An open access database for the evaluation of respiratory sound classification algorithms

Artificial intelligence-based framework to identify the abnormalities in the COVID-19 disease and other common respiratory diseases from digital stethoscope data using deep CNN

The utilization of lung sounds to diagnose lung diseases using respiratory sound features has significantly increased in the past few years. The Digital Stethoscope data has been examined extensively by medical researchers and technical scientists to diagnose the symptoms of respiratory diseases. Artificial intelligence-based approaches are applied in the real universe to distinguish respiratory disease signs from human pulmonary auscultation sounds. The Deep CNN model is implemented with combined multi-feature channels (Modified MFCC, Log Mel, and Soft Mel) to obtain the sound parameters from lung-based Digital Stethoscope data. The model analysis is observed with max-pooling and without max-pool operations using multi-feature channels on respiratory digital stethoscope data. In addition, COVID-19 sound data and enriched data, which are recently acquired data to enhance model performance using a combination of L2 regularization to overcome the risk of overfitting because of less respiratory sound data, are included in the work. The suggested DCNN with Max-Pooling on the improved dataset demonstrates cutting-edge performance employing a multi-feature channels spectrogram. The model has been developed with different convolutional filter sizes (1 × 12 , 1 × 24 , 1 × 36 , 1 × 48 , and 1 × 60 ) that helped to test the proposed neural network. According to the experimental findings, the suggested DCNN architecture with a max-pooling function performs better to identify respiratory disease symptoms than DCNN without max-pooling. In order to demonstrate the model's effectiveness in categorization, it is trained and tested with the DCNN model that extract several modalities of respiratory sound data.

Novel audio characteristic-dependent feature extraction and data augmentation methods for cough-based respiratory disease classification

Respiratory diseases are one of the major health problems worldwide. Early diagnosis of the disease types is of vital importance. As one of the main symptoms of many respiratory diseases, cough may contain information about different pathological changes in the respiratory system. Therefore, many researchers have used cough sounds to diagnose different diseases through artificial intelligence in recent years. The acoustic features and data augmentation methods commonly used in speech tasks are used to achieve better performance. Although these methods are applicable, previous studies have not considered the characteristics of cough sound signals. In this paper, we designed a cough-based respiratory disease classification system and proposed audio characteristic-dependent feature extraction and data augmentation methods. Firstly, according to the short durations and rapid transition of different cough stages, we proposed maximum overlapping mel-spectrogram to avoid missing inter-frame information caused by traditional framing methods. Secondly, we applied various data augmentation methods to mitigate the problem of limited labeled data. Based on the frequency energy distributions of different diseased cough audios, we proposed a parameter-independent self-energy-based augmentation method to enhance the differences between different frequency bands. Finally, in the model testing stage, we leveraged test-time augmentation to further improve the classification performance by fusing the test results of the original and multiple augmented audios. The proposed methods were validated on the Coswara dataset through stratified four-fold cross-validation. Compared to the baseline model using mel-spectrogram as input, the proposed methods achieved an average absolute performance improvement of 3.33% and 3.10% in macro Area Under the Receiver Operating Characteristic (macro AUC) and Unweighted Average Recall (UAR), respectively. The visualization results through Gradient-weighted Class Activation Mapping (Grad-CAM) showed the contributions of different features to model decisions.

Shortcut learning in medical AI hinders generalization: method for estimating AI model generalization without external data

Healthcare datasets are becoming larger and more complex, necessitating the development of accurate and generalizable AI models for medical applications. Unstructured datasets, including medical imaging, electrocardiograms, and natural language data, are gaining attention with advancements in deep convolutional neural networks and large language models. However, estimating the generalizability of these models to new healthcare settings without extensive validation on external data remains challenging. In experiments across 13 datasets including X-rays, CTs, ECGs, clinical discharge summaries, and lung auscultation data, our results demonstrate that model performance is frequently overestimated by up to 20% on average due to shortcut learning of hidden data acquisition biases (DAB). Shortcut learning refers to a phenomenon in which an AI model learns to solve a task based on spurious correlations present in the data as opposed to features directly related to the task itself. We propose an open source, bias-corrected external accuracy estimate, PEst, that better estimates external accuracy to within 4% on average by measuring and calibrating for DAB-induced shortcut learning.

Multi-modal deep learning methods for classification of chest diseases using different medical imaging and cough sounds

Chest disease refers to a wide range of conditions affecting the lungs, such as COVID-19, lung cancer (LC), consolidation lung (COL), and many more. When diagnosing chest disorders medical professionals may be thrown off by the overlapping symptoms (such as fever, cough, sore throat, etc.). Additionally, researchers and medical professionals make use of chest X-rays (CXR), cough sounds, and computed tomography (CT) scans to diagnose chest disorders. The present study aims to classify the nine different conditions of chest disorders, including COVID-19, LC, COL, atelectasis (ATE), tuberculosis (TB), pneumothorax (PNEUTH), edema (EDE), pneumonia (PNEU). Thus, we suggested four novel convolutional neural network (CNN) models that train distinct image-level representations for nine different chest disease classifications by extracting features from images. Furthermore, the proposed CNN employed several new approaches such as a max-pooling layer, batch normalization layers (BANL), dropout, rank-based average pooling (RBAP), and multiple-way data generation (MWDG). The scalogram method is utilized to transform the sounds of coughing into a visual representation. Before beginning to train the model that has been developed, the SMOTE approach is used to calibrate the CXR and CT scans as well as the cough sound images (CSI) of nine different chest disorders. The CXR, CT scan, and CSI used for training and evaluating the proposed model come from 24 publicly available benchmark chest illness datasets. The classification performance of the proposed model is compared with that of seven baseline models, namely Vgg-19, ResNet-101, ResNet-50, DenseNet-121, EfficientNetB0, DenseNet-201, and Inception-V3, in addition to state-of-the-art (SOTA) classifiers. The effectiveness of the proposed model is further demonstrated by the results of the ablation experiments. The proposed model was successful in achieving an accuracy of 99.01%, making it superior to both the baseline models and the SOTA classifiers. As a result, the proposed approach is capable of offering significant support to radiologists and other medical professionals.

Classification of Adventitious Sounds Combining Cochleogram and Vision Transformers

Early identification of respiratory irregularities is critical for improving lung health and reducing global mortality rates. The analysis of respiratory sounds plays a significant role in characterizing the respiratory system's condition and identifying abnormalities. The main contribution of this study is to investigate the performance when the input data, represented by cochleogram, is used to feed the Vision Transformer (ViT) architecture, since this input-classifier combination is the first time it has been applied to adventitious sound classification to our knowledge. Although ViT has shown promising results in audio classification tasks by applying self-attention to spectrogram patches, we extend this approach by applying the cochleogram, which captures specific spectro-temporal features of adventitious sounds. The proposed methodology is evaluated on the ICBHI dataset. We compare the classification performance of ViT with other state-of-the-art CNN approaches using spectrogram, Mel frequency cepstral coefficients, constant-Q transform, and cochleogram as input data. Our results confirm the superior classification performance combining cochleogram and ViT, highlighting the potential of ViT for reliable respiratory sound classification. This study contributes to the ongoing efforts in developing automatic intelligent techniques with the aim to significantly augment the speed and effectiveness of respiratory disease detection, thereby addressing a critical need in the medical field.

Enabling Continuous Breathing-Phase Contextualization via Wearable-Based Impedance Pneumography and Lung Sounds: A Feasibility Study

Chronic respiratory diseases affect millions and are leading causes of death in the US and worldwide. Pulmonary auscultation provides clinicians with critical respiratory health information through the study of Lung Sounds (LS) and the context of the breathing-phase and chest location in which they are measured. Existing auscultation technologies, however, do not enable the simultaneous measurement of this context, thereby potentially limiting computerized LS analysis. In this work, LS and Impedance Pneumography (IP) measurements were obtained from 10 healthy volunteers while performing normal and forced-expiratory (FE) breathing maneuvers using our wearable IP and respiratory sounds (WIRS) system. Simultaneous auscultation was performed with the Eko CORE stethoscope (EKO). The breathing-phase context was extracted from the IP signals and used to compute phase-by-phase (Inspiratory (I), expiratory (E), and their ratio (I:E)) and breath-by-breath acoustic features. Their individual and added value was then elucidated through machine learning analysis. We found that the phase-contextualized features effectively captured the underlying acoustic differences between deep and FE breaths, yielding a maximum F1 Score of 84.1 ±11.4% with the phase-by-phase features as the strongest contributors to this performance. Further, the individual phase-contextualized models outperformed the traditional breath-by-breath models in all cases. The validity of the results was demonstrated for the LS obtained with WIRS, EKO, and their combination. These results suggest that incorporating breathing-phase context may enhance computerized LS analysis. Hence, multimodal sensing systems that enable this, such as WIRS, have the potential to advance LS clinical utility beyond traditional manual auscultation and improve patient care.

Design and application of a flexible nano cardiac sound sensor based on P(VDF-TrFE)/KNN/GR composite piezoelectric film for heart disease diagnosis

The paper proposes a flexible micro-nano composite piezoelectric thin film. This flexible piezoelectric film is fabricated through electrospinning process, utilizing a combination of 12 wt% poly(vinylidene fluoride-co-trifluoroethylene)(P(VDF-TrFE)), 8 wt% potassium sodium niobate (KNN) nanoparticles, and 0.5 wt% graphene (GR). Under cyclic loading, the composite film demonstrates a remarkable increase in open-circuit voltage and short-circuit current, achieving values of 36.1 V and 163.7 uA, respectively. These values are 5.8 times and 3.6 times higher than those observed in the pure P(VDF-TrFE) film. The integration of this piezoelectric film into a wearable flexible heartbeat sensor, coupled with the RepMLP classification model, facilitates heartbeat acquisition and real-time automated diagnosis. After training and validation on a dataset containing 2000 heartbeat samples, the system achieved an accuracy of approximately 99% in two classification of heart sound signals (normal and abnormal). This research substantially enhances the output performance of the piezoelectric film, offering a novel and valuable solution for the application of flexible piezoelectric films in physiological signal detection.

Real-time counting of wheezing events from lung sounds using deep learning algorithms: Implications for disease prediction and early intervention

This pioneering study aims to revolutionize self-symptom management and telemedicine-based remote monitoring through the development of a real-time wheeze counting algorithm. Leveraging a novel approach that includes the detailed labeling of one breathing cycle into three types: break, normal, and wheeze, this study not only identifies abnormal sounds within each breath but also captures comprehensive data on their location, duration, and relationships within entire respiratory cycles, including atypical patterns. This innovative strategy is based on a combination of a one-dimensional convolutional neural network (1D-CNN) and a long short-term memory (LSTM) network model, enabling real-time analysis of respiratory sounds. Notably, it stands out for its capacity to handle continuous data, distinguishing it from conventional lung sound classification algorithms. The study utilizes a substantial dataset consisting of 535 respiration cycles from diverse sources, including the Child Sim Lung Sound Simulator, the EMTprep Open-Source Database, Clinical Patient Records, and the ICBHI 2017 Challenge Database. Achieving a classification accuracy of 90%, the exceptional result metrics encompass the identification of each breath cycle and simultaneous detection of the abnormal sound, enabling the real-time wheeze counting of all respirations. This innovative wheeze counter holds the promise of revolutionizing research on predicting lung diseases based on long-term breathing patterns and offers applicability in clinical and non-clinical settings for on-the-go detection and remote intervention of exacerbated respiratory symptoms.

Evolution of the Stethoscope: Advances with the Adoption of Machine Learning and Development of Wearable Devices

The stethoscope has long been used for the examination of patients, but the importance of auscultation has declined due to its several limitations and the development of other diagnostic tools. However, auscultation is still recognized as a primary diagnostic device because it is non-invasive and provides valuable information in real-time. To supplement the limitations of existing stethoscopes, digital stethoscopes with machine learning (ML) algorithms have been developed. Thus, now we can record and share respiratory sounds and artificial intelligence (AI)-assisted auscultation using ML algorithms distinguishes the type of sounds. Recently, the demands for remote care and non-face-to-face treatment diseases requiring isolation such as coronavirus disease 2019 (COVID-19) infection increased. To address these problems, wireless and wearable stethoscopes are being developed with the advances in battery technology and integrated sensors. This review provides the history of the stethoscope and classification of respiratory sounds, describes ML algorithms, and introduces new auscultation methods based on AI-assisted analysis and wireless or wearable stethoscopes.

BRACETS: Bimodal repository of auscultation coupled with electrical impedance thoracic signals

BACKGROUND AND OBJECTIVE

Respiratory diseases are among the most significant causes of morbidity and mortality worldwide, causing substantial strain on society and health systems. Over the last few decades, there has been increasing interest in the automatic analysis of respiratory sounds and electrical impedance tomography (EIT). Nevertheless, no publicly available databases with both respiratory sound and EIT data are available.

METHODS

In this work, we have assembled the first open-access bimodal database focusing on the differential diagnosis of respiratory diseases (BRACETS: Bimodal Repository of Auscultation Coupled with Electrical Impedance Thoracic Signals). It includes simultaneous recordings of single and multi-channel respiratory sounds and EIT. Furthermore, we have proposed several machine learning-based baseline systems for automatically classifying respiratory diseases in six distinct evaluation tasks using respiratory sound and EIT (A1, A2, A3, B1, B2, B3). These tasks included classifying respiratory diseases at sample and subject levels. The performance of the classification models was evaluated using a 5-fold cross-validation scheme (with subject isolation between folds).

RESULTS

The resulting database consists of 1097 respiratory sounds and 795 EIT recordings acquired from 78 adult subjects in two countries (Portugal and Greece). In the task of automatically classifying respiratory diseases, the baseline classification models have achieved the following average balanced accuracy: Task A1 - 77.9±13.1%; Task A2 - 51.6±9.7%; Task A3 - 38.6±13.1%; Task B1 - 90.0±22.4%; Task B2 - 61.4±11.8%; Task B3 - 50.8±10.6%.

CONCLUSION

The creation of this database and its public release will aid the research community in developing automated methodologies to assess and monitor respiratory function, and it might serve as a benchmark in the field of digital medicine for managing respiratory diseases. Moreover, it could pave the way for creating multi-modal robust approaches for that same purpose.

Deep learning-based lung sound analysis for intelligent stethoscope

Auscultation is crucial for the diagnosis of respiratory system diseases. However, traditional stethoscopes have inherent limitations, such as inter-listener variability and subjectivity, and they cannot record respiratory sounds for offline/retrospective diagnosis or remote prescriptions in telemedicine. The emergence of digital stethoscopes has overcome these limitations by allowing physicians to store and share respiratory sounds for consultation and education. On this basis, machine learning, particularly deep learning, enables the fully-automatic analysis of lung sounds that may pave the way for intelligent stethoscopes. This review thus aims to provide a comprehensive overview of deep learning algorithms used for lung sound analysis to emphasize the significance of artificial intelligence (AI) in this field. We focus on each component of deep learning-based lung sound analysis systems, including the task categories, public datasets, denoising methods, and, most importantly, existing deep learning methods, i.e., the state-of-the-art approaches to convert lung sounds into two-dimensional (2D) spectrograms and use convolutional neural networks for the end-to-end recognition of respiratory diseases or abnormal lung sounds. Additionally, this review highlights current challenges in this field, including the variety of devices, noise sensitivity, and poor interpretability of deep models. To address the poor reproducibility and variety of deep learning in this field, this review also provides a scalable and flexible open-source framework that aims to standardize the algorithmic workflow and provide a solid basis for replication and future extension: https://github.com/contactless-healthcare/Deep-Learning-for-Lung-Sound-Analysis .

Lung anomaly detection from respiratory sound database (sound signals)

Chest or upper body auscultation has long been considered a useful part of the physical examination going back to the time of Hippocrates. However, it did not become a prevalent practice until the invention of the stethoscope by Rene Laennec in 1816, which made the practice suitable and hygienic. Pulmonary disease is a kind of sickness that affects the lungs and various parts of the respiratory system. Lung diseases are the third largest cause of death in the world. According to the World Health Organization (WHO), the five major respiratory diseases, namely chronic obstructive pulmonary disease (COPD), tuberculosis, acute lower respiratory tract infection (LRTI), asthma, and lung cancer, cause the death of more than 3 million people each year worldwide. Respiratory sounds disclose significant information regarding the lungs of patients. Numerous methods are developed for analyzing the lung sounds. However, clinical approaches require qualified pulmonologists to diagnose such kind of signals appropriately and are also time consuming. Hence, an efficient Fractional Water Cycle Swarm Optimizer-based Deep Residual Network (Fr-WCSO-based DRN) is developed in this research for detecting the pulmonary abnormalities using respiratory sounds signals. The proposed Fr-WCSO is newly designed by the incorporation of Fractional Calculus (FC) and Water Cycle Swarm Optimizer WCSO. Meanwhile, WCSO is the combination of Water Cycle Algorithm (WCA) with Competitive Swarm Optimizer (CSO). The respiratory input sound signals are pre-processed and the important features needed for the further processing are effectively extracted. With the extracted features, data augmentation is carried out for minimizing the over fitting issues for improving the overall detection performance. Once data augmentation is done, feature selection is performed using proposed Fr-WCSO algorithm. Finally, pulmonary abnormality detection is performed using DRN where the training procedure of DRN is performed using the developed Fr-WCSO algorithm. The developed method achieved superior performance by considering the evaluation measures, namely True Positive Rate (TPR), True Negative Rate (TNR) and testing accuracy with the values of 0.963(96.3%), 0.932,(93.2%) and 0.948(94.8%), respectively.

Deep Learning-Based Classification of Chest Diseases Using X-rays, CT Scans, and Cough Sound Images

Chest disease refers to a variety of lung disorders, including lung cancer (LC), COVID-19, pneumonia (PNEU), tuberculosis (TB), and numerous other respiratory disorders. The symptoms (i.e., fever, cough, sore throat, etc.) of these chest diseases are similar, which might mislead radiologists and health experts when classifying chest diseases. Chest X-rays (CXR), cough sounds, and computed tomography (CT) scans are utilized by researchers and doctors to identify chest diseases such as LC, COVID-19, PNEU, and TB. The objective of the work is to identify nine different types of chest diseases, including COVID-19, edema (EDE), LC, PNEU, pneumothorax (PNEUTH), normal, atelectasis (ATE), and consolidation lung (COL). Therefore, we designed a novel deep learning (DL)-based chest disease detection network (DCDD_Net) that uses a CXR, CT scans, and cough sound images for the identification of nine different types of chest diseases. The scalogram method is used to convert the cough sounds into an image. Before training the proposed DCDD_Net model, the borderline (BL) SMOTE is applied to balance the CXR, CT scans, and cough sound images of nine chest diseases. The proposed DCDD_Net model is trained and evaluated on 20 publicly available benchmark chest disease datasets of CXR, CT scan, and cough sound images. The classification performance of the DCDD_Net is compared with four baseline models, i.e., InceptionResNet-V2, EfficientNet-B0, DenseNet-201, and Xception, as well as state-of-the-art (SOTA) classifiers. The DCDD_Net achieved an accuracy of 96.67%, a precision of 96.82%, a recall of 95.76%, an F1-score of 95.61%, and an area under the curve (AUC) of 99.43%. The results reveal that DCDD_Net outperformed the other four baseline models in terms of many performance evaluation metrics. Thus, the proposed DCDD_Net model can provide significant assistance to radiologists and medical experts. Additionally, the proposed model was also shown to be resilient by statistical evaluations of the datasets using McNemar and ANOVA tests.

HISET: Hybrid interpretable strategies with ensemble techniques for respiratory sound classification

The human respiratory systems can be affected by several diseases and it is associated with distinctive sounds. For advanced biomedical signal processing, one of the most complex issues is automated respiratory sound classification. In this research, five Hybrid Interpretable Strategies with Ensemble Techniques (HISET) which are quite interesting and robust are proposed for the purpose of respiratory sounds classification. The first approach is termed as an Ensemble GSSR technique which utilizes L 2 Granger Analysis and the proposed Supportive Ensemble Empirical Mode Decomposition (SEEMD) technique and then Support Vector Machine based Recursive Feature Elimination (SVM-RFE) is used for feature selection and followed by classification with Machine Learning (ML) classifiers. The second approach proposed is the implementation of a novel Realm Revamping Sparse Representation Classification (RR-SRC) technique and third approach proposed is a Distance Metric dependent Variational Mode Decomposition (DM-VMD) with Extreme Learning Machine (ELM) classification process. The fourth approach proposed is with the usage of Harris Hawks Optimization (HHO) with a Scaling Factor based Pliable Differential Evolution (SFPDE) algorithm termed as HHO-SFPDE and it is classified with ML classifiers. The fifth or the final approach proposed analyzes the application of dimensionality reduction techniques with the proposed Gray Wolf Optimization based Support Vector Classification (GWO-SVC) and another parallel approach utilizes a similar kind of analysis with the Grasshopper Optimization Algorithm (GOA) based Sparse Autoencoder. The results are examined for ICBHI dataset and the best results are shown for the 2-class classification when the analysis is carried out with Manhattan distance-based VMD-ELM reporting an accuracy of 95.39%, and for 3-class classification Euclidean distance-based VMD-ELM reported an accuracy of 90.61% and for 4-class classification, Manhattan distance-based VMD-ELM reported an accuracy of 89.27%.

Abnormal Respiratory Sound Identification Using Audio-Spectrogram Vision Transformer

Respiratory disease, the third leading cause of deaths globally, is considered a high-priority ailment requiring significant research on identification and treatment. Stethoscope-recorded lung sounds and artificial intelligence-powered devices have been used to identify lung disorders and aid specialists in making accurate diagnoses. In this study, audio-spectrogram vision transformer (AS-ViT), a new approach for identifying abnormal respiration sounds, was developed. The sounds of the lungs are converted into visual representations called spectrograms using a technique called short-time Fourier transform (STFT). These images are then analyzed using a model called vision transformer to identify different types of respiratory sounds. The classification was carried out using the ICBHI 2017 database, which includes various types of lung sounds with different frequencies, noise levels, and backgrounds. The proposed AS-ViT method was evaluated using three metrics and achieved 79.1% and 59.8% for 60:40 split ratio and 86.4% and 69.3% for 80:20 split ratio in terms of unweighted average recall and overall scores respectively for respiratory sound detection, surpassing previous state-of-the-art results.

Constrained Synthetic Sampling for Augmentation of Crackle Lung Sounds

Crackles are explosive breathing patterns caused by lung air sacs filling with fluid and act as an indicator for a plethora of pulmonary diseases. Clinical studies suggest a strong correlation between the presence of these adventitious auscultations and mortality rate, especially in pediatric patients, underscoring the importance of their pathological indication. While clinically important, crackles occur rarely in breathing signals relative to other phases and abnormalities of lung sounds, imposing a considerable class imbalance in developing learning methodologies for automated tracking and diagnosis of lung pathologies. The scarcity and clinical relevance of crackle sounds compel a need for exploring data augmentation techniques to enrich the space of crackle signals. Given their unique nature, the current study proposes a crackle-specific constrained synthetic sampling (CSS) augmentation that captures the geometric properties of crackles across different projected object spaces. We also outline a task-agnostic validation methodology that evaluates different augmentation techniques based on their goodness of fit relative to the space of original crackles. This evaluation considers both the separability of the manifold space generated by augmented data samples as well as a statistical distance space of the synthesized data relative to the original. Compared to a range of augmentation techniques, the proposed constrained-synthetic sampling of crackle sounds is shown to generate the most analogous samples relative to original crackle sounds, highlighting the importance of carefully considering the statistical constraints of the class under study.

Deep learning diagnostic and severity-stratification for interstitial lung diseases and chronic obstructive pulmonary disease in digital lung auscultations and ultrasonography: clinical protocol for an observational case-control study

BACKGROUND

Interstitial lung diseases (ILD), such as idiopathic pulmonary fibrosis (IPF) and non-specific interstitial pneumonia (NSIP), and chronic obstructive pulmonary disease (COPD) are severe, progressive pulmonary disorders with a poor prognosis. Prompt and accurate diagnosis is important to enable patients to receive appropriate care at the earliest possible stage to delay disease progression and prolong survival. Artificial intelligence-assisted lung auscultation and ultrasound (LUS) could constitute an alternative to conventional, subjective, operator-related methods for the accurate and earlier diagnosis of these diseases. This protocol describes the standardised collection of digitally-acquired lung sounds and LUS images of adult outpatients with IPF, NSIP or COPD and a deep learning diagnostic and severity-stratification approach.

METHODS

A total of 120 consecutive patients (≥ 18 years) meeting international criteria for IPF, NSIP or COPD and 40 age-matched controls will be recruited in a Swiss pulmonology outpatient clinic, starting from August 2022. At inclusion, demographic and clinical data will be collected. Lung auscultation will be recorded with a digital stethoscope at 10 thoracic sites in each patient and LUS images using a standard point-of-care device will be acquired at the same sites. A deep learning algorithm (DeepBreath) using convolutional neural networks, long short-term memory models, and transformer architectures will be trained on these audio recordings and LUS images to derive an automated diagnostic tool. The primary outcome is the diagnosis of ILD versus control subjects or COPD. Secondary outcomes are the clinical, functional and radiological characteristics of IPF, NSIP and COPD diagnosis. Quality of life will be measured with dedicated questionnaires. Based on previous work to distinguish normal and pathological lung sounds, we estimate to achieve convergence with an area under the receiver operating characteristic curve of > 80% using 40 patients in each category, yielding a sample size calculation of 80 ILD (40 IPF, 40 NSIP), 40 COPD, and 40 controls.

DISCUSSION

This approach has a broad potential to better guide care management by exploring the synergistic value of several point-of-care-tests for the automated detection and differential diagnosis of ILD and COPD and to estimate severity. Trial registration Registration: August 8, 2022.

CLINICALTRIALS

gov Identifier: NCT05318599.

Smart Devices Are Poised to Revolutionize the Usefulness of Respiratory Sounds

The association between breathing sounds and respiratory health or disease has been exceptionally useful in the practice of medicine since the advent of the stethoscope. Remote patient monitoring technology and artificial intelligence offer the potential to develop practical means of assessing respiratory function or dysfunction through continuous assessment of breathing sounds when patients are at home, at work, or even asleep. Automated reports such as cough counts or the percentage of the breathing cycles containing wheezes can be delivered to a practitioner via secure electronic means or returned to the clinical office at the first opportunity. This has not previously been possible. The four respiratory sounds that most lend themselves to this technology are wheezes, to detect breakthrough asthma at night and even occupational asthma when a patient is at work; snoring as an indicator of OSA or adequacy of CPAP settings; cough in which long-term recording can objectively assess treatment adequacy; and crackles, which, although subtle and often overlooked, can contain important clinical information when appearing in a home recording. In recent years, a flurry of publications in the engineering literature described construction, usage, and testing outcomes of such devices. Little of this has appeared in the medical literature. The potential value of this technology for pulmonary medicine is compelling. We expect that these tiny, smart devices soon will allow us to address clinical questions that occur away from the clinic.

MEMS piezoelectric resonant microphone array for lung sound classification

This paper reports a highly sensitive piezoelectric microelectromechanical systems (MEMS) resonant microphone array (RMA) for detection and classification of wheezing in lung sounds. The RMA is composed of eight width-stepped cantilever resonant microphones with Mel-distributed resonance frequencies from 230 to 630 Hz, the main frequency range of wheezing. At the resonance frequencies, the unamplified sensitivities of the microphones in the RMA are between 86 and 265 mV Pa-1, while the signal-to-noise ratios (SNRs) for 1 Pa sound pressure are between 86.6 and 98.0 dBA. Over 200-650 Hz, the unamplified sensitivities are between 35 and 265 mV Pa-1, while the SNRs are between 79 and 98 dBA. Wheezing feature in lung sounds recorded by the RMA is more distinguishable than that recorded by a reference microphone with traditional flat sensitivity, and thus, the automatic classification accuracy of wheezing is higher with the lung sounds recorded by the RMA than with those by the reference microphone, when tested with deep learning algorithms on computer or with simple machine learning algorithms on low-power wireless chip set for wearable applications.

A Low-Cost AI-Empowered Stethoscope and a Lightweight Model for Detecting Cardiac and Respiratory Diseases from Lung and Heart Auscultation Sounds

Cardiac and respiratory diseases are the primary causes of health problems. If we can automate anomalous heart and lung sound diagnosis, we can improve the early detection of disease and enable the screening of a wider population than possible with manual screening. We propose a lightweight yet powerful model for simultaneous lung and heart sound diagnosis, which is deployable in an embedded low-cost device and is valuable in remote areas or developing countries where Internet access may not be available. We trained and tested the proposed model with the ICBHI and the Yaseen datasets. The experimental results showed that our 11-class prediction model could achieve 99.94% accuracy, 99.84% precision, 99.89% specificity, 99.66% sensitivity, and 99.72% F1 score. We designed a digital stethoscope (around USD 5) and connected it to a low-cost, single-board-computer Raspberry Pi Zero 2W (around USD 20), on which our pretrained model can be smoothly run. This AI-empowered digital stethoscope is beneficial for anyone in the medical field, as it can automatically provide diagnostic results and produce digital audio records for further analysis.

A machine learning approach to the development and prospective evaluation of a pediatric lung sound classification model

Auscultation, a cost-effective and non-invasive part of physical examination, is essential to diagnose pediatric respiratory disorders. Electronic stethoscopes allow transmission, storage, and analysis of lung sounds. We aimed to develop a machine learning model to classify pediatric respiratory sounds. Lung sounds were digitally recorded during routine physical examinations at a pediatric pulmonology outpatient clinic from July to November 2019 and labeled as normal, crackles, or wheezing. Ensemble support vector machine models were trained and evaluated for four classification tasks (normal vs. abnormal, crackles vs. wheezing, normal vs. crackles, and normal vs. wheezing) using K-fold cross-validation (K = 10). Model performance on a prospective validation set (June to July 2021) was compared with those of pediatricians and non-pediatricians. Total 680 clips were used for training and internal validation. The model accuracies during internal validation for normal vs. abnormal, crackles vs. wheezing, normal vs. crackles, and normal vs. wheezing were 83.68%, 83.67%, 80.94%, and 90.42%, respectively. The prospective validation (n = 90) accuracies were 82.22%, 67.74%, 67.80%, and 81.36%, respectively, which were comparable to pediatrician and non-pediatrician performance. An automated classification model of pediatric lung sounds is feasible and maybe utilized as a screening tool for respiratory disorders in this pandemic era.

Transformer-Based Network for Accurate Classification of Lung Auscultation Sounds

Respiratory diseases are a major cause of death worldwide, affecting a significant proportion of the population with lung function abnormalities that can lead to respiratory illnesses. Early detection and prevention are critical to effective management of these disorders. Deep learning algorithms offer a promising approach for analyzing complex medical data and aiding in early disease detection. While transformer-based models for sequence classification have proven effective for tasks like sentiment analysis, topic classification, etc., their potential for respiratory disease classification remains largely unexplored. This paper proposes a classifier utilizing the transformer-encoder block, which can capture complex patterns and dependencies in medical data. The proposed model is trained and evaluated on a large dataset from the International Conference on Biomedical Health Informatics 2017, achieving state-of-the-art results with a mean sensitivity of 70.53%, mean specificity of 84.10%, mean average score of 77.32%, and mean harmonic score of 76.10%. These results demonstrate the model's effectiveness in diagnosing respiratory diseases while taking up minimal computational resources.

Enabling effective breathing sound analysis for automated diagnosis of lung diseases

With the emergence of the COVID-19 pandemic, early diagnosis of lung diseases has attracted growing attention. Generally, monitoring the breathing sound is the traditional means for assessing the status of a patient's respiratory health through auscultation; for that a stethoscope is one of the clinical tools used by physicians for diagnosis of lung disease and anomalies. On the other hand, recent technological advances have made telehealth systems a practical and effective option for health status assessment and remote patient monitoring. The interest in telehealth solutions have further grown with the COVID-19 pandemic. These telehealth systems aim to provide increased safety and help to cope with the massive growth in healthcare demand. Particularly, employing acoustic sensors to collect breathing sound would enable real-time assessment and instantaneous detection of anomalies. However, existing work focuses on autonomous determination of respiratory rate which is not suitable for anomaly detection due to inability to deal with noisy data recording. This paper presents a novel approach for effective breathing sound analysis. We promote a new segmentation mechanism of the captured acoustic signals to identify breathing cycles in recorded sound signals. A scoring scheme is applied to qualify the segment based on the targeted respiratory illness by the overall breathing sound analysis. We demonstrate the effectiveness of our approach via experiments using published COPD datasets.

Exploring machine learning for audio-based respiratory condition screening: A concise review of databases, methods, and open issues

Auscultation plays an important role in the clinic, and the research community has been exploring machine learning (ML) to enable remote and automatic auscultation for respiratory condition screening via sounds. To give the big picture of what is going on in this field, in this narrative review, we describe publicly available audio databases that can be used for experiments, illustrate the developed ML methods proposed to date, and flag some under-considered issues which still need attention. Compared to existing surveys on the topic, we cover the latest literature, especially those audio-based COVID-19 detection studies which have gained extensive attention in the last two years. This work can help to facilitate the application of artificial intelligence in the respiratory auscultation field.

SPRSound: Open-Source SJTU Paediatric Respiratory Sound Database

It has proved that the auscultation of respiratory sound has advantage in early respiratory diagnosis. Various methods have been raised to perform automatic respiratory sound analysis to reduce subjective diagnosis and physicians' workload. However, these methods highly rely on the quality of respiratory sound database. In this work, we have developed the first open-access paediatric respiratory sound database, SPRSound. The database consists of 2,683 records and 9,089 respiratory sound events from 292 participants. Accurate label is important to achieve a good prediction for adventitious respiratory sound classification problem. A custom-made sound label annotation software (SoundAnn) has been developed to perform sound editing, sound annotation, and quality assurance evaluation. A team of 11 experienced paediatric physicians is involved in the entire process to establish golden standard reference for the dataset. To verify the robustness and accuracy of the classification model, we have investigated the effects of different feature extraction methods and machine learning classifiers on the classification performance of our dataset. As such, we have achieved a score of 75.22%, 61.57%, 56.71%, and 37.84% for the four different classification challenges at the event level and record level.

A Progressively Expanded Database for Automated Lung Sound Analysis: An Update

We previously established an open-access lung sound database, HF_Lung_V1, and developed deep learning models for inhalation, exhalation, continuous adventitious sound (CAS), and discontinuous adventitious sound (DAS) detection. The amount of data used for training contributes to model accuracy. In this study, we collected larger quantities of data to further improve model performance and explored issues of noisy labels and overlapping sounds. HF_Lung_V1 was expanded to HF_Lung_V2 with a 1.43× increase in the number of audio files. Convolutional neural network–bidirectional gated recurrent unit network models were trained separately using the HF_Lung_V1 (V1_Train) and HF_Lung_V2 (V2_Train) training sets. These were tested using the HF_Lung_V1 (V1_Test) and HF_Lung_V2 (V2_Test) test sets, respectively. Segment and event detection performance was evaluated. Label quality was assessed. Overlap ratios were computed between inhalation, exhalation, CAS, and DAS labels. The model trained using V2_Train exhibited improved performance in inhalation, exhalation, CAS, and DAS detection on both V1_Test and V2_Test. Poor CAS detection was attributed to the quality of CAS labels. DAS detection was strongly influenced by the overlapping of DAS with inhalation and exhalation. In conclusion, collecting greater quantities of lung sound data is vital for developing more accurate lung sound analysis models.

A temporal dependency feature in lower dimension for lung sound signal classification

Respiratory sounds are expressed as nonlinear and nonstationary signals, whose unpredictability makes it difficult to extract significant features for classification. Static cepstral coefficients such as Mel-frequency cepstral coefficients (MFCCs), have been used for classification of lung sound signals. However, they are modeled in high-dimensional hyperspectral space, and also lose temporal dependency information. Therefore, we propose shifted \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\delta $$\end{document}δ-cepstral coefficients in lower-subspace (SDC-L) as a novel feature for lung sound classification. It preserves temporal dependency information of multiple frames nearby same to original SDC, and improves feature extraction by reducing the hyperspectral dimension. We modified EMD algorithm by adding a stopping rule to objectively select a finite number of intrinsic mode functions (IMFs). The performances of SDC-L were evaluated with three machine learning techniques (support vector machine (SVM), k-nearest neighbor (k-NN) and random forest (RF)) and two deep learning algorithms (multilayer perceptron (MLP) and convolutional neural network (cNN)) and one hybrid deep learning algorithm combining cNN with long short term memory (LSTM) in terms of accuracy, precision, recall and F1-score. We found that the first 2 IMFs were enough to construct our feature. SVM, MLP and a hybrid deep learning algorithm (cNN plus LSTM) outperformed with SDC-L, and the other classifiers achieved equivalent results with all features. Our findings show that SDC-L is a promising feature for the classification of lung sound signals.

Digital auscultation as a diagnostic aid to detect childhood pneumonia: A systematic review

Background

Frontline health care workers use World Health Organization Integrated Management of Childhood Illnesses (IMCI) guidelines for child pneumonia care in low-resource settings. IMCI guideline pneumonia diagnostic criterion performs with low specificity, resulting in antibiotic overtreatment. Digital auscultation with automated lung sound analysis may improve the diagnostic performance of IMCI pneumonia guidelines. This systematic review aims to summarize the evidence on detecting adventitious lung sounds by digital auscultation with automated analysis compared to reference physician acoustic analysis for child pneumonia diagnosis.

Methods

In this review, articles were searched from MEDLINE, Embase, CINAHL Plus, Web of Science, Global Health, IEEExplore database, Scopus, and the ClinicalTrial.gov databases from the inception of each database to October 27, 2021, and reference lists of selected studies and relevant review articles were searched manually. Studies reporting diagnostic performance of digital auscultation and/or computerized lung sound analysis compared against physicians’ acoustic analysis for pneumonia diagnosis in children under the age of 5 were eligible for this systematic review. Retrieved citations were screened and eligible studies were included for extraction. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. All these steps were independently performed by two authors and disagreements between the reviewers were resolved through discussion with an arbiter. Narrative data synthesis was performed.

Results

A total of 3801 citations were screened and 46 full-text articles were assessed. 10 studies met the inclusion criteria. Half of the studies used a publicly available respiratory sound database to evaluate their proposed work. Reported methodologies/approaches and performance metrics for classifying adventitious lung sounds varied widely across the included studies. All included studies except one reported overall diagnostic performance of the digital auscultation/computerised sound analysis to distinguish adventitious lung sounds, irrespective of the disease condition or age of the participants. The reported accuracies for classifying adventitious lung sounds in the included studies varied from 66.3% to 100%. However, it remained unclear to what extent these results would be applicable for classifying adventitious lung sounds in children with pneumonia.

Conclusions

This systematic review found very limited evidence on the diagnostic performance of digital auscultation to diagnose pneumonia in children. Well-designed studies and robust reporting are required to evaluate the accuracy of digital auscultation in the paediatric population.

Embedded system design for classification of COPD and pneumonia patients by lung sound analysis

Chronic obstructive pulmonary disease (COPD) and pneumonia are lethal pulmonary illnesses with equivocal nature of abnormal pulmonic acoustics. Using lung sound signals, the classification of pulmonary abnormalities is a difficult task. A standalone system was conceived for screening COPD and Pneumonia patients through signal processing and machine learning methodologies. The proposed system will assist practitioners and pulmonologists in the accurate classification of disease. In this research work, ICBHI's and self-collected lung sound (LS) databases are used to investigate COPD and pneumonia patient. In this scheme, empirical mode decomposition (EMD), discrete wavelet transform (DWT), and analysis of variance (ANOVA) techniques are employed for segmentation, noise elimination, and feature selection, respectively. To overcome the inherent limitation of ICBHI's LS database, the adaptive synthetic (ADASYN) sampling technique is used to eradicate class imbalance. Lung sound features are used to train fine Gaussian support vector machine (FG-SVM) for classification of COPD, pneumonia, and heathy healthy subjects. This machine learning scheme is implemented on low cost and portable Raspberry pi 3 model B+ (Cortex-A53 (ARMv8) 64-bit SoC @ 1.4 GHz through hardware-supported language. Resultant hardware is capable of screening COPD and pneumonia patients accurately and assist health professionals.

Automated Lung Sound Classification Using a Hybrid CNN-LSTM Network and Focal Loss Function

Respiratory diseases constitute one of the leading causes of death worldwide and directly affect the patient's quality of life. Early diagnosis and patient monitoring, which conventionally include lung auscultation, are essential for the efficient management of respiratory diseases. Manual lung sound interpretation is a subjective and time-consuming process that requires high medical expertise. The capabilities that deep learning offers could be exploited in order that robust lung sound classification models can be designed. In this paper, we propose a novel hybrid neural model that implements the focal loss (FL) function to deal with training data imbalance. Features initially extracted from short-time Fourier transform (STFT) spectrograms via a convolutional neural network (CNN) are given as input to a long short-term memory (LSTM) network that memorizes the temporal dependencies between data and classifies four types of lung sounds, including normal, crackles, wheezes, and both crackles and wheezes. The model was trained and tested on the ICBHI 2017 Respiratory Sound Database and achieved state-of-the-art results using three different data splitting strategies-namely, sensitivity 47.37%, specificity 82.46%, score 64.92% and accuracy 73.69% for the official 60/40 split, sensitivity 52.78%, specificity 84.26%, score 68.52% and accuracy 76.39% using interpatient 10-fold cross validation, and sensitivity 60.29% and accuracy 74.57% using leave-one-out cross validation.

CoCross: An ICT Platform Enabling Monitoring Recording and Fusion of Clinical Information Chest Sounds and Imaging of COVID-19 ICU Patients

Monitoring and treatment of severely ill COVID-19 patients in the ICU poses many challenges. The effort to understand the pathophysiology and progress of the disease requires high-quality annotated multi-parameter databases. We present CoCross, a platform that enables the monitoring and fusion of clinical information from in-ICU COVID-19 patients into an annotated database. CoCross consists of three components: (1) The CoCross4Pros native android application, a modular application, managing the interaction with portable medical devices, (2) the cloud-based data management services built-upon HL7 FHIR and ontologies, (3) the web-based application for intensivists, providing real-time review and analytics of the acquired measurements and auscultations. The platform has been successfully deployed since June 2020 in two ICUs in Greece resulting in a dynamic unified annotated database integrating clinical information with chest sounds and diagnostic imaging. Until today multisource data from 176 ICU patients were acquired and imported in the CoCross database, corresponding to a five-day average monitoring period including a dataset with 3477 distinct auscultations. The platform is well accepted and positively rated by the users regarding the overall experience.

Lung Health Analysis: Adventitious Respiratory Sound Classification Using Filterbank Energies

Audio-based healthcare technologies are among the most significant applications of pattern recognition and Artificial Intelligence. Lately, a major chunk of the World population has been infected with serious respiratory diseases such as COVID-19. Early recognition of lung health abnormalities can facilitate early intervention, and decrease the mortality rate of the infected population. Research has shown that it is possible to automatically monitor lung health abnormalities through respiratory sounds. In this paper, we propose an approach that employs filter bank energy-based features and Random Forests to classify lung problem types from respiratory sounds. The adventitious sounds, crackles and wheezes appear distinct to the human ear. Moreover, different sounds are characterized by different frequency ranges that are dominant. The proposed approach attempts to distinguish the adventitious sounds (crackles and wheezes) by modeling the human auditory perception of these sounds. Specifically, we propose a respiratory sounds representation technique capable of modeling the dominant frequency range present in such sounds. On a publicly available dataset (ICBHI) of size 6898 cycles spanning over 5[Formula: see text]h, our results can be compared with the state-of-the-art results, in distinguishing two different types of adventitious sounds: crackles and wheezes.

Remote Monitoring of Patient Respiration with Mask Attachment—A Pragmatic Solution for Medical Facilities

Remote monitoring of vital signs in infectious patients minimizes the risks of viral transmissions to healthcare professionals. Donning face masks could reduce the risk of viral transmissions and is currently practiced in medical facilities. An acoustic-sensing device was attached to face masks to assist medical facilities in remotely monitoring patients’ respiration rate and wheeze occurrence. Usability and functionality studies of the modified face mask were evaluated on 16 healthy participants. Participants were blindfolded throughout the data collection process. Respiratory rates of the participants were evaluated for one minute. The wheeze detection algorithm was assessed by playing 176 wheezes and 176 normal breaths through a foam mannequin. No discomfort was reported from the participants who used the modified mask. The mean error of respiratory rate was found to be 2.0 ± 1.3 breath per minute. The overall accuracy of the wheeze detection algorithm was 91.9%. The microphone sensor that was first designed to be chest-worn has been proven versatile to be adopted as a mask attachment. The current findings support and suggest the use of the proposed mask attachment in medical facilities. This application can be especially helpful in managing a sudden influx of patients in the face of a pandemic.

Does Facemask Impact Diagnostic During Pulmonary Auscultation?

Facemasks have been widely used in hospitals, especially since the emergence of the coronavirus 2019 (COVID-19) pandemic, often severely affecting respiratory functions. Masks protect patients from contagious airborne transmission, and are thus more specifically important for chronic respiratory disease (CRD) patients. However, masks also increase air resistance and thus work of breathing, which may impact pulmonary auscultation and diagnostic acuity, the primary respiratory examination. This study is the first to assess the impact of facemasks on clinical auscultation diagnostic. Lung sounds from 29 patients were digitally recorded using an electronic stethoscope. For each patient, one recording was taken wearing a surgical mask and one without. Recorded signals were segmented in breath cycles using an autocorrelation algorithm. In total, 87 breath cycles were identified from sounds with mask, and 82 without mask. Time-frequency analysis of the signals was used to extract comparison features such as peak frequency, median frequency, band power, or spectral integration. All the features extracted in frequency content, its evolution, or power did not significantly differ between respiratory cycles with or without mask. This early stage study thus suggests minor impact on clinical diagnostic outcomes in pulmonary auscultation. However, further analysis is necessary such as on adventitious sounds characteristics differences with or without mask, to determine if facemask could lead to no discernible diagnostic outcome in clinical practice.

Classification of Respiratory Conditions using Auscultation Sound

Management of respiratory conditions relies on timely diagnosis and institution of appropriate management. Computerized analysis and classification of breath sounds has a potential to enhance reliability and accuracy of diagnostic modality while making it suitable for remote monitoring, personalized uses, and self-management uses. In this paper, we describe and compare sound recognition models aimed at automatic diagnostic differentiation of healthy persons vs patients with COPD vs patients with pneumonia using deep learning approaches such as Multi-layer Perceptron Classifier (MLPClassifier) and Convolutional Neural Networks (CNN).Clinical Relevance-Healthcare providers and researchers interested in the field of medical sound analysis, specifically automatic detection/classification of auscultation sound and early diagnosis of respiratory conditions may benefit from this paper.

Crackle and wheeze detection in lung sound signals using convolutional neural networks

Respiratory diseases are among the leading causes of death worldwide. Preventive measures are essential to avoid and increase the odds of a successful recovery. An important screening tool is pulmonary auscultation, an inexpensive, noninvasive and safe method to assess the mechanics and dynamics of the lungs. On the other hand, it is a difficult task for a human listener since some lung sound events have a spectrum of frequencies outside of the human hearing ability. Thus, computer assisted decision systems might play an important role in the detection of abnormal sounds, such as crackle or wheeze sounds. In this paper, we propose a novel system, which is not only able to detect abnormal lung sound events, but it is also able to classify them. Furthermore, our system was trained and tested using the publicly available ICBHI 2017 challenge dataset, and using the metrics proposed by the challenge, thus making our framework and results easily comparable. Using a Mel Spectrogram as an input feature for our convolutional neural network, our system achieved results in line with the current state of the art, an accuracy of 43%, and a sensitivity of 51%.

Inception-Based Network and Multi-Spectrogram Ensemble Applied To Predict Respiratory Anomalies and Lung Diseases

This paper presents an inception-based deep neural network for detecting lung diseases using respiratory sound input. Recordings of respiratory sound collected from patients are first transformed into spectrograms where both spectral and temporal information are well represented, in a process referred to as front-end feature extraction. These spectrograms are then fed into the proposed network, in a process referred to as back-end classification, for detecting whether patients suffer from lung-related diseases. Our experiments, conducted over the ICBHI benchmark metadataset of respiratory sound, achieve competitive ICBHI scores of 0.53/0.45 and 0.87/0.85 regarding respiratory anomaly and disease detection, respectively.

LungAttn: advanced lung sound classification using attention mechanism with dual TQWT and triple STFT spectrogram

Objective. Auscultation of lung sound plays an important role in the early diagnosis of lung diseases. This work aims to develop an automated adventitious lung sound detection method to reduce the workload of physicians.Approach. We propose a deep learning architecture, LungAttn, which incorporates augmented attention convolution into ResNet block to improve the classification accuracy of lung sound. We adopt a feature extraction method based on dual tunableQ-factor wavelet transform and triple short-time Fourier transform to obtain a multi-channel spectrogram. Mixup method is introduced to augment adventitious lung sound recordings to address the imbalance dataset problem.Main results. Based on the ICBHI 2017 challenge dataset, we implement our framework and compare with the state-of-the-art works. Experimental results show that LungAttn has achieved theSensitivity, S_e,Specificity, S_pandScoreof 36.36%, 71.44% and 53.90%, respectively. Of which, our work has improved theScoreby 1.69% compared to the state-of-the-art models based on the official ICBHI 2017 dataset splitting method.Significance. Multi-channel spectrogram based on different oscillatory behavior of adventitious lung sound provides necessary information of lung sound recordings. Attention mechanism is introduced to lung sound classification methods and has proved to be effective. The proposed LungAttn model can potentially improve the speed and accuracy of lung sound classification in clinical practice.

Comprehensive Analysis System for Automated Respiratory Cycle Segmentation and Crackle Peak Detection

Digital auscultation is a well-known method for assessing lung sounds, but remains a subjective process in typical practice, relying on the human interpretation. Several methods have been presented for detecting or analyzing crackles but are limited in their real-world application because few have been integrated into comprehensive systems or validated on non-ideal data. This work details a complete signal analysis methodology for analyzing crackles in challenging recordings. The procedure comprises five sequential processing blocks: (1) motion artifact detection, (2) deep learning denoising network, (3) respiratory cycle segmentation, (4) separation of discontinuous adventitious sounds from vesicular sounds, and (5) crackle peak detection. This system uses a collection of new methods and robustness-focused improvements on previous methods to analyze respiratory cycles and crackles therein. To validate the accuracy, the system is tested on a database of 1000 simulated lung sounds with varying levels of motion artifacts, ambient noise, cycle lengths and crackle intensities, in which ground truths are exactly known. The system performs with average F-score of 91.07% for detecting motion artifacts and 94.43% for respiratory cycle extraction, and an overall F-score of 94.08% for detecting the locations of individual crackles. The process also successfully detects healthy recordings. Preliminary validation is also presented on a small set of 20 patient recordings, for which the system performs comparably. These methods provide quantifiable analysis of respiratory sounds to enable clinicians to distinguish between types of crackles, their timing within the respiratory cycle, and the level of occurrence. Crackles are one of the most common abnormal lung sounds, presenting in multiple cardiorespiratory diseases. These features will contribute to a better understanding of disease severity and progression in an objective, simple and non-invasive way.

Pilot study on nocturnal monitoring of crackles in children with pneumonia

BACKGROUND

The clinical diagnosis of pneumonia is usually based on crackles at auscultation, but it is not yet clear what kind of crackles are the characteristic features of pneumonia in children. Lung sound monitoring can be used as a "longtime stethoscope". Therefore, it was the aim of this pilot study to use a lung sound monitor system to detect crackles and to differentiate between fine and coarse crackles in children with acute pneumonia. The change of crackles during the course of the disease shall be investigated in a follow-up study.

PATIENTS AND METHODS

Crackles were recorded overnight from 22:00 to 06:00 h in 30 children with radiographically confirmed pneumonia. The data for a total of 28 800 recorded 30-s epochs were audiovisually analysed for fine and coarse crackles.

RESULTS

Fine crackles and coarse crackles were recognised in every patient with pneumonia, but the number of epochs with and without crackles varied widely among the different patients: fine crackles were detected in 40±22% (mean±sd), coarse crackles in 76±20%. The predominant localisation of crackles as recorded during overnight monitoring was in accordance with the radiographic infiltrates and the classical auscultation in most patients. The distribution of crackles was fairly equal throughout the night. However, there were time periods without any crackle in the single patients so that the diagnosis of pneumonia might be missed at sporadic auscultation.

CONCLUSION

Nocturnal monitoring can be beneficial to reliably detect fine and coarse crackles in children with pneumonia.

CNN-MoE Based Framework for Classification of Respiratory Anomalies and Lung Disease Detection

This paper presents and explores a robust deep learning framework for auscultation analysis. This aims to classify anomalies in respiratory cycles and detect diseases, from respiratory sound recordings. The framework begins with front-end feature extraction that transforms input sound into a spectrogram representation. Then, a back-end deep learning network is used to classify the spectrogram features into categories of respiratory anomaly cycles or diseases. Experiments, conducted over the ICBHI benchmark dataset of respiratory sounds, confirm three main contributions towards respiratory-sound analysis. Firstly, we carry out an extensive exploration of the effect of spectrogram types, spectral-time resolution, overlapping/non-overlapping windows, and data augmentation on final prediction accuracy. This leads us to propose a novel deep learning system, built on the proposed framework, which outperforms current state-of-the-art methods. Finally, we apply a Teacher-Student scheme to achieve a trade-off between model performance and model complexity which holds promise for building real-time applications.

Benchmarking of eight recurrent neural network variants for breath phase and adventitious sound detection on a self-developed open-access lung sound database-HF_Lung_V1

A reliable, remote, and continuous real-time respiratory sound monitor with automated respiratory sound analysis ability is urgently required in many clinical scenarios-such as in monitoring disease progression of coronavirus disease 2019-to replace conventional auscultation with a handheld stethoscope. However, a robust computerized respiratory sound analysis algorithm for breath phase detection and adventitious sound detection at the recording level has not yet been validated in practical applications. In this study, we developed a lung sound database (HF_Lung_V1) comprising 9,765 audio files of lung sounds (duration of 15 s each), 34,095 inhalation labels, 18,349 exhalation labels, 13,883 continuous adventitious sound (CAS) labels (comprising 8,457 wheeze labels, 686 stridor labels, and 4,740 rhonchus labels), and 15,606 discontinuous adventitious sound labels (all crackles). We conducted benchmark tests using long short-term memory (LSTM), gated recurrent unit (GRU), bidirectional LSTM (BiLSTM), bidirectional GRU (BiGRU), convolutional neural network (CNN)-LSTM, CNN-GRU, CNN-BiLSTM, and CNN-BiGRU models for breath phase detection and adventitious sound detection. We also conducted a performance comparison between the LSTM-based and GRU-based models, between unidirectional and bidirectional models, and between models with and without a CNN. The results revealed that these models exhibited adequate performance in lung sound analysis. The GRU-based models outperformed, in terms of F1 scores and areas under the receiver operating characteristic curves, the LSTM-based models in most of the defined tasks. Furthermore, all bidirectional models outperformed their unidirectional counterparts. Finally, the addition of a CNN improved the accuracy of lung sound analysis, especially in the CAS detection tasks.

Electronic Stethoscope Filtering Mimics the Perceived Sound Characteristics of Acoustic Stethoscope

Electronic stethoscopes offer several advantages over conventional acoustic stethoscopes, including noise reduction, increased amplification, and ability to store and transmit sounds. However, the acoustical characteristics of electronic and acoustic stethoscopes can differ significantly, introducing a barrier for clinicians to transition to electronic stethoscopes. This work proposes a method to process lung sounds recorded by an electronic stethoscope, such that the sounds are perceived to have been captured by an acoustic stethoscope. The proposed method calculates an electronic-to-acoustic stethoscope filter by measuring the difference between the average frequency responses of an acoustic and an electronic stethoscope to multiple lung sounds. To validate the method, a change detection experiment was conducted with 51 medical professionals to compare filtered electronic, unfiltered electronic, and acoustic stethoscope lung sounds. Participants were asked to detect when transitions occurred in sounds comprising several sections of the three types of recordings. Transitions between the filtered electronic and acoustic stethoscope sections were detected, on average, by chance (sensitivity index equal to zero) and also detected significantly less than transitions between the unfiltered electronic and acoustic stethoscope sections ( ), demonstrating the effectiveness of the method to filter electronic stethoscopes to mimic an acoustic stethoscope. This processing could incentivize clinicians to adopt electronic stethoscopes by providing a means to shift between the sound characteristics of acoustic and electronic stethoscopes in a single device, allowing for a faster transition to new technology and greater appreciation for the electronic sound quality.

Deep learning based respiratory sound analysis for detection of chronic obstructive pulmonary disease

In recent times, technologies such as machine learning and deep learning have played a vital role in providing assistive solutions to a medical domain's challenges. They also improve predictive accuracy for early and timely disease detection using medical imaging and audio analysis. Due to the scarcity of trained human resources, medical practitioners are welcoming such technology assistance as it provides a helping hand to them in coping with more patients. Apart from critical health diseases such as cancer and diabetes, the impact of respiratory diseases is also gradually on the rise and is becoming life-threatening for society. The early diagnosis and immediate treatment are crucial in respiratory diseases, and hence the audio of the respiratory sounds is proving very beneficial along with chest X-rays. The presented research work aims to apply Convolutional Neural Network based deep learning methodologies to assist medical experts by providing a detailed and rigorous analysis of the medical respiratory audio data for Chronic Obstructive Pulmonary detection. In the conducted experiments, we have used a Librosa machine learning library features such as MFCC, Mel-Spectrogram, Chroma, Chroma (Constant-Q) and Chroma CENS. The presented system could also interpret the severity of the disease identified, such as mild, moderate, or acute. The investigation results validate the success of the proposed deep learning approach. The system classification accuracy has been enhanced to an ICBHI score of 93%. Furthermore, in the conducted experiments, we have applied K-fold Cross-Validation with ten splits to optimize the performance of the presented deep learning approach.