Manu S. Goyal

Manu Goyal, Jonathan D. Marotti, Adrienne A. Workman et al.

Breast cancer is the most common malignancy affecting women worldwide and is notable for its morphologic and biologic diversity, with varying risks of recurrence following treatment. The Oncotype DX Breast Recurrence Score test is an important predictive and prognostic genomic assay for estrogen receptor-positive breast cancer that guides therapeutic strategies; however, such tests can be expensive, delay care, and are not widely available. The aim of this study was to develop a multi-model approach integrating the analysis of whole slide images and clinicopathologic data to predict their associated breast cancer recurrence risks and categorize these patients into two risk groups according to the predicted score: low and high risk. The proposed novel methodology uses convolutional neural networks for feature extraction and vision transformers for contextual aggregation, complemented by a logistic regression model that analyzes clinicopathologic data for classification into two risk categories. This method was trained and tested on 993 hematoxylin and eosin-stained whole-slide images of breast cancers with corresponding clinicopathological features that had prior Oncotype DX testing. The model's performance was evaluated using an internal test set of 198 patients from Dartmouth Health and an external test set of 418 patients from the University of Chicago. The multi-model approach achieved an AUC of 0.92 (95 percent CI: 0.88-0.96) on the internal set and an AUC of 0.85 (95 percent CI: 0.79-0.90) on the external cohort. These results suggest that with further validation, the proposed methodology could provide an alternative to assist clinicians in personalizing treatment for breast cancer patients and potentially improving their outcomes.

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.

Manu Goyal, Junyu Guo, Lauren Hinojosa et al.

Despite the recent advances of deep learning algorithms in medical imaging, the automatic segmentation algorithms for kidneys in MRI exams are still scarce. Automated segmentation of kidneys in Magnetic Resonance Imaging (MRI) exams are important for enabling radiomics and machine learning analysis of renal disease. In this work, we propose to use the popular Mask R-CNN for the automatic segmentation of kidneys in coronal T2-weighted Fast Spin Eco slices of 100 MRI exams. We propose the morphological operations as post-processing to further improve the performance of Mask R-CNN for this task. With 5-fold cross-validation data, the proposed Mask R-CNN is trained and validated on 70 and 10 MRI exams and then evaluated on the remaining 20 exams in each fold. Our proposed method achieved a dice score of 0.904 and IoU of 0.822.

Manu Goyal, Judith Austin-Strohbehn, Sean J. Sun et al.

Background: Deep learning has great potential to assist with detecting and triaging critical findings such as pneumoperitoneum on medical images. To be clinically useful, the performance of this technology still needs to be validated for generalizability across different types of imaging systems. Materials and Methods: This retrospective study included 1,287 chest X-ray images of patients who underwent initial chest radiography at 13 different hospitals between 2011 and 2019. The chest X-ray images were labelled independently by four radiologist experts as positive or negative for pneumoperitoneum. State-of-the-art deep learning models (ResNet101, InceptionV3, DenseNet161, and ResNeXt101) were trained on a subset of this dataset, and the automated classification performance was evaluated on the rest of the dataset by measuring the AUC, sensitivity, and specificity for each model. Furthermore, the generalizability of these deep learning models was assessed by stratifying the test dataset according to the type of the utilized imaging systems. Results: All deep learning models performed well for identifying radiographs with pneumoperitoneum, while DenseNet161 achieved the highest AUC of 95.7%, Specificity of 89.9%, and Sensitivity of 91.6%. DenseNet161 model was able to accurately classify radiographs from different imaging systems (Accuracy: 90.8%), while it was trained on images captured from a specific imaging system from a single institution. This result suggests the generalizability of our model for learning salient features in chest X-ray images to detect pneumoperitoneum, independent of the imaging system.

Manu Goyal, Thomas Knackstedt, Shaofeng Yan et al.

Recently, there has been great interest in developing Artificial Intelligence (AI) enabled computer-aided diagnostics solutions for the diagnosis of skin cancer. With the increasing incidence of skin cancers, low awareness among a growing population, and a lack of adequate clinical expertise and services, there is an immediate need for AI systems to assist clinicians in this domain. A large number of skin lesion datasets are available publicly, and researchers have developed AI-based image classification solutions, particularly deep learning algorithms, to distinguish malignant skin lesions from benign lesions in different image modalities such as dermoscopic, clinical, and histopathology images. Despite the various claims of AI systems achieving higher accuracy than dermatologists in the classification of different skin lesions, these AI systems are still in the very early stages of clinical application in terms of being ready to aid clinicians in the diagnosis of skin cancers. In this review, we discuss advancements in the digital image-based AI solutions for the diagnosis of skin cancer, along with some challenges and future opportunities to improve these AI systems to support dermatologists and enhance their ability to diagnose skin cancer.

Manu Goyal, Moi Hoon Yap, Saeed Hassanpour

Rapid growth in the development of medical imaging analysis technology has been propelled by the great interest in improving computer-aided diagnosis and detection (CAD) systems for three popular image visualization tasks: classification, segmentation, and Region of Interest (ROI) detection. However, a limited number of datasets with ground truth annotations are available for developing segmentation and ROI detection of lesions, as expert annotations are laborious and expensive. Detecting the ROI is vital to locate lesions accurately. In this paper, we propose the use of two deep object detection meta-architectures (Faster R-CNN Inception-V2 and SSD Inception-V2) to develop robust ROI detection of skin lesions in dermoscopic datasets (2017 ISIC Challenge, PH2, and HAM10000), and compared the performance with state-of-the-art segmentation algorithm (DeeplabV3+). To further demonstrate the potential of our work, we built a smartphone application for real-time automated detection of skin lesions based on this methodology. In addition, we developed an automated natural data-augmentation method from ROI detection to produce augmented copies of dermoscopic images, as a pre-processing step in the segmentation of skin lesions to further improve the performance of the current state-of-the-art deep learning algorithm. Our proposed ROI detection has the potential to more appropriately streamline dermatology referrals and reduce unnecessary biopsies in the diagnosis of skin cancer.

Manu Goyal, Moi Hoon Yap, Saeed Hassanpour

Melanoma is clinically difficult to distinguish from common benign skin lesions, particularly melanocytic naevus and seborrhoeic keratosis. The dermoscopic appearance of these lesions has huge intra-class variations and high inter-class visual similarities. Most current research is focusing on single-class segmentation irrespective of classes of skin lesions. In this work, we evaluate the performance of deep learning on multi-class segmentation of ISIC-2017 challenge dataset, which consists of 2,750 dermoscopic images. We propose an end-to-end solution using fully convolutional networks (FCNs) for multi-class semantic segmentation to automatically segment the melanoma, seborrhoeic keratosis and naevus. To improve the performance of FCNs, transfer learning and a hybrid loss function are used. We evaluate the performance of the deep learning segmentation methods for multi-class segmentation and lesion diagnosis (with post-processing method) on the testing set of the ISIC-2017 challenge dataset. The results showed that the two-tier level transfer learning FCN-8s achieved the overall best result with \textit{Dice} score of 78.5% in a naevus category, 65.3% in melanoma, and 55.7% in seborrhoeic keratosis in multi-class segmentation and Accuracy of 84.62% for recognition of melanoma in lesion diagnosis.

Manu Goyal, Neil D. Reeves, Adrian K. Davison et al.

Globally, in 2016, one out of eleven adults suffered from Diabetes Mellitus. Diabetic Foot Ulcers (DFU) are a major complication of this disease, which if not managed properly can lead to amputation. Current clinical approaches to DFU treatment rely on patient and clinician vigilance, which has significant limitations such as the high cost involved in the diagnosis, treatment and lengthy care of the DFU. We collected an extensive dataset of foot images, which contain DFU from different patients. In this paper, we have proposed the use of traditional computer vision features for detecting foot ulcers among diabetic patients, which represent a cost-effective, remote and convenient healthcare solution. Furthermore, we used Convolutional Neural Networks (CNNs) for the first time in DFU classification. We have proposed a novel convolutional neural network architecture, DFUNet, with better feature extraction to identify the feature differences between healthy skin and the DFU. Using 10-fold cross-validation, DFUNet achieved an AUC score of 0.962. This outperformed both the machine learning and deep learning classifiers we have tested. Here we present the development of a novel and highly sensitive DFUNet for objectively detecting the presence of DFUs. This novel approach has the potential to deliver a paradigm shift in diabetic foot care.