Multi-modal trained artificial intelligence solution to triage chest X-ray for COVID-19 using pristine ground-truth, versus radiologists.

The front-line imaging modalities computed tomography (CT) and X-ray play important roles for triaging COVID patients. Thoracic CT has been accepted to have higher sensitivity than a chest X-ray for COVID diagnosis. Considering the limited access to resources (both hardware and trained personnel) and issues related to decontamination, CT may not be ideal for triaging suspected subjects. Artificial intelligence (AI) assisted X-ray based application for triaging and monitoring require experienced radiologists to identify COVID patients in a timely manner with the additional ability to delineate and quantify the disease region is seen as a promising solution for widespread clinical use. Our proposed solution differs from existing solutions presented by industry and academic communities. We demonstrate a functional AI model to triage by classifying and segmenting a single chest X-ray image, while the AI model is trained using both X-ray and CT data. We report on how such a multi-modal training process improves the solution compared to single modality (X-ray only) training. The multi-modal solution increases the AUC (area under the receiver operating characteristic curve) from 0.89 to 0.93 for a binary classification between COVID-19 and non-COVID-19 cases. It also positively impacts the Dice coefficient (0.59 to 0.62) for localizing the COVID-19 pathology. To compare the performance of experienced readers to the AI model, a reader study is also conducted. The AI model showed good consistency with respect to radiologists. The DICE score between two radiologists on the COVID group was 0.53 while the AI had a DICE value of 0.52 and 0.55 when compared to the segmentation done by the two radiologists separately. From a classification perspective, the AUCs of two readers was 0.87 and 0.81 while the AUC of the AI is 0.93 based on the reader study dataset. We also conducted a generalization study by comparing our method to the-state-art methods on independent datasets. The results show better performance from the proposed method. Leveraging multi-modal information for the development benefits the single-modal inferencing.

Scanner Agnostic Ultrasound Image Interpretation.

Ultrasound scanners image the anatomy modulated by their characteristic texture. For certain anatomical regions such as the liver, the characteristic texture of the scanner itself becomes the anatomical marker. Deep Learning (DL) models trained on a scanner-type not only model the anatomical content, they also learn the scanner's characteristic texture. Portability of such models across scanner-types is affected by the learnt styles and results in suboptimal outcome (e.g., for segmentation models, lower Dice values when inferred on images procured from different scanner-type). Instead of retraining the DL model to accommodate this diversity, we transform the texture of the previously unseen data to match the training distribution. Neural style transfer in prior art has used features from the popular VGG network to accomplish this. We not only use a previously trained DL model for the image interpretation task e.g. segmentation, we also utilize its feature maps to accomplish style transfer as well, reducing the complexity of the algorithm pipeline. We demonstrate the improvement in segmentation outcome after such a such style transfer without retraining an existing model.

Fast Marching based Tissue Adaptive Delay Estimation for Aberration Corrected Delay and Sum Beamforming in Ultrasound Imaging.

Conventional ultrasound (US) imaging employs the delay and sum (DAS) receive beamforming with dynamic receive focus for image reconstruction due to its simplicity and robustness. However, the DAS beamforming follows a geometrical method of delay estimation with a spatially constant speed-of-sound (SoS) of 1540 m/s throughout the medium irrespective of the tissue in-homogeneity. This approximation leads to errors in delay estimations that accumulate with depth and degrades the resolution, contrast and overall accuracy of the US image. In this work, we propose a fast marching based DAS for focused transmissions which leverages the approximate SoS map to estimate the refraction corrected propagation delays for each pixel in the medium. The proposed approach is validated qualitatively and quantitatively for imaging depths of upto ∼ 11 cm through simulations, where fat layer-induced aberration is employed to alter the SoS in the medium. To the best of the authors' knowledge, this is the first work considering the effect of SoS on image quality for deeper imaging.Clinical relevance- The proposed approach when employed with an approximate SoS estimation technique can aid in overcoming the fat-induced signal aberrations and thereby in the accurate imaging of various pathologies of liver and abdomen.