A fully automatic deep learning system for COVID-19 diagnostic and prognostic analysis

A deep transfer learning-based convolution neural network model for COVID-19 detection using computed tomography scan images for medical applications

The Coronavirus (COVID-19) has become a critical and extreme epidemic because of its international dissemination. COVID-19 is the world's most serious health, economic, and survival danger. This disease affects not only a single country but the entire planet due to this infectious disease. Illnesses of Covid-19 spread at a much faster rate than usual influenza cases. Because of its high transmissibility and early diagnosis, it isn't easy to manage COVID-19. The popularly used RT-PCR method for COVID-19 disease diagnosis may provide false negatives. COVID-19 can be detected non-invasively using medical imaging procedures such as chest CT and chest x-ray. Deep learning is the most effective machine learning approach for examining a considerable quantity of chest computed tomography (CT) pictures that can significantly affect Covid-19 screening. Convolutional neural network (CNN) is one of the most popular deep learning techniques right now, and its gaining traction due to its potential to transform several spheres of human life. This research aims to develop conceptual transfer learning enhanced CNN framework models for detecting COVID-19 with CT scan images. Though with minimal datasets, these techniques were demonstrated to be effective in detecting the presence of COVID-19. This proposed research looks into several deep transfer learning-based CNN approaches for detecting the presence of COVID-19 in chest CT images.VGG16, VGG19, Densenet121, InceptionV3, Xception, and Resnet50 are the foundation models used in this work. Each model's performance was evaluated using a confusion matrix and various performance measures such as accuracy, recall, precision, f1-score, loss, and ROC. The VGG16 model performed much better than the other models in this study (98.00 % accuracy). Promising outcomes from experiments have revealed the merits of the proposed model for detecting and monitoring COVID-19 patients. This could help practitioners and academics create a tool to help minimal health professionals decide on the best course of therapy.

Interpretable deep learning survival predictive tool for small cell lung cancer

Background

Small cell lung cancer (SCLC) is an aggressive and almost universally lethal neoplasm. There is no accurate predictive method for its prognosis. Artificial intelligence deep learning may bring new hope.

Methods

By searching the Surveillance, Epidemiology, and End Results database (SEER), 21,093 patients' clinical data were eventually included. Data were then divided into two groups (train dataset/test dataset). The train dataset (diagnosed in 2010-2014, N = 17,296) was utilized to conduct a deep learning survival model, validated by itself and the test dataset (diagnosed in 2015, N = 3,797) in parallel. According to clinical experience, age, sex, tumor site, T, N, M stage (7th American Joint Committee on Cancer TNM stage), tumor size, surgery, chemotherapy, radiotherapy, and history of malignancy were chosen as predictive clinical features. The C-index was the main indicator to evaluate model performance.

Results

The predictive model had a 0.7181 C-index (95% confidence intervals, CIs, 0.7174-0.7187) in the train dataset and a 0.7208 C-index (95% CIs, 0.7202-0.7215) in the test dataset. These indicated that it had a reliable predictive value on OS for SCLC, so it was then packaged as a Windows software which is free for doctors, researchers, and patients to use.

Conclusion

The interpretable deep learning survival predictive tool for small cell lung cancer developed by this study had a reliable predictive value on their overall survival. More biomarkers may help improve the prognostic predictive performance of small cell lung cancer.

COVID-19 Detection: A Systematic Review of Machine and Deep Learning-Based Approaches Utilizing Chest X-Rays and CT Scans

This review study presents the state-of-the-art machine and deep learning-based COVID-19 detection approaches utilizing the chest X-rays or computed tomography (CT) scans. This study aims to systematically scrutinize as well as to discourse challenges and limitations of the existing state-of-the-art research published in this domain from March 2020 to August 2021. This study also presents a comparative analysis of the performance of four majorly used deep transfer learning (DTL) models like VGG16, VGG19, ResNet50, and DenseNet over the COVID-19 local CT scans dataset and global chest X-ray dataset. A brief illustration of the majorly used chest X-ray and CT scan datasets of COVID-19 patients utilized in state-of-the-art COVID-19 detection approaches are also presented for future research. The research databases like IEEE Xplore, PubMed, and Web of Science are searched exhaustively for carrying out this survey. For the comparison analysis, four deep transfer learning models like VGG16, VGG19, ResNet50, and DenseNet are initially fine-tuned and trained using the augmented local CT scans and global chest X-ray dataset in order to observe their performance. This review study summarizes major findings like AI technique employed, type of classification performed, used datasets, results in terms of accuracy, specificity, sensitivity, F1 score, etc., along with the limitations, and future work for COVID-19 detection in tabular manner for conciseness. The performance analysis of the four majorly used deep transfer learning models affirms that Visual Geometry Group 19 (VGG19) model delivered the best performance over both COVID-19 local CT scans dataset and global chest X-ray dataset.

Feature fusion based VGGFusionNet model to detect COVID-19 patients utilizing computed tomography scan images

COVID-19 is one of the most life-threatening and dangerous diseases caused by the novel Coronavirus, which has already afflicted a larger human community worldwide. This pandemic disease recovery is possible if detected in the early stage. We proposed an automated deep learning approach from Computed Tomography (CT) scan images to detect COVID-19 positive patients by following a four-phase paradigm for COVID-19 detection: preprocess the CT scan images; remove noise from test image by using anisotropic diffusion techniques; make a different segment for the preprocessed images; and train and test COVID-19 detection using Convolutional Neural Network (CNN) models. This study employed well-known pre-trained models, including AlexNet, ResNet50, VGG16 and VGG19 to evaluate experiments. 80% of images are used to train the network in the detection process, while the remaining 20% are used to test it. The result of the experiment evaluation confirmed that the VGG19 pre-trained CNN model achieved better accuracy (98.06%). We used 4861 real-life COVID-19 CT images for experiment purposes, including 3068 positive and 1793 negative images. These images were acquired from a hospital in Sao Paulo, Brazil and two other different data sources. Our proposed method revealed very high accuracy and, therefore, can be used as an assistant to help professionals detect COVID-19 patients accurately.

Machine Learning and Deep Learning Based Time Series Prediction and Forecasting of Ten Nations' COVID-19 Pandemic

In the paper, the authors investigated and predicted the future environmental circumstances of a COVID-19 to minimize its effects using artificial intelligence techniques. The experimental investigation of COVID-19 instances has been performed in ten countries, including India, the United States, Russia, Argentina, Brazil, Colombia, Italy, Turkey, Germany, and France using machine learning, deep learning, and time series models. The confirmed, deceased, and recovered datasets from January 22, 2020, to May 29, 2021, of Novel COVID-19 cases were considered from the Kaggle COVID dataset repository. The country-wise Exploratory Data Analysis visually represents the active, recovered, closed, and death cases from March 2020 to May 2021. The data are pre-processed and scaled using a MinMax scaler to extract and normalize the features to obtain an accurate prediction rate. The proposed methodology employs Random Forest Regressor, Decision Tree Regressor, K Nearest Regressor, Lasso Regression, Linear Regression, Bayesian Regression, Theilsen Regression, Kernel Ridge Regressor, RANSAC Regressor, XG Boost, Elastic Net Regressor, Facebook Prophet Model, Holt Model, Stacked Long Short-Term Memory, and Stacked Gated Recurrent Units to predict active COVID-19 confirmed, death, and recovered cases. Out of different machine learning, deep learning, and time series models, Random Forest Regressor, Facebook Prophet, and Stacked LSTM outperformed to predict the best results for COVID-19 instances with the lowest root-mean-square and highest R 2 score values.

Additional value of chest CT AI-based quantification of lung involvement in predicting death and ICU admission for COVID-19 patients

Objectives

We evaluated the contribution of lung lesion quantification on chest CT using a clinical Artificial Intelligence (AI) software in predicting death and intensive care units (ICU) admission for COVID-19 patients.

Methods

For 349 patients with positive COVID-19-PCR test that underwent a chest CT scan at admittance or during hospitalization, we applied the AI for lung and lung lesion segmentation to obtain lesion volume (LV), and LV/Total Lung Volume (TLV) ratio. ROC analysis was used to extract the best CT criterion in predicting death and ICU admission. Two prognostic models using multivariate logistic regressions were constructed to predict each outcome and were compared using AUC values. The first model ("Clinical") was based on patients' characteristics and clinical symptoms only. The second model ("Clinical+LV/TLV") included also the best CT criterion.

Results

LV/TLV ratio demonstrated best performance for both outcomes; AUC of 67.8% (95% CI: 59.5 - 76.1) and 81.1% (95% CI: 75.7 - 86.5) respectively. Regarding death prediction, AUC values were 76.2% (95% CI: 69.9 - 82.6) and 79.9% (95%IC: 74.4 - 85.5) for the "Clinical" and the "Clinical+LV/TLV" models respectively, showing significant performance increase (+ 3.7%; p-value<0.001) when adding LV/TLV ratio. Similarly, for ICU admission prediction, AUC values were 74.9% (IC 95%: 69.2 - 80.6) and 84.8% (IC 95%: 80.4 - 89.2) respectively corresponding to significant performance increase (+ 10%: p-value<0.001).

Conclusions

Using a clinical AI software to quantify the COVID-19 lung involvement on chest CT, combined with clinical variables, allows better prediction of death and ICU admission.

Breath-holding physiology, radiological severity and adverse outcomes in COVID-19 patients: A prospective validation study

BACKGROUND AND OBJECTIVE

COVID-19 remains a major cause of respiratory failure, and means to identify future deterioration is needed. We recently developed a prediction score based on breath-holding manoeuvres (desaturation and maximal duration) to predict incident adverse COVID-19 outcomes. Here we prospectively validated our breath-holding prediction score in COVID-19 patients, and assessed associations with radiological scores of pulmonary involvement.

METHODS

Hospitalized COVID-19 patients (N = 110, three recruitment centres) performed breath-holds at admission to provide a prediction score (Messineo et al.) based on mean desaturation (20-s breath-holds) and maximal breath-hold duration, plus baseline saturation, body mass index and cardiovascular disease. Odds ratios for incident adverse outcomes (composite of bi-level ventilatory support, ICU admission and death) were described for patients with versus without elevated scores (>0). Regression examined associations with chest x-ray (Brixia score) and computed tomography (CT; 3D-software quantification). Additional comparisons were made with the previously-validated '4C-score'.

RESULTS

Elevated prediction score was associated with adverse COVID-19 outcomes (N = 12/110), OR[95%CI] = 4.54[1.17-17.83], p = 0.030 (positive predictive value = 9/48, negative predictive value = 59/62). Results were diminished with removal of mean desaturation from the prediction score (OR = 3.30[0.93-11.72]). The prediction score rose linearly with Brixia score (β[95%CI] = 0.13[0.02-0.23], p = 0.026, N = 103) and CT-based quantification (β = 1.02[0.39-1.65], p = 0.002, N = 45). Mean desaturation was also associated with both radiological assessment. Elevated 4C-scores (≥high-risk category) had a weaker association with adverse outcomes (OR = 2.44[0.62-9.56]).

CONCLUSION

An elevated breath-holding prediction score is associated with almost five-fold increased adverse COVID-19 outcome risk, and with pulmonary deficits observed in chest imaging. Breath-holding may identify COVID-19 patients at risk of future respiratory failure.

Use of AI to assess COVID-19 variant impacts on hospitalization, ICU, and death

The rapid spread of COVID-19 and its variants have devastated communities worldwide, and as the highly transmissible Omicron variant becomes the dominant strain of the virus in late 2021, the need to characterize and understand the difference between the new variant and its predecessors has been an increasing priority for public health authorities. Artificial Intelligence has played a significant role in the analysis of various facets of COVID-19 since the early stages of the pandemic. This study proposes the use of AI, specifically an XGBoost model, to quantify the impact of various medical risk factors (or “population features”) on the possibility of a patient outcome resulting in hospitalization, ICU admission, or death. The results are compared between the Delta and Omicron COVID-19 variants. Results indicated that older age and an unvaccinated patient status most consistently correspond as the most significant population features contributing to all three scenarios (hospitalization, ICU, death). The top 15 features for each variant-outcome scenario were determined, which most frequently included diabetes, cardiovascular disease, chronic kidney disease, and complications of pneumonia as highly significant population features contributing to serious illness outcomes. The Delta/Hospitalization model returned the highest performance metric scores for the area under the receiver operating characteristic (AUROC), F1, and Recall, while Omicron/ICU and Omicron/Hospitalization had the highest accuracy and precision values, respectively. The recall was found to be above 0.60 in most cases (with only two exceptions), indicating that the total number of false positives was generally minimized (accounting for more of the people who would theoretically require medical care).

The Capacity of Artificial Intelligence in COVID-19 Response: A Review in Context of COVID-19 Screening and Diagnosis

Artificial intelligence (AI) has been shown to solve several issues affecting COVID-19 diagnosis. This systematic review research explores the impact of AI in early COVID-19 screening, detection, and diagnosis. A comprehensive survey of AI in the COVID-19 literature, mainly in the context of screening and diagnosis, was observed by applying the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Data sources for the years 2020, 2021, and 2022 were retrieved from google scholar, web of science, Scopus, and PubMed, with target keywords relating to AI in COVID-19 screening and diagnosis. After a comprehensive review of these studies, the results found that AI contributed immensely to improving COVID-19 screening and diagnosis. Some proposed AI models were shown to have comparable (sometimes even better) clinical decision outcomes, compared to experienced radiologists in the screening/diagnosing of COVID-19. Additionally, AI has the capacity to reduce physician work burdens and fatigue and reduce the problems of several false positives, associated with the RT-PCR test (with lower sensitivity of 60-70%) and medical imaging analysis. Even though AI was found to be timesaving and cost-effective, with less clinical errors, it works optimally under the supervision of a physician or other specialists.

Predicting COVID-19 progression in hospitalized patients in Belgium from a multi-state model

Objectives

To adopt a multi-state risk prediction model for critical disease/mortality outcomes among hospitalised COVID-19 patients using nationwide COVID-19 hospital surveillance data in Belgium.

Materials and methods

Information on 44,659 COVID-19 patients hospitalised between March 2020 and June 2021 with complete data on disease outcomes and candidate predictors was used to adopt a multi-state, multivariate Cox model to predict patients' probability of recovery, critical [transfer to intensive care units (ICU)] or fatal outcomes during hospital stay.

Results

Median length of hospital stay was 9 days (interquartile range: 5-14). After admission, approximately 82% of the COVID-19 patients were discharged alive, 15% of patients were admitted to ICU, and 15% died in the hospital. The main predictors of an increased probability for recovery were younger age, and to a lesser extent, a lower number of prevalent comorbidities. A patient's transition to ICU or in-hospital death had in common the following predictors: high levels of c-reactive protein (CRP) and lactate dehydrogenase (LDH), reporting lower respiratory complaints and male sex. Additionally predictors for a transfer to ICU included middle-age, obesity and reporting loss of appetite and staying at a university hospital, while advanced age and a higher number of prevalent comorbidities for in-hospital death. After ICU, younger age and low levels of CRP and LDH were the main predictors for recovery, while in-hospital death was predicted by advanced age and concurrent comorbidities.

Conclusion

As one of the very few, a multi-state model was adopted to identify key factors predicting COVID-19 progression to critical disease, and recovery or death.

A multistage multimodal deep learning model for disease severity assessment and early warnings of high-risk patients of COVID-19

The outbreak of coronavirus disease 2019 (COVID-19) has caused massive infections and large death tolls worldwide. Despite many studies on the clinical characteristics and the treatment plans of COVID-19, they rarely conduct in-depth prognostic research on leveraging consecutive rounds of multimodal clinical examination and laboratory test data to facilitate clinical decision-making for the treatment of COVID-19. To address this issue, we propose a multistage multimodal deep learning (MMDL) model to (1) first assess the patient's current condition (i.e., the mild and severe symptoms), then (2) give early warnings to patients with mild symptoms who are at high risk to develop severe illness. In MMDL, we build a sequential stage-wise learning architecture whose design philosophy embodies the model's predicted outcome and does not only depend on the current situation but also the history. Concretely, we meticulously combine the latest round of multimodal clinical data and the decayed past information to make assessments and predictions. In each round (stage), we design a two-layer multimodal feature extractor to extract the latent feature representation across different modalities of clinical data, including patient demographics, clinical manifestation, and 11 modalities of laboratory test results. We conduct experiments on a clinical dataset consisting of 216 COVID-19 patients that have passed the ethical review of the medical ethics committee. Experimental results validate our assumption that sequential stage-wise learning outperforms single-stage learning, but history long ago has little influence on the learning outcome. Also, comparison tests show the advantage of multimodal learning. MMDL with multimodal inputs can beat any reduced model with single-modal inputs only. In addition, we have deployed the prototype of MMDL in a hospital for clinical comparison tests and to assist doctors in clinical diagnosis.

An ensemble prediction model for COVID-19 mortality risk

BACKGROUND

It's critical to identify COVID-19 patients with a higher death risk at early stage to give them better hospitalization or intensive care. However, thus far, none of the machine learning models has been shown to be successful in an independent cohort. We aim to develop a machine learning model which could accurately predict death risk of COVID-19 patients at an early stage in other independent cohorts.

METHODS

We used a cohort containing 4711 patients whose clinical features associated with patient physiological conditions or lab test data associated with inflammation, hepatorenal function, cardiovascular function, and so on to identify key features. To do so, we first developed a novel data preprocessing approach to clean up clinical features and then developed an ensemble machine learning method to identify key features.

RESULTS

Finally, we identified 14 key clinical features whose combination reached a good predictive performance of area under the receiver operating characteristic curve 0.907. Most importantly, we successfully validated these key features in a large independent cohort containing 15 790 patients.

CONCLUSIONS

Our study shows that 14 key features are robust and useful in predicting the risk of death in patients confirmed SARS-CoV-2 infection at an early stage, and potentially useful in clinical settings to help in making clinical decisions.

Real-world data: a brief review of the methods, applications, challenges and opportunities

Background

The increased adoption of the internet, social media, wearable devices, e-health services, and other technology-driven services in medicine and healthcare has led to the rapid generation of various types of digital data, providing a valuable data source beyond the confines of traditional clinical trials, epidemiological studies, and lab-based experiments.

Methods

We provide a brief overview on the type and sources of real-world data and the common models and approaches to utilize and analyze real-world data. We discuss the challenges and opportunities of using real-world data for evidence-based decision making This review does not aim to be comprehensive or cover all aspects of the intriguing topic on RWD (from both the research and practical perspectives) but serves as a primer and provides useful sources for readers who interested in this topic.

Results and Conclusions

Real-world hold great potential for generating real-world evidence for designing and conducting confirmatory trials and answering questions that may not be addressed otherwise. The voluminosity and complexity of real-world data also call for development of more appropriate, sophisticated, and innovative data processing and analysis techniques while maintaining scientific rigor in research findings, and attentions to data ethics to harness the power of real-world data.

Thoracic Imaging in China: Yesterday, Today, and Tomorrow

Thoracic imaging has been revolutionized through advances in technology and research around the world, and so has China. Thoracic imaging in China has progressed from anatomic observation to quantitative and functional evaluation, from using traditional approaches to using artificial intelligence. This article will review the past, present, and future of thoracic imaging in China, in an attempt to establish new accepted strategies moving forward.

MC-GAT: multi-layer collaborative generative adversarial transformer for cholangiocarcinoma classification from hyperspectral pathological images

Accurate histopathological analysis is the core step of early diagnosis of cholangiocarcinoma (CCA). Compared with color pathological images, hyperspectral pathological images have advantages for providing rich band information. Existing algorithms of HSI classification are dominated by convolutional neural network (CNN), which has the deficiency of distorting spectral sequence information of HSI data. Although vision transformer (ViT) alleviates this problem to a certain extent, the expressive power of transformer encoder will gradually decrease with increasing number of layers, which still degrades the classification performance. In addition, labeled HSI samples are limited in practical applications, which restricts the performance of methods. To address these issues, this paper proposed a multi-layer collaborative generative adversarial transformer termed MC-GAT for CCA classification from hyperspectral pathological images. MC-GAT consists of two pure transformer-based neural networks including a generator and a discriminator. The generator learns the implicit probability of real samples and transforms noise sequences into band sequences, which produces fake samples. These fake samples and corresponding real samples are mixed together as input to confuse the discriminator, which increases model generalization. In discriminator, a multi-layer collaborative transformer encoder is designed to integrate output features from different layers into collaborative features, which adaptively mines progressive relations from shallow to deep encoders and enhances the discriminating power of the discriminator. Experimental results on the Multidimensional Choledoch Datasets demonstrate that the proposed MC-GAT can achieve better classification results than many state-of-the-art methods. This confirms the potentiality of the proposed method in aiding pathologists in CCA histopathological analysis from hyperspectral imagery.

Towards smart diagnostic methods for COVID-19: Review of deep learning for medical imaging

The infectious disease known as COVID-19 has spread dramatically all over the world since December 2019. The fast diagnosis and isolation of infected patients are key factors in slowing down the spread of this virus and better management of the pandemic. Although the CT and X-ray modalities are commonly used for the diagnosis of COVID-19, identifying COVID-19 patients from medical images is a time-consuming and error-prone task. Artificial intelligence has shown to have great potential to speed up and optimize the prognosis and diagnosis process of COVID-19. Herein, we review publications on the application of deep learning (DL) techniques for diagnostics of patients with COVID-19 using CT and X-ray chest images for a period from January 2020 to October 2021. Our review focuses solely on peer-reviewed, well-documented articles. It provides a comprehensive summary of the technical details of models developed in these articles and discusses the challenges in the smart diagnosis of COVID-19 using DL techniques. Based on these challenges, it seems that the effectiveness of the developed models in clinical use needs to be further investigated. This review provides some recommendations to help researchers develop more accurate prediction models.

Multi-objective data enhancement for deep learning-based ultrasound analysis

Recently, Deep Learning based automatic generation of treatment recommendation has been attracting much attention. However, medical datasets are usually small, which may lead to over-fitting and inferior performances of deep learning models. In this paper, we propose multi-objective data enhancement method to indirectly scale up the medical data to avoid over-fitting and generate high quantity treatment recommendations. Specifically, we define a main and several auxiliary tasks on the same dataset and train a specific model for each of these tasks to learn different aspects of knowledge in limited data scale. Meanwhile, a Soft Parameter Sharing method is exploited to share learned knowledge among models. By sharing the knowledge learned by auxiliary tasks to the main task, the proposed method can take different semantic distributions into account during the training process of the main task. We collected an ultrasound dataset of thyroid nodules that contains Findings, Impressions and Treatment Recommendations labeled by professional doctors. We conducted various experiments on the dataset to validate the proposed method and justified its better performance than existing methods.

Microcirculatory alterations in critically ill COVID-19 patients analyzed using artificial intelligence

BACKGROUND

The sublingual microcirculation presumably exhibits disease-specific changes in function and morphology. Algorithm-based quantification of functional microcirculatory hemodynamic variables in handheld vital microscopy (HVM) has recently allowed identification of hemodynamic alterations in the microcirculation associated with COVID-19. In the present study we hypothesized that supervised deep machine learning could be used to identify previously unknown microcirculatory alterations, and combination with algorithmically quantified functional variables increases the model's performance to differentiate critically ill COVID-19 patients from healthy volunteers.

METHODS

Four international, multi-central cohorts of critically ill COVID-19 patients and healthy volunteers (n = 59/n = 40) were used for neuronal network training and internal validation, alongside quantification of functional microcirculatory hemodynamic variables. Independent verification of the models was performed in a second cohort (n = 25/n = 33).

RESULTS

Six thousand ninety-two image sequences in 157 individuals were included. Bootstrapped internal validation yielded AUROC(CI) for detection of COVID-19 status of 0.75 (0.69-0.79), 0.74 (0.69-0.79) and 0.84 (0.80-0.89) for the algorithm-based, deep learning-based and combined models. Individual model performance in external validation was 0.73 (0.71-0.76) and 0.61 (0.58-0.63). Combined neuronal network and algorithm-based identification yielded the highest externally validated AUROC of 0.75 (0.73-0.78) (P < 0.0001 versus internal validation and individual models).

CONCLUSIONS

We successfully trained a deep learning-based model to differentiate critically ill COVID-19 patients from heathy volunteers in sublingual HVM image sequences. Internally validated, deep learning was superior to the algorithmic approach. However, combining the deep learning method with an algorithm-based approach to quantify the functional state of the microcirculation markedly increased the sensitivity and specificity as compared to either approach alone, and enabled successful external validation of the identification of the presence of microcirculatory alterations associated with COVID-19 status.

A Comprehensive Review on Smart Health Care: Applications, Paradigms, and Challenges with Case Studies

Growth and advancement of the Deep Learning (DL) and the Internet of Things (IoT) are figuring out their way over the modern contemporary world through integrating various technologies in distinct fields viz, agriculture, manufacturing, energy, transportation, supply chains, cities, healthcare, and so on. Researchers had identified the feasibility of integrating deep learning, cloud, and IoT to enhance the overall automation, where IoT may prolong its application area through utilizing cloud services and the cloud can even prolong its applications through data acquired by IoT devices like sensors and deep learning for disease detection and diagnosis. This study explains a summary of various techniques utilized in smart healthcare, i.e., deep learning, cloud-based-IoT applications in smart healthcare, fog computing in smart healthcare, and challenges and issues faced by smart healthcare and it presents a wider scope as it is not intended for a particular application such aspatient monitoring, disease detection, and diagnosing and the technologies used for developing this smart systems are outlined. Smart health bestows the quality of life. Convenient and comfortable living is made possible by the services provided by smart healthcare systems (SHSs). Since healthcare is a massive area with enormous data and a broad spectrum of diseases associated with different organs, immense research can be done to overcome the drawbacks of traditional healthcare methods. Deep learning with IoT can effectively be applied in the healthcare sector to automate the diagnosing and treatment process even in rural areas remotely. Applications may include disease prevention and diagnosis, fitness and patient monitoring, food monitoring, mobile health, telemedicine, emergency systems, assisted living, self-management of chronic diseases, and so on.

Explainable multi-instance and multi-task learning for COVID-19 diagnosis and lesion segmentation in CT images

Coronavirus Disease 2019 (COVID-19) still presents a pandemic trend globally. Detecting infected individuals and analyzing their status can provide patients with proper healthcare while protecting the normal population. Chest CT (computed tomography) is an effective tool for screening of COVID-19. It displays detailed pathology-related information. To achieve automated COVID-19 diagnosis and lung CT image segmentation, convolutional neural networks (CNNs) have become mainstream methods. However, most of the previous works consider automated diagnosis and image segmentation as two independent tasks, in which some focus on lung fields segmentation and the others focus on single-lesion segmentation. Moreover, lack of clinical explainability is a common problem for CNN-based methods. In such context, we develop a multi-task learning framework in which the diagnosis of COVID-19 and multi-lesion recognition (segmentation of CT images) are achieved simultaneously. The core of the proposed framework is an explainable multi-instance multi-task network. The network learns task-related features adaptively with learnable weights, and gives explicable diagnosis results by suggesting local CT images with lesions as additional evidence. Then, severity assessment of COVID-19 and lesion quantification are performed to analyze patient status. Extensive experimental results on real-world datasets show that the proposed framework outperforms all the compared approaches for COVID-19 diagnosis and multi-lesion segmentation.

COVID-19 Detection on Chest X-ray and CT Scan: A Review of the Top-100 Most Cited Papers

Since the beginning of the COVID-19 pandemic, many works have been published proposing solutions to the problems that arose in this scenario. In this vein, one of the topics that attracted the most attention is the development of computer-based strategies to detect COVID-19 from thoracic medical imaging, such as chest X-ray (CXR) and computerized tomography scan (CT scan). By searching for works already published on this theme, we can easily find thousands of them. This is partly explained by the fact that the most severe worldwide pandemic emerged amid the technological advances recently achieved, and also considering the technical facilities to deal with the large amount of data produced in this context. Even though several of these works describe important advances, we cannot overlook the fact that others only use well-known methods and techniques without a more relevant and critical contribution. Hence, differentiating the works with the most relevant contributions is not a trivial task. The number of citations obtained by a paper is probably the most straightforward and intuitive way to verify its impact on the research community. Aiming to help researchers in this scenario, we present a review of the top-100 most cited papers in this field of investigation according to the Google Scholar search engine. We evaluate the distribution of the top-100 papers taking into account some important aspects, such as the type of medical imaging explored, learning settings, segmentation strategy, explainable artificial intelligence (XAI), and finally, the dataset and code availability.

Machine learning techniques for CT imaging diagnosis of novel coronavirus pneumonia: a review

Since 2020, novel coronavirus pneumonia has been spreading rapidly around the world, bringing tremendous pressure on medical diagnosis and treatment for hospitals. Medical imaging methods, such as computed tomography (CT), play a crucial role in diagnosing and treating COVID-19. A large number of CT images (with large volume) are produced during the CT-based medical diagnosis. In such a situation, the diagnostic judgement by human eyes on the thousands of CT images is inefficient and time-consuming. Recently, in order to improve diagnostic efficiency, the machine learning technology is being widely used in computer-aided diagnosis and treatment systems (i.e., CT Imaging) to help doctors perform accurate analysis and provide them with effective diagnostic decision support. In this paper, we comprehensively review these frequently used machine learning methods applied in the CT Imaging Diagnosis for the COVID-19, discuss the machine learning-based applications from the various kinds of aspects including the image acquisition and pre-processing, image segmentation, quantitative analysis and diagnosis, and disease follow-up and prognosis. Moreover, we also discuss the limitations of the up-to-date machine learning technology in the context of CT imaging computer-aided diagnosis.

Estimated Atherosclerotic Cardiovascular Disease Risk: Disparities and Severe COVID-19 Outcomes (from the National COVID Cohort Collaborative)

Although cardiovascular disease risk factors relate to COVID-19, the association of estimated atherosclerotic cardiovascular disease (ASCVD) risk with severe COVID-19 is not established. We examined the relation of the pooled-cohort ASCVD risk score to severe COVID-19 among 28,646 subjects from the National COVID Cohort Collaborative database who had positive SARS-CoV-2 test results from April 1, 2020 to April 1, 2021. In addition, 10-year ASCVD risk scores were calculated, and subjects were stratified into low-risk (<5%), borderline-risk (5% to <7.5%), intermediate-risk (7.5% to <20%), and high-risk (>=20%) groups. Severe COVID-19 outcomes (including death, remdesivir treatment, COVID-19 pneumonia, acute respiratory distress syndrome, and mechanical ventilation) occurring during follow-up were examined individually and as a composite in relation to ASCVD risk group across race and gender. Multiple logistic regression, adjusted for age, gender, and race, examined the relation of ASCVD risk group to the odds of severe COVID-19 outcomes. Our subjects had a mean age of 59.4 years; 14% were black and 57% were female. ASCVD risk group was directly related to severe COVID-19 prevalence. The adjusted odds ratio of the severe composite COVID-19 outcome by risk group (vs the low-risk group) was 1.8 (95% confidence interval 1.5 to 2.2) for the borderline-risk, 2.7 (2.3 to 3.2) for the intermediate-risk, and 4.6 (3.7 to 5.6) for the high-risk group. Black men and black women in the high-risk group showed higher severe COVID-19 prevalence compared with nonblack men and nonblack women. Prevalence of severe COVID-19 outcomes was similar in intermediate-risk black men and high-risk nonblack men (approximately 12%). In conclusion, although further research is needed, the 10-year ASCVD risk score in adults ages 40 to 79 years may be used to identify those who are at highest risk for COVID-19 complications and for whom more intensive treatment may be warranted.

Automated deep learning-based segmentation of COVID-19 lesions from chest computed tomography images

Purpose

The novel coronavirus COVID-19, which spread globally in late December 2019, is a global health crisis. Chest computed tomography (CT) has played a pivotal role in providing useful information for clinicians to detect COVID-19. However, segmenting COVID-19-infected regions from chest CT results is challenging. Therefore, it is desirable to develop an efficient tool for automated segmentation of COVID-19 lesions using chest CT. Hence, we aimed to propose 2D deep-learning algorithms to automatically segment COVID-19-infected regions from chest CT slices and evaluate their performance.

Material and methods

Herein, 3 known deep learning networks: U-Net, U-Net++, and Res-Unet, were trained from scratch for automated segmenting of COVID-19 lesions using chest CT images. The dataset consists of 20 labelled COVID-19 chest CT volumes. A total of 2112 images were used. The dataset was split into 80% for training and validation and 20% for testing the proposed models. Segmentation performance was assessed using Dice similarity coefficient, average symmetric surface distance (ASSD), mean absolute error (MAE), sensitivity, specificity, and precision.

Results

All proposed models achieved good performance for COVID-19 lesion segmentation. Compared with Res-Unet, the U-Net and U-Net++ models provided better results, with a mean Dice value of 85.0%. Compared with all models, U-Net gained the highest segmentation performance, with 86.0% sensitivity and 2.22 mm ASSD. The U-Net model obtained 1%, 2%, and 0.66 mm improvement over the Res-Unet model in the Dice, sensitivity, and ASSD, respectively. Compared with Res-Unet, U-Net++ achieved 1%, 2%, 0.1 mm, and 0.23 mm improvement in the Dice, sensitivity, ASSD, and MAE, respectively.

Conclusions

Our data indicated that the proposed models achieve an average Dice value greater than 84.0%. Two-dimensional deep learning models were able to accurately segment COVID-19 lesions from chest CT images, assisting the radiologists in faster screening and quantification of the lesion regions for further treatment. Nevertheless, further studies will be required to evaluate the clinical performance and robustness of the proposed models for COVID-19 semantic segmentation.

An efficient recurrent neural network with ensemble classifier-based weighted model for disease prediction

Day-to-day lives are affected globally by the epidemic coronavirus 2019. With an increasing number of positive cases, India has now become a highly affected country. Chronic diseases affect individuals with no time identification and impose a huge disease burden on society. In this article, an Efficient Recurrent Neural Network with Ensemble Classifier (ERNN-EC) is built using VGG-16 and Alexnet with weighted model to predict disease and its level. The dataset is partitioned randomly into small subsets by utilizing mean-based splitting method. Various models of classifier create a homogeneous ensemble by utilizing an accuracy-based weighted aging classifier ensemble, which is a weighted model’s modification. Two state of art methods such as Graph Sequence Recurrent Neural Network and Hybrid Rough-Block-Based Neural Network are used for comparison with respect to some parameters such as accuracy, precision, recall, f1-score, and relative absolute error (RAE). As a result, it is found that the proposed ERNN-EC method accomplishes accuracy of 95.2%, precision of 91%, recall of 85%, F1-score of 83.4%, and RAE of 41.6%.

Using artificial intelligence to improve the diagnostic efficiency of pulmonologists in differentiating COVID-19 pneumonia from community-acquired pneumonia

Coronavirus disease 2019 (COVID-19) has quickly turned into a global health problem. Computed tomography (CT) findings of COVID-19 pneumonia and community-acquired pneumonia (CAP) may be similar. Artificial intelligence (AI) is a popular topic among medical imaging techniques and has caused significant developments in diagnostic techniques. This retrospective study aims to analyze the contribution of AI to the diagnostic performance of pulmonologists in distinguishing COVID-19 pneumonia from CAP using CT scans. A deep learning-based AI model was created to be utilized in the detection of COVID-19, which extracted visual data from volumetric CT scans. The final data set covered a total of 2496 scans (887 patients), which included 1428 (57.2%) from the COVID-19 group and 1068 (42.8%) from the CAP group. CT slices were classified into training, validation, and test datasets in an 8:1:1. The independent test data set was analyzed by comparing the performance of four pulmonologists in differentiating COVID-19 pneumonia both with and without the help of the AI. The accuracy, sensitivity, and specificity values of the proposed AI model for determining COVID-19 in the independent test data set were 93.2%, 85.8%, and 99.3%, respectively, with the area under the receiver operating characteristic curve of 0.984. With the assistance of the AI, the pulmonologists accomplished a higher mean accuracy (88.9% vs. 79.9%, p < 0.001), sensitivity (79.1% vs. 70%, p < 0.001), and specificity (96.5% vs. 87.5%, p < 0.001). AI support significantly increases the diagnostic efficiency of pulmonologists in the diagnosis of COVID-19 via CT. Studies in the future should focus on real-time applications of AI to fight the COVID-19 infection.

Deep-Risk: Deep Learning-Based Mortality Risk Predictive Models for COVID-19

The SARS-CoV-2 virus has proliferated around the world and caused panic to all people as it claimed many lives. Since COVID-19 is highly contagious and spreads quickly, an early diagnosis is essential. Identifying the COVID-19 patients' mortality risk factors is essential for reducing this risk among infected individuals. For the timely examination of large datasets, new computing approaches must be created. Many machine learning (ML) techniques have been developed to predict the mortality risk factors and severity for COVID-19 patients. Contrary to expectations, deep learning approaches as well as ML algorithms have not been widely applied in predicting the mortality and severity from COVID-19. Furthermore, the accuracy achieved by ML algorithms is less than the anticipated values. In this work, three supervised deep learning predictive models are utilized to predict the mortality risk and severity for COVID-19 patients. The first one, which we refer to as CV-CNN, is built using a convolutional neural network (CNN); it is trained using a clinical dataset of 12,020 patients and is based on the 10-fold cross-validation (CV) approach for training and validation. The second predictive model, which we refer to as CV-LSTM + CNN, is developed by combining the long short-term memory (LSTM) approach with a CNN model. It is also trained using the clinical dataset based on the 10-fold CV approach for training and validation. The first two predictive models use the clinical dataset in its original CSV form. The last one, which we refer to as IMG-CNN, is a CNN model and is trained alternatively using the converted images of the clinical dataset, where each image corresponds to a data row from the original clinical dataset. The experimental results revealed that the IMG-CNN predictive model outperforms the other two with an average accuracy of 94.14%, a precision of 100%, a recall of 91.0%, a specificity of 100%, an F1-score of 95.3%, an AUC of 93.6%, and a loss of 0.22.

Deep Learning Models for the Diagnosis and Screening of COVID-19: A Systematic Review

COVID-19, caused by SARS-CoV-2, has been declared as a global pandemic by WHO. Early diagnosis of COVID-19 patients may reduce the impact of coronavirus using modern computational methods like deep learning. Various deep learning models based on CT and chest X-ray images are studied and compared in this study as an alternative solution to reverse transcription-polymerase chain reactions. This study consists of three stages: planning, conduction, and analysis/reporting. In the conduction stage, inclusion and exclusion criteria are applied to the literature searching and identification. Then, we have implemented quality assessment rules, where over 75 scored articles in the literature were included. Finally, in the analysis/reporting stage, all the papers are reviewed and analysed. After the quality assessment of the individual papers, this study adopted 57 articles for the systematic literature review. From these reviews, the critical analysis of each paper, including the represented matrix for the model evaluation, existing contributions, and motivation, has been tracked with suitable illustrations. We have also interpreted several insights of each paper with appropriate annotation. Further, a set of comparisons has been enumerated with suitable discussion. Convolutional neural networks are the most commonly used deep learning architecture for COVID-19 disease classification and identification from X-ray and CT images. Various prior studies did not include data from a hospital setting nor did they consider data preprocessing before training a deep learning model.

Joint Modeling of Repeated Measurements of Different Biomarkers Predicts Mortality in COVID-19 Patients in the Intensive Care Unit

Introduction:

Predicting disease severity is important for treatment decisions in patients with COVID-19 in the intensive care unit (ICU). Different biomarkers have been investigated in COVID-19 as predictor of mortality, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and soluble urokinase-type plasminogen activator receptor (suPAR). Using repeated measurements in a prediction model may result in a more accurate risk prediction than the use of single point measurements. The goal of this study is to investigate the predictive value of trends in repeated measurements of CRP, PCT, IL-6, and suPAR on mortality in patients admitted to the ICU with COVID-19.

Methods:

This was a retrospective single center cohort study. Patients were included if they tested positive for SARS-CoV-2 by PCR test and if IL-6, PCT, suPAR was measured during any of the ICU admission days. There were no exclusion criteria for this study. We used joint models to predict ICU-mortality. This analysis was done using the framework of joint models for longitudinal and survival data. The reported hazard ratios express the relative change in the risk of death resulting from a doubling or 20% increase of the biomarker’s value in a day compared to no change in the same period.

Results:

A total of 107 patients were included, of which 26 died during ICU admission. Adjusted for sex and age, a doubling in the next day in either levels of PCT, IL-6, and suPAR were significantly predictive of in-hospital mortality with HRs of 1.523 (1.012-6.540), 75.25 (1.116-6247), and 24.45 (1.696-1057) respectively. With a 20% increase in biomarker value in a subsequent day, the HR of PCT, IL-6, and suPAR were 1.117 (1.03-1.639), 3.116 (1.029-9.963), and 2.319 (1.149-6.243) respectively.

Conclusion:

Joint models for the analysis of repeated measurements of PCT, suPAR, and IL-6 are a useful method for predicting mortality in COVID-19 patients in the ICU. Patients with an increasing trend of biomarker levels in consecutive days are at increased risk for mortality.

The Use of Chest Radiographs and Machine Learning Model for the Rapid Detection of Pneumonitis in Pediatric

Pneumonia is a common lung disease that is the leading cause of death worldwide. It primarily affects children, accounting for 18% of all deaths in children under the age of five, the elderly, and patients with other diseases. There is a variety of imaging diagnosis techniques available today. While many of them are becoming more accurate, chest radiographs are still the most common method for detecting pulmonary infections due to cost and speed. A convolutional neural network (CNN) model has been developed to classify chest X-rays in JPEG format into normal, bacterial pneumonia, and viral pneumonia. The model was trained using data from an open Kaggle database. The data augmentation technique was used to improve the model's performance. A web application built with NextJS and hosted on AWS has also been designed. The model that was optimized using the data augmentation technique had slightly better precision than the original model. This model was used to create a web application that can process an image and provide a prediction to the user. A classification model was developed that generates a prediction with 78 percent accuracy. The precision of this calculation could be improved by increasing the epoch, among other subjects. With the help of artificial intelligence, this research study was aimed at demonstrating to the general public that deep-learning models can be created to assist health professionals in the early detection of pneumonia.

Development and external validation of a deep learning-based computed tomography classification system for COVID-19

BACKGROUND

We aimed to develop and externally validate a novel machine learning model that can classify CT image findings as positive or negative for SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR).

METHODS

We used 2,928 images from a wide variety of case-control type data sources for the development and internal validation of the machine learning model. A total of 633 COVID-19 cases and 2,295 non-COVID-19 cases were included in the study. We randomly divided cases into training and tuning sets at a ratio of 8:2. For external validation, we used 893 images from 740 consecutive patients at 11 acute care hospitals suspected of having COVID-19 at the time of diagnosis. The dataset included 343 COVID-19 patients. The reference standard was RT-PCR.

RESULTS

In external validation, the sensitivity and specificity of the model were 0.869 and 0.432, at the low-level cutoff, 0.724 and 0.721, at the high-level cutoff. Area under the receiver operating characteristic was 0.76.

CONCLUSIONS

Our machine learning model exhibited a high sensitivity in external validation datasets and may assist physicians to rule out COVID-19 diagnosis in a timely manner at emergency departments. Further studies are warranted to improve model specificity.

AI-Based Chest CT Analysis for Rapid COVID-19 Diagnosis and Prognosis: A Practical Tool to Flag High-Risk Patients and Lower Healthcare Costs

Early diagnosis of COVID-19 is required to provide the best treatment to our patients, to prevent the epidemic from spreading in the community, and to reduce costs associated with the aggravation of the disease. We developed a decision tree model to evaluate the impact of using an artificial intelligence-based chest computed tomography (CT) analysis software (icolung, icometrix) to analyze CT scans for the detection and prognosis of COVID-19 cases. The model compared routine practice where patients receiving a chest CT scan were not screened for COVID-19, with a scenario where icolung was introduced to enable COVID-19 diagnosis. The primary outcome was to evaluate the impact of icolung on the transmission of COVID-19 infection, and the secondary outcome was the in-hospital length of stay. Using EUR 20000 as a willingness-to-pay threshold, icolung is cost-effective in reducing the risk of transmission, with a low prevalence of COVID-19 infections. Concerning the hospitalization cost, icolung is cost-effective at a higher value of COVID-19 prevalence and risk of hospitalization. This model provides a framework for the evaluation of AI-based tools for the early detection of COVID-19 cases. It allows for making decisions regarding their implementation in routine practice, considering both costs and effects.

The Disconnect Between Development and Intended Use of Clinical Prediction Models for Covid-19: A Systematic Review and Real-World Data Illustration

Background

The SARS-CoV-2 pandemic has boosted the appearance of clinical predictions models in medical literature. Many of these models aim to provide guidance for decision making on treatment initiation. Special consideration on how to account for post-baseline treatments is needed when developing such models. We examined how post-baseline treatment was handled in published Covid-19 clinical prediction models and we illustrated how much estimated risks may differ according to how treatment is handled.

Methods

Firstly, we reviewed 33 Covid-19 prognostic models published in literature in the period up to 5 May 2020. We extracted: (1) the reported intended use of the model; (2) how treatment was incorporated during model development and (3) whether the chosen analysis strategy was in agreement with the intended use. Secondly, we used nationwide Dutch data on hospitalized patients who tested positive for SARS-CoV-2 in 2020 to illustrate how estimated mortality risks will differ when using four different analysis strategies to model ICU treatment.

Results

Of the 33 papers, 21 (64%) had misalignment between intended use and analysis strategy, 7 (21%) were unclear about the estimated risk and only 5 (15%) had clear alignment between intended use and analysis strategy. We showed with real data how different approaches to post-baseline treatment yield different estimated mortality risks, ranging between 33 and 46% for a 75 year-old patient with two medical conditions.

Conclusions

Misalignment between intended use and analysis strategy is common in reported Covid-19 clinical prediction models. This can lead to considerable under or overestimation of intended risks.

Development of a Smartphone-Based Expert System for COVID-19 Risk Prediction at Early Stage

COVID-19 has imposed many challenges and barriers on traditional healthcare systems due to the high risk of being infected by the coronavirus. Modern electronic devices like smartphones with information technology can play an essential role in handling the current pandemic by contributing to different telemedical services. This study has focused on determining the presence of this virus by employing smartphone technology, as it is available to a large number of people. A publicly available COVID-19 dataset consisting of 33 features has been utilized to develop the aimed model, which can be collected from an in-house facility. The chosen dataset has 2.82% positive and 97.18% negative samples, demonstrating a high imbalance of class populations. The Adaptive Synthetic (ADASYN) has been applied to overcome the class imbalance problem with imbalanced data. Ten optimal features are chosen from the given 33 features, employing two different feature selection algorithms, such as K Best and recursive feature elimination methods. Mainly, three classification schemes, Random Forest (RF), eXtreme Gradient Boosting (XGB), and Support Vector Machine (SVM), have been applied for the ablation studies, where the accuracy from the XGB, RF, and SVM classifiers achieved 97.91%, 97.81%, and 73.37%, respectively. As the XGB algorithm confers the best results, it has been implemented in designing the Android operating system base and web applications. By analyzing 10 users’ questionnaires, the developed expert system can predict the presence of COVID-19 in the human body of the primary suspect. The preprocessed data and codes are available on the GitHub repository.

Federated Learning Approach with Pre-Trained Deep Learning Models for COVID-19 Detection from Unsegmented CT images

(1) Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. Reverse transcription polymerase chain reaction (RT-PCR) remains the current gold standard for detecting SARS-CoV-2 infections in nasopharyngeal swabs. In Romania, the first reported patient to have contracted COVID-19 was officially declared on 26 February 2020. (2) Methods: This study proposes a federated learning approach with pre-trained deep learning models for COVID-19 detection. Three clients were locally deployed with their own dataset. The goal of the clients was to collaborate in order to obtain a global model without sharing samples from the dataset. The algorithm we developed was connected to our internal picture archiving and communication system and, after running backwards, it encountered chest CT changes suggestive for COVID-19 in a patient investigated in our medical imaging department on the 28 January 2020. (4) Conclusions: Based on our results, we recommend using an automated AI-assisted software in order to detect COVID-19 based on the lung imaging changes as an adjuvant diagnostic method to the current gold standard (RT-PCR) in order to greatly enhance the management of these patients and also limit the spread of the disease, not only to the general population but also to healthcare professionals.

CVD-HNet: Classifying Pneumonia and COVID-19 in Chest X-ray Images Using Deep Network

The use of computer-assisted analysis to improve image interpretation has been a long-standing challenge in the medical imaging industry. In terms of image comprehension, Continuous advances in AI (Artificial Intelligence), predominantly in DL (Deep Learning) techniques, are supporting in the classification, Detection, and quantification of anomalies in medical images. DL techniques are the most rapidly evolving branch of AI, and it's recently been successfully pragmatic in a variety of fields, including medicine. This paper provides a classification method for COVID 19 infected X-ray images based on new novel deep CNN model. For COVID19 specified pneumonia analysis, two new customized CNN architectures, CVD-HNet1 (COVID-HybridNetwork1) and CVD-HNet2 (COVID-HybridNetwork2), have been designed. The suggested method utilizes operations based on boundaries and regions, as well as convolution processes, in a systematic manner. In comparison to existing CNNs, the suggested classification method achieves excellent Accuracy 98 percent, F Score 0.99 and MCC 0.97. These results indicate impressive classification accuracy on a limited dataset, with more training examples, much better results can be achieved. Overall, our CVD-HNet model could be a useful tool for radiologists in diagnosing and detecting COVID 19 instances early.

Explainable artificial intelligence approach in combating real-time surveillance of COVID19 pandemic from CT scan and X-ray images using ensemble model

Population size has made disease monitoring a major concern in the healthcare system, due to which auto-detection has become a top priority. Intelligent disease detection frameworks enable doctors to recognize illnesses, provide stable and accurate results, and lower mortality rates. An acute and severe disease known as Coronavirus (COVID19) has suddenly become a global health crisis. The fastest way to avoid the spreading of Covid19 is to implement an automated detection approach. In this study, an explainable COVID19 detection in CT scan and chest X-ray is established using a combination of deep learning and machine learning classification algorithms. A Convolutional Neural Network (CNN) collects deep features from collected images, and these features are then fed into a machine learning ensemble for COVID19 assessment. To identify COVID19 disease from images, an ensemble model is developed which includes, Gaussian Naive Bayes (GNB), Support Vector Machine (SVM), Decision Tree (DT), Logistic Regression (LR), K-Nearest Neighbor (KNN), and Random Forest (RF). The overall performance of the proposed method is interpreted using Gradient-weighted Class Activation Mapping (Grad-CAM), and t-distributed Stochastic Neighbor Embedding (t-SNE). The proposed method is evaluated using two datasets containing 1,646 and 2,481 CT scan images gathered from COVID19 patients, respectively. Various performance comparisons with state-of-the-art approaches were also shown. The proposed approach beats existing models, with scores of 98.5% accuracy, 99% precision, and 99% recall, respectively. Further, the t-SNE and explainable Artificial Intelligence (AI) experiments are conducted to validate the proposed approach.

Chronic lung lesions in COVID-19 survivors: predictive clinical model

OBJECTIVE

This study aimed to propose a simple, accessible and low-cost predictive clinical model to detect lung lesions due to COVID-19 infection.

DESIGN

This prospective cohort study included COVID-19 survivors hospitalised between 30 March 2020 and 31 August 2020 followed-up 6 months after hospital discharge. The pulmonary function was assessed using the modified Medical Research Council (mMRC) dyspnoea scale, oximetry (SpO2), spirometry (forced vital capacity (FVC)) and chest X-ray (CXR) during an in-person consultation. Patients with abnormalities in at least one of these parameters underwent chest CT. mMRC scale, SpO2, FVC and CXR findings were used to build a machine learning model for lung lesion detection on CT.

SETTING

A tertiary hospital in Sao Paulo, Brazil.

PARTICIPANTS

749 eligible RT-PCR-confirmed SARS-CoV-2-infected patients aged ≥18 years.

PRIMARY OUTCOME MEASURE

A predictive clinical model for lung lesion detection on chest CT.

RESULTS

There were 470 patients (63%) that had at least one sign of pulmonary involvement and were eligible for CT. Almost half of them (48%) had significant pulmonary abnormalities, including ground-glass opacities, parenchymal bands, reticulation, traction bronchiectasis and architectural distortion. The machine learning model, including the results of 257 patients with complete data on mMRC, SpO2, FVC, CXR and CT, accurately detected pulmonary lesions by the joint data of CXR, mMRC scale, SpO2 and FVC (sensitivity, 0.85±0.08; specificity, 0.70±0.06; F1-score, 0.79±0.06 and area under the curve, 0.80±0.07).

CONCLUSION

A predictive clinical model based on CXR, mMRC, oximetry and spirometry data can accurately screen patients with lung lesions after SARS-CoV-2 infection. Given that these examinations are highly accessible and low cost, this protocol can be automated and implemented in different countries for early detection of COVID-19 sequelae.

C-Reactive Protein and Serum Albumin Ratio: A Feasible Prognostic Marker in Hospitalized Patients with COVID-19

(1) Background: C-reactive protein (CRP) and albumin are inflammatory markers. We analyzed the prognostic capacity of serum albumin (SA) and CRP for an outcome comprising mortality, length of stay, ICU admission, and non-invasive mechanical ventilation in hospitalized COVID-19 patients. (2) Methods: We conducted a retrospective cohort study based on the Spanish national SEMI-COVID-19 Registry. Two multivariate logistic models were adjusted for SA, CRP, and their combination. Training and testing samples were used to validate the models. (3) Results: The outcome was present in 41.1% of the 3471 participants, who had lower SA (mean [SD], 3.5 [0.6] g/dL vs. 3.8 [0.5] g/dL; p < 0.001) and higher CRP (108.9 [96.5] mg/L vs. 70.6 [70.3] mg/L; p < 0.001). In the adjusted multivariate model, both were associated with poorer evolution: SA, OR 0.674 (95% CI, 0.551−0.826; p < 0.001); CRP, OR 1.002 (95% CI, 1.001−1.004; p = 0.003). The CRP/SA model had a similar predictive capacity (honest AUC, 0.8135 [0.7865−0.8405]), with a continuously increasing risk and cutoff value of 25 showing the highest predictive capacity (OR, 1.470; 95% CI, 1.188−1.819; p < 0.001). (4) Conclusions: SA and CRP are good independent predictors of patients hospitalized with COVID-19. For the CRP/SA ratio value, 25 is the cutoff for poor clinical course.

Building a predictive model to identify clinical indicators for COVID-19 using machine learning method

Although some studies tried to identify risk factors for COVID-19, the evidence comparing COVID-19 and community-acquired pneumonia (CAP) is inconclusive, and CAP is the most common pneumonia with similar symptoms as COVID-19. We conducted a case-control study with 35 routine-collected clinical indicators and demographic factors to identify predictors for COVID-19 with CAP as controls. We randomly split the dataset into a training set (70%) and testing set (30%). We built Explainable Boosting Machine to select the important factors and built a decision tree on selected variables to interpret their relationships. The top five individual predictors of COVID-19 are albumin, total bilirubin, monocyte count, alanine aminotransferase, and percentage of monocyte with the importance scores ranging from 0.078 to 0.567. The top systematic predictors for COVID-19 are liver function, monocyte increasing, plasma protein, granulocyte, and renal function (importance scores ranging 0.009-0.096). We identified five combinations of important indicators to screen COVID-19 patients from CAP patients with differentiating abilities ranging 83.3-100%. An online predictive tool for our model was published. Certain clinical indicators collected routinely from most hospitals could help screen and distinguish COVID-19 from CAP. While further verification is needed, our findings and predictive tool could help screen suspected COVID-19 cases.

Real-Time Prediction of Mortality, Cardiac Arrest, and Thromboembolic Complications in Hospitalized Patients With COVID-19

Background

COVID-19 infection carries significant morbidity and mortality. Current risk prediction for complications in COVID-19 is limited, and existing approaches fail to account for the dynamic course of the disease.

Objectives

The purpose of this study was to develop and validate the COVID-HEART predictor, a novel continuously updating risk-prediction technology to forecast adverse events in hospitalized patients with COVID-19.

Methods

Retrospective registry data from patients with severe acute respiratory syndrome coronavirus 2 infection admitted to 5 hospitals were used to train COVID-HEART to predict all-cause mortality/cardiac arrest (AM/CA) and imaging-confirmed thromboembolic events (TEs) (n = 2,550 and n = 1,854, respectively). To assess COVID-HEART's performance in the face of rapidly changing clinical treatment guidelines, an additional 1,100 and 796 patients, admitted after the completion of development data collection, were used for testing. Leave-hospital-out validation was performed.

Results

Over 20 iterations of temporally divided testing, the mean area under the receiver operating characteristic curve were 0.917 (95% confidence interval [CI]: 0.916-0.919) and 0.757 (95% CI: 0.751-0.763) for prediction of AM/CA and TE, respectively. The interquartile ranges of median early warning times were 14 to 21 hours for AM/CA and 12 to 60 hours for TE. The mean area under the receiver operating characteristic curve for the left-out hospitals were 0.956 (95% CI: 0.936-0.976) and 0.781 (95% CI: 0.642-0.919) for prediction of AM/CA and TE, respectively.

Conclusions

The continuously updating, fully interpretable COVID-HEART predictor accurately predicts AM/CA and TE within multiple time windows in hospitalized COVID-19 patients. In its current implementation, the predictor can facilitate practical, meaningful changes in patient triage and resource allocation by providing real-time risk scores for these outcomes. The potential utility of the predictor extends to COVID-19 patients after hospitalization and beyond COVID-19.

Development and Validation of a Deep Learning Model to Screen for Trisomy 21 During the First Trimester From Nuchal Ultrasonographic Images

IMPORTANCE

Accurate screening of trisomy 21 in the first trimester can provide an early opportunity for decision-making regarding reproductive choices.

OBJECTIVE

To develop and validate a deep learning model for screening fetuses with trisomy 21 based on ultrasonographic images.

DESIGN, SETTING, AND PARTICIPANTS

This diagnostic study used data from all available cases and controls enrolled at 2 hospitals in China between January 2009 and September 2020. Two-dimensional images of the midsagittal plane of the fetal face in singleton pregnancies with gestational age more than 11 weeks and less than 14 weeks were examined. Observers were blinded to subjective fetus nuchal translucency (NT) marker measurements. A convolutional neural network was developed to construct a deep learning model. Data augmentation was applied to generate more data. Different groups were randomly selected as training and validation sets to assess the robustness of the deep learning model. The fetal NT was shown and measured. Each detection of trisomy 21 was confirmed by chorionic villus sampling or amniocentesis. Data were analyzed from March 1, 2021, to January 3, 2022.

MAIN OUTCOMES AND MEASURES

The primary outcome was detection of fetuses with trisomy 21. The receiver operating characteristic curve, metrics of accuracy, area under the curve (AUC), sensitivity, and specificity were used for model performance evaluation.

RESULTS

A total of 822 case and control participants (mean [SD] age, 31.9 [4.6] years) were enrolled in the study, including 550 participants (mean [SD] age, 31.7 [4.7] years) in the training set and 272 participants (mean [SD] age, 32.3 [4.7] years) in the validation set. The deep learning model showed good performance for trisomy 21 screening in the training (AUC, 0.98; 95% CI, 0.97-0.99) and validation (AUC, 0.95; 95% CI, 0.93-0.98) sets. The deep learning model had better detective performance for fetuses with trisomy 21 than the model with NT marker and maternal age (training: AUC, 0.82; 95% CI, 0.77-0.86; validation: AUC, 0.73; 95% CI, 0.66-0.80).

CONCLUSIONS AND RELEVANCE

These findings suggest that this deep learning model accurately screened fetuses with trisomy 21, which indicates that the model is a potential tool to facilitate universal primary screening for trisomy 21.

Machine Learning-Based Research for COVID-19 Detection, Diagnosis, and Prediction: A Survey

The year 2020 experienced an unprecedented pandemic called COVID-19, which impacted the whole world. The absence of treatment has motivated research in all fields to deal with it. In Computer Science, contributions mainly include the development of methods for the diagnosis, detection, and prediction of COVID-19 cases. Data science and Machine Learning (ML) are the most widely used techniques in this area. This paper presents an overview of more than 160 ML-based approaches developed to combat COVID-19. They come from various sources like Elsevier, Springer, ArXiv, MedRxiv, and IEEE Xplore. They are analyzed and classified into two categories: Supervised Learning-based approaches and Deep Learning-based ones. In each category, the employed ML algorithm is specified and a number of used parameters is given. The parameters set for each of the algorithms are gathered in different tables. They include the type of the addressed problem (detection, diagnosis, or detection), the type of the analyzed data (Text data, X-ray images, CT images, Time series, Clinical data,...) and the evaluated metrics (accuracy, precision, sensitivity, specificity, F1-Score, and AUC). The study discusses the collected information and provides a number of statistics drawing a picture about the state of the art. Results show that Deep Learning is used in 79% of cases where 65% of them are based on the Convolutional Neural Network (CNN) and 17% use Specialized CNN. On his side, supervised learning is found in only 16% of the reviewed approaches and only Random Forest, Support Vector Machine (SVM) and Regression algorithms are employed.

Current Artificial Intelligence (AI) Techniques, Challenges, and Approaches in Controlling and Fighting COVID-19: A Review

SARS-CoV-2 (COVID-19) has been one of the worst global health crises in the 21st century. The currently available rollout vaccines are not 100% effective for COVID-19 due to the evolving nature of the virus. There is a real need for a concerted effort to fight the virus, and research from diverse fields must contribute. Artificial intelligence-based approaches have proven to be significantly effective in every branch of our daily lives, including healthcare and medical domains. During the early days of this pandemic, artificial intelligence (AI) was utilized in the fight against this virus outbreak and it has played a major role in containing the spread of the virus. It provided innovative opportunities to speed up the development of disease interventions. Several methods, models, AI-based devices, robotics, and technologies have been proposed and utilized for diverse tasks such as surveillance, spread prediction, peak time prediction, classification, hospitalization, healthcare management, heath system capacity, etc. This paper attempts to provide a quick, concise, and precise survey of the state-of-the-art AI-based techniques, technologies, and datasets used in fighting COVID-19. Several domains, including forecasting, surveillance, dynamic times series forecasting, spread prediction, genomics, compute vision, peak time prediction, the classification of medical imaging-including CT and X-ray and how they can be processed-and biological data (genome and protein sequences) have been investigated. An overview of the open-access computational resources and platforms is given and their useful tools are pointed out. The paper presents the potential research areas in AI and will thus encourage researchers to contribute to fighting against the virus and aid global health by slowing down the spread of the virus. This will be a significant contribution to help minimize the high death rate across the globe.

Epidemiology of COVID-19 in Tehran, Iran: A Cohort Study of Clinical Profile, Risk Factors, and Outcomes

BACKGROUND

The outbreak of coronavirus disease 2019 (COVID-19) dates back to December 2019 in China. Iran has been among the most prone countries to the virus. The aim of this study was to report demographics, clinical data, and their association with death and CFR.

METHODS

This observational cohort study was performed from 20th March 2020 to 18th March 2021 in three tertiary educational hospitals in Tehran, Iran. All patients were admitted based on the WHO, CDC, and Iran's National Guidelines. Their information was recorded in their medical files. Multivariable analysis was performed to assess demographics, clinical profile, outcomes of disease, and finding the predictors of death due to COVID-19.

RESULTS

Of all 5318 participants, the median age was 60.0 years, and 57.2% of patients were male. The most significant comorbidities were hypertension and diabetes mellitus. Cough, dyspnea, and fever were the most dominant symptoms. Results showed that ICU admission, elderly age, decreased consciousness, low BMI, HTN, IHD, CVA, dialysis, intubation, Alzheimer disease, blood injection, injection of platelets or FFP, and high number of comorbidities were associated with a higher risk of death related to COVID-19. The trend of CFR was increasing (WPC: 1.86) during weeks 25 to 51.

CONCLUSIONS

Accurate detection of predictors of poor outcomes helps healthcare providers in stratifying patients, based on their risk factors and healthcare requirements to improve their survival chance.

Radiomorphological signs and clinical severity of SARS-CoV-2 lineage B.1.1.7

Objective

We aimed to assess the differences in the severity and chest-CT radiomorphological signs of SARS-CoV-2 B.1.1.7 and non-B.1.1.7 variants.

Methods

We collected clinical data of consecutive patients with laboratory-confirmed COVID-19 and chest-CT imaging who were admitted to the Emergency Department between September 1- November 13, 2020 (non-B.1.1.7 cases) and March 1-March 18, 2021 (B.1.1.7 cases). We also examined the differences in the severity and radiomorphological features associated with COVID-19 pneumonia. Total pneumonia burden (%), mean attenuation of ground-glass opacities and consolidation were quantified using deep-learning research software.

Results

The final population comprised 500 B.1.1.7 and 500 non-B.1.1.7 cases. Patients with B.1.1.7 infection were younger (58.5 ± 15.6 vs 64.8 ± 17.3; p < .001) and had less comorbidities. Total pneumonia burden was higher in the B.1.1.7 patient group (16.1% [interquartile range (IQR):6.0-34.2%] vs 6.6% [IQR:1.2-18.3%]; p < .001). In the age-specific analysis, in patients <60 years B.1.1.7 pneumonia had increased consolidation burden (0.1% [IQR:0.0-0.7%] vs 0.1% [IQR:0.0-0.2%]; p < .001), and severe COVID-19 was more prevalent (11.5% vs  4.9%; p = .032). Mortality rate was similar in all age groups.

Conclusion

Despite B.1.1.7 patients were younger and had fewer comorbidities, they experienced more severe disease than non-B.1.1.7 patients, however, the risk of death was the same between the two groups.

Advances in knowledge

Our study provides data on deep-learning based quantitative lung lesion burden and clinical outcomes of patients infected by B.1.1.7 VOC. Our findings might serve as a model for later investigations, as new variants are emerging across the globe.

External Validation of Deep Learning Algorithms for Radiologic Diagnosis: A Systematic Review

Purpose

To assess generalizability of published deep learning (DL) algorithms for radiologic diagnosis.

Materials and Methods

In this systematic review, the PubMed database was searched for peer-reviewed studies of DL algorithms for image-based radiologic diagnosis that included external validation, published from January 1, 2015, through April 1, 2021. Studies using nonimaging features or incorporating non-DL methods for feature extraction or classification were excluded. Two reviewers independently evaluated studies for inclusion, and any discrepancies were resolved by consensus. Internal and external performance measures and pertinent study characteristics were extracted, and relationships among these data were examined using nonparametric statistics.

Results

Eighty-three studies reporting 86 algorithms were included. The vast majority (70 of 86, 81%) reported at least some decrease in external performance compared with internal performance, with nearly half (42 of 86, 49%) reporting at least a modest decrease (≥0.05 on the unit scale) and nearly a quarter (21 of 86, 24%) reporting a substantial decrease (≥0.10 on the unit scale). No study characteristics were found to be associated with the difference between internal and external performance.

Conclusion

Among published external validation studies of DL algorithms for image-based radiologic diagnosis, the vast majority demonstrated diminished algorithm performance on the external dataset, with some reporting a substantial performance decrease.Keywords: Meta-Analysis, Computer Applications-Detection/Diagnosis, Neural Networks, Computer Applications-General (Informatics), Epidemiology, Technology Assessment, Diagnosis, Informatics Supplemental material is available for this article. © RSNA, 2022.

Effective hybrid deep learning model for COVID-19 patterns identification using CT images

Coronavirus disease 2019 (COVID-19) has attracted significant attention of researchers from various disciplines since the end of 2019. Although the global epidemic situation is stabilizing due to vaccination, new COVID-19 cases are constantly being discovered around the world. As a result, lung computed tomography (CT) examination, an aggregated identification technique, has been used to ameliorate diagnosis. It helps reveal missed diagnoses due to the ambiguity of nucleic acid polymerase chain reaction. Therefore, this study investigated how quickly and accurately hybrid deep learning (DL) methods can identify infected individuals with COVID-19 on the basis of their lung CT images. In addition, this study proposed a developed system to create a reliable COVID-19 prediction network using various layers starting with the segmentation of the lung CT scan image and ending with disease prediction. The initial step of the system starts with a proposed technique for lung segmentation that relies on a no-threshold histogram-based image segmentation method. Afterward, the GrabCut method was used as a post-segmentation method to enhance segmentation outcomes and avoid over-and under-segmentation problems. Then, three pre-trained models of standard DL methods, including Visual Geometry Group Network, convolutional deep belief network, and high-resolution network, were utilized to extract the most affective features from the segmented images that can help to identify COVID-19. These three described pre-trained models were combined as a new mechanism to increase the system's overall prediction capabilities. A publicly available dataset, namely, COVID-19 CT, was used to test the performance of the proposed model, which obtained a 95% accuracy rate. On the basis of comparison, the proposed model outperformed several state-of-the-art studies. Because of its effectiveness in accurately screening COVID-19 CT images, the developed model will potentially be valuable as an additional diagnostic tool for leading clinical professionals.