Intra-video Positive Pairs in Self-Supervised Learning for Ultrasound (preprint)

Self-supervised learning (SSL) is one strategy for addressing the paucity of labelled data in medical imaging by learning representations from unlabelled images. Contrastive and non-contrastive SSL methods produce learned representations that are similar for pairs of related images. Such pairs are commonly constructed by randomly distorting the same image twice. The videographic nature of ultrasound offers flexibility for defining the similarity relationship between pairs of images. In this study, we investigated the effect of utilizing proximal, distinct images from the same B-mode ultrasound video as pairs for SSL. Additionally, we introduced a sample weighting scheme that increases the weight of closer image pairs and demonstrated how it can be integrated into SSL objectives. Named Intra-Video Positive Pairs (IVPP), the method surpassed previous ultrasound-specific contrastive learning methods' average test accuracy on COVID-19 classification with the POCUS dataset by $\ge 1.3\%$. Detailed investigations of IVPP's hyperparameters revealed that some combinations of IVPP hyperparameters can lead to improved or worsened performance, depending on the downstream task. Guidelines for practitioners were synthesized based on the results, such as the merit of IVPP with task-specific hyperparameters, and the improved performance of contrastive methods for ultrasound compared to non-contrastive counterparts.

COVIDx CXR-4: An Expanded Multi-Institutional Open-Source Benchmark Dataset for Chest X-ray Image-Based Computer-Aided COVID-19 Diagnostics (preprint)

The global ramifications of the COVID-19 pandemic remain significant, exerting persistent pressure on nations even three years after its initial outbreak. Deep learning models have shown promise in improving COVID-19 diagnostics but require diverse and larger-scale datasets to improve performance. In this paper, we introduce COVIDx CXR-4, an expanded multi-institutional open-source benchmark dataset for chest X-ray image-based computer-aided COVID-19 diagnostics. COVIDx CXR-4 expands significantly on the previous COVIDx CXR-3 dataset by increasing the total patient cohort size by greater than 2.66 times, resulting in 84,818 images from 45,342 patients across multiple institutions. We provide extensive analysis on the diversity of the patient demographic, imaging metadata, and disease distributions to highlight potential dataset biases. To the best of the authors' knowledge, COVIDx CXR-4 is the largest and most diverse open-source COVID-19 CXR dataset and is made publicly available as part of an open initiative to advance research to aid clinicians against the COVID-19 disease.

COVID-Net USPro: An Open-Source Explainable Few-Shot Deep Prototypical Network to Monitor and Detect COVID-19 Infection from Point-of-Care Ultrasound Images (preprint)

As the Coronavirus Disease 2019 (COVID-19) continues to impact many aspects of life and the global healthcare systems, the adoption of rapid and effective screening methods to prevent further spread of the virus and lessen the burden on healthcare providers is a necessity. As a cheap and widely accessible medical image modality, point-of-care ultrasound (POCUS) imaging allows radiologists to identify symptoms and assess severity through visual inspection of the chest ultrasound images. Combined with the recent advancements in computer science, applications of deep learning techniques in medical image analysis have shown promising results, demonstrating that artificial intelligence-based solutions can accelerate the diagnosis of COVID-19 and lower the burden on healthcare professionals. However, the lack of a huge amount of well-annotated data poses a challenge in building effective deep neural networks in the case of novel diseases and pandemics. Motivated by this, we present COVID-Net USPro, an explainable few-shot deep prototypical network, that monitors and detects COVID-19 positive cases with high precision and recall from minimal ultrasound images. COVID-Net USPro achieves 99.65% overall accuracy, 99.7% recall and 99.67% precision for COVID-19 positive cases when trained with only 5 shots. The analytic pipeline and results were verified by our contributing clinician with extensive experience in POCUS interpretation, ensuring that the network makes decisions based on actual patterns.

A Trustworthy Framework for Medical Image Analysis with Deep Learning (preprint)

Computer vision and machine learning are playing an increasingly important role in computer-assisted diagnosis; however, the application of deep learning to medical imaging has challenges in data availability and data imbalance, and it is especially important that models for medical imaging are built to be trustworthy. Therefore, we propose TRUDLMIA, a trustworthy deep learning framework for medical image analysis, which adopts a modular design, leverages self-supervised pre-training, and utilizes a novel surrogate loss function. Experimental evaluations indicate that models generated from the framework are both trustworthy and high-performing. It is anticipated that the framework will support researchers and clinicians in advancing the use of deep learning for dealing with public health crises including COVID-19.

COVID-Net Assistant: A Deep Learning-Driven Virtual Assistant for COVID-19 Symptom Prediction and Recommendation (preprint)

As the COVID-19 pandemic continues to put a significant burden on healthcare systems worldwide, there has been growing interest in finding inexpensive symptom pre-screening and recommendation methods to assist in efficiently using available medical resources such as PCR tests. In this study, we introduce the design of COVID-Net Assistant, an efficient virtual assistant designed to provide symptom prediction and recommendations for COVID-19 by analyzing users' cough recordings through deep convolutional neural networks. We explore a variety of highly customized, lightweight convolutional neural network architectures generated via machine-driven design exploration (which we refer to as COVID-Net Assistant neural networks) on the Covid19-Cough benchmark dataset. The Covid19-Cough dataset comprises 682 cough recordings from a COVID-19 positive cohort and 642 from a COVID-19 negative cohort. Among the 682 cough recordings labeled positive, 382 recordings were verified by PCR test. Our experimental results show promising, with the COVID-Net Assistant neural networks demonstrating robust predictive performance, achieving AUC scores of over 0.93, with the best score over 0.95 while being fast and efficient in inference. The COVID-Net Assistant models are made available in an open source manner through the COVID-Net open initiative and, while not a production-ready solution, we hope their availability acts as a good resource for clinical scientists, machine learning researchers, as well as citizen scientists to develop innovative solutions.

Sensitivity of diffusion-tensor and correlated diffusion imaging to white-matter microstructural abnormalities: application in COVID-19 (preprint)

There has been growing attention on the effect of COVID-19 on white-matter microstructure, especially among those that self-isolated after being infected. There is also immense scientific interest and potential clinical utility to evaluate the sensitivity of single-shell diffusion MRI methods for detecting such effects. In this work, the sensitivities of three single-shell-compatible diffusion MRI modeling methods are compared for detecting the effect of COVID-19, including diffusion-tensor imaging, diffusion-tensor decomposition of orthogonal moments and correlated diffusion imaging. Imaging was performed on self-isolated patients at baseline and 3-month follow-up, along with age- and sex-matched controls. We demonstrate through simulations and experimental data that correlated diffusion imaging is associated with far greater sensitivity, being the only one of the three single-shell methods to demonstrate COVID-19-related brain effects. Results suggest less restricted diffusion in the frontal lobe in COVID-19 patients. Results also demonstrate, for the first time, more restricted diffusion in the cerebellar white matter, in agreement with several existing studies highlighting the vulnerability of the cerebellum to COVID-19 infection. Whereas correlated diffusion imaging can be successfully applied using single-shell diffusion data, different b-values also confer different sensitivities to these two opposing effects. No significant difference was observed in patients at the 3-month follow-up. To summarize, correlated diffusion imaging is shown to be a sensitive single-shell diffusion analysis approach that allowed us to uncovered opposing patterns of diffusion changes in the frontal and cerebellar regions of COVID-19 patients, suggesting the two regions react differently to viral infection.

Towards Trustworthy Healthcare AI: Attention-Based Feature Learning for COVID-19 Screening With Chest Radiography (preprint)

Building AI models with trustworthiness is important especially in regulated areas such as healthcare. In tackling COVID-19, previous work uses convolutional neural networks as the backbone architecture, which has shown to be prone to over-caution and overconfidence in making decisions, rendering them less trustworthy -- a crucial flaw in the context of medical imaging. In this study, we propose a feature learning approach using Vision Transformers, which use an attention-based mechanism, and examine the representation learning capability of Transformers as a new backbone architecture for medical imaging. Through the task of classifying COVID-19 chest radiographs, we investigate into whether generalization capabilities benefit solely from Vision Transformers' architectural advances. Quantitative and qualitative evaluations are conducted on the trustworthiness of the models, through the use of "trust score" computation and a visual explainability technique. We conclude that the attention-based feature learning approach is promising in building trustworthy deep learning models for healthcare.

COVIDx CXR-3: A Large-Scale, Open-Source Benchmark Dataset of Chest X-ray Images for Computer-Aided COVID-19 Diagnostics (preprint)

After more than two years since the beginning of the COVID-19 pandemic, the pressure of this crisis continues to devastate globally. The use of chest X-ray (CXR) imaging as a complementary screening strategy to RT-PCR testing is not only prevailing but has greatly increased due to its routine clinical use for respiratory complaints. Thus far, many visual perception models have been proposed for COVID-19 screening based on CXR imaging. Nevertheless, the accuracy and the generalization capacity of these models are very much dependent on the diversity and the size of the dataset they were trained on. Motivated by this, we introduce COVIDx CXR-3, a large-scale benchmark dataset of CXR images for supporting COVID-19 computer vision research. COVIDx CXR-3 is composed of 30,386 CXR images from a multinational cohort of 17,026 patients from at least 51 countries, making it, to the best of our knowledge, the most extensive, most diverse COVID-19 CXR dataset in open access form. Here, we provide comprehensive details on the various aspects of the proposed dataset including patient demographics, imaging views, and infection types. The hope is that COVIDx CXR-3 can assist scientists in advancing machine learning research against both the COVID-19 pandemic and related diseases.

COVIDx CT-3: A Large-scale, Multinational, Open-Source Benchmark Dataset for Computer-aided COVID-19 Screening from Chest CT Images (preprint)

Computed tomography (CT) has been widely explored as a COVID-19 screening and assessment tool to complement RT-PCR testing. To assist radiologists with CT-based COVID-19 screening, a number of computer-aided systems have been proposed. However, many proposed systems are built using CT data which is limited in both quantity and diversity. Motivated to support efforts in the development of machine learning-driven screening systems, we introduce COVIDx CT-3, a large-scale multinational benchmark dataset for detection of COVID-19 cases from chest CT images. COVIDx CT-3 includes 431,205 CT slices from 6,068 patients across at least 17 countries, which to the best of our knowledge represents the largest, most diverse dataset of COVID-19 CT images in open-access form. Additionally, we examine the data diversity and potential biases of the COVIDx CT-3 dataset, finding that significant geographic and class imbalances remain despite efforts to curate data from a wide variety of sources.

COVID-Net UV: An End-to-End Spatio-Temporal Deep Neural Network Architecture for Automated Diagnosis of COVID-19 Infection from Ultrasound Videos (preprint)

Besides vaccination, as an effective way to mitigate the further spread of COVID-19, fast and accurate screening of individuals to test for the disease is yet necessary to ensure public health safety. We propose COVID-Net UV, an end-to-end hybrid spatio-temporal deep neural network architecture, to detect COVID-19 infection from lung point-of-care ultrasound videos captured by convex transducers. COVID-Net UV comprises a convolutional neural network that extracts spatial features and a recurrent neural network that learns temporal dependence. After careful hyperparameter tuning, the network achieves an average accuracy of 94.44% with no false-negative cases for COVID-19 cases. The goal with COVID-Net UV is to assist front-line clinicians in the fight against COVID-19 via accelerating the screening of lung point-of-care ultrasound videos and automatic detection of COVID-19 positive cases.

COVID-Net US-X: Enhanced Deep Neural Network for Detection of COVID-19 Patient Cases from Convex Ultrasound Imaging Through Extended Linear-Convex Ultrasound Augmentation Learning (preprint)

As the global population continues to face significant negative impact by the on-going COVID-19 pandemic, there has been an increasing usage of point-of-care ultrasound (POCUS) imaging as a low-cost and effective imaging modality of choice in the COVID-19 clinical workflow. A major barrier with widespread adoption of POCUS in the COVID-19 clinical workflow is the scarcity of expert clinicians that can interpret POCUS examinations, leading to considerable interest in deep learning-driven clinical decision support systems to tackle this challenge. A major challenge to building deep neural networks for COVID-19 screening using POCUS is the heterogeneity in the types of probes used to capture ultrasound images (e.g., convex vs. linear probes), which can lead to very different visual appearances. In this study, we explore the impact of leveraging extended linear-convex ultrasound augmentation learning on producing enhanced deep neural networks for COVID-19 assessment, where we conduct data augmentation on convex probe data alongside linear probe data that have been transformed to better resemble convex probe data. Experimental results using an efficient deep columnar anti-aliased convolutional neural network designed via a machined-driven design exploration strategy (which we name COVID-Net US-X) show that the proposed extended linear-convex ultrasound augmentation learning significantly increases performance, with a gain of 5.1% in test accuracy and 13.6% in AUC.

COVID-Net Biochem: An Explainability-driven Framework to Building Machine Learning Models for Predicting Survival and Kidney Injury of COVID-19 Patients from Clinical and Biochemistry Data (preprint)

Since the World Health Organization declared COVID-19 a pandemic in 2020, the global community has faced ongoing challenges in controlling and mitigating the transmission of the SARS-CoV-2 virus, as well as its evolving subvariants and recombinants. A significant challenge during the pandemic has not only been the accurate detection of positive cases but also the efficient prediction of risks associated with complications and patient survival probabilities. These tasks entail considerable clinical resource allocation and attention.In this study, we introduce COVID-Net Biochem, a versatile and explainable framework for constructing machine learning models. We apply this framework to predict COVID-19 patient survival and the likelihood of developing Acute Kidney Injury during hospitalization, utilizing clinical and biochemical data in a transparent, systematic approach. The proposed approach advances machine learning model design by seamlessly integrating domain expertise with explainability tools, enabling model decisions to be based on key biomarkers. This fosters a more transparent and interpretable decision-making process made by machines specifically for medical applications.

Improving Classification Model Performance on Chest X-Rays through Lung Segmentation (preprint)

Chest radiography is an effective screening tool for diagnosing pulmonary diseases. In computer-aided diagnosis, extracting the relevant region of interest, i.e., isolating the lung region of each radiography image, can be an essential step towards improved performance in diagnosing pulmonary disorders. Methods: In this work, we propose a deep learning approach to enhance abnormal chest x-ray (CXR) identification performance through segmentations. Our approach is designed in a cascaded manner and incorporates two modules: a deep neural network with criss-cross attention modules (XLSor) for localizing lung region in CXR images and a CXR classification model with a backbone of a self-supervised momentum contrast (MoCo) model pre-trained on large-scale CXR data sets. The proposed pipeline is evaluated on Shenzhen Hospital (SH) data set for the segmentation module, and COVIDx data set for both segmentation and classification modules. Novel statistical analysis is conducted in addition to regular evaluation metrics for the segmentation module. Furthermore, the results of the optimized approach are analyzed with gradient-weighted class activation mapping (Grad-CAM) to investigate the rationale behind the classification decisions and to interpret its choices. Results and Conclusion: Different data sets, methods, and scenarios for each module of the proposed pipeline are examined for designing an optimized approach, which has achieved an accuracy of 0.946 in distinguishing abnormal CXR images (i.e., Pneumonia and COVID-19) from normal ones. Numerical and visual validations suggest that applying automated segmentation as a pre-processing step for classification improves the generalization capability and the performance of the classification models.

Performance or Trust? Why Not Both. Deep AUC Maximization with Self-Supervised Learning for COVID-19 Chest X-ray Classifications (preprint)

Effective representation learning is the key in improving model performance for medical image analysis. In training deep learning models, a compromise often must be made between performance and trust, both of which are essential for medical applications. Moreover, models optimized with cross-entropy loss tend to suffer from unwarranted overconfidence in the majority class and over-cautiousness in the minority class. In this work, we integrate a new surrogate loss with self-supervised learning for computer-aided screening of COVID-19 patients using radiography images. In addition, we adopt a new quantification score to measure a model's trustworthiness. Ablation study is conducted for both the performance and the trust on feature learning methods and loss functions. Comparisons show that leveraging the new surrogate loss on self-supervised models can produce label-efficient networks that are both high-performing and trustworthy.

COVID-Net MLSys: Designing COVID-Net for the Clinical Workflow (preprint)

As the COVID-19 pandemic continues to devastate globally, one promising field of research is machine learning-driven computer vision to streamline various parts of the COVID-19 clinical workflow. These machine learning methods are typically stand-alone models designed without consideration for the integration necessary for real-world application workflows. In this study, we take a machine learning and systems (MLSys) perspective to design a system for COVID-19 patient screening with the clinical workflow in mind. The COVID-Net system is comprised of the continuously evolving COVIDx dataset, COVID-Net deep neural network for COVID-19 patient detection, and COVID-Net S deep neural networks for disease severity scoring for COVID-19 positive patient cases. The deep neural networks within the COVID-Net system possess state-of-the-art performance, and are designed to be integrated within a user interface (UI) for clinical decision support with automatic report generation to assist clinicians in their treatment decisions.

COVID-Net Clinical ICU: Enhanced Prediction of ICU Admission for COVID-19 Patients via Explainability and Trust Quantification (preprint)

The COVID-19 pandemic continues to have a devastating global impact, and has placed a tremendous burden on struggling healthcare systems around the world. Given the limited resources, accurate patient triaging and care planning is critical in the fight against COVID-19, and one crucial task within care planning is determining if a patient should be admitted to a hospital's intensive care unit (ICU). Motivated by the need for transparent and trustworthy ICU admission clinical decision support, we introduce COVID-Net Clinical ICU, a neural network for ICU admission prediction based on patient clinical data. Driven by a transparent, trust-centric methodology, the proposed COVID-Net Clinical ICU was built using a clinical dataset from Hospital Sirio-Libanes comprising of 1,925 COVID-19 patient records, and is able to predict when a COVID-19 positive patient would require ICU admission with an accuracy of 96.9% to facilitate better care planning for hospitals amidst the on-going pandemic. We conducted system-level insight discovery using a quantitative explainability strategy to study the decision-making impact of different clinical features and gain actionable insights for enhancing predictive performance. We further leveraged a suite of trust quantification metrics to gain deeper insights into the trustworthiness of COVID-Net Clinical ICU. By digging deeper into when and why clinical predictive models makes certain decisions, we can uncover key factors in decision making for critical clinical decision support tasks such as ICU admission prediction and identify the situations under which clinical predictive models can be trusted for greater accountability.

COVID-Net US: A Tailored, Highly Efficient, Self-Attention Deep Convolutional Neural Network Design for Detection of COVID-19 Patient Cases from Point-of-care Ultrasound Imaging (preprint)

The Coronavirus Disease 2019 (COVID-19) pandemic has impacted many aspects of life globally, and a critical factor in mitigating its effects is screening individuals for infections, thereby allowing for both proper treatment for those individuals as well as action to be taken to prevent further spread of the virus. Point-of-care ultrasound (POCUS) imaging has been proposed as a screening tool as it is a much cheaper and easier to apply imaging modality than others that are traditionally used for pulmonary examinations, namely chest x-ray and computed tomography. Given the scarcity of expert radiologists for interpreting POCUS examinations in many highly affected regions around the world, low-cost deep learning-driven clinical decision support solutions can have a large impact during the on-going pandemic. Motivated by this, we introduce COVID-Net US, a highly efficient, self-attention deep convolutional neural network design tailored for COVID-19 screening from lung POCUS images. Experimental results show that the proposed COVID-Net US can achieve an AUC of over 0.98 while achieving 353X lower architectural complexity, 62X lower computational complexity, and 14.3X faster inference times on a Raspberry Pi. Clinical validation was also conducted, where select cases were reviewed and reported on by a practicing clinician (20 years of clinical practice) specializing in intensive care (ICU) and 15 years of expertise in POCUS interpretation. To advocate affordable healthcare and artificial intelligence for resource-constrained environments, we have made COVID-Net US open source and publicly available as part of the COVID-Net open source initiative.

TB-Net: A Tailored, Self-Attention Deep Convolutional Neural Network Design For Detection of Tuberculosis Cases From Chest X-Ray Images (preprint)

Background: Tuberculosis (TB) remains a global health problem, and is the leading cause of death from an infectious disease. A crucial step in the treatment of tuberculosis is screening high risk populations and the early detection of the disease, with chest x-ray (CXR) imaging being the most widely-used imaging modality. As such, there has been significant recent interest in artificial intelligence-based TB screening solutions for use in resource-limited scenarios where there is a lack of trained healthcare workers with expertise in CXR interpretation. Motivated by this pressing need and the recent recommendation by the World Health Organization (WHO) for the use of computer-aided diagnosis of TB in place of a human reader, we introduce TB-Net, a self-attention deep convolutional neural network tailored for TB case screening.Methods: We used CXR data from a multi-national patient cohort to train and test our models. A machine-driven design exploration approach leveraging generative synthesis was used to build a highly customized deep neural network architecture with attention condensers.Results: We conducted an explainability-driven performance validation process to validate TB-Net's decision-making behaviour. Experiments on CXR data from a multi-national patient cohort showed that the proposed TB-Net is able to achieve accuracy/sensitivity/specificity of 99.86%/100.0%/99.71%. Radiologist validation was conducted on select cases by two board-certified radiologists with over 10 and 19 years of experience, respectively, and showed consistency between radiologist interpretation and critical factors leveraged by TB-Net for TB case detection for the case where radiologists identified anomalies.Conclusion: The proposed TB-Net not only achieves high tuberculosis case detection performance in terms of sensitivity and specificity, but also leverages clinically relevant critical factors in its decision making process. While not a production-ready solution, we hope that the open-source release of TB-Net as part of the COVID-Net initiative will support researchers, clinicians, and citizen data scientists in advancing this eld in the ght against this global public health crisis.

COVID-Net CXR-S: Deep Convolutional Neural Network for Severity Assessment of COVID-19 Cases from Chest X-ray Images (preprint)

The world is still struggling in controlling and containing the spread of the COVID-19 pandemic caused by the SARS-CoV-2 virus. The medical conditions associated with SARS-CoV-2 infections have resulted in a surge in the number of patients at clinics and hospitals, leading to a significantly increased strain on healthcare resources. As such, an important part of managing patients with SARS-CoV-2 infections within the clinical workflow is severity assessment, which is often conducted with the use of chest x-ray (CXR) images. In this work, we introduce COVID-Net CXR-S, a convolutional neural network for predicting the airspace severity of a SARS-CoV-2 positive patient based on a CXR image of the patient's chest. More specifically, we leveraged transfer learning to transfer representational knowledge gained from over 16,000 CXR images from a multinational cohort of over 15,000 patient cases into a custom network architecture for severity assessment. Experimental results with a multi-national patient cohort curated by the Radiological Society of North America (RSNA) RICORD initiative showed that the proposed COVID-Net CXR-S has potential to be a powerful tool for computer-aided severity assessment of CXR images of COVID-19 positive patients. Furthermore, radiologist validation on select cases by two board-certified radiologists with over 10 and 19 years of experience, respectively, showed consistency between radiologist interpretation and critical factors leveraged by COVID-Net CXR-S for severity assessment. While not a production-ready solution, the ultimate goal for the open source release of COVID-Net CXR-S is to act as a catalyst for clinical scientists, machine learning researchers, as well as citizen scientists to develop innovative new clinical decision support solutions for helping clinicians around the world manage the continuing pandemic.

COVID-Net CXR-2: An Enhanced Deep Convolutional Neural Network Design for Detection of COVID-19 Cases from Chest X-ray Images (preprint)

As the COVID-19 pandemic continues to devastate globally, the use of chest X-ray (CXR) imaging as a complimentary screening strategy to RT-PCR testing continues to grow given its routine clinical use for respiratory complaint. As part of the COVID-Net open source initiative, we introduce COVID-Net CXR-2, an enhanced deep convolutional neural network design for COVID-19 detection from CXR images built using a greater quantity and diversity of patients than the original COVID-Net. To facilitate this, we also introduce a new benchmark dataset composed of 19,203 CXR images from a multinational cohort of 16,656 patients from at least 51 countries, making it the largest, most diverse COVID-19 CXR dataset in open access form. The COVID-Net CXR-2 network achieves sensitivity and positive predictive value of 95.5%/97.0%, respectively, and was audited in a transparent and responsible manner. Explainability-driven performance validation was used during auditing to gain deeper insights in its decision-making behaviour and to ensure clinically relevant factors are leveraged for improving trust in its usage. Radiologist validation was also conducted, where select cases were reviewed and reported on by two board-certified radiologists with over 10 and 19 years of experience, respectively, and showed that the critical factors leveraged by COVID-Net CXR-2 are consistent with radiologist interpretations. While not a production-ready solution, we hope the open-source, open-access release of COVID-Net CXR-2 and the respective CXR benchmark dataset will encourage researchers, clinical scientists, and citizen scientists to accelerate advancements and innovations in the fight against the pandemic.