of 95.0%. Furthermore, a nomogram analysis was conducted to evaluate the model's effectiveness in cardiovascular risk assessment. A benchmarking study was conducted using state-of-the-art models to evaluate our transformer-driven framework.

Md. Ahasan Atick Faisal, Imene Mecheter, Yazan Qiblawey et al.

In recent years, power line maintenance has seen a paradigm shift by moving towards computer vision-powered automated inspection. The utilization of an extensive collection of videos and images has become essential for maintaining the reliability, safety, and sustainability of electricity transmission. A significant focus on applying deep learning techniques for enhancing power line inspection processes has been observed in recent research. A comprehensive review of existing studies has been conducted in this paper, to aid researchers and industries in developing improved deep learning-based systems for analyzing power line data. The conventional steps of data analysis in power line inspections have been examined, and the body of current research has been systematically categorized into two main areas: the detection of components and the diagnosis of faults. A detailed summary of the diverse methods and techniques employed in these areas has been encapsulated, providing insights into their functionality and use cases. Special attention has been given to the exploration of deep learning-based methodologies for the analysis of power line inspection data, with an exposition of their fundamental principles and practical applications. Moreover, a vision for future research directions has been outlined, highlighting the need for advancements such as edge-cloud collaboration, and multi-modal analysis among others. Thus, this paper serves as a comprehensive resource for researchers delving into deep learning for power line analysis, illuminating the extent of current knowledge and the potential areas for future investigation.

Billel Essaid, Hamza Kheddar, Noureddine Batel et al.

Automatic speech recognition (ASR) plays a pivotal role in our daily lives, offering utility not only for interacting with machines but also for facilitating communication for individuals with partial or profound hearing impairments. The process involves receiving the speech signal in analog form, followed by various signal processing algorithms to make it compatible with devices of limited capacities, such as cochlear implants (CIs). Unfortunately, these implants, equipped with a finite number of electrodes, often result in speech distortion during synthesis. Despite efforts by researchers to enhance received speech quality using various state-of-the-art (SOTA) signal processing techniques, challenges persist, especially in scenarios involving multiple sources of speech, environmental noise, and other adverse conditions. The advent of new artificial intelligence (AI) methods has ushered in cutting-edge strategies to address the limitations and difficulties associated with traditional signal processing techniques dedicated to CIs. This review aims to comprehensively cover advancements in CI-based ASR and speech enhancement, among other related aspects. The primary objective is to provide a thorough overview of metrics and datasets, exploring the capabilities of AI algorithms in this biomedical field, and summarizing and commenting on the best results obtained. Additionally, the review will delve into potential applications and suggest future directions to bridge existing research gaps in this domain.

Ashiqur Rahman, Muhammad E. H. Chowdhury, Md Sharjis Ibne Wadud et al.

Ischemic stroke, caused by cerebral vessel occlusion, presents substantial challenges in medical imaging due to the variability and subtlety of stroke lesions. Magnetic Resonance Imaging (MRI) plays a crucial role in diagnosing and managing ischemic stroke, yet existing segmentation techniques often fail to accurately delineate lesions. This study introduces a novel deep learning-based method for segmenting ischemic stroke lesions using multi-channel MRI modalities, including Diffusion Weighted Imaging (DWI), Apparent Diffusion Coefficient (ADC), and enhanced Diffusion Weighted Imaging (eDWI). The proposed architecture integrates DenseNet121 as the encoder with Self-Organized Operational Neural Networks (SelfONN) in the decoder, enhanced by Channel and Space Compound Attention (CSCA) and Double Squeeze-and-Excitation (DSE) blocks. Additionally, a custom loss function combining Dice Loss and Jaccard Loss with weighted averages is introduced to improve model performance. Trained and evaluated on the ISLES 2022 dataset, the model achieved Dice Similarity Coefficients (DSC) of 83.88% using DWI alone, 85.86% with DWI and ADC, and 87.49% with the integration of DWI, ADC, and eDWI. This approach not only outperforms existing methods but also addresses key limitations in current segmentation practices. These advancements significantly enhance diagnostic precision and treatment planning for ischemic stroke, providing valuable support for clinical decision-making.

Yassine Habchi, Hamza Kheddar, Yassine Himeur et al.

The rapid advancement of deep learning (DL) has transformed healthcare, particularly in cancer detection and diagnosis. DL surpasses traditional machine learning and human accuracy, making it a critical tool for identifying diseases. Despite numerous reviews on DL in healthcare, a comprehensive analysis of its role in cancer detection remains limited. Existing studies focus on specific aspects, leaving gaps in understanding its broader impact. This paper addresses these gaps by reviewing advanced DL techniques, including transfer learning (TL), reinforcement learning (RL), federated learning (FL), Transformers, and large language models (LLMs). These approaches enhance accuracy, tackle data scarcity, and enable decentralized learning while maintaining data privacy. TL adapts pre-trained models to new datasets, improving performance with limited labeled data. RL optimizes diagnostic pathways and treatment strategies, while FL fosters collaborative model development without sharing sensitive data. Transformers and LLMs, traditionally used in natural language processing, are now applied to medical data for improved interpretability. Additionally, this review examines these techniques' efficiency in cancer diagnosis, addresses challenges like data imbalance, and proposes solutions. It serves as a resource for researchers and practitioners, providing insights into current trends and guiding future research in advanced DL for cancer detection.

Promit Basak, Rusab Sarmun, Saidul Kabir et al.

Automated lumbar spine segmentation is very crucial for modern diagnosis systems. In this study, we introduce a novel machine-agnostic approach for segmenting lumbar vertebrae and intervertebral discs from MRI images, employing a cascaded model that synergizes an ROI detection and a Self-organized Operational Neural Network (Self-ONN)-based encoder-decoder network for segmentation. Addressing the challenge of diverse MRI modalities, our methodology capitalizes on a unique dataset comprising images from 12 scanners and 34 subjects, enhanced through strategic preprocessing and data augmentation techniques. The YOLOv8 medium model excels in ROI extraction, achieving an excellent performance of 0.916 mAP score. Significantly, our Self-ONN-based model, combined with a DenseNet121 encoder, demonstrates excellent performance in lumbar vertebrae and IVD segmentation with a mean Intersection over Union (IoU) of 83.66%, a sensitivity of 91.44%, and Dice Similarity Coefficient (DSC) of 91.03%, as validated through rigorous 10-fold cross-validation. This study not only showcases an effective approach to MRI segmentation in spine-related disorders but also sets the stage for future advancements in automated diagnostic tools, emphasizing the need for further dataset expansion and model refinement for broader clinical applicability.

Shahamat Mustavi Tasin, Muhammad E. H. Chowdhury, Shona Pedersen et al.

Inner speech recognition has gained enormous interest in recent years due to its applications in rehabilitation, developing assistive technology, and cognitive assessment. However, since language and speech productions are a complex process, for which identifying speech components has remained a challenging task. Different approaches were taken previously to reach this goal, but new approaches remain to be explored. Also, a subject-oriented analysis is necessary to understand the underlying brain dynamics during inner speech production, which can bring novel methods to neurological research. A publicly available dataset, Thinking Out Loud Dataset, has been used to develop a Machine Learning (ML)-based technique to classify inner speech using 128-channel surface EEG signals. The dataset is collected on a Spanish cohort of ten subjects while uttering four words (Arriba, Abajo, Derecha, and Izquierda) by each participant. Statistical methods were employed to detect and remove motion artifacts from the Electroencephalography (EEG) signals. A large number (191 per channel) of time-, frequency- and time-frequency-domain features were extracted. Eight feature selection algorithms are explored, and the best feature selection technique is selected for subsequent evaluations. The performance of six ML algorithms is evaluated, and an ensemble model is proposed. Deep Learning (DL) models are also explored, and the results are compared with the classical ML approach. The proposed ensemble model, by stacking the five best logistic regression models, generated an overall accuracy of 81.13% and an F1 score of 81.12% in the classification of four inner speech words using surface EEG signals. The proposed framework with the proposed ensemble of classical ML models shows promise in the classification of inner speech using surface EEG signals.

Md. Shaheenur Islam Sumon, Khandaker Reajul Islam, Tanzila Rafique et al.

Cephalometric analysis is essential for the diagnosis and treatment planning of orthodontics. In lateral cephalograms, however, the manual detection of anatomical landmarks is a time-consuming procedure. Deep learning solutions hold the potential to address the time constraints associated with certain tasks; however, concerns regarding their performance have been observed. To address this critical issue, we proposed an end-to-end cascaded deep learning framework (Self-CepahloNet) for the task, which demonstrated benchmark performance over the ISBI 2015 dataset in predicting 19 dental landmarks. Due to their adaptive nodal capabilities, Self-ONN (self-operational neural networks) demonstrate superior learning performance for complex feature spaces over conventional convolutional neural networks. To leverage this attribute, we introduced a novel self-bottleneck in the HRNetV2 (High Resolution Network) backbone, which has exhibited benchmark performance on the ISBI 2015 dataset for the dental landmark detection task. Our first-stage results surpassed previous studies, showcasing the efficacy of our singular end-to-end deep learning model, which achieved a remarkable 70.95% success rate in detecting cephalometric landmarks within a 2mm range for the Test1 and Test2 datasets. Moreover, the second stage significantly improved overall performance, yielding an impressive 82.25% average success rate for the datasets above within the same 2mm distance. Furthermore, external validation was conducted using the PKU cephalogram dataset. Our model demonstrated a commendable success rate of 75.95% within the 2mm range.

Md. Sohanur Rahman, Muhammad E. H. Chowdhury, Hasib Ryan Rahman et al.

In this study, we propose a novel and robust framework, Self-DenseMobileNet, designed to enhance the classification of nodules and non-nodules in chest radiographs (CXRs). Our approach integrates advanced image standardization and enhancement techniques to optimize the input quality, thereby improving classification accuracy. To enhance predictive accuracy and leverage the strengths of multiple models, the prediction probabilities from Self-DenseMobileNet were transformed into tabular data and used to train eight classical machine learning (ML) models; the top three performers were then combined via a stacking algorithm, creating a robust meta-classifier that integrates their collective insights for superior classification performance. To enhance the interpretability of our results, we employed class activation mapping (CAM) to visualize the decision-making process of the best-performing model. Our proposed framework demonstrated remarkable performance on internal validation data, achieving an accuracy of 99.28\% using a Meta-Random Forest Classifier. When tested on an external dataset, the framework maintained strong generalizability with an accuracy of 89.40\%. These results highlight a significant improvement in the classification of CXRs with lung nodules.

Aysen Degerli, Serkan Kiranyaz, Muhammad E. H. Chowdhury et al.

Coronavirus disease 2019 (COVID-19) has been diagnosed automatically using Machine Learning algorithms over chest X-ray (CXR) images. However, most of the earlier studies used Deep Learning models over scarce datasets bearing the risk of overfitting. Additionally, previous studies have revealed the fact that deep networks are not reliable for classification since their decisions may originate from irrelevant areas on the CXRs. Therefore, in this study, we propose Operational Segmentation Network (OSegNet) that performs detection by segmenting COVID-19 pneumonia for a reliable diagnosis. To address the data scarcity encountered in training and especially in evaluation, this study extends the largest COVID-19 CXR dataset: QaTa-COV19 with 121,378 CXRs including 9258 COVID-19 samples with their corresponding ground-truth segmentation masks that are publicly shared with the research community. Consequently, OSegNet has achieved a detection performance with the highest accuracy of 99.65% among the state-of-the-art deep models with 98.09% precision.

Serkan Kiranyaz, Ozer Can Devecioglu, Turker Ince et al.

Continuous long-term monitoring of electrocardiography (ECG) signals is crucial for the early detection of cardiac abnormalities such as arrhythmia. Non-clinical ECG recordings acquired by Holter and wearable ECG sensors often suffer from severe artifacts such as baseline wander, signal cuts, motion artifacts, variations on QRS amplitude, noise, and other interferences. Usually, a set of such artifacts occur on the same ECG signal with varying severity and duration, and this makes an accurate diagnosis by machines or medical doctors extremely difficult. Despite numerous studies that have attempted ECG denoising, they naturally fail to restore the actual ECG signal corrupted with such artifacts due to their simple and naive noise model. In this study, we propose a novel approach for blind ECG restoration using cycle-consistent generative adversarial networks (Cycle-GANs) where the quality of the signal can be improved to a clinical level ECG regardless of the type and severity of the artifacts corrupting the signal. To further boost the restoration performance, we propose 1D operational Cycle-GANs with the generative neuron model. The proposed approach has been evaluated extensively using one of the largest benchmark ECG datasets from the China Physiological Signal Challenge (CPSC-2020) with more than one million beats. Besides the quantitative and qualitative evaluations, a group of cardiologists performed medical evaluations to validate the quality and usability of the restored ECG, especially for an accurate arrhythmia diagnosis.

Nabil Ibtehaz, Muhammad E. H. Chowdhury, Amith Khandakar et al.

Raman spectroscopy provides a vibrational profile of the molecules and thus can be used to uniquely identify different kind of materials. This sort of fingerprinting molecules has thus led to widespread application of Raman spectrum in various fields like medical dignostics, forensics, mineralogy, bacteriology and virology etc. Despite the recent rise in Raman spectra data volume, there has not been any significant effort in developing generalized machine learning methods for Raman spectra analysis. We examine, experiment and evaluate existing methods and conjecture that neither current sequential models nor traditional machine learning models are satisfactorily sufficient to analyze Raman spectra. Both has their perks and pitfalls, therefore we attempt to mix the best of both worlds and propose a novel network architecture RamanNet. RamanNet is immune to invariance property in CNN and at the same time better than traditional machine learning models for the inclusion of sparse connectivity. Our experiments on 4 public datasets demonstrate superior performance over the much complex state-of-the-art methods and thus RamanNet has the potential to become the defacto standard in Raman spectra data analysis

Sakib Mahmud, Nabil Ibtehaz, Amith Khandakar et al.

Cardiovascular diseases are the most common causes of death around the world. To detect and treat heart-related diseases, continuous Blood Pressure (BP) monitoring along with many other parameters are required. Several invasive and non-invasive methods have been developed for this purpose. Most existing methods used in the hospitals for continuous monitoring of BP are invasive. On the contrary, cuff-based BP monitoring methods, which can predict Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP), cannot be used for continuous monitoring. Several studies attempted to predict BP from non-invasively collectible signals such as Photoplethysmogram (PPG) and Electrocardiogram (ECG), which can be used for continuous monitoring. In this study, we explored the applicability of autoencoders in predicting BP from PPG and ECG signals. The investigation was carried out on 12,000 instances of 942 patients of the MIMIC-II dataset and it was found that a very shallow, one-dimensional autoencoder can extract the relevant features to predict the SBP and DBP with the state-of-the-art performance on a very large dataset. Independent test set from a portion of the MIMIC-II dataset provides an MAE of 2.333 and 0.713 for SBP and DBP, respectively. On an external dataset of forty subjects, the model trained on the MIMIC-II dataset, provides an MAE of 2.728 and 1.166 for SBP and DBP, respectively. For both the cases, the results met British Hypertension Society (BHS) Grade A and surpassed the studies from the current literature.

Moncef Gabbouj, Serkan Kiranyaz, Junaid Malik et al.

Although numerous R-peak detectors have been proposed in the literature, their robustness and performance levels may significantly deteriorate in low-quality and noisy signals acquired from mobile electrocardiogram (ECG) sensors, such as Holter monitors. Recently, this issue has been addressed by deep 1-D convolutional neural networks (CNNs) that have achieved state-of-the-art performance levels in Holter monitors; however, they pose a high complexity level that requires special parallelized hardware setup for real-time processing. On the other hand, their performance deteriorates when a compact network configuration is used instead. This is an expected outcome as recent studies have demonstrated that the learning performance of CNNs is limited due to their strictly homogenous configuration with the sole linear neuron model. In this study, to further boost the peak detection performance along with an elegant computational efficiency, we propose 1-D Self-Organized ONNs (Self-ONNs) with generative neurons. The most crucial advantage of 1-D Self-ONNs over the ONNs is their self-organization capability that voids the need to search for the best operator set per neuron since each generative neuron has the ability to create the optimal operator during training. The experimental results over the China Physiological Signal Challenge-2020 (CPSC) dataset with more than one million ECG beats show that the proposed 1-D Self-ONNs can significantly surpass the state-of-the-art deep CNN with less computational complexity. Results demonstrate that the proposed solution achieves a 99.10% F1-score, 99.79% sensitivity, and 98.42% positive predictivity in the CPSC dataset, which is the best R-peak detection performance ever achieved.

Amith Khandakar, Muhammad E. H. Chowdhury, Mamun Bin Ibne Reaz et al.

Diabetes foot ulceration (DFU) and amputation are a cause of significant morbidity. The prevention of DFU may be achieved by the identification of patients at risk of DFU and the institution of preventative measures through education and offloading. Several studies have reported that thermogram images may help to detect an increase in plantar temperature prior to DFU. However, the distribution of plantar temperature may be heterogeneous, making it difficult to quantify and utilize to predict outcomes. We have compared a machine learning-based scoring technique with feature selection and optimization techniques and learning classifiers to several state-of-the-art Convolutional Neural Networks (CNNs) on foot thermogram images and propose a robust solution to identify the diabetic foot. A comparatively shallow CNN model, MobilenetV2 achieved an F1 score of ~95% for a two-feet thermogram image-based classification and the AdaBoost Classifier used 10 features and achieved an F1 score of 97 %. A comparison of the inference time for the best-performing networks confirmed that the proposed algorithm can be deployed as a smartphone application to allow the user to monitor the progression of the DFU in a home setting.

Tawsifur Rahman, Alex Akinbi, Muhammad E. H. Chowdhury et al.

The reliable and rapid identification of the COVID-19 has become crucial to prevent the rapid spread of the disease, ease lockdown restrictions and reduce pressure on public health infrastructures. Recently, several methods and techniques have been proposed to detect the SARS-CoV-2 virus using different images and data. However, this is the first study that will explore the possibility of using deep convolutional neural network (CNN) models to detect COVID-19 from electrocardiogram (ECG) trace images. In this work, COVID-19 and other cardiovascular diseases (CVDs) were detected using deep-learning techniques. A public dataset of ECG images consists of 1937 images from five distinct categories, such as Normal, COVID-19, myocardial infarction (MI), abnormal heartbeat (AHB), and recovered myocardial infarction (RMI) were used in this study. Six different deep CNN models (ResNet18, ResNet50, ResNet101, InceptionV3, DenseNet201, and MobileNetv2) were used to investigate three different classification schemes: two-class classification (Normal vs COVID-19); three-class classification (Normal, COVID-19, and Other CVDs), and finally, five-class classification (Normal, COVID-19, MI, AHB, and RMI). For two-class and three-class classification, Densenet201 outperforms other networks with an accuracy of 99.1%, and 97.36%, respectively; while for the five-class classification, InceptionV3 outperforms others with an accuracy of 97.83%. ScoreCAM visualization confirms that the networks are learning from the relevant area of the trace images. Since the proposed method uses ECG trace images which can be captured by smartphones and are readily available facilities in low-resources countries, this study will help in faster computer-aided diagnosis of COVID-19 and other cardiac abnormalities.

Muhammad E. H. Chowdhury, Nabil Ibtehaz, Tawsifur Rahman et al.

In the break of COVID-19 pandemic, mass testing has become essential to reduce the spread of the virus. Several recent studies suggest that a significant number of COVID-19 patients display no physical symptoms whatsoever. Therefore, it is unlikely that these patients will undergo COVID-19 test, which increases their chances of unintentionally spreading the virus. Currently, the primary diagnostic tool to detect COVID-19 is RT-PCR test on collected respiratory specimens from the suspected case. This requires patients to travel to a laboratory facility to be tested, thereby potentially infecting others along the way.It is evident from recent researches that asymptomatic COVID-19 patients cough and breath in a different way than the healthy people. Several research groups have created mobile and web-platform for crowdsourcing the symptoms, cough and breathing sounds from healthy, COVID-19 and Non-COVID patients. Some of these data repositories were made public. We have received such a repository from Cambridge University team under data-sharing agreement, where we have cough and breathing sound samples for 582 and 141 healthy and COVID-19 patients, respectively. 87 COVID-19 patients were asymptomatic, while rest of them have cough. We have developed an Android application to automatically screen COVID-19 from the comfort of people homes. Test subjects can simply download a mobile application, enter their symptoms, record an audio clip of their cough and breath, and upload the data anonymously to our servers. Our backend server converts the audio clip to spectrogram and then apply our state-of-the-art machine learning model to classify between cough sounds produced by COVID-19 patients, as opposed to healthy subjects or those with other respiratory conditions. The system can detect asymptomatic COVID-19 patients with a sensitivity more than 91%.

Anas M. Tahir, Muhammad E. H. Chowdhury, Amith Khandakar et al.

Coronavirus disease 2019 (COVID-19) has been the main agenda of the whole world, since it came into sight in December 2019 as it has significantly affected the world economy and healthcare system. Given the effects of COVID-19 on pulmonary tissues, chest radiographic imaging has become a necessity for screening and monitoring the disease. Numerous studies have proposed Deep Learning approaches for the automatic diagnosis of COVID-19. Although these methods achieved astonishing performance in detection, they have used limited chest X-ray (CXR) repositories for evaluation, usually with a few hundred COVID-19 CXR images only. Thus, such data scarcity prevents reliable evaluation with the potential of overfitting. In addition, most studies showed no or limited capability in infection localization and severity grading of COVID-19 pneumonia. In this study, we address this urgent need by proposing a systematic and unified approach for lung segmentation and COVID-19 localization with infection quantification from CXR images. To accomplish this, we have constructed the largest benchmark dataset with 33,920 CXR images, including 11,956 COVID-19 samples, where the annotation of ground-truth lung segmentation masks is performed on CXRs by a novel human-machine collaborative approach. An extensive set of experiments was performed using the state-of-the-art segmentation networks, U-Net, U-Net++, and Feature Pyramid Networks (FPN). The developed network, after an extensive iterative process, reached a superior performance for lung region segmentation with Intersection over Union (IoU) of 96.11% and Dice Similarity Coefficient (DSC) of 97.99%. Furthermore, COVID-19 infections of various shapes and types were reliably localized with 83.05% IoU and 88.21% DSC. Finally, the proposed approach has achieved an outstanding COVID-19 detection performance with both sensitivity and specificity values above 99%.

Arafat Rahman, Muhammad E. H. Chowdhury, Amith Khandakar et al.

With the rapid advancement of technology, different biometric user authentication, and identification systems are emerging. Traditional biometric systems like face, fingerprint, and iris recognition, keystroke dynamics, etc. are prone to cyber-attacks and suffer from different disadvantages. Electroencephalography (EEG) based authentication has shown promise in overcoming these limitations. However, EEG-based authentication is less accurate due to signal variability at different psychological and physiological conditions. On the other hand, keystroke dynamics-based identification offers high accuracy but suffers from different spoofing attacks. To overcome these challenges, we propose a novel multimodal biometric system combining EEG and keystroke dynamics. Firstly, a dataset was created by acquiring both keystroke dynamics and EEG signals from 10 users with 500 trials per user at 10 different sessions. Different statistical, time, and frequency domain features were extracted and ranked from the EEG signals and key features were extracted from the keystroke dynamics. Different classifiers were trained, validated, and tested for both individual and combined modalities for two different classification strategies - personalized and generalized. Results show that very high accuracy can be achieved both in generalized and personalized cases for the combination of EEG and keystroke dynamics. The identification and authentication accuracies were found to be 99.80% and 99.68% for Extreme Gradient Boosting (XGBoost) and Random Forest classifiers, respectively which outperform the individual modalities with a significant margin (around 5 percent). We also developed a binary template matching-based algorithm, which gives 93.64% accuracy 6X faster. The proposed method is secured and reliable for any kind of biometric authentication.

Md Nazmul Islam Shuzan, Moajjem Hossain Chowdhury, Muhammad E. H. Chowdhury et al.

Respiratory ailments such as asthma, chronic obstructive pulmonary disease (COPD), pneumonia, and lung cancer are life-threatening. Respiration rate (RR) is a vital indicator of the wellness of a patient. Continuous monitoring of RR can provide early indication and thereby save lives. However, a real-time continuous RR monitoring facility is only available at the intensive care unit (ICU) due to the size and cost of the equipment. Recent researches have proposed Photoplethysmogram (PPG) and/ Electrocardiogram (ECG) signals for RR estimation however, the usage of ECG is limited due to the unavailability of it in wearable devices. Due to the advent of wearable smartwatches with built-in PPG sensors, it is now being considered for continuous monitoring of RR. This paper describes a novel approach to RR estimation using machine learning (ML) models with the PPG signal features. Feature selection algorithms were used to reduce computational complexity and the chance of overfitting. The best ML model and the best feature selection algorithm combination was fine-tuned to optimize its performance using hyperparameter optimization. Gaussian Process Regression (GPR) with fitrgp feature selection algorithm outperformed all other combinations and exhibits a root mean squared error (RMSE), mean absolute error (MAE), and two-standard deviation (2SD) of 2.57, 1.91, and 5.13 breaths per minute, respectively. This ML model based RR estimation can be embedded in wearable devices for real-time continuous monitoring of the patient.

Nabil Ibtehaz, Muhammad E. H. Chowdhury, Amith Khandakar et al.

In recent years, physiological signal based authentication has shown great promises,for its inherent robustness against forgery. Electrocardiogram (ECG) signal, being the most widely studied biosignal, has also received the highest level of attention in this regard. It has been proven with numerous studies that by analyzing ECG signals from different persons, it is possible to identify them, with acceptable accuracy. In this work, we present, EDITH, a deep learning-based framework for ECG biometrics authentication system. Moreover, we hypothesize and demonstrate that Siamese architectures can be used over typical distance metrics for improved performance. We have evaluated EDITH using 4 commonly used datasets and outperformed the prior works using less number of beats. EDITH performs competitively using just a single heartbeat (96-99.75% accuracy) and can be further enhanced by fusing multiple beats (100% accuracy from 3 to 6 beats). Furthermore, the proposed Siamese architecture manages to reduce the identity verification Equal Error Rate (EER) to 1.29%. A limited case study of EDITH with real-world experimental data also suggests its potential as a practical authentication system.

Yazan Qiblawey, Anas Tahir, Muhammad E. H. Chowdhury et al.

Since the breakout of coronavirus disease (COVID-19), the computer-aided diagnosis has become a necessity to prevent the spread of the virus. Detecting COVID-19 at an early stage is essential to reduce the mortality risk of the patients. In this study, a cascaded system is proposed to segment the lung, detect, localize, and quantify COVID-19 infections from computed tomography (CT) images Furthermore, the system classifies the severity of COVID-19 as mild, moderate, severe, or critical based on the percentage of infected lungs. An extensive set of experiments were performed using state-of-the-art deep Encoder-Decoder Convolutional Neural Networks (ED-CNNs), UNet, and Feature Pyramid Network (FPN), with different backbone (encoder) structures using the variants of DenseNet and ResNet. The conducted experiments showed the best performance for lung region segmentation with Dice Similarity Coefficient (DSC) of 97.19% and Intersection over Union (IoU) of 95.10% using U-Net model with the DenseNet 161 encoder. Furthermore, the proposed system achieved an elegant performance for COVID-19 infection segmentation with a DSC of 94.13% and IoU of 91.85% using the FPN model with the DenseNet201 encoder. The achieved performance is significantly superior to previous methods for COVID-19 lesion localization. Besides, the proposed system can reliably localize infection of various shapes and sizes, especially small infection regions, which are rarely considered in recent studies. Moreover, the proposed system achieved high COVID-19 detection performance with 99.64% sensitivity and 98.72% specificity. Finally, the system was able to discriminate between different severity levels of COVID-19 infection over a dataset of 1,110 subjects with sensitivity values of 98.3%, 71.2%, 77.8%, and 100% for mild, moderate, severe, and critical infections, respectively.

Aysen Degerli, Mete Ahishali, Serkan Kiranyaz et al.

Coronavirus disease 2019 (COVID-19) has emerged the need for computer-aided diagnosis with automatic, accurate, and fast algorithms. Recent studies have applied Machine Learning algorithms for COVID-19 diagnosis over chest X-ray (CXR) images. However, the data scarcity in these studies prevents a reliable evaluation with the potential of overfitting and limits the performance of deep networks. Moreover, these networks can discriminate COVID-19 pneumonia usually from healthy subjects only or occasionally, from limited pneumonia types. Thus, there is a need for a robust and accurate COVID-19 detector evaluated over a large CXR dataset. To address this need, in this study, we propose a reliable COVID-19 detection network: ReCovNet, which can discriminate COVID-19 pneumonia from 14 different thoracic diseases and healthy subjects. To accomplish this, we have compiled the largest COVID-19 CXR dataset: QaTa-COV19 with 124,616 images including 4603 COVID-19 samples. The proposed ReCovNet achieved a detection performance with 98.57% sensitivity and 99.77% specificity.

Muhammad Uzair Zahid, Serkan Kiranyaz, Turker Ince et al.

Noise and low quality of ECG signals acquired from Holter or wearable devices deteriorate the accuracy and robustness of R-peak detection algorithms. This paper presents a generic and robust system for R-peak detection in Holter ECG signals. While many proposed algorithms have successfully addressed the problem of ECG R-peak detection, there is still a notable gap in the performance of these detectors on such low-quality ECG records. Therefore, in this study, a novel implementation of the 1D Convolutional Neural Network (CNN) is used integrated with a verification model to reduce the number of false alarms. This CNN architecture consists of an encoder block and a corresponding decoder block followed by a sample-wise classification layer to construct the 1D segmentation map of R- peaks from the input ECG signal. Once the proposed model has been trained, it can solely be used to detect R-peaks possibly in a single channel ECG data stream quickly and accurately, or alternatively, such a solution can be conveniently employed for real-time monitoring on a lightweight portable device. The model is tested on two open-access ECG databases: The China Physiological Signal Challenge (2020) database (CPSC-DB) with more than one million beats, and the commonly used MIT-BIH Arrhythmia Database (MIT-DB). Experimental results demonstrate that the proposed systematic approach achieves 99.30% F1-score, 99.69% recall, and 98.91% precision in CPSC-DB, which is the best R-peak detection performance ever achieved. Compared to all competing methods, the proposed approach can reduce the false-positives and false-negatives in Holter ECG signals by more than 54% and 82%, respectively. Results also demonstrate similar or better performance than most competing algorithms on MIT-DB with 99.83% F1-score, 99.85% recall, and 99.82% precision.

Kaleem Nawaz Khan, Faiq Ahmad Khan, Anam Abid et al.

Cardiovascular diseases (CVDs) are the main cause of deaths all over the world. Heart murmurs are the most common abnormalities detected during the auscultation process. The two widely used publicly available phonocardiogram (PCG) datasets are from the PhysioNet/CinC (2016) and PASCAL (2011) challenges. The datasets are significantly different in terms of the tools used for data acquisition, clinical protocols, digital storages and signal qualities, making it challenging to process and analyze. In this work, we have used short-time Fourier transform (STFT) based spectrograms to learn the representative patterns of the normal and abnormal PCG signals. Spectrograms generated from both the datasets are utilized to perform three different studies: (i) train, validate and test different variants of convolutional neural network (CNN) models with PhysioNet dataset, (ii) train, validate and test the best performing CNN structure on combined PhysioNet-PASCAL dataset and (iii) finally, transfer learning technique is employed to train the best performing pre-trained network from the first study with PASCAL dataset. We propose a novel, less complex and relatively light custom CNN model for the classification of PhysioNet, combined and PASCAL datasets. The first study achieves an accuracy, sensitivity, specificity, precision and F1 score of 95.4%, 96.3%, 92.4%, 97.6% and 96.98% respectively while the second study shows accuracy, sensitivity, specificity, precision and F1 score of 94.2%, 95.5%, 90.3%, 96.8% and 96.1% respectively. Finally, the third study shows a precision of 98.29% on the noisy PASCAL dataset with transfer learning approach. All the three proposed approaches outperform most of the recent competing studies by achieving comparatively high classification accuracy and precision, which make them suitable for screening CVDs using PCG signals.

Tawsifur Rahman, Amith Khandakar, Yazan Qiblawey et al.

The use of computer-aided diagnosis in the reliable and fast detection of coronavirus disease (COVID-19) has become a necessity to prevent the spread of the virus during the pandemic to ease the burden on the medical infrastructure. Chest X-ray (CXR) imaging has several advantages over other imaging techniques as it is cheap, easily accessible, fast and portable. This paper explores the effect of various popular image enhancement techniques and states the effect of each of them on the detection performance. We have compiled the largest X-ray dataset called COVQU-20, consisting of 18,479 normal, non-COVID lung opacity and COVID-19 CXR images. To the best of our knowledge, this is the largest public COVID positive database. Ground glass opacity is the common symptom reported in COVID-19 pneumonia patients and so a mixture of 3616 COVID-19, 6012 non-COVID lung opacity, and 8851 normal chest X-ray images were used to create this dataset. Five different image enhancement techniques: histogram equalization, contrast limited adaptive histogram equalization, image complement, gamma correction, and Balance Contrast Enhancement Technique were used to improve COVID-19 detection accuracy. Six different Convolutional Neural Networks (CNNs) were investigated in this study. Gamma correction technique outperforms other enhancement techniques in detecting COVID-19 from standard and segmented lung CXR images. The accuracy, precision, sensitivity, f1-score, and specificity in the detection of COVID-19 with gamma correction on CXR images were 96.29%, 96.28%, 96.29%, 96.28% and 96.27% respectively. The accuracy, precision, sensitivity, F1-score, and specificity were 95.11 %, 94.55 %, 94.56 %, 94.53 % and 95.59 % respectively for segmented lung images. The proposed approach with very high and comparable performance will boost the fast and robust COVID-19 detection using chest X-ray images.

Aysen Degerli, Mete Ahishali, Mehmet Yamac et al.

Computer-aided diagnosis has become a necessity for accurate and immediate coronavirus disease 2019 (COVID-19) detection to aid treatment and prevent the spread of the virus. Numerous studies have proposed to use Deep Learning techniques for COVID-19 diagnosis. However, they have used very limited chest X-ray (CXR) image repositories for evaluation with a small number, a few hundreds, of COVID-19 samples. Moreover, these methods can neither localize nor grade the severity of COVID-19 infection. For this purpose, recent studies proposed to explore the activation maps of deep networks. However, they remain inaccurate for localizing the actual infestation making them unreliable for clinical use. This study proposes a novel method for the joint localization, severity grading, and detection of COVID-19 from CXR images by generating the so-called infection maps. To accomplish this, we have compiled the largest dataset with 119,316 CXR images including 2951 COVID-19 samples, where the annotation of the ground-truth segmentation masks is performed on CXRs by a novel collaborative human-machine approach. Furthermore, we publicly release the first CXR dataset with the ground-truth segmentation masks of the COVID-19 infected regions. A detailed set of experiments show that state-of-the-art segmentation networks can learn to localize COVID-19 infection with an F1-score of 83.20%, which is significantly superior to the activation maps created by the previous methods. Finally, the proposed approach achieved a COVID-19 detection performance with 94.96% sensitivity and 99.88% specificity.

Muhammad E. H. Chowdhury, Tawsifur Rahman, Amith Khandakar et al.

COVID-19 pandemic has created an extreme pressure on the global healthcare services. Fast, reliable and early clinical assessment of the severity of the disease can help in allocating and prioritizing resources to reduce mortality. In order to study the important blood biomarkers for predicting disease mortality, a retrospective study was conducted on 375 COVID-19 positive patients admitted to Tongji Hospital (China) from January 10 to February 18, 2020. Demographic and clinical characteristics, and patient outcomes were investigated using machine learning tools to identify key biomarkers to predict the mortality of individual patient. A nomogram was developed for predicting the mortality risk among COVID-19 patients. Lactate dehydrogenase, neutrophils (%), lymphocyte (%), high sensitive C-reactive protein, and age - acquired at hospital admission were identified as key predictors of death by multi-tree XGBoost model. The area under curve (AUC) of the nomogram for the derivation and validation cohort were 0.961 and 0.991, respectively. An integrated score (LNLCA) was calculated with the corresponding death probability. COVID-19 patients were divided into three subgroups: low-, moderate- and high-risk groups using LNLCA cut-off values of 10.4 and 12.65 with the death probability less than 5%, 5% to 50%, and above 50%, respectively. The prognostic model, nomogram and LNLCA score can help in early detection of high mortality risk of COVID-19 patients, which will help doctors to improve the management of patient stratification.

Tawsifur Rahman, Amith Khandakar, Muhammad Abdul Kadir et al.

Tuberculosis (TB) is a chronic lung disease that occurs due to bacterial infection and is one of the top 10 leading causes of death. Accurate and early detection of TB is very important, otherwise, it could be life-threatening. In this work, we have detected TB reliably from the chest X-ray images using image pre-processing, data augmentation, image segmentation, and deep-learning classification techniques. Several public databases were used to create a database of 700 TB infected and 3500 normal chest X-ray images for this study. Nine different deep CNNs (ResNet18, ResNet50, ResNet101, ChexNet, InceptionV3, Vgg19, DenseNet201, SqueezeNet, and MobileNet), which were used for transfer learning from their pre-trained initial weights and trained, validated and tested for classifying TB and non-TB normal cases. Three different experiments were carried out in this work: segmentation of X-ray images using two different U-net models, classification using X-ray images, and segmented lung images. The accuracy, precision, sensitivity, F1-score, specificity in the detection of tuberculosis using X-ray images were 97.07 %, 97.34 %, 97.07 %, 97.14 % and 97.36 % respectively. However, segmented lungs for the classification outperformed than whole X-ray image-based classification and accuracy, precision, sensitivity, F1-score, specificity were 99.9 %, 99.91 %, 99.9 %, 99.9 %, and 99.52 % respectively. The paper also used a visualization technique to confirm that CNN learns dominantly from the segmented lung regions results in higher detection accuracy. The proposed method with state-of-the-art performance can be useful in the computer-aided faster diagnosis of tuberculosis.

Anas Tahir, Yazan Qiblawey, Amith Khandakar et al.

Novel Coronavirus disease (COVID-19) is an extremely contagious and quickly spreading Coronavirus infestation. Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), which outbreak in 2002 and 2011, and the current COVID-19 pandemic are all from the same family of coronavirus. This work aims to classify COVID-19, SARS, and MERS chest X-ray (CXR) images using deep Convolutional Neural Networks (CNNs). A unique database was created, so-called QU-COVID-family, consisting of 423 COVID-19, 144 MERS, and 134 SARS CXR images. Besides, a robust COVID-19 recognition system was proposed to identify lung regions using a CNN segmentation model (U-Net), and then classify the segmented lung images as COVID-19, MERS, or SARS using a pre-trained CNN classifier. Furthermore, the Score-CAM visualization method was utilized to visualize classification output and understand the reasoning behind the decision of deep CNNs. Several Deep Learning classifiers were trained and tested; four outperforming algorithms were reported. Original and preprocessed images were used individually and all together as the input(s) to the networks. Two recognition schemes were considered: plain CXR classification and segmented CXR classification. For plain CXRs, it was observed that InceptionV3 outperforms other networks with a 3-channel scheme and achieves sensitivities of 99.5%, 93.1%, and 97% for classifying COVID-19, MERS, and SARS images, respectively. In contrast, for segmented CXRs, InceptionV3 outperformed using the original CXR dataset and achieved sensitivities of 96.94%, 79.68%, and 90.26% for classifying COVID-19, MERS, and SARS images, respectively. All networks showed high COVID-19 detection sensitivity (>96%) with the segmented lung images. This indicates the unique radiographic signature of COVID-19 cases in the eyes of AI, which is often a challenging task for medical doctors.

Mehmet Yamac, Mete Ahishali, Aysen Degerli et al.

Coronavirus disease (Covid-19) has been the main agenda of the whole world since it came in sight in December 2019. It has already caused thousands of causalities and infected several millions worldwide. Any technological tool that can be provided to healthcare practitioners to save time, effort, and possibly lives has crucial importance. The main tools practitioners currently use to diagnose Covid-19 are Reverse Transcription-Polymerase Chain reaction (RT-PCR) and Computed Tomography (CT), which require significant time, resources and acknowledged experts. X-ray imaging is a common and easily accessible tool that has great potential for Covid-19 diagnosis. In this study, we propose a novel approach for Covid-19 recognition from chest X-ray images. Despite the importance of the problem, recent studies in this domain produced not so satisfactory results due to the limited datasets available for training. Recall that Deep Learning techniques can generally provide state-of-the-art performance in many classification tasks when trained properly over large datasets, such data scarcity can be a crucial obstacle when using them for Covid-19 detection. Alternative approaches such as representation-based classification (collaborative or sparse representation) might provide satisfactory performance with limited size datasets, but they generally fall short in performance or speed compared to Machine Learning methods. To address this deficiency, Convolution Support Estimation Network (CSEN) has recently been proposed as a bridge between model-based and Deep Learning approaches by providing a non-iterative real-time mapping from query sample to ideally sparse representation coefficient' support, which is critical information for class decision in representation based techniques.

Mahmoud Dahmani, Muhammad E. H. Chowdhury, Amith Khandakar et al.

In the 34 developed and 156 developing countries, there are about 132 million disabled people who need a wheelchair constituting 1.86% of the world population. Moreover, there are millions of people suffering from diseases related to motor disabilities, which cause inability to produce controlled movement in any of the limbs or even head.The paper proposes a system to aid people with motor disabilities by restoring their ability to move effectively and effortlessly without having to rely on others utilizing an eye-controlled electric wheelchair. The system input was images of the users eye that were processed to estimate the gaze direction and the wheelchair was moved accordingly. To accomplish such a feat, four user-specific methods were developed, implemented and tested; all of which were based on a benchmark database created by the authors.The first three techniques were automatic, employ correlation and were variants of template matching, while the last one uses convolutional neural networks (CNNs). Different metrics to quantitatively evaluate the performance of each algorithm in terms of accuracy and latency were computed and overall comparison is presented. CNN exhibited the best performance (i.e. 99.3% classification accuracy), and thus it was the model of choice for the gaze estimator, which commands the wheelchair motion. The system was evaluated carefully on 8 subjects achieving 99% accuracy in changing illumination conditions outdoor and indoor. This required modifying a motorized wheelchair to adapt it to the predictions output by the gaze estimation algorithm. The wheelchair control can bypass any decision made by the gaze estimator and immediately halt its motion with the help of an array of proximity sensors, if the measured distance goes below a well-defined safety margin.

Tawsifur Rahman, Muhammad E. H. Chowdhury, Amith Khandakar et al.

Pneumonia is a life-threatening disease, which occurs in the lungs caused by either bacterial or viral infection. It can be life-endangering if not acted upon in the right time and thus an early diagnosis of pneumonia is vital. The aim of this paper is to automatically detect bacterial and viral pneumonia using digital x-ray images. It provides a detailed report on advances made in making accurate detection of pneumonia and then presents the methodology adopted by the authors. Four different pre-trained deep Convolutional Neural Network (CNN)- AlexNet, ResNet18, DenseNet201, and SqueezeNet were used for transfer learning. 5247 Bacterial, viral and normal chest x-rays images underwent preprocessing techniques and the modified images were trained for the transfer learning based classification task. In this work, the authors have reported three schemes of classifications: normal vs pneumonia, bacterial vs viral pneumonia and normal, bacterial and viral pneumonia. The classification accuracy of normal and pneumonia images, bacterial and viral pneumonia images, and normal, bacterial and viral pneumonia were 98%, 95%, and 93.3% respectively. This is the highest accuracy in any scheme than the accuracies reported in the literature. Therefore, the proposed study can be useful in faster-diagnosing pneumonia by the radiologist and can help in the fast airport screening of pneumonia patients.

Muhammad E. H. Chowdhury, Tawsifur Rahman, Amith Khandakar et al.

Coronavirus disease (COVID-19) is a pandemic disease, which has already caused thousands of causalities and infected several millions of people worldwide. Any technological tool enabling rapid screening of the COVID-19 infection with high accuracy can be crucially helpful to healthcare professionals. The main clinical tool currently in use for the diagnosis of COVID-19 is the Reverse transcription polymerase chain reaction (RT-PCR), which is expensive, less-sensitive and requires specialized medical personnel. X-ray imaging is an easily accessible tool that can be an excellent alternative in the COVID-19 diagnosis. This research was taken to investigate the utility of artificial intelligence (AI) in the rapid and accurate detection of COVID-19 from chest X-ray images. The aim of this paper is to propose a robust technique for automatic detection of COVID-19 pneumonia from digital chest X-ray images applying pre-trained deep-learning algorithms while maximizing the detection accuracy. A public database was created by the authors combining several public databases and also by collecting images from recently published articles. The database contains a mixture of 423 COVID-19, 1485 viral pneumonia, and 1579 normal chest X-ray images. Transfer learning technique was used with the help of image augmentation to train and validate several pre-trained deep Convolutional Neural Networks (CNNs). The networks were trained to classify two different schemes: i) normal and COVID-19 pneumonia; ii) normal, viral and COVID-19 pneumonia with and without image augmentation. The classification accuracy, precision, sensitivity, and specificity for both the schemes were 99.7%, 99.7%, 99.7% and 99.55% and 97.9%, 97.95%, 97.9%, and 98.8%, respectively.