CS205: Building with Artificial Intelligence

Presently, various DL applications are widespread around the world. These applications include healthcare, social network analysis, audio and speech processing (like recognition and enhancement), visual data processing methods (such as multimedia data analysis and computer vision), and NLP (translation and sentence classification), among others (Fig. 29). These applications have been classified into five categories: classification, localization, detection, segmentation, and registration. Although each of these tasks has its own target, there is fundamental overlap in the pipeline implementation of these applications as shown in Fig. 30. Classification is a concept that categorizes a set of data into classes. Detection is used to locate interesting objects in an image with consideration given to the background. In detection, multiple objects, which could be from dissimilar classes, are surrounded by bounding boxes. Localization is the concept used to locate the object, which is surrounded by a single bounding box. In segmentation (semantic segmentation), the target object edges are surrounded by outlines, which also label them; moreover, fitting a single image (which could be 2D or 3D) onto another refers to registration. One of the most important and wide-ranging DL applications are in healthcare. This area of research is critical due to its relation to human lives. Moreover, DL has shown tremendous performance in healthcare. Therefore, we take DL applications in the medical image analysis field as an example to describe the DL applications.

Fig. 29 Examples of DL applications

Fig. 30 Workflow of deep learning tasks

Classification

Computer-Aided Diagnosis (CADx) is another title sometimes used for classification. Bharati et al. used a chest X-ray dataset for detecting lung diseases based on a CNN. Another study attempted to read X-ray images by employing CNN. In this modality, the comparative accessibility of these images has likely enhanced the progress of DL. used an improved pre-trained GoogLeNet CNN containing more than 150,000 images for training and testing processes. This dataset was augmented from 1850 chest X-rays. The creators reorganized the image orientation into lateral and frontal views and achieved approximately 100% accuracy. This work of orientation classification has clinically limited use. As a part of an ultimately fully automated diagnosis workflow, it obtained the data augmentation and pre-trained efficiency in learning the metadata of relevant images. Chest infection, commonly referred to as pneumonia, is extremely treatable, as it is a commonly occurring health problem worldwide. Conversely, Rajpurkar et al. utilized CheXNet, which is an improved version of DenseNet with 121 convolution layers, for classifying fourteen types of disease. These authors used the CheXNet14 dataset, which comprises 112,000 images. This network achieved an excellent performance in recognizing fourteen different diseases. In particular, pneumonia classification accomplished a 0.7632 AUC score using receiver operating characteristics (ROC) analysis. In addition, the network obtained better than or equal to the performance of both a three-radiologist panel and four individual radiologists. Zuo et al. have adopted CNN for candidate classification in lung nodule. Shen et al. employed both Random Forest (RF) and SVM classifiers with CNNs to classify lung nodules. They employed two convolutional layers with each of the three parallel CNNs. The LIDC-IDRI (Lung Image Database Consortium) dataset, which contained 1010-labeled CT lung scans, was used to classify the two types of lung nodules (malignant and benign). Different scales of the image patches were used by every CNN to extract features, while the output feature vector was constructed using the learned features. Next, these vectors were classified into malignant or benign using either the RF classifier or SVM with radial basis function (RBF) filter. The model was robust to various noisy input levels and achieved an accuracy of 86% in nodule classification. Conversely, the model of interpolates the image data missing between PET and MRI images using 3D CNNs. The Alzheimer Disease Neuroimaging Initiative (ADNI) database, containing 830 PET and MRI patient scans, was utilized in their work. The PET and MRI images are used to train the 3D CNNs, first as input and then as output. Furthermore, for patients who have no PET images, the 3D CNNs utilized the trained images to rebuild the PET images. These rebuilt images approximately fitted the actual disease recognition outcomes. However, this approach did not address the overfitting issues, which in turn restricted their technique in terms of its possible capacity for generalization. Diagnosing normal versus Alzheimer's disease patients has been achieved by several CNN models. Hosseini-Asl et al. attained 99% accuracy for up-to-date outcomes in diagnosing normal versus Alzheimer's disease patients. These authors applied an auto-encoder architecture using 3D CNNs. The generic brain features were pre-trained on the CADDementia dataset. Subsequently, the outcomes of these learned features became inputs to higher layers to differentiate between patient scans of Alzheimer's disease, mild cognitive impairment, or normal brains based on the ADNI dataset and using fine-tuned deep supervision techniques. The architectures of VGGNet and RNNs, in that order, were the basis of both VOXCNN and ResNet models developed by Korolev et al.. They also discriminated between Alzheimer's disease and normal patients using the ADNI database. Accuracy was 79% for Voxnet and 80% for ResNet. Compared to Hosseini-Asl's work, both models achieved lower accuracies. Conversely, the implementation of the algorithms was simpler and did not require feature hand-crafting, as Korolev declared. In 2020, Mehmood et al. trained a developed CNN-based network called "SCNN" with MRI images for the tasks of classification of Alzheimer's disease. They achieved state-of-the-art results by obtaining an accuracy of 99.05%.

Recently, CNN has taken some medical imaging classification tasks to different level from traditional diagnosis to automated diagnosis with tremendous performance. Examples of these tasks are diabetic foot ulcer (DFU) (as normal and abnormal (DFU) classes), sickle cells anemia (SCA) (as normal, abnormal (SCA), and other blood components), breast cancer by classify hematoxylin–eosin-stained breast biopsy images into four classes: invasive carcinoma, in-situ carcinoma, benign tumor and normal tissue, and multi-class skin cancer classification.

In 2020, CNNs are playing a vital role in early diagnosis of the novel coronavirus (COVID-2019). CNN has become the primary tool for automatic COVID-19 diagnosis in many hospitals around the world using chest X-ray images.

Localization

Although applications in anatomy education could increase, the practicing clinician is more likely to be interested in the localization of normal anatomy. Radiological images are independently examined and described outside of human intervention, while localization could be applied in completely automatic end-to-end applications. Zhao et al. introduced a new deep learning-based approach to localize pancreatic tumor in projection X-ray images for image-guided radiation therapy without the need for fiducials. Roth et al. constructed and trained a CNN using five convolutional layers to classify around 4000 transverse-axial CT images. These authors used five categories for classification: legs, pelvis, liver, lung, and neck. After data augmentation techniques were applied, they achieved an AUC score of 0.998 and the classification error rate of the model was 5.9%. For detecting the positions of the spleen, kidney, heart, and liver, Shin et al. employed stacked auto-encoders on 78 contrast-improved MRI scans of the stomach area containing the kidneys or liver. Temporal and spatial domains were used to learn the hierarchal features. Based on the organs, these approaches achieved detection accuracies of 62–79%. Sirazitdinov et al. presented an aggregate of two convolutional neural networks, namely RetinaNet and Mask R-CNN for pneumonia detection and localization.

Detection

Computer-Aided Detection (CADe) is another method used for detection. For both the clinician and the patient, overlooking a lesion on a scan may have dire consequences. Thus, detection is a field of study requiring both accuracy and sensitivity. Chouhan et al. introduced an innovative deep learning framework for the detection of pneumonia by adopting the idea of transfer learning. Their approach obtained an accuracy of 96.4% with a recall of 99.62% on unseen data. In the area of COVID-19 and pulmonary disease, several convolutional neural network approaches have been proposed for automatic detection from X-ray images which showed an excellent performance.

In the area of skin cancer, there several applications were introduced for the detection task. Thurnhofer-Hemsi et al. introduced a deep learning approach for skin cancer detection by fine-tuning five state-of-art convolutional neural network models. They addressed the issue of a lack of training data by adopting the ideas of transfer learning and data augmentation techniques. DenseNet201 network has shown superior results compared to other models.

Another interesting area is that of histopathological images, which are progressively digitized. Human pathologists read these images laboriously; they search for malignancy markers, such as a high index of cell proliferation, using molecular markers (e.g. Ki-67), cellular necrosis signs, abnormal cellular architecture, enlarged numbers of mitotic figures denoting augmented cell replication, and enlarged nucleus-to-cytoplasm ratios. Note that the histopathological slide may contain a huge number of cells (up to the thousands). Thus, the risk of disregarding abnormal neoplastic regions is high when wading through these cells at excessive levels of magnification. Ciresan et al. employed CNNs of 11–13 layers for identifying mitotic figures. Fifty breast histology images from the MITOS dataset were used. Their technique attained recall and precision scores of 0.7 and 0.88 respectively. Sirinukunwattana et al. utilized 100 histology images of colorectal adenocarcinoma to detect cell nuclei using CNNs. Roughly 30,000 nuclei were hand-labeled for training purposes. The novelty of this approach was in the use of Spatially Constrained CNN. This CNN detects the center of nuclei using the surrounding spatial context and spatial regression. Instead of this CNN, Xu et al. employed a stacked sparse auto-encoder (SSAE) to identify nuclei in histological slides of breast cancer, achieving 0.83 and 0.89 recall and precision scores respectively. In this field, they showed that unsupervised learning techniques are also effectively utilized. In medical images, Albarquoni et al. investigated the problem of insufficient labeling. They crowd-sourced the actual mitoses labeling in the histology images of breast cancer (from amateurs online). Solving the recurrent issue of inadequate labeling during the analysis of medical images can be achieved by feeding the crowd-sourced input labels into the CNN. This method signifies a remarkable proof-of-concept effort. In 2020, Lei et al. introduced the employment of deep convolutional neural networks for automatic identification of mitotic candidates from histological sections for mitosis screening. They obtained the state-of-the-art detection results on the dataset of the International Pattern Recognition Conference (ICPR) 2012 Mitosis Detection Competition.

Segmentation

Although MRI and CT image segmentation research includes different organs such as knee cartilage, prostate, and liver, most research work has concentrated on brain segmentation, particularly tumors. This issue is highly significant in surgical preparation to obtain the precise tumor limits for the shortest surgical resection. During surgery, excessive sacrificing of key brain regions may lead to neurological shortfalls including cognitive damage, emotionlessness, and limb difficulty. Conventionally, medical anatomical segmentation was done by hand; more specifically, the clinician draws out lines within the complete stack of the CT or MRI volume slice by slice. Thus, it is perfect for implementing a solution that computerizes this painstaking work. Wadhwa et al. presented a brief overview on brain tumor segmentation of MRI images. Akkus et al. wrote a brilliant review of brain MRI segmentation that addressed the different metrics and CNN architectures employed. Moreover, they explain several competitions in detail, as well as their datasets, which included Ischemic Stroke Lesion Segmentation (ISLES), Mild Traumatic brain injury Outcome Prediction (MTOP), and Brain Tumor Segmentation (BRATS).

Chen et al. proposed convolutional neural networks for precise brain tumor segmentation. The approach that they employed involves several approaches for better features learning including the DeepMedic model, a novel dual-force training scheme, a label distribution-based loss function, and Multi-Layer Perceptron-based post-processing. They conducted their method on the two most modern brain tumor segmentation datasets, i.e., BRATS 2017 and BRATS 2015 datasets. Hu et al. introduced the brain tumor segmentation method by adopting a multi-cascaded convolutional neural network (MCCNN) and fully connected conditional random fields (CRFs). The achieved results were excellent compared with the state-of-the-art methods.

Moeskops et al. employed three parallel-running CNNs, each of which had a 2D input patch of dissimilar size, for segmenting and classifying MRI brain images. These images, which include 35 adults and 22 pre-term infants, were classified into various tissue categories such as cerebrospinal fluid, grey matter, and white matter. Every patch concentrates on capturing various image aspects with the benefit of employing three dissimilar sizes of input patch; here, the bigger sizes incorporated the spatial features, while the lowest patch sizes concentrated on the local textures. In general, the algorithm has Dice coefficients in the range of 0.82–0.87 and achieved a satisfactory accuracy. Although 2D image slices are employed in the majority of segmentation research, Milletrate et al. implemented 3D CNN for segmenting MRI prostate images. Furthermore, they used the PROMISE2012 challenge dataset, from which fifty MRI scans were used for training and thirty for testing. The U-Net architecture of Ronnerberger et al. inspired their V-net. This model attained a 0.869 Dice coefficient score, the same as the winning teams in the competition. To reduce overfitting and create the model of a deeper 11-convolutional layer CNN, Pereira et al. applied intentionally small-sized filters of 3x3. Their model used MRI scans of 274 gliomas (a type of brain tumor) for training. They achieved first place in the 2013 BRATS challenge, as well as second place in the BRATS challenge 2015. Havaei et al. also considered gliomas using the 2013 BRATS dataset. They investigated different 2D CNN architectures. Compared to the winner of BRATS 2013, their algorithm worked better, as it required only 3 min to execute rather than 100 min. The concept of cascaded architecture formed the basis of their model. Thus, it is referred to as an InputCascadeCNN. Employing FC Conditional Random Fields (CRFs), atrous spatial pyramid pooling, and up-sampled filters were techniques introduced by Chen et al. These authors aimed to enhance the accuracy of localization and enlarge the field of view of every filter at a multi-scale. Their model, DeepLab, attained 79.7% mIOU (mean Intersection Over Union). In the PASCAL VOC-2012 image segmentation, their model obtained an excellent performance.

Recently, the Automatic segmentation of COVID-19 Lung Infection from CT Images helps to detect the development of COVID-19 infection by employing several deep learning techniques.

Registration

Usually, given two input images, the four main stages of the canonical procedure of the image registration task are:

• Target Selection: it illustrates the determined input image that the second counterpart input image needs to remain accurately superimposed to.

• Feature Extraction: it computes the set of features extracted from each input image.

• Feature Matching: it allows finding similarities between the previously obtained features.

• Pose Optimization: it is aimed to minimize the distance between both input images.

Then, the result of the registration procedure is the suitable geometric transformation (e.g. translation, rotation, scaling, etc.) that provides both input images within the same coordinate system in a way the distance between them is minimal, i.e. their level of superimposition/overlapping is optimal. It is out of the scope of this work to provide an extensive review of this topic. Nevertheless, a short summary is accordingly introduced next.

Commonly, the input images for the DL-based registration approach could be in various forms, e.g. point clouds, voxel grids, and meshes. Additionally, some techniques allow as inputs the result of the Feature Extraction or Matching steps in the canonical scheme. Specifically, the outcome could be some data in a particular form as well as the result of the steps from the classical pipeline (feature vector, matching vector, and transformation). Nevertheless, with the newest DL-based methods, a novel conceptual type of ecosystem issues. It contains acquired characteristics about the target, materials, and their behavior that can be registered with the input data. Such a conceptual ecosystem is formed by a neural network and its training manner, and it could be counted as an input to the registration approach. Nevertheless, it is not an input that one might adopt in every registration situation since it corresponds to an interior data representation.

From a DL view-point, the interpretation of the conceptual design enables differentiating the input data of a registration approach into defined or non-defined models. In particular, the illustrated phases are models that depict particular spatial data (e.g. 2D or 3D) while a non-defined one is a generalization of a data set created by a learning system. Yumer et al. developed a framework in which the model acquires characteristics of objects, meaning ready to identify what a more sporty car seems like or a more comfy chair is, also adjusting a 3D model to fit those characteristics while maintaining the main characteristics of the primary data. Likewise, a fundamental perspective of the unsupervised learning method introduced by Ding et al. is that there is no target for the registration approach. In this instance, the network is able of placing each input point cloud in a global space, solving SLAM issues in which many point clouds have to be registered rigidly. On the other hand, Mahadevan proposed the combination of two conceptual models utilizing the growth of Imagination Machines to give flexible artificial intelligence systems and relationships between the learned phases through training schemes that are not inspired on labels and classifications. Another practical application of DL, especially CNNs, to image registration is the 3D reconstruction of objects. Wang et al. applied an adversarial way using CNNs to rebuild a 3D model of an object from its 2D image. The network learns many objects and orally accomplishes the registration between the image and the conceptual model. Similarly, Hermoza et al. also utilize the GAN network for prognosticating the absent geometry of damaged archaeological objects, providing the reconstructed object based on a voxel grid format and a label selecting its class.

DL for medical image registration has numerous applications, which were listed by some review papers. Yang et al. implemented stacked convolutional layers as an encoder-decoder approach to predict the morphing of the input pixel into its last formation using MRI brain scans from the OASIS dataset. They employed a registration model known as Large Deformation Diffeomorphic Metric Mapping (LDDMM) and attained remarkable enhancements in computation time. Miao et al. used synthetic X-ray images to train a five-layer CNN to register 3D models of a trans-esophageal probe, a hand implant, and a knee implant onto 2D X-ray images for pose estimation. They determined that their model achieved an execution time of 0.1 s, representing an important enhancement against the conventional registration techniques based on intensity; moreover, it achieved effective registrations 79–99% of the time. Li et al. introduced a neural network-based approach for the non-rigid 2D–3D registration of the lateral cephalogram and the volumetric cone-beam CT (CBCT) images.