Silas Nyboe Ørting

Silas Nyboe Ørting, Kristina Miger, Anne Sophie Overgaard Olesen et al.

Introduction: Chest CT scans are increasingly used in dyspneic patients where acute heart failure (AHF) is a key differential diagnosis. Interpretation remains challenging and radiology reports are frequently delayed due to a radiologist shortage, although flagging such information for emergency physicians would have therapeutic implication. Artificial intelligence (AI) can be a complementary tool to enhance the diagnostic precision. We aim to develop an explainable AI model to detect radiological signs of AHF in chest CT with an accuracy comparable to thoracic radiologists. Methods: A single-center, retrospective study during 2016-2021 at Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark. A Boosted Trees model was trained to predict AHF based on measurements of segmented cardiac and pulmonary structures from acute thoracic CT scans. Diagnostic labels for training and testing were extracted from radiology reports. Structures were segmented with TotalSegmentator. Shapley Additive explanations values were used to explain the impact of each measurement on the final prediction. Results: Of the 4,672 subjects, 49% were female. The final model incorporated twelve key features of AHF and achieved an area under the ROC of 0.87 on the independent test set. Expert radiologist review of model misclassifications found that 24 out of 64 (38%) false positives and 24 out of 61 (39%) false negatives were actually correct model predictions, with the errors originating from inaccuracies in the initial radiology reports. Conclusion: We developed an explainable AI model with strong discriminatory performance, comparable to thoracic radiologists. The AI model's stepwise, transparent predictions may support decision-making.

Silas Nyboe Ørting, Hans Jacob Teglbjærg Stephensen, Jon Sporring

The categorical distribution is a natural representation of uncertainty in multi-class segmentations. In the two-class case the categorical distribution reduces to the Bernoulli distribution, for which grayscale morphology provides a range of useful operations. In the general case, applying morphological operations on uncertain multi-class segmentations is not straightforward as an image of categorical distributions is not a complete lattice. Although morphology on color images has received wide attention, this is not so for color-coded or categorical images and even less so for images of categorical distributions. In this work, we establish a set of requirements for morphology on categorical distributions by combining classic morphology with a probabilistic view. We then define operators respecting these requirements, introduce protected operations on categorical distributions and illustrate the utility of these operators on two example tasks: modeling annotator bias in brain tumor segmentations and segmenting vesicle instances from the predictions of a multi-class U-Net.

Silas Nyboe Ørting

We report on the results of a small crowdsourcing experiment conducted at a workshop on machine learning for segmentation held at the Danish Bio Imaging network meeting 2020. During the workshop we asked participants to manually segment mitochondria in three 2D patches. The aim of the experiment was to illustrate that manual annotations should not be seen as the ground truth, but as a reference standard that is subject to substantial variation. In this note we show how the large variation we observed in the segmentations can be reduced by removing the annotators with worst pair-wise agreement. Having removed the annotators with worst performance, we illustrate that the remaining variance is semantically meaningful and can be exploited to obtain segmentations of cell boundary and cell interior.

Raghavendra Selvan, Silas Ørting, Erik B Dam

The recently introduced locally orderless tensor network (LoTeNet) for supervised image classification uses matrix product state (MPS) operations on grids of transformed image patches. The resulting patch representations are combined back together into the image space and aggregated hierarchically using multiple MPS blocks per layer to obtain the final decision rules. In this work, we propose a non-patch based modification to LoTeNet that performs one MPS operation per layer, instead of several patch-level operations. The spatial information in the input images to MPS blocks at each layer is squeezed into the feature dimension, similar to LoTeNet, to maximise retained spatial correlation between pixels when images are flattened into 1D vectors. The proposed multi-layered tensor network (MLTN) is capable of learning linear decision boundaries in high dimensional spaces in a multi-layered setting, which results in a reduction in the computation cost compared to LoTeNet without any degradation in performance.

Raghavendra Selvan, Silas Ørting, Erik B Dam

Tensor networks are factorisations of high rank tensors into networks of lower rank tensors and have primarily been used to analyse quantum many-body problems. Tensor networks have seen a recent surge of interest in relation to supervised learning tasks with a focus on image classification. In this work, we improve upon the matrix product state (MPS) tensor networks that can operate on one-dimensional vectors to be useful for working with 2D and 3D medical images. We treat small image regions as orderless, squeeze their spatial information into feature dimensions and then perform MPS operations on these locally orderless regions. These local representations are then aggregated in a hierarchical manner to retain global structure. The proposed locally orderless tensor network (LoTeNet) is compared with relevant methods on three datasets. The architecture of LoTeNet is fixed in all experiments and we show it requires lesser computational resources to attain performance on par or superior to the compared methods.

Wouter M. Kouw, Silas N. Ørting, Jens Petersen et al.

Suppose one is faced with the challenge of tissue segmentation in MR images, without annotators at their center to provide labeled training data. One option is to go to another medical center for a trained classifier. Sadly, tissue classifiers do not generalize well across centers due to voxel intensity shifts caused by center-specific acquisition protocols. However, certain aspects of segmentations, such as spatial smoothness, remain relatively consistent and can be learned separately. Here we present a smoothness prior that is fit to segmentations produced at another medical center. This informative prior is presented to an unsupervised Bayesian model. The model clusters the voxel intensities, such that it produces segmentations that are similarly smooth to those of the other medical center. In addition, the unsupervised Bayesian model is extended to a semi-supervised variant, which needs no visual interpretation of clusters into tissues.

Silas Ørting, Andrew Doyle, Arno van Hilten et al.

Rapid advances in image processing capabilities have been seen across many domains, fostered by the application of machine learning algorithms to "big-data". However, within the realm of medical image analysis, advances have been curtailed, in part, due to the limited availability of large-scale, well-annotated datasets. One of the main reasons for this is the high cost often associated with producing large amounts of high-quality meta-data. Recently, there has been growing interest in the application of crowdsourcing for this purpose; a technique that has proven effective for creating large-scale datasets across a range of disciplines, from computer vision to astrophysics. Despite the growing popularity of this approach, there has not yet been a comprehensive literature review to provide guidance to researchers considering using crowdsourcing methodologies in their own medical imaging analysis. In this survey, we review studies applying crowdsourcing to the analysis of medical images, published prior to July 2018. We identify common approaches, challenges and considerations, providing guidance of utility to researchers adopting this approach. Finally, we discuss future opportunities for development within this emerging domain.

Silas Nyboe Ørting, Jens Petersen, Laura H. Thomsen et al.

Accurate assessment of pulmonary emphysema is crucial to assess disease severity and subtype, to monitor disease progression and to predict lung cancer risk. However, visual assessment is time-consuming and subject to substantial inter-rater variability and standard densitometry approaches to quantify emphysema remain inferior to visual scoring. We explore if machine learning methods that learn from a large dataset of visually assessed CT scans can provide accurate estimates of emphysema extent. We further investigate if machine learning algorithms that learn from a scoring of emphysema extent can outperform algorithms that learn only from a scoring of emphysema presence. We compare four Multiple Instance Learning classifiers that are trained on emphysema presence labels, and five Learning with Label Proportions classifiers that are trained on emphysema extent labels. We evaluate performance on 600 low-dose CT scans from the Danish Lung Cancer Screening Trial and find that learning from emphysema presence labels, which are much easier to obtain, gives equally good performance to learning from emphysema extent labels. The best classifiers achieve intra-class correlation coefficients around 0.90 and average overall agreement with raters of 78% and 79% on six emphysema extent classes versus inter-rater agreement of 83%.

Gerda Bortsova, Florian Dubost, Silas Ørting et al.

We propose an end-to-end deep learning method that learns to estimate emphysema extent from proportions of the diseased tissue. These proportions were visually estimated by experts using a standard grading system, in which grades correspond to intervals (label example: 1-5% of diseased tissue). The proposed architecture encodes the knowledge that the labels represent a volumetric proportion. A custom loss is designed to learn with intervals. Thus, during training, our network learns to segment the diseased tissue such that its proportions fit the ground truth intervals. Our architecture and loss combined improve the performance substantially (8% ICC) compared to a more conventional regression network. We outperform traditional lung densitometry and two recently published methods for emphysema quantification by a large margin (at least 7% AUC and 15% ICC), and achieve near-human-level performance. Moreover, our method generates emphysema segmentations that predict the spatial distribution of emphysema at human level.

Silas Nyboe Ørting, Jens Petersen, Veronika Cheplygina et al.

Supervised feature learning using convolutional neural networks (CNNs) can provide concise and disease relevant representations of medical images. However, training CNNs requires annotated image data. Annotating medical images can be a time-consuming task and even expert annotations are subject to substantial inter- and intra-rater variability. Assessing visual similarity of images instead of indicating specific pathologies or estimating disease severity could allow non-experts to participate, help uncover new patterns, and possibly reduce rater variability. We consider the task of assessing emphysema extent in chest CT scans. We derive visual similarity triplets from visually assessed emphysema extent and learn a low dimensional embedding using CNNs. We evaluate the networks on 973 images, and show that the CNNs can learn disease relevant feature representations from derived similarity triplets. To our knowledge this is the first medical image application where similarity triplets has been used to learn a feature representation that can be used for embedding unseen test images