Searcharxiv⌕ Search

arXiv subjects

Andrew P. King

Publications and source records attributed to Andrew P. King.

At least 37 records · Page 2Linked to original sources
arXiv2024

An investigation into the causes of race bias in AI-based cine CMR segmentation

Artificial intelligence (AI) methods are being used increasingly for the automated segmentation of cine cardiac magnetic resonance (CMR) imaging. However, these methods have been shown to be subject to race bias, i.e. they exhibit different levels of performance for different races depending on the (im)balance of the data used to train the AI model. In this paper we investigate the source of this bias, seeking to understand its root cause(s) so that it can be effectively mitigated. We perform a series of classification and segmentation experiments on short-axis cine CMR images acquired from Black and White subjects from the UK Biobank and apply AI interpretability methods to understand the results. In the classification experiments, we found that race can be predicted with high accuracy from the images alone, but less accurately from ground truth segmentations, suggesting that the distributional shift between races, which is often the cause of AI bias, is mostly image-based rather than segmentation-based. The interpretability methods showed that most attention in the classification models was focused on non-heart regions, such as subcutaneous fat. Cropping the images tightly around the heart reduced classification accuracy to around chance level. Similarly, race can be predicted from the latent representations of a biased segmentation model, suggesting that race information is encoded in the model. Cropping images tightly around the heart reduced but did not eliminate segmentation bias. We also investigate the influence of possible confounders on the bias observed.

eess.IV↗
arXiv2024

Improving Deep Learning Model Calibration for Cardiac Applications using Deterministic Uncertainty Networks and Uncertainty-aware Training

Improving calibration performance in deep learning (DL) classification models is important when planning the use of DL in a decision-support setting. In such a scenario, a confident wrong prediction could lead to a lack of trust and/or harm in a high-risk application. We evaluate the impact on accuracy and calibration of two types of approach that aim to improve DL classification model calibration: deterministic uncertainty methods (DUM) and uncertainty-aware training. Specifically, we test the performance of three DUMs and two uncertainty-aware training approaches as well as their combinations. To evaluate their utility, we use two realistic clinical applications from the field of cardiac imaging: artefact detection from phase contrast cardiac magnetic resonance (CMR) and disease diagnosis from the public ACDC CMR dataset. Our results indicate that both DUMs and uncertainty-aware training can improve both accuracy and calibration in both of our applications, with DUMs generally offering the best improvements. We also investigate the combination of the two approaches, resulting in a novel deterministic uncertainty-aware training approach. This provides further improvements for some combinations of DUMs and uncertainty-aware training approaches.

cs.LG↗
arXiv2023

Multi-task learning for joint weakly-supervised segmentation and aortic arch anomaly classification in fetal cardiac MRI

Congenital Heart Disease (CHD) is a group of cardiac malformations present already during fetal life, representing the prevailing category of birth defects globally. Our aim in this study is to aid 3D fetal vessel topology visualisation in aortic arch anomalies, a group which encompasses a range of conditions with significant anatomical heterogeneity. We present a multi-task framework for automated multi-class fetal vessel segmentation from 3D black blood T2w MRI and anomaly classification. Our training data consists of binary manual segmentation masks of the cardiac vessels' region in individual subjects and fully-labelled anomaly-specific population atlases. Our framework combines deep learning label propagation using VoxelMorph with 3D Attention U-Net segmentation and DenseNet121 anomaly classification. We target 11 cardiac vessels and three distinct aortic arch anomalies, including double aortic arch, right aortic arch, and suspected coarctation of the aorta. We incorporate an anomaly classifier into our segmentation pipeline, delivering a multi-task framework with the primary motivation of correcting topological inaccuracies of the segmentation. The hypothesis is that the multi-task approach will encourage the segmenter network to learn anomaly-specific features. As a secondary motivation, an automated diagnosis tool may have the potential to enhance diagnostic confidence in a decision support setting. Our results showcase that our proposed training strategy significantly outperforms label propagation and a network trained exclusively on propagated labels. Our classifier outperforms a classifier trained exclusively on T2w volume images, with an average balanced accuracy of 0.99 (0.01) after joint training. Adding a classifier improves the anatomical and topological accuracy of all correctly classified double aortic arch subjects.

eess.IV↗
arXiv2023

An Investigation Into Race Bias in Random Forest Models Based on Breast DCE-MRI Derived Radiomics Features

Recent research has shown that artificial intelligence (AI) models can exhibit bias in performance when trained using data that are imbalanced by protected attribute(s). Most work to date has focused on deep learning models, but classical AI techniques that make use of hand-crafted features may also be susceptible to such bias. In this paper we investigate the potential for race bias in random forest (RF) models trained using radiomics features. Our application is prediction of tumour molecular subtype from dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) of breast cancer patients. Our results show that radiomics features derived from DCE-MRI data do contain race-identifiable information, and that RF models can be trained to predict White and Black race from these data with 60-70% accuracy, depending on the subset of features used. Furthermore, RF models trained to predict tumour molecular subtype using race-imbalanced data seem to produce biased behaviour, exhibiting better performance on test data from the race on which they were trained.

cs.LG↗
arXiv2023

Uncertainty Aware Training to Improve Deep Learning Model Calibration for Classification of Cardiac MR Images

Quantifying uncertainty of predictions has been identified as one way to develop more trustworthy artificial intelligence (AI) models beyond conventional reporting of performance metrics. When considering their role in a clinical decision support setting, AI classification models should ideally avoid confident wrong predictions and maximise the confidence of correct predictions. Models that do this are said to be well-calibrated with regard to confidence. However, relatively little attention has been paid to how to improve calibration when training these models, i.e., to make the training strategy uncertainty-aware. In this work we evaluate three novel uncertainty-aware training strategies comparing against two state-of-the-art approaches. We analyse performance on two different clinical applications: cardiac resynchronisation therapy (CRT) response prediction and coronary artery disease (CAD) diagnosis from cardiac magnetic resonance (CMR) images. The best-performing model in terms of both classification accuracy and the most common calibration measure, expected calibration error (ECE) was the Confidence Weight method, a novel approach that weights the loss of samples to explicitly penalise confident incorrect predictions. The method reduced the ECE by 17% for CRT response prediction and by 22% for CAD diagnosis when compared to a baseline classifier in which no uncertainty-aware strategy was included. In both applications, as well as reducing the ECE there was a slight increase in accuracy from 69% to 70% and 70% to 72% for CRT response prediction and CAD diagnosis respectively. However, our analysis showed a lack of consistency in terms of optimal models when using different calibration measures. This indicates the need for careful consideration of performance metrics when training and selecting models for complex high-risk applications in healthcare.

eess.IV↗
arXiv2023

Bias in Unsupervised Anomaly Detection in Brain MRI

Unsupervised anomaly detection methods offer a promising and flexible alternative to supervised approaches, holding the potential to revolutionize medical scan analysis and enhance diagnostic performance. In the current landscape, it is commonly assumed that differences between a test case and the training distribution are attributed solely to pathological conditions, implying that any disparity indicates an anomaly. However, the presence of other potential sources of distributional shift, including scanner, age, sex, or race, is frequently overlooked. These shifts can significantly impact the accuracy of the anomaly detection task. Prominent instances of such failures have sparked concerns regarding the bias, credibility, and fairness of anomaly detection. This work presents a novel analysis of biases in unsupervised anomaly detection. By examining potential non-pathological distributional shifts between the training and testing distributions, we shed light on the extent of these biases and their influence on anomaly detection results. Moreover, this study examines the algorithmic limitations that arise due to biases, providing valuable insights into the challenges encountered by anomaly detection algorithms in accurately learning and capturing the entire range of variability present in the normative distribution. Through this analysis, we aim to enhance the understanding of these biases and pave the way for future improvements in the field. Here, we specifically investigate Alzheimer's disease detection from brain MR imaging as a case study, revealing significant biases related to sex, race, and scanner variations that substantially impact the results. These findings align with the broader goal of improving the reliability, fairness, and effectiveness of anomaly detection in medical imaging.

eess.IV↗
arXiv2023

An investigation into the impact of deep learning model choice on sex and race bias in cardiac MR segmentation

In medical imaging, artificial intelligence (AI) is increasingly being used to automate routine tasks. However, these algorithms can exhibit and exacerbate biases which lead to disparate performances between protected groups. We investigate the impact of model choice on how imbalances in subject sex and race in training datasets affect AI-based cine cardiac magnetic resonance image segmentation. We evaluate three convolutional neural network-based models and one vision transformer model. We find significant sex bias in three of the four models and racial bias in all of the models. However, the severity and nature of the bias varies between the models, highlighting the importance of model choice when attempting to train fair AI-based segmentation models for medical imaging tasks.

eess.IV↗
arXiv2023

Deep Learning Framework for Spleen Volume Estimation from 2D Cross-sectional Views

Abnormal spleen enlargement (splenomegaly) is regarded as a clinical indicator for a range of conditions, including liver disease, cancer and blood diseases. While spleen length measured from ultrasound images is a commonly used surrogate for spleen size, spleen volume remains the gold standard metric for assessing splenomegaly and the severity of related clinical conditions. Computed tomography is the main imaging modality for measuring spleen volume, but it is less accessible in areas where there is a high prevalence of splenomegaly (e.g., the Global South). Our objective was to enable automated spleen volume measurement from 2D cross-sectional segmentations, which can be obtained from ultrasound imaging. In this study, we describe a variational autoencoder-based framework to measure spleen volume from single- or dual-view 2D spleen segmentations. We propose and evaluate three volume estimation methods within this framework. We also demonstrate how 95% confidence intervals of volume estimates can be produced to make our method more clinically useful. Our best model achieved mean relative volume accuracies of 86.62% and 92.58% for single- and dual-view segmentations, respectively, surpassing the performance of the clinical standard approach of linear regression using manual measurements and a comparative deep learning-based 2D-3D reconstruction-based approach. The proposed spleen volume estimation framework can be integrated into standard clinical workflows which currently use 2D ultrasound images to measure spleen length. To the best of our knowledge, this is the first work to achieve direct 3D spleen volume estimation from 2D spleen segmentations.

eess.IV↗
arXiv2023

Automatic retrieval of corresponding US views in longitudinal examinations

Skeletal muscle atrophy is a common occurrence in critically ill patients in the intensive care unit (ICU) who spend long periods in bed. Muscle mass must be recovered through physiotherapy before patient discharge and ultrasound imaging is frequently used to assess the recovery process by measuring the muscle size over time. However, these manual measurements are subject to large variability, particularly since the scans are typically acquired on different days and potentially by different operators. In this paper, we propose a self-supervised contrastive learning approach to automatically retrieve similar ultrasound muscle views at different scan times. Three different models were compared using data from 67 patients acquired in the ICU. Results indicate that our contrastive model outperformed a supervised baseline model in the task of view retrieval with an AUC of 73.52% and when combined with an automatic segmentation model achieved 5.7%+/-0.24% error in cross-sectional area. Furthermore, a user study survey confirmed the efficacy of our model for muscle view retrieval.

cs.LG↗
arXiv2023

Addressing Deep Learning Model Calibration Using Evidential Neural Networks and Uncertainty-Aware Training

In terms of accuracy, deep learning (DL) models have had considerable success in classification problems for medical imaging applications. However, it is well-known that the outputs of such models, which typically utilise the SoftMax function in the final classification layer can be over-confident, i.e. they are poorly calibrated. Two competing solutions to this problem have been proposed: uncertainty-aware training and evidential neural networks (ENNs). In this paper, we perform an investigation into the improvements to model calibration that can be achieved by each of these approaches individually, and their combination. We perform experiments on two classification tasks: a simpler MNIST digit classification task and a more complex and realistic medical imaging artefact detection task using Phase Contrast Cardiac Magnetic Resonance images. The experimental results demonstrate that model calibration can suffer when the task becomes challenging enough to require a higher-capacity model. However, in our complex artefact detection task, we saw an improvement in calibration for both a low and higher-capacity model when implementing both the ENN and uncertainty-aware training together, indicating that this approach can offer a promising way to improve calibration in such settings. The findings highlight the potential use of these approaches to improve model calibration in a complex application, which would in turn improve clinician trust in DL models.

eess.IV↗
arXiv2022

Automated Quality Controlled Analysis of 2D Phase Contrast Cardiovascular Magnetic Resonance Imaging

Flow analysis carried out using phase contrast cardiac magnetic resonance imaging (PC-CMR) enables the quantification of important parameters that are used in the assessment of cardiovascular function. An essential part of this analysis is the identification of the correct CMR views and quality control (QC) to detect artefacts that could affect the flow quantification. We propose a novel deep learning based framework for the fully-automated analysis of flow from full CMR scans that first carries out these view selection and QC steps using two sequential convolutional neural networks, followed by automatic aorta and pulmonary artery segmentation to enable the quantification of key flow parameters. Accuracy values of 0.958 and 0.914 were obtained for view classification and QC, respectively. For segmentation, Dice scores were $>$0.969 and the Bland-Altman plots indicated excellent agreement between manual and automatic peak flow values. In addition, we tested our pipeline on an external validation data set, with results indicating good robustness of the pipeline. This work was carried out using multivendor clinical data consisting of 986 cases, indicating the potential for the use of this pipeline in a clinical setting.

eess.IV↗
arXiv2022

A systematic study of race and sex bias in CNN-based cardiac MR segmentation

In computer vision there has been significant research interest in assessing potential demographic bias in deep learning models. One of the main causes of such bias is imbalance in the training data. In medical imaging, where the potential impact of bias is arguably much greater, there has been less interest. In medical imaging pipelines, segmentation of structures of interest plays an important role in estimating clinical biomarkers that are subsequently used to inform patient management. Convolutional neural networks (CNNs) are starting to be used to automate this process. We present the first systematic study of the impact of training set imbalance on race and sex bias in CNN-based segmentation. We focus on segmentation of the structures of the heart from short axis cine cardiac magnetic resonance images, and train multiple CNN segmentation models with different levels of race/sex imbalance. We find no significant bias in the sex experiment but significant bias in two separate race experiments, highlighting the need to consider adequate representation of different demographic groups in health datasets.

eess.IV↗
arXiv2022

A Study of Demographic Bias in CNN-based Brain MR Segmentation

Convolutional neural networks (CNNs) are increasingly being used to automate the segmentation of brain structures in magnetic resonance (MR) images for research studies. In other applications, CNN models have been shown to exhibit bias against certain demographic groups when they are under-represented in the training sets. In this work, we investigate whether CNN models for brain MR segmentation have the potential to contain sex or race bias when trained with imbalanced training sets. We train multiple instances of the FastSurferCNN model using different levels of sex imbalance in white subjects. We evaluate the performance of these models separately for white male and white female test sets to assess sex bias, and furthermore evaluate them on black male and black female test sets to assess potential racial bias. We find significant sex and race bias effects in segmentation model performance. The biases have a strong spatial component, with some brain regions exhibiting much stronger bias than others. Overall, our results suggest that race bias is more significant than sex bias. Our study demonstrates the importance of considering race and sex balance when forming training sets for CNN-based brain MR segmentation, to avoid maintaining or even exacerbating existing health inequalities through biased research study findings.

cs.CV↗
arXiv2022

Deep Learning-based Segmentation of Pleural Effusion From Ultrasound Using Coordinate Convolutions

In many low-to-middle income (LMIC) countries, ultrasound is used for assessment of pleural effusion. Typically, the extent of the effusion is manually measured by a sonographer, leading to significant intra-/inter-observer variability. In this work, we investigate the use of deep learning (DL) to automate the process of pleural effusion segmentation from ultrasound images. On two datasets acquired in a LMIC setting, we achieve median Dice Similarity Coefficients (DSCs) of 0.82 and 0.74 respectively using the nnU-net DL model. We also investigate the use of coordinate convolutions in the DL model and find that this results in a statistically significant improvement in the median DSC on the first dataset to 0.85, with no significant change on the second dataset. This work showcases, for the first time, the potential of DL in automating the process of effusion assessment from ultrasound in LMIC settings where there is often a lack of experienced radiologists to perform such tasks.

eess.IV↗
arXiv2022

AI-enabled Assessment of Cardiac Systolic and Diastolic Function from Echocardiography

Left ventricular (LV) function is an important factor in terms of patient management, outcome, and long-term survival of patients with heart disease. The most recently published clinical guidelines for heart failure recognise that over reliance on only one measure of cardiac function (LV ejection fraction) as a diagnostic and treatment stratification biomarker is suboptimal. Recent advances in AI-based echocardiography analysis have shown excellent results on automated estimation of LV volumes and LV ejection fraction. However, from time-varying 2-D echocardiography acquisition, a richer description of cardiac function can be obtained by estimating functional biomarkers from the complete cardiac cycle. In this work we propose for the first time an AI approach for deriving advanced biomarkers of systolic and diastolic LV function from 2-D echocardiography based on segmentations of the full cardiac cycle. These biomarkers will allow clinicians to obtain a much richer picture of the heart in health and disease. The AI model is based on the 'nn-Unet' framework and was trained and tested using four different databases. Results show excellent agreement between manual and automated analysis and showcase the potential of the advanced systolic and diastolic biomarkers for patient stratification. Finally, for a subset of 50 cases, we perform a correlation analysis between clinical biomarkers derived from echocardiography and CMR and we show excellent agreement between the two modalities.

physics.med-ph↗
arXiv2022

A Deep Learning-based Integrated Framework for Quality-aware Undersampled Cine Cardiac MRI Reconstruction and Analysis

Cine cardiac magnetic resonance (CMR) imaging is considered the gold standard for cardiac function evaluation. However, cine CMR acquisition is inherently slow and in recent decades considerable effort has been put into accelerating scan times without compromising image quality or the accuracy of derived results. In this paper, we present a fully-automated, quality-controlled integrated framework for reconstruction, segmentation and downstream analysis of undersampled cine CMR data. The framework enables active acquisition of radial k-space data, in which acquisition can be stopped as soon as acquired data are sufficient to produce high quality reconstructions and segmentations. This results in reduced scan times and automated analysis, enabling robust and accurate estimation of functional biomarkers. To demonstrate the feasibility of the proposed approach, we perform realistic simulations of radial k-space acquisitions on a dataset of subjects from the UK Biobank and present results on in-vivo cine CMR k-space data collected from healthy subjects. The results demonstrate that our method can produce quality-controlled images in a mean scan time reduced from 12 to 4 seconds per slice, and that image quality is sufficient to allow clinically relevant parameters to be automatically estimated to within 5% mean absolute difference.

eess.IV↗
arXiv2021

Uncertainty-Aware Training for Cardiac Resynchronisation Therapy Response Prediction

Evaluation of predictive deep learning (DL) models beyond conventional performance metrics has become increasingly important for applications in sensitive environments like healthcare. Such models might have the capability to encode and analyse large sets of data but they often lack comprehensive interpretability methods, preventing clinical trust in predictive outcomes. Quantifying uncertainty of a prediction is one way to provide such interpretability and promote trust. However, relatively little attention has been paid to how to include such requirements into the training of the model. In this paper we: (i) quantify the data (aleatoric) and model (epistemic) uncertainty of a DL model for Cardiac Resynchronisation Therapy response prediction from cardiac magnetic resonance images, and (ii) propose and perform a preliminary investigation of an uncertainty-aware loss function that can be used to retrain an existing DL image-based classification model to encourage confidence in correct predictions and reduce confidence in incorrect predictions. Our initial results are promising, showing a significant increase in the (epistemic) confidence of true positive predictions, with some evidence of a reduction in false negative confidence.

eess.IV↗
arXiv2021

The Impact of Domain Shift on Left and Right Ventricle Segmentation in Short Axis Cardiac MR Images

Domain shift refers to the difference in the data distribution of two datasets, normally between the training set and the test set for machine learning algorithms. Domain shift is a serious problem for generalization of machine learning models and it is well-established that a domain shift between the training and test sets may cause a drastic drop in the model's performance. In medical imaging, there can be many sources of domain shift such as different scanners or scan protocols, different pathologies in the patient population, anatomical differences in the patient population (e.g. men vs women) etc. Therefore, in order to train models that have good generalization performance, it is important to be aware of the domain shift problem, its potential causes and to devise ways to address it. In this paper, we study the effect of domain shift on left and right ventricle blood pool segmentation in short axis cardiac MR images. Our dataset contains short axis images from 4 different MR scanners and 3 different pathology groups. The training is performed with nnUNet. The results show that scanner differences cause a greater drop in performance compared to changing the pathology group, and that the impact of domain shift is greater on right ventricle segmentation compared to left ventricle segmentation. Increasing the number of training subjects increased cross-scanner performance more than in-scanner performance at small training set sizes, but this difference in improvement decreased with larger training set sizes. Training models using data from multiple scanners improved cross-domain performance.

eess.IV↗