Bill Cassidy

Imran Chowdhury Dipto, Bill Cassidy, Connah Kendrick et al.

This research conducts an investigation on the effect of visually similar images within a publicly available diabetic foot ulcer dataset when training deep learning classification networks. The presence of binary-identical duplicate images in datasets used to train deep learning algorithms is a well known issue that can introduce unwanted bias which can degrade network performance. However, the effect of visually similar non-identical images is an under-researched topic, and has so far not been investigated in any diabetic foot ulcer studies. We use an open-source fuzzy algorithm to identify groups of increasingly similar images in the Diabetic Foot Ulcers Challenge 2021 (DFUC2021) training dataset. Based on each similarity threshold, we create new training sets that we use to train a range of deep learning multi-class classifiers. We then evaluate the performance of the best performing model on the DFUC2021 test set. Our findings show that the model trained on the training set with the 80\% similarity threshold images removed achieved the best performance using the InceptionResNetV2 network. This model showed improvements in F1-score, precision, and recall of 0.023, 0.029, and 0.013, respectively. These results indicate that highly similar images can contribute towards the presence of performance degrading bias within the Diabetic Foot Ulcers Challenge 2021 dataset, and that the removal of images that are 80\% similar from the training set can help to boost classification performance.

Connah Kendrick, Bill Cassidy, Joseph M. Pappachan et al.

Diabetic foot ulcer is a severe condition that requires close monitoring and management. For training machine learning methods to auto-delineate the ulcer, clinical staff must provide ground truth annotations. In this paper, we propose a new diabetic foot ulcers dataset, namely DFUC2022, the largest segmentation dataset where ulcer regions were manually delineated by clinicians. We assess whether the clinical delineations are machine interpretable by deep learning networks or if image processing refined contour should be used. By providing benchmark results using a selection of popular deep learning algorithms, we draw new insights into the limitations of DFU wound delineation and report on the associated issues. This paper provides some observations on baseline models to facilitate DFUC2022 Challenge in conjunction with MICCAI 2022. The leaderboard will be ranked by Dice score, where the best FCN-based method is 0.5708 and DeepLabv3+ achieved the best score of 0.6277. This paper demonstrates that image processing using refined contour as ground truth can provide better agreement with machine predicted results. DFUC2022 will be released on the 27th April 2022.

Connah Kendrick, Bill Cassidy, Neil D. Reeves et al.

The Diabetic Foot Ulcer Challenge 2022 focused on the task of diabetic foot ulcer segmentation, based on the work completed in previous DFU challenges. The challenge provided 4000 images of full-view foot ulcer images together with corresponding delineation of ulcer regions. This paper provides an overview of the challenge, a summary of the methods proposed by the challenge participants, the results obtained from each technique, and a comparison of the challenge results. The best-performing network was a modified HarDNet-MSEG, with a Dice score of 0.7287.

Samuel William Pewton, Bill Cassidy, Connah Kendrick et al.

One of the more significant obstacles in classification of skin cancer is the presence of artifacts. This paper investigates the effect of dark corner artifacts, which result from the use of dermoscopes, on the performance of a deep learning binary classification task. Previous research attempted to remove and inpaint dark corner artifacts, with the intention of creating an ideal condition for models. However, such research has been shown to be inconclusive due to lack of available datasets labelled with dark corner artifacts and detailed analysis and discussion. To address these issues, we label 10,250 skin lesion images from publicly available datasets and introduce a balanced dataset with an equal number of melanoma and non-melanoma cases. The training set comprises 6126 images without artifacts, and the testing set comprises 4124 images with dark corner artifacts. We conduct three experiments to provide new understanding on the effects of dark corner artifacts, including inpainted and synthetically generated examples, on a deep learning method. Our results suggest that introducing synthetic dark corner artifacts which have been superimposed onto the training set improved model performance, particularly in terms of the true negative rate. This indicates that deep learning learnt to ignore dark corner artifacts, rather than treating it as melanoma, when dark corner artifacts were introduced into the training set. Further, we propose a new approach to quantifying heatmaps indicating network focus using a root mean square measure of the brightness intensity in the different regions of the heatmaps. This paper provides a new guideline for skin lesions analysis with an emphasis on reproducibility.

Bill Cassidy, Christian McBride, Connah Kendrick et al.

The growing rate of chronic wound occurrence, especially in patients with diabetes, has become a concerning trend in recent years. Chronic wounds are difficult and costly to treat, and have become a serious burden on health care systems worldwide. Chronic wounds can have devastating consequences for the patient, with infection often leading to reduced quality of life and increased mortality risk. Innovative deep learning methods for the detection and monitoring of such wounds have the potential to reduce the impact to both patient and clinician. We present a novel multimodal segmentation method which allows for the introduction of patient metadata into the training workflow whereby the patient data are expressed as Gaussian random fields. Our results indicate that the proposed method improved performance when utilising multiple models, each trained on different metadata categories. Using the Diabetic Foot Ulcer Challenge 2022 test set, when compared to the baseline results (intersection over union = 0.4670, Dice similarity coefficient = 0.5908) we demonstrate improvements of +0.0220 and +0.0229 for intersection over union and Dice similarity coefficient respectively. This paper presents the first study to focus on integrating patient data into a chronic wound segmentation workflow. Our results show significant performance gains when training individual models using specific metadata categories, followed by average merging of prediction masks using distance transforms. All source code for this study is available at: https://github.com/mmu-dermatology-research/multimodal-grf

Moi Hoon Yap, Connah Kendrick, Neil D. Reeves et al.

This paper provides conceptual foundation and procedures used in the development of diabetic foot ulcer datasets over the past decade, with a timeline to demonstrate progress. We conduct a survey on data capturing methods for foot photographs, an overview of research in developing private and public datasets, the related computer vision tasks (detection, segmentation and classification), the diabetic foot ulcer challenges and the future direction of the development of the datasets. We report the distribution of dataset users by country and year. Our aim is to share the technical challenges that we encountered together with good practices in dataset development, and provide motivation for other researchers to participate in data sharing in this domain.

Bill Cassidy, Connah Kendrick, Neil D. Reeves et al.

Diabetic foot ulcer classification systems use the presence of wound infection (bacteria present within the wound) and ischaemia (restricted blood supply) as vital clinical indicators for treatment and prediction of wound healing. Studies investigating the use of automated computerised methods of classifying infection and ischaemia within diabetic foot wounds are limited due to a paucity of publicly available datasets and severe data imbalance in those few that exist. The Diabetic Foot Ulcer Challenge 2021 provided participants with a more substantial dataset comprising a total of 15,683 diabetic foot ulcer patches, with 5,955 used for training, 5,734 used for testing and an additional 3,994 unlabelled patches to promote the development of semi-supervised and weakly-supervised deep learning techniques. This paper provides an evaluation of the methods used in the Diabetic Foot Ulcer Challenge 2021, and summarises the results obtained from each network. The best performing network was an ensemble of the results of the top 3 models, with a macro-average F1-score of 0.6307.

Bill Cassidy, Neil D. Reeves, Joseph M. Pappachan et al.

This research proposes a mobile and cloud-based framework for the automatic detection of diabetic foot ulcers and conducts an investigation of its performance. The system uses a cross-platform mobile framework which enables the deployment of mobile apps to multiple platforms using a single TypeScript code base. A deep convolutional neural network was deployed to a cloud-based platform where the mobile app could send photographs of patient's feet for inference to detect the presence of diabetic foot ulcers. The functionality and usability of the system were tested in two clinical settings: Salford Royal NHS Foundation Trust and Lancashire Teaching Hospitals NHS Foundation Trust. The benefits of the system, such as the potential use of the app by patients to identify and monitor their condition are discussed.

Moi Hoon Yap, Bill Cassidy, Joseph M. Pappachan et al.

This paper introduces the Diabetic Foot Ulcers dataset (DFUC2021) for analysis of pathology, focusing on infection and ischaemia. We describe the data preparation of DFUC2021 for ground truth annotation, data curation and data analysis. The final release of DFUC2021 consists of 15,683 DFU patches, with 5,955 training, 5,734 for testing and 3,994 unlabeled DFU patches. The ground truth labels are four classes, i.e. control, infection, ischaemia and both conditions. We curate the dataset using image hashing techniques and analyse the separability using UMAP projection. We benchmark the performance of five key backbones of deep learning, i.e. VGG16, ResNet101, InceptionV3, DenseNet121 and EfficientNet on DFUC2021. We report the optimised results of these key backbones with different strategies. Based on our observations, we conclude that EfficientNetB0 with data augmentation and transfer learning provided the best results for multi-class (4-class) classification with macro-average Precision, Recall and F1-score of 0.57, 0.62 and 0.55, respectively. In ischaemia and infection recognition, when trained on one-versus-all, EfficientNetB0 achieved comparable results with the state of the art. Finally, we interpret the results with statistical analysis and Grad-CAM visualisation.

Moi Hoon Yap, Ryo Hachiuma, Azadeh Alavi et al.

There has been a substantial amount of research involving computer methods and technology for the detection and recognition of diabetic foot ulcers (DFUs), but there is a lack of systematic comparisons of state-of-the-art deep learning object detection frameworks applied to this problem. DFUC2020 provided participants with a comprehensive dataset consisting of 2,000 images for training and 2,000 images for testing. This paper summarises the results of DFUC2020 by comparing the deep learning-based algorithms proposed by the winning teams: Faster R-CNN, three variants of Faster R-CNN and an ensemble method; YOLOv3; YOLOv5; EfficientDet; and a new Cascade Attention Network. For each deep learning method, we provide a detailed description of model architecture, parameter settings for training and additional stages including pre-processing, data augmentation and post-processing. We provide a comprehensive evaluation for each method. All the methods required a data augmentation stage to increase the number of images available for training and a post-processing stage to remove false positives. The best performance was obtained from Deformable Convolution, a variant of Faster R-CNN, with a mean average precision (mAP) of 0.6940 and an F1-Score of 0.7434. Finally, we demonstrate that the ensemble method based on different deep learning methods can enhanced the F1-Score but not the mAP.

Bill Cassidy, Neil D. Reeves, Pappachan Joseph et al.

Every 20 seconds, a limb is amputated somewhere in the world due to diabetes. This is a global health problem that requires a global solution. The MICCAI challenge discussed in this paper, which concerns the automated detection of diabetic foot ulcers using machine learning techniques, will accelerate the development of innovative healthcare technology to address this unmet medical need. In an effort to improve patient care and reduce the strain on healthcare systems, recent research has focused on the creation of cloud-based detection algorithms. These can be consumed as a service by a mobile app that patients (or a carer, partner or family member) could use themselves at home to monitor their condition and to detect the appearance of a diabetic foot ulcer (DFU). Collaborative work between Manchester Metropolitan University, Lancashire Teaching Hospital and the Manchester University NHS Foundation Trust has created a repository of 4,000 DFU images for the purpose of supporting research toward more advanced methods of DFU detection. Based on a joint effort involving the lead scientists of the UK, US, India and New Zealand, this challenge will solicit original work, and promote interactions between researchers and interdisciplinary collaborations. This paper presents a dataset description and analysis, assessment methods, benchmark algorithms and initial evaluation results. It facilitates the challenge by providing useful insights into state-of-the-art and ongoing research. This grand challenge takes on even greater urgency in a peri and post-pandemic period, where stresses on resource utilization will increase the need for technology that allows people to remain active, healthy and intact in their home.