The National Library of Medicine (NLM) is developing a digital chest X-ray (CXR) screening system for deployment in resource constrained communities and developing countries worldwide with a focus on early detection of tuberculosis. A critical component in the computer-aided diagnosis of digital CXRs is the automatic detection of the lung regions. In this paper, we present a nonrigid registration-driven robust lung segmentation method using image retrieval-based patient specific adaptive lung models that detects lung boundaries, surpassing state-of-the-art performance. The method consists of three main stages: 1) a content-based image retrieval approach for identifying training images (with masks) most similar to the patient CXR using a partial Radon transform and Bhattacharyya shape similarity measure, 2) creating the initial patient-specific anatomical model of lung shape using SIFT-flow for deformable registration of training masks to the patient CXR, and 3) extracting refined lung boundaries using a graph cuts optimization approach with a customized energy function. Our average accuracy of 95.4% on the public JSRT database is the highest among published results. A similar degree of accuracy of 94.1% and 91.7% on two new CXR datasets from Montgomery County, MD, USA, and India, respectively, demonstrates the robustness of our lung segmentation approach.

Pneumonia affects 7% of the global population, resulting in 2 million pediatric deaths every year. Chest X-ray (CXR) analysis is routinely performed to diagnose the disease. Computer-aided diagnostic (CADx) tools aim to supplement decision-making. These tools process the handcrafted and/or convolutional neural network (CNN) extracted image features for visual recognition. However, CNNs are perceived as black boxes since their performance lack explanations. This is a serious bottleneck in applications involving medical screening/diagnosis since poorly interpreted model behavior could adversely affect the clinical decision. In this study, we evaluate, visualize, and explain the performance of customized CNNs to detect pneumonia and further differentiate between bacterial and viral types in pediatric CXRs. We present a novel visualization strategy to localize the region of interest (ROI) that is considered relevant for model predictions across all the inputs that belong to an expected class. We statistically validate the models' performance toward the underlying tasks. We observe that the customized VGG16 model achieves 96.2% and 93.6% accuracy in detecting the disease and distinguishing between bacterial and viral pneumonia respectively. The model outperforms the state-of-the-art in all performance metrics and demonstrates reduced bias and improved generalization. Figure 1. Pediatric CXRs: (a) Normal CXR showing clear lungs with no abnormal opacification; (b) Bacterial pneumonia exhibiting focal lobar consolidation in the right upper lobe; (c) Viral pneumonia manifesting with diffuse interstitial patterns in both lungs.Computer-aided diagnostic (CADx) tools aim to supplement clinical decision-making. They combine elements of computer vision and artificial intelligence with radiological image processing for recognizing patterns [4]. Much of the published literature describes machine learning (ML) algorithms that use handcrafted feature descriptors [5] that are optimized for individual datasets and trained for specific variability in size, orientation, and position of the region of interest (ROI) [6]. In recent years, data-driven deep learning (DL) methods are shown to avoid the issues with handcrafted features through end-to-end feature extraction and classification.Convolutional neural networks (CNNs) belong to a class of DL models that are prominently used in computer vision [7]. These models have multiple processing layers to learn hierarchical feature representations from the input pixel data. The features in the early network layers are abstracted through the mechanisms of local receptive fields, weight sharing, and pooling to form rich feature representations toward learning and classifying the inputs to their respective classes. Due to lack of sufficiently extensive medical image data, CNNs trained on large-scale data collections such as ImageNet [8] are used to transfer the knowledge of learned representations in the form of generic image features to the current task. CNNs are also shown to deliver promising...

PurposeChest radiography is the most common imaging modality for pulmonary diseases. Due to its wide usage, there is a rich literature addressing automated detection of cardiopulmonary diseases in digital chest X-rays (CXRs). One of the essential steps for automated analysis of CXRs is localizing the relevant region of interest, i.e., isolating lung region from other less relevant parts, for applying decision-making algorithms there. This article provides an overview of the recent literature on lung boundary detection in CXR images.MethodsWe review the leading lung segmentation algorithms proposed in period 2006–2017. First, we present a review of articles for posterior–anterior view CXRs. Then, we mention studies which operate on lateral views. We pay particular attention to works that focus their efforts on deformed lungs and pediatric cases. We also highlight the radiographic measures extracted from lung boundary and their use in automatically detecting cardiopulmonary abnormalities. Finally, we identify challenges in dataset curation and expert delineation process, and we listed publicly available CXR datasets.Results(1) We classified algorithms into four categories: rule-based, pixel classification-based, model-based, hybrid, and deep learning-based algorithms. Based on the reviewed articles, hybrid methods and deep learning-based methods surpass the algorithms in other classes and have segmentation performance as good as inter-observer performance. However, they require long training process and pose high computational complexity. (2) We found that most of the algorithms in the literature are evaluated on posterior–anterior view adult CXRs with a healthy lung anatomy appearance without considering challenges in abnormal CXRs. (3) We also found that there are limited studies for pediatric CXRs. The lung appearance in pediatrics, especially in infant cases, deviates from adult lung appearance due to the pediatric development stages. Moreover, pediatric CXRs are noisier than adult CXRs due to interference by other objects, such as someone holding the child’s arms or the child’s body, and irregular body pose. Therefore, lung boundary detection algorithms developed on adult CXRs may not perform accurately in pediatric cases and need additional constraints suitable for pediatric CXR imaging characteristics. (4) We have also stated that one of the main challenges in medical image analysis is accessing the suitable datasets. We listed benchmark CXR datasets for developing and evaluating the lung boundary algorithms. However, the number of CXR images with reference boundaries is limited due to the cumbersome but necessary process of expert boundary delineation.ConclusionsA reliable computer-aided diagnosis system would need to support a greater variety of lung and background appearance. To our knowledge, algorithms in the literature are evaluated on posterior–anterior view adult CXRs with a healthy lung anatomy appearance, without considering ambiguous lung silhouettes due to pathological deformities, anatomical alte...

To detect pulmonary abnormalities such as Tuberculosis (TB), an automatic analysis and classification of chest radiographs can be used as a reliable alternative to more sophisticated and technologically demanding methods (e.g. culture or sputum smear analysis). In target areas like Kenya TB is highly prevalent and often co-occurring with HIV combined with low resources and limited medical assistance. In these regions an automatic screening system can provide a cost-effective solution for a large rural population. Our completely automatic TB screening system is processing the incoming CXRs (chest X-ray) by applying image preprocessing techniques to enhance the image quality followed by an adaptive segmentation based on model selection. The delineated lung regions are described by a multitude of image features. These characteristics are than optimized by a feature selection strategy to provide the best description for the classifier, which will later decide if the analyzed image is normal or abnormal. Our goal is to find the optimal feature set from a larger pool of generic image features, -used originally for problems such as object detection, image retrieval, etc. For performance evaluation measures such as under the curve (AUC) and accuracy (ACC) were considered. Using a neural network classifier on two publicly available data collections, -namely the Montgomery and the Shenzhen dataset, we achieved the maximum area under the curve and accuracy of 0.99 and 97.03%, respectively. Further, we compared our results with existing state-of-the-art systems and to radiologists' decision.

PurposeTuberculosis is a major global health threat claiming millions of lives each year. While the total number of tuberculosis cases has been decreasing over the last years, the rise of drug-resistant tuberculosis has reduced the chance of controlling the disease. The purpose is to implement a timely diagnosis of drug-resistant tuberculosis, which is essential to administering adequate treatment regimens and stopping the further transmission of drug-resistant tuberculosis.MethodsA main tool for diagnosing tuberculosis is the conventional chest X-ray. We are investigating the possibility of discriminating automatically between drug-resistant and drug-sensitive tuberculosis in chest X-rays by means of image analysis and machine learning methods.ResultsFor discriminating between drug-sensitive and drug-resistant tuberculosis, we achieve an area under the receiver operating characteristic curve (AUC) of up to 66%, using an artificial neural network in combination with a set of shape and texture features. We did not observe any significant difference in the results when including follow-up X-rays for each patient.ConclusionOur results suggest that a chest X-ray contains information about the likelihood of a drug-resistant tuberculosis infection, which can be exploited computationally. We therefore suggest to repeat the experiments of our pilot study on a larger set of chest X-rays.

Using our proposed algorithm, we were able to increase the overall performance, measured as area under the (ROC) curve (AUC) by 2.4 % over our previous work.

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