Automatic detection of red lesions in digital color fundus photographs

A framework for retinal vasculature segmentation based on matched filters

Background

Automatic fundus image processing plays a significant role in computer-assisted retinopathy diagnosis. As retinal vasculature is an important anatomical structure in ophthalmic images, recently, retinal vasculature segmentation has received considerable attention from researchers. A segmentation method usually consists of three steps: preprocessing, segmentation, post-processing. Most of the existing methods emphasize on the segmentation step. In our opinion, the vessels and background can be easily separable when suitable preprocessing exists.

Methods

This paper represents a new matched filter-based vasculature segmentation method for 2-D retinal images. First of all, a raw segmentation is acquired by thresholding the images preprocessed using weighted improved circular gabor filter and multi-directional multi-scale second derivation of Gaussian. After that, the raw segmented image is fine-tuned by a set of novel elongating filters. Finally, we eliminate the speckle like regions and isolated pixels, most of which are non-vessel noises and miss-classified fovea or pathological regions.

Results

The performance of the proposed method is examined on two popularly used benchmark databases: DRIVE and STARE. The accuracy values are 95.29 and 95.69 %, respectively, without a significant degradation of specificity and sensitivity.

Conclusion

The performance of the proposed method is significantly better than almost all unsupervised methods, in addition, comparable to most of the existing supervised vasculature segmentation methods.

Automated microaneurysm detection method based on Eigenvalue analysis using Hessian matrix in retinal fundus images

Diabetic retinopathy (DR) is the most frequent cause of blindness. Microaneurysm (MA) is an early symptom of DR. Therefore, the detection of MA is important for the early detection of DR. We have proposed an automated MA detection method based on double-ring filter, but it has given many false positives. In this paper, we propose an MA detection method based on eigenvalue analysis using a Hessian matrix, with an aim to improve MA detection. After image preprocessing, the MA candidate regions were detected by eigenvalue analysis using the Hessian matrix in green-channeled retinal fundus images. Then, 126 features were calculated for each candidate region. By a threshold operation based on feature analysis, false positive candidates were removed. The candidate regions were then classified either as MA or false positive using artificial neural networks (ANN) based on principal component analysis (PCA). The 126 features were reduced to 25 components by PCA, and were then inputted to ANN. When the method was evaluated on visible MAs using 25 retinal images from the retinopathy online challenge (ROC) database, the true positive rate was 73%, with eight false positives per image.

Red lesion detection in retinal fundus images using Frangi-based filters

This paper presents a method to detect red lesions related to Diabetic Retinopathy (DR), namely Microaneurysms and Hemorrhages from retinal fundus images with robustness to the presence of blood vessels. Filters based on Frangi filters are used for the first time for this task. Green channel of the input image was decomposed into smaller sub images and proposed filters were applied to each sub image after initial preprocessing. Features were extracted from the filter response and used to train a Support Vector Machine classifier to predict whether a test image had lesions or not. Experiments were performed on a dataset of 143 retinal fundus and the proposed method achieved areas under the ROC curve equal to 0.97 and 0.87 for Microaneurysms and Hemorrhages respectively. Results show the effectiveness of the proposed method for detecting red lesions. This method can help significantly in automated detection of DR with fewer false positives.

A method to assist in the diagnosis of early diabetic retinopathy: Image processing applied to detection of microaneurysms in fundus images

Diabetes increases the risk of developing any deterioration in the blood vessels that supply the retina, an ailment known as Diabetic Retinopathy (DR). Since this disease is asymptomatic, it can only be diagnosed by an ophthalmologist. However, the growth of the number of ophthalmologists is lower than the growth of the population with diabetes so that preventive and early diagnosis is difficult due to the lack of opportunity in terms of time and cost. Preliminary, affordable and accessible ophthalmological diagnosis will give the opportunity to perform routine preventive examinations, indicating the need to consult an ophthalmologist during a stage of non proliferation. During this stage, there is a lesion on the retina known as microaneurysm (MA), which is one of the first clinically observable lesions that indicate the disease. In recent years, different image processing algorithms, which allow the detection of the DR, have been developed; however, the issue is still open since acceptable levels of sensitivity and specificity have not yet been reached, preventing its use as a pre-diagnostic tool. Consequently, this work proposes a new approach for MA detection based on (1) reduction of non-uniform illumination; (2) normalization of image grayscale content to improve dependence of images from different contexts; (3) application of the bottom-hat transform to leave reddish regions intact while suppressing bright objects; (4) binarization of the image of interest with the result that objects corresponding to MAs, blood vessels, and other reddish objects (Regions of Interest-ROIs) are completely separated from the background; (5) application of the hit-or-miss Transformation on the binary image to remove blood vessels from the ROIs; (6) two features are extracted from a candidate to distinguish real MAs from FPs, where one feature discriminates round shaped candidates (MAs) from elongated shaped ones (vessels) through application of Principal Component Analysis (PCA); (7) the second feature is a count of the number of times that the radon transform of the candidate ROI, evaluated at the set of discrete angle values {0°, 1°, 2°, …, 180°}, is characterized by a valley between two peaks. The proposed approach is tested on the public databases DiaretDB1 and Retinopathy Online Challenge (ROC) competition. The proposed MA detection method achieves sensitivity, specificity and precision of 92.32%, 93.87% and 95.93% for the diaretDB1 database and 88.06%, 97.47% and 92.19% for the ROC database. Theory, results, challenges and performance related to the proposed MA detecting method are presented.

Genetic algorithm based feature selection combined with dual classification for the automated detection of proliferative diabetic retinopathy

Proliferative diabetic retinopathy (PDR) is a condition that carries a high risk of severe visual impairment. The hallmark of PDR is the growth of abnormal new vessels. In this paper, an automated method for the detection of new vessels from retinal images is presented. This method is based on a dual classification approach. Two vessel segmentation approaches are applied to create two separate binary vessel map which each hold vital information. Local morphology features are measured from each binary vessel map to produce two separate 4-D feature vectors. Independent classification is performed for each feature vector using a support vector machine (SVM) classifier. The system then combines these individual outcomes to produce a final decision. This is followed by the creation of additional features to generate 21-D feature vectors, which feed into a genetic algorithm based feature selection approach with the objective of finding feature subsets that improve the performance of the classification. Sensitivity and specificity results using a dataset of 60 images are 0.9138 and 0.9600, respectively, on a per patch basis and 1.000 and 0.975, respectively, on a per image basis.

Automated retinal image analysis for diabetic retinopathy in telemedicine

There will be an estimated 552 million persons with diabetes globally by the year 2030. Over half of these individuals will develop diabetic retinopathy, representing a nearly insurmountable burden for providing diabetes eye care. Telemedicine programmes have the capability to distribute quality eye care to virtually any location and address the lack of access to ophthalmic services. In most programmes, there is currently a heavy reliance on specially trained retinal image graders, a resource in short supply worldwide. These factors necessitate an image grading automation process to increase the speed of retinal image evaluation while maintaining accuracy and cost effectiveness. Several automatic retinal image analysis systems designed for use in telemedicine have recently become commercially available. Such systems have the potential to substantially improve the manner by which diabetes eye care is delivered by providing automated real-time evaluation to expedite diagnosis and referral if required. Furthermore, integration with electronic medical records may allow a more accurate prognostication for individual patients and may provide predictive modelling of medical risk factors based on broad population data.

A survey on computer aided diagnosis for ocular diseases

Background

Computer Aided Diagnosis (CAD), which can automate the detection process for ocular diseases, has attracted extensive attention from clinicians and researchers alike. It not only alleviates the burden on the clinicians by providing objective opinion with valuable insights, but also offers early detection and easy access for patients.

Method

We review ocular CAD methodologies for various data types. For each data type, we investigate the databases and the algorithms to detect different ocular diseases. Their advantages and shortcomings are analyzed and discussed.

Result

We have studied three types of data (i.e., clinical, genetic and imaging) that have been commonly used in existing methods for CAD. The recent developments in methods used in CAD of ocular diseases (such as Diabetic Retinopathy, Glaucoma, Age-related Macular Degeneration and Pathological Myopia) are investigated and summarized comprehensively.

Conclusion

While CAD for ocular diseases has shown considerable progress over the past years, the clinical importance of fully automatic CAD systems which are able to embed clinical knowledge and integrate heterogeneous data sources still show great potential for future breakthrough.

Detecting diabetes mellitus and nonproliferative diabetic retinopathy using tongue color, texture, and geometry features

Diabetes mellitus (DM) and its complications leading to diabetic retinopathy (DR) are soon to become one of the 21st century's major health problems. This represents a huge financial burden to healthcare officials and governments. To combat this approaching epidemic, this paper proposes a noninvasive method to detect DM and nonproliferative diabetic retinopathy (NPDR), the initial stage of DR based on three groups of features extracted from tongue images. They include color, texture, and geometry. A noninvasive capture device with image correction first captures the tongue images. A tongue color gamut is established with 12 colors representing the tongue color features. The texture values of eight blocks strategically located on the tongue surface, with the additional mean of all eight blocks are used to characterize the nine tongue texture features. Finally, 13 features extracted from tongue images based on measurements, distances, areas, and their ratios represent the geometry features. Applying a combination of the 34 features, the proposed method can separate Healthy/DM tongues as well as NPDR/DM-sans NPDR (DM samples without NPDR) tongues using features from each of the three groups with average accuracies of 80.52% and 80.33%, respectively. This is on a database consisting of 130 Healthy and 296 DM samples, where 29 of those in DM are NPDR.

A multiscale optimization approach to detect exudates in the macula

Pathologies that occur on or near the fovea, such as clinically significant macular edema (CSME), represent high risk for vision loss. The presence of exudates, lipid residues of serous leakage from damaged capillaries, has been associated with CSME, in particular if they are located one optic disc-diameter away from the fovea. In this paper, we present an automatic system to detect exudates in the macula. Our approach uses optimal thresholding of instantaneous amplitude (IA) components that are extracted from multiple frequency scales to generate candidate exudate regions. For each candidate region, we extract color, shape, and texture features that are used for classification. Classification is performed using partial least squares (PLS). We tested the performance of the system on two different databases of 652 and 400 images. The system achieved an area under the receiver operator characteristic curve (AUC) of 0.96 for the combination of both databases and an AUC of 0.97 for each of them when they were evaluated independently.

Automated detection of proliferative diabetic retinopathy using a modified line operator and dual classification

Proliferative diabetic retinopathy (PDR) is a condition that carries a high risk of severe visual impairment. The hallmark of PDR is neovascularisation, the growth of abnormal new vessels. This paper describes an automated method for the detection of new vessels in retinal images. Two vessel segmentation approaches are applied, using the standard line operator and a novel modified line operator. The latter is designed to reduce false responses to non-vessel edges. Both generated binary vessel maps hold vital information which must be processed separately. This is achieved with a dual classification system. Local morphology features are measured from each binary vessel map to produce two separate feature sets. Independent classification is performed for each feature set using a support vector machine (SVM) classifier. The system then combines these individual classification outcomes to produce a final decision. Sensitivity and specificity results using a dataset of 60 images are 0.862 and 0.944 respectively on a per patch basis and 1.00 and 0.90 respectively on a per image basis.

Computer-aided diagnosis of diabetic retinopathy: a review

Diabetes mellitus may cause alterations in the retinal microvasculature leading to diabetic retinopathy. Unchecked, advanced diabetic retinopathy may lead to blindness. It can be tedious and time consuming to decipher subtle morphological changes in optic disk, microaneurysms, hemorrhage, blood vessels, macula, and exudates through manual inspection of fundus images. A computer aided diagnosis system can significantly reduce the burden on the ophthalmologists and may alleviate the inter and intra observer variability. This review discusses the available methods of various retinal feature extractions and automated analysis.

The reading of components of diabetic retinopathy: an evolutionary approach for filtering normal digital fundus imaging in screening and population based studies

In any diabetic retinopathy screening program, about two-thirds of patients have no retinopathy. However, on average, it takes a human expert about one and a half times longer to decide an image is normal than to recognize an abnormal case with obvious features. In this work, we present an automated system for filtering out normal cases to facilitate a more effective use of grading time. The key aim with any such tool is to achieve high sensitivity and specificity to ensure patients' safety and service efficiency. There are many challenges to overcome, given the variation of images and characteristics to identify. The system combines computed evidence obtained from various processing stages, including segmentation of candidate regions, classification and contextual analysis through Hidden Markov Models. Furthermore, evolutionary algorithms are employed to optimize the Hidden Markov Models, feature selection and heterogeneous ensemble classifiers. In order to evaluate its capability of identifying normal images across diverse populations, a population-oriented study was undertaken comparing the software's output to grading by humans. In addition, population based studies collect large numbers of images on subjects expected to have no abnormality. These studies expect timely and cost-effective grading. Altogether 9954 previously unseen images taken from various populations were tested. All test images were masked so the automated system had not been exposed to them before. This system was trained using image subregions taken from about 400 sample images. Sensitivities of 92.2% and specificities of 90.4% were achieved varying between populations and population clusters. Of all images the automated system decided to be normal, 98.2% were true normal when compared to the manual grading results. These results demonstrate scalability and strong potential of such an integrated computational intelligence system as an effective tool to assist a grading service.

Simple hybrid method for fine microaneurysm detection from non-dilated diabetic retinopathy retinal images

Microaneurysms detection is an important task in computer aided diagnosis of diabetic retinopathy. Microaneurysms are the first clinical sign of diabetic retinopathy, a major cause of vision loss in diabetic patients. Early microaneurysm detection can help reduce the incidence of blindness. Automatic detection of microaneurysms is still an open problem due to their tiny sizes, low contrast and also similarity with blood vessels. It is particularly very difficult to detect fine microaneurysms, especially from non-dilated pupils and that is the goal of this paper. Simple yet effective methods are used. They are coarse segmentation using mathematic morphology and fine segmentation using naive Bayes classifier. A total of 18 microaneurysms features are proposed in this paper and they are extracted for naive Bayes classifier. The detected microaneurysms are validated by comparing at pixel level with ophthalmologists' hand-drawn ground-truth. The sensitivity, specificity, precision and accuracy are 85.68, 99.99, 83.34 and 99.99%, respectively.

Validating retinal fundus image analysis algorithms: issues and a proposal

This paper concerns the validation of automatic retinal image analysis (ARIA) algorithms. For reasons of space and consistency, we concentrate on the validation of algorithms processing color fundus camera images, currently the largest section of the ARIA literature. We sketch the context (imaging instruments and target tasks) of ARIA validation, summarizing the main image analysis and validation techniques. We then present a list of recommendations focusing on the creation of large repositories of test data created by international consortia, easily accessible via moderated Web sites, including multicenter annotations by multiple experts, specific to clinical tasks, and capable of running submitted software automatically on the data stored, with clear and widely agreed-on performance criteria, to provide a fair comparison.

Retinal microaneurysm detection through local rotating cross-section profile analysis

A method for the automatic detection of microaneurysms (MAs) in color retinal images is proposed in this paper. The recognition of MAs is an essential step in the diagnosis and grading of diabetic retinopathy. The proposed method realizes MA detection through the analysis of directional cross-section profiles centered on the local maximum pixels of the preprocessed image. Peak detection is applied on each profile, and a set of attributes regarding the size, height, and shape of the peak are calculated subsequently. The statistical measures of these attribute values as the orientation of the cross-section changes constitute the feature set that is used in a naïve Bayes classification to exclude spurious candidates. We give a formula for the final score of the remaining candidates, which can be thresholded further for a binary output. The proposed method has been tested in the Retinopathy Online Challenge, where it proved to be competitive with the state-of-the-art approaches. We also present the experimental results for a private image set using the same classifier setup.

Decision support system for diabetic retinopathy using discrete wavelet transform

Prolonged duration of the diabetes may affect the tiny blood vessels of the retina causing diabetic retinopathy. Routine eye screening of patients with diabetes helps to detect diabetic retinopathy at the early stage. It is very laborious and time-consuming for the doctors to go through many fundus images continuously. Therefore, decision support system for diabetic retinopathy detection can reduce the burden of the ophthalmologists. In this work, we have used discrete wavelet transform and support vector machine classifier for automated detection of normal and diabetic retinopathy classes. The wavelet-based decomposition was performed up to the second level, and eight energy features were extracted. Two energy features from the approximation coefficients of two levels and six energy values from the details in three orientations (horizontal, vertical and diagonal) were evaluated. These features were fed to the support vector machine classifier with various kernel functions (linear, radial basis function, polynomial of orders 2 and 3) to evaluate the highest classification accuracy. We obtained the highest average classification accuracy, sensitivity and specificity of more than 99% with support vector machine classifier (polynomial kernel of order 3) using three discrete wavelet transform features. We have also proposed an integrated index called Diabetic Retinopathy Risk Index using clinically significant wavelet energy features to identify normal and diabetic retinopathy classes using just one number. We believe that this (Diabetic Retinopathy Risk Index) can be used as an adjunct tool by the doctors during the eye screening to cross-check their diagnosis.

An automated decision-support system for non-proliferative diabetic retinopathy disease based on MAs and HAs detection

Diabetic retinopathy (DR) has become a serious threat in our society, which causes 45% of the legal blindness in diabetes patients. Early detection as well as the periodic screening of DR helps in reducing the progress of this disease and in preventing the subsequent loss of visual capability. This paper provides an automated diagnosis system for DR integrated with a user-friendly interface. The grading of the severity level of DR is based on detecting and analyzing the early clinical signs associated with the disease, such as microaneurysms (MAs) and hemorrhages (HAs). The system extracts some retinal features, such as optic disc, fovea, and retinal tissue for easier segmentation of dark spot lesions in the fundus images. That is followed by the classification of the correctly segmented spots into MAs and HAs. Based on the number and location of MAs and HAs, the system quantifies the severity level of DR. A database of 98 color images is used in order to evaluate the performance of the developed system. From the experimental results, it is found that the proposed system achieves 84.31% and 87.53% values in terms of sensitivity for the detection of MAs and HAs respectively. In terms of specificity, the system achieves 93.63% and 95.08% values for the detection of MAs and HAs respectively. Also, the proposed system achieves 68.98% and 74.91% values in terms of kappa coefficient for the detection of MAs and HAs respectively. Moreover, the system yields sensitivity and specificity values of 89.47% and 95.65% for the classification of DR versus normal.

Automated detection of malarial retinopathy-associated retinal hemorrhages

PURPOSE

To develop an automated method for the detection of retinal hemorrhages on color fundus images to characterize malarial retinopathy, which may help in the assessment of patients with cerebral malaria.

METHODS

A fundus image dataset from 14 patients (200 fundus images, with an average of 14 images per patient) previously diagnosed with malarial retinopathy was examined. We developed a pattern recognition-based algorithm, which extracted features from image watershed regions called splats (tobogganing). A reference standard was obtained by manual segmentation of hemorrhages, which assigned a label to each splat. The splat features with the associated splat label were used to train a linear k-nearest neighbor classifier that learnt the color properties of hemorrhages and identified the splats belonging to hemorrhages in a test dataset. In a crossover design experiment, data from 12 patients were used for training and data from two patients were used for testing, with 14 different permutations; and the derived sensitivity and specificity values were averaged.

RESULTS

The experiment resulted in hemorrhage detection sensitivities in terms of splats as 80.83%, and in terms of lesions as 84.84%. The splat-based specificity was 96.67%, whereas for the lesion-based analysis, an average of three false positives was obtained per image. The area under the receiver operating characteristic curve was reported as 0.9148 for splat-based, and as 0.9030 for lesion-based analysis.

CONCLUSIONS

The method provides an automated means of detecting retinal hemorrhages associated with malarial retinopathy. The results matched well with the reference standard. With further development, this technique may provide automated assistance for screening and quantification of malarial retinopathy.

Detection of neovascularization in diabetic retinopathy

Diabetic retinopathy has become an increasingly important cause of blindness. Nevertheless, vision loss can be prevented from early detection of diabetic retinopathy and monitor with regular examination. Common automatic detection of retinal abnormalities is for microaneurysms, hemorrhages, hard exudates, and cotton wool spot. However, there is a worse case of retinal abnormality, but not much research was done to detect it. It is neovascularization where new blood vessels grow due to extensive lack of oxygen in the retinal capillaries. This paper shows that various combination of techniques such as image normalization, compactness classifier, morphology-based operator, Gaussian filtering, and thresholding techniques were used in developing of neovascularization detection. A function matrix box was added in order to classify the neovascularization from natural blood vessel. A region-based neovascularization classification was attempted as a diagnostic accuracy. The developed method was tested on images from different database sources with varying quality and image resolution. It shows that specificity and sensitivity results were 89.4% and 63.9%, respectively. The proposed approach yield encouraging results for future development.

Three-dimensional segmentation of fluid-associated abnormalities in retinal OCT: probability constrained graph-search-graph-cut

An automated method is reported for segmenting 3-D fluid-associated abnormalities in the retina, so-called symptomatic exudate-associated derangements (SEAD), from 3-D OCT retinal images of subjects suffering from exudative age-related macular degeneration. In the first stage of a two-stage approach, retinal layers are segmented, candidate SEAD regions identified, and the retinal OCT image is flattened using a candidate-SEAD aware approach. In the second stage, a probability constrained combined graph search-graph cut method refines the candidate SEADs by integrating the candidate volumes into the graph cut cost function as probability constraints. The proposed method was evaluated on 15 spectral domain OCT images from 15 subjects undergoing intravitreal anti-VEGF injection treatment. Leave-one-out evaluation resulted in a true positive volume fraction (TPVF), false positive volume fraction (FPVF) and relative volume difference ratio (RVDR) of 86.5%, 1.7%, and 12.8%, respectively. The new graph cut-graph search method significantly outperformed both the traditional graph cut and traditional graph search approaches (p < 0.01, p < 0.04) and has the potential to improve clinical management of patients with choroidal neovascularization due to exudative age-related macular degeneration.

[Automated detection of microaneurysms by using region growing and Fuzzy Artmap neural network]

OBJECTIVE

To assess whether the methodological changes of this new algorithm improves the results of a previously presented strategy.

METHODS

We enhance the image and filter out the green channel of the digital color retinography. Multitolerance thresholding was applied to obtain candidate points and make a seed growing region by varying intensities. We took 15 characteristics from each region to train a Fuzzy Artmap neural network using 42 retinal photographs. This network was then applied in the study of 11 good quality retinal photographs included in the diabetic retinopathy early detection screening program, with initial stages of retinopathy, obtained with the Topcon NW200 non-mydriatic retinal camera.

RESULTS

Two experienced ophthalmologists detected 52 microaneurysms in 11 images. The algorithm detected 39 microaneurysms and 3,752 more regions, confirming 38 microaneurysm and 135 false positives. The sensitivity is improved compared to the previous algorithm, from 60.53 to 73.08%. False positives have dropped from 41.8 to 12.27 per image.

CONCLUSIONS

The new algorithm is better than the previous one, but there is still room for improvement, especially in the initial determination of seeds.

Microaneurysm detection with radon transform-based classification on retina images

The creation of an automatic diabetic retinopathy screening system using retina cameras is currently receiving considerable interest in the medical imaging community. The detection of microaneurysms is a key element in this effort. In this work, we propose a new microaneurysms segmentation technique based on a novel application of the radon transform, which is able to identify these lesions without any previous knowledge of the retina morphological features and with minimal image preprocessing. The algorithm has been evaluated on the Retinopathy Online Challenge public dataset, and its performance compares with the best current techniques. The performance is particularly good at low false positive ratios, which makes it an ideal candidate for diabetic retinopathy screening systems.

A function for quality evaluation of retinal vessel segmentations

Retinal blood vessel assessment plays an important role in the diagnosis of ophthalmic pathologies. The use of digital images for this purpose enables the application of a computerized approach and has fostered the development of multiple methods for automated vascular tree segmentation. Metrics based on contingency tables for binary classification have been widely used for evaluating the performance of these algorithms. Metrics from this family are based on the measurement of a success or failure rate in the detected pixels, obtained by means of pixel-to-pixel comparison between the automated segmentation and a manually-labeled reference image. Therefore, vessel pixels are not considered as a part of a vascular structure with specific features. This paper contributes a function for the evaluation of global quality in retinal vessel segmentations. This function is based on the characterization of vascular structures as connected segments with measurable area and length. Thus, its design is meant to be sensitive to anatomical vascularity features. Comparison of results between the proposed function and other general quality evaluation functions shows that this proposal renders a high matching degree with human quality perception. Therefore, it can be used to enhance quality evaluation in retinal vessel segmentations, supplementing the existing functions. On the other hand, from a general point of view, the applied concept of measuring descriptive properties may be used to design specialized functions aimed at segmentation quality evaluation in other complex structures.

Exudate-based diabetic macular edema detection in fundus images using publicly available datasets

Diabetic macular edema (DME) is a common vision threatening complication of diabetic retinopathy. In a large scale screening environment DME can be assessed by detecting exudates (a type of bright lesions) in fundus images. In this work, we introduce a new methodology for diagnosis of DME using a novel set of features based on colour, wavelet decomposition and automatic lesion segmentation. These features are employed to train a classifier able to automatically diagnose DME through the presence of exudation. We present a new publicly available dataset with ground-truth data containing 169 patients from various ethnic groups and levels of DME. This and other two publicly available datasets are employed to evaluate our algorithm. We are able to achieve diagnosis performance comparable to retina experts on the MESSIDOR (an independently labelled dataset with 1200 images) with cross-dataset testing (e.g., the classifier was trained on an independent dataset and tested on MESSIDOR). Our algorithm obtained an AUC between 0.88 and 0.94 depending on the dataset/features used. Additionally, it does not need ground truth at lesion level to reject false positives and is computationally efficient, as it generates a diagnosis on an average of 4.4s (9.3s, considering the optic nerve localisation) per image on an 2.6 GHz platform with an unoptimised Matlab implementation.

Telehealth practice recommendations for diabetic retinopathy, second edition

Ocular telemedicine and telehealth have the potential to decrease vision loss from DR. Planning, execution, and follow-up are key factors for success. Telemedicine is complex, requiring the services of expert teams working collaboratively to provide care matching the quality of conventional clinical settings. Improving access and outcomes, however, makes telemedicine a valuable tool for our diabetic patients. Programs that focus on patient needs, consider available resources, define clear goals, promote informed expectations, appropriately train personnel, and adhere to regulatory and statutory requirements have the highest chance of achieving success.

Digital ocular fundus imaging: a review

Ocular fundus imaging plays a key role in monitoring the health status of the human eye. Currently, a large number of imaging modalities allow the assessment and/or quantification of ocular changes from a healthy status. This review focuses on the main digital fundus imaging modality, color fundus photography, with a brief overview of complementary techniques, such as fluorescein angiography. While focusing on two-dimensional color fundus photography, the authors address the evolution from nondigital to digital imaging and its impact on diagnosis. They also compare several studies performed along the transitional path of this technology. Retinal image processing and analysis, automated disease detection and identification of the stage of diabetic retinopathy (DR) are addressed as well. The authors emphasize the problems of image segmentation, focusing on the major landmark structures of the ocular fundus: the vascular network, optic disk and the fovea. Several proposed approaches for the automatic detection of signs of disease onset and progression, such as microaneurysms, are surveyed. A thorough comparison is conducted among different studies with regard to the number of eyes/subjects, imaging modality, fundus camera used, field of view and image resolution to identify the large variation in characteristics from one study to another. Similarly, the main features of the proposed classifications and algorithms for the automatic detection of DR are compared, thereby addressing computer-aided diagnosis and computer-aided detection for use in screening programs.

A study on hemorrhage detection using hybrid method in fundus images

Image processing of a fundus image is performed for the early detection of diabetic retinopathy. Recently, several studies have proposed that the use of a morphological filter may help extract hemorrhages from the fundus image; however, extraction of hemorrhages using template matching with templates of various shapes has not been reported. In our study, we applied hue saturation value brightness correction and contrast-limited adaptive histogram equalization to fundus images. Then, using template matching with normalized cross-correlation, the candidate hemorrhages were extracted. Region growing thereafter reconstructed the shape of the hemorrhages which enabled us to calculate the size of the hemorrhages. To reduce the number of false positives, compactness and the ratio of bounding boxes were used. We also used the 5 × 5 kernel value of the hemorrhage and a foveal filter as other methods of false positive reduction in our study. In addition, we analyzed the cause of false positive (FP) and false negative in the detection of retinal hemorrhage. Combining template matching in various ways, our program achieved a sensitivity of 85% at 4.0 FPs per image. The result of our research may help the clinician in the diagnosis of diabetic retinopathy and might be a useful tool for early detection of diabetic retinopathy progression especially in the telemedicine.

[Automatic detection of microaneurysms in colour fundus images]

PURPOSE

We present the development of a tool for the automatic detection of microaneurysms and its clinical evaluation. The intention of this tool is to facilitate the diagnosis of diabetic retinopathy in general screening programs.

METHOD

The designed and developed tool consists of three stages of processing: 1) Obtaining of the basic image of eye with the retinal camera, inverted image on the green channel, and a high-pass filter of the image. This phase enhances the microaneurysms. 2) Detection of the candidates for microaneurysms, by means of an adaptive prediction filter and regions growth. 3) Selection, among the candidates, of whom microaneurysms must be considered to fulfil the criteria of circular shape, high intensity in the inverted green channel and contrasts with respect to the surrounding pixels.

RESULTS

We selected to 20 retinal photographs of good quality and dimensions 600x600 pixels from patients with nonproliferative diabetic retinopathy. The ophthalmologists detected 297 microaneurysms in these images. The tool for automatic detection correctly located 252 microaneurysms, with a mean sensitivity of 89% and a false positives rate of 93%.

CONCLUSIONS

The results obtained seem to indicate that the tool developed will be very useful for its potential use in screening programs in primary care centres. On the other hand, more work is needed on the algorithm to decrease the rate of false positives.

Contextual computer-aided detection: improving bright lesion detection in retinal images and coronary calcification identification in CT scans

Contextual information plays an important role in medical image understanding. Medical experts make use of context to detect and differentiate pathologies in medical images, especially when interpreting difficult cases. The majority of computer-aided diagnosis (CAD) systems, however, employ only local information to classify candidates, without taking into account global image information or the relation of a candidate with neighboring structures. In this paper, we present a generic system for including contextual information in a CAD system. Context is described by means of high-level features based on the spatial relation between lesion candidates and surrounding anatomical landmarks and lesions of different classes (static contextual features) and lesions of the same type (dynamic contextual features). We demonstrate the added value of contextual CAD for two real-world CAD tasks: the identification of exudates and drusen in 2D retinal images and coronary calcifications in 3D computed tomography scans. Results show that in both applications contextual CAD is superior to a local CAD approach with a significant increase of the figure of merit of the Free Receiver Operating Characteristic curve from 0.84 to 0.92 and from 0.88 to 0.98 for exudates and drusen, respectively, and from 0.87 to 0.93 for coronary calcifications.

Detection of new vessels on the optic disc using retinal photographs

Proliferative diabetic retinopathy is a rare condition likely to lead to severe visual impairment. It is characterized by the development of abnormal new retinal vessels. We describe a method for automatically detecting new vessels on the optic disc using retinal photography. Vessel-like candidate segments are first detected using a method based on watershed lines and ridge strength measurement. Fifteen feature parameters, associated with shape, position, orientation, brightness, contrast and line density are calculated for each candidate segment. Based on these features, each segment is categorized as normal or abnormal using a support vector machine (SVM) classifier. The system was trained and tested by cross-validation using 38 images with new vessels and 71 normal images from two diabetic retinal screening centers and one hospital eye clinic. The discrimination performance of the fifteen features was tested against a clinical reference standard. Fourteen features were found to be effective and used in the final test. The area under the receiver operator characteristic curve was 0.911 for detecting images with new vessels on the disc. This accuracy may be sufficient for it to play a useful clinical role in an automated retinopathy analysis system.

On combining computer-aided detection systems

Computer-aided detection (CAD) is increasingly used in clinical practice and for many applications a multitude of CAD systems have been developed. In practice, CAD systems have different strengths and weaknesses and it is therefore interesting to consider their combination. In this paper, we present generic methods to combine multiple CAD systems and investigate what kind of performance increase can be expected. Experimental results are presented using data from the ANODE09 and ROC09 online CAD challenges for the detection of pulmonary nodules in computed tomography scans and red lesions in retinal images, respectively. For both applications, combination results in a large and significant increase in performance when compared to the best individual CAD system.

Optimal filter framework for automated, instantaneous detection of lesions in retinal images

Automated detection of lesions in retinal images is a crucial step towards efficient early detection, or screening, of large at-risk populations. In particular, the detection of microaneurysms, usually the first sign of diabetic retinopathy (DR), and the detection of drusen, the hallmark of age-related macular degeneration (AMD), are of primary importance. In spite of substantial progress made, detection algorithms still produce 1) false positives-target lesions are mixed up with other normal or abnormal structures in the eye, and 2) false negatives-the large variability in the appearance of the lesions causes a subset of these target lesions to be missed. We propose a general framework for detecting and characterizing target lesions almost instantaneously. This framework relies on a feature space automatically derived from a set of reference image samples representing target lesions, including atypical target lesions, and those eye structures that are similar looking but are not target lesions. The reference image samples are obtained either from an expert- or a data-driven approach. Factor analysis is used to derive the filters generating this feature space from reference samples. Previously unseen image samples are then classified in this feature space. We tested this approach by training it to detect microaneurysms. On a set of images from 2739 patients including 67 with referable DR, DR detection area under the receiver-operating characteristic curve (AUC) was comparable (AUC=0.927) to our previously published red lesion detection algorithm (AUC=0.929). We also tested the approach on the detection of AMD, by training it to differentiate drusen from Stargardt's disease lesions, and achieved an AUC=0.850 on a set of 300 manually detected drusen and 300 manually detected flecks. The entire image processing sequence takes less than a second on a standard PC compared to minutes in our previous approach, allowing instantaneous detection. Free-response receiver-operating characteristic analysis showed the superiority of this approach over a framework where false positives and the atypical lesions are not explicitly modeled. A greater performance was achieved by the expert-driven approach for DR detection, where the designer had sound expert knowledge. However, for both problems, a comparable performance was obtained for both expert- and data-driven approaches. This indicates that annotation of a limited number of lesions suffices for building a detection system for any type of lesion in retinal images, if no expert-knowledge is available. We are studying whether the optimal filter framework also generalizes to the detection of any structure in other domains.

Automated detection of red lesions from digital colour fundus photographs

Earliest signs of diabetic retinopathy, the major cause of vision loss, are damage to the blood vessels and the formation of lesions in the retina. Early detection of diabetic retinopathy is essential for the prevention of blindness. In this paper we present a computer-aided system to automatically identify red lesions from retinal fundus photographs. After pre-processing, a morphological technique was used to segment red lesion candidates from the background and other retinal structures. Then a rule-based classifier was used to discriminate actual red lesions from artifacts. A novel method for blood vessel detection is also proposed to refine the detection of red lesions. For a standarised test set of 219 images, the proposed method can detect red lesions with a sensitivity of 89.7% and a specificity of 98.6% (at lesion level). The performance of the proposed method shows considerable promise for detection of red lesions as well as other types of lesions.

Retinal vessel extraction by combining radial symmetry transform and iterated graph cuts

In this paper, we propose a new method for the extraction of blood vessels in retinal images. This approach starts with a Hessian-based multiscale filtering method to enhance blood vessels in gray retinal images. Subsequently, a new radial symmetry transformation, which is based on line kernels, is proposed to improve the detection of vessel structures and restrain the response of nonvessel structures. Finally, an iterated segmentation algorithm is used to extract retinal vessels. The proposed approach has been tested on the two publicly available databases, DRIVE and STARE. The experimental results show the feasibility of the proposed method.

A new supervised method for blood vessel segmentation in retinal images by using gray-level and moment invariants-based features

This paper presents a new supervised method for blood vessel detection in digital retinal images. This method uses a neural network (NN) scheme for pixel classification and computes a 7-D vector composed of gray-level and moment invariants-based features for pixel representation. The method was evaluated on the publicly available DRIVE and STARE databases, widely used for this purpose, since they contain retinal images where the vascular structure has been precisely marked by experts. Method performance on both sets of test images is better than other existing solutions in literature. The method proves especially accurate for vessel detection in STARE images. Its application to this database (even when the NN was trained on the DRIVE database) outperforms all analyzed segmentation approaches. Its effectiveness and robustness with different image conditions, together with its simplicity and fast implementation, make this blood vessel segmentation proposal suitable for retinal image computer analyses such as automated screening for early diabetic retinopathy detection.

Vessel network detection using contour evolution and color components

Automated retinal screening relies on vasculature segmentation before the identification of other anatomical structures of the retina. Vasculature extraction can also be input to image quality ranking, neovascularization detection and image registration. An extensive related literature often excludes the inherent heterogeneity of ophthalmic clinical images. The contribution of this paper consists in an algorithm using front propagation to segment the vessel network, including a penalty on the wait queue to the fast marching method, which minimizes leakage of the evolving boundary. The algorithm requires no manual labeling of seeds, a minimum number of parameters and it is capable of segmenting color ocular fundus images in real scenarios, where multi-ethnicity and brightness variations are parts of the problem.

Assessment of four neural network based classifiers to automatically detect red lesions in retinal images

Diabetic retinopathy (DR) is an important cause of visual impairment in industrialised countries. Automatic detection of DR early markers can contribute to the diagnosis and screening of the disease. The aim of this study was to automatically detect one of such early signs: red lesions (RLs), like haemorrhages and microaneurysms. To achieve this goal, we extracted a set of colour and shape features from image regions and performed feature selection using logistic regression. Four neural network (NN) based classifiers were subsequently used to obtain the final segmentation of RLs: multilayer perceptron (MLP), radial basis function (RBF), support vector machine (SVM) and a combination of these three NNs using a majority voting (MV) schema. Our database was composed of 115 images. It was divided into a training set of 50 images (with RLs) and a test set of 65 images (40 with RLs and 25 without RLs). Attending to performance and complexity criteria, the best results were obtained for RBF. Using a lesion-based criterion, a mean sensitivity of 86.01% and a mean positive predictive value of 51.99% were obtained. With an image-based criterion, a mean sensitivity of 100%, mean specificity of 56.00% and mean accuracy of 83.08% were achieved.